Lake County Addendum Forum

Third Party Administration (TPA) for Workers Compensation and Liability Claims

January 29, 2019

Submission DATE EXTENTED: February 7, 2019 by no later than 2:00 p.m. local time.Proposals received after the time specified will not be opened.

January 24, 2019

Q) I'm requesting the average over the past 3 years for the amounts of medical payments (which applies to both medical only and indemnity claims) and total paid (again, inclusive of both medical only and indemnity payments but includes payment amounts for medical, lost time, and additional expenses charged to the claim).  We can average amounts out with the totals of each for the past 3 years.  For example, medical paid for all workers comp claims in 2018 amounted to $2.5M & Total Paid for all workers comp claims was $5M.  In 2017, medical paid was $3M and total paid was $5.75M. In 2016, it was $3M & 7M respectively.  Ideally, if the County can provide those amounts for 2016-2018 it will go a long way for us to appropriately price our fees. 


Year            Number of Medical Payment          Amount Paid (after med review)

2018               1303                                            $537,075.32

2017               1691                                            $877,023.42

2016               1609                                            $840,994.22  

January 16, 2019

Q) Can you confirm # of takeover claims and type of claim?
A) a. WC – 114 (31 medical, 83 indemnity)
     b. Civil - 113

Q) Can you please confirm that FMLA Administration is not part of this RFP? A) Correct, FMLA Administration is not part of this RFP

Q) Can you let us know many nurse casement assignments are referred annually and who is the current vendor used? A) Our current TPA provides case management services.  We do not current track the number of assignments so we are unable to answer this question.

Q) Can you please provide loss runs for the past 3 years?If loss runs are unavailable, can you please provide brief description of liability type of claims.

A) We are unable to provide loss runs. Please see below.

Coverage Number of Claims:
Auto Liability - Property Dama:     1
Medical Malpractice:                     1
General Liability - Property D:      8
Auto PD - Comprehensive:         12
Errors & Omissions:                    18
Auto PD - Collision:                     20
Property:                                     24
Law Enforcement Liability:          29

January 14, 2019

Please note the due date time noted as 3pm on the online posting is incorrect as the due date time is 2pm. All proposals must be received by no later than 2pm on 1/31/2019.

January 9, 2019

Q) Can we propose life of contract pricing only, or will that disqualify us? A) no

Q) Can you provide actual loss data for the last 5 years? A) we are unable to provide actual loss data as we have open matters in litigation.

Q) RFP is titled for Workers’ Compensation and Liability claims however the loss history on page 12 lists property loss frequency – are first party property losses to be included in this RFP? If so, who is the carrier and is it subject to a Self-Insured Retention or Deductible? 

• Property losses are paid through the TPA but adjusted in-house. 
• Subrogation losses (sign damage, signal damage, road damage, etc) is handled by the TPA

Q) Auto physical damage claim services a part the requested Auto claim services? A) yes

Q) In terms of litigated liability claims, what is the county’s expectation of our role?  Will the TPA will still provide full claim handling services and oversight of the litigated file or are litigated claims entirely handed off to counsel? A) The TPA maintains reserves but in general, litigated claims are handled entirely by the States Attorney Office.

Q) Regarding a Performance Guarantee (PG) – does the county have a PG with the current TPA – if so please provide or indicate what preferred metrics the County would like to see incorporated. A) We do not have a current performance guarantee with our current TPA.

Q) Would it be acceptable to the County that we propose providing written status reports (page 14, 3rd last and last bullets) as part of the quarterly claim reviews?  A) While written status reports are part of our claim reviews, in general, we prefer face to face meetings.

Q) The RFP states that responses to County inquiries are required within 1 business day (16th bullet on page 15).  Our standard to provide a 24 hour 3-point contact for new claims, there may be instances when the required response time of within one business day is not feasible, is this acceptable? A) This is acceptable

Q) What service areas is the County looking to improve from the current TPA? A) We are required to procure vendors every 5 years.  This RFP is in response to that requirement.

January 8, 2019

Q)  Please provide the number of takeover claims? A) a. WC – 114 (31 medical, 83 indemnity) b. Civil - 113

Q) Please provide the bill review volume? A) 2018 - 1065

Q)Do we have to provide life of claim pricing as a lump sum, or can we provide pricing on a  per claim basis? A) Please provide per claim pricing with the expectation that it is for the life of the claim by type.

Q)We operate in a paperless environment, what would the volume of paper files the new TPA would take over? A) Zero

Q) Page 11 - Background - please elaborate on the liability program structure.
A) the $2M SIR through Safety National specific to each GL loss

Q) Regarding loss history information - please provide at least 3 full years and current year to date loss runs for all lines of business to service. 
A) We are unable to provide loss runs as they include information on open claims/pending litigation

Q) For WC claims:  Please have loss runs include amounts for medical and total paid. 
A) We are unable to provide loss runs as they include information on open claims/pending litigation

Q) Provide current number of open takeover claims as well as split of the open medical only to indemnity claims.
A) WC – 114 (31 medical, 83 indemnity)

Q) For liability claims:Provide current number of open takeover claims by line of coverage (ex GL BI/GL PD, Auto BI/Auto PD, E&O, etc.)

A)                                             Coverage Number of Claims
Auto Liability - Property Dama:   1
Medical Malpractice:                     1
General Liability - Property D:      8
Auto PD - Comprehensive:         12
Errors & Omissions:                    18
Auto PD - Collision:                     20
Property:                                       24
Law Enforcement Liability:         29

January 7, 2019

Q) Regarding page 9 # 34 - Can you provide copy of or link to the County Information Security policy & privacy standards?  A) This policy applies in the unlikely event that a vendor is asked to use the Lake County Network. This policy can be provided in the event that a vendor is asked to use the Lake County Network.

Q) Current RFP is missing page 10 - please clarify if this is a page number typo or provide missing page.  A) The pages are inadvertently numbered incorrectly; there are no missing pages.

Q) Page 19 - Under scope of services - RFP states: Proposal should be presented in a tabbed format for ease of review in the sections listed: FMLA Admnistration, Reporting, Technology, and Audit Requirements."  However, the 4 sections in the Scope of Work beginning on pages 14-18 are: A. General Requirements and Expectations, B. Information Systems and Technology Requirements, C. Company Information, & D. Communication Requirements.  Please confirm the sections that these are the sections that should be tabbed in the Scope of Services. A) Please disregard the tabbed format on page 19 as this is a typo. Please follow the instructions found in the Scope of Work beginning on pages 14-18 which are: A. General Requirements and Expectations, B. Information Systems and Technology Requirements, C. Company Information, & D. Communication Requirements.