RFQ - WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION

ALLEN R. HUNSBERGER DEPARTMENT OF PURCHASING AND CONTRACTING BRENDA MILLER
DIRECTOR 5560 OVERLAND AVENUE, SUITE 270, SAN DIEGO, CALIFORNIA 92123-1204 ASSISTANT DIRECTOR
PHONE (858) 505-6367 FAX (858) 715-6452
REQUEST FOR QUOTES (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
May 13, 2026
A. KEY INFORMATION
1. The County of San Diego is seeking quotes from firms interested in providing workers compensation special
claims administration services ("Offerors").
2. The County anticipates a contract term of an initial (base) period of one (1) year, with four (4) one-year option
periods.
3. The County has posted this solicitation on its official BuyNet website at https://sdbuynet.sandiegocounty.gov/
. To see all information related to this RFQ, to submit Questions, and to receive notifications of updates,
Offerors must select "Participate in RFx" for this solicitation in BuyNet.
4. The Contracting Officer for this solicitation is Joseph Craft, Procurement Contracting Officer,
joseph.craft@sdcounty.ca.gov.
5. Schedule: This timeline is subject to change at any time, at the County's sole discretion. The County will issue
an addendum for changes to the Questions due date, or Quote due date.
Event Description Date and Time (San Diego Time)
Questions due May 19, 2026 prior to 5:00 p.m.
Quotes due June 9, 2026 prior to 5:00 p.m.
6. Questions:
6.1. Offerors should submit all Questions, including requests for clarification related to definition or
interpretation of this RFQ, in writing by the Date and Time specified in the Schedule. Offerors should
submit Questions via BuyNet, by sending a message to the Contracting Officer through the "Discussions"
functionality.
6.2. Non-Offerors should direct inquiries regarding this solicitation to the Contracting Officer.
7. Table of Contents:
A. Key Information
B. RFQ Instructions and Rules
C. Submittal Items
D. Required Forms
E. Statement of Work
F. Payment Schedule
G. Draft Agreement

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
B. RFQ INSTRUCTIONS AND RULES
1. INSTRUCTIONS FOR SUBMITTING A QUOTE
1.1. It is Offeror's responsibility to submit a quote based on the most current RFQ, addenda thereto, County's
responses to Questions, any other information posted on BuyNet, and any diligence material made
available by the County. Offerors are advised to regularly check BuyNet for information. The County has
no obligation to contact Offerors directly with any such RFQ-related information.
1.1.1. To see all information related to this RFQ, to submit Questions, and to receive notifications of
updates, Offerors must select "Participate in RFx" for this solicitation in BuyNet.
1.1.2. If an Offeror is unable to download this document, an Offeror may request a hard copy from
Department of Purchasing and Contracting's front desk or contact clerical support at (858) 505-
6367.
1.2. Forms required to be submitted with Offerors response to this RFQ are included in this RFQ or posted on
the County's web site at: https://www.sandiegocounty.gov/content/sdc/purchasing/purchasing-
forms.html.
1.2.1. The County may update posted forms from time to time. Unless otherwise specified, Offerors may
submit the version of a form in place as of the date of the posting of this RFQ or any later version
thereof.
1.3. Offeror must submit a complete original quote in accordance with the format provided in this solicitation
to the County of San Diego, Department of Purchasing and Contracting, through electronic upload to
BuyNet before the Date and Time listed in Schedule.
1.3.1. If Offeror is unable to submit via BuyNet for any reason, Offeror may submit its quote via email
to the Contracting Officer listed in this document or provide the Purchasing and Contracting front
desk with either (i) electronic files on CD/DVD; or, (ii) a printed quote. Offeror must prominently
mark such submissions with the RFQ number on the outside of the packaging. Please use this
method only if unable to submit through BuyNet.
2. QUESTIONS
2.1. Offerors shall direct requests for explanation regarding the RFQ or related documents to the Contracting
Officer, in writing, as a question ("Question"). Offerors may submit Questions by sending a message to
the Contracting Officer through the "Discussions" functionality in BuyNet.
2.2. The County may choose not to respond to Questions received after the date and time stated in the Schedule
for Question submission. Offeror is responsible for ensuring that Questions are received by the County.
3. QUOTE FORMAT
3.1. Submit electronic quotes as files in .pdf format, except where specified otherwise. For pages other than
signature pages, converted and searchable formats are preferred.
3.2. All quotes shall be signed with a handwritten signature by an authorized officer or employee of Offeror.
4. QUOTE ORGANIZATION
4.1. Your quote should be organized in accordance with the Submittal Items in this RFQ.
4.1.1. Offerors shall organize content to correspond to the applicable exhibit and question or item within
each exhibit.
4.1.2. Offerors shall separate each exhibit into one or more files, clearly named as to the exhibit and
order.
4.1.3. Pages shall be consecutively numbered within each exhibit at the bottom or top margin of each
page.
4.1.4. Cost/Price information:
4.1.4.1. Offerors must place all cost and pricing information within the Cost/Price exhibit. Price
shall be inclusive of all proposed compensation.
4.2. Confidential/Proprietary information:

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
4.2.1. The County is a public agency subject to the California Public Records Act, Government Code
7920.000, et seq. Some or all of the documents submitted in response to this RFQ may be subject
to disclosure, and the County intends to publish any resulting contracts to its public website.
4.2.2. It is Offeror's responsibility to identify and separate into a "CONFIDENTIAL/PROPRIETARY"
exhibit and to provide a signed Nondisclosure Indemnification Agreement for:
4.2.2.1. All confidential information that Offeror represents, with legal basis, is exempt from
disclosure pursuant to the California Public Records Act, including PI (Personal
Information), PII (Personally Identifiable Information), or PHI (Protected Health
Information);
4.2.2.2. Any proprietary or other information Offeror represents, with legal basis, is exempt from
disclosure under the California Public Records Act and wishes to protect from
disclosure.
4.2.3. The "CONFIDENTIAL/PROPRIETARY" exhibit must be clearly labeled with all pages marked
as "CONFIDENTIAL/PROPRIETARY."
4.2.4. Offeror should reference material in the "CONFIDENTIAL/PROPRIETARY" exhibit where it is
needed to respond to a Submittal Item through citation to the
"CONFIDENTIAL/PROPRIETARY" exhibit (for example "See response 1 contained within the
'CONFIDENTIAL/PROPRIETARY' exhibit for staff Social Security numbers").
4.2.5. If the County determines that a submission improperly designates information as confidential or
proprietary, the County may, at its sole discretion: (i) deem the information releasable; (ii) declare
the submission non-conforming/non-responsive; (iii) remove such information, or (iv) take any
other appropriate action. (Note: Pricing and Terms and Conditions are generally not confidential
under the California Public Records Act).
5. QUOTE EVALUATION
5.1. Evaluations may consider factors such as technical merit, experience, capacity, history of Offeror
compliance, availability, price, and more to determine the quote(s) that provide the best value to the
County.
5.2. During evaluation, the County may appropriately consider the sustainability and social, human health,
environmental, and economic impact of Offeror's proposed products and/or approach to providing goods
and/or services, in accordance with Board Policy B-67. Therefore, Offerors are encouraged to include
relevant information in their quotes, to the degree related to the goods or services sought.
5.3. During evaluation, the County may appropriately evaluate the cultural competency of Offeror and
Offeror's proposed approach to providing goods and services. Therefore, Offerors are encouraged to
include relevant information in their quotes, to the degree related to the goods or services sought.
5.4. When evaluating an Offeror's cost or pricing, the County may also consider the effect of the quote on the
overall total cost to the County.
6. COUNTY COMMITMENT
6.1. This RFQ does not commit the County to award a contract, nor does it commit the County to pay any of
Offeror's costs incurred in the preparation or submission of the quote. Further, Offeror shall not incur any
reimbursable cost in anticipation of a contract award.
6.2. Neither Offeror nor any of its representatives shall have any claims whatsoever against the County or any
of its respective officials, agents, or employees arising out of or relating to this RFQ or these procedures
(other than those arising under a definitive contract with Offeror in accordance with the terms thereof).
6.3. The County reserves the right to separately procure the same or similar goods or services.
6.4. The County may withhold all information regarding this procurement until after negotiations are complete,
including, but not limited to: the number of quotes received; the identity of Offeror(s); the content of
quotes; the County's evaluation and results thereof. Information releasable after the conclusion of
negotiations is subject to the disclosure requirements and withholding exemptions of the California Public
Records Act.

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
6.5. Pursuant to County Charter 703.10 and 916, award of a contract resulting from this RFQ may be subject
to the County's requirement to determine that the services can be provided more economically and
efficiently by an independent contractor than by persons employed in the Classified Service.
6.6. In the event that an Offeror is involved in a merger, acquisition, or other change in control, the County
reserves the right to award a contract to a resulting entity.
7. DILIGENCE AND DUTY TO INQUIRE
7.1. Should Offeror find discrepancies in or omissions from, or be in doubt as to the meaning of, the RFQ or
related documents, Offeror shall have a duty to submit a Question to the County.
7.2. Offerors are expected to perform reasonable due diligence with regard to this RFQ and the work required,
including, but not limited to, information that is publicly or otherwise reasonably available and, if
applicable, information that can be obtained during a site visit (including verification of measurements,
conditions, and other attributes). Neither the selected Offeror(s), nor any Offerors, shall be entitled to any
price adjustment or other relief based upon information that was discovered or should have been
discovered through due diligence.
7.3. The County makes no representation or warranty, express or implied, as to the accuracy or completeness
of any diligence material or other information provided by the County or any of its agents, representatives,
contractors, or consultants. Such information may reflect good faith assumptions, estimates, or projections,
which may or may not prove to be correct.
7.4. Offeror should not rely upon oral statements made or explanations given by the County, including any oral
responses to Questions or other inquiries. No prior, current, or post award communication(s) with any
officer, agent, or employee of the County shall affect or modify any terms or requirements of this RFQ,
except as explicitly provided for in this RFQ.
8. OFFEROR COMMUNICATIONS
8.1. All communications from Offeror (including its employees, agents, and representatives) to the County or
its officers and employees (including consultants working on or assisting with this procurement), related
to this RFQ or Offeror's quote, must be directed in writing exclusively to the Contracting Officer, unless
otherwise authorized in writing by the Contracting Officer. Offerors shall not communicate with or attempt
to contact any other County personnel about this solicitation, except as otherwise allowed for in this RFQ
or by law. Any improper contact may, at the County's sole discretion, cause Offeror to be removed from
consideration for contract award.
8.2. If Offeror issues any public announcement or otherwise engages in communication that, in the County's
sole determination, compromises the integrity of this RFQ process or attempts to restrain competition,
Offeror may be removed from consideration for award.
8.3. Audio and/or video recording of presentations, discussions, negotiations, or other communications with
the County regarding this RFQ are prohibited, unless specifically authorized in writing by the Contracting
Officer.
9. SOLICITING EMPLOYEES
9.1. Until contract award, Offerors shall not, directly or indirectly, solicit any employee of the County to leave
the County's employ in order to accept employment with Offeror, its affiliates, actual or prospective
contractors, or any person acting in concert with Offeror without prior written approval of the County's
Contracting Officer. This paragraph does not prevent the employment by Offeror of a County employee
who has initiated contact with Offeror.
10. PROHIBITED CONTRACTS AND SUBCONTRACTS
10.1. In accordance with Section 67 of the San Diego County Administrative Code, the County shall not contract
with, and shall reject any quote submitted by, the person or entities specified below, unless the Board of
Supervisors finds that special circumstances exist which justify the approval of such contract:
10.1.1. Persons employed by the County or of public agencies for which the Board of Supervisors is the
governing body;

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
10.1.2. Profit-making firms or businesses in which employees described in subsection 11.1.1 serve as
officers, principals, partners, or major shareholders;
10.1.3. Persons who, within the immediately preceding twelve (12) months, came within the provisions
of subsection 11.1.1 and who (i) were employed in positions of substantial responsibility in the
area of service to be performed by the contract; or, (ii) participated in any way in developing the
contract or its service specifications; and
10.1.4. Profit-making firms or businesses in which the former employees described in subsection 11.1.3
serve as officers, principals, partners, or major shareholders.
10.2. Per Board Policy A-79, a successful Offeror that is a non-profit corporation shall not subcontract any work
under the agreement with a related for-profit subcontractor where an interlocking directorate, management,
or ownership relationship exists, unless specifically authorized by the Board of Supervisors.
10.3. Offeror certifies that, if awarded a contract under this RFQ, such contract will be in compliance with
Sections 11.1 and 11.2 above. Offeror shall promptly notify the County of any change in circumstance
affecting these provisions.
11. CALIFORNIA REVENUE & TAXATION CODE 18662
11.1. In compliance with California Revenue and Taxation Code 18662, if Offeror is a non-resident of
California (out-of-state invoices) that receives California source income and has not completed Franchise
Tax Board Form 590, there may be a backup withholding on all payments. Fifteen (15) business days prior
to the first payment from the County, new suppliers or suppliers with expired forms or forms with incorrect
information must submit new forms to the County (forms are available from the Franchise Tax Board
website listed below).
11.2. Under certain circumstances, Offerors may be eligible for reduced or waived nonresident withholding. If
Offeror has already received a waiver or a reduced withholding response from the State of California and
the response remains valid, Offeror should submit the response to the County in lieu of the forms. Failure
to submit the required forms will result in withholding of payments. Offerors should access the Franchise
Tax Board websites, listed below, for tax forms and relevant information regarding non-resident
withholding, including waivers or reductions. The County will not give Offerors any tax advice. It is
recommended that Offerors speak with their tax advisers and/or the State of California for guidance.
Franchise Tax Board Websites:
https://www.ftb.ca.gov
https://www.ftb.ca.gov/forms/search/
11.3. If selected for award, Offeror must submit applicable forms to the Auditor & Controller via fax, at (858)
694-2060, or mail originals to: County of San Diego, 5530 Overland Avenue, Suite 410, San Diego, CA
92123. The P.O. Number or Contract Number (if available) and "California Revenue and Taxation Code
18662" must appear on fax cover sheet and/or the outside of the mailing envelope.
12. W-9 FORM
12.1. If selected for award, Offeror must complete and submit a W-9 form if a current form is not on file with
the County.

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
C. SUBMITTAL ITEMS
Offeror's response to these Submittal Items shall be no more than forty (40) pages, excluding disclosures, financials,
sample reports, etc.
1. EXHIBIT 1 - REQUIRED FORMS
1.1 Submit a completed and signed Offeror's Cover Page (PC600) form
* Required for all Offerors
* Located at:
https://www.sandiegocounty.gov/content/dam/sdc/purchasing/docs/PC600_dpc_Offerors_Cover_Page.pdf
1.2 Submit a completed and signed Representations and Certifications form (PC601)
* Required for all Offerors
* Located at:
https://www.sandiegocounty.gov/content/dam/sdc/purchasing/docs/PC601_dpc_Reps_and_Certs.pdf
1.3 Submit a completed and signed Small-Local Business Self-Certification Form (PC610)
* All Offerors are encouraged to complete this form to support County data collection.
* Located at:
https://www.sandiegocounty.gov/content/dam/sdc/purchasing/docs/PC610_dpc_Small_Local_Self_Cert.pdf
1.4 Submit a completed and signed Nondisclosure Indemnification Agreement (PC620) (if applicable).
* Required if submitting Confidential/Proprietary Information (see RFQ Instructions and Rules section 4.2)
* Located at:
https://www.sandiegocounty.gov/content/dam/sdc/purchasing/docs/PC620_dpc_Nondisclosure_Indemnity.pdf
2. EXHIBIT 2 - PROGRAM/TECHNICAL EXHIBIT
2.1 Mandatory Minimum Requirements
2.1.1 Provide your Certification by the CA Department of Industrial Relations, Office of Self-Insurance
Plans (OSIP).
2.2 Technical Approach
2.2.1 Compliance to "Exhibit A - Statement of Work (SOW)" requirements. Confirm your agreement to
the requirements as stated.
YES NO

If your organization has exceptions to the SOW requirements, please indicate your proposed
changes in your response. Provide explanations to support any alternative standards/language
proposed. Failure to specifically reject a proposed requirement will be deemed an acceptance
of such requirements.
2.2.2 Provide a brief overview of your Utilization Review (UR) and Bill Review (BR) process.
2.2.3 Provide the name of your workers' compensation claims handling system and a screenshot of the
claim search screen.
2.2.4 Provide a copy of your last California Department of Industrial Relations, Division of Workers'
Compensation State audit report. Provide the total number of penalties and dollars in calendar year
2025.
2.2.5 Provide your average adjuster caseload.

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
2.2.6 Briefly describe your claims handling process.
2.3 Organizational Experience and Qualifications
2.3.1 Provide a brief overview of your proposed technical approach to meet the requirements in Exhibit A,
Statement of Work.
2.3.2 Describe your proposed technical approach to sections 3.1 - 3.3 of the Statement of Work and how
it supports the County's goals.
2.3.3 Briefly describe the assigned adjuster's experience and provide the adjuster's resume, to include
current Continuing Education Unit (CEU) credits.
2.3.4 Provide 3 references for California public sector organizations for which you provide workers'
compensation claims handling services. References should include name of organization and contact
person, contact title, email, phone number, number of years as your client, and number of assigned
claims per year for 2023, 2024, 2025.
2.3.5 Provide a list of defense counsel that would be assigned to the County account. Include years of
service with your company and specify if counsel is contracted or company staff. If counsel is
contracted, please provide a brief summary of the contract.
3. EXHIBIT 3 - COST/PRICE EXHIBIT
3.1 Submit a completed Payment Schedule (attached).
3.2 If applicable, provide a separate listing of additional services and prices if not considered by the Offeror
to be part of the RFQ Payment Schedule's.
4. EXHIBIT 4 - ACCEPTANCE OF TERMS AND CONDITIONS
4.1 Confirm acceptance "YES/NO" of the County of San Diego's Draft Agreement (including insurance
requirements):
YES NO

4.1.1 If "NO," provide a detailed list of exceptions to the terms and conditions, the nature of its concern,
and what terms the Offeror is willing to accept.
Note: The Offeror will be deemed to have accepted any terms and conditions of the Contract to
which it does not take exception to. The County may, as part of its evaluation process, conclude
that exceptions are so numerous and/or material as to make Offeror's response to the solicitation
unacceptable.
4.1.2. Provide disclosure of any lawsuits, pending litigation and/or investigation that involve failure or
alleged failure to delivery performance on contracts and/or lawsuits/litigation that may directly
impact this contract (e.g., non-compliance with legal requirements).
4.1.2.1. Provide information regarding status, resolution, and if any, penalties, fines, or other
actions required. If there are none, state "None" in your response.
5. EXHIBIT 5 - CONFIDENTIAL PROPRIETARY
5.1 Include any Confidential/Proprietary Information in this exhibit, in accordance with RFQ Instructions and
Rules section 4.2

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
D. REQUIRED FORMS
(RESERVED)

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
E. STATEMENT OF WORK
1. Scope of Work/Purpose
The County of San Diego ("County") is self-insured, self-administered for Workers' Compensation insurance. The
County's workers' compensation claims are managed by the Department of Human Resources Risk Management
Division. The Contractor shall provide workers' compensation claims processing for staff injuries within the
County of San Diego ("County") Department of Human Resources and other injuries deemed a conflict of interest.
The number of new claims ranges between 1 - 5 per year.
2. Roles and Responsibilities
2.1. The Contractor shall:
2.1.1. Have at least ten (10) years' experience in California workers' compensation claims administration.
2.1.2. Have at least five (5) years' experience in California public sector claims administration.
2.1.3. Be certified by the CA Department of Industrial Relations, Office of Self-Insurance Plans (OSIP).
2.2. The Contractor staff responsible for handling County claims shall:
2.2.1. Possess a valid California designation for handling California workers' compensation claims and
have 3 years' experience of claims handling in California.
2.3. The County shall:
2.3.1. Assign a designated Senior Workers' Compensation Adjuster as liaison for claims.
2.3.2. Provide a claim payment listing for entry into Contractor's tracking system.
2.3.3. Provide a list of County-contracted medical providers for injured workers.
3. General Requirements for Service Delivery
3.1. The County is committed to successful participation of small and diverse businesses in County contracting.
Contractor is encouraged to subcontract or partner with small, diverse, and/or local community-based
organizations in implementation of this Agreement, when appropriate, and as agreed to by the Contracting
Officer Representative.
3.2. Prioritize environmentally sustainable materials and processes and prioritize electronic communication.
3.3. Services shall be culturally appropriate and offered in the client's preferred language. When this is not
possible, Contractor shall arrange for appropriate interpretation services.
3.4. Contractor shall copy the County liaison on any notice sent to the injured worker. All workers' compensation
notices sent to injured workers shall be sent to the County liaison electronically on the same day.
3.5. Contractor shall retain records in accordance with the County of San Diego retention schedule.
3.6. Contractor shall provide access to all records related to this contract for County of San Diego quality
assurance reviews on a random basis.
3.7. Contractor shall coordinate and comply with auditor requests within the timeframes set by the auditor.
4. Specific Requirements for Service Delivery
4.1. The Contractor shall be responsible for the following:
4.1.1. Provide facilities, equipment, staff, and supervision for the purpose of special claims administration in
accordance to California Labor Code and Public Risk Innovation, Solutions, and Management (PRISM)
standards.
4.1.1.1. When the assigned claims examiner is absent, the Contractor must provide coverage for County
claim management.
4.1.2. Hold regular business hours, excluding County holidays, typically Monday - Friday, 8:00 AM - 5:00
PM Pacific Time Zone.
4.1.3. Process assigned workers' compensation claims from date of injury through final disposition and
continue if future medical care is applicable, or until the County notifies Contractor to cease.
4.1.4. Investigate claims and make timely acceptance or denial. Actions include but are not limited to
collection of statements, acquiring records, and requesting medical evaluations, in accordance with
California Labor Code timelines.

COUNTY OF SAN DIEGO - REQUEST FOR QUOTATIONS (RFQ) 13162
DEPARTMENT OF HUMAN RESOURCES
WORKER'S COMPENSATION SPECIAL CLAIMS ADMINISTRATION SERVICES
4.1.5. Deliver benefits to injured workers, including medical, indemnity, and supplemental job displacement
benefits based on California Labor Code.
4.1.6. Comply with all California Labor Code regulations and laws, including timely completion of
Department of Workers' Compensation (DWC) and other claims notices.
4.1.7. Contact the injured employee, County liaison, and medical providers if appropriate, within 3 working
days of claim receipt. This process is commonly referred to as "3-point contact."
4.1.8. Set appropriate reserves, for a reasonably expected outcome, and promptly communicate the reserves
to the County liaison for input into the County's claims management system.
4.1.9. Review cases on a periodic basis, typically between thirty to ninety (30 - 90) days, (commonly referred
to as "diary") and perform reasonable claims resolutions activities on those review dates.
4.1.10. Provide exceptional customer service by responding to communication from injured workers and
medical providers as soon as possible, ideally same-day, and responding to the County within one
business day.
4.1.11. Consult with the County liaison for approval to assign legal counsel.
4.1.12. Settlement authority shall be provided by the County liaison.
4.1.13. Complete E-filing transactions (e.g. stipulations, applications of adjudication, etc.) through Workers'
Compensation Appeals Board (WCAB) Electronic Adjudication Management System (EAMS).
4.1.14. Provide loss run, payment report, and check register electronically to the County liaison monthly.
4.1.15. Provide injured workers' medical reports within then 10 business days to the County liaison.
4.1.16. Provide Explanation of Benefits to providers within 30 days.
4.1.17. Provide all legally and regulatory required reports, to include but not limited to the Department of
Industrial Relations, Office of Self Insurance Plans, Public Self Insurers Claim Liability - Annual
Report (Form AR-2) by established deadlines.
4.1.18. Submit appropriate paperwork to Independent Medical Review (IMR) through Contractor's UR
provider.
5. Invoices
5.1. Send invoices for injured workers' services with the Explanation of Review (EOR), Utilization Review (UR)
determination letter, report, and instruction to the designated County liaison within 5 business days of receipt.
5.2. Invoices will be submitted electronically, on a monthly basis, to the COR or via mail to:
County of San Diego
Workers' Compensation Unit
5500 Overland Ave., Suite 370
San Diego, CA 92123