Workers Comp Program Services

The Vendor is required to provide workers comp program services requested include: third party administration services, managed care or preferred provider program services, bill review and re-pricing services and any other miscellaneous services that may be beneficial to the education workers compensation program.
- Third party administration services (TPA)
• Promptly investigate all reported claims, obtaining necessary employee information and medical records.
• Determine the validity of occupational injury and illness claims.
• Authorize medical treatment and work cooperatively and in tandem with the education workers’ compensation team
• Determine eligibility for workers’ compensation benefits.
• Ensure payment of workers’ compensation benefits in accordance with state law
• Ensure that employees receive legally mandated workers’ compensation notices.
• Advise education of injured worker medical status, physical restrictions, and return to work status on an ongoing and continual basis.
• Participate in regularly scheduled claim staffing meetings and provide an annual stewardship report in-person.
• Assist in defense of litigated workers’ compensation claims.
• Identify third-party liability and assist in recovery from third parties.
• Identify subsequent injury recovery possibilities and pursue through all phases of the recovery process
• Access to a web-based claims system maintained by the TPA and made available to the education to include sufficient data and claim notes, reserves and reserving strategy, and medical diaries.
• Complete all statutory reporting requirements.
- Claim handling procedures
• Internal claims handling procedures and service standards.
• Handle after-hours and emergency calls
• Staff for the servicing of this account including the average and maximum number of claims per designated examiner that will be assigned.
• State if this case assignment is negotiable with the education.
• State if the provision of an onsite adjuster is an option
• State workers' compensation laws provide challenges for a public entity and how do you plan to handle those challenges.
• In the case of a catastrophic claim, describe the processes that might occur once the claim is received.