HomeMy WebLinkAbout1981-06-23; City Council; Resolution 6595b-r .
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RESOLUTION NO. 6595
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF
CARLSBAQ, CALIFORNIA APPROVING AN AGREEMENT WITH
FLEMING & ASSOCIATES FOR WORKERS' COMPENSATION
CLAIMS ADMINISTRATION SERVICES.
WHEREAS, the City of Carlsbad has established a workers'
:ompensation self-insurance program; and
WHEREAS, as part of this program the City will require claims
idministration services; and
WHEREAS, the City has received and evaluated proposals from
Tarious firms to supply such service.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the
lity of Carlsbad as follows:
1.
2.
That the above recitations are true and correct.
That the Agreement between the City of Carlsbad and
Fleming & 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 Council on the 23rd day of June 1981
by the following vote, to wit:
AYES: Council Members Packard, Casler, hear, Lewis and Kulchin
NOES : None
ABSENT: None
GONALD C. PACKARD, Mayor
ATTEST :
R. S-S, Deputy City Clerk
.. ATTACHMENT A
AGREEVENT BETWEEN THE CITY OF GARLSBAD AND FLEYING & ASSOCIATES FOR SUPERVISION AND ADMINISTRATION OF CITY'S WORKERS' COMPENSATION PROGRAM,
THIS AGREEMENT is entered into in the City of Carbbad
between the City of Carlsbad, (hereinafter "CXTY") and Ed Fleming
Company Inc,, doing business as Fleming & Associates (hereinafter
"SERVICE AGENT 1
RECITALS
WHEREAS, SERVICE AGENT is engaged in the supervision
and administration of programs for self-insured employers; and
WHEREAS, for and in consideration of the mutual obli-
gations hereby assumedp and the performance of the acts herein-
after set forth:
NOW, THEREFORE, the parties hereto agree as Eollows:
1. SCOPE OF SERVICES: SERVICE AGENT agrees to super-
vise and administer the self-insurance program of the CITY, to
act as the representative of the CITY in matters related to the
CITY'S obliqation under the Workers Compensation Laws of the State
of California, and agrees further to provide ta the CITY during the
term of this Agreement all the services more particularly set forth
hereinafter;
2. TERM: This Agreement shall take effect at E2rOL a,m,
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July 1, 1981 and shall continue in effect until July 1, 1983,
after which date this Agreement shall continue in effect until
cancelled as hereinafter provided.
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3, COMPENSATION:
The CITY shall pay the sum of One Hundred and ten
Dollars (SllO.00) for each employee claiming WorkersB Compensation
benefits as a result of any one accident occurring during the time
this Agreement is in effect, said amounts shall be billed and paid:
to Service Agent quarterly, based on the number of such claims
recorded on Service Agentas statistical runsI as may be agreed by
the City, commencing October I, 1981,
In additian, the City shall pay the sum of $85 for
each employee claiming Workersg Compensation benefits as a result
of any accident occurring prior to July P, P98P, whose claim has
not been concluded, or could not have been concluded as a result
af due diligence on the part of Service Agent prior to August 1, L98E,
Said amount shall be billed and paid to Service Agent as SOQII as
practical after August 1, 1981,
4. COMPLIANCE WITH LAWS: -
SERVICE AGEKT agrees that its administration of the
self-insurance plan of the CITY shall be in complete csmp1iiaxrce
with all lays, rules and regulations governing the administration
of self-insurance including but not limited to Sections 3700, et
seq. of th? Labor Code and the California Administrative Procedure
Act as set forth in Government Code Sections l1370-PP528.and any
other applicable laws that shall apply during the period this
Agreainent is in effect.
5. CLAIMS ADMINISTRATION :
SERVICE AGENT agrees to perform the following services
in the administration of claims;
A. Assign Nona Fals-Grancell as principal account
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examiner to the City to provide liaison between City an&
Service Agent.
principal account examiner to the City is a material con-
sideration in City employing Service Agent, and assignment
of another examiner to City by Service Agent without prior
The assignment of Nona Fals-GrancePE as
approval by City will. constitrare a material, breach of this
Agreement, €or which
B, Prepare and
for the CITY for tRe
said manual to cover
the responsibilities
in handling employee
the names of SERVICE
accounts e
City can terminate inmtediateLy,
submit an sperating manual of procedure
reporting of claims t~ SEKVXCE: &GENT.
in detail with specific instructions
and procedures to be followed by CITY
on-the-job injuries of any nature arid,
AGENT IS key personnel. hih6li-mj~~CXT.Y 'S
C, Establish and maintain in SERVICE AGEXT'S offices
for a period of five (5) yearsB all records and fixes on
each. of CITYPS reportable employee injuires and complete.
accounting records in connection with each reported case,
Said files and records shall be the property af CETY and
subject to CITYBS inspection at any time,
docm~e~.:?Is will be delivered to CITY in the event a new plan
for kac2.ling Workers Compensation is developed by the CITY,
Such records shall not be disposed of or destroyed without
prior authorization of CITY.
Said files and
0. Determine the injured employee's correct average
earnings to conpute various weekly compensation rates and
compute ax3 pay all. required compensation benefits and
medical becefits from funds provided for that purpose,
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E. Review, compute and authorize pimy" of temporary
disability and permanent disability benefits due injured
- employees, and to pay voluntarily, or under Decisions, 0r&rsp
or Findings and Awards of the Workers Compensation Appeals
Board, and will give the CITY informal advisory ratings and
consulting evaluations in cases involving. permanent disabflikgp,
F, Determine and calculate any possible Ilife/pension
involvement, evaluating factors of injurys occupation, age,
subject complaints and general physical condition, using
currently acceptable actuarial metkadfs,
G, Notify CITY'S Excess Reinsurance Carrier an behalf Qf
the self-insurer of all. claims which may exceed CITY'S zetentbn
and maintain records and effect collection un all cases wherein
CITY is entitled to reimbursement for a loss in excess of its
retention
H. Maintain all payroll and loss records as required
by the California Inspection Rating Bureau,
I, Determine liability of questionable claims in CITYFs
behalf, including necessary investigation, if required., ta
affirra that injury did or did not arise olxk of or during
the cozrse of and scope of employment,
of a questionable nature, where additional investigation is
'On serious cases
deemed necessary, assignments will be made to an independent
adjustment firm. Payment of services will be made from the
loss fund and handled as an allocated expense.
3. Review and report to the Rehabilitation Bureau of
the Division of Industrial Accidents those case that my
require vocational rehabilitation under the Vocational
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Rehabilitation Act, Develop and monitor closely plans
which are submitted $0 the Rehabilitation Bureau for
Vocational Rehabilitation.
6. DEDICAZ ADMINISTRATION :
SERVICE AGENT agrees to perform the following services
in the administration of the medical aspects of claims:
A, Provide a panel of selected physicians or medical
specialists to which injured employees shall be referred when
their injury so requires, The panel will be reviewed annually
by SERVICE AGENT and CITY.
B. Provide continuing medical controi, supervision and
management of employee injury cases so that each employee shall
have all necessary care and treatment and will be returned tcr his
job when his medical condition permits.
@. Authorize hospitalization, surgeryB and all other
types of
in conformance with Labor Code Sections 4600 and 460E,
treatment as required after determination of liability
D.
nature, extent and duration of temporary disability of each
Obtain and evaluate medical expert opinion as to the
employee azd the amount of residual permanent disability, if
anyI to be expected.
E, Provide and maintain a panel of qualified physicians
for treatment of disabled employees as is reasonably required
to cure or relieve the effects of the injury.
not progress adequately from a medical standpoint, SERVICE
Should employee
AGENT shall refer the employee to specialists in the field of
medicine as hdicated e
F. Arrange medical care so that a16 billings €or treatment
shall be made to SERVICE AGENT for auditing and processing for
payment
G. Review, audit, compute and authorize payment of aZL
medical billings in accordance with the Recommended Minbm
Fee Schedule as set forth by the State Division of Industrial
Accidents,
H. Complete administration and processing of any life-
time medical cases awarded or ordered by the Workers Campen-
sation Appeals Board,
I, Provide qlaidance in the evaluation of physical eapa- .
city or injured employees to return to work.
J. Assist in the development of medical standards and
health requirements for all jobs, and incorporate such standards
in a program of pre-employment and periodic examination,
'7, LEGAL ADMIMISTRATIOM:
SERVICE AGENT agrees to provide the following services
in the legal administration of claims;
A. On the application of an injured employee for a hearing
before the 'lilorkers Compensation Appeals Board, SERVICE AGENT
shall where necessary refer the claim to an attorney retained
by the Ciry for the purpose of defending Workers Compensation
claims.
by Ci-tll Attorney of City in advance of retention by SERVICE AGENT,
Said legal counsel shall be acceptable to and approved
B. SE:RVICE AGENT shall confer as is necessary with CITY
and the attorneys during all stages of any legal proceedings to
insure that all facts and investigations necessary will be
available and tiinely, On serious cases of questionable nature,
where additional investigation is deemed necessary, assignments
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will be made to an independent adjusting firm,
services will be made from a loss fund and handled as an alfoeated.
expense.
Payment af the
c. SERVICE AGENT shall protect and preserve the interests aS
CITY and supervise the legal aspects of its obligations to its
injured employees,
interests in all third pasty cases whereever indicated, incluc55ng.
filing of subrogation claims, and liens where appropriate, with
approval of the City Attorney.
SERVICE AGENT shall protect the CITY'S
D. Inform the City Manager or his designee of any current
changes in khe law, in procedures, or of Appeals Board or Court
decisions which might affect CITY'S interests,
E. SERVICE AGENT shall prepare md fj.le a11 reports k
the name of CITY which CITY is required to file, now or in the
future, with the State of California or other bodies as to claim
reserves, accident statistics, and other documents,
F. SERVICE AGENT shall process payments of permanent
disability compensation and death benefits in accordance with
Advisory Ratings, Findsings and Awards, or settlement agreements,
all which have been approved by the City in advance an& alE
Compromise and Release Agreements, Computatians, and Permanent
Disability Ratings resulting from an informal rating or from a
Formal E'inChgs and Award shall be prepared as part of the
administration services.
8. EXPLOYEE SERVICES:
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SERVICE AGENT agrees to provide the following services
as part of an employee informational and rehabilitation program:
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A, provide consultation and recommendations regarding
the development of policies and procedures for employee advisory
services.
B. Provide informatian and guidance to all injured
employees,
C. Identify and assist in soPviag employee problems arising
out of work-incurred disabilities,
D, Consult with employee groups, ‘clllions, on problem
cases at CITY’S direction,
E. Assist in the development sf policies and procedures
to ensure that return to work or reassignment of injured employees
is consistent with the findings of State AdMiniStratiVe Agencies,
9. SB 90 STATE MANDATED LOCAL COSTS ~Il4BlJRSEN3NT SERVICESz
SERVICE AGENT agrees to provide computer and management
assistance services to permit filing for reimbursement sf State
Mandated Costs under Senate Bill 90 with respect to Workers
Compensation benefits a& expenses. Said services shall inc1ucXe
the provision of a breakdown under both Method I and Methad 17:
of the State Instructions commencing with fiscal year ending
June 39, 1982.
IC, ASSUEPTION OF EXISTING CLAIMS: --
SFXJICE AGENT shall acquire and maintain all CITY’S
open and closed claim files, log books and other records from
previous SERVICE AGENT, All open claims shall be reviewed and
updated. Past claim information shall be inputted in SERVICE
AGENT’S computer system and included in periodic reports here-
after described.
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1l, "NEST ACCOUNT:
A, CITY shall deposit with the SERVICE AGENT funds which
SERVICE AGENT will use to establish a trust account on behalf
of the CITY for the settlement of claims, Upan request of the
SERVICE AGENT, the CITY shall transmit sufficient funds to main-
tain the trust account balance at a level adequate to meet
current expenditures as authorized by this Agreement,
B, All caneeEled checks drawn upon the trust account the
bank's statement for the trust account shall. be forwarded to CITY
monthly, In addition, numbered colored carbon copies of all
checks issued shall be mailed weekly to CITY,
C, All. employees of SERVICE AGENT who have access to the
trust account, or the records thereof, shall be bonded,
12. PERIODIC REPORTS:
SERVICE AGENT agrees to provide any and ala statistical
services necessary to maintain control of self-insurance costs
and continue the efficient operation of the Program. Said services
shall include, but not be limited to, %he following:
A, Provision of a monthly loss report for the preceedirq
month, on or before the twentieth (20) day of such succeeding
calendai: Panth, setting forth, not by way of limitation, the
followiPn3 infcrmatfon: the location, the aescription af the
lossL zhe na*ll.xe of the injury, the number of days lost from
workf CiSXA coding, and reserves and payments made during the
given month.
B, Submission of a comprehensive monthly report, for
the preceding month, on or before the twentieth (20) day of such
succeeding calendar month, delineating a "year to date" complete
run of all incurred reserves and payments.
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&1, provision of a complete monthly breakdown for the
preceding month, on or before the kwentieth (20) day of each
month, of all claims as well as "year to date" breakdown by
location and department,
D. Maintenance of all records and statistical data on
losses arising from employee injuries as may be required under
the appropriate laws of the State sf California, and mks and
regulations thereto,
E, Provision of data and informatiall relative ta the
establishment of a reserve dollar amount. for each and every claim
after Administrator's analysis of said elaim, monitor each and
every claim, at a minimum quarterly, to determine if a change in
the reserve dollar amount is required, and provide an analysis af
the reserve fund at such times as the City may require, in order
to insure the adequacy of said fund in light of anticipated and
accrued costs, expenses and claims,
r". Provision of a quarterly narrative status report on all
major claims with a total expected cost sf Ten Thousand Dollars
($10,000) or more,
claims believed to involve legal expense in excess of One
Thousarzd Dollars ($1,000) a
Such report shall also identify those cases/
G, Provision of a comgrehensive annual statistical summary
survey az:d narrative report to serve as the basis for evaluation
of the city's self-insurance program and to permit preparation of
reports required by the Department of Industrial Relations. Such
report shall be submitted to the City no later than August 8,
following the end of each contract year.
13, PNDE~MNIFICATION:
WRVICE AGENT agrees to indemnify, hold harmless and
defend CITY, its City Council and each member thereof, and every
officer and employee of CITY from any and all liability or
financial loss resulting from any suits, claims losses QSZ actians
brought against and from all costs and expenses of Pitigatian
brought against CITY, its City Council and each member thereaf and
any officer ar employee of CITY which results directly or krrd&ect%y
from the wrongful or negligent acts of SERVICE AGENT while engaged
by SERVICE AGENT in the performance of this Agreement,
14, PNSTJRANCE:
A. SERVICE AGENT agrees to maintain inn farce st aXX tim@s
during the term of this Agreement, Workers Compensation Itnsrxrmce
as required by Paw,
B. SERVICE AGENT agrees to maintain in farce at a111 times
during the term of this Agreement, Professional Liability Insur-
ance in the amount of One Million ($K.,OOO,OOO) dollars which shall
provide coverage for any damages or losses suffered by CITY as the
result of any error or omission or neglect by SERVICE AGENT which
arises out of -the professional services required by this Agreement,
C, 1r.swrance policies shall provide that the insurance
coversge shall not be cancelled or reduced- by the insurance
carrier wit'l?out CITY having been given forty-Eive (45) days prior
written notice thereof by such carrier, SERVICE
that it will not cancel or reduce said insurance
AGENT agrees
coverage ..
E, At all times during the term of this Agreement,
SERVICE AGENT shall maintain on file with the City Clerk of
CITY a certificate of the insurance carrier or carriers
showing thak the aforesaid policies are in effect in the amounts
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above provided, and that %he polices cannot be cancelkd or
reduced except on forth-five (45) days' notice to CITY,
SERVICE AGENT shall not have the right to receive compensation
under this Agreement until such certificate or certificates are
filed with the City Clerk,
15, CANCELLATION:
This Agreement may be cancelled by the CITY or the
SERVICE AGENT at any time with or without cause upon giv-rjcng
written notice of at least sixty (60) days prior to the date
of termination,
16, DISPOSITION OF CLAIM FILES AND RECORDS ON
TERMINATION OF AGREEMENT:
All files and records an each claim shall be the
property of the CITY., In the event of cancellation or expiration
of this Agreement and the Agreement is not renewed, the CITY
shall require SEXVICE AGENT %O retun all elaim files to tl~e CITY,
17. CONTmCT ADMINISTRATOR
The Contract Administrator for CITY shall, be. the Rssistarrt
City Ma~ager/Administration~ or his designee.
18. SVCGESSORS AND ASSIGNS.
This Agreement covers professional services of a
specific and unique nature and SERVICE AGENT shall not assign,
sTlblet nor transfer its interest in this Agreement without the
prior written consent of CITY,,
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19. CONFLICT OF I"?XREST
SERVICE AGENT agrees not to accept any employment during
the tern of this Agreement by any other person, firm or corporation
which employment is OF may likely develop a conflict of interest
between CITY'S interests and the interests of third parties,
t*~onflict'P as used herein shall be defined and interpreted in
accordance with Section 1090 of the mvernment Code,
Executed this . day of June 3.381 in the
city of Carlsbad, California,
City of CarPsbad, a Municipal Corporation of the State of
California,
BY FRANK ALESHIRE, City Manager
ATTEST :
ALETHA L. MUTBNKRANZ, City Clerk
FLEMING AND ASSOCIATES
BY
Approved as to form: --
VINCENT F. BIONDO, Jr.
City Attorney