Professional Automobile Liability, Medical-Malpractice and Property Claims Administration Services

The Vendor is required to provide professional automobile liability, medical-malpractice and property claims administration supervisory, administrative and adjustment services on all automobile liability, medical malpractice and property claims that fall within the self-insured retained limit of the county, and as appropriate, work with applicable insurance carriers regarding claims that exceed this limit.
- Requirement:
•    Assume the adjusting of all existing open claims to closure including approximately 30 automobile liability claims, 40 open medical-malpractice claims, and 5 future property claims. 
•    Adjust and maintain claims files upon receipt of the claim, lawsuit or other equivalent information, and negotiate with claimant and plaintiff on those cases that have clear liability on the part of the county. 
•    Conduct investigations of claims and lawsuits filed against the county in a manner that adheres to the fair claims practices act and in accordance with guidance from county risk management and legal representatives. 
•    Investigations may include some or all of the following:
o    Contact and obtain information from the claimant(s), witnesses and other interested parties, as appropriate; 
o    Obtain police reports 
o    Take pictures or prepare diagrams to illustrate the mechanism, cause or location of the incident; 
o    Assess extent of liability
•    Manage claims data administration. 
•    The files should contain at least the following information or documentation, but not limited to:
o    All pertinent information regarding the claim including name of claimant, claim number, date of loss, description of loss, and involved department(s) and employee(s); 
o    A reserve amount of the estimate of the potential cost of the claim; 
o    A copy of the claim, lawsuit or other related documentation;
o    An analysis of the potential exposure of the county including liability and estimated damages; 
o    Written contact with the claimant or claimant’s representative; 
o    Any follow-up recommendations to bring claim to conclusion and closure
o    Documentation regarding the resolution including settlement agreements or releases; 
o    Communication with the county risk manager and county attorneys (in litigated matters) regarding the resolution or settlement of the case including letters pertaining to authorization for settlement; 
o    Letters, correspondence, memos, legal documents and notes that pertain to the claim; 
o    A full report of investigation including recorded or written statements from involved employees, managers, witnesses and claimant which may include photographs and any other visual information pertaining to the claim or lawsuit; 
o    Correspondence or case notes regarding conversations with either claimant, plaintiff or his or her legal representative.
•    Conduct periodic review and adjustment of reserves on all open liability claims at least every 60 days. 
•    Whenever investigation results in a determination that county sustained a liability to a third party, contractor shall process any such claim or potential claim for settlement in accordance with instructions and policies of county for settlement of such claims. 
•    Notify the county's primary and excess coverage providers of all claims which exceed county’s retention, maintenance of liaison between the coverage providers and the county on matters affecting the adjustment of such claims and seek reimbursements for loss in excess of retention or deductible. 
•    Subrogation on the county's behalf against any party responsible or partially responsible for loss incurred by county, in accordance with instructions and policies of the county. 
•    Obtain release agreement on settlements of any claims or potential claims as appropriate, unless client requests otherwise.
•    Provide county, during the term of this agreement upon request, tabulated loss run reports on all active claims during the term of this agreement, indicating the status of each reported claim assigned to contractor, the details of each claim, the payments during the month and the reserve status. 
•    On a quarterly basis, provide the county with a comprehensive listing of all open and closed claims including claim number; claimant name; date of loss; date reported to county; reserve amounts broken out by property damage, bodily injury and expense; total amounts paid broken out by property damage, bodily injury and expenses; and total incurred. 
•    On a quarterly basis, provide the county with a listing of all open claims by claim number including claimant name, responsible department, and total reserve. 
•    On a semi-annual and annual basis, provide the county with a summary report by fiscal year of all open and closed claims that includes the total number of reported claims; the number of open claims; the total reserves broken out by property damage, bodily injury and expenses; the total paid amounts including property damage, bodily injury and expenses; and the total incurred of all claims. 
•    For property claims, serve as the county’s representative to coordinate with the county's department of public works, insurance adjusters, as well as vendor services such as contractors, emergency repair, cleaning services, and various replacement services as needed. 
•    Monitor loss run for litigation. 
•    Communicate with risk management, county attorneys and various departments regarding recommendation for further handling, investigation, resolution, settlement, or denial of liability. 
•    Meet with county risk management and county attorney no less than semi-annually to review open or complex claims.