Workers' Compensation Insurance Services

The Vendor is required to provide workers' compensation insurance program in which the contractor assumes complete financial responsibility for all covered claims.
- Claims management and administration
• Prompt acknowledgment, intake, and investigation of all reported workers' compensation claims within timeframes mandated by the state labor code and department rules, including timely filing of the employer's first report of injury and all subsequent required forms with department.
• Assignment of dedicated, state -licensed claims adjusters with demonstrated experience handling workers' compensation claims for state public school districts or comparable state governmental entities.
• Maintenance of individual claim files for each reported injury or illness, documenting all medical treatment, indemnity payments, lost time, return-to-work status, and claim reserves in accordance with state recordkeeping requirements.
• Regular claim status updates to the district's designated risk manager or human resources director no less than monthly, or more frequently upon request or in the event of a significant claim development.
• Coordination of medical management services, including utilization review conducted by a department -certified utilization review agent (URA), medical bill review and application of the state workers' compensation fee schedule, and coordination with treating physicians in accordance with state law.
• Identification and active pursuit of subrogation opportunities on behalf of agency where third-party liability may exist, with regular reporting to the district on subrogation recovery efforts.
• Any subrogation recoveries shall be credited to the district's loss experience in accordance with standard industry practice.
• Full compliance with all state dispute resolution processes, including department benefit review conferences (BRC) and contested case hearings (CCH).
• Maintain a state-based claims office or designate a state-licensed claims representative as the primary point of contact for all district claims.