City of LA Claims Administrator Guide

City of LA Claims Administrator Guide

The City of Los Angeles is a public-sector self-insured employer. As such, billing for the treatment of its injured workers can be complicated. For injured worker claims, the City of LA uses either one of three different Third-Party Administrators (TPAs) or the city self-administers the claims itself.

If that sounds convoluted…it is.

But not to worry! Below, see our handy chart outlining which TPAs are responsible for which departments, as well as City of LA contact information for when the correct department is unknown, and more.

City of LA Claims Administrators (by Department)

In California workers’ comp, employers can fulfill their legal obligation to cover the costs of work-related injuries by:

  • Utilizing an insurer: Most employers take this route, paying an insurance company to cover work-related injuries on the employer’s behalf.
  • Self-insuring: Employers that can meet the financial requirements established by California’s Office of Self-Insurance Plans (OSIP) may eschew insurance companies, and cover their own employees’ work-related injuries.
  • As a further wrinkle, OSIP makes a distinction between self-insured employers that are private-sector and those that are public entities, such as the City of Los Angeles.

As far as managing (or “administering”) injured workers’ claims and paying provider bills for injured workers’ treatment, both insurers and self-insured employers may:

  • Self-administer: The insurer or employer manages claims, and adjudicates and processes provider bills for injured workers’ treatment, or
  • Utilize a TPA: An outside company manages claims, and adjudicates and processes provider bills for injured workers’ treatment.

The City of LA both self-administers and utilizes TPAs, depending on the department in which the injured worker is employed. Claims for some city departments are administered by a TPA, while the city administers claims for other injured workers, as outlined in the chart above and in the table below:

City of LA Department

Claims Administrator

Fire (Sworn & Civilian)

Sedgwick Claims Management Services

Personnel, City Attorney

Sedgwick Claims Management Services

Police Civilian (Non-Sworn)

Elite Claims Management

Police (Sworn)

Intercare Holdings Insurance, Inc.

California Public Self-Insured Roster

For more information, though not always timely updated, consult the OSIP’s website, which includes lists (called “rosters”) and addresses of the various types of self-insured employers. The City of Los Angeles appears on the OSIP’s Public Self-Insured Roster (non-JPA Roster), which is labeled “OSIP Public stand alone roster” on this page of its website.

Presumably, the OSIP will update its information to reflect that Acclamation Insurance Management Services, Pomona and Tristar Risk Management, Alhambra are no longer active TPAs for the City of LA.

Notes on terminology:

OSIP uses all of these terms for entities such as the City of LA:

  • public entities (most frequent)
  • public agencies
  • public sector self-insured employers

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