Liability Claims Third Party Administration Services

The Vendor is required to provide the claims adjusting service is divided into five categories: personnel, claims administration, litigation management, reporting of claims activities, and general requirements.
- The City’s liability claims program is categorized in to two separate categories.
- Non Transit Claims: as of Feb 2025 the city had a total of 55 open non transit claims of which 29 were litigated and 26 none litigated; the third-party administrators (TPA) will be handling the non-transit claims except transit employment practices liability which the TPA will handle; the city has an excess liability coverage thru prism with self-insured retention (sir) of $5 million.
- provide the City with sufficient qualified personnel to efficiently and effectively meet the responsibilities as defined below and any other duties incidental, or in addition, to those responsibilities that are related to liability claims management from claims initiation, processing, reporting, litigation coordination and any other support as necessary and requested by the City.
- Claims Administration
• In coordination with the city, develop claims handling instructions document; the document will establish claims handling and investigation protocols for the city in accordance with the state tort claims act; please provide a copy of the claims management program if there is already one in place.
• Conduct a thorough investigation of all new claims; city has a claims technician to assist in identifying city departments and personnel to retrieve required investigative reports; the TPA is responsible for following up with applicable departments and conducting the investigation.
• Review all “open" files individually to determine claim status and develop plan of action regarding claim closure.
• Apply accepted claims management practices and city protocols consistently.
• The city averages 200-250 new claims reported annually; currently there are approximately 55 open claims (by incident/occurrence).
• Promptly create a claim file within twenty-four (24) hours of receipt of the claim form or accident report from the city and make contact with claimant.
• Establish monetary reserves reasonably adequate for the expected value of the claim in coordination with the city risk management division.
• Handle claim to conclusion and obtain all appropriate releases; authority for settlements must be obtained from the city prior to settlement resolutions with claimant.
• Report losses to city’s excess insurance carrier as required in their reporting requirements.
• The TPA shall promptly initiate investigation of issues identified as material to potential litigation; the city shall be alerted to the need for special outside investigation or appraisal services as soon as possible and before the investigation and/or surveillance is initiated; authorization for surveillance shall be obtained from the risk manager; the city shall be kept informed on the scope and results of all investigations; all activities shall be clearly documented in the claim file.
- Litigation Management
1. Litigation management and defense are controlled by city attorney’s office, and/or outside legal counsel.
2. TPA shall refer all litigated claims to risk manager and city attorney’s office unless otherwise directed by the city.
• Even when cases are litigated and handled through the city attorney’s office, the TPA shall maintain an open case file and ensure loss runs accurately report claims that become litigated including legal fees, legal costs, settlements, and judgements.
• TPA shall participate in any meetings, receive/review and respond to emails and communicate (in person or virtually) to and with the city attorney’s office to coordinate claims handling.
- Customer Service Phone Line
• The City requires that the TPA provide exceptional customer service to all claimants. TPA shall establish a customer service phone number and email address to enable inquiries to be answered made by claimants. Replies will be within three (3) business days and all inquiries made by Risk Management staff on the same day, preferably, but no later than within one (1) business day.
- Customer Complaints
• The TPA shall document and respond to all complaints and inquiries received from claimants, defense counsel, and/or Risk Management and bring about resolution of such within three (3) business days. TPA shall provide City with quarterly reports of all complaints received, resolution, and documentation of follow-up with claimants.
- Bank Trust Account
• TPA shall provide bank trust account to be funded by the City. Payments for non-litigated claims include indemnity and expense payments will be made from the trust account.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: March 3, 2025