REQUEST FOR PROPOSAL FOR WORKERS' COMPENSATION CLAIMS AUDIT SERVICES FOR VENTURA COUNTY SCHOOLS SELF-FUNDING AUTHORITY

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1 REQUEST PROPOSAL WORKERS' COMPENSATION CLAIMS AUDIT SERVICES VENTURA COUNTY SCHOOLS SELF-FUNDING AUTHORITY RETURN PROPOSALS TO: Elizabeth Atilano Pool Administrator Ventura County School Self-Funding Authority 5189A Verdugo Way Camarillo, CA DEADLINE FILING: September 14, 2012

2 REQUEST PROPOSAL WORKERS COMPENSATION CLAIMS AUDIT SERVICES VENTURA COUNTY SCHOOLS SELF-FUNDING AUTHORITY TABLE OF CONTENTS I. INTRODUCTION... 3 II. SCOPE OF SERVICES... 3 III. PROPOSAL REQUIREMENTS... 4 IV. INDEMNIFICATION... 5 V. INSURANCE REQUIREMENTS... 5 VI. SELECTION PROCESS

3 I. INTRODUCTION The Ventura County Schools Self-Funding Authority is seeking proposals from qualified firms to audit the claims administration of its workers compensation program to determine the efficiency, effectiveness, and the consistency of claims adjusting service and the accuracy of loss runs. The Ventura County Schools Self-Funding Authority began self-insuring its California workers' compensation exposures in It currently self-insures 28 school districts and charter schools up to $600,000 per occurrence and purchases excess insurance above that amount to statutory limits. Ventura County Schools Self-Funding Authority handles the California claims out of its Third Party Administrator s office, York Risk Services Group, in Oxnard, CA. They have handled the claims since July 1, Currently, there are 593 open indemnity claims, 279 open Future Medical claims and 60 open medical only claims. A copy of the most recent Self-Insurer s Annual Report filed with Department of Industrial Relations, Self-Insurance Plans is enclosed with this RFP. II. SCOPE OF SERVICES The general objectives of the claims audit are: 1. To assess the efficiency and effectiveness of the present claims administrator; 2. To review a reasonable sample of open and closed claim files; 3. To evaluate the examiner s experience, competence, and staffing levels; 4. To obtain suggestions for improvement in claims handling, reserving, and reporting; and 5. To ensure that all provisions of the contract for services are met. The claims audit report must address the following areas: 1. Accuracy of the claim reserves; 2. Timeliness of payments; 3. Control of medical costs; 4. Adequacy, if any, of early dispositions evaluation; 5. Direction and control of claims; 6. Claims reporting to excess carriers; 7. Control of litigation costs; 8. Adequacy of claims file reviews by supervisors; 9. Adequacy of file documentation; 10. Examiner and supervisor caseloads; 11. Effectiveness and thoroughness of the claims investigation techniques, including the appropriateness of the use of outside investigative services; 12. Evaluation of timely recognition and preservation of subrogation rights; 13. Evaluation of finalization and closure of claims; 14. General competence of the administration services being used; 15. Areas of deficiencies in claims handling procedures; 3

4 16. Evaluation of litigation services; 17. Quality and effectiveness of the early return to work program; 18. Claim file financial reconciliation with loss run; 19. Procedures for meeting critical deadlines such as payment of claims, denial of claims, subrogation notices and others; 20. Reasonableness of charges by purveyors; 21. Effective use of diary system; and 22. Evaluation of compliance with the California State Audit Unit timelines for furnishing of DWC Form-1 and filing of form The audit should include a review of 174 open indemnity claims, approximately percent, with at least one half of the claims having an incurred loss in excess of $50,000. Also, the audit should include a review of 15 medical only claims and 15 closed indemnity claims. We request the ability to select a portion of the claims prior to the fieldwork being completed. The audit should include a comparison of the claims management activities against a standard defined in the report that will reduce as much as possible, subjective measurements. The report should thoroughly address the purposes of the report and areas outlined above. The report will be due by November 30, At least twenty-five (25) bound and two (2) unbound copies of the report must be delivered to the offices of the Ventura County Schools Self-Funding Authority by that date. III. PROPOSAL REQUIREMENTS 1. Each proposer shall submit a complete proposal with all information requested. The content of the proposal will be as follows: A. Consultant Corporate Data This section should include: 1. A description of at least two similar or related contracts under which the proposer has provided services within the last year 2. A brief description of the experience and qualifications of the proposed staff member(s) who will be conducting the audit 3. A brief description of the organization 4. A list of references 4

5 B. Work Plan This section should contain the proposer's work plan for providing the services required. C. Cost Data This section should contain a complete breakdown of all costs relating to the contents of the proposal, including the maximum total cost, as well as an itemized breakdown of the compensation required to accomplish the full performance of all tasks outlined in the proposal. IV. INDEMNIFICATION The Consultant shall indemnify, defend and hold harmless the Client, its member districts, and additional covered parties from any and all claims, demands, losses, damages, and expenses, including legal fees and costs, or other obligations or claims arising out of any liability or damage to property, if any, suffered by the Client, its member districts, and additional covered parties solely and exclusively by reason of the Consultant s proven gross negligence or willful misconduct. V. INSURANCE REQUIREMENTS Proposers shall take out and maintain during the entire term of the agreement insurance pertaining to the activities associated with the agreement. Proposers will be required to obtain, at its own cost and expense, all insurance coverage and endorsements required below and shall provide evidence of such insurance and endorsements to the Ventura County Schools Self-Funding Authority prior to commencing work. Insurance: Workers Compensation and Employer s Liability Coverage: Workers Compensation Insurance and Employer s liability insurance, on all of its employees to be engaged in work related to the performance of this Agreement, in accordance with applicable California law. Commercial General Liability Coverage: Commercial General Liability Insurance for bodily injury, personal injury, and property damage, in an amount not less than one million dollars ($1,000,000.00) per occurrence, with not less than two million dollars ($2,000,000) aggregate. Consultant s Commercial General Liability Insurance shall name VCSSFA, its member districts, and additional covered parties as additional insured. 5

6 Automobile Liability Coverage: Automobile Liability Insurance covering bodily injury and property damage for all activities of the Consultant arising out of or in connection with the work to be performed under this Agreement, including coverage for owned, hired and nonowned vehicles, in an amount not less than one million dollars ($1,000,000.00), combined single limit. Professional Liability Coverage: Professional Liability Insurance for protection against claims arising out of the negligent acts, errors, or omissions of Consultant s operations under this Agreement, in an amount not less than one million dollars ($1,000,000.00). VI. SELECTION PROCESS Upon receipt of the proposal, Ventura County Schools Self-Funding Authority staff will review each firm s response to this Request for Proposal. Failure to properly address all the items set forth above may disqualify the prospective auditor s proposal. Ventura County Schools Self-Funding Authority reserves the right to reject any or all proposals at its sole discretion. At their discretion, staff may interview one or more firms to further assist in the review process. Ventura County Schools Self-Funding Authority reserves the right to award the contract to the auditor at its discretion depending upon multiple areas of criteria. All proposals must be received in our office by 5:00 p.m. on September 4, Late proposals will be rejected. Please send ten (10) copies of your proposal and correspondence to: Elizabeth Atilano 5189A Verdugo Way Camarillo, CA Questions concerning this Request for Proposal should be addressed to: Elizabeth Atilano 5189A Verdugo Way (805)

7 The following is the selection timetable: September 14, 2012 September 17-21, 2012 October 9, 2012 October 16, 2012 Proposals due by 5:00 p.m. Review proposals Selection will be made by Executive Committee Board approves selection of the firm The Ventura County Schools Self-Funding Authority reserves the right to cancel and/or modify the above dates at anytime or to make a dual appointment. 7

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