The vendor is required to provide workers compensation insurance services for include:
1. Claims handling
• Activate necessary files upon first report of injury.
• Review claim reports and process claim in accordance with statutory requirements.
• Investigate claims and determine compensability.
• Establish cash reserves and periodically update.
• Make payments to injured employee, medical providers and others relating to a file.
• Arrange independent medical exams and coordinate medical data.
• Recommend selection of counsel and assist in litigated cases.
• Attend hearings as required.
• File all required reports and statements as may be required by the state
2. Loss control
• Perform no less than two (2) on site exposure and ergonomic surveys.
• Prepare written report highlighting exposures found in survey with recommendations to either correct or reduce the exposure to loss.
• Prepare written ergonomic report with recommendations which could include job redesign or educational programs.
• Provide one written and one electronic loss control manual.
• Provide a minimum of 40 hours of loss prevention and/or ergonomic services to city of pawtucket.
3. Medical case management
• Review first report of injury.
• Monitor the progress of injured employees.
• Meet with employee and treating physician as required.
• Recommend alternative treatment plans as required.
• Assist employee, employer, and treating physician in developing transitional employment.
• Maintain communication between the employee, employer, attending physician, claims and risk management staff.
• Review medical bills to assure that they are in line with the injury and the service rendered and process payments accordingly.
• Established medical provider network must be located within a 10-mile radius from the city of boundaries.
4. Processing and management information
a. Monthly loss reports which include as a minimum:
• Claim number, date of loss, name, cause and injury.
• Claim status (open or closed).
• Reserves by claim and grant total.
• Total incurred losses.
• Total incurred losses.
b. Monthly case review meeting with city human resources:
• Claims review, counter-measures, and management.
c. Quarterly loss analysis summaries which include at a minimum:
• Number of claims closed by insurance year showing the total amount paid for medical and indemnity.
• Number of claims outstanding by insurance year showing the total amount paid for medical and indemnity and the outstanding reserves.
- Contract Period/Term: 12 Month