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HomeMy WebLinkAboutRES 09-084 RESOLUTION NO. 09-084 BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF BEAUMONT: THAT the City Manager be and he is hereby authorized to enter into a one (1) year contract with Abercrombie, Simmons & Gillette, Inc., effective April 1, 2009, to administer the City's self-insured workers'compensation program for$63,600 with the option to renew for four(4)additional years at the rates of$63,600 for option year one, $64,824 for option years two and three, and $64,828 for option year four. PASSED BY THE CITY COUNCIL of the City of Beaumont this the 24th day of March, 2009. AW - Mayor Becky Ames - d i 4����, J� s CITY OF BEAUMONT Resolution No. 09-084 SERVICE AGREEMENT FOR ADMINISTRATION OF SELF-INSURED WORKERS' COMPENSATION CLAIMS FOR THE CITY OF BEAUMONT STATE OF TEXAS ) COUNTY OF JEFFERSON ) This Service Agreement is made and entered into this 1st day of April, 2009 by and between the City of Beaumont (hereinafter referred to as "The City", a Texas municipal corporation,acting by and through its City Manager, and Abercrombie, Simmons&Gillette, Inc. a Texas corporation having its principal place of business at 5300 Hollister, Suite 400, Houston, Texas 77040 (hereinafter referred to as "Contractor"), acting by and through its Vice President, Wanda Browning. I. CONTRACTOR'S SERVICES A. The Contractor will perform the following services under this contract as an independent contractor in its relationship with the City, in accordance with the terms and provisions of this contract: (a) Examine on behalf of the City, all reports of job-related injury to or job-related disease of City employees reported to it. (b) Maintain a hard-copy claim file for each reported claim, which file shall be available to the City at all times for inspection. Each file shall contain all data pertinent to the claim to support its disposition. (c) Conduct the necessary investigation of each case by competent and qualified personnel, including such investigation as is necessary to determine the City's liability. The City reserves the right to require additional investigation. (d) After a full and final investigation, decide on behalf of the City what, if anything, should be paid or rendered for each reported claim. Notify the City, of all denials or recommended denials, with specific basis for such, and the outcome of any investigations requested by the City. (e) Pay claims and allocated loss expense out of funds provided by the City. i Page 2 (f) Through utilization review, case management and other cost containment means, monitor care and treatment, and evaluate the propriety of medical treatment and the cost of same prior to the payment of medical and drug bills on compensable workers' compensation claims. (g) Work with City preferred provider organization and pharmaceutical arrangements, if requested. (h) Provide a fee schedule audit of all workers' compensation medical bills against the State-prescribed fee schedule through Argus Services Corporation, a cost containment company. (1) When appropriate, coordinate case management and coordinate timely referrals of workers' compensation claimants to the Texas Rehabilitation Commission. (j) Assign appropriate work involved under this contract to persons who are capable, competent, and experienced in servicing workers' compensation in the State of Texas. (k) With the concurrence of the City, engage the services of persons, or firms outside its organization for special work in connection with investigation, hereinafter referred to as an "Allocated Loss Expense", as that term is defined hereinafter in Paragraph 11. (1) Handle all Benefit Review Conferences, Contested Case Hearings and Appeals Panel procedures before the Texas Department of Insurance, Division of Workers' Compensation, through a law firm chosen by the City. The City will allow Dean G. Pappas & Associates to serve as the City's Designated Austin TWCC Representative. (m) Attend legal proceedings requested by the City. (n) Under the direction of the Law firm selected by the City, obtain and prepare all relevant information necessary to litigation once appeal from the final order of the Texas Department of Insurance, Division of Workers' Compensation, has been filed. (o) Work with City employed experts, when necessary, in the course of claims investigation and hearing and trial preparation. (p) Maintain claim files which reflect all materials and reports necessary for the Page 3 recovery of subrogation claims. The Contractor shall advise the City in writing of any claims upon which subrogation would be proper where all efforts by the Contractor for recovery have been exhausted and legal intervention is recommended. (q) Consult with and advise the City on any matter, including but not limited to loss prevention, employee safety and administrative policy, arising in connection with the business of the City which involves the subject matter of this contract. All such matters shall be handled through the person (or persons) designated by the City. (r) Timely recommend and/or establish Reserves for each claim. Provide all statistical information as requested by the City. (s) Contractor will store City's reported claims data electronically to consist of claim file date, payment record date, and adjuster's notes for as long as all open claims exist in the contracted year of service and City renews with Contractor for the current contract year. (t) Contractor shall provide City with software to allow City to interface with Contractor's computer system using City's personal computer and modem. Interface will allow City to view claims payment records and adjuster notes. (u) Contractor will provide City a report showing the status of each claim assigned, the total reserved amount, the total payments made, and the unspent reserves on each claim. In addition Contractor will supply the City with a single set of loss analysis reports at no additional cost, along with a checks-issued register. This copy will be furnished in (pdf) format or a printed copy as per agreement with City. Contractor shall forward such report to the City by the 5th date of the following month. Any additional data manipulation requests or analysis reports requested by the City will be furnished in accordance with Contractors ability to produce the report in a reasonable time period at no additional charge, or if special programing is required , on an agreed-cost basis in advance of preparation and delivery of report. B. All Contractor's services under this contract shall be performed in the highest professional manner and to the full satisfaction of the City, and in complete accordance with and to conform in every respect to the following instruments. (a) Contractor's proposal submitted on 01/14/09. (b) City of Beaumont's RFP # PF0109-15. i Page 4 The above documents are made a part hereof for all purposes as though they were written word for word herein. (c) For purposes of administration of this Contract, the City will be represented by a designated representative(hereinafter called"Claim Administrator"), and Contractor will be represented by its designated officials. (d) During the term of this Contract, the Contractor shall at all times have an adequately staffed office for the performance of these services. II. ALLOCATED LOSS EXPENSE AND COMPENSATION "Allocated Loss Expense" shall mean costs in connection with hearings before the Texas Department of Insurance, Division of Workers'Compensation,to include Designated Austin Representative, Benefits Review Conferences, Contested Case Hearings and Appeals Panels. Appeals from the final order of the Texas Department of Insurance, Division of Workers'Compensation, including court costs, legal fees and expense of the judicial review, fees for service of process and fees to attorneys shall be allocated loss expense. The cost of services of private investigators, where the same are deemed to be necessary; the costs of employing experts for the purpose of preparing appraisals, maps, photographs and diagrams; chemical, physical, medical or other scientific analysis or giving expert advice or opinions; the cost of transcripts of testimony at coroner's inquests or criminal or civil proceedings and the cost of obtaining copies of any public record shall be allocated lost expense. 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 shall be allocated loss expense. "Allocated Loss Expense" shall not include (i) any of the fees, costs, or expenses that are included in the claims service fees payable to Contractor by the City as agreed to herein or (ii)any payment of fees,costs, or expenses for actual medical or hospital treatment involving a claimant. III. CONTRACT TERM The initial term of this Contract shall be approximately 12 months, commencing on April 1, 2009 and terminating on March 31, 2009 unless sooner terminated in accordance with the applicable provisions hereof. This contract includes an option exercisable by the City to renew four additional one year terms. Page 5 IV. PAYMENT The Contractor claims administration services flat fee proposal is $63,600 for the contract year. This contract includes an option exercisable by the City to renew four additional one year terms at the rate of $63,600 for option year one, $64,824 for option years two and three, and $64,828 for option year four. Inconsideration of the services performed under this contract, City agrees to pay Contractor the lump sum component of each year's fee in twelve equal installments upon receipt and approval of Contractor's monthly invoice. Payments to Contractor shall be in the amount shown by the invoice and other documentation submitted. In the event that the City has neither renewed this Contract nor secured alternative services from another contractor on or before the initial termination date, this Contract may be extended on a month to month basis for a period not to exceed six(6) months at the same terms and conditions herein. The fee for this monthly extension is defined as one twelfth of the annual fee corresponding to the applicable annual fee proposed by Contractor, or in the event of an extension beyond the last renewal year proposed, the fee will be one twelfth of the annual fee proposed for the last year of the contract. Contractor shall cooperate in providing all necessary information and records to the City's successor contractor prior to final termination of this Contract.. V. ACCOUNTING RECORDS, FILES AND REPORTS The Contractor shall maintain all books,documents, papers accounting records and other evidence pertaining to the claim cost incurred, and shall make such materials available at all reasonable times during the terms of this contract for inspection and audit by the City. Upon termination of this Contract, Contractor will deliver all claim files on cases reported to it under this contractor to the City as soon as reasonably practicable. The Contractor shall prepare and submit monthly reports to the City reflecting City's coding system, the names, social security number of the claimants, the amounts of the payments to claimants,the reserve set up forthe future payments to claimants, the dates of injuries or loss, a division between the payments. The monthly reports will be submitted to the City within five (5) days after the end of the prior month. The contractor will provide reports to City's excess carrier on a monthly, quarterly or annual basis and will comply reporting requirements. Contractor shall file , on a timely basis on behalf of the City, such forms and reports as may be required by any Administrative Agency. Contractor shall collect, process, and report data in the manner prescribed by the Internal Revenue Service for the purpose of preparing the City's 1099 Miscellaneous Income filing with respect to the claims payments which are in the subject of this agreement. Page 6 VI. CLAIM PAYMENT ACCOUNT The City agrees to make available funds for the,payment claims and for Allocated loss Expenses. The funds furnished by the City will be accessed through a "Zero Balance Account"maintained at the City's depository bank and funded through the City's "Master Fund" at the same bank. The City will maintain the copy of the canceled checks. Contractor shall have the authority to make payments on any claim handled by Contractor pursuant to this agreement. Contractor shall have the authority to pay, on behalf of the City, any claims-related services falling within the definition of Allocated Expenses. Contractor shall make no single payment in excess of its authority limit of $5,000, without the approval of the City. City reserves the right , on any particular claim, and upon written notice to Contractor, to revoke the authority limit granted and treat such claim as requiring City's approval prior to final disposition. VII. INSURANCE Contractor shall furnish the City with Employee Fidelity Insurance guaranteeing the fidelity of the persons drafting on the funds of the City. Contractor shall also maintain, for the term of this Contract, Commercial General Liability, Automobile Liability, Professional Errors and Omissions, Workers' Compensation and other applicable coverage. Neither the bonds nor the insurance shall be canceled during the terms of this Contract or while Contractor has possession of any City property or funds. VIII. POST CONTRACT SERVICES Contractor shall cooperate in providing information to any contractor who takes over administration of open claims. IX. AMENDMENTS The City may require changes in the scope of services to be performed hereunder. The changes which are mutually agreed upon between the City and Contractor shall be incorporated by written amendments to this contract. Page 7 X. CONTRACT TERMINATION The City may, upon sixty (60) days prior to written notice, terminate this Contract for unsatisfactory performance by Contractor, for non-appropriation of funds, or for any reason deemed in City's best interest. Upon termination, a final accounting will be made of the fees payable to the Contractor and any funds belonging to the City in possession of the Contractor, and any balance due either party will be promptly paid by the debtor party. All City's rights to cancel or terminate this contract for the convenience of the City are expressly retained. The Contractor will also have the right to cancel or terminate this contract for good cause with sixty (60) days prior written notice. XI. APPLICABLE LAWS AND VENUE This contract is made subject to all applicable Federal and State laws. This contract shall be enforceable in Beaumont, Jefferson County, Texas, and if legal action is necessary by either party with respect to the enforcement of any or all of the terms and conditions herein, exclusive venue for same shall lie in Jefferson County, Texas. This contract shall be governed by and construed in accordance with the Laws and Court Decisions of the State of Texas. XII. ENTIRE AGREEMENT This contract contains all commitments and agreements of the parties hereto, superseding any previous and contemporary verbal or written agreements between the parties, and no modification to this contract may be made, except as provided in Paragraph IX above. CONTRACTOR covenants and agrees to FULLY INDEMNIFY and HOLD HARMLESS the CITY and its elected officials, employees, officers, directors and representatives, individually or collectively, from and against any and all costs, claims, liens,damages, losses,expenses,fees,fines, penalties, proceedings, actions,demands, causes of action, liability and suits of any kind and nature, including but not limited to, personal or bodily injury, death and property damage, made upon the CITY directly or indirectly arising out of, resulting from or related to CONTRACTOR'S activities under this CONTRACT, including any acts or omissions of CONTRACTOR, any agent, officer, director, representative, employee, consultant or sub-contractor of CONTRACTOR, and their respective officers, agents, employees, directors and representatives while in the exercise of performance of the rights or duties under this CONTRACT. The indemnity Page 8 provided for in this paragraph shall not apply to any liability resulting from the negligence of CITY, its officers or employees, in instances where such negligence causes personal injury, death, or property damage. In the event contractor and CITY are found jointly liable by a court of competent jurisdiction, liability shall be apportioned comparatively in accordance with the laws of the state of Texas, without, however, waiving any governmental immunity available to the City under Texas law and without waiving any defenses of the parties under Texas law. The provisions of this INDEMNIFICATION are solely for the benefit of the parties hereto and not intended to create or grant any rights, contractual or otherwise, to any other person or entity. CONTRACTOR shall promptly advise the CITY in writing of any claim or demand against the CITY or CONTRACTOR known to CONTRACTOR related to or arising out of CONTRACTOR'S activities under this CONTRACT. Page 9 XIII. ASSIGNMENTS AND RESPONSIBILITY FOR WORK This contract shall not be assigned or transferred by Contractor without the prior written consent of the City. IN WITNESS WHEREOF,the ity of Beaumont has caused this Contract to be executed on the `�' day of , And Contractor, signing by and through its duly authorized officer, thereby binding the parties hereto, their successors, and assigns for the faithful and full performance of the terms and provisions of this contract. CONTRACTOR: Abercrombie, Simmons & Gillette, Inc. BY: W,, aA'JA � &iau Aa Wanda Browing Vice President STATE OF TEXAS KATHERINE BWMELEW �• toy putt state afTem My Cwntom E*m 04--2011 COUNTY OF JEFFERSON SWORN TO AND SUBSCRIBED before me this 9-1 h day of A r� 2009, by Wanda Browing. w � 9Notary Public CITY OF BEAUMONT I B Y � l Kyle Hayes City Manager STATE OF TEXAS Page 10 COUNTY OF JEFFERSON § SWORN TO AND SUBSCRIBED before me this 'yam day of e" 2009, as the representative of the City of Beaumont J! Public +o�`•" P°4'4s FAYE S, JOHNSON Notary Public,Stets of Texas 1 My Commission Expires August 7Z, 2009 i