Municipal Entity Underwriting Application
When and what type of losses are referred out to another adjusting firm or an attorney?
Does the TPA have a separate unit to pursue subrogation?
Does the claims adjuster handle this function?
What medical case management firms does the TPA use?
Are all medical and hospital bills audited per the state fee schedule?
If no, please describe audit process.
How are bills audited?
If outside firm, provide name of firm.
Please provide the following information on the TPA.
Proof Of E&O And Fidelity
License To Act As A Third Party Administrator
Confirmation Of Adjuster Licenses
Organizational Chart With Resume Or Experience Level Of Associates
In Place Written Reporting Requirements
Copy Of TPA Claim Policy, Service Standards And Procedures
List Of Defense Counsels And Experts Used
Copy of service agreement between TPA and entity containing detail on the TPA’s responsibility to excess carriers/reinsurers; confirming claims handling on a runoff basis; monthly quarterly, and annual reporting provisions; fund balance, reserving and payment provisions.
Is TPA claim system
Can claims report be generated on an “as needed” basis?
Do claims reports include
Details On The Current Status Of Each Claim Paid Amount
Incurred Amount A Description Of The Type Of Loss
Does the system have the ability to track aggregate losses?
Please provide the following sample reports.
Captioned reports of specific losses
Aggregate Tracking and aggregate loss fund (if applicable)
Loss and Historical Exposure Information
Please provide a summary of a minimum of six years (current year plus 5 historical years) of ground up losses (include copies of loss runs) for all desired lines of coverage.
Loss Data Valued as of:
Claims Processor (In-house, Insurance Co. Name, TPA Name)
# Of Claims
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