HomeMy WebLinkAboutRFP - P910 CLAIMS ADMINISTRATOR SERVICES (2)CITY OF FORT COLLINS
REQUEST FOR PROPOSAL
CLAIMS ADMINISTRATOR SERVICES
PROPOSAL NO. P-910
PROPOSAL DATE: November 7, 2003 - 3:00 p.m. (our clock)
other payments to date.
4. Reports showing IBNR factors and trending, claims pay -out profiles and
claims development analysis.
5. Sorting capabilities of Program.
C. Can your organization customize reports for our needs? Is there an extra charge
for this service?
D. Can your organization interface with the J. D. Edwards One World Workforce
Management System?
E. Does your organization have the capability to captures all correspondence,
medical records, letters, etc., electronically and store them in the claimants file?
F. Is it possible for the City to access your data base? If so, please describe your
system, the necessary mechanics, and what information would be available to
access.
G. Advise how frequently your system is updated.
H. Please submit samples of each standard report generated by your system and
explain any additional ad hoc reporting capability you could put at our disposal.
4. AVAILABILITY
A. Approximately how far is the servicing office from downtown Fort Collins? Will
you be able to have an operational office in Fort Collins at contract inception?
B. Can your firm respond immediately to investigate an incident that has just
occurred? Indicate how long it would take a claim representative to physically be
on site of an incident after telephone notification.
C. Are your claim representatives "on call" 24 hours per day? Are pagers, cell
phones or similar devices provided to the representatives?
D. How many representatives could reasonably be expected to handle claims for
the City?
5. PRICING AND FEES
If different pricing and fees are used for workers' compensation and liability, please
quote separately.
A. Quote your per claim fee in one or more of these ways:
1. Cost per claim (regardless of type).
2. Cost per claim by type.
3. Minimum cost/maximum costs.
4. Lifetime handling of claims.
If a flat fee is submitted, please include the total number of claims included in the fee
and the annual maximum cost. Other pricing methods will also be considered.
Indicate if a different fee could be charged to track "record only" claims.
The City currently pays a guaranteed one-time fee for a specified number of claims per
year for life time handling of those claims. The third party administrator handles these
claims until all are closed. An additional fee per claim is paid if the number of claims
handled by the T.P.A. exceeds the number of claim specified in the contract. Simple
claims that require no investigation (a check or denial letter is issued) are handled at a
cost of $50 per claim.
B. Specify whether or not your fee includes your firm performing all of the
necessary state filing.
C. Indicate whether the per claim cost includes recovery of subrogation losses.
D. Indicate the types of allocated claims expenses which are not included in your
per case claims costs.
E. State what services or type of claims that are not included in your standard fees.
F. Occupational Health Services at Poudre Valley Health Systems is the City's
designated health care provide. Are they part of your organizations PPO network
and if so what discount do you receive? What other Northern Colorado health
care providers are part of your PPO network?
G. Exhibit I II is a list of the top 30 drugs prescriptions in 2003. If your organization
has a prescription discount program, what would be the unit cost, to the city, for
each of these drugs? Explain your prescription drug program process.
H. Since the term of the contract will be five years, renewable annually, give an
indication of expected increase in rates and basis for increases.
E
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.
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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.
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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.
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SECTION III
CLAIMS PHILOSOPHY
The City of Fort Collins' claims management philosophy is as follows:
1. To be certain claimants are given a high standard of care and concern to avoid
poor public opinion.
2. To be certain employees are advised of their benefits under Workers'
Compensation in a timely fashion.
3. To give prompt attention to all claims matters in an attempt to discourage
unnecessary litigation.
4. To encourage early recovery from injury and early return to productive work.
5. To encourage employees' return to work for modified duty.
6. To identify fraudulent claims and aggressively defend those claims.
7. To identify cause of loss and correct, if necessary, to prevent future loss.
8. To keep communication open between the TPA, Risk Management staff,
employees, claimants, and medical providers.
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SECTION IV
SPECIAL PROVISIONS
1. CLAIM ASSIGNMENT
The City of Fort Collins does not 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.
2. CANCELLATION BY ADMINISTRATOR
Because of the time required to replace this contract on a favorable basis, each firm
must include in their proposal a written agreement not to change the rates and terms of
the contract, nor cancel the contract during the first annual term, except in the case of
non-payment of fees. Each firm must also agree not to change the rates and terms of
the contract at renewal or refuse to renew the contract without ninety (90) days advance
written notice.
3. CLAIMS RUN-OFF PROVISIONS
Ensure that your company's claims run-off requirements, including fees for present as
well as future claims, are included as a contract provision in your specimen contract.
4. 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.
5. INSURANCE
Required insurance limits are listed in Exhibit B, Section VI.
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SECTION V
APPENDIX DATA
EXHIBIT I Citizen Claims Procedure
EXHIBIT II Five Year Claim History
EXHIBIT III Top 30 Drugs
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Exhibit I
CITIZEN CLAIMS PROCEDURE
The following is a summary of the claims handling process that is used:
Risk Management receives notice of an incident involving property damage or bodily
injury. This notice may come from a number of sources including the citizen involved,
the City department involved, or a police report. An Incident Report is completed by an
employee of the department involved. This report contains basic information about the
incident that helps determine if the City is legally liable for the incident.
2. A citizen who expressed the desire to file a claim against the City is informed that claim
forms can be mailed to them or can be obtained at the Risk Management office. Claims
may also be initiated by the filing of a Notice of Claim (usually from the claimant's
attorney or insurance company) which is in compliance with Section 24-10-109 C.R.S
(If a Notice of Claim does not comply with that section, the City Attorney's office will
notify Risk Management of that fact so that it can be raised as a defense at a later date,
if necessary.)
3. Upon receipt of a claim, a copy is sent by Risk Management to the department involved.
In addition, two or three letters are generated by Risk Management. The first is a letter
to our third -party claims administrator (in 2000 this is Occupational Healthcare
Management Services) informing them of the claim. Included with this letter is the claim
form or Notice of Claim and all supporting documentation provided by the claimant. The
second letter is sent to the claimant stating that the City is in receipt of their claim and
has forwarded the information to our claims administrator. It also gives the address and
telephone number for our claims administrator, encouraging the claimants to contact the
claims administrator directly if they have questions or problems regarding their claim.
The third letter is to the City's insurance carrier who may provide coverage for the claim,
if any, notifying it of the claim. If the insurance carrier is involved, Risk Management will
ensure that it is kept apprised of the status of the claim, contacted for settlement
authority and is otherwise involved to the extent desired by the insurance company.
4. After receiving the claim, the claims administrator assigns an adjuster to the case who
then begins an investigation of the incident. The adjuster contacts City employees
involved, witnesses, and the claimant.
5. Periodic meetings are held with the City Attorney's Office, Risk Management, and the
claims administrator to discuss each claim and to make recommendations concerning
whether and to what extent the claim should be paid. As a general rule, a citizen's claim
will be paid if:
a. The claim is filed within the required 180 days of the accident or occurrence;
(and)
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b. The City is legally liable for the damages alleged; (and)
c. Governmental immunity for the type of claim presented does not exist.
Compromise settlements may occur in some cases if there is a question regarding one
or more of the above criteria.
Occasionally, departments may choose to pay part or all of a claim as a good will gesture,
regardless of whether the City's liability is clear. Such payments are made out of the
department's budget, rather than the Loss Fund. Such payments are discouraged because of
the risk of setting a precedent, which the City cannot afford to follow. When made, such
payments should only be made through Risk Management after the signing of a release by the
claimant.
6. The size of the claim determines who can authorize claim payments:
a. If the claim is less that $50,000, the Director of Purchasing and Risk Management,
the third party administrator and the City Attorney's Office will determine if payment
should be made. The City Manager will be notified by a semi-annual report of all
claims settled for $10,000 or more.
b. Settlement amounts above $50,000 but less than $100,000 (excluding claim
processing related costs such as investigative fees and defense costs and fees) will
only be paid after approval from the City Manager.
c. City Council will be informed of the status of statutory claims and pending litigation in
the semiannual Litigation Update Report prepared by the City Attorney's office.
Although the Director of Purchasing and Risk Management has authority to pay
claims up to the limits set out in the Self -Insurance Ordinance ($150,000 to any one
person for claims arising out of a single incident or occurrence or $600,000 to all
persons for claims arising out of a single incident or occurrence, in accordance with
the State of Colorado Governmental Immunity Act), staff will confer with City Council
in executive session on any settlement amounts of $100,000 and over.
7. The claims administrator issues a payment or a denial letter to the claimant. Payments are
only issued after the claimant signs a release for all damages arising out of the claim. This
concludes the claims handling process.
8. The claims administrator provides the City with a monthly -computerized loss report.
This report contains information about the number of claims handled, the departments
involved and the cost of claims.
9. If a lawsuit is filed, the City Attorney decides whether the City's interests will be represented
by staff attorneys or by outside counsel and whether any conflict of interest exists between
the City and any individually named defendants. The litigation of most claims is handled by
outside counsel rather than the City Attorney's staff, but the decision is made by the City
Attorney's office on a case- by -case basis. In the event that outside counsel is hired, the
City Attorney's office will choose the counsel. The City Attorney will notify the Director of
Purchasing and Risk Management of the firms selected. The claims administrator will
continue to monitor the case only to the extent necessary to keep the monthly -computerized
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TABLE OF CONTENTS
REQUEST FOR PROPOSAL
PAGE 1
PURPOSE AND BACKGROUND
PAGE 2
SELECTION CRITERIA AND METHOD
PAGE 2-3
SPECIFICATIONS
PAGE 3
ANCILLARY SERVICES
PAGE 3
CONTINUANCE OF SERVICE CONTRACT
PAGE 3
SECTION I - PROPOSAL REQUIREMENTS
PAGE 4
SECTION 11
CLAIMS IMPLEMENTATION AND TERMINATION
PAGE 5-8
SECTION III
CLAIMS MANAGEMENT STANDARDS & PROCEDURES PAGE 9-11
SECTION III - CLAIMS PHILOSOPHY
PAGE 12
SECTION IV - SPECIAL PROVISIONS
PAGE 13
SECTION V - APPENDIX DATA
PAGE 14
Exhibit 1
3 pages
Exhibit II
1 page
Exhibit 111
5 pages
Exhibit IV
1 page
Exhibit V
1 page
Exhibit VI
5 pages
SECTION VI - PROFESSIONAL SERVICES AGREEMENT
PAGE 1-5
Exhibit B Insurance Requirements
1 page
loss report current. Risk Management will coordinate with the City Attorney's office to
ensure that any insurance company involved on behalf of the City receives appropriate
reports concerning the status of the litigation. If the litigation results in an award to a
claimant, the City Attorney (and outside counsel if appropriate) will make estimates and
recommendations to City staff and, when appropriate City Council, as to the costs and
merits of an appeal.
Adopted:
John Fischbach, City Manager
James B. O'Neill ll, CPPO
Exhibit II
Five Year Claim History
1. Workers' Compensation
Year # Claims # Med Only # Indemnity # Open Incurred Cost
1999
221
190
31
1
$415,754
2000
214
214
21
2
$270,797
2001
217
217
21
1
$320,822
2002
218
218
44
6
$576,017
2003
130
111
19
27
$350,151
2. Auto Liability
Year
# Claims
# Open
Incurred Cost
1999
67
0
$ 39,589
2000
43
3
$ 87,800
2001
72
0
$ 79,873
2002
77
2
$123,557
2003
115
28
$213,019
3. General Liability
Year # Claims # Open Incurred Cost
1999
200
0
$176,670
2000
244
1
$274,682
2001
177
3
$244,536
2002
181
11
$222,417
2003
75
22
$163,933
Of the auto liability and general liability claims listed, the City of Fort Collins handles
approximately 150 of these claims in-house per year. The TPA has to either issue a check for
payment or a denial letter on these files.
All claims data as of 10/13/03.
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Exhibit III
Top 30 Drugs
Rank
1
g
Hydrocodone
Generic
y
2
Oxycodone
y
3
Vim
N
4
Celebrex
N
5
Propoxy
y
6
Ibuprofen
y
7
Cyclobenzaprine
y
8
Neurontin
N
9
Bextra
N
10
Naproxen
y
11
Skelaxin
N
12
Oxycontin
N
13
Ultracet Tablet
N
14
Tramadol Hcl
y
15
Cephalexin
y
16
Carisoprodol
y
17
Ambien
N
18
Percocet
0
19
Tizanidine Hcl
y
20
Amitriptyline Hcl
y
21
Acetaminophen
y
22
Diazepam
y
23
Prednisone
y
24
Lidoderm
N
25
Duragesic
N
26
Z010ft
N
27
Methocarbamol
y
28
Mobic
N
29
Flexeril
N
30
Alprazolam
y
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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
"Service Provider".
W ITNESSETH:
hereinafter referred to as
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 Service Provider agrees to provide services in
accordance with the scope of services attached hereto as Exhibit "A", consisting of ( )
page[s], and incorporated herein by this reference.
2. The Work Schedule. [Optional] The services to be performed pursuant to this
Agreement shall be performed in accordance with the Work Schedule attached hereto as
Exhibit "B", consisting of ( ) page[s], and incorporated herein by this reference.
3. Time of Commencement and Completion of Services. The services to be
performed pursuant to this Agreement shall be initiated within
( ) days
following execution of this Agreement. Services shall be completed no later than
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.
4. Contract Period. [Option 1] This Agreement shall commence upon the date of
execution shown on the signature page of this Agreement and shall continue in full force and
effect for one (1) year, unless sooner terminated as herein provided. In addition, at the option
of the City, the Agreement may be extended for an additional period of one (1) year at the rates
provided with written notice to the Professional mailed no later than ninety (90) days prior to
contract end.
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4. Contract Period. [Option 2] This Agreement shall commence 200_,
and shall continue in full force and effect until 200_, 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 _ (_) 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.
5. 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 notice to the City of such condition within fifteen (15) days from
the onset of such condition.
[Early Termination clause here as an option.
6. 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:
Service Provider:
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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.
7. 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
($ ) [Option Cost Breakdown is attached Exhibit "C"]
Dollars
8. 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.
9. 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 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.
10. 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.
11. 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.
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12. Warranty.
(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.
13. 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.
14. 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.
15. Bindinq Effect. This writing, together with the exhibits hereto, constitutes the
entire agreement between the parties and shall be binding upon said parties, their officers,
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employees, agents and assigns and shall inure to the benefit of the respective survivors, heirs,
personal representatives, successors and assigns of said parties.
16. 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 _,
consisting of (_) pages[s], 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.
17. 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.
18. 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.
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19. Special Provisions. [Optional] Special provisions or conditions relating to the
services to be performed pursuant to this Agreement are set forth in Exhibit _, consisting of
( ) page[s], attached hereto and incorporated herein by this reference.
ATTEST:
City Clerk
APPROVED AS TO FORM:
Assistant City Attorney
CITY OF FORT COLLINS, COLORADO
a municipal corporation
By:
John F. Fischbach
City Manager
James B. O'Neill II, CPPO, FNIGP
Director of Purchasing and Risk Management
Date:
[Insert Corporation's name] or
[Insert Partnership name] or
[Insert individual's name]
Doing business as [insert name of business]
By:
PRINT NAME
CORPORATE PRESIDENT OR VICE PRESIDENT
ATTEST: (Corporate Seal)
CORPORATE SECRETARY
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EXHIBIT B
INSURANCE REQUIREMENTS
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 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.
2. Insurance coverages shall be as follows:
A. Workers' Compensation & Employer's Liability. The Service Provider shall
maintain during the life of this Agreement for all of the Service Provider's employees
engaged in work performed under this agreement:
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.
1
7/98
REQUEST FOR PROPOSAL
CITY OF FORT COLLINS
CLAIMS ADMINISTRATOR SERVICES
PROPOSAL NO. P-910
The City of Fort Collins is requesting proposals from firms for Claims Administrator Services
Written proposals, four (4) will be received at the City of Fort Collins' Purchasing Division, 215
North Mason St., 2nd floor, Fort Collins, Colorado 80524. Proposals will be received before
3:00 p.m. (our clock), November 7, 2003. Proposal No. P-910. If delivered, they are to be sent
to 215 North Mason Street, 2"d Floor, Fort Collins, Colorado 80524. If mailed, the address is
P.O. Box 580, Fort Collins, 80522-0580.
Questions concerning the scope of the project should be directed to the Project Manager,
Stewart Ellenberg, ARM-P, Risk Manager (970) 221-6774.
Questions regarding proposals submittal or process should be directed to James B. O'Neill II,
CPPO, Director of Purchasing and Risk Management (970) 221-6775.
A copy of the Proposal may be obtained as follows:
Call the Purchasing Fax -line, 970-416-2033 and follow the verbal instruction to
request document #30910.
2. Download the Proposal/Bid from the Purchasing Webpage,
www.fcqov.com/purchasing.
3. Come by Purchasing at 215 North Mason St., 2"d floor, Fort Collins, and request a
copy of the Bid.
Sales prohibited/conflict of interest: No officer, employee, or their dependent or person residing
in and sharing the expenses of their household, shall have a financial interest in the sale to the
City of any real or personal property, equipment, material, supplies, or services. This rule also
applies to subcontracts with the City. This shall not apply to members of any authority, board,
committee or commission of the City, other than the members of the City Council. Soliciting or
accepting any gift, gratuity favor, entertainment, kick -back or any items of monetary value from
any person who has or is seeking to do business with the City of Fort Collins is prohibited. Any
vendor knowing of this type of activity is encouraged to report in confidence to the Director of
Purchasing and Risk Management, Director of Finance, City Attorney or City Manager so the
matter can be dealt with.
The City of Fort Collins reserves the right to reject any and all proposals and to waive any
irregularities or informalities.
No proposal shall be accepted from, or any purchase order awarded, to any person, firm or
corporation that is in default on any obligation to the City.
Non -Collusion: Your authorized signature on this proposal assures that such proposal is
genuine and is not a collusive or sham proposal.
Vendors: The City of Fort Collins Purchasing Division has implemented an on-line vendor
registration system. This system allows vendors to register, view and
update their business information and commodities. In the future,
vendors will also be able to receive Requests for Proposals (RFP's)
through the on-line system. All vendors doing business with the City of
Fort Collins are requested to register.
The vendor registration system is accessible through the City of Fort Collins Purchasing
Department internet webpage at www.fcqov.com/purchasing.
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The vendor registration form is located by
clicking https://secure2.fcgov.com/bso/lo-gin.osr)
the printable instruction pages link.
If you have any difficulty completing the registration process, please call the Purchasing
Division at (970)221-6775 for assistance.
ly,
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'jamisB. O' eillIl, CPPO
r of Purchasing & Risk Management
2
REQUEST FOR PROPOSAL
The City of Fort Collins invites your firm to submit a proposal for Third Party Claims
Administrator to provide self insured workers' compensation and liability claims services.
1. PURPOSE AND BACKGROUND
The City's purpose is to select a qualified claims administrator handling both
workers' compensation and liability. The City's insurance program is out to bid.
When the evaluation is complete, the Claims Administrator will be awarded. The
Claims Administrator may administer both workers' compensation and liability, or
depending on excess markets, may administer one or the other.
The City's liability and worker's compensation claims have been administered by
Cannon Cochran Management Services, Inc. since 01-01-99.
Due to the need to maintain a close working relationship, and timely responses
in the event of an incident requiring immediate assistance, the Claim
Administrator will be required to have a servicing office in Fort Collins.
2. SELECTION CRITERIA AND METHOD
A Review Team will rank the proposals based on the City of Fort Collins'
procedures for the review of professional firms. The three highest ranked firms
may then be invited to discuss their proposals and qualifications with the review
team. Based on these interviews, a final ranking of the consultants will be made
and contract negotiations will be initiated with the highest ranked firm. On -site
tours may be requested.
THE FOLLOWING POINT SYSTEM WILL BE USED:
POINTS
QUALIFICATION
STANDARD
1 - 5
Adequacy of current
Meeting and under -
Proposal in light of
standing needs;
The Proposal
administrative
Requirements
procedures
1 - 15
Qualifications to
References,
perform services
management and
staff assigned
1 - 15
Computer support
Data base
and reports
availability
reports initiated
1 - 5
Availability
Ability to be at an
Incident scene
within one hour
3
1 - 10 Reasonable cost for Services provided
proposed service
Total Points (50 points possible)
3. SPECIFICATIONS
Proposals are to be submitted in strict compliance with these specifications.
These specifications are to be considered as providing desirable claims
administration services. Any limitations or deviations from these specifications
must be designated in the proposal; otherwise, companies proposing will be
strictly held to the specifications. This Request for Proposals and your response
will become an integral part of a final contract should your firm be selected.
A failure to deliver services and fees quoted in your proposal may result in a mid-
term cancellation of the Service Contract and a replacement of the Third Party
Administration firm.
The information contained in the specifications is believed to be correct, but is
not warranted. The responsibility for determining the full extent of the exposure
and the verification of all information shall rest solely upon the Third Party
Administrator. The City of Fort Collins or its representatives will not be
responsible for any errors or omissions, nor for the failure on the part of the Third
Party Administrator to determine the full extent of the exposures.
4. ANCILLARY SERVICES
All Proposals must fully describe the nature of any ancillary services which your
firm may offer. If independent firms are to be used, the name and address of the
firms are to be shown.
5. CONTINUANCE OF SERVICE CONTRACT FOR A FIVE YEAR PERIOD
It is the intent of the City to continue the service contract for a minimum period of
five years without competitive quotations. However, the City reserves the right to
cancel or non -renew the contract at its discretion.
Il
SECTION I
PROPOSAL REQUIREMENTS
Please address the following questions, in the order they are asked, in your proposal.
1. QUALIFICATIONS
A. Give a brief description of your firm including:
1. Names of principal owners, partners or officers.
2. Length of time the firm has been in business.
3. Number of offices and locations.
4. Offices that would service this account.
5. The availability of a toll -free number for the use of claimants and the
City.
B. Indicate the proposed number of personnel (including supervisory and
management) who would be assigned to administer the City's program and give
details regarding:
1. Position of each
2. Experience and education
3. Experience with public entities
4. Length of time with your firm
5. Computer skills
C. Would technical personnel assigned to the City also be assigned to other
accounts? If so, how many?
D. Would an Account Executive be assigned to the City as the primary contact on
items not directly related to specific claims?
E. Describe training programs offered to claim personnel and incentives for
employees to further their training and education.
F. In the past two years, what percentage of employee turnover has your firm
experienced for the office that will be handling the City's claims.
G. What is the anticipated case load of open files that would be managed by
examiners assigned to the City?
H. Provide names, addresses, telephone numbers and length of service with at
least three Colorado references for whom you have provided worker's
compensation and liability claims services (preferably public agencies).
I. Describe any additional special programs or areas of emphasis that you think
would be beneficial in helping us to understand your level of expertise.
5
2. CLAIMS IMPLEMENTATION, PROCESSING AND TERMINATION
A. Provide procedure and timetable for initial set -UP and implementation of City's
account into your system.
B. Provide the set-up, process and timetable for a new claim to be placed in the
system.
C. Advise how frequently your diary system allows claims supervisory personnel to
review open claims.
D. Describe your procedures for making initial and follow-up contact with injured
employees or claimants.
E. Describe your company philosophy and procedures for the establishment of case
reserves. What are the procedures for revising reserves?
F. Describe cost containment procedures utilized by your firm.
G. Under the current arrangement, the City provides an account and checks for the
processing of claim payments by the claim administrator. Indicate if this system
would work for your firm.
H. Advise in what instances an independent adjustor would be required and which
independent claims service you would use.
I. Attach copies of all standard forms used in your administration process.
J. Submit samples of any cards, letters, pamphlets, et cetera, that would be
provided to injured employees and claimants.
K. Do you have a formal program for managing lawsuits and litigation expense? If
so, please describe.
L. Provide the City with various options regarding the handling of open claims in the
event of termination or regular expiration of the claims administrator contract.
M. Include any other information that you feel would contribute a positive and
successful program if your firm were selected. Describe in detail the claims
administrator's various investigative techniques and general claim handling
philosophies, addressing the following:
1. Method of explaining claimant's right.
2. Circumstances when in -person investigations would be used rather than
by telephone.
3. Philosophy and method of contesting and denying claims payments.
0
N. Provide a description of the quality controls currently in place. The description
should include the approach to and frequency of internal claims audits of claims
offices.
3. DATA PROCESSING AND REPORTING SERVICES
A. To demonstrate your data processing and report system, provide an online
demonstration of twenty five worker's compensation claims. Five claims shall be
re -opened from the year 2000, ten claims shall be medical only, and ten shall be
indemnity claims. Be as detailed as possible, showing all charges, fee schedule,
PPO & prescription discounts, and the bottom line cost to the city for each claim.
All claims shall contain, but not be limited to, the following information.
Workers' Compensation
a. Claim Number
b. Department Code
C. Employee Name
d. Injury Date, Day of Week and Time of Day
e. Brief Verbal Description of Injury/Accident
f. Nature of Injury
g. Body Part
h. Nature of Incident
i. Object Causing Injury
j. Medical, Indemnity and Expense Paid to Date
k. Subrogation
I. Rehabilitation
M. Reserved
n. Litigation
o. Status
2. Liability
a.
Line of Coverage
b.
Department Code
C.
Claim Number
d.
Accident Date, Date of Week and Time of Day
e.
Claimant's Name
f.
Brief Verbal Description of Accident
g.
Nature of Accident
h.
Object causing Accident
I.
Payment and Expense Paid to Date
j.
Reserve
k.
Indication if in Suite
I.
Status (Open/Closed)
B. Indicate whether the following reports could be provided online:
1. Accident analysis report giving a breakdown by cause, body part, injury,
day, time et cetera.
2. Vendor report to identify service providers and attorney involvement.
3. Cumulative check register giving a summary of all medical, indemnity and
7