The Claims Services Division provides oversight of the Old Fund for the Offices of the Insurance Commissioner (OIC), which is the state’s claims liability following the privatization of Workers’ Compensation. The Old Fund consists of injury claims, occupational disease claims, occupational pneumoconiosis claims, and dependent claims with a date of injury or date of last exposure prior to July 1, 2005. Claims Services is also responsible for the oversight of Coal Workers’ Pneumoconiosis Fund claims with a date of last exposure prior to January 1, 2006.
The primary responsibility of the Claims Services Division regarding the Old Fund claims is to conduct reviews relative to quality claims processing and compliance with statutory and regulatory provisions. Claims Services ensures proper management of these claims via on-site bi-annual claims best practices reviews, monthly quality assurance reviews, quarterly large loss reviews, reserve payment approval with a threshold of $25,000 or greater, settlement approval with a threshold of $25,000 or greater, and review and approval of benefit payments.
Click on the applicable links below to download an information brochure for each third party administrator (TPA):
P.O. Box 14490
Lexington, KY 40512
HealthSmart Disability Management
P.O. Box 3389
Charleston, WV 25333-3389