The Vendor is required to provide for claims administration services to support its self-insured workers compensation, property, and liability insurance program.
- Objectives
• Establishing a relationship with an innovative third-party administrator (TPA) geared toward returning injured employees back to work quickly and resolving all claims as efficiently as possible
• High quality, stable team
• Excellent customer service
• User friendly RMIS system
- Services include:
o TPA will provide costs for reporting claims via internet, email, fax and phone.
o TPA will set initial reserves as soon as possible.
o Each new claim will be investigated including collection of recorded statements as appropriate.
o Adjuster will make contact with claimants as appropriate in a reasonable period of time, and document contact in claim notes. For workers compensation claims, claimant will be contacted within 24 hours of receipt of claim from the city. Throughout claim management, TPA return correspondence between claimants shall also occur within 24 hours. Witnesses will also be contacted as soon witness information is available.
o TPA will assign a senior liability claim adjuster to handle all litigated liability files, a liability adjuster to handle all non-litigated liability claims and all auto claims.
o TPA will assign a senior workers compensation claim adjuster to handle all indemnity files and assign a medical only adjuster.
o TPA will make available a property adjuster to adjust property claims over $5,000. A supervisor will oversee all activities.
o Initial claim notices will be sent to the city contact and will include the claim number, date of loss, claimant name, adjuster name and initial reserve. Initial claim notices are to be sent within three days of receipt of the claim by the TPA.
o TPA will send a special report whenever a reserve is increased by more than $10,000 and when a claim is closed.
o TPA will request settlement authority in writing.
o TPA will handle all necessary state filings
o TPA will provide written status report on each claim three days prior to the four quarterly claims review meetings.
o Outsourcing adjusting to other firms will not be allowed.
o TPA shall maintain files on each claim and have files available for audit and/or inspection at any time. At termination of the contract, TPA shall return all files to the city at no cost to the city.
o No files will be destroyed without prior written consent of the city.
o TPA will provide a tape transfer of all historic loss data at termination of agreement at no cost to the city.
o TPA will report all qualified claims to excess insurers based on each insurer’s requirements.
o TPA will provide the following monthly loss reports (these can be posted on web portal):
o Summary loss report showing number of open, closed and total claims by pool year, including run-in policy period. Amounts paid (separating expenses), reserved (separating expenses) and total incurred, amounts due / received from excess insurers, net experience.
o Claim experience report for each policy period showing same data as in 16.a. (above), by line of coverage.
o Monthly financial report showing all payments and changes in reserves for all claims.
o Monthly claim register showing all claims.
o Monthly loss report is to be sent electronically to the city.
o TPA will provide clients with internet access to loss data and adjusters notes. Client will have 5 users.
o TPA will maintain a claims paying checking account and provide a monthly check register and bank reconciliation.
o TPA will not make personnel changes without prior approval of client.
o TPA will secure approval prior to incurring any charged expense to a claim file.
o The city will approve the assignment of legal counsel to each litigated claim.
o TPA will perform litigation management and review and approve legal bills using their criteria.
o TPA will develop claim handling instructions.
o TPA will identify and pursue subrogation on all potential claims for no additional cost.
o Amounts recovered by TPA will be deposited into client’s claims paying checking account and a notice of same sent to the city.
o TPA will make available individual email addresses for each adjuster.
o TPA will maintain client pyramid and include at least 4 levels.
o TPA will have $0 settlement authority on all claims.
o TPA will provide claim electronic forms to be used by the client in filing claims. Claims shall be filed online.
o TPA will provide or outsource MSSEA services.
o TPA will provide a catastrophic event plan to handle a surge in new claims (e.g. flood / sewer back-ups).
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: January 7, 2026
