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HomeMy WebLinkAbout144217 CANNON COCHRAN MGMT SERVICES CCMSI - CONTRACT - RFP - P686 CLAIMS ADMINISTRATOR SERVICESPROFESSIONAL SERVICES AGREEMENT
THIS AGREEMENT made and entered into the day and year set forth below, by
and between THE CITY OF FORT COLLINS, COLORADO, a Municipal Corporation,
hereinafter referred to as the "City" and OCCUPATIONAL HEALTHCARE
MANAGEMENT SERVICES, INC (OHMS), a corporation, hereinafter referred to as
"Professional".
WITNESSETH:
In consideration of the mutual covenants and obligations herein expressed, it is
agreed by and between the parties hereto as follows:
1. Scope of Services. The Professional agrees to provide services in
accordance with the scope of services attached hereto as Exhibit "A", consisting of Four
(4) pages, and incorporated herein by this reference.
2. Time of Commencement and Completion of Services. The services to be
performed pursuant to this Agreement shall be initiated within a fifteen (15) days
following execution of this Agreement. Services shall be completed no later than
December 31,1999. Time is of the essence. Any extensions of the time limit set forth
above must be agreed upon in writing by the parties hereto. In addition, at the option of
the City, the Agreement may be extended for additional one year periods not to exceed
four (4) additional one year periods. Pricing changes shall be negotiated by and agreed
to by both parties and may not exceed the Denver - Boulder CPI-U as published by the
Colorado State Planning and Budget Office. Written notice of renewal shall be provided
to the Service Provider and mailed no later than ninety (90) days prior to contract end.
3. Early Termination by City. Notwithstanding the time periods contained
herein, the City may terminate this Agreement at any time without cause by providing
written notice of termination to the Professional. Such notice shall be delivered at least
PSA 10/97
D. To encourage early recovery from injury and early return to productive work.
E. To encourage employees' return to work for modified duty.
To identify fraudulent claims and aggressively defend those claims indicating no
negligence on the City's part.
G. To identify cause of loss and correct, if necessary, to prevent future loss.
H. To keep communication open between the Administrator, Risk Manager, Employees,
Claimants, and Doctors.
SECTION IV
The City of Fort Collins does D&2 send all claims to a third party claims administrator. The City
Attorneys Office and the Risk Management division reserves the right to determine which
claims will be handled in house and those that will be assigned to the third party administrator.
B. TITLE RIGHTS
Ensure that the City shall have full, complete and absolute title to all studies, files, documents,
correspondence, tapes, movies, recordings, reports, analyses and other materials prepared or
acquired regardless of the state of completion.
Further ensure that the City may make full and complete use of said materials as it desires, and
within its own discretion without liability of any kind whatsoever to the Administrator other than
payment of consideration as provided.
PSA 10/97
EXHIBIT B
INSURANCE REQUIREMENTS
1. The Service Provider will provide, from insurance companies acceptable to the City, the insurance
coverage designated hereinafter and pay all costs. Before commencing work under this bid, the
Service Provider shall furnish the City with certificates of insurance showing the type, amount, class of
operations covered, effective dates and date of expiration of policies, and containing substantially the
following statement"
"The insurance evidenced by this Certificate will not be canceled or materially altered, except after
thirty (30) days written notice has been received by the City of Fort Collins."
In case of the breach of any provision of the Insurance Requirements, the City, at its option, may take
out and maintain, at the expense of the Service Provider, such insurance as the City may deem proper
and may deduct the cost of such insurance from any monies which may be due or become due the
Service Provider under this Agreement. The City, its officers, agents and employees shall be named
as additional insureds on the Service Provider's general liability and automobile liability insurance
policies for any claims arising out of work performed under this Agreement.
2. Insurance coverages shall be as follows:
A. Workers' Compensation and Employer's Liability. The Service Provider shall maintain during
the life of this Agreement Workers' Compensation insurance as required by Colorado law, and
Employer's Liability Insurance, in an amount not less than $400,000 for each occurrence, for all
of the Service Provider's employees engaged in work performed under this Agreement.
B. Commercial General Liability. The Service Provider shall maintain during the life of this
Agreement such commercial general liability and automobile liability insurance as will provide
coverage for claims for damages for personal injury, including accidental death, as well as for
claims for property damage, which may arise directly or indirectly from the performance of work
under this Agreement. Coverage for property damage shall be on a "broad form" basis. The
amount of insurance to be provided shall be not less than $1,000,000 combined single limits for
bodily injury and property damage.
In the event any work under this Agreement is performed by a subcontractor, the Service
Provider shall be responsible for any liability directly or indirectly arising out of the work
performed under this Agreement by a subcontractor, which liability is not covered by the
subcontractor's insurance.
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EXHIBIT "C"
Year 2000 Compliance
Blue Cross and Blue Shield of Colorado and Rocky Mountain Administrative Services Company, Inc., and all
corporate affiliates, (collectively referred to as the "Company") have established a corporate -wide Year 2000
Project Plan and warrant that the Company's essential services, operating systems, software, firmware,
hardware and associated equipment will be Year 2000 ready.
"Year 2000 ready" means that all hardware, software and other information technology equipment will:
• correctly identify, recognize and process four -digit dates;
• continue to function properly with regard to dates before, during and after the transition to year 2000
including, but not limited to, the ability to roll dates from December 31, 1999, to January 1, 2000, and
beyond with no errors or system interruptions;
• accurately perform calculations and comparisons on dates that span centuries;
• accept and properly process dates that could span more than 100 years (e.g., calculating a person's
age from their birth date and the current date);
• properly sort and sequence dates that span centuries;
• understand that the year 2000 starts on a Saturday;
• recognize that February 29, 2000 is a valid date and that the Year 2000 has 366 days;
• prohibit use of data fields for any purpose other than to store valid dates; and
• preclude the use of 12/31/99 or any other valid date to indicate something other than a date (e.g.,
12/31/99 in a date file means "do not ever cancel").
In the event of a breach of this warranty, the Company's affirmative obligation to act shall be limited to
commercially reasonable efforts to correct any such breach. The liability of the Company for damages to
Customer as a result of any breach of this warranty shall be limited to the amount of payments to the
Company by Customer under this Agreement.
Y2KFtCollins
7/98
Service Agreement for The City of Fort Collins
Workers' Compensation/Liability Self-insurance Program
Attachment #1
Compensation Schedule/Agreement
Compensation
1. Claims Manag ment:
An annual Claims administration fee of $65,000.00, payable in twelve (12) monthly
installments of $5,416.67, and
If total claims volume exceeds 400 new claims (workers' compensation and/or liability
claims), additional claims will be charged at the following rate:
Indemnity Claims$ 600.00 per claim.
Medical Claims $ 120.00 per claim.
Liability Claims $ 355.00 per claim.
2. Preferred Provider and Medical Cost Contaiment•
2.1 The preferred provider network access fee shall be 50% of the difference, if any, between
the Colorado State Fee Schedule for a given service or treatment, and the amount actually
paid by Client for such service or treatment. This fee is only applied to those bills/services
that are rendered by participating OHMS network providers.
2.2 Medical Fee Review service fees shall be:
$1.35 medical fee line item. This fee is only applied to bills for which services have b
en rendered by a provider that is not in the OHMS network.
7/98
3.
4.
2.3 Medical & Disability Case Management safety, loss control & early RTW services
professional services(full assignment $75 / hour
or field work)
(Optional: Travel & wait time $35 / hour)
mileage $.35 / mile
2.4 Early Intervention Clinical Review Services (includes review of workers'
compensation claims that meet OHMS criteria)
No Charge
Medical Case Manager attendance at
bi-weekly provider meeting No Charge
3.1 Furnish to Client five (5) standard reports on a monthly basis and three (3) standard reports
on a quarterly basis for no additional fee.
3.2 Furnish to Client the necessary reports on an annual and biannual basis for no additional
fee:
As agreed upon between Client and OHMS.
3.3 Additional Reports: Provide custom reports at the request of client for a programming fee
of $125.00 per hour.
Participate in and attend bi-weekly claims status meetings. Hourly charges for additional
meetings that include non -risk management staff are:
Adjuster
Nurse
Management
Mileage
Other Expenses
$65.00 per hour
$75.00 per hour
$75.00 per hour
$.35 per mile
Expenses as actual
7/98
5. Additional Services:
Data conversions and/or special programming fees: $125.00 per hour.
Initial data conversion fees: $125.00 per hour not to exceed a total of $7,500.00.
Provide and bill for additional services as mutually agreed upon by OHMS and the Client.
6. Payment of Invoices.
6.1. OHMS shall submit to Client on or before the 101h day of each month, an invoice for all service
fees payable under this Agreement. Such invoice shall reflect the basis for the calculation of the
fees due.
Upon receipt, Client agrees to pay the amount invoiced by check or wire transfer within fourteen
(14) days following the date of invoice. Client agrees to pay any fees imposed by Client's bank
for the use of wire transfer.
Client Account: Client shall establish and maintain a sufficiently funded bank account
authorizing OHMS to make payments from that account. OHMS shall issue any and all
payments made on behalf of client under this agreement, from this account. OHMS will forward
[Optional: daily, weekly, monthly] a check register, listing all payments, to client when checks
have been drawn on their account.
OHMS will provide 24 hour notice to the City of any single transaction that is in the amount of
ten thousand dollars ($10,000.00) or higher.
7/98
Exhibit D
CONFIDENTIALITY
IN CONNECTION WITH SERVICES provided to the City of Fort Collins (the City ) pursuant to this Agreement
(the Agreement ), the Contractor hereby acknowledges that it has been informed that the City has established
policies and procedures with regard to the handling of confidential information and other sensitive materials.
In consideration of access to certain information, data and material (hereinafter individually and collectively,
regardless of nature, referred to as information ) that are the property of and/or relate to the City or its
customers or suppliers, which access is related to the performance of services that the Contractor has agreed
to perform, the Contractor hereby acknowledges and agrees as follows:
That information that has or will come into its possession or knowledge in connection with the performance of
services for the City may be confidential and/or proprietary. The Contractor agrees to treat as confidential (a)
all information that is owned by the City, or that relates to the business of the City , or that is used by the City
in carrying on business, and (b) all information that is proprietary to a third party (including but not limited to
customers and suppliers of the City) . The Contractor shall not disclose any such information to any person
not having a legitimate need -to -know for purposes authorized by the City. Further, the Contractor shall not
use such information to obtain any economic or other benefit for itself, or any third party, except as specifically
authorized by the City.
The foregoing to the contrary notwithstanding, the Contractor understands that it shall have no obligation
under this Agreement with respect to information and material that (a) becomes generally known to the public
by publication or some means other than a breach of duty of this Agreement, or (b) is required by law,
regulation or court order to be disclosed, provided that the request for such disclosure is proper and the
disclosure does not exceed that which is required. In the event of any disclosure under (b) above, the
Contractor shall furnish a copy of this Agreement to anyone to whom it is required to make such disclosure
and shall promptly advise the City in writing of each such disclosure.
In the event that the Contractor ceases to perform services for the City, or the City so requests for any reason,
the Contractor shall promptly return to the City any and all information described hereinabove, including all
copies, notes and/or summaries (handwritten or mechanically produced) thereof, in its possession or control or
as to which it otherwise has access.
The Contractor understands and agrees that the City s remedies at law for a breach of the Contractors
obligations under this Confidentiality Agreement may be inadequate and that the City shall, in the event of any
such breach, be entitled to seek equitable relief (including without limitation preliminary and permanent
injunctive relief and specific performance) in addition to all other remedies provided hereunder or available at
law.
7198
(303)773-9999 FAX
,rthur J. Gallagher & Co. - Denver
7900 E. Union Suite 200
Denver, CO 80237
ONLY AND CONFERS NO RIGHTS UPON THE
HOLDER. THIS CERTIFICATE DOES NOT AME
ALTER THE COVERAGE AFFORDED BY THE
24/1998
OR
kttn:
COMPANY
American
Motorists (Kemper)
Ty Penvari EXt: 414
_.
A
INSURED _...
Blue Cross & Blue Shield of Colorado
'. CO BgNv
American
5,
Mfrs. Mutual (Ke'Ih`IJeF)
700 Broadway RM 0738
„
Denver, CO 80273
COMPANY
Republic
Western Insurance "
CA':
COMPANY
D
INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENDT ABOVE WITH RESP CT TO LWHICH TH ICY SD
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
CO TYPE OF INSURANCE POLICY EFFECTIVE POLICY EXPIRATION
LTR ' POLICY NUMBER
DATE (MM/OD/YV) GATE(MM/ODII'1') '. LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE X OCCUR
A _._. 7KP622923-01
OWNER'S 8 CONTRACTOR'S PROT
X tA9g applies per
lOCati on
AUTOMOBILE LIABILITY
X IANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
B 7KP622923-01
' HIRED AUTOS
NON -OWNED AUTOS
GARAGE LIABILITY
ANY AUTO
EXCESS LIABILITY
UMBRELLA FORM
OTHER THAN UMBRELLA FORM
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
C THE PROPRIETOR/ RSU0501185
PARTNERS/EXECUTIVE INCL
OFFICERS ARE: EXCL:
GENERAL AGGREGATE S 2, 000, 000
PRODUCTS COMP/OP AGG $
'. 2, 000, 000
09/01/1998 09/01/1999 PERSONAL S ADV INJURY $ _1, 000, 000
EACH OCCURRENCE $ 11000,000
FIRE DAMAGE (Any one fire) $ 1, 000, 000
MED EXP (Any one person) $ 1.
10.000
'.. '., COMBINED SINGLE LIMIT $
_.... _... _.. 11000,000
BODILY INJURY
(Per Person) $
09/01/1998 09/01/1999 ---- --....
BODILY INJURY
(Per accident) $
PROPERTY DAMAGE $
-AUTO ONLY - EA ACCIDENT
$
OTHER THAN AUTO ONLY
'
EACHACCIDENT
..............................
$
AGGREGATE'.
$
EACH OCCURRENCE
$
AGGREGATE
$
X :70RV LIMITS' ER
09/01/1998 09/01/1999 EL EACIHACCIDENIT $ 11000,000
EL DISEASE POLICY LIMIT $ 11000,000
'EL DISEASE - EA EMPLOYEE $ 1, 000.000
E: City Of Fort Collins Third Party Administrator Contract; The insurance evidenced by this
ertificate will not be cancelled or materially altered, except after thirty (30) days written notice
as been received by the City Of Fort Collins.
City Of Fort Collins
Mr. James B. O'Neill, II; Director of
Purchasing & Risk Management
256 W. Mountain Avenue
P.O. Box 580
Fort Collins, CO 80522
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL
�O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,
BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY
OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESENTATIVES.
John McLaughlin
sixty (60) days prior to the termination date contained in said notice unless otherwise
agreed in writing by the parties. All notices provided under this Agreement shall be
effective when mailed, postage prepaid and sent to the following addresses:
Professional: City: With Copy To:
OHMS
Terry M. Lee
State Director, Colorado
P. O. Box 173682
Denver, CO 80217 3682
Stewart Ellenberg, ARM
Risk Manager
City of Fort Collins
P. O. Box 580
Fort Collins, CO 80522
James B. O'Neill ll, CPPO
Director of Purchasing and
Risk Management
City of Fort Collins
P. O. Box 580
Fort Collins, CO 80522
In the event of any such early termination by the City, the Professional shall be paid for
services rendered prior to the date of termination, subject only to the satisfactory
performance of the Professional's obligations under this Agreement. Such payment shall
be the Professional's sole right and remedy for such termination.
4. Design Project Indemnity and Insurance Responsibility. The
Professional shall be responsible for the professional quality, technical accuracy, timely
completion and the coordination of all services rendered by the Professional, including
but not limited to designs, plans, reports, specifications, and drawings and shall, without
additional compensation, promptly remedy and correct any errors, omissions, or other
deficiencies caused by the Professional's negligence or gross negligence. The
Professional shall indemnify, save and hold harmless the City, its officers and
employees in accordance with Colorado law, from all damages whatsoever claimed by
third parties against the City arising out of the Professional's negligence, gross
negligence or willful misconduct in its performance of this agreement; and for the City's
costs and reasonable attorneys fees, arising directly out of the Professional's
negligence, gross negligence or willful misconduct in its performance of any of the
services furnished under this Agreement. The Professional shall maintain commercial
PSA 10/97
general liability insurance in the amount of $500,000 combined single limits, and errors
and omissions insurance in the amount of $1,000,000.00.
5. Compensation. In consideration of the services to be performed
pursuant to this Agreement, the City agrees to pay Professional a fixed fee in the
amount of Sixty-five Thousand ($65,000.00). Attachment #1 consisting of 3 pages, and
incorporated herein by this reference, outlines the Compensation Schedule for any
additional charges. Monthly partial payments of Five Thousand Four Hundred Sixteen
Dollars and sixty-seven cents ($5,416.67) based upon the Professional's billings and
itemized statements are permissible. The amounts of all such partial payments shall be
based upon the Professional's City -verified progress in completing the services to be
performed pursuant hereto and upon the City's approval of the Professional's actual
reimbursable expenses. Final payment shall be made following acceptance of the work
by the City. Upon final payment, all designs, plans, reports, specifications, drawings,
and other services rendered by the Professional shall become the sole property of the
City.
6. City Representative. The City will designate, prior to commencement of
work, its project representative who shall make, within the scope of his or her authority,
all necessary and proper decisions with reference to the project. All requests for
contract interpretations, change orders, and other clarification or instruction shall be
directed to the City Representative.
8. Per i%A Drawings. Upon conclusion of the project and before final
payment, the Professional shall provide the City with reproducible drawings of the
project containing accurate information on the project as constructed. Drawings shall be
of archival quality, prepared on stable mylar base material using a non -fading process to
prove for long storage and high quality reproduction.
9. Independent Contractor. The services to be performed by Professional
are those of an independent contractor and not of an employee of the City of Fort
PSA 10/97
Collins. The City shall not be responsible for withholding any portion of Professional's
compensation hereunder for the payment of FICA, Workers' Compensation, other taxes
or benefits or for any other purpose.
10. Personal Services. It is understood that the City enters into this
Agreement based on the special abilities of the Professional and that this Agreement
shall be considered as an agreement for personal services. Accordingly, the
Professional shall neither assign any responsibilities nor delegate any duties arising
under this Agreement without the prior written consent of the City.
11 Acceptance Not Waiver. The City's approval of drawings, designs, plans,
specifications, reports, and incidental work or materials furnished hereunder shall not in
any way relieve the Professional of responsibility for the quality or technical accuracy of
the work. The City's approval or acceptance of, or payment for, any of the services shall
not be construed to operate as a waiver of any rights or benefits provided to the City
under this Agreement.
12. Default. Each and every term and condition hereof shall be deemed to
be a material element of this Agreement. In the event either party should fail or refuse
to perform according to the terms of this agreement, such party may be declared in
default.
13. Remedies. In the event a party has been declared in default, such
defaulting party shall be allowed a period of ten (10) days within which to cure said
default. In the event the default remains uncorrected, the party declaring default may
elect to (a) terminate the Agreement and seek damages; (b) treat the Agreement as
continuing and require specific performance; or (c) avail himself of any other remedy at
law or equity. If the non -defaulting party commences legal or equitable actions against
the defaulting party, the defaulting party shall be liable to the non -defaulting party for the
non -defaulting parry's reasonable attorney fees and costs incurred because of the
default.
PSA 10/97
14. Binding Effect. This writing, together with the exhibits hereto, constitutes
the entire agreement between the parties and shall be binding upon said parties, their
officers, employees, agents and assigns and shall inure to the benefit of the respective
survivors, heirs, personal representatives, successors and assigns of said parties.
15. Law/Severabilit. The ,laws of the State of Colorado shall govern the
construction, interpretation, execution and enforcement of this Agreement. In the event
any provision of this Agreement shall be held invalid or unenforceable by any court of
competent jurisdiction, such holding shall not invalidate or render unenforceable any
other provision of this Agreement.
16. Special Provisions. Special provisions or conditions relating to the
services to be performed pursuant to this Agreement are set forth in Exhibit "C", Year
2000 Compliance consisting of one (1) page, attached hereto and incorporated herein
by this reference and Exhibit "D", Confidentiality Agreement, consisting of one (1) page,
attached hereto and incorporated herein by this reference.
PSA 10/97
THE CITY OF FORT COLLINS, COLORADO
By: (1,;) 1S-9
John 112. Fischbach
Cit Manager
By: D
J es B. O'Neill II, CPPO
Direc or f Purchasing & Risk Management
DATE: / 2_1 / Q il
ATTEST:: _blv
City Clerk
APPROVED AS TO FORM:
Assistant City Attorney
OCCUPATIONAL HEALTHCARE MANAGEMENT
SERVICES INC. (OHMS)
By: 1> \L 1
Title:
CORPORATE PRESIDENT OR VICE PRESIDENT
Date: _ _ \\—Z3 -` %
7ATTE4S,,:,j.
r
(Corporate Seal)
Corpo to S retary
PSA 10/97
EXHIBIT "A"
SCOPE OF SERVICES
CLAIMS MANAGEMENT STANDARDS & PROCEDURE
Following are standards and services the City wishes to maintain.
CLAIMS ADMINISTRATION
A. Create files and reserve within two (2) working days from receipt of the initial report.
B. Establish diaries so each claim is reviewed at least every thirty (30) days, or more
frequently where needed. Document confirmation of review.
C. Examine and analyze all claims to determine compensability of claimed injuries and
liability of City.
D. Pay bills promptly per City instructions.
E. Audit medical bills and repair bills for casual relationship and reasonableness of
charges.
Report all indemnity claims to the Index Bureau upon file creation, and retain a copy
with the file.
G. Review medical -only claims for possible closure no less frequently than every thirty (30)
days.
H. Provide copies of all written correspondence from the administrator to doctors,
claimants, attorneys, rehabilitation counselors, investigators and state agencies.
I. Clearly document all file activity, including telephone conversations or personal
meetings, and diary reviews to reflect the date, individuals involved, content of
discussion and plan of action.
J. Establish specific direction on the investigation and handling of all indemnity cases
within three (3) working days from receipt of the initial report, and clearly evidenced in
the file.
K. Notify appropriate excess insurer(s) of all claims or losses meeting the reporting
requirements of the insurer and provide such insurer with all required information and
updates. Send update reports to excess carriers no less frequently than semi-annually.
L. Provide a written analysis of all proposed settlements by stipulation or compromise for
consideration and authorization, in losses valued in excess of $5,000.
M. Establish claim reserves and provide a continual review and update of reserves to
reflect changes.
PSA 10/97
N. Maintain a file for each claim submitted with the file available for review by the City at
any reasonable time.
O. Consult and cooperate with the City and its employees as may be necessary to achieve
a successful program. This includes regular meetings between City staff and the Third
Party Administrator being held every 7-14 days, to discuss claim settlements/denials.
P. Maintain a Fort Collins Operational Claims Servicing Office.
A. Conduct the necessary investigation of each claim using competent and qualified
personnel, including such investigation as is necessary to determine he City's liability.
The City reserves the right to require additional investigation. With the approval of the
City, engage the services of persons of firms outside its organization for special work in
connection with investigations.
B. Contact or attempt to contact all employees and claimants within three (3) days of
receipt of claim. Upon initial contact, document the description of injury/accident.
Document attempts to contact employee or claimant.
C. Contact the department and designated employee for City's statement before
determining liability.
D. Contact the City within three (3) days to confirm whether compensability/liability is
acknowledged or should have been questioned.
E. Monitor treatment program for injured employees to assure that treatment is related to
the compensable injury or illness.
F. Maintain a close liaison with treating physicians to assure that employees receive proper
care and to avoid over treatment situations.
G. Determine eligibility for and authorize payment of Temporary Disability compensation in
accordance with medical advice and rehabilitation efforts.
H. Maintain telephone or personal contact with temporarily disabled employees no less
frequently than monthly, to maintain rapport and to monitor medical progress and return
to work status.
Schedule independent medical examinations with qualified physicians in cases where
treatment, length of disability or extent of permanent disability assigned is in question.
Investigate whether subrogation can be rule out or pursued in all cases which may
involve third party negligence.
K. Refer litigated cases to attorneys utilizing an agreed listing or legal firms. Assist in the
preparation of litigated cases and participate as needed in hearings and settlement
actions.
PSA 10/97
L. Attend bi-weekly meetings with City's designated physician.
III. CLAIMS ANALYSIS AND REPORT
r
A. Provide the City with continuing information on the progress of individual claims and the
effectiveness of cost control programs relating to all claims.
B. Submit monthly statistical summaries and narrative reports to assist in the evaluation of
the City's program.
C. Assist the City in the analysis of claims in an effort to prevent future occurrences of a
similar nature.
D. Maintain a claim file for each reported claim which shall be available to the City at all
times for inspection. Such file shall contain all data pertinent to the claim to support its
disposition and shall remain the exclusive property of the City.
E. Assist the City in preparation of required self insurance reports and reports required by
the city's insurance carriers.
A. Provide information and guidance to the employees regarding Workers' compensation
benefits and respond to inquiries regarding specific injuries and permanent disability
ratings.
B. When appropriate, develop rehabilitation programs for injured employees for approval
by the City, the employee and appropriate agencies ensuring that rehabilitation,
retraining or reassignment is provided to employees with physical or performance
limitations resulting from industrial injuries.
C. Review existing City programs and procedures and recommend changes as needed.
SECTION III
• •-
The City of Fort Collins' claims management philosophy is as follows:
A. To be certain claimants are given a high standard of care and concern to avoid poor
public opinion.
B. To be certain employees are advised of their benefits under Workers' Compensation in
a timely fashion.
C. To give prompt attention to all claims matters in an attempt to discourage unnecessary
litigation.
PSA 10/97