3-TPA Commuter Rail SOW.pdf
PDF 46 KB Posted
- Attached to
- BPO for Third Party Admin Claims Service
- Solicitation number
- Req #2097588
- Issued by
- Dallas County, Texas
About this file
This is a Scope of Work document for a Third-Party Administrator (TPA) claims management services contract issued by the Dallas Area Rapid Transit Authority (DART) in conjunction with the Fort Worth Transit Authority (Trinity Metro), Trinity Railway Express (TRE), and other commuter rail entities including Herzog Transit Services, Union Pacific Railroad, and Burlington Northern Santa Fe Railroad. The TPA will manage all aspects of the claims process for bodily injury and property damage claims arising from Commuter Rail Passenger Service within the self-insured retention limits. Key responsibilities include establishing procedures for claim acceptance and documentation, designating staff for field investigations and evidence collection, initiating recorded statements from claimants, coordinating investigations with service providers and witnesses through DART Risk Management, submitting initial investigation reports within one week of obtaining statements and photographs, and providing status reports at intervals determined by claim severity (minimum quarterly). The contractor must also develop settlement procedures with DART, coordinate with legal counsel on litigated claims, identify recovery opportunities including subrogation and deductibles, and implement safeguards for claim payment disbursement with monthly reconciliation due by the fifth day of each following month.
The contract requires submission of invoices upon completion of each adjusting task accompanied by acceptable reports or supporting documentation. DART maintains oversight of the entire claims management process and retains final authority on all claim resolution decisions, settlement amounts, and litigation management. The TPA must designate specific staff who will meet with DART prior to accepting the first claim assignment and must obtain authorization from DART Risk Management before conducting any field investigations. All reports, photographs, and recorded statements should be transmitted electronically whenever possible. The contractor is responsible for protecting DART's interests in any claim recoveries and must immediately forward any recovered amounts to DART Risk Management. Payment terms are Net 30, with invoices submitted in triplicate to APInvoices@dart.org, and the contract is subject to DART's standard Purchase Order Terms and Conditions.
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Other files
| File | Type | Posted |
|---|---|---|
| 2-Event Schedule.pdf | ||
| 1-Purchase Order Terms and Conditions.pdf |
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Text version
The Authority provides a combination of self-insurance and an excess liability insurance policy to cover bodily injury and property damage claims allegedly arising out of Commuter Rail Passenger Service on the TRE and other Commuter Rail corridors.
The policy covers Dallas Area Rapid Transit, The Fort Worth Transit Authority also known as Trinity Metro, Trinity Railway Express (TRE) and other entities involved in providing Commuter Rail Service. Those entities, including but not limited to Herzog Transit Services, Union Pacific Railroad and Burlington Northern Santa Fe Railroad, that require additional insured status by written agreement are also covered by this policy.
The purpose of this solicitation is to identify a Third-Party Administrator (TPA) to handle all aspects of the claims process, for any claim within the self-insured retention, on behalf of all insured parties arising from Commuter Rail Services. The foremost objective is to manage each claim in a timely, equitable and cost-effective manner. The TPA must have the technical expertise to address this objective. Invoices may be submitted upon completion of each adjusting task provided that an acceptable report or other documentation is also received. In general, the contractor shall engage in the following tasks in the performance of this agreement:
SCOPE
1. DART Risk Management oversees the claims management process for all Commuter Rail claims and will make the initial claim assignment to the Contractor. The Contractor shall have an established procedure for the acceptance and documentation of claim assignments. Depending on the nature of the claim, assignments may be made via telephone, fax or email.
2. For both security purposes and to facilitate the adjusting process, the Contractor shall designate specific staff to conduct field investigations, obtain photo documentation, prepare scene diagrams and obtain claimant and witness statements. Designated staff will be required to meet with DART prior to acceptance of the first claim assignment. No outside or field investigation shall be conducted unless authorized by DART Risk Management.
3. Upon receipt of a claim assignment, the Contractor shall initiate contact and obtain a recorded statement over the telephone from the claimant. If so directed, the Contractor shall obtain an in person recorded statement, a photograph of the claimant and a medical authorization at the time the recorded statement is taken. If the Contractor is unable to obtain either the photograph or medical authorization, documentation evidencing that this information was requested must be included in the Contractor’s report.
4. The Contractor shall coordinate contact with the Commuter Rail Service Provider, on-site investigation, and any witnesses, if necessary, through DART Risk Management.
Following these initial contacts, the Contractor shall submit an initial report to DART Risk Management. All reports, photos and recorded statements should be transmitted to DART electronically whenever possible. Statement and any other interviews, a preliminary assessment of liability and recommendations for any additional work needed to complete the claim investigation. This report, along with the recorded statement, photos and any other material generated as part of the investigation shall be forwarded to DART Risk Management within one week after the statements and photos have been obtained.
6. After receipt and review of the initial report, DART and the Contractor shall establish an ongoing reporting procedure to provide updated status on each claim. The nature and severity of the claim will be the basis for determining how frequently reports will be needed. Based upon industry standards, status reports may be required every 30, 60 or 90 days until the claim is resolved. Unless agreed to by DART, status reports shall be submitted no less than quarterly.
7. Upon completion of all its investigation, the Contractor shall provide DART with a final report and recommendation regarding negligence and any subrogation opportunities that have been identified. Based upon the Contractor’s assessment, DART Risk Management shall either request additional investigation or authorize the Contractor to resolve the claim.
All authority to resolve a claim by settlement must be obtained from DART Risk Management. Upon receipt of authority, the Contractor shall contact the claimant both by telephone and in writing to convey the agreed upon decision. Denial letters shall indicate the denial is based upon the contractor’ s investigation.
8. If settlement authority has been granted, the Contractor shall initiate negotiations with the goal of resolving the claim in the most cost-effective manner. All such negotiations shall be documented and communicated to DART Risk Management. If the Contractor is unable to settle the claim within the authorized settlement amount, Risk Management must be contacted. The Contractor shall provide an updated summary of all negotiation efforts along with a revised recommendation regarding claim settlement.
9. DART and the Contractor shall develop a claims settlement and authority procedure that will allow for the most efficient and cost-effective method for disbursement of claims-related payments. The Contractor shall implement the necessary safeguards to insure adherence to this procedure. Monthly reconciliation of all claim payments shall be due no later than the fifth day of the following month
10. In the event of a lawsuit, the Contractor shall work with DART Legal, DART Risk Management, and assigned legal counsel to ensure that all information required to effectively defend the lawsuit is either provided or obtained in a timely manner. The Contractor shall obtain a litigation management plan for each litigated file to minimize duplication of effort. DART shall retain control of and manage that portion of any lawsuit in which it is a co-defendant. Coordination of all litigation activities shall be done through
DART.
11. The Contractor shall identify and pursue all potential recovery of sums expended in payment of claims including subrogation, contribution, salvage and deductibles. Any recoveries shall be immediately forwarded to DART Risk Management. The contractor shall at all times, protect DART’s interest in any claim recovery.
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