Attachment1SpecialHandling.12.11.25.pdf

Attachment 1

SPECIAL HANDLING INSTRUCTIONS

Pinellas County Sheriff’s Office special handling instructions:

Contact telephone numbers:

Gretchen Reagan 727-582-5674 or greagan@pcsonet.com

Members of the HR team and supervisors will input claims into the system as claims come in.

3-point contact – initial contacts should be made to the injured member, the supervisor listed on the initial report (only when additional clarification is needed on a claim), and the medical provider. If the adjuster is having issues communicating with the member or supervisor, please send an email to the PCSO WC e-mail (WorkersCompInjuryReport@pcsonet.com), requesting assistance.

A 13-week wage statement is to be requested through PAYROLL@pcsonet.com, and you are to include the member's name, date of injury, and the date range for the wage statement. The adjuster also needs to confirm with payroll the paid through date for the full salary. This goes for school crossing guards as well. While the member is employed, all TTD/TPD checks will be issued to PCSO for reimbursement.

All members who no longer work for PCSO or are on PTD, benefits paid directly to the member. IIBs are also paid directly to the member. If a school crossing guard is injured, the adjuster needs to be in touch with PCSO payroll for the last full salary date; after that date, they will be paid directly.

Denials – after the adjuster investigates the claim, they are to send their recommendation for denial to the County Attorney’s Office and the PCSO WC e-mail box (WorkersCompInjuryReport@pcsonet.com).

Whenever possible, the decision needs to be made within the first 14 days. If the County Attorney agrees, they will send a request to PCSO to deny the claim. Claims cannot be denied until the adjuster receives approval.

Approval of claims – once a final determination has been made on acceptance of a claim, the determination and condition being accepted should be sent to the PCSO WC e-mail box (WorkersCompInjuryReport@pcsonet.com). Please include the claim number, date of injury, and the member’s name.

120 Day letters are not to be sent until after the first 14 days if the claim is still being investigated.

In response to PFBs, the adjuster is to evaluate the PFBs and communicate with the County Attorney’s Office regarding the issues and responses. Once the response is agreed upon, the County Attorney’s Office will email PCSO to obtain approval to respond.

Monthly meeting – PCSO holds a monthly in-person meeting to review claims with the adjuster and under the adjuster's supervision for members on light duty or out of work. Included in that meeting is a legal update from the County Attorney’s Office. Once a Quarter, the review is to encompass all open and reopened claims.

Questionable claims and all claims that involve the coming and going rule are to be discussed with the County Attorney and PCSO HR.

All presumption claims are to have a nurse assigned to them, and pre-employment physicals and applications can be requested from PCSO HR, PCSO WC e-mail (WorkersCompInjuryReport@pcsonet.com) – the County Attorney should be notified and involved from the beginning of the claim.

mailto:WorkersCompInjuryReport@pcsonet.com mailto:PAYROLL@pcsonet.com mailto:WorkersCompInjuryReport@pcsonet.com

Any claims settlements must be evaluated in detail, and the adjuster must work with the County Attorney’s Office on the evaluation. Once the evaluation is finalized, the County Attorney’s Office will send the request for authority to settle to the PCSO and Claims Manager.

Change of physicians – if a member is not happy with medical treatment, we always offer a one-time change. We do not allow changing of physicians without a written request for a one-time change.

Second opinions are only offered on special occasions and after the one-time change of physicians has been made. If there is a request or need for a second opinion after this, a request and approval should be made through PCSO Management via WorkersCompInjuryReport@pcsonet.com .

The client approves the Initial Treatment sites, and the contractor updates and manages the written document. Contractor provides updates to the Claims Manager and PCSO so the intranet sites may be updated.

PC Board of County Comm. and other members of the Risk Fund- Special Handling Instructions:

Contact telephone numbers:

Keith Bentley, Claims Manager – 727-464-3221 Claims Support Specialist – 727-464-5293 Main line – 727-464-3664 Main Fax number – 727-464-4060 General e-mail box for Risk Management – riskmgmt@pinellascounty.org

Members of the Risk Fund are as follows:

6th Judicial Court – there are specific people who we cover as they are State employees, but for purposes of WC, they are covered under our plan Business Technology Services County Attorney’s Office Human resources Office of Human Rights Pinellas County BOCC Pinellas County Sheriff’s Office Property Appraiser’s Office Supervisor of Elections Tax Collector’s Office

Members of the Risk Management team will enter claims as they come in.

3-point contact – initial contacts should be made to the injured worker, the supervisor listed on the initial report, and the medical provider. If the adjuster is having issues communicating with the employee or supervisor, please call Pam Grabo at 727-464-3221 or e-mail pgrabo@pinellascounty.org. In the alternative, you can contact the claims support specialist at 727-464-5293 or e-mail riskmgmt@pinellascounty.org

13 13-week wage statement is to be requested through Payroll@pinellascounty.org, and you are to include the employee's name, the employee's ID number, and the date range for the wage statement.

Adjusters also need to confirm with the supervisor that the timecard is correct for the initial 40 hrs. LWP (the waiting period). All benefits are payable directly to employees by the carrier.

Denials – after the adjuster has completed their claim investigation and determined that the claim is not compensable, the adjuster needs to obtain an opinion from the County Attorney’s Office and then request a denial from the Claims Manager pgrabo@pinellascounty.org

In response to PFBs, the adjuster is to evaluate the PFBs and communicate with the County Attorney’s Office regarding the issues and responses. Once the response is agreed upon, the County Attorney’s Office will email the Claims Manager to obtain approval to respond.

mailto:riskmgmt@pinellascounty.org mailto:pgrabo@pinellascounty.org mailto:riskmgmt@pinellascounty.org mailto:Payroll@pinellascounty.org mailto:pgrabo@pinellascounty.org

Any claims settlements must be evaluated in detail, and the adjuster must work with the County Attorney’s Office on the evaluation. Once the evaluation is finalized, the County Attorney’s Office will send the request for authority to settle to the Claims Manager.

Change of physicians – if an injured worker is not happy with medical treatment, we always offer a one-time change. We do not allow changing of physicians without a written request for a one-time change.

Second opinions are only offered in unusual cases, and this needs to be discussed with the Claims Manager.

120 Day letters are not to be sent until after the first 14 days if the claim is still being investigated.

The client approves the Initial Treatment sites, and the contractor updates and manages the written document. Contractor provides updates to Claims Manager and HR Director so that we can update our intranet sites.

**Special Handling Instructions may be updated on an intermittent basis as approved by County staff and as needed over the duration of the agreement without a formal written amendment to the agreement.