Third Party Claims Administrator Services

The Vendor is required to provide administering the following types of claims for governmental entities (collectively, “claims”): (i) workers compensation claims(“workers compensation claims”); and (ii) act claims, property claims,  general liability claims, automobile claims, and federal claims applicable to municipal utilities (collectively, “other claims”).
- The City uses Origami risk management software for claims tracking and management. Must be able to import origami data. Utilities is willing to support either a locally installed or cloud-based solution.
- Create accurate files and set monetary reserves within two (2) working days from receipt of the initial report. 
- Audit medical bills to determine if there is a causal relationship to the injury and if such bills are reasonable. 
- Annually review medical maintenance for closure and make note of such cases.
- Report all indemnity claims to the Index Bureau when a file is created and retain a copy of such a claim within that file. 
- Review medical-only claims for possible closure no less than every thirty (30) days. 
- Provide information and guidance to claimants regarding workers' compensation benefits, and respond to claimants’ inquiries regarding specific injuries and permanent disability ratings. 
- When appropriate, develop rehabilitation programs for claimants for approval by: Utilities, the claimant, and any applicable agencies to ensure that rehabilitation, retraining, or reassignment is provided to claimants with physical or performance limitations.
- Maintain a close liaison with treating providers to assure that claimants receive proper care and are not over-treated. 
- Be medically knowledgeable in accordance with industry standards.
- Monitor a claimant’s treatment program to ensure that it is related to the compensable injury or illness. 
- Determine eligibility for, and authorize payment of, Temporary Disability compensation in accordance with medical advice and rehabilitation efforts. 
- Attend monthly meetings with the Clinic.
- Encourage claimants’ return to work for modified duty.