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HomeMy WebLinkAbout2021-05-18; City Council; ; Award an Agreement for the Third-Party Administration of Workers’ Compensation Claims to AdminSure, Inc. Meeting Date: May 18, 2021 To: Mayor and City Council From: Scott Chadwick, City Manager Staff Contact: Debbie Porter, Senior Management Analyst debbie.porter@carlsbadca.gov, 760-621-1221 Judy von Kalinowski, Human Resources Director judy.vonkalinowski@carlsbadca.gov, 760-473-4670 Subject: Award an Agreement for the Third-Party Administration of Workers’ Compensation Claims to AdminSure, Inc. District: All Recommended Action Adopt a resolution awarding an Agreement for the third-party administration of workers’ compensation claims to AdminSure, Inc. Executive Summary / Discussion In January 2021, the city requested proposals from outside third-party administrators to manage and administer its workers’ compensation claims. The current contract with AdminSure expires May 31, 2021. A workers’ compensation third-party administrator partners with city staff to provide employees the medical treatment they need to recover and return to work as quickly as possible. This type of third-party administrator investigates and manages claims in accordance with the regulations adopted by state’s Division of Workers’ Compensation, coordinates medical treatment, interfaces with employees who have experienced a work-related injury or illness, provides compliance and financial reporting services, coordinates claim settlements and performs other related functions, such as cost containment, utilization and medical bill review, and payment of benefits to employees. The city received five proposals for this work. The proposals were evaluated based on the quality of the proposals, cost, experience, staff qualifications and level of services available. The city also conducted interviews with the three companies that had the highest-rated proposals. AdminSure received the highest overall rating during the evaluation process. The evaluation is on file with the Office of the City Clerk. AdminSure Inc. proposed services to the city consisting of five claims adjusters and management staff with specialized California professional licenses and certifications and other staff assigned as needed, including registered nurses, state certified bill reviewers and contracted physicians. The services also include maintaining records in specialized databases May 18, 2021 Item #4 Page 1 of 14 and allowing city staff in the Human Resources Department to access these records for purposes of monitoring claim resolution and reviewing data analytics to help with injury prevention and cost management. The term of the proposed agreement with AdminSure will be for five years. The annual fee for the first year is $238,800, with a 3% increase for each of the subsequent years. A scope of services provided by AdminSure and a price proposal is included in Attachment A of Exhibit 1 of this staff report. Under Carlsbad Municipal Code Section 3.28.060, the City Council’s approval is required for the city to procure services and professional services that will cost the city more than $100,000 per agreement year. Options Staff provides the following options for the City Council’s consideration: 1. Authorize execution of an agreement for third-party administration of workers’ compensation claims to AdminSure in the amount of $238,800 for the first agreement year of a five-year agreement with price increases of 3% for each additional agreement year for a total agreement value of $1,267,822. Pros • Contractor has trained staff with specialized skills, state licenses and certifications who are available on an as-needed basis to respond to a varying workload • Lowest cost and highest-rated bidder • Sufficient funding is available for the agreement Cons • None identified 2. Do not authorize execution of an agreement to AdminSure and request staff re-solicit agreement at a future date. Pros: • None identified Cons: • Creates a delay in providing medical treatment to employees who have experienced a work-related injury or illness • Likely higher bids and increased contract cost • Likely to require additional funding appropriation • Potential protest by the lowest responsible and responsive bidder Staff recommend City Council adopt option 1 above. The agreement would become effective June 1, 2021. Fiscal Analysis The proposed agreement contains an annual fee of $238,800 in the first year and a 3% increase for each of the subsequent years. Sufficient funds for this expense have been included in the fiscal year 2020-21 budget and future fiscal year impacts will be reflected during the annual budget process. May 18, 2021 Item #4 Page 2 of 14 Next Steps Staff will complete all administrative actions necessary to implement the new agreement with AdminSure. Environmental Evaluation (CEQA) This action does not constitute a “project” within the meaning of the California Environmental Quality Act under California Public Resources Code Section 21065 in that it has no potential to cause either a direct physical change in the environment or a reasonably foreseeable indirect physical change in the environment. Therefore, it does not require environmental review. Public Notification and Outreach Public notice of this item was posted in keeping with the Ralph M. Brown Act and it was available for public viewing and review at least 72 hours before the scheduled meeting date. Exhibits 1. City Council resolution May 18, 2021 Item #4 Page 3 of 14 RESOLUTION NO. 2021-118 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA, AWARDING AN AGREEMENT FOR THIRD PARTY ADMINISTRATION OF WORKERS' COMPENSATION CLAIMS TO ADMINSURE, INC. WHEREAS, the City Council of the City of Carlsbad, California has determined that the city requires the professional services of a third party administrator that is experienced in managing and administering the city's workers' compensation claims. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as follows: 1.The above recitations are true and correct. 2.The Agreement awarding the contract to AdminSure Inc. to provide third party administration of workers' compensation claims (Attachment A) is approved. PASSED, APPROVED AND ADOPTED at a Regular Meeting of the City Council of the City of Carlsbad on the 18th day of May, 2021, by the following vote, to wit: AYES: Hall, Blackburn, Acosta, Bhat-Patel, Schumacher. NAYS: None. ABSENT: None. MATT HALL, Mayor BARBARA ENGLESON, City Clerk (SEAL) May 18, 2021 Item #4 Page 4 of 14 DocuSign Envelope ID: BDB42EF0-5097-4EC5-AC5E-3D978DOB9CC6 ATTACHMENT A AGREEMENT FOR THIRD PARTY ADMINISTRATION FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATION SERVICES ADMINSURE THIS AGREEMENT is made and entered into as of the 18th day of May , 20 21 , by and between the CITY OF CARLSBAD, a municipal corporation, ("City"), and AdminSure Inc., a corporation, ("Contractor"). RECITALS A.City requires the professional services of an outside agency that is experienced in third party administration of workers' compensation claims. B.Contractor has the necessary experience in providing professional services and advice related to the administration of workers' compensation claims. C.Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work. NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained herein, City and Contractor agree as follows: 1.SCOPE OF WORK City retains Contractor to perform, and Contractor agrees to render, those services (the "Services") that are defined in attached Exhibit "A". which is incorporated by this reference in accordance with this Agreement's terms and conditions. 2.STANDARD OF PERFORMANCE While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California Area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise. 3.TERM The term of this Agreement will be effective for a period of five years from June 1, 2021. 4.TIME IS OF THE ESSENCE Time is of the essence for each and every provision of this Agreement. 5.COMPENSATION The total fee payable for the Services to be performed during the initial Agreement year will be two hundred thirty-eight thousand eight hundred dollars ($238,800). The total fee payable for the Services to be performed shall increase by three percent (3%) per Agreement year in years two through five. No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. The City reserves the right to withhold a ten percent (10%) retention until City has accepted the work and/or Services specified in Exhibit "A". Incremental payments, if applicable, should be made as outlined in attached Exhibit "A". 6.STATUS OF CONTRACTOR Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under control of City only as to the result to be accomplished, but will consult with City as City Attorney Approved Version 6/12/18 May 18, 2021 Item #4 Page 5 of 14 DocuSign Envelope ID: BDB42EF0-5D97-4EC5-AC5E-3D978D0B9CC6 necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes. The payment made to Contractor pursuant to the Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At the City's election, City may deduct the indemnification amount from any balance owing to Contractor. 7.SUBCONTRACTING Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor. Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City. 8.OTHER CONTRACTORS The City reserves the right to employ other Contractors in connection with the Services. 9.INDEMNIFICATION Contractor agrees to indemnify and hold harmless the City and its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys' fees arising out of the performance of the work described herein caused by any negligence, recklessness, or willful misconduct of the Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. The parties expressly agree that any payment, attorney's fee, costs or expense City incurs or makes to or on behalf of an injured employee under the City's self-administered workers' compensation is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement. 10.INSURANCE Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor's agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California's List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best's Key Rating Guide of at least "A:X"; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report. City Attorney Approved Version 6/12/18 2 May 18, 2021 Item #4 Page 6 of 14 DocuSign Envelope ID: BDB42EF0-5D97-4EC5-AC5E-3D978D0B9CC6 10.1 Coverage and Limits. Contractor will maintain the types of coverage and minimum limits indicated below, unless the Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense. The full limits available to the named insured shall also be available and applicable to the City as an additional insured. 10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an "occurrence" basis, including personal & advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for City). $2,000,000 combined single-limit per accident for bodily injury and property damage. 10.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this. 10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor's profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work. 10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions: 10.2.1 The City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to the City. 10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage. 10.2.3 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement. 10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City. 10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement. City Attorney Approved Version 6/12/18 3 May 18, 2021 Item #4 Page 7 of 14 DocuSign Envelope ID: BDB42EF0-5D97-4EC5-AC5E-3D978D0B9CC6 10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements. 11.BUSINESS LICENSE Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time. 12.ACCOUNTING RECORDS Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of three (3) years from the date of final payment under this Agreement. 13.OWNERSHIP OF DOCUMENTS All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy of the work product for Contractor's records. Contractor shall agree and understand that all discussions with the Contractor and all information gained by the Contractor as a result of the Contractor's performance under the contract, shall be confidential and that no reports, documentation, or material prepared as required by the contract shall be released to the public without the prior written consent of the City of Carlsbad. 14.COPYRIGHTS Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes all claims to the copyrights in favor of City. 15.NOTICES The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement. For City Name Ed Garbo For Contractor Name Alithia Vargas-Flores Title President Title Risk Manager Department Human Resources Address 3380 Shelby Street City of Carlsbad Address 1635 Faraday Ave Carlsbad CA 92008 Phone No. 760-814-4288 Ontario CA 91764-5566 Phone No. 909-396-5814 Email Avargas-flores@adminsure.com Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address. City Attorney Approved Version 6/12/18 4 May 18, 2021 Item #4 Page 8 of 14 DocuSign Envelope ID: BDB42EF0-5D97-4EC5-AC5E-3D978D0B9CC6 16.CONFLICT OF INTEREST Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. The Contractor shall report investments or interests in all categories. YesE No El 17.GENERAL COMPLIANCE WITH LAWS Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations. Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement. 18.DISCRIMINATION AND HARASSMENT PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination and harassment. 19.DISPUTE RESOLUTION If a dispute should arise regarding the performance of the Services the following procedure will be used to resolve any questions of fact or interpretation not otherwise settled by agreement between the parties. Representatives of Contractor or City will reduce such questions, and their respective views, to writing. A copy of such documented dispute will be forwarded to both parties involved along with recommended methods of resolution, which would be of benefit to both parties. The representative receiving the letter will reply to the letter along with a recommended method of resolution within ten (10) business days. If the resolution thus obtained is unsatisfactory to the aggrieved party, a letter outlining the disputes will be forwarded to the City Manager. The City Manager will consider the facts and solutions recommended by each party and may then opt to direct a solution to the problem. In such cases, the action of the City Manager will be binding upon the parties involved, although nothing in this procedure will prohibit the parties from seeking remedies available to them at law. 20.TERMINATION In the event of the Contractor's failure to prosecute, deliver, or perform the Services, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, City will make a determination of fact based upon the work product delivered to City and of the percentage of work that Contractor has performed which is usable and of worth to City in having the Agreement completed. Based upon that finding City will determine the final payment of the Agreement. Either party upon tendering thirty (30) days written notice to the other party may terminate this Agreement. In this event and upon request of City, Contractor will assemble the work product and put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable City Attorney Approved Version 6/12/18 5 May 18, 2021 Item #4 Page 9 of 14 DocuSign Envelope ID: BDB42EF0-5D97-4EC5-AC5E-3D978D0B9CC6 under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made. Upon expiration or termination of the contract, Contractor shall assist the City to ensure an orderly transfer of responsibility and/or continuity of those services required under the terms of the contract to an organization designated by the City, if requested in writing. Contractor shall provide and/or perform any or all of the following responsibilities: •Contractor shall deliver, FOB destination, prepaid, all records, documentation, reports, data, recommendations, master, or printing elements, etc., which were required to be produced under the terms of the contract to the City and/or to the City's designee within seven (7) calendar days after receipt of the written request. Any and all records which are on electronic media must be delivered in a format which is compatible with the system(s) currently in use by the City of Carlsbad. •Contractor shall agree to continue providing any part or all of the services in accordance with the terms and conditions of the contract for a period not to exceed thirty (30) calendar days after the expiration, termination or cancellation date of the contract for a price not to exceed those prices set forth in the contract. 21.COVENANTS AGAINST CONTINGENT FEES Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee. 22.CLAIMS AND LAWSUITS By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorney's fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for City to terminate this Agreement. 23.JURISDICTION AND VENUE Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county. City Attorney Approved Version 6/12/18 6 May 18, 2021 Item #4 Page 10 of 14 Mayor ATTEST: 7/d/...a.- Z72. for BARBARA ENGLESON City Clerk DocuSign Envelope ID: 3210E289-10EA-4DBA-970B-C4CBE651B042 24.SUCCESSORS AND ASSIGNS It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld. 25.ENTIRE AGREEMENT • This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and' understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. 26.AUTHORITY The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement. CONTRACTOR CITY OF CARLSBAD, a municipal corporation of the State of California By: By: (sign here) Alithia Vargas-Flores, President (print name/title) By: gsLtui Sas (sign here) Ashley Sells, Secretary (print name/title) If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups. Group A Group B Chairman, Secretary, President, or Assistant Secretary, Vice-President CFO or Assistant Treasurer Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation. APPROVED AS TO FORM: CELIA A. BREWER, City Attorney BY: Ciat, Assistant City Attorney City Attorney Approved Version 6/12/18 7 May 18, 2021 Item #4 Page 11 of 14 DocuSign Envelope ID: BDB42EF0-5D97-4EC5-AC5E-3D978D0B9CC6 EXHIBIT "A" SCOPE OF SERVICES Contractor shall provide usual and customary claims administration services that shall include, at minimum, the following: 1)Review all claims and loss reports filed against the City of Carlsbad and provide a copy of your Best Practices for claim handling. 2)Thoroughly investigate all claims made against City of Carlsbad through appropriate claim procedures as necessitated by the severiN of the injury and ensure correct payment of medical and time loss claims. 3)Provide assistance with tracking COVID-19 claims pursuant to SB 1159 Section 3 and Section 4 and AB 685. 4)Provide cost containment services, including medical fee reductions and a preferred provider network, provide quarterly report of cost containment services. 5)Integrate the current Medical Provider Network into the claims management process. 6)Prepare claim files for submission to a defense attorney. 7)Attend trials, mediations and /or settlement conferences as appropriate. 8)Develop and maintain an investigative file on each claim in accordance with an approved format by the City of Carlsbad. Files are to be readily available for the City of Carlsbad to review and shall be well documented and up-to-date. 9)Notify excess insurance carriers of claims and or occurrences at predetermined levels required by Excess insurers within 30 days of recognition. Provide information and status of claims as requested by the excess insurance carrier. Obtain reimbursements from Excess carrier and maintain accurate refund records on the claim file. 10)Develop and maintain a claims database to be used in the administration of the claims and to generate reports to the City of Carlsbad. 11)Provide the City of Carlsbad with a monthly report of account for individual claims and aggregate loss experience analysis. This report shall show the status of each open claim and experience year-to-date of all claims. 12)Have the capability of providing data necessary to prepare financial and statistical reports on losses or claims. 13)Within 24 hours contact employees and/or injured parties regarding the status of their claim. Return calls or inquiries from employees and/or injured parties within 24 hours of receipt of inquiry. City Attorney Approved Version 6/12/18 8 May 18, 2021 Item #4 Page 12 of 14 DocuSibn Envelope ID: BDB42EF0-5097-4EC5-AC5E-3D978D0B9CC6 14) Provide assistance as necessary to the City of Carlsbad staff for proper procedural handling of claims. 15) Identify and investigate all subrogation possibilities for potential recovery including investigation, evaluation and negotiation of subrogation cases. Maintain financial records of all recoveries on the claim file.. 16) Attend quarterly meetings with the City of Carlsbad staff. 17) Prepare administrative reports required by the State of California. Monitor the compliance of the City's employer reporting requirements and record keeping requirements and advise of any deficiencies in the City of Carlsbad overall self-insured compliance matters. 18) Prepare and/or assist City staff with all appropriate responses to audits and inquiries of all regulatory agencies. 19) Provide 24/7 on-line electronic access to the City of Carlsbad's claims, including payments, claim notes, status and messaging capabilities and ad-hoc report capability. 20) Provide sufficient data producing capability to provide the reporting requirements outlined in this RFP as well as a sufficient records and electronic data retention and back-up and business recovery plan. 21) Provide Bi-Annual program review of claim activity, claim frequency, total incurred, and payment analysis. 22) Have, at a minimum, the following qualifications: 1.A claims administration office located in Southern California. 2.The Contractor's firm and staff should have five years of experience in handling claims for self-insured public entities. 3.Sufficient staff to conduct field investigations, prompt reporting, prompt adjudication of medical and time loss payments and the appropriate level of supervisory personnel to assure compliance with the content of the proposal. The City shall be notified within 24 hours of professional staff turnover and resumes for replacements shall be provided to the City prior to selection. 4.The Contractor's third party administrator services shall be provided in compliance with all applicable federal, state and local laws, requirements and/or ordinances relating to such services. 23) Prepare data to provide to actuary upon request. 24) Maintain and keep all records directly related to the City of Carlsbad's accounts. 25) Upon reasonable notice and at a reasonable time during normal business hours, allow authorized City Human Resources personnel the privilege, of inspecting, examining and/or auditing, any/all records which are directly related to the City's accounts. All inspection, examination and/or auditing shall be conducted at the Contractor's locations where records shall normally be kept. All expenses related to such inspection, examination and/or auditing will be the responsibility of the city. City Attorney Approved Version 6/12/18 9 May 18, 2021 Item #4 Page 13 of 14 Workers' Compensation Claims Administration Services Price Proposal — Guaranteed Pricing City of Carlsbad Price Proposal — Guaranteed Pricing Workers' Compensation Program Services Flat Fee — Claims Administration • • Year one shall not exceed $19,900 per month 3% increase for all litture years (Includes all open, closed and future claims) Electronic 5020 Process • No Additional Fee Transition & Implementation . • No Additional Fee City On-Line Access (All Data/Reports) All Reports & Custom/Ad Hoc Reports • • No Additional Fee — Unlimited Number of Read-Only Users No Additional Fee MMSEA, WC1S, 1SO/EDEX & 1099s • No Additional Fee Training & Development of Special Account Instructions/Procedures, MCM Services, Internal MPN/Banking Management • No Additional Fee. Please note that any MGM, MI-W, or banking fees charged by the City's choice of MCM, MPAT, or bank shall he at-cost as we shall not add on any fee for our internal assistance/services All Meetings, Claim Reviews, Forms, Correspondence, Posters, Pamphlets, Checks, and Storage of Claims II • No Additional Fee Note: Legal Representatives and Copy Services are ancillary costs captured in each claim file and we do not add on any additional fee Page i of I May 18, 2021 Item #4 Page 14 of 14