02-24-2015 Special School Board Meeting
Agenda Item #32

The Workers' Compensation, General Liability, and Auto Liability Claims Third-Party Administration Contract with Sedgwick Claims Management Services, Inc.


The District has utilized the services of Sedgwick Claims Management Services as the District's third-party administrator for workers’ compensation, general liability, and auto liability claims adjustment/handling.  The pricing for the past three years has been 11.7% of the claims cost with a maximum payment of $12,000 for any one claim.  Following negotiations this year, Sedgwick CMS has agreed to reduce their rate from 11.7% to 9.9% with the maximum payment of $15,000 for any one claim. 

Sedgwick CMS will provide the following as the result of this agreement: 
1. An on-site claims adjuster located in the Risk Management department's office.
2. Full managed care arrangement services in-house with Sedgwick nurses and staff.  This includes clinical consultation services for injured workers and school/department sites.
3. Provide claim's adjusting/handling for the life of each claim.   
4. Two site licenses for Risk Management to access and view ViaOne, Sedgwick CMS claims adjuster claim file's work screens.  This allows Risk Management to run reports, verify status, and check the progress of the adjuster claim handling, review imaged physician notes/bills submitted for payment, and react to any issue that arises in the prosecution of the claim either internally or externally.
5. Sedgwick will act as the District’s representative in all mandatory reporting of non-group health plans  (workers’ compensation, general liability, and auto liability settlements) as required by Medicare, Medicaid, and the State Children’s Health Insurance Act of 2007 (MMSEA).
6. Sedgwick CMS will not require a loss deposit (escrow of funds), which they normally require of all other third-party administrators.
7. This agreement locks in pricing at this rate for three years with an option to continue the same pricing for two additional one-year periods.
8. The maximum fee for service is limited to $15,000 and most other Sedgwick CMS clients have no limit.
9. Sedgwick CMS provides medical bill review and adjustments for all authorized physicians.  The cost of this service for the last three years has been 20% of each dollar saved as a result of this review.  This contract reduces that fee from 20% to 18%.

Approve the Sedgwick CMS three-year contract with the option of two additional one-year extensions at a cost of 9.9% with a maximum payment of $15,000 per claim.

Meeting Date(s)
Information - 2/24/2015
Consent after Information3/10/2015

Authority for Action
Board Policy 8710, Florida Statute 768.28, Florida Adminstrative Code 6A-1.012(15)

Involves Expenditure of Funds Directly in the Classroom

Source of Funding
Agenda Item will not Require the Expenditure of Funds

Cost Center

Mark Langdorf, Director, Risk Management, Ext. 620
Judy Preston, Associate Superintendent, Financial Services, Ext. 600

Attachment:  2015-18 TPA Agreement - Sedgwick CMS.pdf