REQUEST FOR QUALIFICATIONS Independent Adjusting Services for the Washington State Transit Insurance Pool Submissions due by: 5:00 p.m. July 01, 2018. Please send submissions as they are completed, as we will review them as they are received. Please direct inquiries to Cedric Adams at cedric@wstip.org. Introduction The Washington State Transit Insurance Pool (WSTIP) is a public agency formed for the purposes of risk sharing, loss prevention, and insurance purchasing. This request for qualifications (RFQ) is to solicit and select qualified individuals working with a firm or as a sole practitioner with adjusting expertise and experience in adjusting the following types of claims: auto-liability (both property damage and bodilyinjury), general-liability (both property damage and bodily-injury), property damage, under/un-insured motorist coverage, and medical-payment coverage. Selected individuals will provide representation to WSTIP and its members as an independent contractor; not a WSTIP employee. Organizational Overview The Washington State Transit Insurance Pool (WSTIP) is a joint self-insurance and risk management pool authorized by Revised Code of Washington (RCW) 48.62.031. This law authorizes the governing body of a local entity to join or form a self-insurance program with other entities and may purchase insurance or reinsurance with other entities for property and liability risks. The agreement to form a joint-insurance program shall be made under chapter 39.34 RCW and may create a separate legal or administrative entity. With that said, WSTIP is a public entity comprised of 25 public transit systems located in the State of Washington. Despite its name, WSTIP is not an insurance company. WSTIP is regulated by the State Risk Manager in the office of Risk Management, a division of the Department of Enterprise Services, instead of the Washington State Insurance Commissioner. Independent Adjusters The role of an adjuster who works for WSTIP is to provide representation to the WSTIP Claims Staff and its members by at a minimum: Coordinate contact and communication between claimants and WSTIP; Gather and analyze facts and documentation; Provide coverage analysis; Provide liability analysis; Provide damages analysis; Provide appropriate, accurate, and timely reports; Coordinate appraisals and totaling of vehicles; Negotiate settlements and communicate denials; and, Be available to respond to questions and requests for information in a timely manner.
Adjusters work closely with WSTIP Claims Staff and member representatives responsible for collecting necessary information at each organization. Qualifications Experience in Experience in insurance, automobile, bodily-injury, property or some other form of adjusting. Proposal Requirements Written proposals must include the following sections: 1. Your history or history of the firm. 2. Statement of types and scope of services performed by you or your firm and how they relate to the duties and qualifications required by this RFQ. Your response should include a description of adjusting experience, indicating clients of similar makeup to WSTIP for which you provide(d) services. 3. A list of references knowledgeable of your and your firm s representative work (if applicable). Please include telephone numbers and addresses. 4. Your resume and a list of personnel, with resume, who would also work WSTIP claims. 5. Statement of rates, as well as how travel rates are figured. Hourly rates should include all overhead, indirect costs, incidental travel, and any other miscellaneous expenses. WSTIP has members across the state, so travel at times is required. If you would not like to travel or have assignments, outside of a certain geographical zone, please state the boundaries. 6. List of any conflicts or potential conflicts and description of how those would be handled/managed. 7. Provide certification of professional liability insurance. 8. List of any professional, ethical, or criminal complaints or disciplinary actions. Questions Questions regarding this request shall be submitted via email to cedric@wstip.org. Process Submittals shall be in the form of a PDF and emailed to: cedric@wstip.org, with the subject of: WSTIP Independent Adjuster RFQ. WSTIP s Executive Director and Claims Manager will review the submissions and schedule follow-up interviews, visits, and request for more information as warranted. The deadline for submissions is no later than 5 p.m. July 01, 2018. WSTIP reserves the right to not pursue any or all submissions.
INDEPENDENT CLAIMS ADJUSTER GUIDELINES 2018 I. Introduction. Who is WSTIP? The Washington State Transit Insurance Pool (WSTIP) is a joint self-insurance and risk management pool authorized by Revised Code of Washington (RCW) 48.62.031. This law authorizes the governing body of a local entity to join or form a self-insurance program with other entities and may purchase insurance or reinsurance with other entities for property and liability risks. The agreement to form a jointinsurance program shall be made under Chapter 39.34 RCW and may create a separate legal or administrative entity. With that said, WSTIP is a public entity comprised of 25 public transit systems located in the State of Washington. Despite its name, WSTIP is not an insurance company and is regulated by the State Risk Manager in the Office of Risk Management, a division of the Department of Enterprise Services, instead of the Washington State Insurance Commissioner. A. A Board of Directors and an Executive Committee govern WSTIP. Claims management is led by its Claims Manager with oversight from its Executive Director. The WSTIP Claims Department also consists of a Claims Specialist and a Claims Associate. B. Expectations. WSTIP expects its adjusters to provide the highest-quality representation to its members for the claims they are assigned; and, to do so in the most cost-effective manner possible without compromising quality. During each assignment, we expect adjusters to treat everyone with respect, dignity, and fairness. Persons encountered and communicated with include, but are not limited to: WSTIP staff, member staff (administrative staff as well as drivers), claimants, passengers, witnesses, law enforcement, attorneys, physicians, medical personnel, and others. It is also expected that our adjusters will let us know before reaching capacity in regard to WSTIP claims, or claims in general, and that adjusters will communicate vacation and extended absences for our planning purposes. WSTIP truly practices a quality over quantity philosophy in assessing an adjuster s value to the organization. C. Our Approach. These Independent Adjuster Guidelines are intended to promote a better understanding of our mutual duties, responsibilities, and expectations. We recognize that each claim is different and wish to avoid implementing regimented and detailed requirements which may not make sense in an assigned claim or might prohibit creativity, flexibility, and adaptability. WSTIP manages and monitors all pending claims. The Claims Staff are responsible for assigning adjusters and tracking all open claims. The WSTIP Claims Staff wants and needs to know the investigation progress, analysis/assessment, development, and opinion/conclusion of the claims assigned to you. Reports and/or Notes are expected every 30, 60, or 90 days, depending on the claim, as a way of managing our open claims and recording the history for our closed claims. Adjusters are expected to assess the particular claim needs to both inform current Claims Staff for strategy and settlement authority decisions and document the file for future claims management and possible litigation. A monthly report, which includes all the open-claims assigned to the adjuster, is published and Page 1 of 5
distributed to all adjusters and claims personnel. If there are any questions, comments, or concerns, please bring them to WSTIP attention as soon as possible, but the report is intended to be a reminder to provide updates, corrections, invoice, and ensure proper file documentation. Final claim decisions are reserved for WSTIP Claims Staff. However, open and honest opinions, suggestions, and recommendations are expected and greatly appreciated. To maximize communication and claim-flow quarterly, bi-annual, or annual meetings between WSTIP staff and adjusters may be requested and scheduled. The Claims Staff s mission is to care for claims by and against members in a FAIR and EFFICIENT manner through their vision of managing claims with preparation, analysis, and determination. Each claim truly is our most important claim. II. Claim Assignment. A. Email or Phone. Your assignment will commence with a request by the Claims Staff on behalf of one of our members. Our member is your client. The initial email will briefly state our request for you to contact the claimant, take statements, determine liability, or go to the scene and complete a full-investigation of all parties involved. Each claim assignment will be different, and with these directions you have freedom to examine the situation as your professional experience leads. B. Primary Adjuster. WSTIP hires adjusters--not companies. The adjuster designated in the assignment is the person with overall responsibility and accountability for direction and control of the claim. The Adjuster shall, at a minimum: 1) Verify receipt and acceptance of the assignment; 2) Review and create Origami (WSTIP Risk Management System/Tool) file Notes and review and include any event/claim attachments (the Notes tell the story of the claim; if someone, not involved with the file, were to look at the file they should be able to know what has occurred and what the next steps are); 3) Contact (call, leave contact information in necessary, and/or send a letter) the claimant(s) as-soonas-possible, if over 72-hours please notify WSTIP personnel; 4) Leave summary Notes in Origami; 5) Attach important documents to the claim in Origami; 6) Report initially within 30-days and after, in a timely and cost-efficient manner; enter a Note containing pertinent WSTIP Coverage, Liability (to include percent at-fault), Injury/Damages including estimate for reserves, Plan of action, Reserve recommendations, Date of first contact ; and leaving a Note if not able to provide this information within the first 60-days; 7) Compile case files and forward to representing attorney and litigation manager if requested; 8) Invoice WSTIP, at a minimum, every three months, upon request, and in an expeditious manner to closeout a WSTIP file after resolution. III. Getting Started A. Claimant and Member Contact. Adjuster should acknowledge receipt of the assignment and contact the claimant within twenty-four (24) hours of the claim assignment and 72-hours at the latest. The purpose of this is to: Page 2 of 5
1) Establish mutual rapport; 2) Establish necessary contacts; 3) Arrange to visit location or facilities involved in the case; 4) Meet personnel involved in the event (incident or accident); and, 5) Become familiar with photos, reports, videos, citations, and other attached records/files. B. Initial Report. The Adjuster shall provide an initial report within thirty (30) days of the claim assignment, containing: 1) Who from WSTIP assigned you the claim(s) and on what date; 2) A brief recap of the event; 3) Summary/analysis/comparison of operator/member statement; 4) Claimant name, address, phone number, DOB, and SS# (for bodily injury claims) (verify that the SS# is loaded into the claimant s information in Origami Contacts, it does not have to be in the report); 5) Summary of claimant statement; 6) Your assessment regarding liability; 7) Your assessment regarding damages; 8) Suggested reserves for damages; 9) Your initial thoughts on how to resolve the claim; and, 10) The next-steps to reach resolution of the claim, who will take them, and when. IV. Interim Reports A. Notes vs Reports. The Claims Staff wants to know what you are doing to move the claim towards resolution. This does not have to be an actual report. The Note option is available and encouraged for shorter updates and to ensure the Notes can quickly tell the story of the file. For efficiency and effectiveness, if there is minimal new information or updates, please utilize the Notes. B. Minimum Notes Reporting. In addition, we request brief typed Notes in the Claim File: 1) At claim milestones; 2) Notifying WSTIP of correspondence to or from legal offices or letters to claimant; 3) Recorded statements or pictures of the claimant, scene, or auto; or, 4) At least every six (6) months but more often according to the particular files requirements and staff requests. C. Content of Interim Reports. Your report should include: 1) Always a brief description of the event, can be the same as the initial, unless something has changed; 2) Confirmation of discussions with WSTIP Claims Staff; 3) Important facts, including medical records, you have acquired or updates which have occurred since your last report; 4) Changes in your assessment of liability and damages; 5) Changes in claimant representation or medical treatment; and, 6) Settlement authority requests and negotiation updates. V. Other Considerations A. Expert Witness and Technical Services. You must obtain prior approval from Claims Staff to hire expert witnesses, do chart reviews, perform medical exams, or hire appraisers and please have a Page 3 of 5
cost estimate available upon request. B. Requests for Settlement Authority. Prior to your claim negotiation and closure, you must provide a report which includes: 1) Your analysis of all important facts and issues regarding the claimant(s); 2) Settlement demands and offers from claimant or attorney; 3) Settlement recommendations based on your liability assessment and damages to date; 4) Assessment of liability (clear liability, percentage of liability, or no liability found); 5) Valuation of monetary reserves; and, 6) Your recommendations. C. Check Requests. When requesting a check from WSTIP staff, you must provide an email or report which includes: 1) The claim number and claimant name; 2) How much the check should be for; 3) Who the check should be made out to; 4) The address the check should be sent to; 5) Necessary documentation to validate the request if not already in the file; 6) A copy of the signed release, a Note if it is already attached to the file, or a statement that the release will be exchanged for a completed check and attached at a later date. 7) If needed to enter the check recipient as a payee, then please include a W-9 Form - Taxpayer and Identification Number and Certification. **WSTIP checks are usually mailed on Fridays of each week; requests submitted after noon on Thursday will be processed and mailed out the following week. *** All checks must be deposited and accounted for at the end of each calendar year. If a new year begins and a WSTIP check (payment or settlement) is not cashed, please notify WSTIP personnel and a new check for the current year will be issued. VI. Meetings with Members and Claimants. Meetings with members and claimants may be necessary to properly facilitate your assigned claim. As with all costs, particular consideration is expected with meetings (a telephone call or e-mail may be sufficient in place of a meeting with the client or with the claimant). VII. Billing. A. Bills for services must include: 1) Adjuster & Company Address/Phone/FAX; 2) CLAIM NUMBER & Claimant Name; invoices are paid from individual claims (example 18-001023-5) not from an event (example 18-001023); 3) Hourly Adjuster rate as negotiated; 4) Dates of Service for the current billing (stated on first page of invoice); 5) Single line detailed description of work performed each day; and, 6) Itemized list of any additional charges. B. Billing Details. 1) Billings for clerical services or word processing are not accepted; Page 4 of 5
2) Photocopies and Digital Photograph charges are not allowed; and, 3) Mileage rates for travel shall not exceed the current IRS rate per mile. *During initial training and orientation, WSTIP staff will teach each adjuster the invoicing procedures utilizing pay.me@wstip.org. VIII. On-Going Communications. A. The Claims Staff requests copies of the following documents be attached to the matching claim number within Origami: 1) Transcribed statements; 2) Recordings; 3) Adjuster Reports and Invoices; 4) Medical Bills and Chart Notes; 5) Signed medical authorization forms; 6) Settlement demands/offers and Signed Releases (settlements $1,000 or over ALL require a signed release before the claim is closed); 7) All Correspondence, including letters to the claimant or attorney; 8) Signed Releases and Medicare/Caid forms; and, 9) Other Items as requested or relevant. IX. Settlements. A. Policy. WSTIP favors All-Inclusive settlements. Negotiations should proceed as such and requested exceptions are granted in only the most unique circumstances. Please be vigilant for opportunities to settle early claims fairly, creatively, and reasonably. B. Approval of Settlement Negotiation. All settlement agreements must be approved in advance by the WSTIP Executive Director or Claims Staff. Page 5 of 5