The Vendor is required to provide third-party administrators to provide workers’ compensation claims administration services for the city’s self-insured workers’ compensation program.
- The selected TPA will be responsible for the administration of all existing Workers’ Compensation claims, as well as new claims filed on or after the program inception date of June 2, 2026. Proposals should include, as applicable, responses addressing both life of claim and life of service agreement options.
- The selected Administrator must demonstrate the ability to:
• Process claims in a timely and professional manner
• Actively pursue subrogation opportunities
• Assist in returning injured employees to work
• Maintain strong communication with both the injured worker and City staff
- When a City employee experiences a workplace injury or illness, the following process is initiated:
• In accordance with state law, employees must report work-related injuries or illnesses to the hr department within 30 days of becoming aware of the condition.
• Upon notification, the supervisor must complete and submit an investigation of the industrial illness or injury within 24 hours. The supervisor also provides the employee with a workers’ compensation packet.
• Completed forms are submitted to the HR department, which then forwards copies to company.
- The Workers’ Compensation Program is self-insured up to $500,000.
- Investigative services shall include, but is not limited to, the following:
• Review all incident reports that may result in claims.
• Conduct thorough investigations within 30 days, including interviews, official reports, and photographs.
• Perform field investigations when necessary.
• Submit written recommendations identifying liability, defenses, and proposed actions.
• Apply relevant legal defenses (e.g., immunities, comparative negligence).
• Maintain a reporting service for incidents and initiate immediate investigations for high-exposure or complex claims.
• Perform special investigations as directed by the city’s authorized representatives.
- Claim handling shall include, but is not limited to, the following:
• Open and maintain claim files promptly, ensuring compliance with statutory timelines.
• Determine liability per code.
• Evaluate claims and recommend reserves for indemnity and legal expenses.
• Ensure timely communication and follow-up with claimants.
• Coordinate with excess insurers as required.
• Secure settlement agreements and releases for resolved claims.
• Comply with the medicare, medicaid, and act section 111 reporting requirements.
• Assign a dedicated lead adjuster; personnel changes require city approval.
• Provide audit access to claims records; participate in annual agency audit.
- Legal support services shall include, but is not limited to, the following:
• Assist the city in retaining outside counsel for litigation.
• File and maintain required reports with the state.
• Advise on statutory and regulatory changes affecting workers’ compensation.
• Review the city’s workers’ compensation program and attend related meetings.
• Provide litigation support and transfer claim files to counsel upon notification.
• Represent the city in small claims actions and city council appearances as requested.
- Bill review shall include, but is not limited to, the following:
• Review bills for compliance with fee schedules and reduce as appropriate.
• Eliminate duplicate or unauthorized charges.
• Ensure billing aligns with approved treatment plans.
• Provide monthly, annual, and ad hoc reports on bill review activity.
• Respond to provider inquiries regarding billing adjustments.
- Medical management shall include, but is not limited to, the following:
• Oversee medical treatment to ensure cost-effectiveness and relevance to the injury.
• Approve or deny service requests within required timeframes.
• Report on utilization review outcomes and savings.
• Arrange medical/legal evaluations and coordinate with stakeholders.
• Provide nurse case management (telephonic and field).
• Promote proactive case management and return-to-work strategies.
• Recommend medical panels for city approval.
- Information system shall include, but is not limited to, the following:
• Provide 24/7 internet-based access to claim data and reports.
• Ensure real-time data availability or daily uploads.
• Offer technical support and import pre-June 2, 2026 loss data.
• Assist with required reporting to state agencies, insurers, and consultants.
• Maintain data integrity and confidentiality through robust security protocols.
• Track individual claim costs and future liability estimates.
- Contract Period/Term: 5 years
- Questions/Inquires Deadline: February 13, 2026
