HomeMy WebLinkAboutAgenda Bill 3.D 11/15/2004•
CITY OF PETALUMA,,CALIFORNI
No vem* "'ber 15
AGENDA BILL
AeendA Title:
Meeting Date:
Resolution approving and authorii-in2 execution of Professional
November 15, 2004
Services Agreement with the Redwood Empire, Municipal Insurance
Fund (REMIF) for the workers' compensation claims administration
Meeting Time Z 3:00 PM
services.
❑ 7:00 PM
Category (c eck one),: Z'Conse E1P4bli'cHearM*'g New Business
❑ Unfinished Business • ❑ Presentation
Departinentfinance,
Director:
Contact Person:
P hone Number:
Risk Management, &
Joe Netter
Ron Blanqu r ie:,
Human Resources
Pamal'a R6bbln I s
778-4343
Division
Cost of ProposAL, $76'680 annually (already budgeted)
Account Number: 3361 56430
Amount Budgete $1 00,000. not to exceed annually
N ame of Fund:
General'Pund - Benefits – Workers'
Compensation Administration
,Attachments to Agenda Packet Item:
1. Resolution approving and. authorizing execution of agreement for workers' compensation claims
administration , services between the City of Petaluma -and the Redwood Empire Municipal Insurance Fund.
2. Proposed professional services ag eement with REMIT for workers compensation administration
services.
Summary Statement
The City of P etaluma s
luma is self-inured I t' $7-50 �O 00 for i6vorkers" corn
.1 -11 1 1 1. Q I compensation program. The self-insured
retention (S,I.R.) has been administered by a public entity, Redwood Empire Municipal Insurance Fund
(REMIT) since. 1986. Requests, foriproposals and the :selection process, for a qualified service provider has
and completed this'" year. We are recbrn]nehaing� that the city stay with their current
been -con.RIEM.
Iducted,
Wh
provider,' : anupddted contract for services.
I F has agreed t o
Recommended City Council Action /Suggested :Motion:
gn hedagreem,ent by approving, the attached resolution.
Authorize the City Manager to sign he,.attac b
ReVji'eved, by FiJlian�e',biredor,
ReV , ie, b I C_k?
Approved v Maifa2er:
Date:,
e.
' Revision
To ate. Vt
# and Date' -Revisedi,
File Code/
bill
4i
CITY OF P.ETALUMA;: CALIFORNIA
NOVEMBER 1'S 2004
AGENDA REPORT.
FOR
Rewintion Approving and Authorizing Execution, of Professional Services Agreement with the Redwood
Empire Municipal Insurance Fund ( REMIF) for the Workers' Compensation Claims Administration
Services
1. EXECUTIVE' SU MMARY : The City Petaluma recently requested', a,proposal,for service to evaluate cost
of services, establish performance .objectives and to updateits contract for workers' compensation
claims administration services: This evaluation had not, been done since 1986. The two responsive
firms are very competitive; ire broth their-services and pricing.
2. BACKGROUND The City of Petaluma requested .a proposal for services., We, received interest from
three interested parties, one of which decided not to submit a wri tten proposal. Written proposals were
y g p p ate sector any — Greg Bragg & Associates
submitted b our existm rovider REMIF and a riv
Inc. Interviews and other selection criteria were conducted and completed by a city appointed panel
consisting of the following individuals:
A. Ron Blanquie, Risk Manager.
B.. Dennis Morris, Former.Human.Resource.Director
C. Pamala Robbins, Interim Human Resource Manager
1]
•
After careful review and analysis =by this city appomted.panel, the City Attorney's Office, Risk
Management and the Human Resources Division, it is recommended that the city enter into an updated
and current contract with its current service.provider, REMIF':`
Proposal Cost Comparison
Average Workers' Compensation Claire. Life Cycle 2:6 Years
REMIF - Guaranteed Claims per .year _ 90 , Claims
234 Claims @ $852.00 per claini for 2.6 years'
$199,368 Claims costs for 2:6 years
-0- Risk Management Information System (RMIS)' and Claims Management Information System
(CMT$.) fees -for 2.6 years!
-0= Other service'fees, such'as� meetings tra rings, analysis; consulting fees, etc.
$199,368' Total estimated fees for 2.6 years
$ 76,680 Average °per ,year
BRAG:G & A
GREG SSOCIATES, INC. Estimated Claims per year - SS Claims
138 "Claims. @ 1.250.00'per;claim for 2.6 years
$1.72,500 Claims costs for- years
7,500 Risk Managemennt Information System (RMIS)'I an`d Claims Management Information System
(CMIS) fees for 2:6' years
36,000 Other estimated service fees, such as, meetings, trainings, analysis, consulting fees, etc.
$216,000 Total estimated fees for 2.6 years
$83,077 Average per year
3. ALTERNATIVES
A. Continue with the outdated contract- with. REMIF.• •
B. Award contract to Greg Bragg & Associates, Inc.
4. FINANCIAL IMPACTS The cost of this program (is not to: exceed $100 per. fiscal, year) with REMIF.
S. CONCLUSION The recommended service provider, REM and the attaehedprofessional services
agreement will benefit the city's position both in the short term and long- term,' °;so. we can.obtain the best
service opportunities for our,.employees and continue to lower the overall costs of our' current - and any
future workers' compensation program
6. OUTCOMES OR PERFORMANCE MEASUREMENTS THAT WILL IDENTIFY'SUCCESS OR•.COMPLETION:
A. Frequency and severity of workers.' compensation claims will continue to decrease'.
$'. Both workers' compensation claim costs and their related expense costs will decrease.
C. Creation of an or and contractual structure that will allow the Cty.of.Petaluma to
successfully meetlthe future challenges of the ever changing and unpredictable workers'
compensation laws and regulations.
7. RECOMMENDATION Approve the resolution as. attached.
® `DRAFT RESOLUTION NO.
RESOLUTION APPROVING; AND AUTHORIZING EXECUTION OF PROFESSIONAL
SERVICES AGRE
EMENTWITH THE REDWOOD EMPIRE MUNICIPAL
INSURANCE FUND (REMIF) FOR THE WORKERS' COMPENSATION CLAIMS-
ADMINISTRATION SERVICES.
WHEREAS, the City of Petaluma has determined, that the continuation of self - insured
workers' compensation program,is cost effective; .and,
WHEREAS, based! on, the advice by the city''§ staff and its selection committee, that an
outside firm be retained to adnirister: the city's workers compensation program,
NOW, THEREFORE .
BE' IT RESOLVED that the Council of the City of Petaluma
approves the execution of an agreement between the City and the Redwood Empire Municipal
e'.1VIa "or or the City Manager is authorized to execute such an
Insurance Fund MIF and th y ty g
agreement. The council `hereby„ approves the professional services agreement attached hereto
subject, however, to the authority, hereto given of the City Manager to revise such terms to
/ clarify the obligation of the parties agreement.
40
• PR
OFESSI'ONAL.SERVICES AGREEMENT
Workers' Compensation; Claims Admnistratioii,Services
(Project Account Code No., )
THIS PROFESSIONAL SERVICES AGREEMENT ("Agreement ") is entered into
and effective as of January 1, 2005 ( "Effective
Date "), by and between the City of Petaluma, a municipal. corporation and a charter city ("City")
and Redwood Empire Mxli tci'pal Insurance Fund,. a Public Entity ( "Consultant ") (collectively,.
the "Parties" ).
WHEREAS, the Parties enter 'i;nto this Agreement for alle purpose of Consultant providing
workers' compensation claims administration services to City under tlhe terms and conditions set
forth herein:
THEREFORE, in consideration oPthe mutual covenants contained in this Agreement, the Parties
agree _as follows:,
' S'ervices . Consultant shall provide the services as described herein and in accordance
A aft ed hereto and incorporated ach
" ".
with the ':erfonnance ob'•eclrves set forth in - Exhrbi't „
herein ( "Services ").
2. , Compensation.
_ A. For the full perfo,rtnan.ce I?y
of the . services described herein, City
agrees to pay Consultant a fee of $'852 per, claim. The $852 fee will be in effect
Janrrar, ] , 2005,
frorn� y 5,. and will apply whether the claim is
through June . 3;0,.200
for medical treatment only or .is an i�nd'enulity, claim. Provided that City is given .
written notice no .later than Ap A ,15, Consultant may adjust the fee, up to a
maximuriT increase of %, for each subsequent fiscal year. The fiscal year shall
run from Jlily 1 through -the following June °30: .
B.' - The 'minimum guaranteed number of claims per fiscal year is 90, not to'exceed
$ ] 00 p;er fiscal year'., City shall' a minimum annual fee equal to the then
minimum guaranteed number of`.clainis• per fiscal, year times the. clam's fee in
:effect, for that fiscal year. Any. claims over`the guaranteed minimum will be billed
at the then „,current claim fee., ln the event tl ere is,a continuing, trend of more than
90 claim's per year, the parties' 'may,, ' :by agreement, increase the minimum
g basis ill, subsequent years.
uaraiitecd ,number of clauns to be b i'II'cd oil air. annual
•
C. The aboyeAescribed claim fees will b�e billed and become due and payable. three
tildes per :y„ „ear: the billing in Julie. (payable in. Jury) will be for one -half of the
guaranteed minimum annual The for; the- following fiscal year; the billing in
December ;( payable in: January) will be for the 'second half of the guaranteed
minirnurn, annual fee for that- fiscal year, flier e will be a billing by July 15`x' for the
number of claims. opened, in the prior year which exceeded the' *agreed upon
PROFESSIONAL, SERVICES AGREEMENT - CITY
February 200.1
guarainteed minimum for the prior year.
D. Consultant shall 'be compensated for services in iddrt'ion. to those 'dessribed .i l
Exhibit A,, o,iily if Consultant and `City execute a written 'amendment to this
Agreement describing the additional. services to. be performed -and the
compensation to be paid for Such services.
E. City's obligation to pay compensation to Consultant as. provided -herein is
g p 's performance, of the Services pursuant to the_ terms
contin pri upon Consultant
and conditions of this Agreement dad - any amendnienis thereto.: .
3. Term The term of ,this is Agreement comnieiices on the Effective. Date; and. ternntnates on .
December 31,; 20.07, .unless sooner terminated in accordance with 'Section .4. This
Agreeiiietit'shall be iii .effect for an initial term of three years, c,ommencing•on J,anuary.l,.
-
2005, and ending on December 3'1, 2007,, and shall be alitorriatically renewed each year
'thereafter finless tenninated pursuant to section 4` Herein. For the`purpose of maintam>ng .
the continuity' of'ch ims ,administration for' the City upon termination ;of this: Agreement,
Consultant, at the discretion of the city',, at no additional fee, shall, continue to handle and
adjust. p ending claims to their conclusion. Upon tenninati'on, any and all of City's
docurnents or materials provided to Consultant and any and all- of the: doftih , is or
materials prepared for City -or relating to the performance of the .shall be.
delivered to the° City as soon as" po'ssibl'e, but not later than fourteen (14) clays after
term ;ination�of.the Agreem ent unless a later tune is agreed upon.
A. Termination Either party shall -have, the right to terminate this agreement upon giving
the other arty sixty, (60) days,prior' written rnolice: The terImpation Will be effective: - on
,p
the elate_ stated in the written notice which must be least sixty (60) days "afterthe:date of
the notice.
in the 'event the City. purchases Workers' Compensation Insurance (exclud "ing excess) or .
'its "Certif sate of Consent:=to Self- Insure" is rescinded, this: contract automatically and
immediately is terminated and canceled.
Upon termination of the contract, a, final accounting will be made :of the service fees and.
Allocated Loss: Expense, if any, owed to Consultant and .of any funds belonging to the
City in possession of Consultant and anybalance due shall be promptly paid.
Upohteriiiination of this contract, at the discretion of.the city, all, handling and adjusting
of pending elaiins by Consultant, shall continue at no additional cost to the City. A final .
accounting alto amounts owed withrespect -to such pending claim(s); shall be.made when
responsibility for the outstanding claim(s) is,transferred'to the City.
City may ,immediately terminate or suspend ,this Agreement for cause. Cause for
immediate te>>nination ,or. suspension 'shal_l include, but;not be invited to, any
`breach of
this Agreement by Cons ultant - or'Coiisultant's bankruptcy or insolvency. Upon rece- pt.of"
no -tree of termmati'oi1 ors >spension for cause Consultant shall jmmediately stop all work
rider this Agreement. In the event. of earl: termination: of this Agreement,
in progress u
Consultant shall 'be entitled to pa' n eiit' for all Services "performed, to the date of
PROPE,SSIONAL:S TI2V,ICES AGREGMGN'I - crrY
February 2003
12. Coii'flict of'Inferest Consultant re resents that itnresently has no interest, and covenants
that i't shall acquire any 7teest, direct or- indirect, financial or otherwise, which
would confiJ t .un,;'any manner or degree with. rm
the perfoance of the Services hereunder.
Cons'L ltant further covenants that, 'in the performance of this Agreement it shall not
knowingly eimploy any subcontractor or person having such a conflict of interest.
Consu r em to ee of Cis or w-i'P Have any financial interest under the
Agreement is an � office hat at no � On Y who ha 'ty. If such conflict of interest arises during this
3
i'i20FIsS51c)Nn1. S{ RV ICT S AGRITN I NT•- CITY
February 2003
lermi�iation. If City tee mii g `en( for ,cause, Consultant. shall be liable o
fates this A teem_
City for any excess cost City incurs for completion of the.Services.
5.
Consultant's Rel)i-esentation; IndependOlt' Cont ractor. Consultant represents that
Consultant possesses distinct `professiona_l :skills in perfonnit�g the Services. City ,has
relied upon said represen afibi ° as a material inducement to, ; enter into this Agreement.
Consultant shall, the�.efore; provide properlyskilled ° professional and technical personnel
to pefform .all Services under' this Agreement. !It is expressly understood that Consultant
and its agents and employees; shall act in air independent capacity and as an independent
contractor and not as officers, employees or .agents of City. This Agreement shall not be..
construed as air "agreement for eM' ployrneilt.
6.
Facilities and Equ'ipmen't Consultant shall, at its sole cost and expense, furnish all
facilities and egoipiuen( "that may he required foie f[in- skiing; Services .pursuant to this
Agreement. City shall furnish to Consultant no facilities or equipment, unless the City
otherwise agrees in writing to provide the same.
7.
Licenses, Pet, Etc Consultant shall, -at Consultant' sole cost and .expense, keep .in.
'roes duiiig the term of'this Agreement any`licenses, permits or other such
effect at all t_i
approvals which arec legally required for per- forming the Services.
8.
Trine Consultant shall devote such time to, :the peifor;i»ance of the Services as illy be
reasonably necessary for satisfactory.performance - of Consultant's obligations pursuant to
this Agreement.
9.
Inspection Consultan(:shall City ev,eiy reasonable opportunity to ascertain
that the Services are being performed in accordA ce with "the requirements and intentions
of this Agreeiiaent. All work done' and materials ftin ished; if any, shall be subject to
inspection and approval, by the City: Thee inspection of such work shall not relieve
Consultant of anyof its obi igati oil s pursuant; to this Agreement.
10.
p y' quest,Consu fait shall provide, in a foam . mutually.„
U on. file Cit s re
Prowess Reports " .
agreeable to' City written' progress reports of.ali oral and written observations,, opinions,
recommendations, analyses, progress and conclusions related to . Consultant's
performance of the Services. '
11.
Confidentiality In the co u i se of Consultant=. s en 1 inay have access
o Consult
p n
which > s ..nt
to. trade secrets and confidential: >inflorn�ation; discfos"ure protected or limited
by `law. Coi sU tant shall not directly or indirectly',disclose or use any such confidential
information, excdj t as required for the performance of the Services.
12. Coii'flict of'Inferest Consultant re resents that itnresently has no interest, and covenants
that i't shall acquire any 7teest, direct or- indirect, financial or otherwise, which
would confiJ t .un,;'any manner or degree with. rm
the perfoance of the Services hereunder.
Cons'L ltant further covenants that, 'in the performance of this Agreement it shall not
knowingly eimploy any subcontractor or person having such a conflict of interest.
Consu r em to ee of Cis or w-i'P Have any financial interest under the
Agreement is an � office hat at no � On Y who ha 'ty. If such conflict of interest arises during this
3
i'i20FIsS51c)Nn1. S{ RV ICT S AGRITN I NT•- CITY
February 2003
Agre I ernerit or an.y extension, Consultant will immediately advise City and City may, at
its sole discretion, immediately terininate this Agreement.
13. Consultant••N.o Age nt Except as s cfed..in Exhibit "A" and as City ' p er
- p ' may specify in
writing, Consultant shall have no.authority, express or implied, to action behalf of City in
any capacity whatsoever• as ;ail agent. ConsOltarit shall have no authority',' express or
innplied, pursuant to this Agreement to bind City to any"o.4ligatio, n whatsoever.
14. Swid'ard of Performahce Consultant shall perform all the Services in °a manner -
consi'ste''nl with the al�u�d`ard's of Consultant' "s:. pro :fession, All insirtinmits of service of
whatsoever nature which 'ConRdtant delivers to City pursuant to, this „Agreement shall be
'prepared in a substantial_, first class and workmanlike: mariner and conform to the
standards of Consultant's'profession. All such instruments of service shall become the
sole. and exclusive property of City upon delivery of 'the.same.
City shall make f4u d's available' upon which-'Consultant. may draw of any time and. from
time . to time for claims or loss payments, including approved `settlernents, medical
expenses, temporary aiid permanent di ability payments rehab" l _ ion expenses and' for
all Allocated,Loss.Expenses.
15 Assi1nmeitt /T'Iransfer No assignment or transfer in whole or ;in part of this Agreement
-"',shall be made without the prior written consent of City.
16: Sub'contracto'rs Given the nature of'tbe `t work aiid' the - services supplied ,as ,
part 'of' contract; subcontractor. shall be :defined only as another :Consultant directly
supplying workers' compensation claims services to the City,. Subcontractor sliall nod e
defined as any- :person,, company, or organization.1hat the Consultant uses-for any services
to administer the City's workers'" compensation claims in accordance. with Exhibit "A of
aiay local-, �state•or.federal law:
Consultant shall ,directly perform all Services, and. shall not' subcontract any portion ,of
performance. of the Services without the -prior written consent of City. Any such
subcontractors shall be required to comply,. to the full extent applicable, with the •terms
and conditions of'this Agreement, including but riot ; limited to, procuring and maintaining
insurance coverage as required herein and which: shall name City as an additional insured'.
17. Compliance With All Laws Consultant shall frilly comply with :all applicable local,.
'state and federal riles, laws, regulations ,and or=dinances pertaining perfo"i=mance of the,
Services required Hereunder. To the extent "that airy other government agency or entity
provides compensation. for any Services, Consultant shall comply with all rules and'
regulations applicable to such.'fiscal assistance.
Coi1sultaiit, not City shall be responsible for all 'fiiies penalties or fees ass'essed`wl ether
state mandated, self- imposed or" :imposed by. a state audit, .that are. the result df handling
errors ofthe;City's filesb,yConsultani.
4 it-y,
,, not Consultant shall be res onsible for.ail• f nes,.�' �penaltres� or- fees assessed whether
C y, p
state nandated, self`unposed or imposed,bya state: audit, that are the responsibility of
q
PROF FSSIONAt SERVICES nGREENENa'- ,Cll'Y
- 6111ary 2003
•
City, including, but not limited, to,
A. Failure by City to provide an'Employe,e Claim Form within'twenty - four (24)
hours upoli request of`the worker or his /her agent. Failure of employer to
complete "13WC -1 as required lythe'Labor .Code, even when'DWC - is submitted
to employer an, attorney.
B. Failure by City to provide Consultant, with an Employer's First Report within
seven (7) days of the ,date of injury. .
C. Failure by City to advise, Consultant of subsequent periods of disability after a
worker returns 1.0 work. .
D. Failure by City to;advise Consultant of the,conclusion of'salary continuation.
E. Any penalties for late,.payment;of any required, payrnent if late payment is due to
failure by.City to make funds available for such required payment.
F. Any penalties or sanctions ordered by the court in a litigated' case unless
Consultant litigated the case' without obtaining permission from City.
18. Discrimination Dur the performance of this Agreement, Consultant shall not
discriminate against any employee or applicant for employment because of race, religion,
creed, color, national origin,, ancestry; gender,. sexual orientation, age or physical or
mental disability in violation of any applicable law.
19. Notice Except as otherwise speclfied`in this Agreement, all notices to be sent pursuant to
this Agreement shall be made in writing, and sent to the Parties at their respective
addresses specified''below or to such other address as a Party may designate by written
notice delivered to the: other' Party in accordance with this Section. All such notices shall
be ;sent by:
(i) personal delivery in wlii_ch case notice is effective 'upon delivery;
certified or registered mail, return. "receipt requested, in which case notice shall be.
deemed delivered ;on receipt if delivery is confirmed by a return receipt;
(iii). nationally recognized overnight "courier, with charges prepaid or .charged to the
senders account ' h case, notice xs effective on delivery if delivery is
;rn �whic
c I inmed,`by the delivery service or
C
(iv) facsimile transmission, :in which case notice shall be deemed . delivered upon
transmittal, provided, that ('a)� a. dupl�!cate. copy of -the notice s, promptly delivered
by first - class or, certified mail or by overnight delivery, or (b) a transmission
report is enerated reflecting the accurate'transn ission thereof. Any notice given
g g
by facsimileshal_l be considered to have`been received on the next business day if
it is received after 5:00 p.m. recipient's time or on a non - business day.
S
PROFESSIONAL SERVICES AGREEMENT -CITY
February 2003
City: City Cleric.
City of Petaluiila
..'postOffice Box ,61 - . .
Petaluii-ia, California 94953
Tetepl o - ne: (707) 778- 43.60
Facsimile: (707) 778-4
And:
Telephone:
Facsiniile:
Consultant: Jeffrey -1. Davis
General, Manager
Redwood Empire Municipal Insurance Fuind
P:..O. Box 885
Sonoma,• CA. 95476
Telephone: (707) 938 -2388 ext, l_ 1
Facsimile: (707) 938 - 03.74
6
PROFESSION AL ISERV;ICES'nGREEMENT, - CITY
February 2003
O,'rvner•s'hip of D'o rents Alf original papers, - documents or computer material oil disk
• : or microfilm; and copies 'thereof, produced as a result ,of this Agreement, shat] be the
property of "City and may not he used by Consultant, outside of'the claims' administration .
work, without the written consent of City. Copies of such documents or'papers shall not
be disclosed to others, outside of tlie claims administration work, without the written
consent of Mae "City.Manager orhi 's or'fher designated"representative.
21. I ndemnil'i'c�fion . ;Consultantahall indemnify, defend with counsel acceptable to City,
and hold .hai City and its officers, officials, employees,., agents and volunteers from
and against any and all liability, loss damage, claims,' expenses, and costs (including,
without limitation, attorney's fees and costs and" fees of litigation) (collectively,
"Liability") of everynatu,re.arising�o,Lit of or iai coili ection with Consultant's performance
of the Services or its 1`ailu_'re, to comply- with any �of its obligations contained in this
Agreement, except such Liability caused, by : the: n egligence or misconduct of City.
Notwithstanding 'the foregoing, to the extent that this Agreement is a "construction
contract within tlie of Civil Code Section 2783,, as maybe amended from time
to time, such indern-nity shall i of -include Liability for the active negligence of City..
22. Insurance Consultant shall comply with the "Insurance Requirements for Consultants"
in Exhibit B- , attached' hereto and. ''incorporated herein by reference. [Indicate
attached exhibit, e.g: "'Xi." or ")3 -2. "]
23. Amendment This, Agreemenl,may be amended .only by a written instrument executed by
• both Parties.
24. Litig fion If litigation: ensues which pertains' lo the subject matter of Consultant's
services hereunder, COnsultant, upon request from City, agrees to testify therein at a
reasonable and- customary "
25. Construction This Agreement is the product of negotiation and compromise on the part
of both Parties and that the Parties "agree that, notwithstanding Civil Code section 1654,
any uncertainty iii th'e Agreement !shall not be construed, against the drafter of. the
Agreement.
26. Governing Law; Venue This A- greement shall, enforced and interpreted tinder "tile
laws of the State of Cal`ifoi-nia and the City of ,Petaluma. Any action °arising from or
brought 'in connection with, 'this Agreement shall' be venued in a court of competent
Jeri "sdiction in the County of Sonoma, S'tate,ofCalifornia.
27. Non- W.aiVer The City's 'failure; to enforce any proyrsiori of this Agreement or the: waiver
thereof in .a, particular instance shall not be construed -as ,a general waiver of any part of
-such provision.. The provision shall remain in full force and effect.
28. Severability If any term or .portion of this Agreement is. held to 'be invalid, illegal, or
otherwise unenforceable by a cobrt of competent jurisdiction, the remaining provisions of
this Agreement shay continue in full force and effect..
7 .
PROFESSIONAL SERVICES AGREEMENT- C
February 2003
29. NO TI111-4 P UIV Bellefi'ckities The 'Parties, do not' intend to create, and notliing, in, this
Agreement shall be construed to create: any benefit or right in any third party.
30. 1 cd ,ation Tl�e Parties agi ee `to make a, good faith - attempt to. resolve,. any dispute arising
out bf this Agreement through ,inddiation prior :to `The Parties
col�imepting litigation:.
shall mulc►ally agree upon the inediator and shall divide the costs of:>nediation equally.
31. Consiiltant Roohs and .Recor=ds
A. Consultant will retain all do.curiients and records in accordance with, state and
y
Federal ' law. Upon closing the injured employees file, the Cit will be consulted
about the return of these files to the :City or their el=ectronic copying !arid
destruction of the physical file: All claims files, records; reports, computer - tapes,.
and other documents and .material pertaining to City'`s workers' compensation
claims shall be the property. of City and shall b'e - delivered to the City or its
designee, at the City's expense upon' °termination of this Agreement.
B. Ally ;records or documents required to be maintained pursuant to this Agreement
shall be made available for inspection �or audit, zat any time during r.egular"bitsiness
hours, upon written request by. the City Manager,, City Attonley, City Finance
Director, or a designated :represe itutive of these) officers: Copie 'Of .such
docuiiients shall. be prov,"ided to'the City for'inspection atPetaluma;City Hall when
it is practical to do so. Otherwise, unless an alterrnative- is mutually: agreed .upon,
the records shall .be available at Consultant's address indicated for receipt, of
notices iii this Agreement.
C. Where City has reason to believe that such records or documents may be lost or
discarded due to di solution, disbandment or termination
of Consultant's business
City may, 'by written request by any of the above .named officers, require that
custody of the records `be, gwen, to the City and that the: records and documents be
�al
stained in Petaluma City I'lall. ,Access to such records 'and documents shall be
n
granted to any party authorized by` Consultant, Co>isultant's; ,representatives, or
Consultant's successor in interest.
32. fleadings The'headibgs used "in tills ; Agreement are for - coiiVe - me only and are not
Inteided to affect the interpretation or construction of any provisions herein.
33. S'urvi41 All obligation's arising prior to the : termination of this Agreement aid all
provisions 'of this Agreement allocating liabil'ity' between ' City and Consultant shall
survivelhe termination °of this Agreement..'
34. Entire A>reement This Agreement, including the exhibits ,attached.. Hereto -arid
incorporated herein, constitutes the entire' agreement between the Parties with respect to
the S',ervi'ces, and supercedes; ;all prior agree — enfs or understandings, oral or written,
between theParti'es'in this regard. •
8
PROFESSIONAL,,SERVICES AGREEMENT. -.CITY
Febnniary 2003
m
PROFESSIONAL SERVICES AGREEMENT - CITY
February 2003
IN WITNESS WHEREOF,
the parties Hereto have executed this document the day, month arld
yea " r first above written.
CITY OF PETALU'MA
REDWOQDEMPIRE MUNICIPAL .
INSURANCE FUND
By .
City Manager
Name'
ATTEST:.
Title
By ,
City Cleric
Name-
APPROVED AS TO FORM: ,
Title
Address
City Attorney
APPROVED:,
City State Zip
N iber
Taxpayer I.D. . m
Tax er a,
De �artment Director
1
APPROVED:
Risk Mdnager
APPROVED:
'
Finance Director
m
PROFESSIONAL SERVICES AGREEMENT - CITY
February 2003
. EXMI1IT -"A
pERFORMANCE OBJECTIVES
1. Caseload
REMIF I 's standard for each examiner is L85 claimants with open
indemnify,.fti6&bzAl only, and future; medical claims. The. standard for the
supervisor is s 85 claimants with open indemnity, medical only, and future
medical claims.
2. Forms
REMIF shall provide all forms necessary for the :processing of benefits or
claims ififbimadon,including"the Em ployer's'Rdport of Injury, Form
1, medical servi . ce�Orders, return to work slips, lost lime information
reports, vouchers, checks and other related forms, as, required.
3. Claim File Set Up and 'Diary Review;
Upon r6ceipt of the Employer's Report in,'Inj'ury, REMIF will prepare an
individual claim file within one w - oikirig day each claim. All. claim
files,shall .be .reviewed at least every thirty (3 0) days for active claims and
at least every , six (6) months for claims that have, settled but are open for
the e triployee' future me,dical,care':,Theexaminer shall distinguish the
ts
regular diatyxeview from routine"file documentdtion'in the computer
notepad. The ':iupervisor shallm" file
the ,diary reviews by printing a "No
Activity"' tep6tt'each'month to identify any files that have fallen off the
diary - system. I stern- kEMIF shall design an iiiiplement an internal audit system
to ensure compliance with PETALU I MA and other State and regulatory
requirements:..
4. Emplo y Contact
REMIF qshall imme-diat6ty. ,request fthd "Employer',s Report of Injury form
t'R Rep received first.
when okif Doctor's First on njur y isirec
If `has' notreceived. the DWC Form 1 within two days after
r' the examiner w ill contact
receiving the,'Employer's Repo t, of hij ury,
PETALLJMA to ensure that the. I)WC Form 1 was given to the employee
within one workinj day' of kn6wledgt ofthe injury, If'ADWC Form I had
not .been given to the injured,em ployee, REMIF shall immediately send
the 1)WC Form I directly to the employee.
Page 1,
REMIF shall contact PETALUMA within'two (2) working days of receipt
of a notice of claim.
When a claim reaches or exceeds $50 in total :incurred value, REMIF
shalt report to PETALUMA every ninety (90) days regarding the status of
the claim Such report shall include the examiner's plan of action' for the
future handling of the claim.
REMIF will provide on-site file reviews quarterly if requested'by
PETALUMA. Other periodic on -site ;file reviewswill be scheduled based
upon the,needss of PETALUMA.
5. Employee. Contact.
REMIF contacts injured: employees who have,.not returned to. work within'
two working days of receipt of the. claim. That contact continues as. often
as necessary, but.at,least,monthly unless contact 'is,not allowed due to
attorney representation on the part of the employee.
Return ,phone calls tto employees: will be accomplished'' within twenty-'four
(24) hours.
ondence from. employees wi
11 be re on
&d "spded to within fi
All corres ve .(5)
working days of receipt.
6. Reserves
REMIF ,uses a computerized reserve worksheet that :includes categories; of
reserves for medicattreatrnent, temporary disability; permanent disability
vocational rehabilitation, ;expenses, 485.0 benefits, and totals'. They are
then divided into: total incurred, _paym6nts; outstanding reserves,, recovery,
and net incurred.
The claims assistant shall, have the authority to establish;reserves up to,
S3,000'. An examiner shall have authority to establish reserves up to
$75,000. A senior. examiner shall -have authority to establish, reserves' up
to $150;000., The cI 'ims; administrator shall have.authorityto establish
reserves up to $200,000. The General Manager of REMIF shall review
and. approve "all reserves in excess of $200,000.
7. Medical Administration
RElVIIF shall select a panel of g'erieral practitioners; specialists; hospitals,
and.emergency treatment facilities to which injured employees should be
referred, as approved by PETALUMA, a4OX -MIF shall, regularly review
and update the panel. •
Page 2
Aphyscian' "s,'office will, be contacted within five (5) working days of
notice of claim: Such contact will continue as needed during the
continuation of temporary disability to assure that treatment is related to a
cgmperisable.injury or illness.
REMIF shall maintain conta
et with treating physicians to ,ensure
e ive ro er.
c
empl y ' " ' p p medical�treatment and are returned to full or
o ees re
modified employment at the earliest possible date.
REMIF shall maintain direct contact with medical service providers to
ensure their reports are received in 'a. timely, manner.
Is
REMIF shall, arrange evaluations when needed, reasonable, and/or
requested m compliance with the current,Labor Code, not to exceed
$5,000 without prior approval.by PETALUMA.
REMIT "shall ensure that medical bills are reduced,to the Relative, Value
Schedule (RVS) and'recommendedrates established by the Administrative
Director , of Workers' Compensation. The use any RVS service
contractor is acceptable provided PETALUMA's approval is. first
es char ed b the service con
racnefto of the services .
rovided, however, and, b ttor shall have been
obtained PETALUMA shall a for the use
discussed PETALUfe g by
,the
prior to "the provision of services.
PETALUMA shall pay forythe use and benefits of�the services provided by
agreed upon, service providers that are ,deernedthemost cost effective for
PETALUMA and that achieve the best results for the injured worker.
g. 1Vledical Payments
Medical billswill be reviewed for correctness, approved for payment and
paid within'sikty (60) days of receipt.. 'If all or part of the bill is being
disputed, REMIT will notify the medical _provider, on the appropriate form
letter, within thirty (30) days
•
9.„ Plan of Action
Each claim file shall contain the: examiner's plan of action for the future .
handling of that. claim. Such'plan 6f.-action will be identified in the
computer notepad.
10.. investigation
REMIF will subscribe to the.Index:Bureau at the direction of
PETALUMA, at'PETALUMA' S `cost.
Page,
I Coifigensability
mpe' ec tance
The 66 determination (accept claim orAelay c p
pending.the results of add' I itional ihvestigation),and the reasons for such
.
4eterminationwill'bernade. and, documented in:thefile�N�ithi-ii,, .3 j
WG .
wo rking; days of 'th&'re6eipt, of the nofifiditi -of the loss.. Delay of benefit
I . dtters shaft be:m?dled in compliance with the- Division of lndustn�af
P
Relations guidelines.
I , n:no case shall.,a final compensahility docision extended beyond ninety
(90) days from . PETALUMNs'knowledge ofthe claim, and receipt of
employee's claim form (DWC-1).
12. Provision of )Benefits;
VEMIF' shall provide all -6bm�geiisation,hd n d clb rftely
_ a en efitsin a,ti Irlp'lianceui manharand mi.�co ih the statutory ni ruirements of the
RE
California Labor Cod ft
and otheelatedxequirements.,�, _MI.Fshall
com and pay temporary and permanerit disability ]?�enqfi�ts'. to,i]R' d
MP .inure
employees based-upon earnings ,informati0n;and,authorized disability
perio 'REMIF shall reviewl compute, and pay all informal ,peno - 5 r atings,
-
death benefits, findings andz awards, life pensions ,oncompromise; and
release settlements: However, all such benefits shall- , be paid by AEwV
from PETALUMA's established '. trust fund.
f3. Initial Indemifity Payniej6t
The initial indemnity payment or voucher will be issued and, mailed to the
injured employee together with a proper completed DWC benefit notice
within fourteen (14) days of the first day of disability
14. Su'bsequeht Indemnity ftymeiftg
All indemnit payments or vouchers subsequent to :the first,payment will
be veiriffed,:.exceptfor obvious long-term disability, and issued in
compliance with Labor Code Section 465
Late; payments must include the seff-imposed 1 0% pbnalty in 'accordance
with. Ldbor. code Section 4650.
15. Return t6 Work
- to PETALUM�k in establishing A
REMIFandll- provide assistance
modified work program; whichis appropriate for injured employees while
recovering and prior. to their return to regular duties
.
Page 4
hall. fte uentl con
IF s q y sulf with PETALUMA
RE ;in th ose cases where'
the in `residuals might involve permanent work restrictions and/or
retirement potential.
16. Transportation Expense
Transportation; ~ reimbursement will° be-,mailed within. l 4 days of receipt of
the claim for reimbursement, rattier than the legally required 30 days..
17. Permanent Disability
REMIF shall provide an. explanation and assistance to the non - represented 1.
injured employees ,in�,completing the necessary forms for obtaining a
permanent disability- ratng'as need ed.
REMIF shall determine tthe nature "and extent .of permanent,disability. If
unable =to determine the extent, .REMIF will. arrange for an informal
disability rating, whenever possible; in :order to avoid Workers'
Compensation Appeals Board litigation.
All p erinanentudis ene
ability bfit notices` shall be sent to the employee as
re uired'b the.Labor•Cdde,-
18. Litigated Cases
REMIF shall promptly initiate an investigation ofissues_as material to
pofentiallitigation. PETALUMA s hall be aleried'to the need for an
outside:investigation as�,soon as possible and the examiner shall appoint an
investigator who is acceptable, to PETALUMA. PETALUMA shall be
kept informe on the scope and results` of all investigations and an
estimate of cost.
•
When defense. counsel is riot REMIF shall work closely with
the applicant's' attorney in informaldisposition of litigated cases. All
asst nmentst co
'g to 'out idside e and unsel will be done with PETALUMA' S prior
author'ization c will b&'noted. n the case file notebook: In
con ion with h E
counsel's progress. ETALUMA, REMIF shall monitor the outside
p gr `REMIF shale audit all bills before payment.
REMIF or defense counsel,' in a concise and clear form, either written or
verbal, shall forward settlement proposals: directly to PETALUMA with a
reason (s)�'for such recommendation, All preparation for a trial shall
involve M A
'PETALU so that all : material evidence and witnesses are
utilized to a favorable result for the defense.
Page 5
The sue P
p Com ensation
rvisor or the examiner shall attend Workers'
Appeals °Board hearings, rehabilitation hearings; meefings v�nth.defense
eo' 61, and meetings with member cities.' staff, depai orients,, and
employee groups as necessary- and as requested to do so:
19. Settiements
RE,MIF -shall contact and ob`tain PETALUMA' S authorization
'settlements, or stipulatioins. At`the "time' of the.request for settlement
�authority,,information_ will be ptov ded:including the .claim °summ_ary,
estimate of.permanent; disability acid defense counsel's comments and
recommendations if any. „
20. Subrogation
In; all cases where a.ihiid.party is- responsible. for the injury to the.,
employee, REMIF will send a letter to PETALUMA indicating they will
pursue subrogation unless instructed otherwise by PETALUMA. When
subrogation is,to. be pursued, the.third party shall;be..contacted within ten
(1,Q) days with; notification of PETALUlVIA's right to subrogation and the
recovery of certain claim' expenses. If the thirdparty is a governmental
entity, a claim;shall be filed with the governing board °within,six° (6)
months of the injury or notice of njury:
Periodic contact shall be umade -with the responsible party and/or insurer to
provide notification of the amount of the esti nated.recovery to whieh.
" ETALUMA`will be' entitled.
`
If the iniured worker - brings a civil action against the - party °xesponsible.for
the injury, REMIF shall consult; with PETALUMA,.about the value of-the
subrogation claim: and other considerations. Upon receipt of
PETALUMA's authorization, subrogation counsel shall be assigned to. file.
a Lien or Complaint in Intervention in the civil action.
Whenever practical RE1VI'IF should take advantage of any settlement h. a
civil;action by ;attempting to settle the" workers' compensation claim by
means ofa party compromise -and release. If such attempt does not
succeed; then. every ' effort' should b&made throughtthe WCAB to offset
claim, expenses through a credit.,against the the injured
worker's civil action.
21'. Vocation" at Rehabilitation,
Determination of the Qualified Injured Worker/ ' on- Qualified Injure
Worker status sha11 be made in; accordance:: with,Labor Code laws.and
regulations. `REMIF shall advise the injured worker of his/her
Page 6,
rehabilitation benefit's iii accordance With the•.Rules�of the Division of
-Workers' Compensation, within ten (10) working days of knowledge'of
medical eligibility.. REMIF` will:
a. make: timely referral to a >Qualified Rehabilitation.Representative in
'accordance with Labor Code, Section 4637,
b. control
ontrol rehabilitation costs, and
c. secure the prompt conclusion ofyocationalrehabilitation benefits.
•
•
22. Claim Reconciliation
All claim files- shall,be reconciled to ensure ,all medical „indemnity, and
expense payments ,have been made correctly. The reconciliation should
verify than a' mentswere made, to the in the correct
amount; afid' from the correct claim file. The physical file should, be
verified with the computer information. All open cl'airn files shall be
reconciled 1) any time there is a changefrorn one benefit to another (e.g.,
from temporary disability to permanent disability), 2) when ten indemnity
checks have'been_issued, or 3) at least! annually. Proof.of the
reconciliation should remain in the claim file.
23. Excess Ifisurance
REMIF willreport cases to the excess carrier, that meet the carrier's excess
reporting requirements.
All cases, which meet
the established reporting criteria, are to be reported
Within ten (1.0) days of'the,dayon which it is.known the criterion is met.
24. Award Payment
Payrrient&on awards, computations or.compromise-and release agreements
will be igsued within ten (10) working days of receipt of the appropriate
documents, or as stated in the .settlement document.
"25. Penalties
PETA 5
� • _ "LUMA� will” be advsed,w.ithin:fiye (5) working days, of the
a s of any penalty fine
, ; or assessment against.PETALUMA or
OMIF, the reason thereof, and REMIF's plans for payment of such
penalty.
26. Ca$e Closure
REMIF shall ,close all claims on all aldical and compensation .
'benefits have "been provided within a reasonable amount of time. Claim
Page 7
12
files shd 1 11 not be allowed, to go without ekamiher,�aftent.ion for •a period of
fime,longer than six (6) months. Medical - .only .claims shall not :.remain
open longer than six '(6) months without good cause.
Medical only cases must be, closed within sixty (6Q.) :days from the date the
lettetwent to the employee indicating there is no permanent disability.
- will mOftit6t stipulated pulated cases wit hfuture medical provisions..
.Reserves for future medical will be reviewed -semi- annually and adjusted
according to 'use.
27. Loss; Runs
The loss run shall be i§sued by theI-7 of the month `following the
date ,.' An y co rrections that are requested to be made the4oss�ru.q shall be
_
made- within. thirty- 0) days.
Requests for status of claims generated by PETALUMA, shall be provided'
within thirty (30)days.
,28, Claims Rieportin.9
REMIF assist:in the.prejparatlo'n� of all .reports; which -are :now :Or., will
be required by the State of Califpnna other.g&%�e en"t agendidsvithi
E IF will 190 as�sist in the;
self- 'insurance programs. ,.R.
preparation of all reipo y the C Institute
parts databases required b_
-for Public Risk Anaf ys is (qIP-R--A) or, other statistical database
organizations as requested ibyPETALUNLk
29. Record Retention
All claim file& shall bemidintainedin accordance with statutory time
requirements andP P-TALUMA's Record Retention Policy.
-
30. Claim 9
REMIF shall provide supervisory. staff, that will regularly revidw work
produc'tofthe�olaims ex"ammifiers; Thd review atfl'east.tch
pe rcent (1 0 %) of`ea examiner's' case d each, mWithAo ensure each
examifidAs! following, the,pqrfQrr.h4hc,e, giaridar4toutline4 in-,this, In
ad the supervisor shall condu6t,aregul quarterly review Of 'all
open indemnity claims with reserves in excess of $56,060 and all problem
or complex - claims .
•
Page'8
31. Availability of Personnel
REMIF,does not as'sig p specific ENTITY. It is
n s ecific examuiers to a,
REMIF's practice to assign claims to examiners based on the severity and
complexity of the claim:' REMIF: is willin g to.discuss with PETALUMA
and consider assignrrient of a particular• ; claimant to a specific examiner,
when -this result's in the most .effective resolution of the claim.
Barring an emergency, there will always be at least one.clairns examiner
s during and one claun ' "assistant available dornormal business hours to respond
m n
to questions by`PETALUMA.
If required; a 24 -hour, emergency phone; number may be provided to
PETALUMA: This number would.eitler be that of the General Manager
or the Claims Administrator o - REMIF.
32'. Examiner Training
REMIF . shall ensure ;each' claims examiner. handling;.PETALUMA's claims
wilt receive continuing education training ,each,year. REMIF shall
annually certify "this in writing.
• 33. Member Services
REMIF shall, provide special on =site training services annually to
personnel from PETALUMA to ensure that the people within
PETALUMA who process workers'' compensation claims are effectively
carrying out the procedur iced for a successful program. A copy of
PETALUMA ',s claims manual should be zreadily available for review by
the appropriate PETALUMA. staff or. representative.
REMIF will'be available to attend city council meetings;PETALUMA
department head meetings, and other training sessions agreed upon and
scheduled byPETALUMA and.'REMIR REMIF will discuss, in closed
session, the particular casesrof interest to the city council and with
e proper authorization to share confidential
A
PETALUM`;staff who have th
medical information.
REMIF shall provide one'or more of the examiners to meet with
PETALUMA personnel, at PETALUMA's `location, at least once per year
to revi ,program
other ro s r garding workers' compensation reporting
re u�r
` ` q ` ements 'rte rote ores e matters•that require the timely'
. ,. p gr
particpation:and response of PETALUMA'S personnel.
Page' 9
REMIF shall require the claims admirtiitrator,otan examiner to. be
available- and readily respond to an,,,PETALUN4A',s request for a_ ssistance
with problem - cases; ih6ludiiig on-site visits, o the city.
REMIF shall provide PETALUMA with information' regarding, statutes,
proposed chaft,ges,tb'staiLdes, and: chabges`,Io the rulbs:andiegulations
affecting PETALUMA and its responsibility as A, legally uninsured'
workers' compen.sation authority and impIemenVwith,'PETALUMA
co nstnf 'req ulitements thereof.
REMIF will not develop policies and procedures . in,tht areas ,of. pre-
ii . ortht like
since loymefitphy§icals, workres�frictions, disability retirement
is afield of expq that should be handlod"by PETALUMA
HR and legal staff. REMIF Will ,discuss recommendations., for changes
of the policies and procedures that Will then 'be dealt with
by PETALUMA'& HR.and legal staff.
34. . Employee; yee� ervvices
As required, REMIF will : develop,: for review by.PETALUNIA, materials
"Whichvill' Provide, information and guidance "to PETALUMAVs
employees regarding workers: compensation and the self-insurance'
program.
As requiied, With input from PETALUMA, REMIF will discuss, - and/or
meef:w.ith and ,a�ssist:noir represe workers in reso0ving
problems that arise, rom injury or illness claim
3 5. 'Audi't
PETALUMA, at lheir oPiiori,g, shall hdve, the right to, have; a claims audit
performed on a random 'selection; of files yearly, The audit will be
- :generally , directed to the following areas:
1. Compliance with contractual . obligations;
,
2. Coffiplia with PETALUMA's performance, standards;
3. A ppli c ation of all - cuiient , W. C.A.B.rul e's and regulations and case
law;
4. Accuracy. of computerloss runs and records.
16. 04se File-Review
As requested, a: quarterly meeting shall be held between. EMIF and
PETALUMA sta:ff. This , review will 'be primarily ,directed toz the
evaluation, of open; ndemn-ity claims including litigated cases.. The
purpose Of thexeview�shall be to outline losses, andidaitify:problems,
Page 10
examiner . serves identi current trends, discuss changes in the Labor '
code,.,a 1. new case law existin g clai discuss the need for
improving or altering claims rnana ement, and to -make recommendations
for improvement'in communication between the claims examiner and
PETALVMA.
•
I[]
Page 11