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Home My WebLink AboutCC Resolution 11347 (Workers Comp. Claims Administrative Svcs; Claims Mgmt.)RESOLUTION NO. 11347 RESOLUTION AUTHORIZING THE SIGNING OF AN AMENDMENT TO THE AGREEMENT WITH CLAIMS MANAGEMENT, INC. FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATION SERVICES (FROM JULY 1, 2003 TO JUNE 30, 2004) THE CITY COUNCIL OF THE CITY OF SAN RAFAEL RESOLVES as follows: The MAYOR is authorized to execute, on behalf of the City of San Rafael, an Amendment to the Agreement with Claims Management, Inc. for Workers' Compensation Claims Administration Services from July 1, 2003 to June 30, 2004. I, JEANNE M. LEONCW, Clerk of the City of San Rafael, hereby certify that the foregoing resolution was duly and regularly introduced and adopted at a regular meeting of the City Council of said City on Monday, the 7th day of July, 2003, by the following vote, to wit: AYES: COUNCILMEMBERS: Cohen, Heller, Miller, Phillips & Mayor Boro NOES: COUNCILMEMBERS: None ABSENT: COUNCILMEMBERS: None JE NE M. LEONCINI, City Clerk ORIGINAL ,,%0 AMENDMENT TO AGREEMENT BETWEEN CITY OF SAN RAFAEL AND CLAIMS MANAGEMENT, INC. FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATION SERVICES This Amendment to Agreement is made and entered into this 7th of July, 2003 by and between the CITY OF SAN RAFAEL (hereinafter "CITY'), and CLAIMS MANAGEMENT, INC. (hereinafter "ADMINISTRATOR"). WHEREAS, since June 15, 2001, ADMINISTRATOR has provided workers' compensation claims administration services to CITY and the current agreement expires effective June 30, 2003; and WHEREAS, CITY and ADMINISTRATOR wish to continue this agreement into the future; and pursuant to the original agreement, compensation must be renegotiated; NOW, THEREFORE, the parties hereby agree as follows: 1. Section 1 of the Agreement, PROJECT COORDINATION, second paragraph is amended to read as follows: ADMINISTRATOR shall assign a single PROJECT DIRECTOR to have overall responsibility for the progress and execution of this Agreement for ADMINISTRATOR. Scott D. Kramer is hereby designated as the PROJECT DIRECTOR for ADMINISTRATOR. Should circumstances or conditions subsequent to the execution of this Agreement require a substitute PROJECT DIRECTOR for any reason, the ADMINISTRATOR shall notify the CITY within ten (10) business days of the substitution. 2. Section 2 of the Agreement, "Duties of Administrator", is amended to add the following paragraph: Administrator shall also perform in compliance with the Performance Standards as described in Exhibit "A", attached and incorporated herein. 3. Section 4 of the Agreement, "Term of Agreement", first paragraph is amended to read as follows: "The term of this Agreement shall be for one (1) year, commencing on July 1, 2003 and ending on June 30, 2004." Upon mutual agreement of the parties, and subject to the approval of the City Manager, the term of this Agreement may be extended for an additional period of up to two (2) years. 4. Section 5 of the Agreement, "Compensation", is amended to read as follows: "For the full performance of the services described herein by ADMINISTRATOR, CITY shall pay ADMINISTRATOR $137,000 for claims administration and $2000 for modem access for the period from 7/1/03 — 6/30/04 fiscal years. Said sum shall be payable monthly, due and deliverable to Administrator upon receipt by Project Manager of monthly invoices submitted by the ADMINISTRATOR during the term of this Agreement, unless this payment schedule is altered by written mutual agreement of the parties hereto. Except for the amendments referenced in paragraphs 1, 2, 3 and 4 above, all other terms, covenants and conditions of the original agreement remain in full force and effect. IN WITNESS WHEREOF, the parties have executed this Agreement as of the day, month and year first above written. CITY OF SAN RAFAEL ALBERT J. BORO, Mayor ATTEST: JEANNE M. LEONCINI, City Clerk APPROVED AS TO FORM: Clark Guinan Assistant City Attorney 2 ADMINIS TOR SCOTT D. KR.AMER, President Claims Management, Inc. EXHIBIT "A" PERFORMANCE STANDARDS Contact with the Injured Worker • The injured worker will receive a personalized letter introducing the TPA and explaining the interaction/accountability of the TPA, the City and the injured worker. • The injured worker will be provided with the Claims Examiner's name. • Two or three point contact will be made within twenty-four hours. Diary Systems • Files will be reviewed every 30 days. • Critical claims will be maintained on a separate diary by the Claims Manager or Supervisor. Documentation • Each file will contain a brief summary of the claim. • Every conversation will be documented in the claims database or written in the file. • Major activities (e.g. ratings, medical reports, legal analysis) will be analyzed and documented. Excess Claim Identification & Handling • The Self Insured Retention level will be identified in the claim notes. • Reimbursement requests will be made on a regular basis, at least every 6 months. • Copies of recovery checks will be maintained in the claim file. Investigation • Questionable claims wil be identified and investigated. • Referrals to outside investigation firms require approval of the City and should take place within 10 days from receipt of the claim. l-lousekeeping: File Organization & Maintenance • Files will be neat and organized. • Packets of information will be labeled for identification. • Information on separate injuries for the same person is to be maintained in separate files. Litigation • Referral to legal counsel requires approval from the City. Upon receipt of City's approval, file will be copied and sent to legal counsel within 48 hours. • Claims staff will require initial legal analysis within 30 days of referral. • Claims staff will obtain status reports from legal counsel at least every sixty days. • Settlements will address all known outstanding issues, to the extent possible by law. Medical Direction and Control • Claims staff will ensure that quality medical care is provided to injured workers. • Use of nurses or medical managers to coordinate medical care requires City approval. • Claims staff will direct City employees who have not predesigned a physician to one of the City's designated facilities for medical control in the first 30 days of treatment. • Claims staff will contact the physician's office during the continuation of temporary disability to assure that treatment is related to a compensable injury or illness and that payment of benefits is justified. • Claims staff will contact the physician's office as needed to get the medical restrictions whenever a City employee is taken off work. Whenever a physician repeatedly fails to respond to the request for medical restrictions, claims staff will request a referral to legal counsel so the physician's deposition can be scheduled in a timely manner. Permanent disability • Permanent disability advances will be made in a timely manner. • In the event of overpayment of any indemnity benefit, the amount of the overpayment will be recorded in the database and written in the claim file. • Claims staff will pursue repayment of all overpayments. Planning & Direction • Every file will have a plan of action. • The plan will be labeled in the claim notes. • Plans will be updated whenever a significant event occurs. Reserves Reserves will reflect the total probable cost of the claim, consistent with State regulation. Future medical claims will be reserved based on the injured worker's life expectancy and past usage of the medical Award. Reserves will be reviewed every 90 days and such review will be documented in the claim file. Subrogation • Files involving subrogation will be kept on a separate diary by the Claims Manager or Supervisor. • The City will be copied on all correspondence pertaining to subrogation. Misc. • Claims staff will evaluate claims for Compromise & Release potential and at least annually and will document their attempt to "buy out" claims involving only future medical care for the City's ex-employees.