Third-Party Administration Services

The vendor required to provide third-party administration services for the county’s self-insured workers’ compensation and disability plans.
- Requirement:
•    Administer the county’s self-insured workers’ compensation (including volunteer firefighters and ambulance) and disability plan claims. 
•    Achieve orderly transition of all open claims, without delay or negative impact on service, progression, resolution, and other matters related to said claims. 
•    Review all existing claims and recommend a strategic plan to minimize the county’s liability accordingly. 
•    Investigate and evaluate all incidents of employee job-related claims referred by county during the terms of this contract to determine if the incidents or claims are covered under workers’ compensation statutes of the state. 
•    Establish claim files and make prompt contact with administrative county staff, claimants, and medical providers. 
•    Make appropriate investigations into each incident to ascertain facts of the accident and nature of injuries. 
•    Confer with the county’s legal counsel for the determination of viable defense of claims, prior to providing defense of such claims.
•    Coordinate and provide legal counsel and appropriate, licensed representation at all hearings and depositions, including timely witness notifications, and assure appropriate action. 
•    Maintain case files and diaries with action plans for each case. 
•    Establish reserves for each case. 
•    Review and assure compliance with medical treatment guidelines for applicable injuries. 
•    Verify all medical fee invoices are in accordance with the state workers’ compensation fee schedules. 
•    Review to assure appropriate prescription drug medication management. 
•    Prepare all files for, and attend arbitration hearings for testimony as required. 
•    Prepare and file all forms required by the workers’ compensation board in a timely manner, pursuant to industry standards. 
•    Prepare check register and payment reports and forward to the county to allow timely indemnity benefits and medical payments (in accordance with state workers’ compensation law). 
•    Process bi-weekly workers’ compensation payment 
•    To secure necessary claims-related services on behalf of the county (e.g., hospital and medical reports). 
•    Prior to securing such services on behalf of the county, inform and confer with the county to determine the necessity of:
o    Rehabilitation services 
o    Nurse case management 
o    Surveillance and use of private investigator(s).
•    Schedule independent medical examinations (IMES) with appropriate medical specialists and prepare and forward all required and necessary claim information and reports to IME physicians. 
•    Secure prior authorization before commencing any discussions concerning lump sum settlements. 
•    Reserve county rights for reimbursement and apply for any recovery opportunities on respective files, including but not limited to special funds conservation committee, loss transfer, and other subrogation opportunities. 
•    Calculate and report disability payments due to applicable employees, separately listing taxable wages, as well as FICA and medicare deductions on a weekly basis. 
•    Recap and report disability payment, FICA, and medicare totals on a semiannual basis 
•    Notify and report to excess insurance carriers regarding all qualified claims as per the reporting requirements of the respective policy period. 
•    Prepare and furnish the county and designee with a monthly claim activity report, quarterly loss information, separately listing claims for each participant employer entity with categorical expense and reserves for indemnity/medical/legal/rehabilitation. 
•    Contractor shall be available for periodic on-site meetings and case reviews as requested by the county. 
•    To complete and submit all claims forms necessary for proper claims administration from the perspective of a self-insured employer, including but not limited to 1099 forms, medicare SCHIP, and public goods pool reporting. 
•    Provide all reporting under the state workers’ compensation law. 
•    Records shall be made available for county review upon request for audit purposes. 
•    County shall have the option for final approval of selected vendors providing causal services, including, but not limited to, private investigators, rehabilitation nurses, and independent medical consultants. 
•    Prosecute appeals to the state workers’ compensation board, where necessary. 
•    Provide electronic access to county file information, reports, forms, and adjuster’s notes 
•    Assist the plan in the administration of GML 207-a and 207-c claims as needed. 
•    In cooperation with key plan personnel, establish and coordinate procedures and practices to meet the plan’s claims management needs as well as applicable state regulations. 
•    Present training seminars to plan participant staff who are involved in processing workers’ compensation claims or losses, on the essential elements of effective and efficient claims management and loss prevention techniques. 
•    Provide information on changes or proposed changes in legislation, rules, and regulations affecting the responsibility of the plan and its participants. 
•    Assist the plan in estimating, preparing, and managing its annual budget, with attention to cash reserve levels for claims already incurred.
•    Provide the plan with estimates of reimbursements from the special fund’s conservation committee.

- Contract Period/Term: 1 year
- Questions/Inquires Deadline: February 17, 2026