A. Workers’ Compensation TPA Program Requirements/Responsibilities 1. The Contractor shall assign an account team to be available 90 days prior to the start of the contract to ensure a smooth transition with the current Contractor. The team is expected to be responsive daily to the City’s administrative needs and data reporting needs. 2. The Contractor’s account team must include: a. One senior account executive with at least 5 years’ public entity experience. b. One dedicated senior workers’compensation adjuster to handle indemnity claims with at least five years of experience in workers’ compensation, with experience in insurance matters for municipalities handling no more than 150 open indemnity claims. c. One qualified, dedicated medical only claims adjuster handling maximum of 300 medical only claims. d. One claims supervisor with at least 10 years supervisory public entity experience. e. All dedicated adjusters to the City of Corpus Christi account shall maintain proper adjuster licensing requirements as required by the Texas Department of Insurance. Also, it is equally important to provide a list of back-up personnel detailing, title, position, license and other designations should this be required. Contractor will replace any member of the account team who has departed for any reason with a permanent replacement named no later than 30 days after separation with equal or greater experience. 3. The Contractor shall provide a list of all servicing personnel on this account with a current resume of the designated adjuster(s) and backup adjuster who will handle City claims. Any additional personnel to be involved in City claims handling at a later date should have a resume submitted for prior consultation with the City. 4. In the event an assigned adjuster be unable to perform the assigned duties satisfactorily as determined by the City, immediate replacement of such adjuster is required. The City’s Risk Manager will be consulted in decisions regarding adjusters who will be handling City claims. 5. The Contractor’s hours of operation will be Monday through Friday 8:00 a.m. to 5:00 p.m. 6. The Contractor will collect and report data as required by federal, State and local authorities, for the purpose of income filings for those claim payments made by the Contractor and in accordance to best claims adjusting practice. 7. The Contractor shall provide a full range of workers’ compensation claims administration services in accordance with all requirements of the Texas Labor Code, Texas Insurance Code, Texas Department of Insurance Administrative Rules, and the Texas Workers’ Compensation Act. 8. All administrative fines, fees and legal expenses levied by the Texas Department of Insurance, or any other regulatory body for any matters under the Contractor’s control for failure to comply with the Texas Workers’ Compensation Act and related rules shall be handled and paid by the Contractor. 9. The Contractor shall follow all rules applicable to HIPPA and any other similar law. 10. The Contractor shall act as the City’s designated Reporting Agency for Section 111: Mandatory Reporting for Medicare and Medicaid Extension Act of 2007.
