The Vendor is required to provide third party administrative services to manage claims for the County’s self-insured workers’ compensation program.
- Serve as the third-party administrator will be required to manage all workers’ compensation claims with opened or reopened dates after May 1, 2026, and to assume management of all existing open claims.
- Services include:
• Provide management services and issue payments for a workers’ compensation function that supports and assists a highly proactive approach to injury and claims management.
• Receive, review, and analyze all petitions for benefits made by claimants.
• Receive notice of and create files on each claim reported and maintain these files for the county.
• Investigate all claims as required to determine their validity and compensability.
• Attend regular meetings with county personnel, or others as requested.
• Forward copies of the following records to the county’s risk management specialist immediately upon receipt:
o Initial reports;
o Status reports and action plans;
o Modified work or return to work correspondence.
• Determine proper benefits due on compensable claims.
• Make timely payment of benefits due.
• Recoup benefits paid in error by the contractor.
• Maintain a current database of all claims and claim payments with the capability of granting access to risk management staff.
• This database should also provide requested reports and act section 111 data.
• Maintain claim records and make available to the county upon request, including but not limited to:
o IMES;
o Reports from nurse case managers or vocational counselors;
o Closing requests and confirmations.
• Establish reserves in a timely manner; review at least monthly, or as the claim indicates.
• Write initial review, action plan, and outcome goals for each time loss and/or large medical claim and regularly transmit information to county risk management specialist.
• Attend trials and settlement conferences. County authorization shall be obtained prior to all settlements.
• Prepare documentation and defense of cases considered non-compensable and assist legal counsel selected by county in preparation of cases for hearing, appeals, and/or trial.
• Consult with the county risk management specialist before assigning an attorney to any claim. The county risk manager and/or risk management specialist reserves the right to designate counsel.
• Advice the county’s risk management specialist about assigning case managers, counselors, independent medical examiners, therapists, etc., in a timely manner, as indicated or directed.
• Provide training and updates on recent legal requirements and data management system changes. Provide information on changes or proposed changes in legislation, rules and regulations affecting the responsibility of the county.
• Pursue reasonable subrogation and distribute any recovered sums.
• Provide loss control services, defined as loss control, consultations and surveys as mutually agreed.
• Assist and provide guidance and expertise in responding to audits by the state or other inquiries from outside agencies.
• Assure prompt and proper closure of claims.
- Contract Period/Term: 2 years
- Questions/Inquires Deadline: January 20, 2026
