General Liability Third Party Administration Services

The Vendor is required to provide for the furnishing of general liability third party administration services for the city.
- Program Administration
•    Manage the transition from the current TPA (if applicable). 
•    Maintain a claims management information system with the capability to store and record file activity and generate reports. 
•    City users shall have access to view city claims data. 
•    Include any costs associated with providing city users access to the claims management information system in their response.
•    Maintain an effective claim electronic data security system which includes adequate access, integrity controls, financial controls and continuity for uninterrupted systems operations.
•    Inform the city of changes or proposed changes in statutes, rules and regulations and case law that may affect the liability program.
•    Assist with loss prevention efforts and provide city with trend analysis reports at least annually to identify potential safety and risk issues.
•    Attend meetings, conferences, court appearances, and on-scene investigations at the request of the city.
•    Provide or arrange for translators to assist with non-English speaking claimants.
- Case Review and Documentation
•    Documentation should be detailed and timely, routinely reflecting any significant developments in the file and including a plan of action. Plan of action statements should be updated at the time of examiner diary review.
•    The TPA will contact the non-represented claimant or their attorney within 2 working days of receipt of the claim. The contact will be documented in the claim file. In the event, the party is non-responsive, there should be evidence of at least three documented attempts to reach an individual.
•    The examiner should review the file at intervals not to exceed 60 calendar days.
•    The supervisor shall monitor activity on open files at intervals not to exceed 120 calendar days.
•    Claim files should be correctly categorized upon initial review. If claims are maintained in a paperless system, documents shall be clearly identified in accordance with naming conventions defined by city staff.
•    TPA must provide copies of all correspondence to the city that is sent to claimants or their attorneys within 3 working days of the original being sent.
•    TPA must notify the city within 3 working days, when any previously closed claim is reopened and provide the rationale for reopening.
•    The city shall be kept informed on the scope and results of all investigations. In certain cases the city may request that the TPA assume the responsibility for the claim investigation.
•    The initial liability determination (to accept claim, reject the claim or send a notice of insufficiency) will be made by the TPA in compliance with the tort act and communicated to the city contact prior to any final decision, which must be approved by the city risk manager, or risk management staff. 
•    The TPA will send out all legal notices as appropriate upon approval.
•    Meet with city risk management staff quarterly to review case files and make strategy recommendations.
•    Within 30 days of a new claim being filed, the TPA is to submit a written report to the city that addresses the facts of the case, a liability assessment, possible defense, damages and a recommendation for action. This report will be based on information received from the city and also from any investigation directed by the city, as well as the TPA’S knowledge of current case laws and statutes. 
•    The TPA may assist in the development of policies and procedures relating to the general liability claims program.
•    The TPA will inform the city of problem areas or trends, both potential and perceived, and provide recommendations and/or solutions to address problem areas or trends.
•    The TPA will attend appointments, including but not limited to meetings, conferences, court appearances, and scene investigations at the request of the city.
- Case Load
•    Each claims examiner should handle a caseload of not more than 130 claims.
•    Supervisory personnel should not handle a caseload, although they may handle specific issues.
•    A dedicated claims adjuster or team must be provided. Adjusters must have at least 5 years of technical claim adjusting experience within the state jurisdiction and experience with public entity claims and law and ability to provide professional and technical expertise.
•    Identify proposed staff members who would be assigned to the city and submit statements or resumes detailing their qualifications and experience with municipalities.
•    If workloads increase over the life of the service agreement, propose how the TPA would meet the increased staffing needs.
•    Disclose the turnover ratio in the last 3 years of your management team and claim adjusters. Describe the TPA’S staffing back up plan in cases when the team is not available.
- Investigation
•    TPA will coordinate with city departments to gather reports, photos, and other relevant information in order to conduct a thorough investigation.
•    From time to time the TPA may be called upon to take statements, conduct scene investigations, coordinate sub-rosa activities, and perform other investigative tasks.
•    If the TPA faces delays in gathering information, they will coordinate with risk management staff to resolve the delay.
- Communication
•    Return calls shall be made within 1 business day of the original inquiry.
•    All calls shall be documented.
•    All correspondence received shall be clearly stamped or digitally noted with the date of receipt.
•    All correspondence requiring a written response shall have such response completed and transmitted within 5 working days of receipt
- Catastrophic Claims
•    One or more fatalities
•    Loss of limb
•    Loss of sight or hearing
•    Severe burns or disfigurement
•    Spinal Cord injuries/quadriplegic/paraplegic
•    Serious loss of any body part or function
•    Long term hospitalization (30 days or more)
•    Brain injury
- Reserving and Financial Reports
•    Using the information available at claim file set up, an initial reserve shall be established for the most probable case value. An accomplishment level of 95% shall be considered acceptable.
•    The initial reserve shall be electronically posted to the claim within 30 calendar days of receipt of the claim. 
•    An accomplishment level of 95% shall be considered acceptable.
•    Reserves should be reviewed at least every 90 days for appropriateness and again when significant developments occur, such as receipt of litigation or medical records.
•    Allocated expense reserves shall include medical cost containment, legal, investigation, copy service, and other claim related fees. Allocated expense reserves should not include TPA services. An accomplishment level of 100% shall be considered acceptable.
•    A brief status report is required when reserves are established for more than $5,000 and less than $25,000.
•    A comprehensive status report will be provided to the city at the time any claim exceeds a total incurred value of $25,000.
•    Within 10 working days of receiving information indicating that payments have been made or a claim has been resolved, the TPA shall adjust the reserves to the appropriate levels.
- Claims Management Information System (CMIS)
•    If necessary, TPA shall convert all open and closed claims data and enter new claims data into TPA’S CMIS.
•    City human resource and risk management personnel should have the ability to electronically view the progression of any of their claims. 
•    Claims notes should include all correspondence, phone contacts, and case plans of action and analyses. 
•    Supervisory notes should also be visible to the city. Reserve rationale should be visible. 
•    Claim data should be available in real time.
•    The city or its designated representative must be authorized to visit the TPA’S processing or storage premises and have access to all data including, but not limited to, paper documents, electronic documents, and any other type of documents that relate to payments or non-payments made by the TPA and charged to the city.
•    The city risk management personnel should have the ability to run ad-hoc and standardized loss runs from the carrier’s system. Reports should be able to be exported into various Microsoft products, i.e. Word, excel, and PowerPoint. 
•    The ad hoc reporting capabilities may include, but not be limited to, injury types, loss causation, loss location, claim duration, and litigation indicators.
•    TPA to provide CMIS technical support for questions, problems or development of customized reporting.
•    Image system to scan capabilities for all documents received pertaining to the case.
•    Any CMIS problems will be resolved within 48 hours or less.
•    Secured system that may include, but not limited to, security audits, protected by intrusion prevention and intrusion detection systems, communications of any claimant’s personal information or personal health information is protected (i.e. Monitoring of email and internet traffic, encrypted email, access restricted by user id and password, or other similar security methods). 

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: October 21, 2025