HomeMy WebLinkAbout1983-06-21; City Council; Resolution 72501
F
1
4
E c.
E
'i
E
s
1c
11
12
12
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
--%- RESOLUTION NO.
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.
That the City Manager is hereby authorized to sign the
agreement on behalf of the City.
3.
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 :
NOES : None
Council Mrs Casler, Lewis, Kulchin, Chick and Prescott
ABSENT: None
ATTEST :
AGREEMENT FOR -WORKERS COMPENSATION
ADMINISTRkTION 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 "CitylI.
The Parties agree as foll.ows:
I. The period of this Agreement shall be from July 1, 1983 through
June 30, 1986.
II, Rierly shall perform the following services on behalf of the
City:
A, P RCG R,w DEVELOPMENT ---.-
1, the necessary procedures practices and coordination to i.mplement the City's Sel-f-Insured Program and to meet the legal requirements of the State.
Consult with the City's personnel and assist in deve1opir.g
2. CoRduct, or assist in conducting , orientation meetings €or the City7 s personriel. involved directly or indirectly in the
processing of industrial injury cases.
Provide the City with information on changes or proposed
changes in statutes, rilles and regulations affecting the City's
responsibility under -a legally uninsured Workers' Compensation
Progr ani a
9 39
4. P.eview with the City's representatives program progrgss,
including identification of problem areas and E2commend solutj.ons
thereto,
5. Establish procedures and necessary documentation to
provide for the payment of benefits, riiedical costs, legal fees
and other related costs to enable either the City or Bpirly to
issue checks to cover such expenditures.
B. CLAIMS ADMINIST'RXTION ~-_.---..-
1, Acquire and maintain all 'CITY'S open and closed claim
files, log books and other records fr-ofn previous SERVICE AGENT. all open claims sha1l.h reviewed and updated. Claims informatior, shall. be inp:rtted in BIERLY'S computer system and
included in reports hereafter described.
2. Review and process all clainis for Workers' Compensation
benefits in accordance with the requirements .05 the Industrial
Relations Department for reporting and notification e
3. Determine the compensability of claimed injuries and illnesses in accordance with the Sta.te's Workers' Compensation
. law.
4. Determine eligibility for and authorize payments of
medical benefits and authorize examinations to determine the
nature and extent of disability when appropriate e
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 disability, if any, of
injured workers utilizing as necessary and desireable, advisory
ratings of the Permanent-, Disability Rating Bureau.
7. Authorize the payment of pernanent disabi.3.ity 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 litigated cases to attorneys, utilizing an agreed listing of
legal firms. Assist in the preparation of litigated cases, negotiations of Compromise and Release settlements and subrogation actions. .
9. Maintain current estimates of costs of all anticipated
benefits and related expenses on each case.
10. Investigate or aruange for investigation of, as necessary
and appropriate, questionable cases and the status of disabled
employees in oruer to adjust all cases and to assist in the trial or settlement of litigated cases,
11. Assure that sufficient numbers of claims personcel 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 subrogation claims, and liens where appropriate, with approval of CITY.
13. Notify CITYc'S Excess Reinsurance Carrier on behalf of the
self-ins.urer of all claims which m8y exceed CITY'S retention and
maintain records and effect collection on all cases wherein CITY is entitled to reimbursement €or a loss in excess of its retention,
C. MEDICAL CONTROL
1. Develop and recommend to the City a panel of physicians, dentists , chiropractors and other practitioners €or t'he treatement 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 injured employees including
the review of all "Doctor's First Report of Work Injury" to
ensure that the treatment is related to a compensable injury or illness,
3. Maintain close liaison with treating physicians to ensure
that employees receive proper care and to avoid over-treatment
situations
4. Consult with the City's personnel and provide guidance and evaluations of the physicai capabilities of injured employees to
return to work.
5. Recommend and assist in the development of medical standards and health requirements €or the City's occupational classifications.
D. -- EMPLOYEE SERVICES
1. Provide information and guidance Lo the City's employees regarding Workers ' Compensation benefits , inquiries on specific injuries and permanent disabilities ratings in .accordance with
the City's policies e
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
employee, and other agencies to provide rehabilitation, retraining or reassignment for employees with physical or performance limitations resu1tin.g .from industrial injuries.
4. Consult with employee groups and unions on problem cases in accordance with thc City's policies within a reasonable scope
5. Develop and recommend policies and procedures to insEre that the employee's ability to work is consistent with the
findings of the Workers Compensation Appeals Board
c
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. Subnit monthly statistical summaries and narrative reports to assist in the evaluation of the City's program.
3. Provide periodic projections of cash flow and actuarial projections of annual incur'red 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 cases/claims believed to involve legal expense in excess of One Thousand Dollars ($1,000).
5. Provide computer and mangement assistance services to permit filing for reimbursement of State Mandated Costs under
Senate Bill 90 with respect to Workers' Compensation benefits
and expenses, Said services shall include the provision of a breakdown under both Method I and Method I1 of the State Instructions commencing with fiscal year ending June 30, 1984.
I11 * INSUKIiNCE
A, BIERLY agrees to maintain in force at all times during the term
of this Agreement, Workers' Compensation Insurance as required by
law.
B. RIERLY agrees to maintain in force at all times during the term
of this Agreement, Pro€essional Liabiltiy Insurance in the amount of One MiLLion ($1,000,000) Zollars which shall provide ccverage for any damages or Losses suffered by CITY as the result of any error or
omission or neglect by RIERLY which arises out of the professional
services required by this Agreement
C. Rierly agrees to inaintain in force at all times during the term
of this Agreement Fidelity Insurance in an mount not less than
~1,000,000, Said Fidelity Insurance shall cover all officers and
enployees of BIERLY.
D, Insurance policies shall provide .that the insurance coverage
shall not be cancelled or reduced by the insurance carrier without
CITY having been given forty-five (45) days prior written notice
thereof by such carrier. BIERLY agrees that it will not cancel or
reduce said insurance coverage. .
E. At all times during the term of this Agreement, BIERLY shall
maintain on file with the City Clerk of CITY a certificate 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, BIERLY 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 tnan 90 days preceding the expiration date of the
contracts
V, TERMINATTON OF AGREEMENT
After the first nine (9) months, either party nay terminate the
Agreement or any renewel by submitting 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 Subject to a maximum annual fee of Six Thousand Dollars ($6,000) the City shall pay the sum of Seventy-Five Dollars ($75) for each
employee claiming FJorkers' 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 a11 urban consumers and said ad-justed amounts shall apply
L
, during the second ar,d third year of this Agreement respectively.
Payment shall be made monthly commencing August 1, 1983, at an estimated monthly rate of $500. The July 1 billing each year shall reflect any 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 administration of elairns reported to previous service agent ,,
The precediray 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.
Allocated Loss Expenses shall mean all Workers' Compensation Appeals
Board 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, diagrams, 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 expnses properly chargeable to the defense of a particular claim or to the protection of the
subrogation rights of the City - provided however, that any of the
above services performed by salaried employees of Bierly shall not be considered allocated expenses. Allocated Loss Expenses are not
included in the Bierly service fees.
-7
VI1 Additional Conditions
A. Bierly 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 li-ablity or financial loss resulting from
any suits, claims losses or actions Srouqht against and from all
costs and expenses of litigation brought against City, its City Council and each member therof and any of€icer or employee of City which results directly or indirectly from the wrongful or negligent acts of Bierly, 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 services to be performGd by Bierly shall specifically
exclude, any which n.ow 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 e Bierly shali 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 Le Miller as Principal Account
Examiner to the City to provide liaison between City and Bierly. The assignment of Bruce Le Miller as Principal Account Examiner to
the City is a material consideration in City employing Beirly, and assignment of another examiner to City by Bierky without prior
approval by City wil.1 constitute a material breach of this Agreement, for which City can ‘cerminiate immediately,
.
Executed this day-of June,' 1983 in the City of-Carlsbad,
California.
ATTEST:
City of Carlsbad, a Municipal Corporation
of the State of California
By :
mArG ALESHIRE, City Manager
ALETHA L. RAUTENKRANZ, City Clerk
BIERLtY AND ASSOCIATES
---- .--e -- By :
Approved as to form:
-- -III VINCENT F. B~ONDO ~r , city Attorney
c