Third Party Administration of Workers' Compensation Benefits

The City of Hayward, California, is seeking a licensed third party administrator (TPA) to run claims administration for its self-insured workers' compensation program. The City employs roughly 844 people, is self-insured for $500,000 per occurrence, and carries a program budget of about $6.6 million. The term is expected to be three years with two one-year renewal options based on satisfactory performance. The selected administrator would handle the full claims lifecycle in accordance with California law: opening a file and contacting the injured employee within one business day, determining compensability, investigating questionable claims, and recommending acceptance, denial or settlement while final authority stays with the City. It would also manage utilization review, medical bill review through a preferred provider network, nurse case management, litigation management and subrogation recovery, Medicare reporting under Section 111, and reporting to the City's excess insurance carrier. The TPA would operate an imprest account for benefit payments, produce loss runs, quarterly open-claim status reports, Cal-OSHA logs, state and actuarial reports, and provide City staff with access to its claims system, including ad hoc reporting. The City also expects the TPA to analyze loss data, identify cost trends, and to transition existing claim data into its system within thirty days of award.