HomeMy WebLinkAboutExhibit 2ATTACHMENT A
SCOPE OF SERVICES
I.
GENERAL PROVISIONS:
The services which are the subject matter of this Agreement (the "Services") consist of Workers
Compensation Claims Administration ("Part I Services"), and General, Automobile & Professional
Liability Claims Administration ("Part II Services"), which are as of the date hereof being provided by the Provider.
Unless otherwise specifically stated, the General Provisions shall apply to both Part I Services and Part II Services.
In the event of conflict or inconsistency between the General Provisions and provisions specifically included under
Part I Services or Part II Services, the specific provisions shall control.
The City reserves the right not to tum over to Provider, and to retain `the management, handling and control of, all
or some of the claims which are the subject of this Agreement, with prior written notice to the Provider. Further, the
City reserves the right to perform, or caused to be performed by other parties, some or all of the services that are
subject to Allocated Expenses, as the term is defined in Section 11.1 C. of this Attachment "A".
1. THE SERVICES — PROPOSAL:
The Services are described in the Proposal, as modified by Provider's presentation before the Evaluation Committee
on February 24, 2003, and as fin-ther modified hereunder. In the event of a conflict in the description of the Services
as described in the Proposal, the presentation and hereunder, the description or interpretation of the Services that is
most favorable to the City shall control_
SAFETY PROGRAM/LOSS CONTROL SERVICES:
The Provider and the City agree to take the necessary steps to improve the City's Safety Program. The Provider shall
assist the Department of Risk Management (the "Department") in improving the Safety Program, to the City's
satisfaction, and fully implementing it for the City and all labor groups, recognizing that a strong safety program is a
primary tool for mitigating losses. At a minimum, the Provider will conduct two (2) one -day evaluations of the
City's largest safety concerns, including a comprehensive report on it's findings, within the first year of this
Agreement.
When requested by the City to do so, the Provider shall consult with the City, its employees, 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 the
Provider 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.
REPORTING REQUIREMENTS AND STATUS REPORT:
A. The Provider shall immediately, but not later than (a) 1 hour following receipt of a fatality claim;
and (b) 24 hours or the next business day following the occurrence of a "Reporting Event", advise
the Risk Management Administrator or designee (the "Administrator") by telephone or electronic
mail, followed by written document, of it's occurrence. A "Reporting Event" is herein defined as a
claim that meets any one of the following conditions: (i) a claim with a reserve set at or above
$50,000; (ii) a claim involving a "Serious Injury", which is defined to include, in addition to the
Serious Injury Categories defined in the Proposal, back problems involving surgery, serious burns or
disfigurement, paraplegia, quadriplegia, amputation, partial loss of sight or hearing, partial brain
damage, environmental exposures/conditions or other permanent injury; (iii) any non -workers
compensation claim involving the City's Police Department(iv) any category of injury or disability
included in the Control Loss Program; or (v) any claim in which there is a notice or likelihood of
litigation.
B. All files will be created and assigned the proper facility and location code, and entered into
Provider's computer system within twenty-four (24) hours or the next business day upon receipt of
first report of incident or claim.
C. The Provider shall provide to the City such information or interim report as the City may from time
to time request on specific files.
D. The Provider shall submit to the Administrator 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 the claim is
open or has been fmalized. These reports must be delivered by the 106 of each month and must
provide summary information by department, by participant, and by total program. The City shall
have full access to all data, records, reports and information maintained by the Provider under this
Agreement, through the various media and methods described in the Proposal, at no cost to the City.
E. Provider's `Designated Personnel", as defined in Section 6 of the Agreement and described in
Attachment "C" thereto shall be available to attend meetings, as required by the City, at the City's
office, or such other place as may be required by the City, if requested by the City, at no additional
cost to the City.
F. The Provider, at no additional cost to the City, shall meet with the Administrator and other personnel
as may be designated by the Administrator to discuss selected files subject to auditing in accordance
with the provisions of the Performance Agreement, attached to the Agreement as Attachment "E".
The files to be audited must be accompanied, at a minimum, by status reports, printed claim file
notes, and payment registers.
G. No later than ninety (90) days prior to the expiration of the initial, and if applicable, any extended
term of this Agreement,' the Provider shall submit a written report to City detailing all activities
conducted by the Provider for the City during the corresponding term, The report shall include a
discussion of any known problems and recommendations for solutions to those problems and a
listing of objectives to be accomplished. If the Agreement is not renewed, or there are no extensions
available, Provider shall provide City with a summary of outstanding items, and Provider shall
submit all original claim files and any additional documentation necessary for the City to transfer the
City's claims administration programs to another third party administrator.
4. SETTLEMENT AUTHORITY:
A. Provider shall have no authority to retain legal counsel on behalf of the City, unless expressly
approved by the City Attorney. Provider acknowledges that all cases involving the City of Miami
are handled by the City's Law Department (the "City Attorney").
B. Prior to the commencement of litigation, the Provider shall have the authority to settle, on behalf of
the City, workers' compensation claims up to $10,000, per claim, and all other claims, up to $3,000,
per claim, or as otherwise provided "by City ordinance. Claims involving amounts greater than the
authorized amount shall not be settled without the written authorization of the City Attorney. The
request for authorization must be presented to the City Attorney and the Administrator in writing,
including the adjuster's evaluation and recommendation in a format required by the City. After
authorization is granted, the Provider will settle the claim and obtain the appropriate release(s). The
City's release of any claimant, if necessary, shall be subject to the approval of the City Attorney.
C. All settlements obtain by Provider shall include a release of potential fixture "bad faith actions".
D. Provider shall have no authority to settle any labor or employment claims. Additionally, Provider
shall have no authority to settle any claims after commencement of litigation without the prior
written authorization of the City Attorney.
5. LITIGATION MANAGEMENT:
A. Provider shall provide a copy of the complete claim file upon the City Attorney's notification to the
Provider that litigation has commenced.
B. Prior to the initiation of litigation, Provider shall contact the Administrator if, in its good judgment,
it determines that there is the need for legal counsel concerning a claim.
C. Within three (3) working days of Provider being provided with notice by the City Attorney of the
initiation of litigation concerning a claim, the Provider shall send a letter to the City Attorney
outlining the claim status, work remaining to be done by the Provider and the time frame in which
the work shall be completed. All information shall be updated, as needed, to assist the City Attorney
in the handling of the claim.
D. After commencement of litigation concerning a claim, Provider shall perform all investigative and
claims related services necessary, in the sole judgment of the City Attorney, to assist the City
Attorney in the defense of a claim in litigation.
E. Within 30 days after notice to the Provider of the initiation of litigation concerning a claim, the
Provider shall provide to the City Attorney its written opinion as to compensability, value and
settlement/defense strategy.
F. The Provider agrees to abide by the any Litigation Management Guidelines that may be promulgated
by the City Attorney, as amended from time to time.
G. Provider shall provide a designated representative at any mediation pursuant to the rules of
procedure for workers compensation adjudication or whenever requested by the City Attorney.
Provider shall provide such periodic updates on ongoing litigation as may be requested by the
Administrator or City Attorney.
H. Provider shall coordinate with representatives of any excess liability insurance carrier, as required
by the Administrator.
I. Provider shall deliver to the Administrator copies of all documents, correspondence and information
that it is required to deliver to the City Attorney under this Section.
6. RESERVES:
The Provider shall establish a realistic reserve for each claim within 3 business days after receipt of notification of a
claim. The amount of the reserve will take into consideration probable payments related to the loss, including
liability, damages, statutory cap, Allocated Expenses, and any other factor necessary to determine the estimated
amount the City will be required to pay on that claim.
Provider shall immediately notify the Administrator, verbally or via email, of any information that may affect the
value of a claim and will require an adjustment to the Reserve, by increasing it or decreasing it, by an amount in
excess of $10,000. Not later than three (3) business days after this preliminary notification, Provider agrees to give
the City written notice of same, including a detailed explanation of the anticipated need for such adjustment.
OTHER GENERAL REQUIREMENTS:
The Provider shall:
A. Provide on a monthly basis, two (2) copies of loss runs to the Administrator sorted separately by
line of coverage (Workers' Compensation General Liability, Automobile Liability, Police Tort and
Public Officials Liability), loss year, and department/location. Loss runs shall list each claim
separately. Specific summary reports must also be provided. This requirement may be satisfied by
utilizing the Provider's on-line system. The following reports, at a minimum, are required:
1. Claims list — lists all claims alphabetically;
2. Check register;
3. Cumulative report by line of coverage by year;
4. Annual summary reports;
5. Location report;
6. Large loss or severity report;
7. Safety report;
8. Excess insurance report;
9. Litigation report;
10. Legal payments report;
11. SAF 300 (OSHA log) - Provider will submit to the City's managed care vendor, any and
all information required to be included in this report;
12. Annual SAS 70 report
B. Provide the Administrator with a directory of Designated Personnel including addresses, direct
phone numbers, email addresses and fax numbers, said directory to be updated as needed.
C. The Provider shall maintain at all times during the Term an 800 or toll-free telephone line for calls.
D. The Provider shall give the Administrator at least 30 days advance notice of any change in the
Designated Personnel. The City reserves the right to request a change or reassignment of any of the
Designated Personnel, in its reasonable discretion.
E. Provide to the Administrator Provider's procedures manual for claims reporting and the provision of
the Services, together with all amendments thereto.
F. Provider shall provide to the City all amendments and updates to its policies and procedures manual,
and agrees to make such modifications to the manual, as it pertains to the Services, as may be
reasonably requested by the City.
G. Obtain the Administrator's written approval prior to issuing a Denial of Claim letter.
H. Provider acknowledges and agrees that all files created or maintained pursuant to this Agreement are
the property of the City. Every two (2) years, during the Term, Provider shall deliver to the City all
files that have been closed during the corresponding period, categorized by year, and in alphabetical
order, and labeled as required by the City, together with an inventory of each container. Pending
delivery to the City the files shall be maintained and stored by Provider at no cost to the City.
I. Make written recommendations to Administrator regarding any procedure or condition that should
be examined to prevent future claims, which are revealed during the Provider's investigation of a
claim.
1. Provider understands and agrees that at the request of the City, it may be required to continue to
handle claim files that have been reported to Provider prior to the termination date of the Agreement
until their conclusion, or such earlier time as may be required by the City. In such event, the amount
of compensation shall be renegotiated by the parties, in good faith, but shall not exceed the lowest
rates charged by the Provider, to its preferred clients, as of one (1) day prior to the.date of such
termination.
K. The Control Loss Criteria outlined under the Control Loss Program section of the Workers'
Compensation and Liability Product Standards in the Proposal shall include Reporting Events, as
defined in Section I. 3. A. hereof.
L. Provider will notify by e-mail, the City's managed care vendor of any changes in claims status (i.e.,
settlements, file closings and re -openings, controverted claims, presumption claims, litigated claims
or attorney representation of claimant). Provider will work with the City's managed care vendor
and the Administrator to develop policies and procedures that specifically outline the working
relationship and requirements for exchanging information. These policies and procedures will be
finalized within 45 calendar days of the effective Date.
S. COMMUNICATION:
A. Provider shall maintain open, general lines of communication with the Department on an ongoing
basis and shall respond to requests of the Department or the City Attorney, on a timely basis and in a
cooperative manner.
B. At no additional cost to the City, Provider shall be available to attend meetings required by the
Administrator in order to: (i) educate its own and the Department' a personnel on relevant
laws/filings and claim handling procedures that affect any claim, (ii) discuss specific cases of
concern, (iii) resolve any problems involving the claims administration program, and (iv) address
such other matters as may be reasonably required by the Administrator relative to the performance of
services under this Agreement, including specifically, but without limitation, any training that may
be needed as a result of legislative changes or case law trends.
C. Provider shall immediately provide the Administrator with information any Workers' Compensation
legislative changes. Additionally, Provider shall, on a yearly basis, deliver to the Administrator a
summary of any changes in the law, or its interpretation, that may affect the claims, or the provision
of the Services hereunder, together with the corresponding analysis
D. Provider shall return phone calls from the City or injured employee within one (1) working day and
represents that it will have staff available to discuss claims with the City or the injured employee on
the same day the claim is made. Other requests from the City will be responded to in a timely
manner. Failure to comply with the provisions of this Section shall release the City from payment of
the per -claimant fee described in Attachment B with respect to such claim.
9. STAFFING, QUALITY CONTROL AND SUPERVISION:
The Provider shall render high-quality (to be determined by the Performance Standards, as they may change from
time to time) claims management and adjusting services throughout the Term. The Designated Personnel shall have,
at a minimum, the following levels of experience and licensing:
Supervisor or supervising adjuster 4 years
Adjusters 3 years
Medical -only processor(s) 1 year
Provider shall assign personnel with the ability to provide frill service to English, Spanish, and Haitian -Creole
speaking individuals when needed.
A list of the Designated Personnel is attached to the Agreement as Attachment "C", and shall be updated, as needed.
The City reserves the right to request a change or reassignment of any of the Designated Personnel, in its reasonable
discretion.
Claims personnel must be employees of the Provider. The use of independent adjusters, subcontractors, or
temporary adjusters will not be acceptable without prior approval of the Administrator. Adjuster trainees are not
acceptable for handling of the City's claims.
The Provider shall ensure that all Designated Personnel are familiar with the City's labor contracts and any changes
thereto, and are kept abreast of all applicable laws, including, specifically, the Workers' Compensation Statutes,
DWC rules, and applicable laws.
10. BANKING/LOSS FUND MANAGEMENT:
The Proposal describes three (3) Banking Options. The City selects the Automated Payment and Control System
(APCS), with the Self Insured Money Management System (SIMMS) option, as more particularly described in the
Proposal. The City and the Provider agree to establish the agreed upon imprest balance and the funding frequency
within thirty (30) days after the date of the Agreement. At a minimum, Provider will report the following activity to
the City on the imprest account:
A. Monthly activity report reflecting checks written;
B. Statement of actual clearing activity through the imprest account;
C. Monthly reconciliation report.
11. "BAD FAITH" LAWSUITS:
The City Attorney and the Administrator shall be notified of all "bad faith" lawsuits filed against the Provider,
which include breach of good faith and fair dealing. Any "bad faith" lawsuits filed against the City shall be handled
by the City Attorney. If the allegation is that the Provider committed or acted in "bad faith," the defense of the
lawsuit and attorneys' fees and expenses shall be the Provider's responsibility, but the City Attorney shall have the
right to monitor the progress of the lawsuit to its conclusion. Once a "bad faith" lawsuit has been filed, a separate
file pertaining only to the issues on "bad faith" shall be established,
12. IRS FILING REQUIREMENTS OF PROVIDER:
Provider will famish required tax information for the Internal Revenue Service including 1099s with a magnetic
tape of the 1099s submitted to the IRS. In the event the City requires the Provider to continue to handle claims after
the termination of the Agreement, as provided in Section 7.J. above, then, at the City's option, the Provider will file
with the IRS all required information and/or documents, or will deliver such information and/or documents to the
City, in the format required by the City, at no additional cost to the City.
13. OTHER REPORTS AND REQUIRED FILINGS:
Provider shall be required to provide the following services:
A. Prepare, maintain, and file all records and reports as may be required by legal authorities (Local,
State or Federal).
B. Prepare, maintain, and file statistical data, records, or reports as required by excess insurers, City
actuaries or designee, and the State.
C. Prepare, maintain, and file statistical information required by worker's compensation rating bureaus,
including all data required for the promulgation of the City's experience modification and state
assessment.
D. Prepare and file any other reports as required by the City and the State relating to claims experience,
payments, etc.
E. Review files for accuracy and compliance for the state assessments/audits, prior to the due date of
the assessment
F. Prepare and submit to the Administrator, for its review and approval, all reports and/or data required
to satisfy Florida's self-insurance requirements. Required self-insurance reports shall be completed
and delivered to the Administrator on a timely basis but in no event later than 30 days prior to their
due date, so that the City will have sufficient time to review and execute the documents before the
due date.
G. Prepare and submit to the Administrator, for its review, the Unit Statistical Report (LES form S 1-17)
at least 30 days prior to its due date.
H. Provide to the City all information and reports as reasonably required by the City in order to comply
with applicable escheat and unclaimed property obligations under Florida. law.
14. COMPUTER INFORMATION:
Provider shall ensure compatibility of its systems with the current system and software used by the City as the same
may be upgraded or replaced. Provider farther ensures, at its cost, that its systems will remain a viable solution for
on-line claims administration in the event the City upgrades or replaces any aspect of its systems throughout the
Term. Provider shall be responsible for data integrity, which will include, without limitation, inputting all cause
codes, facility codes, location codes, loss descriptions, and other claims information. The Provider warrants the
integrity of the combined data once the data conversion is completed and agrees to assume all responsibility for all
claims, penalties, liabilities or losses that may result from, or arise out of, a breach of thin warranty with respect to
the Transferred Claims and the New Claims being handled by Provider under this Agreement_
Provider shall ensure successful integration/migration of all computer systems, software, and data utilized for the
performance of all Services throughout the term of the Agreement. Provider shall further ensure the successful
conversion of the computer systems software and data to the systems of a successive administrator, upon termination
of the term of the Agreement, at no additional cost to the City.
Provider shall ensure that all system notes are printed out and placed in the claim files upon termination of this
Agreement.
Provider shall ensure that all claims, payment data and historical data are not purged from the existing system nor
merged into the new system.
Workers compensation claims that do not involve indemnity payment or medical treatment shall be recorded in the
database as reporting purpose only (RPO), first aid or no pay cases and should be identified in the system that same
way.
15. PENALTIES OR OTHER ASSESSMENTS:
Provider agrees to pay on behalf of the City any and all penalties, late fees or other amounts that may be assessed
against the City, or that the City may be required to pay, as a result of Provider's failure to comply with its
obligations under the Agreement. The Provider further agrees to reimburse the City for payments made in error.
16. PEFORMANCE AGREEEMENT:
Provider shall execute a Performance Agreement substantially in the form attached to this Agreement as Attachment
"E". Provider further agrees to comply with all the Performance Standards which are attached to Attachment "E", as
they may be changed or replaced, from time to time. Provider acknowledges that the Performance Standards are
intended to measure not only the standards described in Attachment "E" but also Provider's performance under this
Agreement. Accordingly, Provider acknowledges that the City has the right, from time to time during the Term, in
its reasonable discretion and after giving Provider notice, as required under the Performance Agreement, to modify
the Performance Standards to measure Provider's compliance with other provisions under the Agreement. It is
understood and agreed that the new Performance Standards shall measure objective obligations of the Provider
under this Agreement which are easily identified and measured and are not intended to amend this Agreement to
increase Provider's obligations hereunder.
17. CLOSING OF NEW CLAIMS:
Provider represents to the City that every twelve (12) months during the Term, commencing on the anniversary date
of the Effective Date, it will close a minimum of 40% of the New Claims.
II.
PART I SERVICES
WORKERS COMPENSATION CLAIMS ADMINISTRATION
Part I Services include, but are not limited all specified adjusting services for all claims made against the City for
Workers' Compensation, as well as all other required services, such as administration, computerized claim/loss
statistical information and loss fund reconciliation. Specific services to be provided are outlined in the Solicitation
Documents. Provider acknowledges and agrees that the City reserves the right to add additional services as may be
deemed necessary, in its sole but reasonable discretion.
The Provider shall assume all of the Department's day -today activities in the processing and handling of Workers'
Compensation claims. The Provider shall recommend risk control measures and safety programs to protect the
City's interest. The staff of the Provider shall work closely and in cooperation with the City Attorney, the Finance
Department and other major departments in the City.
The Provider represents and warrants to the City that it is, and at all times during the tent hereof shall be, familiar,
and comply with all existing and future labor contracts involving the City, as they may be amended from time to
time, and with all local, state and federal laws, rules and regulations pertaining to the subject matter of this
Agreement, including, but are not limited to, any and all laws regarding discrimination, the Florida Rules of
Workers' Compensation, F.S. 440; Rules for Self -Insurers under the Workers' Compensation Act, Title 4 of the
Department of Insurance; and the Rules of the Division of Workers' Compensation, Title 38, Department of Labor
and Employment Security, as the same may be amended from time to time.
The Provider represents that the claims personnel designated to the City for the provision of Services shall be
available on a 7 day, 24 hour basis for investigating claims,
1. INVESTIGATION:
The Provider shall ensure that the following procedures are followed and observed:
A. 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 claims adjustor must follow up in writing with a request for written verification. If
treating physician releases the employee to modified work, the Provider must, within one business
day following its receipt of the release from the treating physician, determine if modified work is
available and offered to the employee before benefits are terminated.
B. Where needed, rehabilitation and/or retraining will be recommended. The recommendation will be
discussed with the Administrator to determine the availability of a permanent modified job. If City
does not have a job available, rehabilitation will be initiated with concurrence by the Administrator
as soon as practicable and the progress will be closely monitored and controlled. The Administrator
shall be provided with a copy of all rehabilitation plans.
C. Allocated Expenses will be used only where necessary, on a limited investigation basis, and only
after approved by the Administrator. The file will include the reason for the outside assignment and
the approving source at Department. The Provider will exercise discretion and control exercised on
the outside person retained. Allocated Expenses are the expenses allocated to a particular claim file,
which are not covered by Provider's compensation, and are limited to the expenses described in the
Proposal as "Allocated Expenses", excluding photographs, video/audio tapes, supplies, postage, and
other services or equipment which are normally utilized in the provision of investigative services.
2. REPORTING REQUIREMENTS AND STATUS REPORTS:
The Provider shall provide to the Administrator a listing every 30 days indicating all employees that are
losing time or working in a light-duty or restricted capacity.
3. ADDITIONAL PROVIDER DUTIES:
In addition to all other responsibilities set forth in the Agreement, and at no additional cost to the City, the
Provider shall:
A. Attend Workers' compensation hearings, depositions, mediations and Pension Board hearings
involving work-related injuries as requested by the City and provide responses to discovery as
required by the City Attorney.
B. Provide notification of pro -litigation discovery and litigation being filed against the City for any
reason, to the City Attorney and to the Administrator within twenty-four (24) hours.
III.
PART II SERVICES
GENERAL AUTOMOBILE & PROFESSIONAL LIABILITY CLAIMS ADMINISTRATION
1. FILE DOCUMENTATION:
Provider agrees as follows:
A. Updated case analysis summaries will be completed and placed in any claim file involving bodily
injury at least every ninety (90) days after the opening of the file, The summary will include any
and all information that relates to the direction and value of the ease, as well as further work to be
done and a target date for completion.
2. INVESTIGATION:
Provider agrees as follows:
A. Conduct a thorough and complete investigation of the incident, according to the requirements of the
City which shall include, but is not be limited to, the following:
1. Provider shall use best efforts to have photographs of accident scenes taken before the
automobiles have been removed from the scene.
2. Photographs or diagrams are required for all claims.
3. For automobile claims, obtain, at a minimum, the police and/or fire rescue report and rescue
field copy, and such other documents or information as may assist in the investigation
including, but not limited to, id photos from the Miami Police Department, driver's license
history and disposition of traffic citation.
4. For premises liability claims, obtain, at a minimum, if applicable, fire rescue report and field
copy, police report, public works statement on jurisdiction and maintenance history of the
accident location.
5. For police liability claims, where applicable, obtain, at a minimum, the following:
a. Internal affairs file relating to the claim and Internal Affairs profile of
involved officers
b. Control of persons report
C. K9 Bite report
d. OC Usage report
e. Tazer report
f. Arrest affidavit
g. Incident report/persons report
h. State Attorney's file
i. Criminal Court file
j. Jail Booking record and jail photo
k. Bonding Video
1. Fire/rescue report and field cop—
m. Disposition of any hearing panel such as DDRB or Accident Review Board
n. Discharge of firearms report
0. Claimant's prior arrest history
p. Communications tape
q. Homicide file and supplementary report
r. ID Unit photos
S. P sheet
t. Officer worksheet
6. For fire/rescue claims, obtain, at a minimum, the fire/rescue report and field copy, and
applicable portions of medical protocols.
7. For labor claims,
where applicable, obtain, at a minimum, the following:
a.
Employees personnel files
b.
Employment history with City
C.
Job announcements and advertisements for job classification
d.
Civil service hearing records
e.
Labor relations reports and findings
f.
Court transcripts
g.
Internal security records at Miami Police Department
h.
Payroll summaries
i.
EEOC records
j.
Department's employee personnel records
k.
Timesheet records
I.
Employment shift records at Miami Police Department
in.
RFP/Bid package and responses
n.
Employment applications
o.
Register and Certification lists
P.
Public Records requests/responses
q.
Justice Department approvals
B. As soon as possible, Provider shall obtain authorization from the injured party to obtain the pertinent
information from the treating medical facility to establish the extent of injury, length of disability,
and causal relationship of the injury to the alleged incident.
3. ADDITIONAL PROVIDER DUTIES:
Provider shall attend all mediations and trials as requested by the City Attorney, at no additional cost to the
City. With respect to claims with impending trial dates, the Provider will take an active and aggressive role
in settlement or preparation for trial.
ATTACHMENT B
COMPENSATION
The City shall pay Provider an amount not to exceed $150,000, on a month-to-month basis, for
the Services described in Attachment A, commencing on the date hereof and shall terminate
upon thirty (30) days with written notice from the City to Provider.
ATTACHMENT C
DESIGNATED PERSONNEL
Provider shall assign the following personnel to provide Services specified in this Agreement:
1. ACCOUNT MANAGER: The Account Manager is fully qualified and responsible for
the performance of Provider's responsibilities under the Agreement. The Account Manager's
responsibilities include, but are not limited to:
i. Act as Provider's representative on any claim issue or problems;
ii. Act as a liaison between the City, managed care provider, medical network and
any other parties as deemed necessary by the City.
iii. Participate with and assist the Administrator in the performance reviews, as
required under the Performance Agreement attached to the Agreement as
Attachment "E" and review of other claims as requested by the Administrator
under the Agreement.
iv. Meet at least once a month with the Administrator to review pending claims.
The Account Manager assigned to the City is: Katherine Brown -Mowers, Provider shall
give the Administrator at least thirty (30) days prior written notice of any change of Account
Manager. The notice shall include all information required by the City to make and maintain
contact with the Account Manager.
2. CLAIMS REPRESENTATIVE:
i. Provider shall describe duties of claim's representatives and give required
information about the Claim Representatives designated for the City.
ii. Provider represents and warrants to the City that the Claims Representatives will at
all times during the Term, maintain a case load consistent with the provisions of
the Proposal, but no event less favorable that those provided in the industry.
iii. Provider shall maintain the City informed of the names and changes to the
designated Claims Representatives. Provider agrees to give the City at least three
(3) business days prior written notice of any change of designated Claims
Representatives.
iv. Upon notification to the City, Provider may assign or change such other personnel
as Provider deems necessary to provide the Services to the City. In such event,
Provider shall replace the personnel listed above, with qualified and experienced
personnel.
ATTACHMENT D
PROVIDERS' INSURANCE REQUIREMENTS
Provider agrees to maintain in full force and effect the following policies of insurance during the term of this
Agreement:
TYPE
LIMITS OF LIABILITY
Workers Compensation Statutory
Employers Liability $1,000,000
$1,000,000
$1,000.000
Commercial General Liability $1,000.000
$2,000.000
Each Acc., Bodily injury
Each Employee, Disease
Policy Limit, Disease
Each Occurrence
General Aggregate
Business Auto Liability $1,000,000
Each Accident
Umbrella Liability $10,000,000
Each Occurrence
$10,000,000
Aggregate
Errors & Omissions $10,000,000
Each Occurrence
$10,000.000
Aggregate
Provider shall submit a certificate or certificates evidencing the coverages in a form satisfactory to City. Said
certificates(s) shall provide for thirty (30) days notice to City prior to cancellation, non -renewal or material change
of any insurance required by this Agreement.
Receipt of deficient certificates by City, or by any of City's representatives, does not constitute a waiver of
Provider's obligation to fulfill the insurance requirements herein.
Provider shall be responsible for assuring that the insurance certificates required in conjunction with this Section
remain in force for the duration of the contractual period; including any and all option terms that may be granted to
the Provider.
If insurance certificates are scheduled to expire during the contractual period, the Provider shall be responsible for
submitting new or renewed insurance certificates to the City at a minimum of ten (10) calendar days in advance of
such expiration.
In the event that expired certificates are riot replaced with new or renewed certificates which cover the contractual
period, the City shall, in addition to all other remedies available to it in equity or at law, for a. default under the
Agreement:
(i) Suspend any payments due to the Provider under the Agreement until such time as the new
or renewed certificates are received by the City, provided, however, that nothing contained
herein shall release the Provider from performance of its obligations under the Agreement.
(ii) The City may, at its sole discretion, terminate the Agreement for cause and seek re -
procurement damages from the Provider in conjunction with the violation of the terms and
conditions of the Agreement without waiving any of the City's rights under the Agreement,
including specifically, without limitation, the right to require Provider to continue to handle
claims that have been reported prior to the date of termination.
ATTACHMENT E
PERFORMANCE AGREEMENT
Gallagher Bassett Services, Inc. ("Provider") has been retained to provide claims administration services
to the City of Miami ("City') in accordance with the provisions of the Professional Services Agreement
dated , 2009 (the "Agreement"), which is hereby incorporated by reference and made a
part of this Performance Agreement. The term of the Agreement the "Term" is a month-to-month term,
commencing on , 2009 and shall terminate upon thirty (30) days written notice from
the City to Provider. In no event shall this Agreement terminate until such time as the City has completed
a competitive procurement process for services to provide Workers' Compensation, Claims
Administration, General Automobile and Professional Liability, and Managed Care Services.
The Provider and the City agree that performance reviews of Provider's obligations, under the Agreement
("Performance Reviews") will be conducted after the first six months of the Term. The Performance
Reviews will be conducted with respect to all New Claims and Transferred Claims (as the terms are
defined in the Agreement) reported and handled during the first 6 months of the Term, and every six-
month period thereafter (each, a "Performance Period"). Each Performance Review will involve 100
randomly selected files, excluding workers' compensation "medical only" files, The make-up of the files
selected for each review will be approximately 50 from workers' compensation, 15 auto liability, 15
general liability, and 20 police professional or public officials' liability, with at least 50% open files in
each category.
Claims for review will be randomly selected by the Administrator. Provider will provide the City with a
listing of all claims being handled during each Performance Period, sorted by type of claim. The City will
select random claims, such as every tenth claim, from each category until the appropriate number of
claims has been selected.
The City will perform two Performance Reviews for each annual period of the Agreement. The initial
review
will cover claims administration services rendered during the first six (6) months of the Term. Each
Performance Review will occur approximately 1-2 months after the conclusion of the Performance
Period. The Chart attached hereto as Exhibit "A" outlines the schedule of Performance Reviews.
The Performance Reviews are intended to measure Provider's performance of its obligations under the
Agreement. Each Performance Period shall measure seven (7) objective obligations of Provider under the
Agreement which are easily identified and measured (each, a "Performance Standard"). Each claim
subject to Performance Review will generate a maximum of 12 points. All timeliness standards of
performance are stated in business, not calendar, days. In all instances where a standard is not applicable
to a particular claim file, the file will be' awarded the appropriate point(s) for that standard.
Attached hereto as Exhibit "B" are the initial Performance Standards to be measured under this
Performance Agreement. The City has the right to change, add, delete or substitute (collectively, a
"change") any or all Performance Standards at any time during the Term; provided, however, that any
change to a Performance Standard shall be communicated by the Administrator to the Provider, in
writing, at least sixty (60) days prior to the Performance Period that will measure the changed
Performance Standard, Each communication of a change to a Performance Standard shall be deemed to
amend Exhibit `B" accordingly.
Failure to reach expected levels of performance during each Performance Period will result in a financial
penalty of 5% of the amount that would be charged by the Provider for the claims reported during the
Performance Period subject to the review. Any financial penalties will be credited against future amounts
invoiced by Provider to the City.
After each Performance Review is performed, Provider will meet with the Administrator to discuss initial
evaluation results. Thereafter, a final tally of the review results will be prepared. The outcome of all
reviews will be presented to the Administrator for approval. The first review will be for information
purposes only and no penalties will be imposed.
Provider and the City have agreed on a percentage which represents the expected level of compliance
with the Performance Standards per claim (the "Average Compliance Expectation"). Failure to meet the
Average Compliance Expectation with respect to a claim shall result in the imposition of financial
penalties, as herein provided. The Average Compliance Expectation during the first year of the Term is
80% ((i.e. average of 10 of the possible 12 points for each claim reviewed). During the second year of the
Term, the Average Compliance Expectation shall be raised to 90%. Thereafter the Average Compliance
Expectation shall be 91%. The Performance Periods, Average Compliance Expectations and Financial
Penalties are outlined in Exhibit "A" hereto.
Provider and the City understand and agree that the purpose of this Performance Agreement is to measure
Provider's performance under the Agreement and provide financial penalties for failure to meet expected
performance, but nothing contained herein shall prevent the City from seeking other remedies for default,
or embracing Provider's obligations under the Agreement by other legal or equitable means.
All notices required or permitted under this Performance Agreement shall be given in the manner set forth
in the Agreement.
IN WITNESS WHEREOF, the parties hereto have caused this instrument to be executed by their
respective officials thereunto duly authorized, this the day and year above written.
ATTEST:
By:
Print Name:
Title:
ATTEST:
By:
Priscilla A. Thompson, City Clerk
Approved as to Form and Correctness:
"Provider"
Gallagher Bassett Services, Inc.,
an Illinois. corporation
By:
Print Name:
Title:
"City"
CITY OF MIAMI, a municipal corporation
Pedro G. Hernandez, City Manager
Approved as to Insurance Requirements:
By: By:
Julie O. Bru, City Attorney
Risk Management Director