HomeMy WebLinkAboutStaff Report 4.C 04/02/2018DATE: April 2, 2018
TO: Honorable Mayor and Members of the City Council through City Manager
FRO Amy Reeve, Director of Human Resources
SUBJECT: Resolution Approving an Agreement with Keenan and Associates for Workers'
Compensation Claims Administration Services and Authorizing the City Manager
to Execute the Agreement
RECOMMENDATION
It is recommended that the City Council adopt the attached Resolution Approving an Agreement
with Keenan and Associates for Workers' Compensation Claims administration services and
Authorizing the City Manager to Execute the Agreement.
BACKGROUND
The,City has participated in an insurance pool through Redwood Empire Municipal Insurance
Fund (REMIF) who has served as the third party administrator for workers' compensation claims
administration since 1987. On February 1, 2018, the City was notified that REMIF would no
longer be providing workers' compensation claims administration services and the City was
given a sixty day notice of cancellation.
To assist its client jurisdictions with the transition, REMIF conducted a bidding process, with
nine proposals from workers' compensation administrators submitted. REMIF provided the data
from that Request for Proposal (RFP) process. The City also requested proposals from outside
vendors for consideration, including the selected vendor, Keenan and Associates.
DISCUSSION
REMIF selected Athens Administrators as the workers' compensation claims administrator for
REMIF cities; however after reviewing the proposal submitted by Athens to the City of
Petaluma, it was felt that the increased costs were prohibitive. .
The proposal from Keenan and Associates is a comprehensive solution which will enhance the
current workers' compensation claims handling process by streamlining submittals through an
online portal. Injured workers will have access to an online system, with real time information
related to their claim. Comprehensive reports provided on a monthly, quarterly and annual basis
as well as regular claims review meetings, will allow the City to observe trends and implement
preventative measures to reduce injuries. Keenan offers a Managed Provider Network which
will cut costs and ensure access to local specialists and medical experts. Additionally, the new
relationship offers access to training, nurse case management and a variety of safety program
initiatives.
FINANCIAL IMPACTS
The workers' compensation claims administration services through Keenan will cost
approximately $137,000 per year which is less than the proposal submitted by Athens
Administrators. This cost will be paid out of the workers' compensation budget and is expected
to be approximately $30,000 more than the existing contract with REMIF.
ATTACHMENTS
1. Resolution and Exhibit A (Agreement)
2
Attachment 1
Resolution No. 2018 -XXX N.C.S.
of the City of Petaluma, California
RESOLUTION APPROVING AN AGREEMENT WITH KEENAN AND
ASSOCIATES FOR WORKERS' COMPENSATION CLAIMS
ADMINISTRATION SERVICES AND AUTHORIZING THE CITY MANAGER
TO EXECUTE THE AGREEMENT
WHEREAS, the City of Petaluma has determined that the continuation of a self-
insured workers' compensation program is cost effective; and,
WHEREAS, the current provider of workers' compensation claims
administration services, Redwood Empire Municipal Insurance Fund, is no longer
providing said services and has provided notice to the City of its intent to terminate the
contract with the City; and,
WHEREAS, ten vendors providingworkers' compensation claims administration
services submitted proposals which were considered by the City; and,
WHEREAS, based on evaluation of proposals received, City staff recommends
that the firm Keenan and Associates be retained to administer the City's workers'
compensation program,
NOW, THEREFORE, BE IT RESOLVED that the City Council of the City of Petaluma
approves the agreement between the City and Keenan and Associates attached and incorporated
herein as Exhibit A, and authorizes the City Manager to sign agreements substantially in
accordance with those attached as Exhibit A.
3
SELF-INSURED CLAIMS ADMINISTRATION AGREEMENT
This Self -Insured Claims Administration Agreement ("Agreement') is made and entered into by and
between City of Petaluma ("Client") and Keenan & Associates ("Keenan") as of May 1, 2018
("Effective Date"). Client and Keenan are also referred to individually as a "party" and collectively as
the "parties."
RECITALS
A. Client has established a self-insured Workers' Compensation Program for the benefit of its
employees ("Program").
B. Keenan is a specialty insurance services provider with special expertise in the insurance and
services needs of California school districts, municipalities, health care providers and their related
entities and, as such, is qualified to provide the services described in this Agreement and other
services that Client may request from time to time.
C. Client has requested that Keenan perform calms administration functions for the Program as
described herein.
AGREEMENT
The parties agree as follows:
1. TERM:
The term of this Agreement is from May 1, 2018 through April 30, 2019 ("Term') unless
extended or terminated earlier as provided herein.
2. KEENAN RESPONSIBILITIES AND SCOPE OF SERVICES:
A. Keenan shall provide Client with the services described in Exhibit A and Exhibit A-1
("Services') for all new and currently open Workers' Compensation claims.
B. The relationship of the parties shall be that of independent contractor and each party shall at
all times remain responsible for its own operational and personnel expenses. Under no
circumstance shall any employee of one party look to the other party for any payment or the
provision of any benefit, including without exception, workers' compensation coverage.
Except as may be expressly set forth in or contemplated by this Agreement, neither party shall
have the right to act on behalf of the other, or to bind the other to any contract or other
obligation.
C. Keenan's services are limited to the specific obligations described herein. Client shall remain
responsible for all other aspects of the Program. Keenan shall not provide any legal, tax, or
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accounting service, advice, or opinion, and under no circumstances are the Services to be
construed or interpreted as representing any such advice or opinion. It is Client's
responsibility to seek the counsel of its own attorney on all legal issues and to consult with its
own tax and accounting experts on all tax, accounting, financial matters relating to its
operations, including without limitation, the establishment, implementation and operation of
its Program.
D. Keenan shall comply with all applicable state and federal Laws and regulations and obtain and
maintain all necessary licenses, registrations, and/or permits necessary for the performance of
its duties under this Agreement.
E. Keenan reserves the right to engage independent contractors and/or subcontractors to assist
it in performing the Services. The use of such individuals shall not relieve either party of any
of its duties under this Agreement.
3. CLIENT'S DUTIES AND RESPONSIBILITIES;
A. Client, subject to the specific Services set forth herein, shall retain all final authority and
responsibility and expenses incidental thereto unless specifically assumed by Keenan
hereunder, and Keenan is authorized to act on behalf of Client in connection with the Program
only as expressly stated in this Agreement. Client shall retain final authority and responsibility
and expenses incidental to the management of the Program and is responsible for all aspects
of the Program except for the Services to be provided by Keenan under this Agreement.
B. Client shall provide Keenan with all applicable information in a timely manner so that Keenan
can fulfill its obligations under this Agreement. Client represents and warrants that all
information provided to Keenan shall be complete, accurate and timely and that Keenan may
rely upon such information without further investigation or review. Client understands and
agrees that such information has not been audited by Keenan and that Client shall remain
liable for its accuracy.
C. Client shall provide Keenan with timely access to such information and individuals including
its outside advisors and consultants as may be necessary for Keenan to perform the Services.
Meetings, telephone calls, and other necessary communications shall be scheduled at the
mutual convenience of the parties and their representatives. Keenan shall not be responsible
for any delay in its performance that results from the failure of Client or any person acting on
behalf of Client to make available any information or individual in a timely manner.
D. Client shall fund a claims payment account from which all claims payments and loss
adjustment expenses shall be paid. 'llie account shall be established and funded in accordance
with written procedures to be established by the parties. Under no circumstance will Keenan
be required to advance any funds for the payment of claims.
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E. To the extent Keenan requires the assistance of Client's staff or any third parties who are
assisting, advising or representing Client to fulfill its obligations hereunder, Client shall have
its staff and these third parties assist Keenan.
F. Client understands that Keenan is not providing any legal, tax or accounting services or advice
and agrees to seek the counsel of its own attorney on all legal issues or matters and consult
with its own tax and accounting experts on all tax and accounting issues and matters relating
to the services.
G. Client will comply with all federal, state and local reporting and filing requirements for the
Program.
4. COMPENSATION:
Client agrees to pay Keenan for the services outlined in Exhibit A at the rates stated in Exhibit B
and Exhibit C, all of which are attached hereto and incorporated herein by reference.
5. CONFIDENTIALITY:
Keenan shall keep confidential all information concerning Client and its employees possessed by
Keenan, regardless of the medium thereof, except information that is generally available to the
public. Except as authorized or required by law or in this Agreement, Keenan shall not release any
report, any portion thereof, or any result of any investigation it may undertake on behalf of the
Client to any person outside of Client's organization without the express written consent of Client.
G. AUDIT:
If Keenan is requested to disclose its books, documents or records relating to the services provided
under this Agreement, Client shall notify Keenan in writing at least thirty (30) days prior to the
inspection and/or disclosure date of the nature and scope of the request and Keenan shall make
available all such books, documents or records during Keenan's regular business hours.
7. FINES & PENALTIES:
Keenan shall pay any fines and/or penalties levied by regulatory authorities that (i) are imposed as
a result of the improper denial of claims and (ii) failed to comply with the administrative rules,
regulations and state laws governing Workers' Compensation, provided that such actions were not
at the direction of or with the approval of the Client, were not the result of the failure of Client
or any individual acting on behalf of Client or claimant to timely provide complete and accurate
information needed for the processing of claims, or the failure of the Client to adequately fund
the claims payment account. Client shall pay all other fines and/or penalties relating to the
Program or otherwise.
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8. INSURANCE:
Keenan shall procure and maintain THE INSURANCE COVERAGES DESCRIBED ON
Exhibit B-2
9. INDEMNIFICATION:
To the maximum extent permitted by law, Consultant shall, at its own expense, indemnify,
defend with counsel acceptable to the City, (which acceptance will not be unreasonably
withheld), and hold harmless City and its officers, officials, employees, agents and volunteers
("Indemnitees") from and against any and all liability, loss, damage, claims, suits, actions,
arbitration proceedings, administrative proceedings, regulatory proceedings, civil penalties and
fines, expenses and costs (including, without limitation, claims expenses, attorney's fees and
costs and fees of litigation) (collectively, "Liability") of every nature, whether actual, alleged or
threatened, arising out of or in connection with the Services or Consultant's failure to comply
with any of the terms of this Agreement, regardless of any fault or alleged fault of the
Indemnitees.
The Consultant's obligation to indemnify, defend and hold harmless under this provision shall
not be excused because of the Consultant's inability to evaluate Liability, or because the
Consultant evaluates Liability and determines that the Consultant is not or may not be
liable. The Consultant must respond within 30 calendar days to any tender for defense and
indemnity by the City, unless the time for responding has been extended by an authorized
representative of the City in writing. If the Consultant fails to accept tender of defense and
indemnity within 30 calendar days, in addition to any other remedies authorized by law, so much
of the money due or that may become due the Consultant under this Agreement as shall
reasonably be considered necessary by the City, may be retained by the City until disposition has
been made of the matter subject to tender, or until the Consultant accepts the tender, whichever
occurs first. In the event that the City must file responsive documents in a matter tendered to
Consultant prior to Consultant's acceptance of tender, Consultant agrees to fully reimburse all
costs, including but not limited to attorney's fees and costs and fees of litigation, incurred by the
City in filing such responsive documents.
The Consultant waives any and all rights to express or implied indemnity against the
Indemnitees concerning any Liability of the Consultant arising out of or in connection with the
Services or Consultant's failure to comply with any of the terms of this Agreement. The defense
and indemnification obligations of this Agreement shall no way be limited by, the insurance
obligations that apply to this Agreement pursuant to Section 23.
Notwithstanding the foregoing, to the extent this Agreement is a "construction contract" as
defined by California Civil Code Section 2783, as may be amended from time to time,
Consultant's duty to indemnify under this provision shall not apply when to do so would be
prohibited by California Civil Code Section 2782, as may be amended from time to time.
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10. LIMITATION OF LIABILITY:
Notwithstanding anything to the contrary in this Agreement, in no event shall Keenan be liable
for any punitive damages, lost profits or revenues, fines, penalties, taxes or any indirect, incidental
or consequential damages incurred by Client, its officers, employees, agents, contractors or
consultants whether or not foreseeable and whether or not based in contract or tort or otherwise,
arising out of or in connection with this Agreement even if advised of the possibility of such
damage. Client further agrees that Keenan's liability under this Agreement shall be limited to, and
shall not exceed, the amount of insurance coverage outlined in this Agreement.
11. DISPUTE RESOLUTION:
A. In the event of any dispute arising out of or relating to this Agreement, such dispute shall be
resolved by submission to binding arbitration before Judicial Arbitration & Mediation Services
("JAMS") or ADR Services, at the claimant's choice, in Los Angeles County, California, before
a retired judge or justice. If the parties are unable to agree on a retired judge or justice, the
selected arbitration service (JAMS or ADR Services) will select the arbitrator.
B. In any such arbitration, the parties shall be entitled to take discovery in accordance with the
provisions of the California Code of Civil Procedure, but either party may request that the
arbitrator limit the amount or scope of such discovery, and in determining whether to do so,
the arbitrator shall balance the need for the discovery against the parties' mutual desire to
resolve disputes expeditiously and inexpensively.
C. The prevailing party in any action, arbitration, or proceeding arising out of or to enforce any
provision of this Agreement will be awarded reasonable attorneys' fees and costs incurred in
that action, arbitration, or proceeding, or in the enforcement of any judgment or award
rendered.
12. TERMINATION:
A. Either party may terminate this Agreement upon the occurrence of any of the following
events:
(1) Upon 60 days written notice by either party;
(2) The breach of this Agreement by either party if the alleged breach is not cured within 30 days
of receiving notice of the breach from the non -breaching party;
(3) The dissolution or insolvency of either party;
(4) The filing of a bankruptcy petition by or against either patty (if the petition is not dismissed
within 60 days in the case of an involuntary bankruptcy petition); or
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16. GENERAL:
A. This Agreement and its recitals and related exhibits and amendments (incorporated into this
Agreement by this reference) contains the entire understanding between the parties related to
the subject matter covered by this Agreement and supersedes all prior and collateral
statements, presentations, communications, reports, agreements or understandings, if any,
related to such subject matters.
B. All terms of this Agreement (other than Keenan's obligation to perform services and Client's
obligation to pay for such services) shall survive the expiration or termination of this
Agreement.
C. Notwithstanding any provision herein to the contrary, this Agreement is made for the benefit
of the parties and not for the benefit of any third party. Enforcement of any remedy for
breach of this Agreement may only be pursued by the parties to this Agreement.
D. No modifications or amendments to this Agreement shall be binding unless in writing and
signed by authorized representatives from both parties.
E. Any provision determined by a court of competent jurisdiction to be partially or wholly invalid
or unenforceable shall be severed from this Agreement and replaced by a provision that is
valid and enforceable and that comes closest to legally expressing the intention of such invalid
or unenforceable provision.
F. Neither party shall be liable or deemed to be in default for any delay or failure in performance
under this Agreement resulting, directly or indirectly, from acts of God, civil or military
authority, acts of public enemy, war, accidents, fires, explosions, earthquakes, floods, failure
of transportation, machinery or supplies, vandalism, strikes, or other work. interruptions or
any similar or other cause beyond the reasonable control of either patty. However, both
patties shall make good faith efforts to perform under this Agreement in the event of any such
circumstances.
G. All payments and invoices are due and payable upon presentation by Keenan. In' the event
Client fails to pay any invoice within thirty (30) days of presentation, Keenan shall be entitled
to receive interest on such outstanding invoice from the date of presentation at the rate of (a)
1'/z percent per month or (b) the maximum interest rate permitted by applicable law,
whichever is lower. Keenan has the right to suspend performance of its Services if any balance
remains unpaid for more than sixty (60) days from the date of the invoice.
H. All notices hereunder shall be in writing and shall be deemed to have been duly given upon
(1) delivery, or (2) when mailed by registered or certified mail, postage prepaid and properly
addressed to the party, or (3) on the second business day after sending by fax and receiving
confirmation of fax receipt. Notices shall be sent to the parties at the address or fax number
indicated in the signature section below unless written notice of a different address or fax
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number is previously given. If a notice given to Keenan relates to a legal matter or dispute, a
copy should be sent to Keenan's Legal Department at Keenan's main office located at 2355
Crenshaw Blvd., Ste, 200, Torrance, CA 90501, fax (310) 533-0573.
This Agreement may be executed in counterparts and by fax signatures. Each person signing this
Agreement on behalf of a party represents and warrants that he or she has the necessary authority
to bind such party and that this Agreement is binding on and enforceable against such party.
ity of Petalurng
Keenan& Ass i tes
i n
Si tur e: \ V11AA
John Brown
T Sc '
Title:
City Manager
Title: Senior Vice President
Address:
11 English Street
Address: 1 2355 Crenshaw Blvd. Ste, 200
Petaluma, CA 94952
1 Torrance, CA 90501
Attention:
ATI Reeve
Attention: I Kyle McKibbin
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EXHIBIT A
SERVICES
Keenan shall perform the following services:
1. Claims Administration.
A. Determine liability for claimed injuries and illnesses in accordance with California Workers'
Compensation Laws.
B. Review and process all claims in accordance with rules and regulations established by the
California Department of Self -Insurance Plans.
C. Establish files containing medical and factual information on each reported claim together with
complete accounting records and maintain them in accordance with statutory time
requirements.
D. Compute and pay temporary disability benefits to injured or ill employees based on earnings
information and authorized disability periods.
E. Determine nature and extent of permanent disability and arrange for informal disability rating
whenever possible to avoid Workers' Compensation Appeals Board litigation.
F. Explain to and assist employees in completing necessary forms for permanent disability ratings.
G. Review, compute and pay informal ratings, findings and awards, life pensions, and compromise
and release settlements.
H. Maintain and establish reserve estimates for each reported claim.
I. Arrange for and supervise necessary investigation to determine eligibility for compensation
benefits and/or liability of negligent third parties.
J. Handle excess reinsurance claims on Client's behalf, complying with conditions of the
reinsurance contract. Submit billings and collect paid losses in excess of self-insurance
retention.
K. Arrange and supervise rehabilitation services where appropriate.
L. Pay claims and loss adjustment expenses in accordance mutually agreed upon, written claims
payment guidelines established by Client and/or Keenan, as applicable.
M. Use reasonable efforts to maintain the designated claims examiner's claim inventory so it does
not exceed 150 active open indemnity files at any given time.
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2. Medical Administration
A. If Client participates in the Medical Provider Network ("MPN") which the State of California
approves, then Keenan will select, with Client's approval, a medical provider panel of general
practitioners, specialists, hospitals and emergency treatment facilities to which injured
employees should be referred. The panel will be reviewed and updated on at least an annual
basis. Keenan will work with Client to formulate medical provider panels in order to derive
maximum benefit from legislative (SB 899) medical control changes.
B. Authorize, review and monitor medical treatment required for injury or illness claims. Audit
and pay medical expenses through PRIME, Keenan's medical management and Bill Review
program. PRIME services will be billed separately to the Claim File. See Exhibit C.
C. Maintain close contact with Client and/or treating physicians to ensure employees receive
proper medical treatment and are returned to full employment at the earliest date.
D. Arrange for medical -legal opinions in disputed cases and confer with medical examiners, Client
and legal counsel when needed.
E. Consult with Client in cases where an injury residual might involve restriction and/or
retirement potential.
3. Legal Administration
A. Recommend defense attorneys to the Client; receive Client's written approval and acceptance
of counsel. Counsel shall, once accepted by Client, defend Client's interest in all cases that are
subject to litigation before the Workers' Compensation Appeals Board and the courts. All
attorney fees shall be considered part of the loss adjustment expenses and shall be paid from
the client's claim's account.
B. Work closely with counsel in preparing defense of litigated cases.
C. Keenan will also work closely with claimants and Client's legal counsel to informally dispose
of litigated cases.
D. Work closely with counsel in an effort to protect and preserve Client's interests in potential
subrogation cases.
E. Attend, when appropriate, and as agreed in advance by the parties, Workers' Compensation
Appeals Board hearings on behalf of Client.
4. 1�sk Management Services
A. Review and update Client on Workers' Compensation benefits, rules and regulations, and
legislative issues.
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B. Communicate with injured employees telephonically or in writing to assist them in resolving
problems that arise from injury or illness claims.
C. Meet quarterly with Client to review best practice policies and procedures, recommend areas
for improvement and assist Client in implementing improvements.
D. Produce ad hoc reports as needed to provide meaningful loss analysis to aid in risk
management program development and tracking.
S. Statistical.
A. Report to Client monthly status of claim payments and reserves on an individual basis and in
the aggregate.
B. Report to Client quarterly loss analysis of claims filed by frequency and severity.
C. Provide quarterly PRIME (medical management and bill review) reports detailing savings and
fees.
D. Assist in the preparation of all reports required by the State of California or other government
agencies relating to Workers' Compensation claims.
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EXHIBIT A-1
MEDICARE SECTION 111 SERVICES
It is acknowledged and agreed that Client is the Responsible Reporting Entity ("RRE"), as defined by
the Center for Medicare Services ("CMS"), for any liability or workers' compensation claim settlement
or payment made by Client to a claimant. This includes payments made within the Client's Member
Retained Limit ("MRL") or deductible.
2. Keenan shall act as Client's reporting agent for the preparation and submission of all reports
("Reports") required under Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007
("Section 111") with respect to those settlements and payments of claims for which Keenan acts as
claims administrator, and for which Client is deemed to be the RRE.
3. Keenan shall prepare and file the Reports in accordance with the requirements of all applicable, laws
and regulations, and the directives of CMS and/or any other government agency that has, or may be
granted the authority to require, direct, or control the preparation and/or filing of the Reports.
4. Client shall timely provide Keenan with all information necessary for the preparation and filing of the
Reports. Keenan shall have no liability to Client for any penalty or fine that is assessed against Client
for a failure to file a timely, accurate and/or complete Report if such failure was the result of the
failure Client or any of its respective employees, representatives or agents to provide Keenan with all
information necessary to file a timely, accurate, and complete Report.
5. Keenan shall not issue a payment to a claimant until it has received from the claimant, or the claimant's
representative, all necessary claimant information that is required for the filing of a Report.
6. Keenan, as Client's manager and claims administrator, shall have no responsibility to file any Report
for any settlement or payment for which Client is not the RRE.
7. Members shall at all times, be responsible for their own Section 111 compliance in situations where
they are the RRE. This includes, without limitation, the determination of whether or not a Report
must be submitted, as well as the preparation and filing of all Reports.
8. When the total payment for a claim exceeds Client's MRL/deductible, Keenan will submit a Report
only for that portion of the claim that is paid from the Client's MRL/deductible. The insurer or other
entity paying the remaining amount is responsible for reporting for the amount in excess of that paid
by the Client
9. Keenan shall not file a Report for any claim unless it has been engaged by Client to act as the third
party administrator for such claim.
Keenan & Associates — Idcense 40451271
Self -Insured Claims Administration
Confidential For Client Use Only
(Rev) 4/06/16
Page 12 of 15
EXHIBIT B-1
COMPENSATION
1. Year One
During the first year of this contract Client shall pay Keenan, an annual fee of $136,750, payable in equal quarterly
instalments commencing on the Effective Date. This fee is based on 112 indemnity count and will be renegotiated
if the claim count differs by +/- 10%.
2. Optional Year Two
If this Agreement is renewed for an additional one year term ("Renewal Term"), Keenan's fee for the Renewal
Term shall be $140,852, payable in equal quarterly installments commencing on the first day of the Renewal Term.
3. All payments and invoices are due and payable upon presentation by Keenan. In the event Client fails to pay any
invoice within thirty days of presentation, Keenan shall be entitled to receive interest on such outstanding invoice
from the date of presentation at the rate of (a) I1/a percent per month or (b) the maximum interest rate permitted
by applicable law, whichever is lower.
Keenan & Associates — License #0451271
Self -Insured Claims Administration
Confidential For Client Use Only
(Rev) 4/06/16
Page 13 of 15
INSURANCE REQUIREMENTS
EXHIBIT B-2
Consultant's performance of the Services under this Agreement shall not commence until
Consultant shall have obtained all insurance required under this paragraph and such insurance shall
have been approved by the City Attorney as to form and the Risk Manager as to carrier and
sufficiency, All requirements herein provided shall appear either in the body of the insurance
policies or as endorsements and shall specifically bind the insurance carrier.
Consultant shall procure and maintain for the duration of the contract all necessary insurance
against claims now and in the future for injuries to persons or damages to property which may
arise from or in connection with the performance of the Services by the Consultant, the
Consultant's agents, representatives, employees and subcontractors. Required professional
liability insurance shall be maintained at the level specified herein for the duration of this
Agreement and any extension thereof and for twelve additional months following the Agreement
termination or expiration.
A. Minimum Scope of Insurance
Coverage shall be at least as broad as:
1. Insurance Services Office Commercial General Liability coverage:
a. Personal injury;
b. Contractual liability.
2. Insurance Services Office form covering Automobile Liability, code 1(any auto).
3. Workers' Compensation insurance as required by the State of California and
Employer's Liability Insurance.
4. Professional Liability insurance,
5. Such other insurance coverages and limits as may be required by the City.
B. Minimum Limits of Insurance
Consultant shall maintain limits no less than:
l . General Liability: $1,000,000 per occurrence for bodily injury, personal injury and
property damage. If Commercial General Liability Insurance or other form with a
general aggregate liability is used, either the general aggregate limit shall apply
separately to this Agreement or the general aggregate limit shall be twice the
required occurrence limit.
2. Automobile Liability: $1,000,000 per accident for bodily injury and property
damage.
3. Employer's Liability: Bodily Injury by Accident - $1,000,000 each accident.
Bodily Injury by Disease - $1,000,000 policy limit.
Bodily Injury by Disease - $1,000,000 each employee.
4. Professional Liability insurance: $1,000,000.
5. Such other insurance coverages and limits as may be required by the City.
C. Deductibles and Self -Insured Retentions
Any deductibles or self-insured retentions must be declared to and approved by the City.
At the option of the City, either: the insurer shall reduce or eliminate such deductibles or
Exhibit B2
Page 1 of 3
INSURANCE REQUIREMENTS (City)
(609325) Oct 2017
self-insured retentions as respects the City, its officers, officials, employees, and
volunteers; or the Consultant shall procure a bond guaranteeing payment of losses and
related investigations, claim administration and defense expenses.
City reserves the right to review any and all of the required insurance policies and/or
endorsements, but has no obligation to do so. City's failure to demand evidence of full
compliance with the insurance requirements set forth in this Agreement or City's failure to
identify any insurance deficiency shall not relieve Contractor from, nor be construed or
deemed a waiver of, its obligation to maintain the required insurance at all times during the
performance of this Agreement.
D. Other Insurance Provisions
The required general liability and automobile policies are to contain, or be endorsed to
contain the following provisions:
1. The City, its officers, officials, employees, agents and volunteers are to be covered
as Additional Insureds as respects: liability arising out of activities performed by
or on behalf of the Consultant; products and completed operations of the
Consultant; premises owned, occupied or used by the Consultant; or automobiles
owned, leased, hired or borrowed by the Consultant. The coverage shall contain no
special limitations on the scope of protection afforded to the City, its officers,
officials, employees, agents or volunteers.
2. For any claims related to this project, the Consultant's insurance coverage shall be
primary insurance as respects the City, its officers, officials, employees, agents and
volunteers. Any insurance or self-insurance maintained by the City, its officers,
officials, employees, agents or volunteers shall be excess of the Consultant's
insurance and shall not contribute with it.
3. Any failure to comply with reporting or other provisions of the policies including
breaches of warranties shall not affect coverage provided to the City, its officers,
officials, employees, agents or volunteers.
4. The Consultant's insurance shall apply separately to each insured against whom
claim is made or suit is brought except, with respect to the limits of the insurer's
liability.
5. Each insurance policy required by this clause shall be endorsed to state that
coverage shall not be suspended, voided, canceled by either party, reduced in
coverage or in limits except after thirty (30) days' prior written notice by certified
mail, return receipt requested, has been given to the City.
6. Consultant agrees to waive subrogation rights for commercial general liability,
automobile liability and worker's compensation against City regardless of the
applicability of any insurance proceeds, and to require all contractors,
subcontractors or others involved in any way with the Services to do likewise.
7. It shall be a requirement under this Agreement that any available insurance
proceeds broader than or in excess of the specified minimum insurance coverage
requirement and/or limits shall be available to the additional insured. Furthermore,
the requirement for coverage and limits shall be (1) the minimum coverage and
limits specified in this Agreement, or (2) the broader coverage and maximum limits
of coverage of any insurance policy or proceeds available to the named insured;
whichever is greater.
Exhibit B2
Page 2 of 3
INSURANCE REQUIREMENTS (City)
(609325) Oct 2017
8. The limits of insurance required in this Agreement may be satisfied by a
combination of primary and umbrella or excess insurance. Any umbrella or excess
insurance shall contain or be endorsed to contain a provision that such coverage
shall also apply on a primary and non-contributory basis for the benefit of the City
of Petaluma before the City of Petaluma's own insurance or self-insurance shall be
called upon to protect it as a named insured.
E. Acceptability of Insurers
Insurance is to be placed with insurers with a current A.M. Best's rating of no less than
ANII.
F. Verification of Coverage
Consultant shall furnish the City with original endorsements effecting coverage required
by this clause. The endorsements are to be signed by a person authorized by that insurer
to bind coverage on its behalf. All endorsements are to be received and approved by the
City before the Services commence.
Exhibit B2
Page 3 of 3
INSURANCE REQUIREMENTS (City)
(609325) Oct 2017
EXHIBIT C
I? T A/fI7
Fee Schedule - Effective July 1, 2015
(Subject to change upon notice)
MANAGED CARE SERVICES
Early Intervention Initial Assessment / Triage .......... $50 / Hour
Total Case Management ................................................. $98 / Hour
• PPO Channeling
• 4 PT Contact
• Initial Evaluation
• RTW Plan
• Medical Care Evaluation
• Written/Case Management Action Plan
Utilization Review ..................................................... $110 / Referral
Physician Advisor ...................................................... $200 / Referral
• Medical Necessity Determination
• Physician -to -Physician Contact
Specialty Physician Review .......................................... $375 / Hour
• Specialty match required
• Appeals
STOP (Pharmacy Review) ........................................... $300 / Hour
• Peer -to -Peer Contact
• Management of Opioid Use
• Written Treatment Plan / Recommendations
Keenan & Associates — License #0451271
Self -Insured Claims Administration
Confidendsl For Client Use Only
(Rev) 4/06/16
BILL REVIEW SERVICES
Price bills to State Fee Schedules ........................... 10% of Savings
• $10,000 per bill cap regardless of savings
PPONetwork Access .............................................. 24% of Savings
• $10,000 per bill cap regardless of savings
• Retrospective Network Capture
• Preferred Vendor Pricing (Ancillary Services)
MPN Access........................................................ $1.50 per WN bill
• Care ConciergeTM Medical Access Assistant
• Physician Based Outcome Analytics
Pharmacy Benefit Management ............................. 20% of Savings
Negotiations.............................................................. 24% of Savings
Complex Bill Review by Physician ........................ 24% of Savings
eBillAccess........................................................ No Charge to Client
State Reporting Administrative Fee .............. No Charge to Client
Page 15 of 15