Worker's Compensation and NYSGML 207c Claims Administration

The County of Rockland is soliciting proposals for a third-party administrator (TPA) to provide workers' compensation and NYSGML 207c claims administration services for the county, Rockland Community College, and Rockland County Sewer District No. 1. The procurement seeks a qualified firm with at least 10 years of experience in municipal workers' compensation plan administration to manage a self-funded program. Key deliverables include providing a dedicated claims team, implementing a Special Investigative Unit (SIU), developing a modified duty/return to work program, and maintaining medical cost containment networks. The RFP (RFP-RC-2025-022) requires comprehensive claims processing services, including claims investigation, medical cost containment, and detailed reporting. Evaluation criteria will assess understanding of county needs, technical capability, managerial experience, past performance, and annual cost. A virtual pre-proposal meeting is scheduled for August 14, 2025, at 10:00 AM via Microsoft Teams, with proposals due by September 4, 2025.

The procurement does not explicitly specify set-aside designations for disadvantaged enterprises, though the RFP includes provisions for affirmative steps toward small, minority, and women-owned business participation. The current incumbent is PMA Management Corp., which has been providing claims administration services under a contract running from December 1, 2020, through November 30, 2025, with annual fees ranging from $120,000 to $129,890. Historical claim data shows the county's gross payrolls increasing from $174,506,491 in 2020 to a projected $199,746,030 in 2024, indicating the substantial scale of the claims administration work. The county currently processes approximately 243 Physician Acquired Reports and 2,160 bills annually, with 162 open workers' compensation indemnity claims through 2024. The contract will require the selected TPA to integrate with existing county systems, provide web imaging, case management, and risk control consulting services, with a primary focus on reducing workers' compensation fraud over the next three years.