Third Party Administration Firefighter's Workman's Compensation Claims Services

The City of Orlando’s Procurement and Contracts Division, is soliciting proposals from interested and qualified Proposers to provide Third-Party Administration of Firefighters’ Worker Compensation Claims.

1. This RFP is being issued by the City of Orlando (the “City”) whereas the City currently utilizes the services of a Third-Party Administrator (“TPA”) for the purposes of adjusting workers' compensation claims for the City’s self-insured sworn firefighters within the City’s Fire Department. The successful proposer will assume handling of all prior claims from the City’s Fire Department as well as new claims.
2. Pharmacy Benefit Management (PBM) shall be incorporated into the proposal's responsive documents. The current PBM is Mitchell Pharmacy Solutions, and the current PBM is self performed by the current TPA.
3. Preferred Provider Organization (PPO) is self performed by the current TPA.
4. TPA services for other City employees are not within the scope of this RFP.
5. The City currently utilizes the TPA services of CorVel Corporation for sworn firefighters within the City’s Fire Department. The City’s current Contract with CorVel Corporation is expiring. Therefore, the City is seeking proposals from qualified and professional claim administration companies.
6. The City’s Fire Department currently has five hundred and eighty-four (584) sworn firefighters.
7. Ten Year Historical Claims Data: Ten (10) years of historical sworn firefighters’ workers compensation claims data is provided in Exhibit “Two” of this RFP.
8. There are 1 to 2 Utilization Review and 1 to 2 Field Case Management referrals per year.
9. The City’s Risk Management Division
   1. The City’s Risk Management Division, under the Risk Management Division Manager, oversees the activities of TPA.
   2. A Risk Management Committee, comprised of five (5) senior City officials, meets monthly to review and approve all claim settlements of $25,000 or greater.
10. First Report of Injury (FROI) Dedicated Injury/Exposure Hotline: The City currently utilizes AdventHealth to accept 24 hours a day Workers Compensation First Report of injury/illness via the City employee calling a dedicated injury/exposure hotline that takes the First Report of Injury (FROI) from either the employee or the supervisor. Risk Management and the Third-Party Administrator will then receive an email with the FROI and a likely referral to an Advent health facility for initial treatment. Currently, the City intents to continue to use AdventHealth for claims reporting for completion of the FROI and triage/treatment.
11. Self-Insurance Program Background: The City has been self-insured since 1983 and has utilized TPA services for the City’s sworn firefighters since 2010. The City’s formal risk management and self-insurance program is comprised of several important components, including:
    1. Claims Management/Loss Control Emphasis:
       1. The City’s elected officials and top management teams have a long-standing commitment to a sound risk management program with special emphasis on claims management and loss prevention/reduction. The Risk Management Division provides administration and oversight of the claims adjusting function. Employees with the Risk Management Division perform safety audits and implement loss prevention programs, including loss prevention training for the City.
       2. Through September 30, 2020, the City currently had excess carrier coverage that covered all City self-insured programs. As of October 1, 2020, the City no longer has excess carrier coverage over worker’s compensation claims.
       3. There are currently eighty-seven (87) claims and approximately half of those are indemnity claims.
       4. There are currently six (6) sworn firefighter claims that are piercing the excess carrier’s coverage.

1. 1. Risk Management Committee: This Committee is charged with responsibility for, and guidance of, the self-insurance program. The Committee is comprised of high-level administrative executives who are uniquely familiar with, and committed to, the goals of the program. This Committee is also responsible for the review and approval of all settlements greater than $25,000.
   2. Light Duty Program: The City has an aggressive light duty program and most employees can be temporarily placed in sedentary positions.