Workers’ Compensation Claims Administration Services

The Vendor is required to provide for workers’ compensation claims administration services and complex liability claims processing (hereinafter referred to as “TPA”).
- The City’s Risk Manager oversees the self-insured workers’ compensation/liability program and TPA.
- The City utilizes the services of a third-party claim administer to assist in the delivery of services for this program and to ensure that it complies with all applicable state statues.
- The City is self-insured for workers’ compensation and liability coverage within our retention.
- TPA should identify the key and support personnel that will be housed at this location.
- TPA shall provide a toll-free telephone for claims reporting.
- TPA shall provide a secure electronic method or methods for agencies and claimants to report incidents and claims.
- The TPA shall have procedures to handle all types of claims submittals.
- The TPA should provide continual and monitored telephone coverage, 24-hours-a-day, to include weekends and holidays, for the purpose of receiving incident reports and messages. This may be accomplished by voicemail, an answering service, or other alternative means.
- Statistics compiled on a fiscal year basis include but are not limited to total number of:
•    Open claims (including claim type),
•    Closed claims (including claim type),
•    Closing ratio
•    Outstanding reserves on open claims
•    Total payments made on both open and closed claims and
•    Medical cost savings.
- Assist City Risk Management staff with IT and reporting needs, including data field research, troubleshooting, and creation of custom loss runs and other types of reports;
- Review key deliverables and other formal work products prepared by TPA’s staff prior to submission to the City;
- TPA shall assign full-time adjusting staff members.
- TPA shall apply insurance industry standard caseloads/claim counts.