Workers’ Compensation Administration Services

The Vendor is required to provide third party administrators (TPА) to provide administrative and case management services in support of the city self-insured workers' compensation program and disability management services under city.
- Requirement:
•    Review all existing and future claims for loss reports of personal injury, illness, or disease incurred by an employee in the course of their employment with the city, or the death resulting at any time from any of the forgoing. 
•    Process each claim or loss report with respect to minimizing the city's losses in accordance with applicable statutory and administrative notification requirements.
•    Review all existing and future medical and other §8a-6 disability claim billings by health care providers, for approved §8a-6 disability claims referred by the police department's designated physician for treatment of injuries and illnesses sustained in the performant of duty. 
•    The review shall be to ensure the completeness and accuracy, including repricing, of said billings and to acquire whatever additional information is necessary to ensure timely payments of said medical billings.
•    Review all existing and future medical billing submitted in state, out-of-state, and other by health care providers regarding management and treatment of performance of duty related injuries and illness sustained by retired police department uniformed personnel whose disability claim(s) under §8a-6 were approved. 
•    The review shall be to ensure the completeness and accuracy, including re-pricing, of said medical billing to acquire whatever additional information is necessary for timely payments of said billing.
•    Conduct an investigation of each reported claim or loss under subparagraph "a" above in conjunction with the city's plan administrator to the extent deemed necessary to substantiate the validity of the claim. 
•    Work with the city's plan administrator and personnel to facilitate returning the employee to work at the earliest possible date.
•    Calculate and disburse medical and death benefits and temporary or permanent disability compensation, if in the judgment of the provider, such payment is legally appropriate.
•    Perform administrative and clerical functions required in connection with qualified claims and losses, including the preparation of checks or drafts bearing the name of the city and drawn on accounts established for payments of claims. 
•    The TPA shall establish, manage, and maintain a separate bank account on behalf of the city and provide monthly bank statements and reconciliations to the city as well as request, periodic funding draws from the city as necessary to meet current check runs.
•    Must have the ability to provide the city departments with direct input of workers' compensation claim information.
•    Monitor safety trends: analyze the nature of injuries and affected body parts to implement proactive safety improvements. 
•    Track operational impact: review lost time and medical only claim statuses
•    Maintain compliance: access aggregated or claim-specific data for operational planning without exposing personally identifiable information (PII) or protected health information (PHI).
•    Must maintain a case for each qualified claim or loss with all information required to substantiate the claim and ensure that all case files are available for review. 
•    Must be able to meet with city management staff in person when requested to discuss cases involving lost time, awards, lump sum settlement, and etc.
•    Work with the city for selection of counsel to defend qualified claims or losses.