COUNTY OF NORTHAMPTON, PENNSYLVANIA REQUEST FOR PROPOSALS WORKERS COMPENSATION AND EMPLOYERS LIABILITY CLAIMS ADMINISTRATION SERVICES RFP #

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1 1. GENERAL CONDITIONS The County of Northampton is soliciting proposals for Workers Compensation and Employers Liability Claims Administration Services in accordance with this Request for Proposals (RFP). Proposals are requested for workers compensation and employer s liability claims administration services for the County of Northampton and its related authorities, boards and commissions, as specified in the following pages to become effective: November 1, 2015 This is a request for proposals and not an order for services. Information and specifications can be downloaded at The County will no longer distribute bid specifications from the Courthouse office. At the initial stage, you will be asked to register (which is free), for both the general website and then with Northampton County as the Agency, and will have access to the documents. A. Proposer Qualifications Refer to the Scope of Services Section 2. C. of this RFP for an outline of the necessary qualifications. B. Delivery of Proposals Sealed envelopes clearly marked Workers Compensation and Employers Liability Claims Administration Services containing the proposal must be submitted no later than 2:00 p.m. on July 16, The proposal opening will consist only of the name and address of recording respondents. As this is an RFP requiring evaluation, no pricing information will be read aloud at the time of the opening. Mail or deliver your original response (with original signatures) along with five (5) complete copies and one (1) CD containing a.pdf file with the complete submittal to: Mrs. Kathryn Anderson, C.P.M. Purchasing Manager County of Northampton 669 Washington Street, Room 2101 Easton, PA

2 All pre-award communications with the County shall be directed through the Public Purchase Platform. The Public Purchase website is the sole entity authorized to provide this RFP package to interested companies or individuals for the County of Northampton. If you are working from an RFP package obtained from any other source, you may have an incomplete set of documents. The County assumes no responsibility for any error, omission, or misinterpretation resulting from the use of an incomplete RFP package. If you have received the RFP package from a source other than the Public Purchase website, you are advised to register on to obtain an official bid document. This will ensure that you receive all RFP related communications and documents, including addenda. Responses will be communicated to all utilizing the same Public Purchase Platform. No communications received with fewer than six (6) working days until the date the responses are due will be answered. No verbal responses by any County personnel will have any bearing on the bid responses nor be incorporated into any subsequent award. Following the award of the contract, official communications with the County shall be directed to the following address: or by fax (610) Any addendum will be issued to all firms via Public Purchase Platform should one be required. The minimum scope of services desired is defined in this Request for Proposal (RFP). The County shall have the right to modify this scope, as it deems necessary. The terms of the Agreement between the County and Consultant shall be subject to review and modification by the County s Solicitor. The County reserves the right to reject any or all proposals, or parts thereof or items therein, and to waive technicalities required as deemed in the best interest of the County. Omission of any information may be sufficient cause for rejection of the proposal. It is understood that by requesting this proposal, the County shall not create any contractual rights or obligations by and between the County and any person or entity responding hereto. This proposal is subject to the Terms and Conditions attached. 2

3 C. Specifications The attached specifications are to be considered an outline of the desired claims administration services. At the option of the Proposer, proposals for broader or more limited services may be submitted. However, deviations from the specifications for more limited service must be specified on the enclosed "Proposal Form" or by explanatory letter, which is also subject to the same time requirement as the proposal. Otherwise, the submitting Proposer will be considered bound, upon notification of acceptance by the County, by the terms of the specifications. All representations made in the proposal form, as submitted and as modified through the date of award, shall be considered part of any subsequent contract for services. Proposers are advised that under no circumstances will any information submitted to or provided by the County in connection with this RFP be considered or held to be proprietary, confidential, or in any other way not subject to public disclosure. D. Loss Data and Other Information Detailed loss information valued 1/1/12-12/31/14 is included as part of this Request-for- Proposal. E. Proposals Enclosed is a "Proposal Form". All applicable sections of this form must be completed and returned with any proposal. Upon acceptance by the County, Proposers will be bound to the terms of their proposal for the five year term. The County is requesting a flat annual fee for all claims administration services as outlined in this RFP. Further, bill re-pricing fees must be clearly outlined. Revenue share agreements with any and all vendors must be clearly disclosed; including ownership interests. Any fees or costs in addition to the above must be disclosed or shown in the "Proposal Form" or in an attachment thereto. All proposals must remain valid for a period of sixty (60) days from the due date for proposals. 3

4 F. Signature All proposals must be signed by a duly authorized representative of the Proposer. G. Service Fee Payment The County desires flexible payment options as may be available with no finance charges applicable. H. Right to Accept, Reject or Waive The County may waive any informalities, irregularities, omissions and/or errors occurring at any time during the proposal process and reserves the right to award notwithstanding any non-conformities in the proposal. Under no circumstances shall the County be liable for any costs or expenses of any kind which are incurred by any Proposer in connection with any response to this RFP. I. Award of Service Contract The County intends to award the contract for services on approximately September 1, 2015 with a start date of November 1, The County is soliciting proposals from qualified third party administrators (TPA) interested in providing workers compensation and employers liability claims administration services for a five (5 )year period, J. Proposer's insurance Upon award of a contract for services, the Proposer will be required to provide annual evidence of the following insurance: Statutory workers compensation and employers liability insurance with limits of $500,000 each accident for bodily injury, $500,000 each employee for bodily injury by disease and $500,000 each policy year for bodily injury by disease. Commercial general liability insurance with limits of at least $1,000,000 for bodily injury and property damage each occurrence, $1,000,000 personal and advertising injury, $2,000,000 products and completed operations aggregate and $2,000,000 general aggregate. 4

5 Business automobile liability insurance with limits of at least $1,000,000 each accident for bodily injury and property damage liability. Coverage is to include all owned, non-owned, and hired autos. Umbrella excess liability insurance with minimum limits of $3,000,000 per occurrence and annual aggregate, as applicable. Professional liability / errors and omissions liability insurance with limits of at least $1,000,000 each claim and $2,000,000 aggregate. Employee theft insurance with a limit of at least $500,000 including "client coverage". The County may waive or amend the above insurance requirements, in its discretion, if appropriate. K. Proposal Format Proposals are to be accompanied by a completed Proposal Form showing all fees for proposed services. Fees are to be proposed for: Claims presented on or after November 1, 2015, limiting services to the contract term; Claims presented on or after November 1, 2015, with services provided until conclusion; Services for claims presented prior to November 1, 2015; and Services other than claims adjustment (trust administration, R.M.I.S., etc.). This other fee is to include all available services offered by the Proposer that are listed in 2.C and 2.D of the RFP that are beyond the scope of your typical claims adjustment charge. The other fee is not to include allocated loss adjustment expenses (ALAE). Each proposal shall include a brief transmittal letter on the Proposer s letterhead, signed by a representative of the firm who is authorized to bind the firm to the proposed services and prices contained in the proposal. Proposals shall present information in numbered and lettered responses that track with the items in Section 2 of the RFP. Attached is a sample contract and terms and conditions applicable to this proposal. 5

6 Proposals should present, in a concise manner, how the Proposer intends to provide the services requested, with accompanying exhibits that may more fully describe specific features of the proposal. L. Evaluation Criteria An Evaluation Committee will use the following criteria in its review of proposals. Responsiveness to the RFP, and clarity of the proposal; Overall qualifications, experience of the firm with similar governmental entities and references; Qualifications of the personnel to be assigned responsibility under the contract; Ability to perform the overall Scope of Work specified in 2. Program Description and Scope of Services of the RFP; and Cost of services. 2. PROGRAM DESCRIPTION AND SCOPE OF A. Program Description The County of Northampton is located in the Lehigh Valley and is 60 miles north of Philadelphia and 80 miles west of New York City. The attached organizational chart illustrates the various departments of the County government. The County owns and operates the Gracedale Nursing Home in Nazareth, PA and a prison in Easton, PA. Additional information on the County's operations is available from the County's web site at There are approximately 1,600 employees. The County established a self-insured retention program for workers compensation and employer s liability in The Northampton County Workers Compensation Trust was established at that time to accumulate funds for the County's workers compensation liabilities. PMA Management Corporation is the current TPA. The County retains a $750,000 per occurrence self-insured retention for the Nursing Home and Police Officers (Sheriff Department and Corrections Officers). All other is $650, Safety National Casualty Corporation provides excess workers compensation insurance coverage on a statutory basis. Excess employer s liability coverage is afforded with $1,000,000 per occurrence and aggregate limits. The Safety National Casualty Corporation policy expires on January 1,

7 B. Office Location The Proposer must maintain a claims office in or reasonably close to the County, and shall absorb all costs associated with such an office, or any other overhead expenses incurred while performing services for the County. C. Proposer's Qualifications 1. Provide a brief history of your company. 2. List the experience and qualifications of key personnel who will be assigned work under this contract, including résumés of the account management team and their job responsibilities. Disclose the reserve authority level of each individual. 3. Provide the three (3) most recent audited financial statements, which must include a balance sheet, income statement and a statement of cash flow or equivalent information that indicates the financial position of your company. 4. Provide a list of several current clients, with the point of contact, their address and phone number. These should be clients of similar size, claim frequency, and exposures as Northampton County, if possible. Also, provide information on your firm s experience in working with Pennsylvania governmental entities. 5. Describe your firm s: Process for assigning claims to adjusters and supervisors; Claimant notification and contact standards; Reserving practices and philosophy; Use of recorded statements; Use of private investigators; Use of vocational services contractors; Impairment Rating Evaluation (IRE) procedures; Internal peer review policies; 7

8 Efforts to enforce the 90 Day Panel Requirement; Medical bill review procedures; Managed care arrangements for discounted medical treatment, prescription drugs and durable medical goods; Case management philosophy; including field-based and telephonic services; Assignment of nurse case managers; Procedures to conduct independent medical exams; Procedures regarding modified or light duty/return to work programs; Subrogation procedures; and Fraud investigation and reporting philosophy. Identify any third party vendors used for these or any other activities. 6. Describe your experience in administering workers compensation trusts and your procedures for processing claim payments and issuing checks. 7. Describe the funds reconciliation process that will be employed. 8. Describe your firm s employee training programs. The Proposer must demonstrate that they will provide experienced and competent claims adjusters to perform the services outlined in the RFP with the highest professional standards, and in accordance with all applicable laws and regulations. 9. Disclose the maximum pending caseload for each adjuster proposed to work on this account, including information on what will occur if the maximum caseload per adjuster is reached or exceeded. 10. Provide a detailed implementation plan that outlines how you will phase in the delivery of services. The plan should outline responsibilities and due dates. At a minimum, your plan must address and describe the following: Transitional meetings with the County; 8

9 System and data conversion, including testing of interfaces and migrating existing loss history data into the Contractor s system; Adjuster and staff training; Trust administration, creation of check writing authority and the management of the financial operation of claims administration; Communication, e.g. notification to claimants, providers, etc. of the transition; and Assumption of the management of existing open claims, if the County decides the Proposer to provide such services. 11. Identify any performance guarantees that you would put in place if awarded the contract. 12. Provide information on the firm s and individuals licensing and certifications required by Pennsylvania regulations governing claims adjusting. 14. Demonstrate the capability and willingness to competitively bid and place excess workers compensation and employers liability insurance for the January 1, 2016 effective date. Remuneration for the placement of insurance shall be included within the fee. No commission income is to be earned by the Proposer from the excess insurer. 15. Agree that claim files remain the property of the County and shall be surrendered at the expiration of the contract in a form acceptable to the County for conversion into a new data system. Disclose the amount of any additional fee, if any, that would apply. 16. Agree to allow the County input on and selection of third party vendors. 17. Describe claim reporting, including any on-line reporting and access options, telephone communication options, and other features that would simplify the process. Also, provide detailed examples and samples of R.M.I.S. features and loss report formats, including sample screen shots, information on data field options, and the types of reports and data search options that are available on the system. The R.M.I.S. shall allow for on-line access to summary loss information, as well as individual claim files including adjustor activity notes. Proposer shall provide for the training of up to five (5) County personnel on the R.M.I.S. If special equipment or software is needed to access the claims 9

10 information, the Contractor shall supply the County with all necessary equipment or software. 18. Confirm ability and willingness to act as the County's agent in ensuring compliance with Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) including the completion of and reporting of all necessary claims, files and reports. 19. Demonstrate Statement on Auditing Standards (SAS) 70 certification. D. Workers Compensation and Employers Liability Claims Adjustment Services The following are minimum services to be performed: 1. Act as administrator of the Northampton County Workers Compensation Trust, pay claims and expenses on the County's behalf and provide monthly financial reports. 2. Timely investigation, adjustment, and settlement (where authorized or within any established discretionary limit), of all workers compensation and employers liability claims subject to the contract. 3. Receive reports and record all workers compensation and employers liability claims. 4. Identify, adjust and report all fraudulent claims. 5. Institute and carry out subrogation proceedings against responsible third parties. 6. Perform all necessary administrative tasks associated with the adjustment, investigation, and settlement of claims. 7. When necessary, attend hearings and trials and cooperate with and provide claim investigation information to appointed legal counsel. 8. Establish records of all claims, including those resulting in no payment ( Record only ), medical only and compensable, including allocated loss adjustment expenses ( ALAE ). 10

11 9. Complete any regulatory reporting forms, or other documents required by governing authorities. 10. Establish claimant contact in a timely fashion, and make necessary medical and lost time payments to claimants and medical providers. 11. Employ third party vendors and special investigators when necessary. 12. Attempt to achieve the return to work of injured employees, and render advice to the County regarding the return to work and light duty options that could be utilized. 13. Establish appropriate reserves and maintain records of all payments for medical, indemnity, and expenses for each workers compensation claim. 14. Meet with County personnel at least once per quarter to review the status of the claims administration process and other matters pertinent to the services being performed. 15. Conduct an annual stewardship meeting reviewing the services performed the previous year, the status of open claims, loss payment history and trends, and incurred loss experience and trends, with recommendations for the upcoming year. 16. Report claims to the excess insurer in accordance with the requirements of the policy. 17. Provide claim status reports as requested by the County. E. County Universal Contract 1. Attached to this RFP is a sample County Contract for review. The successful bidder will be required to enter into an agreement with the County using this contract. F. No Bid/No Reply 1. To assist in obtaining good competition on Request-for-Proposals, each firm who has received an RFP but does not wish to participate is asked to complete and return the No Bid/No Reply Form. This information will not preclude receipt of future invitations. 11

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