Third Party Administrator and Workers Compensation Services

The Vendor is required to provide for workers’ compensation third party administration (“TPA”) for district’s self-insured workers’ compensation program.
- District employees provide services in professional, classified, secretarial, labor, transportation, and other education-related capacities.
- Provide complete administrative workers’ compensation claim services in accordance with applicable labor code laws and regulations, including but not limited to 24-hour reporting service access by injured employees, claims adjusting services, thorough and complete investigations for claims, utilization and bill reviews, contact with injured worker within twenty-four hours (one business day) of notice, further periodic contact with injured worker as needed, establishment of claim files within three (3) days of notice, full claim documentation in chronological order, reporting to district’s regarding non-cooperation of an employee, return of employees to work within the applicable state waiting period whenever possible and medically appropriate, and monitoring  return to work and district’s workers’ compensation administrator regarding restrictions and release to work.
- Determine eligibility for and authorize payments of medical, disability, and other allowable benefits in a timely manner. 
- Provide mail, e-mail, or phone contact with all injured workers, the medical provider and District Workers’ Compensation Administrator within three (3) working days of each claim.  
- Develop and maintain adequate claim reserves.  
- TPA shall automatically notify district of reserve changes/charges exceeding $10,000.
- Coordinate investigations and litigation with attorneys approved by district and the Excess Workers’ Compensation Insurance Carrier.
- Provide data and reports on a monthly basis including, but not limited to, the name of the injured employee, date of injury, extent of injury, amount paid to date for medical, indemnity, rehabilitation, and expense, amount in reserves for medical, indemnity, rehabilitation, and expense, cause of injury, description of accident, body part, and any other information required, to the district Workers’ Compensation Administrator.
- Provide to district the following accounting information monthly: bank reconciliation statements, check registers and any other credit or expenditure report, un-cashed checks and voided checks, and other financial accounting information needed.
- Provide monthly data reports regarding number of injuries by type and site location (most recent month and rolling year), number of injuries by type and position classification (most recent month and rolling year), expenditure breakdowns (rolling year, including most recent month), annual trends and statistics, and other reports as needed or requested.  
- Pursue aggressively all subrogation recovery opportunities and assist in identifying and aggressively defending against fraudulent workers’ compensation claims.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: November 05, 2025