Workers' Compensation Third Party Administrator Services

The Vendor is required to provide third-party administrators to day-to-day claims management and managed care services for the county’s workers’ compensation program.
- Contract with a single TPA for both claims management and managed care services or two separate TPAs.
- Contractor(s) must demonstrate the following:
• Relevant claim information will be gathered;
• Information will be processed in a timely manner;
• Appropriate wage and medical payments will be issued;
• A safe and healthy environment will be promoted for county employees.
• A brief description of the contractor’s mission and purpose.
• Name or names of technical resources assigned by the contractor to this account.
• Account manager responsible for day-to-day activity.
• Identify any areas of emphasis that make contractor better qualified for selection as the
• County’s third-party workers compensation claims administrator.
- The TPA may also be requested to provide safety/risk control recommendations based on applicable claims data.
- The TPA’s duties and responsibilities shall include, but are not limited to, the following:
• Provide a dedicated claims unit composed of professionally trained, appropriately licensed claims staff and a dedicated clam’s manager to ensure excellence in all areas of service required under this contract.
• Perform a complete and timely implementation of third-party claims administration services which meets the contract effective date.
• Agree to cooperate with all other county workers’ compensation program contractors in the on-going coordination and delivery of services to the county, and in any transfer of responsibility.
• Provide county departments with on-line, facsimile, telephonic, and e-mail claim reporting capabilities.
• Respond within 1 business day to any inquiry, complaint or request received from the county, the department of labor and industry-workers’ compensation division, other regulatory agencies, a claimant, or other interested party.
• Review all incident, claim and loss reports received from the county, and process each such claim or loss report to conclusion in accordance with applicable statutory and administrative regulations.
• Establish an incident only or near-miss file for any event for which a county employee becomes aware of the potential for injury or property damage, but for which the employee involved has not claimed injury and a claim is not anticipated.
• This will be for reporting purposes only.
• Establish and reserve a claim file for each reported claim in accordance with the TPA’s standard time frame requirements.
• Maintain a current estimate of expected total cost of each claim or loss and provide for reserve calculation tracking (including initial reserve establishment and all subsequent changes) within the claim file.
• Conduct a thorough investigation of each reported incident, claim or loss to the extent necessary, which may include but not be limited to photographs, diagrams, police reports, and statements from involved parties and all witnesses to determine the county’s liability, etc.
• Process each claim in accordance with rules, regulations, and restrictions of the state department of labor and industry-workers’ compensation division and the laws of the state.
• The county shall have the right at its discretion to take over the handling of any claim and to direct the handling of any claim at any time during the life of the contract and the life of the claim, but with no expense or reduction in claim service fees or allocated claim expense incurred by the TPA with respect to such claims.
• Safety/loss personnel must make on-site contact within one business day of the notice to the TPA of the incident, claim, or loss, in the event of notification of an incident, claim, or loss involving death of an employee, or a serious injury with an initial indemnity and medical reserve over $50,000.