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Page 10 of 22 <br />16. All claims settlements require approval from the city, with those exceeding $20,000 requiring <br />approval from the city council. The TPA has no authority to settle claims. With the city's <br />approval, the TPA may arrange for independent investigators or other experts, to the extent <br />deemed necessary, in connection with processing the qualified claim or loss. <br />17. Maintain current knowledge of all city liability coverage in effect and reporting requirements <br />for excess insurance carrier(s). Provide updated reports on claims as requested. <br />18. Provide a written report for proposed claims settlement or recommended claims denial. <br />19. Respond promptly and courteously to inquiries from claimants, claimant representatives, and <br />city staff. <br />20. Consult and cooperate with the city and its employees to achieve a successful program, <br />including full cooperation with claims audits. <br />21. The city does not expect a unit dedicated strictly to our account. However, the city does <br />expect to have specific assigned staff for our account. The purpose is to ensure that the <br />chosen TPA will assign dedicated claim staff to the city’s account, making it easy for the city <br />and claimants to have a designated point of contact. Changes in claim staff must be <br />communicated to the Risk Manager well in advance. <br /> <br />B. CLAIMS INVESTIGATION AND MANAGEMENT <br />1. Assertively investigate each claim using competent and qualified personnel to evaluate <br />potential liability and damages. The city reserves the right to require additional investigation. <br />With the city's approval, engage external persons or firms for specialized investigative work. <br />2. Contact all witnesses promptly after receipt of the claim. Document the description of the <br />incident or related injuries. Document all attempts to contact witnesses. <br />3. Ensure that the city department and designated employees have submitted statements <br />before determining liability. Obtain relevant work orders, reports, and records as appropriate. <br />4. Promptly assess and identify claims exposure that may exceed $50,000 and notify the city. <br />5. Investigate potential subrogation and third-party liability situations in all cases involving third <br />parties; with the city's approval, pursue recovery from third parties as appropriate. <br />6. Identify all subrogation claims and initiate a written report to the city on the potential success <br />of subrogation; identify all costs, including attorney fees, involved in specific subrogation <br />eligible files; provide recommendations based upon cost-benefit analysis of potential <br />subrogation files. <br />7. Assist in the preparation of litigated cases and participate as needed in hearings and <br />settlement actions. <br />8. Prepare and provide legal counsel with a complete electronic claim file copy within five (5) <br />working days of notice of litigation. <br />9. The city expects all records to be maintained electronically. <br />10. Provide narrative or analytical reports of litigated cases whenever requested by the city. <br />11. The TPA will act as the city’s Reporting Agent in compliance with the Medicare Secondary <br />payer requirements under the CMS Section 111 Mandatory Reporting Program. <br />12. Inactive files are reviewed with the city within sixty (60) calendar days of last activity. <br /> <br /> <br />