NIGP 94993: Worker's Comp., Indemnity Claims

NIGP 94993 Worker's Compensation, Indemnity Claims (Item) covers third-party administration of workers' compensation claims, including compensability determinations, indemnity benefit payments, medical bill processing, subrogation recovery, and related claims management services. State and local governments procure these services to manage self-insured or partially self-insured workers' compensation programs, outsourcing claims administration to licensed third-party administrators rather than handling adjudication in-house. Issuing bodies include counties, municipalities, special-purpose districts (public hospital districts), and city governments. Recent opportunities show third-party claims administration dominating the code, with scope ranging from approximately 1,000 to 14,000 covered employees per contract. Requirements typically include state licensure as a claims adjuster or TPA, on-site staffing with dedicated claims managers and supervisors, responsibility for transitioning open and closed claims without additional implementation fees, compliance with HIPAA and state privacy regulations, and performance guarantees with financial penalties for service failures such as improperly denied claims or data breaches.

Recent activity spans Arizona, Texas, and Florida. The City of Phoenix issued RFP PS270005 in September 2026 for a five-year worker's compensation TPA contract covering approximately 14,000 employees, with offers due July 31, 2026, requiring DBE-N small-business participation and a Most Favored Nations pricing clause. Central Health (Travis County Healthcare District) posted RFP 2606001 in June 2026 for hospital indemnity insurance with proposals due July 13, 2026, emphasizing MBE/WBE good-faith effort and coverage for approximately 2,300 employees effective January 1, 2027. Monroe County, Florida released RFP 629 in May 2026 for three-year workers' compensation third-party claims administration covering approximately 1,320 employees with an incumbent contractor (Relation Insurance Services) and proposals due July 16, 2026, incorporating local business preference scoring and requiring assumption of 82 open claims with $3.8 million in reserves. All three RFPs emphasize on-site service delivery, electronic data integration, and compliance with federal and state regulatory requirements.