The vendor required to provide third-party administrators (TPAs) for loss control engineering and workers’ compensation (WC) claims administration services.
- Workers’ compensation loss adjustment services, including, but not limited to:
• Thorough investigation and processing of lost time (indemnity) and medical only claims:
o Visit site to investigate accident and incident, if necessary to document and confirm.
o If lost time claim, make personal contact (phone or visit) with claimant.
• Timely payment of benefits and related expenses; denial of benefits when applicable.
• Timely filing of all state-required documents.
• Establish reserves and update reserves regularly.
• Schedule medical exams:
o Follow up on phone for same-day report.
• Pay medical bills in accordance with state fee schedule.
• Consult authority staff in rehabilitation decisions.
• Assignment to, and coordination with, authority -appointed legal counsel on litigated claims:
o Audit and pay legal bills.
o Respond to attorney’s correspondence.
o Attend trials, redemptions, mediations, hearings as needed.
o Inspect authority personnel files to provide relevant material for attorneys.
• Report claims to excess insurer as required.
• Report claims on authority behalf as required by law including but not limited to reporting to the medicare administration.
• Attend authority quarterly claim review meetings:
o prepare status reports with reserve sheets in advance.
• Subrogation and coordination
• Evaluate each lost time claim and assign light-duty where appropriate.
• Timely claim recording and monthly loss run preparation (do not drop any claims)
• authority performs direct deposits for TPA use.
• The TPA must provide weekly disbursement reports.
• TPA will be required to generate data requests for all authority claims handled by the TPA.
• Any and all reports must be provided to authority within 2 weeks of the reporting period or at the completion of the data collection period
• One individual must be designated as a liaison to authority, and shall serve as an account executive responsible for the general and day-to-day functioning of the business transacted
• Complete cooperation and assistance during periodic audits.
• All claims must be handled for the life of the claim.
• Computer access to TPA claim system by authority personnel.
• Tracking trends in claims related data and generation of key performance indicators, including but not limited to, ratios of reserved to paid claims and ratios of litigated claims as compared to number of accidents and claims, claims frequency rates, claim closure ratios, and the tracking of claim trends.
• Assistance in developing key performance indicators that may be useful to the authority in reducing the number of claims it receives.
• Ability to integrate new technology and software being developed by authority safety, risk, and training department that will, among other things, track accident-related data.
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: January 27, 2026
