Third Party Administrator Services for Workers Compensation

Third-Party Administrator for Workers’ Compensation, process, review, investigate and document all Workers’ Compensation claims made by the City-Claims Administration
1. Perform all of the administrative services required and control the disposition of all claims in accordance with applicable statutory and administrative notification requirements of the Arizona Workers’ Compensation Act, and all applicable City policies and procedures. Copies of all Notices of Claim Status, medical investigative and legal reports will be sent to the HR Manager upon generation or
receipt.
2. Review all claims made by the City of Yuma of personal injury, sickness or disease incurred by an employee arising out of and in the course of employment during the term of the Agreement, and of death resulting at any time from any of the foregoing. 3. Conduct an investigation of each reported claim to the extent deemed necessary or at the request of the City . Request from the Industrial Commission of Arizona information on prior injuries on all new claims and as otherwise requested by the City.
4. Subject to prior City approval and vendor selection, arrange for independent investigators, experts or other professional when such action is necessary to properly process cases, assist in determining the status of disabled claimants, prepare litigated cases, or at the request of the City. The Offeror will obtain authorization from the HR Manager prior to arranging for any investigators, experts or other professionals.
5. Maintain an electronic file for each claim or loss including but not limited to medical reports, legal reports, cost data, and estimates of future liability on an individual claim basis which shall be available for review by the Cityor its authorized agents. (All files whether electronic or paper shall remain the property of the City during and subsequent to the expiration of any contract or agreement and
shall be returned to the city prior to destruction.)
6. Timely pay all benefits as provided by the Arizona Workers’ Compensation Act. Assure that medical bill payments comply with medical fee schedules and/or discounted fee arrangements negotiated by or on behalf of the City and city approved/selected cost containment vendor, coordinate payment of any temporary disability pay benefits with the staff of the City.
7. Assist and support legal counsel selected or retained by the City in the preparation and defense of litigated cases and negotiation of settlements and provide periodic analytical or narrative reports of litigated cases to the City. Under no condition will a claim be settled without the express written and signed approval of the City.