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HomeMy WebLinkAbout1986-06-03; City Council; Resolution 8575RESOLUTION NO. 8575 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' canpensation self- insurance progran; and WHEREAS, as part of this program the City will require claims administration services; and WHEREAS, the City has received and evaluated a proposal fran Bierly and Associates to continue to supply such service. NOW, THEREFORE, RE IT RESOLVED by the City Council of the City of Carlsbad as follows: 1. That the abwe 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 Manqer 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 -- 3rd day of June , 1986, by the following vote, to wit: AYES: Council Members Casler, Lewis, Kulchin, Chick and Pettine NOES: None 1 2 3 4 5 6 7 8 9 LO 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ABSENT: None ATTEST: ALETW &d&- L. RAUTENKRANZ, City Clerk AGR EMENT FOR WORKERS ' COHPENSAT IO N ADMINISTRATION SERVICES day of --. , 1986, between THIS AGREEMENT is entered into this BIERLY AND ASSOCIATES, hereinafter cm "Bierly" and thmOF CARLSRAD, hereinafter called ''City" . The Parties agree as follows: I. The period of this Agreement shall be fran 3uly 1, 1986 through 3une 30, 1 989. 11. Rierly shall perform the following services on behalf of the City: A. PROGRAM DEVELOPMENT 1. Consult with the City's personnnel and assist in developing the necessary procedures, practices and coordination to implement the City's Self-Insured Program ard to meet the legal requirements of the State. 2. personnel involved directly or indirectly in the processing of industrial injury cases. Conduct, or assist in corducting, orientation meetings for the City's 3. statutes, rules and regulations affecting the City's responsibility under a 1 eg a1 ly un insur ed Workers ' Com pe nsa t io n Pr ogr an. Pruvide the City .with infomation on chaqes or proposed charges in 4. Review with the City's representatives progran progress, including identification of problem areas and recanmerd solutions therem. 5. Estdlish procedures and necessary documentation to provide for the payment of benefits, medical costs, legal fees and other related costs to enhle either the City or Bierly to issue checks to cover such expenditures . B. CLAIMS ADMINISTRATION 1. Maintain all City's open and closed claim files, log books and other records. Claims information shall be inputted in Bierly's canputer system and included in reports hereafter described. 2. Review and process all claims for Workers' Compensation benefits in accordance with the requirements of the Industrial Relations Department for reporting and notification. 3. Determine the.canpensability of claimed injuries and illnesses in accordance with the State's Workers' Compensation law. 4. Determine eligibility for authorized payments of medical benefits and authorize examinations to determine the nature and extent of disability when appropriate. 3 C. 5. disability canpensation in coordination with medical advice and rehabilitation efforts. Determine eligibility for and autbrize payment of tanporary 6. workers utilizing as necessary and desireable, advisory ratings of the Permanent Disability Rating Bureau. Determine the degree of permanent disability, if any, of injured 7. benefits in accordance with advisory ratings, orders of the Workers' Compensation Appeals Board, or Compranise and Release settlements. Authorize the payment of permanent disability canpensation and death 8. Where necessary, and with approval of City, refer litigated cases to atbrneys, utilizing an agred listing of legal firms. Assist in the preparation of litigated cases, negotiations of Comprmise 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 arraqe for investigation of, as necessary ad appropriate, questionable cases and the status of disabled employees in order to adjsut all cases and to assist in the trial or settlement of litigated cases. 11. that no claims examiner will be required to handle more than 200 open indemnity cases at any one time. Assure that sufficient numbers of claims personnel are available so 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. of all claims which may exceed City's retention and maintain records and effect collection on all cases wherein City is entitled to reimbursement for a losss in excess of its retention. Notify City's Excess Reinsurance Carrier on behalf of the self-insurer MEDICAL CONTROL 1. Develop and recanmend to the City a panel of physicians, dentists, chiropractors and other practitioners for the treatment of injured employees and recanmend a panel. of such specialists as may be required for log-term or other disabilities requiring special treatment. 2. Monitor treatment prograns for injured employees including the review of all "Doctor's First Report of Work Injury" to ensure that the treatment is related to a canpensable 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 Cty's personnel and provide guidance and evaluations of the physical capabilities of injured employees to return to work. 4' D. E. 5. Recanmend and assist in the development of medical standards and health requirements for the City's occupational classifications. EMPLOYEE. SERVICES 1. Provide information and guidance to the City's employees regarding Workers' Comensation benefits, inquiries on specific injuries and penanent disabilities ratings in accordance with the City's policies. 2. Assist in resolving employee problems related to an industrial injury or illness in non-litigated cases. 3. 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 resulting fran industrial injuries. When medically appropriate, develop rehabilitation prograns for 4. with the City's policies within a reasonable scope. Consult with employee groups and unions on problem cases in accordance 5. Develop and recanmend policies and procedures to insure that the employee's ability to work is consistent with the findings of the Workers' Compensation Appeals Board. 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 prqrans on Workers' Compensation claims. 2. Submit monthly statistical summaries and narrative reports to assist in the evaluation df the City's progran. 3. annual incurred costs. Provide periodic projections of cash flow and actuarial projections of 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 canputer and management assistance services to pennit 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 Methoc I and Method I1 of the State Instructions. I 11. INSURANCE A. Agrement, Workers' compensation Insurance as required by law. Bierly agrees to maintain in force at all times during the tan of this 6. Agreement, Professional Liability Insurance in the amount of One Million Dollars ($1,000,000) which shall provide coverage for any damages or losses suffered by City as the result of any error or omission or neglect by Bierly which arises out of the professional services required by this Agreement. C. Agreement Fidelity Insurance in an amount not less than $1,000,000. Fidelity insurance shall cover all officers and employees of Bierly. Bierly agrees to maintain in force at all times during the term of this Bierly agrees to maintain in force at all times during the term of this Said 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. agrees that it will not cancel or reduce said insurance coverage. Bierly E. At all times during the term of this Agrement, 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. compensation under this Agreement until such certificate or certificates are filed with the City Clerk. Bierly shall not have the right to receive 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. TERMINATION OF AGREEMENT After the first nine (9) months, either party may terminate the Agreement or any renewal by submitting to the other party in writing its intent to terminate at lest 60 days prior to the date of termination. perform any of its services beyond the date of termination. Bierly shall not be required to VI. FEES - Subject to a maximum anmal fee of Fourteen Thousand Three Hundred Seventy Five Dollars ($14,375.00) the City shall pay the sum of One Hundred Fifteen Dollars ($115) for each employee claiming Workers' Compensation benefits as a result of any one accident occurring during the first year this Agrement is in effect. Said amounts shall be adjusted on 3uly 1, 1987 and again on 3uly 1, 1988 in accordance with the 3une San Diqo 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 be made monthly canmencing August 1, 1986, at an estimated monthly rate of $1,000. The 3uly 1 billing each year shall reflect any adjustment based on the number of claims recorded on Bierly's statistical run, as .nay be agreed by City. previous service agent. Bierly will recieve no fee for administration of claims reported to c * The preceding fees shall include all payments made by Bierly on the City's benefits or allocated loss expenses. services under this Agrement except for behalf for medical, disability, other 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, photographs, diagrans, chemical 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 expenses properly chargeable to the defense of a particular claim or to the protection of the subrogation rights of the City - prwided however, that any of the abwe services performed by salaried employees of Bierly shall not be considered alocateed expenses. Allocated Loss Expenses are not included in the Bierly service fees. VII. 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 frcm any and all liability or financial loss resulting fran any suits, claims losses or actions brought against and fran all costs and expenses of litigation brought against City, its City Council and each member thereof and any officer or employee of City which results directly or indirectly fran the wrongful or negligent acts of Bierly, its officers, agents, or employees while engages in the performance of this Agrement . 6. While performing services hereunder, Bierly is an independent contractor and not an officer, agent or employee of the City. C. written consent of the other party. Neither party shall assign this Agreement or any part thereof witbut the D. now or in the future are deemed to be the practice of law. The services to be performed by Bierly shall specifically exclude any which 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 ccmputer tapes containiq canputerized data pertaining to the City and its claims, together with the format thereof upon such termination. 7 day of -*---' 1986, in the City of Carlsbad, - Executed this California. City of Carlsbad, a Municipal Corporation of the State of California BY: --rrL---u-uu -_Y__y FRANK ALESHIRE, City Manqer ATTEST: BIERLY AND ASSOCIATES BY: -- -~ -u- - Approved as to fonn: I1I- VINCENT F.BIONDO,gr., CityAttorney