Workers Compensation Third Party Administrator Services

The Vendor is required to provide third-party administration services for the City’s workers’ compensation claims.
- The City retains $5,000,000 of each presumptive workers compensation claim for Firefighters, Police Officers, and Fire Investigators, $4,000,000 of each non-presumptive workers compensation claim for Firefighters, Police Officers, and Fire Investigators, and $1,000,000 of each workers compensation claim for all other municipal employees.
- Review all claim reports for illnesses and injuries incurred or reported on or after the Effective Date of the resultant Contract and process each claim report in accordance with applicable statutory and administrative regulation requirements. 
- Investigate each reported claim, including the use of medical or other experts, to the extent deemed necessary by the successful Proposer and with prior approval by the City in connection with processing any claim.
- Reasonable costs of experts shall be borne by the City. 
- The final determination of compensability for any questionable claim or occupational heart, lung or cancer claim must be approved by the City. 
- All claim payments shall be made with City funds up to the self-insured retention.
- Medical bills submitted shall be paid by successful Proposer on behalf of the City at the lowest of the following: agreed network provider rate; the medical industrial fee schedule; or billed charges.
- Review all pending legislation, Code, and any case law that may affect the City’s self-insurance program and advise the City of impact and options.
- Pay all allocated claim expenses with City funds. Allocated claim expenses will include all expenses incurred in connection with the investigation, adjustment, settlement, or defense of claims.
- Allocated claim expenses will include, but not be limited to, charges for:
•    Independent medical examinations of claimants;
•    Managed care expenses. Examples of managed care expenses includes but are not limited to state fee schedule, PPO networks, utilization review, nurse case management, medical bill audits and medical bill review;
•    Fraud detection expenses, such as surveillance, and other related expenses associated with the detection, reporting and prosecution of fraudulent claims, including legal fees;
•    Attorneys, experts, and special process servers;
•    Court costs, fees, interest, and expenses;
•    Depositions, court reporters, and recorded statements;
•    Independent adjusters and appraisers.
- Notify the City of claims resulting in major surgery, lost time, possible rehabilitation, and all claims concerning litigation.
- Maintain a current estimate of the expected total cost of each claim. Reserve change rationales must be specifically documented in the adjuster’s notes.
- Provide claim forms and other forms believed by successful Proposer to be appropriate for the efficient operation of the City’s Self-Insurance Program and consistent with state statutes and administrative codes.
- The claims account manager shall be responsible for:
•    Contract administration;
•    Trouble shooting and providing effective solutions to resolve issues or problems with the Contract and/or Services;
•    Identifying key outcome-based measurements that are tracked, and delivering program improvements and cost reduction results;
•    Developing and delivering an annual stewardship report;
•    Monitoring claim trends and auditing claim handling procedures to ensure a high level of customer service;
•    Hosting quarterly claim reviews with the City with participation of the claims adjusters and, as-needed, defense attorneys and nurse case managers;
•    Assisting with development of long-range goals, objectives and strategies, including recommending innovative ideas and new products, proven programs, and services to ensure a cost-effective workers’ compensation program; and
•    Aiding in communication/coordination with the City’s safety team as necessary, including providing claims data needed to target safety, prevention, and loss reduction initiatives.

- Contract Period/Term: 3 years
- Questions/Inquires Deadline: January 06, 2026