Meeting_Body
FINANCE, BUDGET, AND AUDIT COMMITTEE
APRIL 16, 2026
Subject
SUBJECT: WORKERS' COMPENSATION UTILIZATION AND PEER REVIEW SERVICES
Action
ACTION: APPROVE RECOMMENDATION
Heading
RECOMMENDATION
Title
AUTHORIZE the Chief Executive Officer to execute Modification No. 2 to Contract No. PS73428000 with Genex Services, LLC in the amount of $259,125 to continue to provide workers' compensation utilization and peer review, physician consulting, and expedited review services, increasing the contract value from $609,090 to $868,215.
Issue
ISSUE
Metro's current contract for workers' compensation (WC) utilization and peer review services expires on June 30, 2027. There has been an increase in contract usage, attributed to the current open WC claims of 2,437, up from 1,429 at the start of FY21. This contract modification will ensure that WC utilization and peer review, physician consulting, and expedited review services can continue through June 30, 2027.
Discussion
BACKGROUND
Metro is a self-insured, self-administered employer that administers WC claims through the WC division of the Risk Management Department (RMD). RMD's WC division processes thousands of WC related payments monthly for items such as medical services, equipment, pharmaceuticals, legal fees, indemnity benefits, and other expenses.
Consistent with industry best practices, RMD uses a variety of techniques to lower WC medical expenditures. Such techniques include bill review, utilization review (UR), Preferred Provider Organizations (PPO) discounts, and nurse case management services.
The California Labor Code specifies that insurers and self-insured employers may evaluate the appropriateness of medical care prescribed by an injured employee's treating physician or other medical provider and may deny treatments inconsistent with accepted protocols. Types of treatment subject to review include surgeries, some diagnostic tests, physical therapy, and others. This UR process in Cal...
Click here for full text