The Vendor is required to provide third-party administration services for self-insured workers’ compensation.
- Claims Administration Services:
• Determine liability for claimed injuries and illnesses on a timely basis and in accordance with the code.
• Determine eligibility for and authorize payment of medical and indemnity benefits on a timely basis.
• Review, compute, and, after approval by the district, pay all informal ratings, findings and awards, settlements and life pensions; arrange for informal disability ratings whenever possible to avoid unnecessary litigation.
• Pay any and all penalties due in accordance with the code. Such penalties shall be paid by the claims administrator and reimburse to district within 14 days of notice should the penalties be from the error of the third party administrator (TPA) and its representatives or subcontractors.
• Establish files containing medical and factual information on each reported claim, together with complete accounting records and maintain same in accordance with statutory time requirements and district policy
• Maintain all payroll and loss information as required by the state, department of self-insurance.
• Prepare and file in a timely manner all reports and forms required by the state regulating self-funded programs.
• Arrange for and supervise all necessary investigations to determine eligibility for compensation benefits and liability of negligent third parties.
• Provide (at no cost to the district) informational pamphlets in appropriate languages to employees as required by the state relative to their workers' compensation benefits.
• Attend on-site or remote quarterly review meetings to discuss claim status, trends, and recommend improvements.
• Attend an on-site annual review meeting of the entire program within the first quarter of the calendar year to review and discuss all ongoing claims.
- Artificial Intelligence (“AI”)
• TPA shall:
o Claims triage
o Fraud detection
o Claims processing
o Denial prediction and prevention
o Cost analysis
o Reporting and dashboard
o Other workers’ compensation processes
- Legal Administration Services
• Refer litigated cases to attorneys approved by the district for the purpose of defending the district's interest before the workers' compensation appeals board and courts of law.
• Monitor, audit, and approve the invoices of all attorneys defending the district on its workers' compensation claims and/or subrogation issues. Evaluate the performance of defense counsel after conclusion of the claim.
• Assist in the preparation of defense of litigation cases, negotiations for settlements, and subrogation actions.
• Prepare and submit requests for district's authorization of settlements, providing an in-depth analysis and rationale for the recommended settlement amount(s).make written recommendations to the district regarding settlement/disposition of workers compensation claims (all settlement authority rests with the district).
• Attend, where indicated, trials, hearings, arbitrations, rehabilitation hearings and any and all legal proceedings.
• Discharge on behalf of the district all legal obligations to its injured employees imposed by the division of workers' compensation and applicable courts.
• Investigate or arrange for investigation of, questionable cases and the status of disabled employees as necessary and appropriate, in order to adjust all cases and to assist in the trial or settlement of litigated cases.
• Handle all non-complex legal cases in-house whenever possible, and refer to outside counsel only those cases where defense counsel services is indicated and approved by the District.
- Provide clear evidence of ability to produce checks and requisite financial supporting documentation of payments. Established procedures to support the payment of all benefits and allocated expenses together with appropriate documentation necessary to reconcile a trust/imprest checking account.
- Contract Period/Term: 3 years
- Questions/Inquires Deadline: February 10, 2026
