Workers Compensation Claims Third Party Administrator

The City is seeking informal proposals from qualified firms for services of a third-party claims administrator (TPA) to provide professional workers' compensation claim processing services to the City for one year, with an option to renew for four additional one-year terms.

The services to be provided by a successful Proposer include, but are not limited to, the following:

1. Thoroughly investigate all claims made against City through appropriate claim procedures as necessitated by the severity of the injury and ensures correct payment of medical and time loss claims.
2. Recommend surveillance or activity checks as deemed appropriate and arrange same upon prior approval of City.
3. Provide cost containment services, including medical fee reductions and provide quarterly report of cost containment services.
4. Assist the City in preparing the defense of litigated or administratively contested claims.
5. Attend trials and/or settlement conferences as appropriate.
6. Develop and maintain an investigative file on each claim in accordance with an approved format by City. Files are to be readily available for City review and shall be well documented and up-to- date.
7. Notify excess insurance carriers of claims and or occurrences at predetermined levels required by excess insurers. Provide information and status of claims as requested by the excess insurance carrier.
8. Develop and maintain a claims database to be used in the administration of the claims and to generate reports to City.
9. Within 15 days following the end of each quarter, provide City with a report to account for individual claims and aggregate loss experience analysis. This report shall show the status of each open claim and experience year-to-date of all claims.
10. Have the capability of providing data necessary to prepare financial and statistical reports on losses or claims.
11. Within 24 hours, respond to inquiries from employees regarding the status of their claim.
12. Provide assistance as necessary to City staff for proper procedural handling of claims.
13. Provide claim materials as deemed appropriate by City staff.
14. Identify and investigate all subrogation possibilities for potential recovery including investigation evaluation and negotiation of subrogation cases.
15. Attend periodic meetings (generally 3-4 months apart) with City staff to review and strategize pending and/or threatened claims.
16. Prepare administrative reports required by the State of Oregon. Monitor the compliance of City's employer reporting requirements and record keeping requirements and advise City staff on any deficiencies in City's overall self-insured compliance matters.
17. Prepare and/or assist City staff with all appropriate responses to audits and inquiries of all regulatory agencies (e.g., OSHA 300 Log preparation).
18. Provide competent and qualified loss control services on request.