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HomeMy WebLinkAbout1983-06-21; City Council; 6645-1; Workers comp claims admin services agmt- '74' L 5-+ 69 - CIT\r OF CARLSBAD - AGENDk BILL ,B# h 423 "A, dl TITLE AGREEMENT FOR WORKERS ' COMPENSATION IEPT. PER ITG. 6/21/83 CLAIMS ADMINISTRATION SERVICES DEPT. HD.,% CITY MGR& CITY ATlYm RECOMMENDED ACTION: That Council approve Resolution No. '725-0 authorizing agreement with Bierly and Associates or Workers' Compensation Claims Administration Services ITEM EXPLANATION: The City currently contracts with Fleming and Associates of La Canada, California for workers' compensation claims adjust- ing services. The contract with Fleming was for a two-year period that will end on July 1, 1983 or until cancelled. Proposals for workers' compensation claims adjusting services were requested from various companies. Five firms responded and their proposals were evaluated based on cost, municipal claims experience, staff qualifications and level of services available. Representatives of the firms were interviewed by a panel consisting of the Personnel Director, Finance Director, and the City's Risk Management Consultant, Don Jack. The recommendation to change from the present claims administrator was based upon cost, experience and staff quali- fications. Bierly and Associates maintains a San Diego office. Bierly and Associates is one of the largest workers' compensa- tion claims administrators in California with broad experience in both the private and public sectors. office handles only one other municipal account, the City of Poway, the company also handles the San Diego Unified School District and major private corporations. Bruce Miller, the manager of Bierly's San Diego office, will personally handle the City's account. Mr. Miller has excellent experience and has handled municipal clients in the past. Although the San Diego 'ISCAL IMPACT: The current contract with Fleming and Associates is based on a charge of $110 per claim. The proposed agreement with Bierly and Associates would be based on a charge of $75 per claim with an annual maximum charge of $6,000. The charge may be adjusted annually in response to changes in the San Diego consumer price index. The estimated annual charge with Bierly and Associates is $6,000. The estimated annual cost next year if the City remains with Fleming and Associates is $11,600, based on 80 claims being opened. ZXHIBITS: Resolution No. 72 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 2c 21 22 2z 24 25 26 * 27 28 L RESOLUTION NO . 7250 - .- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA APPROVING AN AGREEMENT WITH BIERLY AND ASSOCIATES FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATION SERVICES. WHEREAS, the City of Carlsbad has established a workers' compensation self-insurance program; and WHEREAS, as part of this program the City will reuqire claims administration services; and WHEREAS, the City has received and evaluated proposals from various firms to supply such service. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad as . follows: 1. That the above recitations are true and correct. 2. That the Agreement between the City of.Carlsbad and Bierly and Associates for claims administration services, attached hereto as Exhibit A is hereby approved. 3. That the City Manager is hereby authorized to sign the agreement on behalf of the City. PASSED, APPROVED AND ADOPTED at a regular meeting of the City Counicl on the 21st day of June, 1983 by the following vote, to wit: AYES: Council Kenkers Casler, Lewis, Kulchh, Chick and Presmtt NOES : None ABSENT: None -- MARY H.;/CASLER, Mayor ATTEST : 4 / ALETHA L. RAUTENKRANZ, City Cle- k .. .. AGREEMENT FOR *WORKERS I 'COMPENSATION ADMINISTRATION SERVICES .. THIS AGREEMENT is entered into this day of June, 1983, between BIERLY AND ASSOCIATES, hereinafter called "Bierly" and the .City of Carlsbad hereinafter called the aCityl'. ' .. The Parties agree as follows: I. The period of this Agreement shall be from July 1, 1983 through 0. June 30, 1986. .* 11. Bierly shall perform the following services on behalf of the City: A. PROGRAM DEVELOPMENT. - 1. the necessary procedures , practices and coordination to implement the City's Self-Insured Program and to meet the legal requirements of the State. Consult with the City's personnel and assist in deve1opir.g 2. Conduct, or assist in conducting, orientation meetings for the City's personnel involved directly or indirectly in the processing of industrial injury cases; - 3. Provide the City with information on changes or proposed changes in statutes, rules and regulations affecting the City's responsibility mder -'a legally uninsured Workers Compensation Program. .. 4. Review with the City's representatives program progress, including identification of problem areas and recommend solutions thereto. .. 5. Establish procedures and necessary documentation to provide for the payment of benefits, medical costs, legal fees and other related costs to enable either the City or I3cj.rly to issue checks to cover such expenditures. B C LA1 MS ADMINISTRATION * 1. Acquire _and maintain all CITY'S open and closed claiin files , log books and other records from previous SEJ1VI:CE AGENT. all open claims shall be reviewed and updated. Claj.ms infoririation shall he inputted in nIEru,YVs computer system and includcd in reports hercaf ter described 3 . .. .. -. , . .. L 2. Review and process all claims for Workers' Compensation Relatioris Department for reporting and notification. .. benefits in accordance with the requirements .of the Industrial 3. Determine the compensability of claimed injuries and illnesses in accordance with the State's Workers' Compensation . law, 4. Determine eligibility for and authorize payments of medical benefits and authori.ze examinations to determine the nature and extent of disability when appropriate. 5. Determine eligibility for and authorize payment of temporary disability Compensation in coordination with medical advice and rehabilitation efforts. 6. Determine tbe degree of permanent disabi.lity, if any, of injcred workers utilizing as necessary and desireable , advisory ratings of the Permanent Disability Rating Bureau. 7. Authorj.ze the. payment of permanent disabi.lity compensation and death benefits in accordance with advisory ratings, orders of the Workers Compensation Appeals Board, or Compromise and Release settlements. 8. Where necessary, and with approval of City, refer legal. firms. Assist in the preparation of litigated cases, negotiations of Compromise and Release settlements and . litigated cases to attorneys, utilizing an agreed listing of * subrogation actions. .. 9. Maintain current estimates of costs of all anticipated benefits and related expenses on each case. 10. Investigate or arrange for investigation of, as necessary and appropriate, questionable cases and the status of disabled employees in order to adjust all cases and to assist in the trial , or settlement of litigated cases. 11 . Assure that sufficient numbers of claims personnel are available so that no claims examiner will be required to handle more than 200 open indemnity cases at any one time. * 12. Protect CITY'S interests in all third party cases wherever indicated, including filing of subroqktion claims, and liens where appropriate, with approval ~clf CITY. 13. ' self-insurer of ill claims which mrly 'exceed CI'I'Y'S w.-.t-cnt-.ion and maintain records and effect col1ecti.on on all ca---'? wherein CITY retention. Notify CITY'S Excess Rcinsurance Carrier on behalf of tnc is entitled to reimbursement for a loss in e::.ccris of its c a. .1 ---.~ . ... .. c. . MEDICAL CONTROL 1. dentists, chiropractors and other practitioners for t'he treatcment of injured employees and recommend a panel of such specialists as may be required for long-term or other disabilities requiring special treatment. : -'2. Monitor treatment programs for in jured employees including the review of all "Doctor's First Report oE Work Injury" to ensure that the treatment is related to a compensable injury or illness. Develop and recommend to the City a panel of physicians, 3. Maintain close liaison with. treating physicians to ensure that employees receive proper calre and to avoid over-treatment situations. 4. Consult with the Cityls personnel and provide guidance and evaluations of the physical capabilities of. injured employees to return to work. 5. Recommend and assist in the development of medical standards and health requirements for the City's occupational classifications. .. D . EMPLOYEE SERVICES 1. Provide information and guidance to the City's employees regarding Workers' Compensation benefits, inquiries on specific injuries and permanent disabilities ratings in .'accordance with the CityI.s policies. 2. Assist in resolving employee problems related to an industrial injury or illness in non-litigated cases. 3. When medically appropriate, develop rehabilitation programs for injured employees for approval by the City, the retraining or reassignment for employees with physical or performance limitations resulting .from industrial injuries. * employee, and other agencies to provide rehabilitation, 4. 'ConsuJt with employee groups and unions on problem cases . in accordance with the City's policies within a reasonable scope. 5. Develop and recommend policies and procedures to insure that the employee's ability to woqk is consistent with the findings of the Workers ' Compensation Appeals Board. ... E. FISCAL ANALYSIS _. 1, Provide the City's Administration with continuing information on the progress of individual claims and the effectiveness of safety and other cost control programs on Workers' Compensation claims. 2, to asgist in the evaluation of the City's program. pubmit monthly statistical summaries and narrative reports 3, provide periodic projections of cash flow and actuarial prajeFtions of annual incurred costs. 4, Provide a quarterly narrative status report on all major claims with a total expected cost of Ten Thousand Dollars ($10,000) or more. Such report shall also identify those cqses/clairns believed to involve legal expense in excess of One Tiiqusand Dollars ($1,000) . c 5, Provide computer and mangement assistance services to permit Piling for reimbursement of State Mandated Costs under Senate Bill 90 witl! respect to Workers' Compensation benefits and expenses. Said services shall include the provision of a bfegh-down under both Method I and Method 11 of the State Jnstquctions commencing with fiscal year ending June 30, 1984. 111 INSURANCE A. -l3Ipl?f;Y agrees to maintain in force at all times during the term of this Agreement, Workers' Compensation Insurance as required by law. __ B. BTFjpLY agrees to maintain in force at all times during the term of this Agreenent, ProEessional Liabiltiy Insurance in the amount of One Mill.iq ($1,000,000) lollars which shall provide ccveragc for any omission or neglect by BIERLY which arises out of the professional services yequired by this Agreement. . damages or losses suffered by CITY as the result of any error or C. Pie~Ty agrees to mai.ntaj.n in force at all times during the term . of this egreemcnt Fidelity Insurance in an amount ndt less than $1 ,O.OG,QOO, employees of BIERLY. D. shall ])a! be cancelled or reduced by the insurance carrier without CITY having been given forty-five (45) days prior writken notice thereof by such carries. BIERLY agrees -that it will not cancel or reduce 5gi-d insurance coverage-. . Said Fidelity Insurance shall Cover al.l. officers and XnSqFancc pol.icies shall provide ,that the insurance coceragc c E. At all times during the term of this Agreement, BIERLY'shall maintain on file with the City Clerk of CITY a ceEtificate of the insurance carrier or carriers showing that_ the aforesaid policies are in effect in the amounts above provided, and that the policies cannot be cancelled or reduced except on forty-five (45) days notice to CITY. BIEKLY shall not have the right to receive compensation under this Agreement until such certificate or certif.icates are filed with the' City Clerk. IV. RENEWAL OF AGREEMENT After the initial contract period this Agreement may be renewed from year to year by mutual. consent provided, however, that any proposed revisions in the Agreement by either party must: be submitted in writing no later than 90 days preceding the expiration date of the contract. V. TERI4TNATTOPJ OF AGREEMENT . After the first nine (9) months, either party may terminate the Agreement or any renew91 by subrnitting to the other party in writing its intent to terminate at least 60 days prior to the date of termination. Bierly shall not be required to perform any of its services beyond the date of termination. VI. FEES Subject0 a maximum annual fee of Six Thousand Dollars ($6,000) the City shall pay the SUM of Sevent:y-Five Dollars ($75) for each employee claiming Workers' Compensation benefits as a result of any one accident occurring during the first year this Agreement is in effect. Said amounts shall be adjusted on July 1, 1984 and again on JULY 1 1985 in .accordance with the June San Diego consumer price index for all urban consumers and said adjusted amounts shall apply , during the second and third year of this Agreement respectively. .. Payment shall he made monthly commencing August. 1, 1983, at an estimated monthly rate of $500. The July 1 billing each year shall reflect: amy adjustment based on the number of claims recorded on Bierly's statistical run, as may be agreed by City. Bierly will receive no fee for adminis'tration of claiins reported to previous The preceding fees shall include all services under this Agreement except for payments made by Bierly on the City's behalf for medical, disability, other benefits or allocated'loss expenses. -I----. Allocated Loss Expenses shall mean all Workers * Compensation Appeals Bcaril or court costs, fees and expenses; fees for service of process; fees to attorneys; fees of independent adjusters or salaried employees' of Bierly; the cost of employing experts for the purpose of preparing maps, photgraphs, diagram, chemcial or physical questions; the cost of copies of transcripts. of testimony at coroner's inquests or private' records; the cost of depositions and court reporter or recorded statements, and any similar costs or. exp,enses properly chargeable to the defense of a particular claim or to the protection of the subrogation rights of the City' -L provided however, that any of the ' above se,rviccs performed by salari.4 employees of Dierly shall not be considercd allocated expenses. Allocated Loss Expenses are not *. included in the Bicrly service fees. service agent. .. . .. . .. . .. - 'VII.'Additional Conditions ' A. Bierly agrees to indemnify, hold harmless and defend City, its City Council and ea.& member thereof, and every officer and employee of City from any and all liablity or financial loss resulting from any suits, claims losses or actions brought against and from all : costs arid expenses of litigation brought againsb City,. its City Council and each member therof and any ofEicer or einpl'oyee of City which results directly or indirectly from the wrongful or negligent acts of Bicrly, its officers, agents, or employees while engaged in the performance of this Agreement. B. While performing services hereunder Bierly is an independent conractor and not an officer, agent or employee of the City. C. Neither party shall assign this Agreement or any part thereof without the written consent of the other party. D. The servi.ces to be performed by Biekly shall. specifically exclude any which now or in the future are deemed to be the practice of law. E. All claim files, records, reports and other documents and material pertaining to the City's claims shall be the property of the City and shall be delivered to the City or its designee by Bierly ' upon termination of this Agreement. Bierly shall also provide computer tapes contaning computerized data pertaining to the City and its claims, together with the format thereof upon susch termination. F. Bierly agrees to assign Burce L. Miller as Principal Account Examiner to the City to provide liaison between City and Bierly. The assignment of Bruce L. Miller as Principal Account Examiner to the City is a materj.al consideration in City employing Beirly, and assignment of another examiner to City by Bicrly without prior approval by City wil.l constitute a material breach of this Agreement, for which City can terminiate immediately. 1 c . -. . .. Executed this day-of June,' 1383 in the City of- Carlsbad, California. .. City of Carlsbad, a Elunicipal Corporation of the State of Cal.ifornia By : FRANx ALESHIRE, City Manager AT T E ST' : . ALE'I'HA L. RAUTENKRANZ, City Clerk BIERLY AND .ASSOCIATES -- By : Approved as to form: VINCElJT F. BIONDO, Jr., City Attorney c c