City of Santa Clara logo

Legislative Public Meetings

Share to Facebook Share to Twitter Bookmark and Share
File #: 20-508    Version: 1 Name:
Type: Consent Calendar Status: Agenda Ready
File created: 4/28/2020 In control: Council and Authorities Concurrent Meeting
On agenda: 6/23/2020 Final action: 6/23/2020
Title: Action on Agreement with Sedgwick Claims Management Services, Inc., for Third Party Administrator (TPA) Services in Support of the City's Self-Insured Workers' Compensation Program [Council Pillar: Manage Strategically Our Workforce Capacity and Resources]
Attachments: 1. Agreement with Sedgwick Claims Management Services, Inc.
REPORT TO COUNCIL
SUBJECT
Title
Action on Agreement with Sedgwick Claims Management Services, Inc., for Third Party Administrator (TPA) Services in Support of the City's Self-Insured Workers' Compensation Program [Council Pillar: Manage Strategically Our Workforce Capacity and Resources]

Report
BACKGROUND
Sedgwick Claims Management Services, Inc (Sedgwick) is the successor organization to Gates McDonald and Cambridge and has been providing Workers' Compensation TPA services to the City since 1977. The service components consist of basic claims administration services and ancillary services designed to assist in managing employee workers' compensation claims, claims costs, and claims outcomes in accordance with the State Labor Code. The ancillary services include bill review, utilization review and nurse case management. Council approved an amendment to the current agreement with Sedgwick extending the term an additional year through June 30, 2020 in order to provide sufficient time to administer a Request for Proposals (RFP) process to ensure that the City was getting the best services and value. This procurement process was to also evaluate the relationship with Sedgwick relative to service delivery, cost structure and best-practice claims administration considerations.

DISCUSSION
As TPA services were being reviewed, Sedgwick acquired one of the largest public entity TPA providers in California, York Risk Services Group (York) in September 2019. This acquisition significantly changed the marketplace, as York has the largest public entity practice in this market and was a potential successor to Sedgwick. Additionally, York has been a key provider of TPA services to the California State Association of Governments Excess Insurance Authority (CSAC- EIA), the risk pool the City participates in to buy its excess lines and specialty insurance coverage, including Workers' Compensation. York has been an integral partner with the EIA on their first-dollar primar...

Click here for full text