Electronic Adjudication Management System Modernization System (EAMS) - Claims

The California Department of Industrial Relations (DIR), Division of Workers' Compensation (DWC), is issuing a Request for Proposal to procure a Commercial Off-The-Shelf (COTS) Workers' Compensation Claims Management System as part of the Electronic Adjudication Management System (EAMS) Modernization initiative. The procurement seeks qualified vendors to provide a unified claims management platform that will support both Uninsured Employer Benefits Trust Fund (UEBTF) and Subsequent Injury Benefits Trust Fund (SIBTF) claims processing, replacing the aging system deployed in 2008. The solution must address current infrastructure vulnerabilities, enhance security, improve system performance, and provide mobile accessibility while managing approximately 30,000 active cases and processing approximately 200,000 payments annually. Key deliverables include Project Setup and Solution Planning, Design, Build and Test, Mock Production, Organizational Change Management, Go-Live services, and Maintenance and Operations support structured as fixed-price, deliverable-based compensation with successful completion and acceptance requirements. The system must accommodate 139 functional requirements and 93 non-functional requirements, supporting 1,500 concurrent internal users and 5,000+ external users with one-second response times, 99.9 percent uptime, and comprehensive security compliance including FIPS 140-3 encryption, multi-factor authentication, role-based access controls, and compliance with NIST SP 800-53 (moderate), HIPAA, FISMA, and California DGS Cloud Computing Policy. Critical dates include a question submission deadline of January 16, 2026, proposal submission deadline of March 6, 2026, demonstrations and interviews scheduled for April 17-24, 2026, and notification of intent to award on May 1, 2026, with a protest period ending May 8, 2026; the base contract term is two years with an option for one additional one-year extension, with an anticipated go-live date of 12 months from contract execution and system acceptance occurring 180 days post-go-live.

Small Business and Disabled Veteran Business Enterprise (DVBE) socioeconomic preferences are available at 5 percent and up to 5 percent respectively, though no incumbent vendor is specified. The solution must integrate with the DIR's Google Cloud Platform (GCP) Enterprise Data Lake for near-real-time data transmission and must incorporate interfaces with existing systems including FileNet for document retrieval, Curam for case management and workflow tracking, IBM Cognos Analytics for reporting, and future integrations with BigQuery, Looker, eSignature capabilities, a Document Management System (BOX), and the DIR's court application system. Additional requirements mandate Section 508 ADA compliance, 50-year data retention capability, secure API-based file transfer using DIR-approved tools, comprehensive audit logging with 18-month retention, and malicious code detection. Vendors must maintain commercial general liability insurance ($2 million), cyber liability ($5 million), technology professional liability ($5 million), and worker's compensation coverage with employer's liability limits of $1 million. The State will apply a 10 percent withholding on invoiced amounts, released only upon final system acceptance, though specific contract award values or budget ranges are not disclosed in the available RFP documentation.