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HomeMy WebLinkAboutR-95-0393J-95-436 5/11/95 RESOLUTION NO. 9 5- 3,93 A RESOLUTION, WITH ATTACHMENT(S), AUTHORIZING THE CITY MANAGER TO ISSUE A REQUEST FOR PROPOSALS ("RFP"), IN SUBSTANTIALLY THE ATTACHED FORM, TO SOLICIT PROPOSALS FROM FIRMS TO PROVIDE SERVICES CONCERNING ALL PHASES OF RISK MANAGEMENT FOR THE CITY OF MIAMI; ESTABLISHING A REVIEW COMMITTEE TO REVIEW SAID PROPOSALS AND MAKE RECOMMENDATIONS TO THE CITY MANAGER; j AND PROVIDING FOR APPOINTMENT OF MEMBERS TO SAID COMMITTEE. WHEREAS, the City of Miami is interested in soliciting proposals from private firms to provide services for all phases of Risk Management, including, but not limited to worker's Compensation, General Liability, Public Officials Liability, Police Tort and Insurance for Liability and Property; and WHEREAS, it is the intent of the City to streamline its operations and determine if it is feasible and in the City's best interest to privatize Risk Management; and WHEREAS, it is necessary for the City Commission to establish a committee and appoint members to review the proposals submitted; NOW, THEREFORE, BE IT RESOLVED BY THE COMMISSION OF THE CITY OF MIAMI, FLORIDA: CITY CO=ISSION MEETI!dG OF. MAY 1 1 1995 Resolution No. 95- 393 Section 1. The recitals and findings contained in the Preamble to this Resolution are hereby adopted by reference thereto and incorporated herein as if fully set forth in this Section. Section 2. The City Manager is hereby authorized-" to issue a Request for Proposals ("RFP"), in substantially the attached form, to solicit proposals from firms to provide services concerning all phases of Risk Management for the City of Miami. Section 3. A Review Committee is hereby established to review said proposals and make recommendations to the City Manager, and it is hereby further provided that the appointment of members to the Review Committee shall be submitted in writing by the members of the City Commission upon notification by the City Manager that proposals have been received. Section 4. This Resolution shall become effective immediately upon its adoption. ' / The herein authorization is further subject to compliance with all requirements that may be imposed by the City Attorney, including but not limited to those prescribed by applicable City Charter and Code provisions. -2- 95- 393 PASSED AND ADOPTED this 11th day of May 1995. <j h WC...<:�7 . STEPYIEN P. CLAR , MAYOR ATTEST: MATTY H CITY CL APPROVED AS TO FORM AND CORRECTNESS: eu,j;lowx�,wwl 4:7 A. f Q O I I CITY ATT Y W072:BSS -3_ 95- 393 G/8/95 CITY OF MIAMI RISK MANAGEMENT REQUEST FOR PROPOSALS The City of Miami is seeking qualified Proposers for the Management and Operations of their Risk Management function. The Proposer must respond to each area addressed in the scope of services individually and as a complete package encompassing all functions. This will be a one year contract for the initial term with additional one (1) year extensions up to a maximum of three (3) years. The Proposer must be prepared to assume all the day to day activities in the processing and handling of worker's compensation claims, liability claims and insurance matters of the City. The Proposer will be required to work closely with the City Attorney's Office, the Finance Department and other major departments in the City. The Proposer should be able to recommend risk control measures and safety programs to protect the City's interest. The Proposer must become familiar with existing labor contracts which affect the benefits of worker's compensation claims. The Proposer will report all activities to the Self Insurance and Insurance Trust Committee or their designee as requested, but at least on a monthly basis. The successful Proposer must provide a timetable identifying significant milestones for the smooth transition of the operations, as well as, the necessary support they will require from City staff. 95- 393 2 511195 M M a � V CITY OF MIAMI RISK MANAGEMENT REQUEST FOR PROPOSAL General Information About the Risk Management Program Self Insured Program -General Information The City of Miami maintains a formal Self -Insurance Program in accordance with Section 18-93 through 18-104 of the City of Miami Code. (Copy attached). The City of Miami utilizes this program to provide protection to the City for all property and casualty loss exposures, workers' compensation claims and to provide group health benefits to its active and retired employees. Although the program utilizes a single insurance fund, (The Self Insurance and Insurance Trust Fund), the scope of this request, will address the areas of Workers' Compensation and Property and Casualty. The Division of Risk Management within the Department of Fire -Rescue is charged with the Administration and claims handling of the Self -Insurance Program. To this end, the functions are assembled into three sections covering Workers' Compensation, Tort Liability and Insurance. The Division of Risk Management is comprised of thirty professionals and support staff. All adjusters and supervisors are licensed in the State of Florida. Risk Management works closely with the City Attorney's Office in the negotiating and settlement of claims. Self -Insurance and Insurance Trust Committee This Committee is charged with the responsibility for, and guidance of, the Self - Insurance Program. The Committee is comprised of high level administrators from the City of Miami. The members are uniquely familiar with and committed to the Program. All activities of the Administrator will be reported to this Committee or their designee. Safety Program The City recognizes the importance of a strong Safety Program as the primary tool for mitigating loss. The City is currently in the process of revamping the Safety Program in order to achieve a more cohesive and centralized unit from which policies and strategies can be developed, implemented and enforced. Light Duty The City of Miami has managed Light Duty Programs within the Police, Fire and GSA Departments for many years. Currently, Risk Management has developed a 95- 393 k,. 5/1/95 M M p � V modified Duty Program to establish a pool of Light Duty employees for use in various City departments. EXHIBIT A SCOPE OF SERVICES 1. GENERAL REQUIREMENTS OWNERSHIP OF CLAIM FILES All claim files maintained by Administrator pursuant to this agreement, and all materials therein or gathered by or entrusted to Administrator in the course of investigating or administering any claims pursuant to this agreement, shall be and remain the sole property of the City of Miami, and such files and materials shall be delivered over by the Administrator to the City upon demand, thereof, by the City. Administrator agrees to treat and handle as confidential all such files and materials, to the full extent that same is permitted by applicable law. Said files and materials shall at all times by physically kept and maintained by Administrator at its offices in the City of Miami, Dade County, Florida. Please state how long you will retain the City's claims records. The claims administrator shall provide written comment on its understanding that all claims files and other records, documents, lists, supplies, etc. pertaining to claims are the property of the City, not the administrator, and should be given to the City upon demand. The administrator is permitted to make and maintain duplicate copies of the files, records, documents etc., if the administrator is desirous of such records subsequent to contract termination. LOSS CONTROL SERVICES When requested by the City of Miami to do so, Administrator agrees to consult with the City, its employees and agents and others, concerning workplaces, operations, work procedures, and equipment owned or operated by the City, and make recommendations to the City regarding same, for the purpose of establishing loss control systems to mitigate and/or control losses, damage, and claims; provided, however, it is understood and agreed that neither the rights of Administrator to make inspections, nor its recommendations or reports as to loss control, shall constitute an undertaking on behalf of or for the benefit of the City, or its employees or others, to determine, warrant, or guarantee that such work places, operations, procedures, or equipment are free and safe from defects and/or hazards. 3 95- 393 k-- 511195 M D W � V "RUN-OFF" CLAIMS The Administrator agrees to assume responsibility -for the accurate and professional management of all open claims previously administered by the City. Financial data will be accurately merged into the risk management information system so that loss history information for prior periods will be accurately included in the City's loss reports and for remote claims status inquiry. (Indicate file conversion ability and cost). For claims occurring after the contract date, it is desired that the claims administrator will handle all claims occurring during the term of the contract to their final settlement without regard to complexity or length of time and without additional charge. SELF-INSURANCE ADMINISTRATION SUPPORT Administrator will provide the necessary reports and/or data to satisfy Florida's self- insurance requirements. Required forms will be completed by Administrator, and will be sent to the City for review and appropriate signatures. Required self-insurance reports will be provided on a timely basis so that the City will have sufficient time to review and execute the documents before the due date. QUALITY CONTROL AND SUPERVISION The City of Miami expects the claims administrator to render high quality claims management and adjusting set -vices throughout the entire contract period. It is expected that the personnel will have the following levels of experience and licensure: Supervisor or supervising adjuster 5 years Adjusters) (workers' compensation and Liability 3 years Medical -only processor(s) 1 year A copy of each adjuster's and supervisor's Florida adjusting license must be made available prior the assignment of any claims. Files must reflect evidence of supervisory direction and involvement at every level. All files must be kept current. File review should be performed on 30, 60, 90, or 120 day cycles as appropriate. Periodic review by the handling adjuster and all supervisors should be reflected in the file. Supervisors should receive all First reports and outline investigative needs a well as assigning out for assistance when necessary. These supervisors should assign the most difficult files to the most qualified adjuster. 35- 343 4 k__ 5/1/95 D UU "BAD FAITH" LAWSUITS The City of Miami shall be notified of all "bad faith" lawsuits which include breach of good faith and fair dealing. Any "bad faith" lawsuit filed against the City or the Administrator shall be handled by the City of Miami's law Department or their designee. If the allegation is that the Administrator committed or acted in "bad faith", the lawsuit and attorneys' fees shall be the Administrator's responsibility, but the City of Miami attorneys will monitor the conclusion. If a claim is in litigation and there is also a "bad faith" claim alleged, it may be necessary to retain separate attorneys. Once a "bad faith" lawsuit has been filed, a separate file pertaining only to the issues on "bad faith" shall be established. AUDITS The City of Miami and/or its agents, employees, and designees shall have the right and authority at all times during normal business hours to conduct audits of said claim files at the Administrator's office. On an ongoing basis, the most recent Financial Statements and audit reports, whether internal or outside audits, must be provided to the City of Miami. LAWSUITS Whenever the Administrator receives notification of suit being filed against the City of Miami for any reason, notification shall be given to the City Attorney's office. RECOVERIES The Administrator shall aggressively pursue recoveries to the satisfaction of the City of Miami including recoveries based on subrogation and special disability trust fund. In particular, the Administrator will assist in the collection of claims against others for damage to participants; property and make recommendations regarding salvage matters. The Administrator will pursue, track and provide quarterly reports on all second injury fund, subrogation and other recovery opportunities. DATA INTEGRITY The Administrator agrees to be responsible for data integrity. This includes properly inputting all cause codes, location codes, loss descriptions, and other- claims information. If a data conversion is involved, the Administrator must attest to the integrity of the combined data. MANDATORY REPORTING Administrator evil) furnish required tax information for the Internal Revenue Service including 1099s with a magnetic tape of the 1099s submitted to the IRS. Any IRS 95- 393 5/1/95 M M i u u V requirements initiated subsequent to this contract will also be provided by the Administrator. The Administrator will provide special administrative reports such as but not limited to the OSHA 200 Report -Bureau of Labor Statistics Log and Summary of Occupational injuries and illnesses, and any -reports- required by the Florida Division of Workers' Compensation and/or Bureau of Self Insurance. ACCESS TO CLAIMS OFFICE The Administrator agrees that it will have and maintain claim offices in Dade County, Florida, and that the services required under this agreement will be performed by employees of that office, except in special circumstances, which will require approval of the City of Miami. The administrator shall provide adequate toll -free telephone access to the claims office. AVAILABILITY OF MANAGEMENT PERSONNEL The Administrator shall make available to the City of Miami an individual with management authority to meet with the Self -Insurance Committee or their designee upon reasonable notice. The Administrator will meet with the Self -Insurance Committee on a quarterly or as needed basis to discuss claims of interest. Sufficient advance notice will be given to allow adequate preparation and data collection. The Administrator's personnel, including the adjuster or supervisor, must be available to attend Mediation conferences as necessary. CLAIMS PROCESSING HIT The Administrator shall be responsible for providing to the City of Miami a claims processing kit for their use in filing claims with the Administrator. The kit shall contain an adequate supply of pre-printed First Reports, wage statements, and instruction material on how to complete the forms. The First Reports must be pre- printed with the claim office address and contact number. In addition, the Administrator shall be available to answer any questions from the City of Miami on accident reporting matters. It is expected that service calls will be made prior to execution of a contract to assure that all procedures are understood, and that a cooperative, communicative relationship is established. RISK MANAGEMENT INFORMATION SYSTEM Proposer will submit a description of the standard loss reports provided, as well as samples. Descriptions and samples of additional reports will be provided, including any additional fees. 95- 393 5/1/95 Administrator will provide.a computer terminal/modem installation for claims status inquiry to the City of Miami. Any procedures, equipment, and/or costs necessary to connect with the City's hardware and software will. be provided in detail. Administrator will analyze and recommend the best method to link the City and the Administrator's computer system. The Administrator shall submit monthly experience/statistical reports which shall include but not be limited to a summary of experience by department stating cause of accident, frequency and cost. Open and closed claims shall include specific information on the accident date, claimant's name, cause of accident, injury type, amount paid and reserved and state if open or final. These reports must be delivered by the 10th of each month and must provide summary information by coverage, by department, by participant and by total program. Explain any options which your system has that will permit the City to generate reports from, and make direct (dial up) inquiries into your data base from a PC and modem. Identify the costs of providing your terminals (up to 3) in the City's office, and any special conversion systems, license and software costs for accessing your system. Indicate if you have the ability to provide detailed information in your reports such as type of accident, accident site, department, date and time, cause of accident, injury and part of body. Describe any safety/loss control reports that are provided by your system. Submit a listing of the variety of claims reports available and sample copies of formats that may be requested by the City. Risk Management utilizes an on-line claim processing system where all data is maintained, updated and payments are issued. The servicing company is Corporate Systems. The adjudication of Workers' Compensation medical bills and payments to the City's providers are performed through this system. Indemnity payments and all settlement payments are also processed through this system. On a monthly basis, Corporate Systems provides the City with a bank reconciliation tape and a tape to interface with the City's financial system. The successful proposer must provide a similar mechanism for updating the City's financial information. The proposer will be responsible for the conversion of any data necessary should the current system not be compatible with their proposed system. EXTENT Or OPTIONS The City reserves the right to decide, at its discretion, which options and services shall be purchased, and in which combination, from among those proposed. 95- 393 7 spivs i � U MODIFICATION OF NORMAL SERVICES Some desires expressed in this request may require .modifications of existing procedures, forms and contracts to serve the City's best interests. Whenever such modifications may require a substantially greater fee than services without the modifications, the amount of additional fee for the modifications should be disclosed so the City will have an option to purchase them or not. It is preferred by the City that all desired modifications be provided with little or no additional fee. PAYMENT OF SERVICE FEES Payments will be paid in equal monthly installments, with no additional charge for interest. If not, the most favorable terms should be set forth. TERM This is a multi year contract for an initial period of three years with two one year extensions up to a maximum of five years. UNINTENTIONAL OMISSION OF LOSS DATA Due to the extensive nature of the City's loss data, it is possible that items may have inadvertently been omitted or incorrectly stated in assembling this request for proposals. TELEREPORTING Explain what procedures are available for direct reporting of claims by telephone to the claims administrator. Describe any additional costs for this arrangement. ON SITE WORKERS' COMPENSATION ADJUSTER Please describe what additional cost, if any, would be involved with placing one of the assigned WC adjusters on -site at the City of Miami. IIOLD HARMLESSANDEMNIFICATION The Administrator shall agree to hold harmless and indemnify the City for any errors in handling claims and for any fines which may result from the fault of the administrator. Proposers shall agree that any payments in excess of valid claims that cannot be recovered shall be refunded to the City. 95 - 393 8 511195 Exhibit A. SCOPE OF SERVICES 2. Workers' Compensation C1aifns The City of Miami is 100% Self -Insured in the area of Workers' Compensation. There are no policies covering excess workers' compensation of catastrophic claims. This section handles all aspects of a Workers' Compensation claim. The prime concern and responsibility is to care for the City's injured workers. Attention is focused in the areas of safety awareness, prevention, treatment of injured workers, rehabilitation, job placement, education and communications with the employees and the departments. The City is interested, as part of this package, for an infections exposure protocol and treatment tracking program to be included as part of the services to be provided. Consideration must be given to include compliance with the Ryan White Act (Public Law 101-381). Guidelines for the treatment and care of injured employees are based on Florida Statutes 440 which govern the State's Workers' Compensation Law. However, as a result of bargaining agreements, additional benefits are granted depending on the bargaining unit. The proposer must become familiar with the existing labor contracts. These contracts will be made available to the proposer upon request. PROMPT CONTACT WITH INJURED EMPLOYEES Injured employees will be contacted by the adjusteravithin 24 hours from the date the First Report is received on cases involving lost time beyond the waiting period, compensability issues, and/or subrogation possibilities. In certain cases a statement shall be taken from the claimant. The statement should include, but not be limited to the following: a description of the accident; the nature of the injury; identification of witnesses; the name of the treating physician; explanation of previous injuries noting whether- they were compensable and if so, the amount of money paid. Examiners should exercise discretion in determining need for additional statements. All statements, contact with witnesses, employees, insureds, doctors, and other investigations should be fully covered in written memoranda to the file. In most cases, the statements are to be taken by the examiner and shall not result in an allocated expense. 95- 393 9 5/1/95 M M a ( V CONTACT WITH SE, LL! INSURANCE COMMITTEE ON DESIGNEE The City shall be contacted by telephone on all claims where the compensability or the relatedness of the medical expenses on the claim is in question. FOLLOW UP CONTACT Lost time employees should be contacted at least every four weeks, for the duration of temporary total disability payments. When an employee is represented, the attorney shall be contacted when appropriate. If attorney contact is appropriate, it is recommended that contact be on a 60 day basis. INDEX BUREAU All lost time and/or questionable cases must be reported to the Index Bureau. RESERVES Initial reserves shall be set by the Administrator within thirty (30) days of receipt of the First Report. All files must be reserved adequately to extend through the expected life of the claim. Although all the necessary facts may not be available at the onset of a claim, reserves should be adjusted when medical information or investigation indicates the existing reserve is inadequate or overstated. The following factors shall be considered when setting a reserve: the injury; the investigation; medical treatment and costs; projected temporary total disability benefits to be paid; projected permanent partial disability/wage loss; and potential use of outside experts (i.e., rehabilitation service providers, attorneys, etc.) The adequacy of reserves shall be reviewed at least every three months, and documentation in the file should reflect this review. PROMPT PAYMENT Within 14 days after the Date Disability Begins (DDB), one of the following shall be accomplished: 1. Commence weekly benefits, or 2. File a statement of controversion fully explaining why compensation was not started. All uncontroverted and/or unquestioned hospital, doctor and drug bills must be paid promptly and no later than 30 days from the date of receipt of properly completed forms. 95- 393 5/1/95 SETTLEMENTS DGipffii All settlements must be presented in writing to the City Attorney for approval, regardless of the amount. The injured employee will not be contacted regarding settlement until after the City Attorney has approved the proposed settlement. CONTROVERTED BENEFITS All DWC riles must be followed when compensation, medical or other benefits are being controverted. The case must be discussed with the Self Insurance Committee or their designee before the claim is denied. MEDICAL REPORTS Medical reports must be obtained as necessary to determine the status of the employee's injury and to verify disability. Injured employees should be encouraged to use medical specialists, depending on the injury. The use of an Independent Medical Examination (EAE) is usually a matter of judgment; this should be obtained when necessary or when instructed by the City. The DWC rules and the applicable Workers' Compensation Statute section shall be followed when obtaining an IME. MEDICAL AUDITS All medical bills shall be reviewed and/or audited by the Administrator for compliance with the applicable fee schedule. All medical 'bills exceeding $5,000 shall be specifically audited for accuracy, reasonableness, and medical necessity. In addition, a comprehensive utilization review program shall be implemented by the Administrator after City approval on all medical services. Quarterly reports are required by the City showing cost and savings as a result of cost containment. REHABILTTATION/MEDICAL MANAGEMENT Rehabilitation services shall be used when appropriate. The following claims shall be reviewed for rehabilitation/medical management services appropriateness. I. All claims where the injury is considered to constitute statutory total and permanent disability. 2. Serious burn cases (third degree burns covering 25% or more of the body or second degree burns covering 50% or more of the body) and burns coupled with internal injuries, crush injuries, traumatic amputations, and/or diabetes. 95- 393 5/1/95 3. Single limb amputations above the knee or elbow, and digital amputations, (fingers and toes) involving three or more digits on the same extremity or complete amputation of a thumb or great toe. 4. Gunshot wounds to the torso involving internal injuries: 5. All claims involving diagnosed spinal cord or brain injuries including diagnosed or possible skull fractures and/or any gunshot wound to the head or face. 6. When an employee receives restrictions from his treating physician which. do not allow him to return to his prior job and the employee or his attorney claims total and permanent disability, a job market survey shall be performed in the area where the employee resides. The rehabilitation vendor shall determine if there are jobs available in the area within the restrictions applicable to the claimant. Monthly reports on cases involving rehabilitation/medical management shall be submitted to the Self Insurance Committee or their designee. FATALITIES All claims involving a fatality shall be reported to the Self Insurance Committee or their designee immediately be telephone, if not already known to the City. Payments on these files shall be made in accordance with the Florida Workers' Compensation Law and/or governing contractual agreements. Periodic activity checks shall be performed to insure the dependent receiving survivor's benefits is still eligible, INVESTIGATION Investigation shall start when the First Report is received or sooner if notice of the accident has been received. Enough information shall be gathered to show whether the injury may be compensable. All claims shall be reported to the Index Bureau. A follow-up report should be performed in six months. Five year DWC record checks shall be requested on appropriate claims. HEARINGS/TRIALS The requirements for hearing conferences/trials are as follows: 1. Pre -hearing or pre-trial reports shall be submitted by the claims administrator to the City Attorney at least two weeks prior to the hearing conference/trial. 2. The reports must contain all information pertinent: to the file including transcribed statements. 3. The administrator shall obtain settlement authority from the City of Miami prior to any hearing conference/trial. 4. Statement of Position and Notices of Appeal will be timely filed by such administrator/counsel. ►2 95- 393 h,r 5,1,95 o ° DW 5. Any recommendations made by such administrator pertaining to the file should be carried out or referred to the Self -Insurance Trust committee for resolution. 6. Such Administrator/counsel shall files Notices of Intention to Appeal. r EXPERTS The hiring of experts in connection with claims against the City entities requires the approval of the Self Insurance Trust Committee. Experts include, but are not limited to, rehabilitation vendors and private investigators. REPORTING An immediate telephone report to the City is required of the Administrator, if the information is not already known to the City on: 1. fatalities; and 2. catastrophic occurrences with potential exposure of $50,000 or more. "Full captioned reports" shall be submitted within 30 days of setting reserve at or above $20,000. The content of the "full captioned reports" shall include, but not be limited to, the following: coverage items; the employees' background (e.g., age, resident); dependents; employee's job description, occurrence; injury; medical management; wage and compensation rates; dates and periods of disability; rehabilitation; employee' other benefits; litigation; index/state filings; subrogation; remarks and/or recommended actions; and future strategy. A "full captioned report" is required on all files in litigation. Copies of all pleadings shall be provided along with the report. Follow-up reports shall be received within 90 days of the "full captioned report." "BAD FAITH" PROCEDURES The following procedures shall be followed to avoid potential actions for breach of good faith and fair- dealings. 1. Termination of Weekly Benefits: weekly benefits may be terminated only upon written or verbal notification by the treating physician or the City when employee returns to work. If return to work information is obtained verbally, the examiner must follow up in writing with a request for written verification. If an IME physician releases the employee to modified work, the Administrator must promptly determine if modified work is available and offered to the employee before benefits are terminated. 2. Controvert ingr Claims: the supervisors or examiner shall contact the City prior to formally denying a claim. This will not be necessary when conlroverting the reasonableness and necessity of medical bills. 9 ;— 393 lid 5,1,95 D G� 3. Judgments/Settlements: judgments/settlements should release potential future "bad faith" actions. 4. Penalties and Fines: penalties and fines assessed by the DWC shall be paid by the Administrator if such fines and penalties result from negligent performances of its duties. WORKERS' COMPENSATION STATUTE, DWC RULES AND APPLICABLE LAW All adjusters handling City of Miami cases shall keep abreast of the Workers' Compensation Statutes, DWC rules, and applicable law. The minimum standards of performance shall conform to the Florida statutes and administrative rules or future changes therein, if any. All DWC filings, including compromise settlement agreement payments, must be made in a correct and timely manner. MANAGED CARE The proposer must address the issue of Managed Care. It is the proposers responsibility to recommend the best approach for the City, in order to be in compliance with Florida Statutes by 1/l/97. 95- 393 14 5/1/95 Exhibit A SCOPE OF SERVICES 3. Liability Claims 1 GENERAL The City of Miami retains most of its casualty risk exposure without excess coverage. The areas of liability administered by this section are; General Liability, Auto Liability, Police Professional Liability and Public Officials Liability. The primary focus of this section is to investigate all claims in the areas of liability mentioned above. Personnel in this section work closely with the Law Department in the investigation and settlement of claims. They also work closely with other departments for the resolution of unsafe and hazardous situations REPORTING CLAIMS All Notices of Loss must be picked up by the Administrator at the City of Miami on a daily basis. PROMPT CONTACT In all cases involving injury, the claimant will be contacted within two working days by the adjuster from the date the Notices of Loss is received. If a serious bodily injury is involved, a recorded statement should be taken from the claimant, preferably in person. The statement should include, but not be limited to the following: a description of the accident; the nature of the injury; identification of witnesses; the name of the treating physiciati(s); explanation of previous injuries/illnesses to determine if they will have an impact on rate of recovery; amount of time lost from work, if any; amount of salary/wages lost or expected to be lost, if any; employer's name, address, phone, and contact name so wage loss can be verified; name of claimant's automobile insurance company, if applicable. In addition, a medical information release form must be provided to the claimant for his/her signature so that appropriate medical information may be gathered, and the apprpriate records assembled. All statement, contact with witnesses, claimants, City representatives, doctors, and other investigations should be fully covered in written memoranda to the file. In most cases, the statements are to be taken by the adjuster and shall not result in allocated expense. 95- 393 15 511195 RESERVES DD 11uU In1 U Initial reserves shall be set wtihin thrity (30) days of receipt of the Notice of Loss. All files must be reserved adequately to extend through the expected life of the claim. Reserves should be adjusted when medical information, disability information, or investigation indicates the existing reserve is iadequate or overstated. The following factors should be considered when setting a reserve: the injury, including the diagnosis, treatment plan, and prognosis; the investigation; medical treatment and costs; anticipated wage/salary loss, if any; projected permanent disability settlements, if any; property damage and loss of use claims, if any; potential allocated expenses, including attorneys, court costs, court reporters, rehabilitation providers, cost containment specialists, private investigators, independent medical examination charges, and other file -related expenses. The adequacy of reserves shall be reviewed at least every three months, and documentation in the file should reflect this review. PROMPT PAYMENTS All payments for which the Cityo f Miami is legally liable, and for which the City has extended authority, should be paid as soon as possible. MEDICAL REPORTS Medical reports must be obtained as necessary to determine the status of the claimant's injury. Independent Medical Examinations (IMEs) and/or Second Opinions should be obtained when necessary or when instructed by the City. The City of Miami must be consulted prior to the use of an IME or Second Opinion. INDEX BUREAU In all cases where bodily injury is alleged or likely to be alleged, the claimant should be researched through, and added to the database of, the Index Bureau early in the handling, of the claim. RETAINING OUTSIDE SERVICES Prior approval from the City must be granted prior to retaining expert witnesses, surveillance, IME physicians, etc. IIECON'ERIES The Administrator shall aggressively pursue recoveries to the satisfaction of the City of Miami including recoveries based on subrogation and third parties. In particular, 16 95- 393 k, sw9s 1 �' the Administrator will assist in the collection of claims against others for damage to participants; property and make recommendations regarding salvage matters. The Administer will pursue, track and provide quarterly reports on all subrogation and other recovery opportunities. 95- 393 17 511195 Exhibit A SCOPE OF SERVICES 4. Insurance GENERAL The City of Miami maintains commercial insurance policies where analysis of cost has shown it to be more advantageous to the City. Principal coverage's are for the city's properties and for areas where the City is contractually obligated to maintain such coverage. A schedule of all City commercially purchased insurance is attached. REQUIRED SERVICE 1. Review and approve insurance requirements in all agreements entered by the City; develops the appropriate insurance language as needed. 2. Provide specialized and technical assistance to departments regarding insurance requirements, as requested. 3. Review insurance coverage's for special events held in the City of Miami, contact City Departments or outside agency to ensure the proper insurance coverage when using City Property or facility and determine if limits of coverage are appropriate. 4. Maintain a schedule of insurable valuables for all City owned Properties, including type of coverage, policy limits and deductibles. 5. Underwrite Special Events Insurance Coverage's under the City's Special Events Policy. 6, Analyze insurance policies. 7, Analyze and identify risk. 8. Prepare technical and administrative insurance related reports for the SIITC, Departments, the City Manager and City Commissioners. 9. Coordinate Activities of agents, brokers and Administrative Service Companies utilized in the Insurance Management Program and Contractors that service the City. BROILERS. AGENT OF RECORD The City's current Broker and Agent of Record is Alexander and Alexander. Their offices are located at 7000 S.W. 97th Avenue, Suite 200, Miami, FL 33173. Their telephone is (305)279-7870. Tile City's contact person at Alexander & Alexander is Mr. Jorge Andino. HS. 95- 393 W-- 5/1/95 SELECTION CRITERIA D A recommendation shall be made to the City Commission based upon the following criteria: - CRITERIA POINTS Proposer's ability, qualifications, experience, current caseloads and references 30 Scope of response and understanding and approach to the required services 25 Firm's size, resources, financial stability and location 15 Cost of services 20 Compliance wtih Minority/Women Business Affairs utilization goals 10 TOTAL 100 19 95- 393 UM 5/1/95 _ ]EXHIBIT B D I. Have you read the scope of services and do you agree to provide the services specified? 2. If you do not agree to payment of service fees in equal monthly installments, with no additional charge for interest, what are your most favorable terms? 3. What is the predetermined guaranteed maximum cost increase in your fees for the second and third year of your service contract (indicate the percentage increase). 4. Office(s) where the City's claims will be serviced. 5. Does your company maintain a claims procedures manual? Have you provide a copy? 6. Provide information about the size of your firm, e.g. size of staff, locations, volume of claims handled per adjuster, etc., and provide resumes and identify licenses/certifications for personnel who will serve the City? 7. Have you provided your firm's financial statement? 8. Is your firm owned by a parent organization? _If so, identify the parent organization(s). 9. Explain the caseloads of your adjusters and claims handling staff. What is your formula for establishing a ratio of adjusters to claims? how many claims do they handle? Explain._ 10. Have you included a copy of your State of Florida certificate for claims administration services? 11. Which persons will handle first aid and medical claims only and which will handle litigated files and indemnity? 12. What is the turnover of your staff? Explain. I 13.Is your firm audited regularly for claims quality control and or accounting jcontrols? Provide 1 the name of the audit firm and copy of claims audit performed within the last five years. 14. Will you agree to pick up mail from the City's Risk Management Department on a regular basis? 15. to what extent do you use outside adjusters private investigators, vocational rehabilitation specialists, medical auditors and others outside of your firm? 20 95- 393 k. sw9s 0 o d 16. Explain your automobile physical damage appraisal services and if a flat fee per claim is proposed. Comment if the appraisal services will be subcontracted. 17. Describe your firms file conversion. abjlity, experience and procedures. 18. Do you agree to perform the claims handling services/functions described in the request for proposals? 19. Explain if any of your basic claims handling services are not included in your proposal. 20. Do you provide medical cost containment for workers' compensation claims? Explain. 21. Do you agree to handle all claims to conclusion at no additional service fee in the future if your contract should be terminated or expires? 22. Explain the procedure to be utilized after hours and in the event of an emergency. Include a contact name and telephone number. 23. Do you agree to hold harmless and indemnify the City for any errors in handling claims and for fines which may result from your action or inaction. 24. Do you agree to indemnify the City for any payments in excess of valid claims that cannot be recovered, except for such payments resulting from the City's sole negligence? 25. Do you agree to the City directing you regarding payment of claims, including setting limits on the amount that can be paid without special authorization? 26. Do you agree that attorneys must be approved by the City? 27. Do you agree that the City shall have the right to inspect, copy or audit the files, including the right to use an outside auditor? 28. WilI you extend your cooperation to the outside auditor? 29. Do you agree that claims files and other records, documents lists, supplies, etc., pertaining to claims are the property of the City and will be given to the City upon demand or contract termination? (You are permitted to make duplicate copies of the files records, documents etc.,. if you are desirous of such records subsequent to contract termination). 30. Do you agree to offer a workers' compensation adjuster at the City of Miami Risk Management Department? At what cost? 95— 393 21 5/1/95 IJ � LfU 31. Will you provide all necessary claims forms? 32. Have you provided sample claims forms? 33. Have you enclosed samples of information provided to injured employees? 34. Will claims information include a description in plain English, as requested or in easily readable format? 35. Will the claims information include a description of each claim and the amounts paid and reserved? 36. Do you agree to provide monthly experience/statistical reports as requested by the 1 Oth of each month. 37. Do you agree to provide reports within 10 days of the end of each month which recap each year's experience, including prior years to date? 38. Do you agree to pursue, track and provide quarterly reports on all second injury fund, subrogation and other recovery opportunities as reqested? 39. Do you agree to provide the OSHA 200 Report, Bureau of Labor Statistics Log and Summary of Occupational Injuries and Illness by department? 40. Will you provide 1099s to the IRS on magnetic tape? 41. Have you provided a listing and samples of your basic claims reports; have you stated which ones will be provided to the City and have you stated the cost basis for eacli report? 42. Can you provide claims information and reports and a separate breakdown by entity and departments? 43. State how long you will retain the City's claims records. 44. Can you offer the option of dial -up computer accessibility by the City to your data? Identify the costs of providing up to three terminals. 45. Do you have the capability to provide the following information in your monthly reports: type of accident, accident site, department, date and time cause of accident, injury, part of body. 46. Do you agree to provide copies of pertinent medical bills and narrative reports; have you stated which ones are available to the City and have you stated the cost basis for each report? 47. Have you provided a listing and samples of your claims and loss control reports; have you stated which ones are available to the City and have you stated the cost basis for each report? 48. NVill you evaluate the City's workers' compensation experience modification and take the necessary action to obtain any corrections or revisions? zz 95- 393 M 5/1/95 MM W� V 49. State you ability to accommodate the City's claims payment arrangement. 50. State the banking arrangement proven most efficient for your clients and what you recommend to the City for . prompt payment of claims. 51. Will you perform periodic claim and reserve reviews with the City. 52. Have you provided information about your policy for reserving claims and the extent to which you will consider the City's input? 53. Can you provide safety program performance measurement and practical recommendations to reduce the frequency and severity of the city losses? Explain. 73 95- 393 kf CITY OF MIAMI, FLORIDA �� INTER -OFFICE MEMORANDUM TO Honorable Mayor and Members DATE : -,! =j I - . FILE of the City Commission SUBJECT Resolution Authorizing Issuance of Request for Proposal FROM Cesa O REFERENCES: City er ENCLOSURES: Proposed Resolution and Draft RFP RECOMMENDATION: It is respectfully recommended that the City Commission adopt the attached resolution authorizing issuance of a Request for Proposals (RFP), in a form acceptable to the City Attorney for Risk Management services for the City of Miami. BACKGROUND: The Division of Risk Management of the Fire -Rescue Department is interested in soliciting proposals from private firms for all phases of Risk Management to include, but not limited to, Worker's Compensation, General Liability, Public Officials Liability, Police Tort and Insurance to include Liability and Property. It is the City's intent to streamline its operations and determine if it is feasible and in the City's best interest to privatize Risk Management. Enclosure 95- 393 61-1