RFP26-0265_Exhibit_3_-_Claim_Review_Form.pdf

This is a Claim Review Form exhibit for Request for Proposal 26-0265 issued by the City of Orlando's Procurement and Contracts Division to procure Third-Party Administration services for Firefighters' Worker Compensation Claims. The form serves as a standardized template for the TPA contractor to document and manage individual firefighter workers' compensation claims throughout their lifecycle. The RFP solicits proposals for comprehensive administrative services covering all prior and new workers' compensation claims for the City's 584 sworn firefighters, with approximately 87 currently open claims and historical data indicating an average of 113-173 total claims annually across four categories: First Aid, Indemnity, Medical Only, and total claims. The scope includes full 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. The non-mandatory pre-proposal conference is scheduled for April 3, 2026, at 11:00 a.m. via Microsoft Teams, written questions are due by April 10, 2026, at 5:00 p.m., and proposals are 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 service total.

Compensation shall be structured as a fixed-fee arrangement covering all service requirements, labor, and expenses including travel, lodging, meals, and communications, 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 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. No set-aside designations for disadvantaged enterprises are mandated; however, Veteran Business Enterprise Participation is evaluated at 2 points. The current contractor, CorVel Corporation, will be replaced through this procurement process. The successful proposer must execute the contract within 15 calendar days of the Notice of Award and provide required bonds and insurance certificates, including workers' compensation, commercial general liability with limits of $1,000,000 per occurrence, automobile liability, contractors pollution liability, and cyber liability insurance with limits of $10,000,000 per occurrence if applicable. Historical claims data shows 2,312 cumulative claims over the past ten fiscal years with less than 13.7% resulting in litigation over the past five years and only three open claims involving Permanently Totally Disabled employees.