Third Party Administrator General Liability and Property Program Services

The vendor is required to provide third party administrator (TPA) general liability and property workers’ compensation program, occupational health and safety programs, property and casualty insurance, contractor bonding assistance, contractual risk transfer, and the city’s self-insurance programs for general liability and workers’ compensation.
- Program administration
•    Performing liability claims adjusting services;
•    Inform district staff in any changes to current laws that could have an impact on the city’s liability claims program;
•    Advise risk management of any claim trends that may have an impact on the city’s claim program. 
•    Provide data and analytics regarding the city’s program to the risk manager and risk analyst on a monthly basis; provide ad hoc reports as requested by the city. 
•    Attend meetings and file reviews and provide updates on the city’s open liability cases; 
•    Provide statistical reports on a monthly basis that depict the claims opened or closed per month, payments that have been issued and current reserves on all open claims; and other reports as needed;
•    Respond to any inquiries the city’s excess carrier may have in regards to any particular claim as well as providing the excess carrier with any reports requested. 
•    Identify all subrogation claims and initiate a written report to the city on potential success of subrogation; identify all costs including attorney fees involved in specific subrogation eligible files; provide recommendations based upon cost-benefit analysis of potential subrogation files.
- Claims administration
•    Set up a claim file within 24 hours of receipt of the claim; 
•    Send an acknowledgment letter on all new files opened; 
•    Assign an initial case reserve; 
•    The claim to verify the claim complies with the reporting requirements as set forth in the (gov. code, § 911.2.) code; 
•    With prior approval of the city on a per claim basis, issue the appropriate letters and notices to the claimant advising of any deficiencies; claim rejections; claim denials; or any other pertinent correspondence as required under the (gov. code, § 911.2.) government code. 
•    Provide first investigative report to risk management within thirty (30) days of receipt of claim. 
•    After investigation is complete, determine whether to accept or reject claim; 
•    If rejection is appropriate, issue rejection notice to claimant or claimant’s attorney or representative, which will include an explanation of why the claim was rejected; and may include any and all other notices required under the (gov. code, § 911.2.) government code. 
•    All files will be updated at appropriate intervals to allow for timely completion of required activity. 
•    Claims administrator shall prepare a settlement request and forward that request to the risk manager and risk analyst for approval; 
•    All settlements are subject to city approval and the claims administrator has no settlement authority; 
•    Report claims to city’s excess carrier as appropriate and directed; and in compliance with excess insurance policy requirements; provide ongoing reporting for all excess cases as may be requested or required by the excess insurance carrier;
•    Obtain reimbursement from excess carrier should expenditures exceed self-insured retention; monitor and manage all excess reporting and reimbursement from the excess carrier; all reimbursements shall be reconciled by the third-party administrator and any and all reductions or short pays shall be immediately flagged and identified for specific discussion and reporting to the city; 
•    All reimbursements paid in full and received by the TPA must be immediately provided to the city for deposit into the city’s bank account.
•    Provide monthly reports on reimbursement or excess carrier recoveries; and monitor excess carrier request for reimbursement every 30 days.
- Subrogation services
•    Supervise and administer the subrogation program. 
•    Represent the city in all matters related to the investigation 
•    Provide investigation of such accidents, incidents, claims or cases will include determining responsibility, establishing damage amount, pursuing collection, negotiating settlements and processing of monetary recovery.
- Litigation
•    Immediately acknowledge receipt of summons and complaints from the city and verify routing to appropriate defense counsel selected by the city (TPA shall not be, and is not authorized to receive any summons and complaint or any other legal documents on behalf of the city) 
•    Transmit a complete copy of the claims file to defense counsel once chosen by the city so that a timely response to the complaint can be filed; 
•    Oversee the efforts of defense counsel through a sound litigation management plan; responsible for obtaining a copy of defense counsel’s proposed defense budget; and setting reserve appropriately for each specific case/file/claim.
•    Timely review all legal bills for accuracy and issue payment; 
•    Attend settlement conferences, mediations, court hearings, as may be requested by the city; 
•    If a settlement is reached, in conjunction with defense counsel, prepare a settlement recommendation and transmit to the city’s risk manager and risk analyst; and
•    If necessary and requested by the city, attend trial or hearings and provide written reports to the risk manager and risk analyst on a daily basis.
- Billing and invoicing
•    All bills for legal fees and other related costs for all claims referred to claims administrator shall be reviewed by the TPA as to appropriateness and adjusted based upon city agreements with outside law firms. 
•    Adjusted fee must be communicated to and agreed upon by the city. 
•    All legal payments will be recorded in the claims management system. 
•    TPA shall describe its practices for reviewing billing of outside counsel fees and costs, so as to reduce inappropriate charges to the city, as part of their response.
- Claims management system reporting
•    The claims administrator shall provide monthly and yearly statistical reporting that shall include, but not be limited to, claims opened and closed each month; the current open claims; all claims by date of injury and fiscal year; all claims by payment type and all litigated claims listed by defense counsel, law firm. 
•    These statistical reports shall be supplied to the city no later than the 5th day of each month. 
•    To regular monthly claims data information, data and analytics, key performance indicators as mentioned elsewhere in, the system must have the capability for the designated city staff (i.e., risk manager, risk analyst) to log into the system and independently review file notes and case reserves. 
•    The claims administrator shall provide technical support for the use and access to the administrator’s claims system upon request from the city.

- Contract Period/Term: 2 years