Workers' Compensation Third Party Administrator

The City of Modesto is seeking a qualified third-party administrator (TPA) to run claims administration for its self-insured workers' compensation program, on behalf of the Human Resources Department's Risk Division. The program covers roughly 1,700 full-time and part-time employees, about 350 of them police and fire personnel who receive Labor Code 4850 salary continuation benefits. The City carries a $750,000 per-incident self-insured retention and belongs to the PRISM joint powers authority for excess coverage. The current administrator is Athens Administrators, and the selected firm will take over all existing claims, 259 of them open at the time of the solicitation (20 future medical, 231 indemnity and 27 medical only). The TPA must act as the City's representative under California workers' compensation law and coordinate every part of the program with Risk Management. Work includes injury reporting and employee contact, lost-time and salary information, claim investigation, benefit payment, medical management, litigation management, claims audits, quality assurance, reporting and record retention, and training for managers, supervisors and employees on workers' compensation procedures. The City also expects support for return-to-work and transitional duty programs, ADA and FEHA accommodation efforts, CalPERS disability retirement inquiries, essential functions job analyses, and timely delivery of permanent and stationary and work status reports. The TPA bears the cost of penalties caused by its own errors or delays, and must work with the City's ancillary vendors, including nurse case management providers and the CarivaCare injury reporting system, without charging implementation, data interface or scanning fees.