Worker’s Compensation and FMLA Third Party Administration Services

The Vendor is required to provide Third-party Administrator firms, also referred herein as the “TPA”, for administration of the District’s Workers’ Compensation Insurance Program and Family Medical Leave Act (FMLA).
- The District recently completed a major comprehensive organizational re-engineering process.
- The District manages an award winning Geographic Information System (“GIS”) that supports its many activities.
- The database contains detailed utility and land base information for each of the member municipalities as well as natural resource information for watershed land.
- The system is capable of producing utility and street index maps as well as special purpose maps.
- It is also linked to the District's business application software, allowing users to query data and locate specific utility equipment. GIS also provides mapping services to member towns.
- Claim Service Manager – TPA will provide a designated Claim Service Manager with the authority to manage the services and resolve all applicable issues, or offer an acceptable alternative to the District’s satisfaction, within fourteen (14) business days of notification of claim. TPA will return all District’s telephone calls within one (1) business day of District’s effort to contact TPA.
- Claim Reporting/File Establishment/Data Quality
• TPA will provide a claim-reporting tool via a dedicated toll-free phone and web reporting service with the ability to add customized questions as necessary. The District expects the TPA to have the ability to take telephone loss reports 24 hours a day, seven days a week, and 365 days a year. The TPA will also make an Internet Reporting option available.
• TPA will establish all claims in the claim system during the 1st business day received and immediately assign them to the appropriate field office claim unit for handling within 24 hours from Date Notice Received (DNR). TPA will provide written or computerized notification of each claim to the District contact reporting the claim with a copy to HR and EH&S for WC related absences.
• Within three (3) business days from DNR, the correct policy/contract number, policy period and loss location information will be identified, verified and entered by the TPA into the PTA’s claim system.
- Delegated Settlement Authority – TPA has no delegated settlement authority. TPA should contact the MDC and submit the Worker’s compensation Settlement Authorization Form for all proposed settlements.
- Reserving & Reserve Notice
TPA will use an ultimate claim value approach to the establishment of reserves. However, it is agreed that prior to any reserve increase of $10,000 or more, a conference will be held with the District , TPA Claim Service Manager and the local claim supervisor at which time TPA shall explain to the District
TPA will send out Reserve Advisory letters, outlining the facts of the claim, theory of compensability/liability, rationale for the reserves and action plan for resolution on all initial and subsequent reserve increases of $10,000, or more, to the District within fourteen (14) business days of the reserve change.
- TPA will provide written or computerized ninety (90) day Status Updates to be forwarded to the District on all files reserved at $25,000 or above outlining the current rationale for the reserves, and a definitive action plan, including proposed time frame and specific action items for resolving the claim.
- Personnel/Staffing – TPA will provide a designated Claims Team for the District. The claims examiner shall be experienced with a minimum of five (5) years’ experience adjusting claims as a claims examiner handling Workers' Compensation claims.