Third Party Administrator Services

The Vendor is required to provide automobile claims adjustment services using general guidelines established by division.
- Requirement:
1. Nature of program and service:
•    The contractor shall receive, directly from advantage members, all automobile liability and property claims involving advantage-registered vanpools used by authorized personnel on official vanpool business. 
•    Provide a high level of customer service and responsiveness to advantage members, division staff, and staff, including appropriate updates throughout the claims process. 
•    The contractor shall provide a prompt and thorough investigation of all claims, adhering to industry standard claims practices. 
•    Refrain from unfair claim settlement practices such as those listed in §38.2- 510 of the code of state. 
•    Abide by guidelines established by division. 
•    Claim settlement guidelines shall be provided by the code of state and by the advantage state vanpool self-insurance program coverage agreement, including specifically:
o    The contractor shall be granted claim settlement authority in an amount not to exceed $25,000 or other negotiated and agreed-to limits. 
o    Claims valued in excess of $25,000 or other acceptable limits must be approved by division prior to settlement. 
o    The contractor shall notify division promptly if a claim’s value exceeds $25,000 to determine whether contractor shall proceed with excess authority or division shall take over handling of claim.
•    The contractor shall actively pursue subrogation and place all proceeds into a fund designated by division. 
•    The contractor shall conduct salvage disposal in compliance with industry standards and statutory requirements and place all proceeds into a fund designated by division. 
•    The contractor shall maintain appropriate documentation related to salvage disposal and produce for inspection as needed.
•    Provide database management, including subscription and submission of reports to the index bureau. 
•    Agree to any existing special account handling procedures that have been developed between the parties and perform such other general administrative and advisory services that may be necessary to assist division in developing and maintaining effective management controls. 
•    Establish a reasonable sum for reserves covering loss and expense on each claim as soon as sufficient facts have been developed, and provide a timely update of reserves for all open claims. 
•    Maintain all claim files and have them available for inspection or audit at any time by division or its designated representative. 
•    Each file shall be complete and contain all necessary information concerning the particular claim. 
•    Provide status reports to division on any individual claim, as requested. 
•    Provide a payment analysis, claims stratification, and claims experience summary report as of June 30, in a format agreed to by July 15 annually. 
•    Submit soc-1 report annually. 
•    Provide division with a monthly listing of individual claims and a summary of experience, including claims paid, allocated expenses, reserves, quarterly run-off reports for previous fiscal years and all other information as gathered and agreed to by the parties.
•    Should a claim managed by the contractor result in litigation, division will assign qualified legal defense counsel and manage the litigation. 
•    Cooperate closely with such counsel throughout all stages of any litigation. 
•    Make settlement recommendations to division. 
•    Final decisions regarding disposition shall be at the sole discretion of division. 
•    Notify division within one business day of becoming aware of a lawsuit being filed and served. 
•    Contractor shall not accept service on behalf of advantage members. 
•    Make all reasonable efforts to dispose of claims submitted as amicably as possible and prepare compromises, agreements, and releases for division, and where required, file the same with proper public authorities. 
•    Preserve and support any loss recovery rights of the vanpool owner arising out of transactions and cooperate with division in pursuing such rights to conclusion. 
•    Examine, tabulate and recommend for payment, all expenses incident to claims, including payments in settlement of damages and injury, which shall be paid in the manner prescribed by division. 
•    Compile basic information necessary for the completion of all reports required to be filed with the department of motor vehicles. 
•    Confer with division and any designated representative and make recommendations regarding the best manner to process, settle and dismiss cases of questioned or unclear liability or serious exposure. 
•    Upon dissolution of the contract, the contractor shall provide division with all claims history data and records within 30 calendar days. 
•    Hold quarterly update meetings with division and commission. 
•    Meetings may be held virtually. 
•    Provide division and commission a primary point of contact who shall be able to answer questions related to the program. 
•    Division and shall be promptly notified of changes to the point of contact.
2. Contractor operations:
•    Division shall establish an imp rest fund for payment of claims. 
•    The contractor will be authorized to sign checks from the imp rest account established by division and will be responsible for providing operations with advance notice of any payment which will exceed $25,000. 
•    Responsible for implementing required procedures related to the imp rest account, including positive pay approvals. 
•    Have or establish a statewide toll-free number for the initial reporting of claims and follow-up of claims. 
•    If the contractor wishes to change the phone number during the contract period, the contractor shall notify division and commission in writing prior to the change. 
•    Use a web-based information system provided by division to verify coverage. 
•    Division reserves the right to audit all vanpool claim files at any time. 
•    No case will be archived until it has been closed for five years or until division authorizes such, whichever occurs first. 
•    All cases and all files remain the property of division. 
•    Such files shall be maintained, stored and archived by the contractor for the required statutory and agreed to period. 
•    Such files will be returned to division upon dissolution of the contract.
3. Automation support:
•    Accurate and timely electronic data processing hardware and software, including initial and on-going training, allowing the commonwealth to review claims (real-time), and prepare individualized custom reports (ad hoc reporting). 
•    Automation support shall continue to be provided beyond the termination of this contract until all claims are closed.