Injured on Duty Claims 3rd Party Admin. & Accidental Disability Retirement for SPD and SFD

CITY OF SPRINGFIELD MASSACHUSETTS Request for Proposals for Injured on Duty Claims Third-Party Administration for Fire and Police Personnel M.G.L. Chapter 41, Sections 100 and 111F and Chapter 32 Accidental Disability Retirement March 18, 2024 The City of Springfield requests proposals from qualified bidders for third-party administration of both current and new injured on duty and accidental disability retirement claims for Fire and Police personnel subject to M.G.L. Chapter 41, Sections 100 and 111F and Chapter 32 Accidental Disability Retirement. The contract will be for a one (1) year term. The City reserves the right to renew the contract on a yearly basis for up to two (2) additional years. The City reserves the right to terminate this contract upon a written sixty (60) day notice. Proposals will be received until 2:00 P.M. EST on April 3, 2024 at the Office of Procurement. If at the time of the scheduled RFP opening, City Hall or the Office of Procurement is closed due to

uncontrolled events such as fire, snow, ice, wind, or building evacuation, the RFP opening will be postponed until 2:00 PM on the next normal business day. RFP will be accepted until that date and time. Injured On Duty and Accidental Disability Retirement Claims Administration and Case Management Services Injured on duty (IOD) third-party administration (TPA) services shall consist of claims administration, claims monitoring, and case management to and through resolution of all active past, current and future claims and cases. The services shall include: receipt, processing, filing and maintenance of all claim-related forms, reports and notices as required by state law for controlling losses; verification of all medical billings and determination of state authorized rate for payments, including public safety personnel granted accidental disability retirement (ADR); processing of approved payments to medical providers; timely follow-up with doctors and claimants and investigation of cases, when necessary, to reduce exposure and cost; recommendations of appropriate salary status for final decision by the City. Administration may also include incorporation of nursing or other professional medical services to provide advice and assist in case management. The service provider will maintain frequent personal contact via telephone, fax and meetings with the Human Resources & Labor Relations Director, City Solicitor, and the Police Superintendent and Fire Commissioner and/or their designees as needed to coordinate all information, actions, and decisions, including weekly site visits with the Superintendent and Commissioner and/or their designees. Loss reports for Police and Fire Departments will be issued monthly on claims activity or more frequently if required by the City. The loss report will include information such as claimant’s name, and date of injury/illness, type of injury/illness, nature of the incident, determine if an OSHA recordable work-related injury/illness and document accordingly, medical costs to date, and date of next medical appointment and reason for it. The report will also include actual payments for salary, if such information is so provided by City. The service provider shall conduct analysis of open claims and loss activity, with findings presented to the Human Resources & Labor Relations Director, City Solicitor, Police Superintendent and Fire Commissioner, and/or their designees at least monthly or more frequently if required by the City, including collecting, recording and maintaining the reporting information for affected departments’ OSHA Forms 300 and 300A and produce them as needed in a format acceptable to the City and U.S. Department of Labor and Massachusetts Department of Labor Standards. These services shall be provided for all covered public safety employees, as described under “Background Information”. BACKGROUND INFORMATION File Maintenance The service provider will maintain copies of all salient documentation and files resulting from public safety employee injuries the City deems necessary. The service provider will also maintain all medical reports, attorney letters, notice of third-party liens, or any other documentation or files the City deems necessary. The service provider will outline the aforementioned in the narrative of its proposal as well as how it will access City IOD and ADR records and documents with no interruption to the City’s office staff. Ancillary Support Services The service provider will offer education and training on interpretation and application of related legislation, various procedures, and interpretive case law, (where applicable). The service provider will assist in advising the City with regard to any administrative or legal proceedings relating to injured on duty claims. The service provider will identify claims with subrogation potential, will assist in placing notice of lien and will monitor status of such claims. Supplementary Services When determined necessary, independent medical evaluations, private investigations, occupational safety and health consultants, rehabilitation and functional capacity evaluation service firms, or utilization reviewers will be retained within the parameters of discussions between the service provider and the City. Further, the service provider will not schedule the use of the aforementioned supplementary services without the approval of the Human Resources Department. The service provider will also communicate time limits and budget considerations with outside services and will monitor progress through the conclusion of each claim. Medical Services Bill Review and Payment The service provider, upon receipt of bills, shall review bills for causation, appropriateness, and medical necessity. Each bill shall be set to the state rate setting standard using the state CMR designated by the City. The service provider shall process payment of all approved bills to the respective medical providers and shall reconcile said payments on a monthly or monthly billing cycle. The service provider shall also respond to all billing inquiries and provide 1099 forms to all vendors.