NEW YORK LIQUIDATION BUREAU REQUEST FOR PROPOSAL

Transcription

1 NEW YORK LIQUIDATION BUREAU REQUEST FOR PROPOSAL Workers Compensation Claims Administration October 26, 2012 The New York Liquidation Bureau ( Bureau ) carries out the responsibilities of the Superintendent of Financial Services of the State of New York ( Superintendent ) in his capacity as receiver ( Receiver ) administering the affairs of impaired or insolvent insurance companies that are in court-ordered receivership. I. DESCRIPTION OF SERVICES The Bureau requires the services of a qualified third party administrator ( TPA ) to provide cost-effective claims administration for approximately 3300 workers compensation claims in a timely manner and in accordance with Articles 74 and 76 of the New York Insurance Law and Article 6A of the Workers Compensation Law ( Services ). The Services to be provided by the selected TPA ( Awardee ) include, but are not limited to, the following: Handle claims from inception to disposition, which includes at a minimum: communicating regularly with claimants, assisting in returning claimants to restrictive duty positions, identifying and defending fraudulent claims, making indemnity and medical payments in a timely fashion, pursuing subrogation, including researching and pursuing any and all available Section 15.8 recoveries, obtaining Medicare Set Aside ( MSA ) estimates and approvals, and providing regular reports to the Bureau. Set reserves. Attend hearings. Assign counsel. Negotiate and settle claims for amounts pre-approved by the Bureau. Arrange for independent medical examinations. Arrange for and monitor rehabilitation services. Comply with all Centers for Medicare and Medicaid (CMS) reporting procedures. File reports with the State and excess insurance providers. The Bureau will have final approval of all outside vendors utilized, including attorneys, independent medical examiners and vocational experts. A redacted list of the claims to be handled by the TPA will be provided to Proponents upon written request to the Workers Compensation and No-Fault Manager, Riccardo Zucaro, at rzucaro@nylb.org, with a copy to Evelyn Delgado, Acting Chief Compliance Officer at edelgado@nylb.org.. Page 1 of 8

2 In addition to the Services outlined above, the Awardee must demonstrate that the TPA will be able to meet the following minimum staffing requirements: Trained, competent, and licensed claims adjusters to perform the Services outlined in this RFP in a manner commensurate with the highest professional standards, in good faith and in accordance with all applicable laws and regulations. A Claims Manager who has more than 12 years of experience in investigation, evaluation and settlement negotiation of workers compensation claims and at least five years of experience in a claims supervisory or management role. Claims Supervisor who each have at least one year of experience in a supervisory role, seven years of experience in investigation, evaluation and settlement negotiation of workers compensation claims, and at least five years of experience handling lost-time cases. Claims units must have a ratio of 1 Supervisor to every 4 examiners. Lost-time case diary counts for these Services should not exceed 200. The Bureau invites all qualified TPAs ( Proponents ) to draft and submit to the Bureau, at the Proponents expense, a proposal ( Proposal ) in accordance with the requirements outlined in this request for proposal ( RFP ). The Awardee will perform the Services solely on behalf of the Superintendent as Receiver, not in his capacity as regulator. II. RULES AND INSTRUCTIONS In order to facilitate a fair evaluation of all Proposals, the Bureau requires that all Proposals maintain a uniform format. Accordingly, all Proposals should adhere to the requirements outlined in this RFP. The Bureau may, in its sole discretion, modify, rescind or provide an addendum to this RFP, require Proponents to revise their Proposals or supply additional information in response, and/or invite any Proponent to appear for an interview. All compliant Proposals will be reviewed by a committee that will, under the supervision of the Bureau s Acting Chief Compliance Officer, consider Proponents based exclusively on the Proposals submitted and any subsequent interviews with Proponents and/or additional information submitted by Proponents at the request of the Bureau. Proposals must specifically supply all items of information requested in Section III below in the exact format set forth below. Material deviations from the required format will likely result in disqualification of the Proposal. If any item in Section III does not apply to Proponent, Proponent must specifically indicate that the item is not applicable. Proponents may not satisfy an item of requested information by submitting or referring to a brochure, promotional or descriptive literature, or any other document, unless the request expressly permits such submission or reference. Proposals must be formatted in 12-point or larger font. The cover of each Proposal shall include the name of the Proponent and the subject matter, as follows: RFP: Workers Compensation Claims Administration. Each Proponent shall submit one original and six copies Page 2 of 8

3 of its Proposal. Each Proposal must be signed and dated by the Proponent. In submitting a signed Proposal, Proponent certifies that the information in the Proposal is materially complete, truthful and accurate. Proponent shall be bound by the information contained in its Proposal, including fees quoted for services. Proposals may be withdrawn from consideration at any time by written submission to Acting Chief Compliance Officer, Evelyn Delgado, at the address listed below. Proposals must be sent to: New York Liquidation Bureau 110 William Street New York, New York Attn: Evelyn Delgado Acting Chief Compliance Officer RFP: Workers Compensation Claims Administration Proposals must be received no later than 5:00 p.m., EST, on Thursday, November 16, 2012, unless such deadline is extended in writing by, and at the sole discretion of, the Bureau. Late Proposals will be disqualified from consideration. Proponents may submit questions no later than 5:00 p.m., EST, on Monday, November 12, 2012, by to the Workers Compensation and No-Fault Manager, Riccardo Zucaro, at rzucaro@nylb.org, with a copy to Evelyn Delgado, Acting Chief Compliance Officer at edelgado@nylb.org. Proposals will remain under seal and will be opened at a closed meeting under the supervision of the Acting Chief Compliance Officer. Except as provided in this RFP and as otherwise necessary for conducting business operations previously established with the Bureau, Proponents may not communicate with Bureau personnel who are involved in the review, evaluation or selection of Proponents. The Bureau will disqualify Proponents who engage in prohibited communications of a material nature, as determined by the Bureau. III. CONTENTS OF PROPOSAL Proposals shall set forth the following information: A. General Information 1. Name of Proponent. 2. Primary Office Address (include County). 3. All Other Office Addresses (include Counties). 4. The designated office or offices that will provide the Services. 5. General Telephone and Fax Numbers. 6. Contact Person (include specific contact information). 7. Alternate Contact Person (include specific contact information). Page 3 of 8

4 8. List Proponent s tax identification number and Certificate of Authority to do business in the State of New York. 9. List all relevant licenses held by Proponent in New York or any other state Proponent is willing to provide services. 10. A general overview and history of the Proponent, including without limitation the number of years in business, number of years performing workers compensation administration services, total number of employees, and brief description of Proponent s organization, including any operating divisions or working groups. Include a brief statement regarding any major changes in Proponent s senior management positions within the last three years. 11. A general overview of the how Proponent will complete the Services, such as the number of claims adjusters that Proponent will assign to complete the Services and the number of files each claims adjuster will handle. 12. Provide a list of all governments or quasi-governmental agencies Proponent has provided these types of Services within the past five years. 13. Provide a list of all other vendors, including names, phone numbers, specific statements, and qualification of each vendors firm and its key personnel, with whom you have a working or contractual relationship to assist in providing the Services.. Provide a client reference list for such vendor(s). 14. Provide a copy of the most recent financial statement or SEC filing, such as 10-K and 10-Q filing, as applicable. 15. Provide a copy of the claim/loss reports filed by Proponent for the three years prior to October 15, 2012, as it relates to professional liability and fidelity coverage. 16. Provide a copy of Proponent s most recent Statement of Auditing Standards No. 70 report ( SAS 70 Report ). If not applicable, provide a copy of the most recent security and controls audit report prepared for Proponent. 17. A general overview of the status of Proponent s business continuity planning and disaster recovery plans, including testing schedule for 2013 and With regarding to information technology ( IT ) capabilities, please: i. State whether Proponent s IT Department is in-house or outsourced. If outsourced, provide a copy of the most recent SAS 70 Report or disaster recovery plan for the vendor; ii. State whether the IT system(s) utilized to process claims loss and expense payments can be electronically linked with the Bureau and can validate payments to a vendor file supplied by the Bureau; iii. State whether Proponent has the ability to securely transmit data via an FTP site or by other secure means; iv. State whether Proponent s claims system is equipped to provide Bureau personnel with remote access to review claims status and processing; v. State whether Proponent has the ability to transmit data in a specific fixedlength format, including without limitation the Uniform Data Standards (UDS v2.1) as defined by the National Conference of Insurance Guaranty Funds, which can be found at vi. Set forth a proposed timeline for initiating the electronic file transfer to and from the Bureau, including without limitation the import of data transmitted to Proponent in a specified fixed-length format (utilizing a Page 4 of 8

5 UDS V2.1 Record A format); vii. Set forth Proponent s current backup procedures and schedule; and viii. State whether Proponent can perform OFAC screening. 19. Provide a copy of Proponent s claim handling procedure manual. B. Expertise Proponent shall provide a detailed statement of Proponent s qualifications and experience in performing the Services, specifically examples of comparable projects, project dates and a list of client references for which Proponent provided services in the last three years. Proponent shall also provide resumes of all professional personnel, including examiners and IT staff, who will be providing Services to the Bureau. Each resume should set forth the staff member s number of years of claims handling experience, the type of claims handled, the position the staff member occupies currently, the length of time the staff member has been employed by Proponent, and a detailed description of the staff member s involvement with projects of similar scope. C. Reputation and Integrity 1. State Proponent s number of years in the business. 2. State all names used by Proponent within the past 10 years. 3. Certify that Proponent and all of the staff who will potentially work on the assignments are in good standing in all jurisdictions in which they have been licensed or certified. 4. Set forth a brief statement regarding the integrity and reputation of Proponent and its employees, including whether in the last ten years Proponent or any of its partners or senior officers have been the subject of any criminal conviction or any final non-appealable civil judgments for malfeasance (including actions or proceedings by governmental authorities). 5. For every judgment entered against Proponent and/or any of its staff as a result of a claim against Proponent and/or any of its staff for professional malpractice, negligence or other malfeasance, set forth the date, all monetary relief granted, all injunctive relief granted, and the amount of the monetary judgment that currently remains unsatisfied, if any. 6. Set forth the number of settlements within the last 10 years resulting in a payment of greater than $10,000 in connection with any claims for professional malpractice, negligence or other malfeasance brought against Proponent or any of its staff. 7. If any of Proponent s staff has been convicted of any crime (felony or misdemeanor), set forth the relevant facts relating thereto. 8. If Proponent or any of its staff has been the subject of any investigation by any governmental or regulatory authority within the last five years, provide a brief description of the circumstances of each investigation, including the name of the investigating authority, the nature of the investigation, the date on which the investigation was commenced, and the status or disposition of the investigation. 9. Provide a brief statement regarding whether Proponent has ever been disciplined, Page 5 of 8

6 fired or sanctioned by any governmental or regulatory authority, licensing body, trade group or association, or disciplinary or ethics panel(s). Provide a detailed description of the underlying complaint and a summary of the finding. D. Potential Conflicts Of Interest 1. A list of all known employees of Proponent or any parents, subsidiaries or affiliates of Proponent who are related by blood or marriage to any Bureau employees and/or who are living in the same household as any Bureau employee. 2. A list of all known employees of Proponent or any parents, subsidiaries or affiliates of Proponent who were previously employed by the Bureau. 3. A list of all known Bureau employees previously employed by Proponent or any parents, subsidiaries or affiliates of Proponent. 4. Whether Proponent or any parents, subsidiaries or affiliates of Proponent have been involved in litigation against the Receiver, the Bureau and/or its estates within the last 10 years as a party, witness or otherwise. 5. The names of all persons or entities, if any, asserting claims against the Bureau and/or its estates for whom Proponent is currently performing work. 6. A brief statement regarding whether Proponent has previously provided services to the Bureau, including whether Proponent has any financial interest in any organization that has contracted to provide services to the Bureau. E. Fees and Audit Plan Timetable Proponent must provide a breakdown of the fees to be charged to perform the Services by using the following models: Price per claim/per year o Lost-Time Indemnity Claim o Medical-Only Claim o PPD/PTD Claims (This includes repetitive pay claims that have already been classified at the Workers Compensation Board) Price for medical cost-containment services to be offered o Medical bill review o Medical management programs o Pharmacy programs Proponents may, at their discretion, discuss any other pricing models they wish to propose, in addition to the foregoing. Proponent must provide the Bureau with a recommendation and explanation as to which pricing model suits the Bureau s overall objective in the most cost-efficient manner. Page 6 of 8

7 Proponent must provide and delineate the costs associated with moving the claims files from their existing location in lower Manhattan to Proponent s offices, including the cost of both physical and electronic transfer. F. EEO/Diversity/MWBE Status 1. Set forth facts sufficient to demonstrate that Proponent is an equal opportunity employer and complies with all relevant federal, state and municipal equal employment opportunity and non-discrimination laws, regulations and executive orders. Proponent may attach hard copies of any equal employment opportunity policy statements or other relevant official firm documents. 2. Are you certified as an MWBE with the New York State Department of Economic Development? If yes, please provide a copy of your certification. If no, please list any other jurisdictions and/or certifying bodies that have deemed Proponent to be minority or women owned. Please provide a copy of any such certification. 3. If Proponent has applied for, but has not, as of the date of this RFP, been awarded certification as an MWBE by the New York State Department of Economic Development, please submit proof of a pending application, and indicate the filing date thereof. 4. Please provide any additional information that may demonstrate your commitment to equal employment opportunity and diversity in the workplace. IV. EVALUATION AND AWARD This RFP does not commit the Bureau to select an Awardee or enter into a contract with any Proponent. The Bureau reserves the right to: (a) rescind, revoke or modify this RFP prior to execution of a contract with an Awardee; and (b) utilize any ideas from the Proposals. The Bureau may in its sole discretion: (a) reject a Proposal if it is non-responsive or non-compliant with the requirements set forth in this RFP; or (b) waive minor discrepancies in any Proposal. All materials submitted in response to this RFP become the property of the Bureau and will not be returned. In selecting an Awardee, the Bureau will consider, among other factors it deems appropriate, whether the Proponent: (1) has the appropriate expertise to provide the particular services sought under this RFP; (2) has demonstrated that it will commit appropriate staffing and resources to perform the Services; and (3) is in good standing in the State of New York and conducts its business in an ethical manner. The Bureau is not bound to accept the lowest-priced Proposal. Additionally, the Bureau may decide to proceed with only a portion of the Services described in this RFP and therefore select an Awardee for only a portion of the Services described in this RFP. Page 7 of 8

8 V. INSURANCE Insurance coverage must comply minimally with the following requirements, and be indicated on the enclosed Schedule A-1, which must be submitted with the enclosed Schedule A as part of your Proposal. Insurance Requirements: General Liability (Bureau as additional General Aggregate Unsured and waiver of subrogation) $2,000,000 Products/Comp/Op Agg: $2,000,000 Personal and Adv Injury $1,000,000 Each Occurrence $1,000,000 Fire Damage (any one fire) $50,000 Med. Exp. (Any one person $5,000 Excess Liability Workers Compensation and Employer s Liability Each Occurrence $3,000,000 (minimum) Statutory Limits V. ADDITIONAL TERMS AND INFORMATION The information contained herein shall be used for the sole purpose of responding to this RFP. The Bureau will not, and is under no obligation to, pay the costs, in whole or in part, incurred by Proponent during the preparation of Proposals. The Bureau disclaims responsibility and liability for any costs related to Proponent s participation in this RFP. Page 8 of 8