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HomeMy WebLinkAbout144217 CANNON COCHRAN MGMT SERVICES CCMSI - CONTRACT - RFP - P1148 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 Cannon Cochran Management Services, Inc., hereinafter referred to as "Service Provider". 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 Service Provider 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. Contract Period. This Agreement shall commence January 1, 2009, and shall continue in full force and effect until December 31, 2009, 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. Renewals and pricing changes shall be negotiated by and agreed to by both parties. The Denver Boulder Greeley CPIU published by the Colorado State Planning and Budget Office will be used as a guide. Written notice of renewal shall be provided to the Service Provider and mailed no later than ninety (90) days prior to contract end. 3. 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 fifteai (15) days from the onset of such condition. 4. 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 sixty (60) days prior to the termination date contained in said notice unless otherwise agreed in writing by the parties. All SA rev07/08 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 ruled 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. L. Attend monthly meetings with City's designated physician. 3. CLAIMS ANALYSIS AND REPORTING 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. ON-LINE SYSTEM: A. All claims shall contain, but not be limited to, thr 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 rev06/07 3 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. Reports to be provided online include: 1. Accident analysis report giving a breakdown by cause, body part, injury, day, time etcetera. 2. Vendor report to identify service providers and attorney involvement. 3. Cumulative check register giving a summary of all medical, indemnity and other payments to date. 4. Reports showing IBNR factors and trending, claims payout profiles and claims development analysis. 5. 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 proceduresand recommend changes as needed. rev06/07 4 EXHIBIT B FEE SCHEDULE . ........... Qption_2 — Flat Annual Fee (Life of Contract) $113,900.00 — Based on S53,900 for W/C and $60,000.00 for Property/Casualty If total claim volume exceeds qyn files, per file charge will apply as follows: W/C Indemnity $750.00 per claim W/C Med Only $125.00 per claim P&C Claims $400.00 per claim PLUS 50.00 each claim that requires denial only (in-house claim) claims Mnnugemenl Fees include • All clairns management functions • Claims Administration Fee • State filings and reporting • Claims investigation (field%vork by adjustor) • Litigation Management • Subrogation • Designated Account Manager • Preparation and participation in quarterly claims reviews • Quarterly Client Scorecard evaluations • Annual stewardship meeting • Maintenance of the loss fund account and all bank charges • Filing of all required state forms inrludingstate mandated • Reporting to excess/fronting carrier • File storage "Proposed fees may be negotiable Tail Claims a NIA Administration Fees _._ __..... 7.S% of Claim Fees (in addition to claims management fees in Option i, included in annual fee in Option 2) Annua/Admittistratlon Fee includes: • Account Implementation • Designated Account Manager • Preparation and participation in quarterly claims reviews • Quarterly Client Scorecard evaluations • Annual stewardship meeting • Maintenance of the loss fund account and all bank charges • Filing of all required stale forms including State mandated • Reporting to excess,/fronting carrier • Fite storage, rev06/07 RMIS Fee (included in Option_1 and Option 2) Annual RMISServices include • Risk Management Information System (iCE) cost to include: 5 User ID*s. Internet access tOclaim files; the ability to email your adjuster and Account Manager; access to our library of template risk management reports together with initial training and ongoing, support • Monthly loss runs and loss fund activities reports Data Conversion/Data Transfer (Does not Apply) Managed Care Services/Other Services Service fee Fee schedule re -pricing $8,50 per bill or $1.30 per line 5 line Minimum pP-6'Wetw—ork Access 30% of savings below state fee schedule Hospital 'Specialty Review ................. Pharmacy Benefit Program 30% of savings below state fee schedule ........... -- ..... . ... . 15% of savings Nurse Case Management At cost Index Bureau I $9.00/ctaim annual fee (includes z searches per year) Loss Control Services (Optional) ....... ... $100/Hour CCMSI has an experienced and sophisticated loss control department with significant healthca re experience including a local loss control professional. We will design a program collaboratively to provide maximum benefit to Denver Health. Custom Repp�q:iri,g (Optional) CCMSI will provide special reports, (reparis not currently programmed or written) fora fee of $125 per hour for system programming time. COVISI wilt provide an estimate of charges before any work will be done. Please note we have over 400 standard re outs from which Vou can choose therefore it is highly unlikely it would be necessary to develop custom reports. Loss Control Services *CCMSI will provide 50 Complimentary Loss Control Service hours. rev06/07 EXHIBIT C CLAIM INFORMATION 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 reserve the right to determine which claims will be handled in-house and those that will be assigned to the third party administrator. 2. 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. 3. 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. rev06/07 EXHIBIT D CITY CLAIMS PHILOSOPHY The City of Fort Collins' claims management philosophy is as follows: Claimants are given a high standard of care and concern to avoid poor public opinion. 2. 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 provders. rev06/07 EXHIBT E 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, 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 courtorder 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. rev06/07 1 i EXHIBIT F 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 commencingwork 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, tle 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 clams 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 lerformed under this Agreement by a subcontractor, which liability is not covered by the subcontractor's insurance. rev06/07 notices provided under this Agreement shall be effective when mailed, postage prepaid and sent to the following addresses: City: Copy to: Service Provider: City of Fort Collins City of Fort Collins Cannon Cochran Attn: Purchasing Attn: Lance Murray Management Services, Inc. PO Box 580 PO Box 580 Attn: Stacy Ross Fort Collins, CO 80522 Fort Collins, CO 80522 7600 E. Orchard Road, Suite 360N Greenwood Village, CO 80111 In the event of early termination bythe 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. 5. Contract Sum. The City shall pay the Service provider for the performance of this Contract, subject to additions and deletions provided herein, per the attached Exhibit "B", consisting of two (2) pages, and incorporated herein by this reference. 6. 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. 7. 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. 8. 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. 2 SA rev07/08 9. 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. 10. 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. 11. 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. 12. 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. 3 SA rev07/08 13. 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. 14. 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 B, 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. 15. 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. 16. 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. 4 SA rev07/08 17. Prohibition Against Employing Illegal Aliens. Pursuant to Section 8-17.5-101, C.R.S., et. seq., Service Provider represents and agrees that: a. As of the date of this Agreement: 1. Service Provider does not knowingly employ or contract with an illegal alien who will perform work under this Agreement; and 2. Service Provider will participate in either the e-Verify program created in Public Law 208, 104th Congress, as amended, and expanded in Public Law 156, 108th Congress, as amended, administered by the United States Department of Homeland Security (the "e-Verify Program") or the Department Program (the "Department Program"), an employment verification program established pursuant to Section 8-17.5-102(5)(c) C.R.S. in order to confirm the employment eligibility of all newly hired employees to perform work under this Agreement. b. Service Provider shall not knowingly employ or contract with an illegal al6n to perform work under this Agreement or knowingly enter into a contract with a subcontractor that knowingly employs or contracts with an illegal alien to perform work under this Agreement. C. Service Provider is prohibited from using the e-Verify Program or Department Program procedures to undertake pre -employment screening of job applicants while this Agreement is being performed. d. If Service Provider obtains actual knowledge that a subcontractor performing work under this Agreement knowingly employsor contracts with an illegal alien, Service Provider shall: 1. Notify such subcontractor and the City within three days that Service Provider has actual knowledge that the subcontractor is employing or contracting with an illegal alien; and 2. Terminate the subcontract with the subcontractor if within three days of receiving the notice required pursuant to this section the subcontractor does not cease employing or contracting with the illegal alien; except that Service Provider shall not terminate the contract with the subcontractor if during such three days the subcontractor provides information to establish that the subcontractor has not knowingly employed or contracted with an illegal alien. e. Service Provider shall comply with any reasonable request bythe Colorado Department of Labor and Employment (the "Department") made in the course of an investigation that the Department undertakes or is undertaking pursuant to the authority established in Subsection 8-17.5-102 (5), C.R.S. SA rev07/08 f. If Service Provider violates any provision of this Agreement pertaining to the duties imposed by Subsection 8-17.5-102, C.R.S. the City may terminate this Agreement. If this Agreement is so terminated, Service Provider shall be liable for actual and consequential damages to the City arising out of Service Provider's violation of Subsection 8-17.5-102, C.R.S. g. The City will notify the Office of the Secretary of State if Service Provider violates this provision of this Agreement and the City terminates the Agreement for such breah. 18. Special Provisions. Special provisions or conditions relating to the services to be performed pursuant to this Agreement are set forth in Exhibit "C", consisting of one (1) page, Exhibit "D", consisting of one (1) page, and Exhibit "E", consisting of one (1) page, attached hereto and incorporated herein by this reference. R SA rev07/08 City Clerk •---N-WIP Assista ATTEST: CORPORATE SECRETARY CITY OF FORT COLLINS, COLORADO a municipal corporation By:VzP— Jame B: 'Neill II, CP O, FNIGP Direct f Purchasing and Risk Management Date: Z d ManagementCannon Cochran - - By: . I., - � A&� // kiwi ffzlo __WjjWA1 Date: / / 0 q te- SA rev07/08 7 EXHIBIT A SCOPE OF SERVICES CLAIMS MANAGEMENT STANDARDS & PROCEDURES Following are standards and services the City wishes to maintain 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. Working with City of Fort Collins Risk Management staff, 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. 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. 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. rev06/07 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. P. Consult quarterly with City Risk Management and Legal staff to review open claims and reserve settings. Q. Maintain a liability claims adjuster in Fort Collins. 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 ofinjury/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/liabity 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. Consult with the City Safety & Workers Compensation Administrator priorto authorizing medical procedures. G. Maintain a close liaison with treating physicians to assure that employees receive proper care and to avoid over treatment situations. H. Determine eligibility for and authorize payment of Temporary Disability compensation in accordance with medical advice and rehabilitation efforts. I. With City approval, 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. rev06/07