Laserfiche WebLink
BACKGROUND <br />Administration of workers' compensation claims is a complex process due in part to the <br />numerous and constantly changing legal mandates and medical pieces in handling <br />these types of claims. Workers' compensation claims personnel are expected to <br />interface with medical and legal professionals representing a city and /or injured <br />employees. Delays or mistakes in processing claims may result in severe penalties, <br />financial liability and poor employer - employee relations. Therefore, it is common for <br />municipalities to hire third -party administrators with the expertise and experience in <br />handling the unique challenges and compliance requirements of the specialized field of <br />workers' compensation administration. <br />The City initially retained Innovative Claims Services, Inc. (ICS) in 2001 to provide third - <br />party administration for the City's workers' compensation program. The current contract <br />with ICS expired on June 30, 2015. Consistent with the City's purchasing policies, the <br />Human Resources Department conducted a request for proposal process (RFP) for <br />third -party administration services for the workers' compensation program. <br />DISCUSSION <br />The City of Pleasanton's Purchasing Procedures Manual requires that three written <br />proposals be obtained for contracts for consultant services in excess of $20,000. A <br />request for proposal process was initiated on May 27, 2015 to seek the services for a <br />third -party administrator for the City's workers' compensation program. The City <br />received three timely proposals which were reviewed by members of the Human <br />Resources Department. One vendor quoted significantly higher fees for the same <br />relative service and was not considered further. Two vendors, ICS and Tristar, were <br />chosen to continue to the reference check phase and finalist interviews. Both vendors <br />performed well in the process. <br />Both firms provided quotes for a three year contract and included fees for an optional <br />fourth and fifth year. In comparing the flat annual fees, ICS quoted fees that were <br />slightly higher, by approximately 4.5% for the three -year term ($524,387 versus <br />$501,680) and 5% higher for the five -year term ($900,722 versus $857,385). However, <br />in analyzing the quotes for ancillary services such as bill review, (a service in which the <br />City pays to have bills scrutinized for accuracy and appropriateness of charges), ICS <br />was less costly than Tristar. This offset makes ICS slightly less expensive overall, <br />although the difference between the two vendors is negligible. <br />The City has worked closely with ICS over the years to monitor claims frequency, <br />causes and types of injuries, types of claims (indemnity versus medical only), bill review <br />savings, litigation rates and utilization and peer review findings and savings. In addition, <br />providing exceptional customer service to both injured workers and City staff who <br />perform a function in the workers' compensation program has been emphasized. ICS <br />has performed well over the years to meet the needs and maintain the high standards <br />set by the City. Third -party administrators must engage in timely communication with <br />injured workers and Human Resources staff. They are required to maintain <br />comprehensive and meticulous records regarding the status of injured employees, <br />Page 2 of 3 <br />