The Vendor is required to provide services for third party claims administration for property, liability and workers compensation claims for county’s risk management division.
- Provide to assessing loss data, develop reports, and support safety and loss prevention initiatives toward the common goal of reducing the overall number of claims and the cost of those claims related to county’s casualty programs.
- Liability claims investigation and adjusting services
• The claims administrator will review all first notices of claim reports received from the county (this will consist of loss reports, claim letters, suits or claims that are phoned, mailed, faxed or emailed in by the county), and then assign an adjuster.
• The claims administrator will designate adjusters who will conduct a complete investigation of the accident, which includes but is not limited to the following:
• Contact the claimant or the claimant's attorney within 24 hours of the time the accident report is received by the service company; in the case of unrepresented claimants, personal contact is required the same day the claim is received; all claim files must contain adjuster's logs documenting all contact and activity.
• Obtain recorded statements from the claimant, witnesses and appropriate county personnel; personal contact of all unrepresented claimants by outside adjusters is required.
• Complete a timely scene investigation consisting of photos and diagrams; this is required within 2 days of receipt of any serious auto liability or general liability claim assignment.
• Obtain the police and/or fire rescue report, if applicable.
• Obtain and review all medical reports and bills submitted by the claimant or their attorney.
• Obtain and review all estimates and appraisals for property damage claims.
• Establish appropriate reserves on all claims and revise the reserves as needed.
• Submit a report to the risk manager within 30 days of receipt of the claim, summarizing:
(a) Date/time/location of loss
(b) Claimant information
(c) Description of accident
(d) Injuries or damages
(e) Witnesses' statement(s)
(f) Liability analysis
(g) Evaluation of claim (i.e. amount of recommended settlement, denial, reserves, attorney demand)
- Workers’ compensation claims adjusting and investigation services
• Accept or deny all reported claims for employees' injuries on behalf of the county in accordance with the applicable workers' compensation law.
• Conduct the required investigations as deemed necessary as it relates to workers' compensation including scene investigations and personal claimant contact on all lost time or light duty cases.
• Contact with claimants is to be made within 24 hours of the claims administrator's receipt of the claim.
• Review all medical bills and other services for which a claim is being made for reasonableness and conformity to appropriate medical and surgical fee schedules and network discounts; bill review is an appropriate allocated cost.
• Coordinate the medical treatment of all claims by setting appointments and authorizing necessary physician referrals and treatments.
• The claims administrator will attend workers' compensation hearings and mediations as requested by the county.
• Provide medical case management with a dedicated nurse/medical case manager employed by the claims administrator and located in the local claims office.
• Medical case management services shall be performed at the direction of the branch manager or adjuster.
• This directed staff of nurses will provide medical case management services on county workers’ compensation claims to insure that injured employees receive prompt and appropriate medical treatment, thereby controlling medical expenses for the county and expediting employees return to work.
- The claims administrator may be asked to furnish adjustment services or expertise related to County property, employment, or other miscellaneous insurance claims.
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: April 14, 2025