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CLAIM LIFECYLE (CLAIMS CREATION (Set Claim Type, Origami creates Initial…

- - - - Could possibly
        be accepted
  - - - Worker can apply
        for SDI from EDD
      - investigation result, either deny or accept
  - - - PROCESS INDEMNITY CLAIM
    - - PROCESS MEDICAL-ONLY CLAIM
    - - PROCESS FIRST-AID CLAIM
- - - - Treatment is denied?
        
        Workers goes to
        IMR
        
        Provider sends
        Medical Legal Bill to the county
      - EKHealth sends UR
        doc to SCC
      - Go to "Physician Examines
        Worker Condition"
  - - - Physician sends P&S
        Report to SCC
    - - Physician sends Medical Report
        to SCC
    - - QME
        non-litigated
      - AME
        (litigated)
- - - - Worker receives
        Benefits](https://www.dir.ca.gov/InjuredWorkerGuidebook/Chapter1.pdf)
        
        Supplement Job
        Displacement Benefits
        
        Death Benefits
        
        Permanent Disability
        Benefits
        
        Temporary Disability
        Benefits
        
        Medical Care
    - - System sends
        Positve Pay File to Wells Fargo
    - - Update Reserve
    - - Loss Time
      - Modified Work
  - - - Process claim as
        PD
        
        Calculate % of disability
        using rating, etc)
        
        Adjuster Determine
        Rating (Impairment Number)
        
        Worker agrees
        with the rating
    - - Send letter to the worker
        max TD was reached
        
        Send TD Termination
        letter to Claimant
        
        Stop TD Benefit Payment
      - WC Decide within 14 days
        after the max TD was reached
      - WC can decide to do a PD delay
        (duration varies)
      - IW can apply for SDI. SS benefits
        after WC TD is finished
    - - Adjuster Updates
        Work Status screen
- - - - Update Reserve
    - - Origami Sends
        Issued Checks File to Origami
      - Origami Sends Positive Pay
        File to Wells Fargo
    - - Wells Fargo sends
        Cleared Checks file to SAP
  - - - 4850 Payments
      - Overpayments
    - - Subro