Claims Administration Self-Funded Workers' Compensation Program

The Vendor is required to provide third party administrators for the claims adjustment and ancillary services of a self-insured workers compensation program.
- Services in the following areas:
•    Claims management philosophy;
•    Claims adjusting ability;
•    Experience level of staff assigned to account;
•    EDP services available including flexibility of system;
•    Loss control capabilities;
•    Anticipated cost of services;
•    Liability coverage for “claims handling”.
- Claims management philosophy is:
•    To be certain that employees injured in the course and scope of their employment are provided statutory benefits in a timely manner;
•    To be certain that injured employees are provided quality and necessary medical care;
•    To be certain that injured employees are treated fairly, consistently, and with respect throughout the process;
•    To process and promptly pay approved medical bills;
•    To manage claims in such a way that early recovery from injury and early return to productive employment is encouraged;
•    To minimize unnecessary litigation; but also identify and aggressively defend claims that are not properly payable under provisions of law;
•    To identify areas of high exposure in order to reduce the frequency and severity of injuries to employees; and
•    To mitigate losses through subrogation of claims.
- Claim Data
•    Claim number
•    Injury Date
•    Date claim reported Department name
•    Nature of Injury
•    Body part
•    Nature of incident
•    Injury location
•    Job classification
•    Length of service
•    Male / Female
•    Paid-to-date amounts by indemnity, medical, and expense
•    Reserved amounts by indemnity, medical, and expense
•    Total incurred amounts by indemnity, medical, and expense
•    A summary listing of numbers of open claims, closed claims, and total claims
•    Subtotals of claims by department
- The district is also interested in the claims administrator’s ability to provide analysis of payments by types (i.e., defense counsel, outside investigation, vocational rehabilitation, etc.) and by specific payee.