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HomeMy WebLinkAbout144217 CANON COCHRAN MANAGEMENT SERVICES INC - CONTRACT - RFP - P910 CLAIMS ADMINISTRATOR SERVICESSERVICES 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 Canon Cochran Management Services, Inc., hereinafter referred to as "Service Provider". W ITNESSETH: In consideration of the mutual covenants and obligations herein expressed, it is agreed by and between the parties hereto as follows: Scope of Services. The Service Provider agrees to provide services in accordance with the scope of services attached hereto as Exhibit "A", consisting of three (3) 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 immediately following execution of this Agreement. Services shall be completed no later than December 31, 2004. Time is of the essence. Any extensions of the time limit set forth above must be agreed upon in a writing signed by the parties. 3. Contract Period. This Agreement shall commence January 1, 2004, and shall continue in full force and effect until December 31, 2004, unless sooner terminated as herein provided. 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. 4. Delay. If either party is prevented in whole or in part from performing its obligations by unforeseeable causes beyond its reasonable control and without its fault or negligence, then the party so prevented shall be excused from whatever performance is prevented by such cause. To the extent that the performance is actually prevented, the Service Provider must provide written SA 10/01 3. 5. 6. 2.2.3 Nurse Negotiated Fees for medical bills at $75.00 @ hr. 2.3 Medical & Disability Case Management & early RTW services Nurse Case Management Services $75.00 @ hr Travel & Wait Time $35.00 @hr Mileage $ .37 @ mile Other Expenses Actual Renortina- 3.1 Furnish to Client the following reports on a monthly Basis for no additional fee: Claim Register, Case Log, Claim Composite, Check Register, Cost Containment, Loss Analysis Report, and Lag Time Report 3.2 Furnish to Client the following reports on an annual and biannual basis for no additional fee: Provide claim information required for annual state and federal reports or as agreed upon between CCMSI and Client. 3.3 Additional Reports: Provide custom reports at the request of client for fee of $125.00 per hour Additional Meetings: Participate in and attend quarterly claims status meetings. Hourly charges for additional meetings are: Adjuster $75.00 per hour Nurse $75.00 per hour Management $85.00 per hour Mileage $ .37 per mile Other Expenses Expenses as actual Additional Services: SA 10/01 10 7. Taxes: Data conversions at $125.00 per programming hour with initial data conversion not to exceed a total of $7,500.00. Provide and bill for additional services as mutually agreed upon by CCMSI and the Client. All applicable sales tax, service, and/or use or receipts taxes shall be the responsibility of Client and shall be in addition to the fees described in this Addendum. S. Invoice Payment Requirements: 7.1. CCMSI shall submit to Client on or before the 104° 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. 9. Claims Fund Reimbursement:. Client shall establish and maintain a sufficiently funded bank account authorizing CCMSI to make payments from that account. CCMSI shall issue any and all payments made on behalf of client under this agreement, from this account. CCMSI will forward a check register, listing all payments, to client when checks have been drawn on Client's account. CCMSI 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. SA 10/01 11 EXHIBIT "C" INSURANCE REQUIREMENTS The Service Providerwill 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 cancelled or materially altered, except after ten (10) 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. Insurance coverages shall be as follows: A. Workers' Compensation & Employer's Liability. The Service Providershall maintain during the life of this Agreement for all of the Service Provider's employees engaged in work performed under this agreement: 1. Workers' Compensation insurance with statutory limits as required by Colorado law 2. Employer's Liability insurance with limits of $100,000 per accident, $500,000 disease aggregate, and $100,000 disease each employee. B. Commercial General & Vehicle 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 damage claims of 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 for each coverage, Commercial General and Vehicle, shall not be less than $500,000 combined single limits for bodily injury and property damage. In the event any work 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. SA 10/01 12 Exhibit " M 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 employees, 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, including but not limited to confidential employee records; (b) all information that is proprietary to a third party (including but not limited to customers and suppliers of the City); and (c) health information of City employees, including but not limited to medical records . 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 Contractor's 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. SA 10/01 13 notice to the City of such condition within fifteen (15) days from the onset of such condition. 5. Early Termination by City/Notice. 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 Service Provider. Such notice shall be delivered at least fifteen (15) 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: City: City of Fort Collins, Purchasing Attn: James B. O'Neill, II PO Box 580 Fort Collins, CO 80522 Service Provider: Canon Cochran Management Services, Inc. Attn: Nancy Lea Carr PO Box 173682 Mail Code OH1172 Denver, CO 80217-3682 In the event of early termination by the City, the Service Provider shall be paid for services rendered to the date of termination, subject only to the satisfactory performance of the Service Provider's obligations under this Agreement. Such payment shall be the Service Provider's sole right and remedy for such termination. 6. Contract Sum. The City shall pay the Service provider for the performance of this Contract, subject to additions and deletions provided herein, the sum of Seventy Four Thousand Seven Hundred Fifty Dollars ($74,750.00) plus reimbursable direct cost basis according to the Compensation/Schedule Agreement attached hereto as Exhibit "B", consisting of three (3) pages, and incorporated herein by this reference. 7. City Representative. The City will designate, prior to commencement of the work, its representative who shall make, within the scope of his or her authority, all necessary and proper decisions with reference to the services provided under this agreement. All requests concerning this agreement shall be directed to the City Representative. 8. Independent Service provider. The services to be performed by Service Provider are those of an independent service provider and not of an employee of the City of Fort Collins. The SA 10/01 PA City shall not be responsible for withholding any portion of Service Provider's compensation hereunder for the payment of FICA, Workmen's Compensation or other taxes or benefits or for any other purpose. 9. Personal Services. It is understood that the City enters into the Agreement based on the special abilities of the Service Provider and that this Agreement shall be considered as an agreement for personal services. Accordingly, the Service Provider shall neither assign any responsibilities nor delegate any duties arising under the Agreement without the prior written consent of the City. 10. Acceptance Not Waiver. 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 or cause of action arising out of performance of this Agreement. 11. Warran . (a) Service Provider warrants that all work performed hereunder shall be performed with the highest degree of competence and care in accordance with accepted standards for work of a similar nature. (b) Unless otherwise provided in the Agreement, all materials and equipment incorporated into any work shall be new and, where not specified, of the most suitable grade of their respective kinds for their intended use, and all workmanship shall be acceptable to City. (c) Service Provider warrants all equipment, materials, labor and other work, provided under this Agreement, except City -furnished materials, equipment and labor, against defects and nonconformances in design, materials and workmanship/workwomanship for a period beginning with the start of the work and ending twelve (12) months from and after final acceptance under the Agreement, regardless whether the same were furnished or performed by Service Provider or by any of its subcontractors of any tier. Upon receipt of written notice from City of any such defect or nonconformances, the affected item or part thereof shall be redesigned, repaired or replaced by Service Provider in a manner and at a time acceptable to City. 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 thereof. SA 10/01 M 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 party's reasonable attorney fees and costs incurred because of the default. 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. Indemnity/Insurance. a. The Service Provider agrees to indemnify and save harmless the City, its officers, agents and employees against and from any and all actions, suits, claims, demands or liability of any character whatsoever brought or asserted for injuries to or death of any person or persons, or damages to property arising out of, result from or occurring in connection with the performance of any service hereunder. b. The Service Provider shall take all necessary precautions in performing the work hereunder to prevent injury to persons and property. c. Without limiting any of the Service Provider's obligations hereunder, the Service Provider shall provide and maintain insurance coverage naming the City as an additional insured under this Agreement of the type and with the limits specified within Exhibit "C", consisting of one (1) page, attached hereto and incorporated herein by this reference. The Service Provider before commencing services hereunder, shall deliver to the City's Director of Purchasing and Risk Management, P. O. Box 580 Fort Collins, Colorado 80522 one copy of a certificate evidencing the insurance coverage required from an insurance company acceptable to the City. SA 10/01 4 16. Entire Agreement. This Agreement, along with all Exhibits and other documents incorporated herein, shall constitute the entire Agreement of the parties. Covenants or representations not contained in this Agreement shall not be binding on the parties. 17. Law/Severability. 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. 18. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit "D", consisting of one (1) page, attached hereto and incorporated herein by this reference. CITY OF FORT COLLINS, COLORADO a municipal corporation M PO, FNIGP and Risk Management Q 2✓2-----, DENT OR VICE PRESIDENT r(�i7rport') SA 10/01 EXHIBIT "A" SECTION II CLAIMS MANAGEMENT STANDARDS & PROCEDURES Following are standards and services the City wishes to maintain. Review these points and indicate any area that could be a problem in your firm. I. 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/validity of workers' compensation and liability claims. D. Pay bills promptly per City instructions. E. Audit medical bills and repair bills for casual relationship and reasonableness of charges. F. 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 $50,000. SA 10/01 N. M. Establish claim reserves and provide a continual review and update of reserves to reflect changes. It is expected that reserves will be reviewed at least twice a year with city staff. 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 claims management program. This includes regular meetings between City staff and the Third Party Administrator being held every 7- 14 days, to discuss claim settlements/denials. 2. CLAIMS INVESTIGATION AND MANAGEMENT: 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. J. Investigate whether subrogation can be rule out or pursued in all cases which may involve third party negligence. SA 10/01 7 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. L. Attend bi-weekly meetings with City's designated physician. 3. CLAIMS ANALYSIS AND REPORT A. Provide the City with continuing information on the progress of individual claims and the effectiveness of cost control programs relating to all claims. A closing report is required for every claim indicating the amount paid to settle the claim. B. Submit statistical summaries and narrative reports as requested 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, reports required by the city's insurance carriers, and information for the NCCI to calculate the workers' compensation modifier. F. Prepare an annual report related to workers' compensation claims to assist City payroll staff with W-2 adjustments of employees who received TPD payments. 4. SPECIAL SERVICES A. Provide information and guidance to city 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 claims management programs and procedures and recommend changes as needed. SA 10/01 N EXHIBIT "B" Service Agreement for City of Ft Collins Workers' Compensation, Property & Casualty Self Insurance Program 2004 & 2005 Compensation Schedule/Agreement Compensation 1. Claims Management: An annual Claims administration fee of $74,750.00, payable in twelve (12) monthly installments of $6229.00 (breakdown of $34,385 annually for workers compensation; $2865.00 monthly; $40,365.00 annually for Property and Casualty claims; $3364.00 monthly). If the total claims volume exceeds 460 new claims for the year 2004 & 2005 (which include work comp, property and casualty claims), additional claims charges will be charged at the following rates: Work Comp Indemnity Claims $800 per claim Work Comp Medical Only Claims $150.00 per claim Property & Casualty Claims $400.00 Record only claims, defined as claims requiring no investigation at the Clients direction, requiring a denial statement or simple payment only will not be included in the claims count and will be charged at $50.00 per claim. 2. Preferred Provider and Medical Cost Containment: 2.1 The preferred provider network access fee shall be 30% of the difference, if any, between the Colorado State Work Comp Fee Schedule for a given service or treatment, and the amount actually paid by the Client for such service or treatment. This fee applies to those bills/services that are rendered by participating CCMSI network providers. 2.2 Medical Fee Review service fees shall be $1.45 medical fee line item. This fee is applied to all bills. 2 Line minimum. SA 10/01 9