RFP26-0265_Exhibit_2_-_10_Years_Historical_Claims_Data.pdf

This document 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 services of Firefighters' Worker Compensation Claims. The procurement seeks a qualified Third-Party Administrator (TPA) to manage all prior and new workers' compensation claims for the City's 584 sworn firefighters, encompassing full claim administration including Pharmacy Benefit Management and Preferred Provider Organization 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, along with current Florida licensure. 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 up to 120 months of cumulative service.

The contract 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. Evaluation criteria allocate 28 points to proposer and 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. No set-aside designations for disadvantaged enterprises are mandated. The current contractor, CorVel Corporation, will be replaced through this procurement process. Historical data from fiscal year 2015/16 through 2024/25 shows cumulative totals of 2,312 claims, with approximately 87 currently open claims (roughly half indemnity claims) and an average of 113-173 total claims annually in recent years. Less than 13.7% of claims have resulted in litigation over the past five years, and only three open claims involve Permanently Totally Disabled employees. The successful proposer must execute the contract within 15 calendar days of Notice of Award and provide required bonds and insurance certificates, including workers' compensation, 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. Awards exceeding $100,000 are subject to City Council approval.