RFP26-0265_Exhibit_2_-_10_Years_Historical_Claims_Data.pdf

This is a historical claims data exhibit supporting Request for Proposal 26-0265 issued by the City of Orlando's Procurement and Contracts Division for Third-Party Administration (TPA) services of Firefighters' Worker Compensation Claims. The RFP seeks comprehensive administrative services covering all prior and new workers' compensation claims for the City's 584 sworn firefighters, including claim administration, Pharmacy Benefit Management (PBM), and Preferred Provider Organization (PPO) medical services. Proposers must demonstrate a minimum of five years of active TPA experience with governmental entities and at least three years of experience handling First Responder claims for a governmental entity, along with current Florida licensure for Third-Party Claim Administration. The non-mandatory pre-proposal conference is scheduled for April 3, 2026, at 11:00 a.m. via Microsoft Teams, with written questions due by April 10, 2026, at 5:00 p.m., and proposals due electronically by April 24, 2026, at 2:00 p.m. Local Time. The City intends to award a three-year initial contract term with options to extend for seven additional twelve-month periods, providing a cumulative total of up to 120 months of service.

The ten-year historical claims data spans fiscal years 2015/16 through 2024/25 and shows cumulative totals of 2,312 claims, with recent annual claims ranging from 113 to 173 total claims across four categories: First Aid, Indemnity, Medical Only, and total claims. Approximately 87 claims are currently open, with roughly half classified as indemnity claims and only three open claims involving Permanently Totally Disabled employees. Less than 13.7% of claims have resulted in litigation over the past five years, establishing a relatively stable and manageable claims profile. Compensation shall be structured as a fixed-fee arrangement covering all service requirements, labor, and expenses, with allocated loss adjustment expenses such as provider bill review, nurse case management, outside attorney fees, and surveillance billed separately and subject to City pre-approval. The current contractor, CorVel Corporation, will be replaced through this procurement process. Evaluation criteria allocate 28 points to Proposer's Experience, Staff Experience, and Financial Stability; 30 points to Claims Services and Information Services; 40 points to Price Proposal; and 2 points to Veteran Business Enterprise Participation, for a total of 100 points. The successful proposer must execute the contract within 15 calendar days of the Notice of Award and provide required bonds and insurance certificates, including commercial general liability with limits of $1,000,000 per occurrence and cyber liability insurance with limits of $10,000,000 per occurrence if applicable.