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BILL NO. 00� 1-121 pr
SPONSORED BY COUNCILMAN VINCENT „
ORDINANCE NO.
,j!' � lt}ri2::''Yi 5.}1,T�MI;.ti•1
^•"'1 Yr S. a`F.,}7
-,? AN ORDINANCE OF THE CITY OF JEFFERSON, MISSOURI, AUTHORIZING THE � ' ' �t. ,�
MAYOR AND CITY CLERK TO EXECUTE AN AGREEMENT WITH CCMI FOR CLAIMS
MANAGEMENT SERVICES. '
� F
WHEREAS, CCMI is engaged in the business of the administration, investigation and � _41 .
,,;ten>*
payment of claims arising from self-insured workers compensation and casualty programs; Y,,:;n
y and
WHEREAS, in conjunction with City's property and casualty insurance program through
St. Paul, a plan and claim administration agreement is required with CCMI
,
BE IT ENACTED BY THE COUNCIL OF THE CITY OF JEFFERSON, MISSOURI, AS
. .�
FOLLOWS:
:a ,
Section 1. The Mayor and City Clerk are hereby authorized to execute an :w�:u�r
agreement with CCMI. `
Section 2. The agreement shall be substantially the same in form and content
as that agreement attached hereto Exhibit A. `'
Section 3. This Ordinance shall be in full force and effect from and after they, >ti;,; i
date of its passage and approval.
'�,,,,i tS}Yti f •
:t Passed:_ �Q' :�.`�-L�d Approved:
u'^r
PresidOg Officer Mayor ,ta
.,
` ATTEST: APPROVED AS TO FORM:
�+Zyp�gxv /,�Ynj44�4
City Coun o ry" .
}<4 City Cle k
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CITY OF JEFFERSON
CLAIMS ADMINISTRATION AGREEMENT
iG, St
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THIS AGREEMENT is made as of November 1 2002 between Corporate Claims Management ►�ct,.,���; „3a
hic., a corporation organized and existing under the laws of the State of Missouri (hereinafter
.. Fl 11 "Client"). `-€17�.�r `t�•.rtl:Ss:;�
Administrator11) and The City of Jefferson City, Missouri (hereinafter
r>r
WITNESSETH: ;
:r WHEREAS, Administrator is engaged in the business of the administration, investigation and F a r ent of claims arisin from self=insured workers' com ensation and casual ro ams for its I�
clients• and 47� 5' i
Kf WHEREAS, Client requires the services of an independent contractor to administer its self-insured
property/casualty program up to its self-insured retention; and r, ` •.
'r�.Tai: �q�t P p�7�•%Z,tJ7,,
WHEREAS, Client desires to retain Administrator for the provision of its services for Client's
claims for its self-insured property/casualty program to the extent as set forth in the following
n' articles of this Agreement; ,. "t•
NOW THEREFORE, in consideration of the mutual promises and covenants hereinafter '4,
es
contained' and other good and valuable consideration the receipt and sufficiency of which is hereby
acknowledged, the parties hereto, intending to be legally bound, hereby agree as follows: r �`°+`,:`�•• �'''
a 1. Definitions t.� +
As used in this Agreement, the following terms shall have the following meanings:
g g g g
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.;, (a) Agreement shall mean this Agreement, as originally executed and amended or
supplemented from time to time.
A (b) "Allocated Loss Adjustment Expense" shall mean such of the following items of
expense incurred or authorized by Administrator on behalf of Client as may be
reasonable and necessary in connection with Administrator's rendition of services in ff '
accordance with this Agreement: n. • ;
i. Medical examinations of claimants, including the reasonable and necessary
t transport ation expenses of claimants.
t.
ii. Reports from attending or examining physicians. ; I
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iii. Attome s' fees and disbursements. IFj 'II
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` iv. Court reporter services and transcripts.
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V. Stenographic services and transcripts.
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vi Witness attendance fees
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vii. Court casts. ,
viii. Appeal bonds.
ix, Printing costs related to trials and appeals.
x. Testimony, opinions, appraisals, reports, surveys, and analyses of
professionals and experts.
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xi. Automobile and Property appraisals.
xii. Trial and hearing attendance fees.
xiii. Reports from government agencies or branches.
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xiv. Credit bureau reports.
xv. Private investigators.
xvi. Photographs.
F. xvii. Medical or vocational rehabilitation.
xviii. Medical cost containment services including but not limited to hospital bill
?. t > i
audit, provider bill audit, and medical case management incurred with the •�,x:r,.,
'Y consent of Client.
xix. Extraordinary claim investigation and/or travel expense incurred with the
,t consent of Client. '
xx. Fees for services provided by any investigation or adjusting fine other thant.
Administrator related to the investigation and defense of a particular claim.
' xxi. Any similar service related to die investigation and defense of a particular
Claim, or the protection of and collection of the subrogation rights of the :1!•F
i, Client, for which Client shall have given prior approval. ;
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xxii. Costs, fees and expenses incurred by Administrator for services above and . Y
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beyond those covered by this agreement.
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�t';� • JAS}� {{�iit :{:
(c) "Claim” shall mean any occurrence from which injury, damage, or expenses are
t sustained or asserted or from which liability under various Missouri Tort Statutes is
` alleged.
},
( ) Claimant shall mean any person alleging or. having a right to file a claim against
:. l3 ipD` errs«<i..
the client for damages as a result of client's duty or breach of duty under any various
t .
Civil laws.
(e) "Client Program" or the "Program" shall mean the Client's self insured
rt';r54 property/casualty program as the context requires.
q (fl Claims Payment Account" shall mean a bank account to be established by Client
11 which Client
and to wl will contribute the amounts agreed hereunder and from which stw„
Administrator may draw funds to pay claims and Allocated Loss Adjustment
Expenses required in the administration of Client's Program covered by this .., •.,.,r,.""
i1 Agreement.
"Party” shall mean Client or Administrator as the context requires, and the term
"Parties" shall mean both Client and Administrator.
(h) "Loss Run" shall mean a computer generated listing of claims that have been posted : ' ' u'
to Administrator's Claims Administration Information System yr ;
r computer
"Loss Payment Accounting Record" means a
generated listing of
accounting activity in the Claims Payment Account, as described below, during the
preceding month that has posted to the
P Administrators Claims Administration
f! Information System.
(j) "Administrator's Authority Limit" shall mean the amount of claim settlement <''�
authority provided by the Client to Administrator for each claimant set forth `
writing from time to time, which Administrator may utilize in its sole judgement to
f;J settle claims as described herein. 3
2. Term
Administrator agrees to provide all services set forth herein to Client in connection with its
�q
self insured claims exposures occurring during the period commencing November 1 2002 Y� ..,: `�tr;
t and ending October 31, 2003, unless earlier terminated pursuant to Section 3 hereof.
3.
'rertninatian fr
{ Unless explicitly renewed by the Parties in writing, this Agreement shall terminate on }. •a ..;•
October 31, 2003. Any continuation or renewal of this Agreement shall be the subject of ,
further negotiation between Client and Administrator. If renewed or continued, the price for
'j Claims Administration Services for the period of November 1, 2003 through October 31
2004 will be based on the current year's frequency of Claims reported, calculated at the per
Claimant rates established in this agreement plus an amount not to exceed the lesser of(I) t '
the change in the Broad Based Consumer Price Index during the term of this agreement plus
t R
3
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,{ k B� y �£�;�•��,r>t.wi, sv .!. tY' :t• tl. ,k' �i4. _
h .tri, Iffli
y: fr H'z:•q '
`� ^y �d t5i tnits,krt
,i two percent (CPI + 2%) or (ii) six percent (6%). This Agreement may be canceled at any
time with or without cause by either Party giving the other Party written notice of
} cancellation sixty(60) days prior to the effective date of such cancellation.
If this Agreement is canceled by Client before October 31, 2003 for any reason. Client shall df4'rtyr3 Vi
exercise one of the following options: `rt "�t'` `}
(a) Client may require Administrator to conclude the handling of all claims occurring
during the term of this Agreement whether reported before or after the term of this
Agreement, subject, however, to the terms, conditions and limitations of this w ;}
}`? Agreement.No further compensation shall be owed to Administrator for its handling
of Claims reported prior to the Termination of this Agreement to their conclusion.
(b) Client may require Administrator to return all open and/or finalized files to the
Client. Such return of open and/or finalized -files shall not result in a reduction in fees ;;";xi-�
for all Claims referred to Administrator but not finalized prior to the effective date of
f
'.�
termination.
1
J 4. Compensation
Client shall pay Administrator fees as follows as compensation for the administrativec { f
services Administrator herein agrees to perform: ; •;�; �� ,
=1j Administrator shall provide all claims administration services as detailed in this
Agreement for an annual fee of $25,080.00 for new claims reported during the term of
the agreement.
''4`l ?frr.h 'd ✓ �f r 'v'
;t Administrator reserves the right to offer Guaranteed Cost renewal pricing for subsequentr� '.; '"
Y ears of this p r b am contin g ent upon claim frequencies e q uencies re P orted during .` ).
the most recent
ast year. Pricing for subsequent years claims administration fees will be based upon the
last ear's actual fre uenc , times the per-claimant flat-rates detailed below, plus an L ,.;�.
Y q Y p p ••. �,;�.��{��
Y amount equal to the change in the broad-based Consumer Price Index CPI-U) plus 2 '�
} percent (2%) during the previous 12 month period. �a^
All fees will be billed quarterly during the Term of the Agreement, except as detailed
below in this section. trr
W74
Guaranteed Cost Renewal pricing for subsequent years renewal of this program shall 4+ onF?
4 utilize the following price schedule as a basis for such pricing (plus the change in the
CP1-U plus two percent during the previous 12 month period):
i•7• 'S
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i
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• ( �.*;' � tai.Y L i +Yy'3 :t: a r .1 r S .1 4 i r4, r , ;f t ; ..�.,1.:rSi r� a��� i�tiv { `r,:�
spt �`. •� �:1f�' r� r�Fi,:is#„} .e :qt, 7. � rbS 'f. E L';;.{i .i r.,•i f 7 e I /� t'p+�r' ii f>7{,'"4,.�'C.�{
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i
>
Type of Case Expected Flat Rate
Projected
Frequency Per Claimant Total
.err a
General Liability --- x $418.00
•'' Auto Liability ___ x $418.00 17� ?�,�u �•�z; t..
$
Auto Ph s. Damage --- x
$346.00 =
x� Errors & Omissions __
--- x $418.00 — $ --------
Personal injury --- x $418.00 — $ __---
Quarterly
t. Q y Management Claim Reviews — $ No Charge n, '
Monthly Loss Runs/Special Reports
_ $ No Charge
' Total Claims Administration Expected Cost - New Claims $ 25,080.00 ?
ADDI'T'IONAL FEES:
NONE APPLICABLE
Client agrees to pay Administrator all fees as outlined in this section. Fees for claims
handling shall be billed on the first of the month of each calendar quarter during the
Term of this agreement, and such billings will be paid by Client within thirty(30) days of i't. xtfd5'
l: Such billing.
gig
R,�
5. Services To lie Performed
Administrator
lilt., (�
trator shall adjust, supervise, and administer fully the Clients Program in a
manner so that such Program is at all times in full compliance with all current and future
gr
applicable laws, rules and regulations governing such self-insured programs; and, in
i fulfilling the foregoing obligations, Administrator will act as the independent contractory �
and/or representative of Client in all matters related to the administration of the Program.
In addition to the t foregoing obligations, Administrator hereby agrees to perform fill y all
'I of the following duties:
(a) To review all claim and/or loss reports with claim and/or dates incurred during ';
the term of this Agreement for all losses involving the hereinabove stated 3
exposures to the Client. Y,
(b) To establish a file with respect to each claim.
5
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(c) To investigate, to the extent deemed necessary n the mutual judgement of the f"'''x�t- .TMx , ,
y tt}rtrt;r 1
+ Parties, all reported Claims as defined in Section 1 above.
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(d) To provide each Claim file with a written chronology of all actions taken with
S respect to the underlying Claim,
(e) To furnish all claim forms necessary for proper claims administration.
� •Vhf'.�.
(f) To investigate, adjust, settle or resist all such losses and/or Claims as defined in
Section 1 above within the per claim discretionary settlement authority limit of
the Administrator as agreed upon by Administrator and Client.
' (/ T) To investigate, adjust, settle or resist all such losses and/or claims as defined in
Section 1 in excess of the discretiona ry settlement authority limit of the
' Administrator with specific prior a pp roval of the Client.
(h) To assist in all litigation or other proceedings involving any Claim as directed by };;, e*ji .y I I
Client. .
sa 'r ,
(i) To retain all Claim files for a period of two (2) years after the applicable statute
of limitations has expired. After this period, files will be returned to the Client or � , -.Z. 'S
destroyed as Client requests.
1
i To recommend adequate reserves and provide to Client a continuous review of
.I ;. . .. q
such reserves and any required changes to such reserves.
(k) To monitor all treatment programs recommended to a Claimant by any care
� try�+ ����;��•.r?'c',s:
provider. ,nt
(1) To furnish to Client and/or its designees on a monthly basis, a Loss Run and Loss ,
i Payment Accounting Record Report. Administrator also shall furnish to Client
and/or designees on an as requested basis ad-hoc reports as may be available
i within its claims administration system.
(m) To pay on claims check stock provided by Client all payments required to be
:i made in the administration of Client's Program and provide to Client a daily `r' , 't:' �!
:j record of all such payments. } ,,
(n) To prepare and file all reports required by any current or future a pp licable law, s
hp'
rule or regulation. t ,,.
w. .
(o) Discretionary settlement authority, as referred to in Section (F) & (G) above is
$0.00 per claimant. ?
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6. Covenants and Agreements of Client
0� Client covenants and agrees as follows:
(a) Client appoints Administrator as its claims management company, as its agent
' and authorized Administrator to exercise in Client's behalf, Administrator's sole
i;
judgement and discretion to pay, or resist all claims within Administrator's
r p y
discretionary settlement authority as stated in Section (5.0) above, Client
' reserves the right to advise Administrator to not pay any particular claim or to pay f y
;.,. a lessor amount even within Administrator's discretionary settlement authority, if
-,j any.
(b) To pay to Administrator the fees prescribed in Section 4. If client fails to pay
Administrator the fees prescribed in Section 4 and/or in accordance with the time
frames set forth therein, Administrator may terminate this Agreement
;i..;
immediately, notwithstanding the sixty (60) days prior written notice set forty in
Section 3. In the event of such immediate Agreement termination, the options
' a
upon termination as set forth in Section 3, shall not be available to Client, but c;
instead Administrator shall return to Client all Claims and/or losses pending onE SFr
the date of such termination for the Client to handle to a conclusion, and such
handling shall not result in any expense or reduction of fees to Administrator. 3j ”
(c) To pay all Allocated Loss Adjustment Expense, as defined herein, in addition to
.k the fees to be aid to Administrator as prescribed in Section 4 hereof.
V,, p
;•,r, (d) To indemnify, protect, save, defend and hold Administrator and Administrators
directors, officers, attorneys, employees, shareholders, agents and other d
representatives wholly harmless from and against any and all loss, cost, damage
' or expense (including attorney's fees and costs incurred by Administrator in ''"`
connection therewith) arising out of the administration or handlin of an claims
by reason of any negligent, grossly negligent or willful act or omission of Client "
or of Client's directors, officers, shareholders, attorneys, employees, agents or
other representatives, taken or omitted to be taken pursuant to this Agreement, ,.
r,
+, including, without limitation, any such loss, costs, damage or expense incurred by
reason of the following: .•I
i. Any act or omission or Administrator or any of Administrator's directors,
officers, attorneys, employees, agents or other representatives taken oru ,,
omitted to be taken at the direction of Client or any of Clients directors,
officers, shareholders, agents, or other representatives;
t ii. Administrators being named in litigation as the insurer of record or other `'°'
J.
capacity based upon its present or past relationship with Client; "F
iii.
� The failure of Administrator or Administrator's directors, officers,
attorneys, shareholders, employees, agents or other representatives to `�
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settle a claim that could have been settled within Administrator's ,
Authority Limit (so long as such failure to-settle does not result from a
negligent, grossly negligent, or willful act, error or omission b
Administrator or by any of Administrator's directors, officers,
shareholders, attorneys, employees, agents or other representative); or
iv. The failure of Administrator or Administrator's directors, officers,
>i shareholders, attorneys, employees, agents or other representative to payb'�
any Claim or Allocated Loss Adjustment Expense on a timely basis due to
the failure of Client or Client's directors, officers, shareholders, attorneys,
employees, agents or other, representatives to comply with Section G, t
' subparagraphs (e) and (f) hereunder.
i V In the event Administrator or an of its directors officers shareholders attorneys,
t.a.'i )�n"..•,.
J
employees, agents or other representatives, is named as a defendant in, or is
-. otherwise obligated to defend, any such action asserting any Claim indemnified ;gipp,•, ���',��:r'�:'
hereunder, Client will assume, at Clients Expense, the defense of such actions on Y '
P behalf of Administrator and its directors officers shareholders attorneys,
c;��;; •.,y fir;,t
agents employees, a
g• s or other representatives, as the case may be. Client shall have
1 the sole discretion to select the attorneys who will defend any such action, * �
provided, however, that Client shall exercise such discretion reasonably. �` fr
ri.Le. i
Notwithstanding the foregoing, nothing herein shall waive any rights of any party I ,[
hereto to contributory negligence claims or defenses with respect to any
indemnity provided herein. This indemnity shall survive termination of this
l 4 Agreement.
(e) To provide sufficient funds to the Claims Payment Account to enable
Administrator at all times to pay Claims and Allocated Loss Adjustment ;; . ; ;
Expenses in accordance with the terms and conditions contained herein.
To authorize and hereby oes authorize Administrator to issue payments as may
Y p Y1 Y
be necessary o enable Administrator to a Claims. Administrator may also
y y pay y ��.
,4;1 payments as may be necessary to enable Administrator to pay all Allocated Loss : • .rr ;!'`
' ' Adjustment Expenses.
7. Covenants and Agreements of Administrator c:
`^ agrees
Administrator covenants and as follows:
1}rr
Lr (a) To Client's right to assume the control and handling of any Claim at any time, and
Administrator agrees to deliver promptly any Claim file to Client which it may
=w+' request, but without any off-set or deduction from any of the fees or charges paid
or payable by Client to Administrator under Section 4 above. The parties agree
'tf that at all times prior to and after the cancellation of this Agreement, all Claim :
tiles are owned by and are the property of Client. Claim files are subject to review a
a4 8
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•..�r:� by Client and its employees and authorized agents during Administrator's regular
business hours, with reasonable prior notice.
r, (b) To exercise reasonable effotls to manage the services provided hereunder in such
a way and in such manner as to insure that every adjuster, claims investigator,
. , and/or employee used by the Administrator or subcontracted to by thee,"' 5`'x
Administrator will adjust and/or investigate every alleged Claim or matter
covered by this Agreement in accordance with this Agreement and any claim �tF.
handling instructions as implemented from time to time.
(c) To provide to Client, upon written request, certificate of insurance evidencing
adequate General Liability Insurance, Automobile Liability Insurance, Workers'
Compensation Insurance, Fidelity Coverage (Bond) and Errors and Omissions
'1 Insurance (Professional Liability Coverage)
':•� d To provide all necessary personnel to perform the services agreed upon herein,
,,...• .��' rye M„'�+;-1
(e) To indemnify, protect, save, defend and hold Client and Client's directors, ...i
r officers, shareholders, attorneys, employees, agents and other representatives
s5 wholly harmless from any and all loss, cost, damage or expense arising out of the } A f �' !,•
"r. administration or handling of any claims by reason of any negligent, grossly
negligent or willful act or omission of Administrator or of Administrator's
,
directors, officers, shareholders, attorneys, employees, agents or other
representatives, taken or omitted to be taken pursuant to this Agreement;
provided, however, that Administrator shall have no obligation to indemnify '
anyone pursuant hereto with respect to the following: '
U
i.
Any act or omission of Administrator or any of Administrator's directors, ; +
{; officers, shareholders, attorneys, employees, agents or other
representatives taken or omitted to be taken at the direction of client or
p ��tt
any of Clients directors, officers, shareholders, attorneys, employees,
agents or other representatives,
f ii. Administrator being named in litigation as the insurer of record
iii. The failure of Administrator or Administrator's directors, officers, ?u
shareholders, attorneys, employees, agents or other representatives to
settle a Claim that could have been settled within Administrator's '
Authority 'Limit (so long as such failure to settle does not result from a
grossly negligent or willful act, error or omission by Administrator or by
any of Administrator's directors, officers, shareholders, attorneys,
� + employees, agents or other representatives), or, ,
' iv. The failure of Administrator or Administrator's directors, officers,
a shareholders, attorneys, employees, agents or other representatives to pay
Al any Claim or Allocated Loss Adjustment Expense, on a timely basis due ,
tir �
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�,, Fh"4w;�h ..�Y�: ^T,���•S. '{-*Y;S;.%•.. �1.,>. .�+.�>,'L S?3r. .,h,�.. , i?4'.�h. _ _ _ �i
to Client, to the failure of Client's directors, officers, attorneys, employees, : <;'''
1,;j
agents or other representatives to comply with Section 6, subparagraphs
(e) and (f) of this Agreement.
In the event Client or any of its directors, officers, attorneys, employees, agents or
other representatives, is named as a defendant in, or is otherwise obligated t4 '�
defend, any such action asserting any Claim indemnified hereunder,
Administrator will assume, at Administrator's expense, the defense of such 4h'"
actions on behalf of Client and its directors, officers, attorneys, employees, agents . < t
} or other representatives, as the case may be. Administrator has sole discretion to w'
select the attorneys who will defend any such action, provided, however, that
Administrator shall exercise such discretion reasonably. Notwithstanding the
foregoing, nothing herein shall waive any rights of any party hereto to
contributory negligence claims or defenses with respect to any indemnity
f' provided herein.
8. Miscell
' (a) This Agreement shall be governed and constructed in accordance with the laws of
the State of Missouri.
(b) If any provision of this Agreement shall be held to be invalid or unenforceable for 33 �
r,� r.,k 'y7j•YI
any reason, such invalidity or unenforceability shall not affect any other
provisions of this Agreement. f �'
(c) No waiver or modification of this Agreement or of any covenant, condition or ,: :, �•. , :�
`. limitation contained shall be valid unless in writing and duly xecuted b the
Parties. Y Y
(d) The failure of either Party to insist, in any one or more instances upon
performance of the terms or conditions of this Agreement shall not be construed w ' �l,�I
as a waiver or a relinquishment of an right
' q y g granted hereunder or of the future
performance of any such term, covenant, or condition.
r. /f•7.1'.?
k (e) This Agreement is personal to the Parties and may not be assigned by either Part
in whole or in part without prior written consent of the other Party. ��' �' ` • ��' ,��:
�.1
(f) Any notice to be given hereunder shall be deemed sufficient if in writing and4;'
delivered either personally or by certified mail, return receipt requested, to the
following:
If to Administrator: Michael D. Greco, President r ''
I{ ,ry
Corporate Claims Management, Inc.
782 Spirit 40 Park
a
1
C�esterfie
Iit ld Missouri 63005
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If to Client: B. Allen Garner, City Counselor ,
The City of Jefferson City, Missouri +r
320 E. McCarty rest
St
..
Jefferson City, Missouri 65101 1.
fi (g) The headings of this Agreement are intended solely for convenience of reference
and shall have no effect on the construction or interpretation of this Agreement. ,
(h) In the event of any litigation between the Parties, the prevailing party shall be
M:to entitled to recover from the non prevailing party any attorney's fires and expenses
<jl
incurred.
!!;s (i) This Agreement shall be binding upon and inure to the benefit of each party
' hereto and their respective permitted successors and permitted assigns.
IN WITNESS WHEREOF, the parties by their authorized agents have caused this
Agreement to be executed as of the date first written above.
f
On Behalf of On Behalf of
f,.
The City of Jefferson City, Missouri Corporate Claims Management, Inc.
4s q;
BY' / BY: X
Mi ae'l D. Greco
TITLE: Aar TITLE: President
DATE: _ G' 17 Z-•-- DATE:
' ATTEST: ATTEST: "
/J � � 1� 1� 1 •1�t , ;,I�rl
City eric Title:
'i
rt' APPROVED AS TO FORM:
il
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City Counselor <k,
� �rJ ,
Ha\Contract Piles\Professional Services\Corporate Claims Hanagenlcl\Jefferson City TPA Agreement 2002.wpd
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CITY OF JETFERS'ON
(7) CLAIMADMINIS'TRATIONAGREENENT
THIS AGREEMENT is made as of November 1, 2001, between Corporate Claims Management,
Inc., a corporation organized and existing under the laws of the State of Missouri (hereinafter
"Administrator") and The City of Jefferson City Missouri (hereinafter "Client"). ,a
WITNESSETH: '''
Kr Sa':
WHEREAS, Administrator is engaged in the business of the administration, investigation and
payment of claims arising from self-insured workers' compensation and casualty programs for its
clients; and
WHEREAS,Client requires the services of an independent contractor to administer its self-insured
property/casualty program up to its self-insured retention; and
.,Yr;F•r
WHEREAS,Client desires to retain Administrator for the provision ofits services for Client's claims
for its self-insured property/casualty program to the extent as set forth in the following articles of this
Agreement
NOW THEREFORE,in consideration of the mutual promises and covenants hereinafter contained,
and other good and valuable consideration, the receipt and sufficiency of which is hereby
t r;. A P
acknowledged, the parties hereto, intending to be legally bound, hereby agree as follows:
C., 1. Definitions
;. As used in this Agreement, the following terms shall have the following meanings: ,
(a) "Agreement" shall mean this Agreement. as originally executed and amended or
Xi
supplemented from time to time.
(b) Allocated Loss Adjustment Expense shall mean such of the following items of expensessi-r ,
incurred or authorized by Administrator on behalf of Client as may be reasonable and
necess� in connection with Administrator's rendition of services in accordance with this
Agreement:
°.r r•= i Medical examinations of claimants, including the reasonable and necessary
transportation expenses of claimants. ? ;
ii. Reports from attending or examining physicians.
iii. Attorneys' fees and disbursements.
rc r���u�i aI
iv. Court reporter services and transcripts.
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V. Stenographic services and transcripts. �l}'
vi. WItness attendance fees.
vii. Court costs.
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.a, .. �
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viii. Appeal bonds.
ix. I
rinting costs related to trials and appeals.
X.
experts.Testimony,opinions, appraisals,reports,surveys,and analyses of professionals and r �;
J
Property.xi Automobile and Pro appraisals.
uh
p- Y raisals
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xii. Trial and hearing attendance fees. �yat
xiii. Reports from government agencies or branches.
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xiv. Credit bureau reports.
l xv. Private investigators. :
JJ xvi. Photographs.
xvii. Medical or vocational rehabilitation.
`. xviii Medical cost containment services including but not limited to hospital bill audit,
ti
provider bill audit,and medical case management incurred with the consent of Client. try
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xix Extraordinary claim investigation and/or travel expense incurred with the consent of � ,`,,
Client.
xx. Fees for services provided by any investigation or adjusting firm other than
Administrator related to the investigation and defense of a particular claim.
xxi. Any similar service related to the investigation and defense of a particular Claim, or
the protection of and collection of the subrogation tights of the Client for which
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r' Client shall have given prior approval.
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xxii. Costs, fees and expenses incurred by Administrator for services above and beyond ,y(r
those covered by this atn•eement. KKc�`
(c) Claim shall mean any occurrence from which injury, damage, or expenses are sustained
or asserted or from which liability under various Missouri Tort Statutes is alleged. `-
i,
`•:Y (d) "Claimant" shall mean any person alleging or having a right to file a claim against the client
for damages as a result of client's duty or breach of duty under any various Civil laws. '' .1
k (e) "Client Program" or the "Program" shall mean the Client's self-insured property/casualty ' +
program as the context requires. -'
(f) "Claims Payment Account" shall mean a bank account to be established by Client and to
` which Client will contribute the amounts agreed hereunder and from which Administrator
' may draw funds to pay claims and Allocated Loss Adjustment Expenses required in the
administration of Client's Program covered by this Agreement. N{
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(g) Party shall mean Client or Administrator as the context requires, and the term "Parties”
shall mean both Client and Administrator.
(h) "Loss Run" shall mean a computer generated listing of claims that have been posted to
Administrator's Claims Administration Information System.
it
i (r) Loss Payment Accounting Record" means a computer generated listing of accounting
activity in the Claims Payment Account,as described below,during the preceding month that ' `3 '4} ;A
has posted to the Administrator's Claims Administration Information System.
f (j) "Administrator's Authority Limit" shall mean the amount of claim settlement authority
provided by the Client to Administrator for each claimant, set forth in writing from time to
time, which Administrator may utilize in its sole judgement to settle claims as described
herein. ""
2. Term
Administrator agrees to provide all services set forth herein to Client in connection with its
self-insured claims exposures occurring during the period commencing November 1, 2001, and ".",•,.;
ending October 31, 2002, unless earlier terminated pursuant to Section 3 hereof.
3. Termination
'i 5 i1 �i+i'ri•
Unless explicitly renewed by the Parties in writing, this Agreement shall terminate on October 31 �,�. � krt•.._:,,
2002. Any continuation or renewal of this Agreement shall be the subject of further negotiation
g k;4:+:;rye�•>�r�''-,t
between Client and Administrator. If renewed or continued, the price for Claims Administration 'it::'`'SK ''''
Services for the period of November 1, 2002 through October 31, 2003 will be based on the current
year's frequency of Claims reported, calculated at the per Claimant rates established in this j � :x' • 'rrs-
Y
agreement plus an amount not to exceed the lesser of(i) the change in the Broad Based Consumer �;��a.,�,��•:.�z,�.y.�w.'.';;.
Price Index during the term of this agreement plus two percent(CPI+ 2%)or(ii)six percent(6%).
s-ask;,.iF
This Agreement may be canceled at any time with or without cause b y either art y giving eith P ivin('�the other
4•.0 1*rim:}�,�j;� t3 ti`'
Party written notice of cancellation sixty (60) days prior to the effective date of such cancellation" ot£q fi }'
If this Agreement is canceled by Client before October 31,2002 for any reason,Client shall exercise +;,ii�•��r�Y.I��,,�cC {:-
�� one of the following options:
( ) Client may require Administrator to conclude the handling of all claims occurring during the
term of this Agreement whether reported before or after the term of this Agreement,subject
O' J ,�k. 41,1(1tii.Fl• 'R•t.`�i!.'."
however, to the terms, conditions and limitations of this Agreement. No further ,��w
'f compensation shall be owed to Administrator for its handling of Claims reported prior to the
� Termination of this Agreement to their conclusion.
t Client may require Administrator to return all open and/or finalized files to the Client. Such return
of open and/or finalized files shall not result in a reduction in fees for all Claims referred to ;'�t:Yi `f '
Administrator but not finalized prior to the effective date of termination.
4. Compensation '' '•;t�,
0 Client shall pay Administrator fees as follows as compensation for the administrative services
0
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a ��'•, Div )
if`.t,�•t� rytt
Administrator herein agrees to perform: sF ±"-
t Administrator shall provide all claims administration services as detailed in this Agreement for an
annual fee of$23 000,00 for new claims reported during the term of the agreement,
s� � p b b
Administrator reserves the right to offer Guaranteed Cost renewal pricing for subsequent years of
this program contingent upon claim frequencies reported during the most recent past year. Pricin g
��••�:;�r„`:'s;��'y�
5=
for subsequent Y ears claims administration fees will be based upon the last ear's actual f-e uenc Y,
times the per-claimant flat-rates detailed below, plus an amount equal to the change in the broad- ;
k” based Consumer Price Index (CPI-U) during the previous 12 month period.
All fees will be billed quarterly durin g the Term of the Agreement, except
as detailed below in this
section.
a
Guaranteed Cost Renewal pricing for subsequent years renewal of this program shall utilize the '';w..
following price schedule as a basis for such pricing (plus the change in the CPI-U during the a %�
previous 12 month period):
ti'R'l7rwr..+�til'''a.rt r'' J
Type of Case Expected Flat Date Projected
Frequency Per Claimant 'Total
General Liability — x $410.00 = $ --------
I Auto Liability — x $410.00 = $ --------
b t,• i�
Auto Ph s. Damage x $338.00 $ --------
e; Errors & Omissions -- x $410.00 = $ --------
Personal Injury — x $410.00 = $ -------- fix. • ;�,
Quarterly Management Claim Reviews = $ No Charge
Monthly Loss Runs/Special Reports = $ No Charge }i � ,
lj�J }'err .J4,slv,:
Total Claims Administration Expected Cost -New Claims $ 23,000.00
.r
l �:�r!�}�,��#• x,`7;:5,
ADDITIONAL FEES:`'`';`'
r+ NONE APPLICABLE ,xf`rio`i
Client agrees to a Administrator all fees as outlined in this section. Fees for claims handling shall s> } ' ''•;A''
n' b pay g
be billed on the first of the month of each calendar quarter during the Term of this agreement, and
J such billings will be paid by Client within thirty 30 days of such billing.
5. Services To Be Performed " h
Administrator shall adjust, supervise, and administer fully the Client's Program in a manner so that
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such Program is at all times in full compliance with all current and future applicable laws rules and
regulations governing such self-insured programs; and, in fulfilling the foregoing obligations,
Administrator will act as the independent contractor and/or representative of Client in all matters + '
related to the administration of the Program.
In addition to the foregoing obligations, Administrator hereby agrees to perform fully all of the
<.r
following duties:
(a) To review all claim and/or loss reports with claim and/or dates incurred during the
term of this Agreement for all losses involving the hereinabove stated exposures to � �'<i •�;
the Client. `
To establish a file with respect to each claim.
(c) To investigate, to the extent deemed necessary in the mutual judgement of the ` it irk;
Parties, all reported Claims as defined in Section 1 above. 'h`r1zg
..;
d To provide each Claim file with a written chronology of all actions taken with respect
to the underlying Claim. '
(e) To furnish all claim forms necessary for proper claims administration. '['
tic'•. ;j�� f,�'��:;,F a
To investigate, adjust settle or resist all such losses and/or Claims as defined in rr '
Section 1 above within the per claim discretionary settlement authority limit of the
Administrator as agreed upon by Administrator and Client.
(g) To investigate, adjust, settle or resist all such losses and/or claims as defined in
Section 1 in excess of the discretionary settlement authority limit of the
is Administrator with specific prior approval of the Client. 'r
t (h) To assist in all litigation or other proceedings involving any Claim as directed by
Client. ' ''' ,:
(i) To retain all Claim files for a period of two (2) years after the applicable statute of
limitations has expired. After this period, files will be returned to the Client or
a
destroyed as Client requests.
Y q
(j) To recommend adequate reserves and provide to Client a continuous review of such
reserves to such reserves.
t reserve s and any required changes � i
(k) To monitor all treatment programs recommended to a Claimant by any care provider.
(1) To furnish to Client and/or its designees on a monthly basis, a Loss Run and Loss ,
Payment Accounting Record Report.Administrator also shall furnish to Client and/or
f designees on an as requested basis ad-hoc, reports as may be available within its �.
'r claims administration system.
(m) To pay on claims check stock provided by Client, all payments required to be made
in the administration of Client's Program and provide to Client a daily record of all
such payments. i + >
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r 1 (n) To prepare and file all reports required by any current or future applicable law, rule h„ ff$W , f3 ;ti
t or regulation. r7 >�
•� �
(o) Discretionary settlement authority,as referred to in Section(F)&(G)above is$0.00
per claimant.
a 1PYC'Mkt�yfi?lei::�=
6. Covenants and Agreements of Client '" `}
' Client covenants and agrees as follows: '
a Client appoints Administrator as its claims management company, as its agent and ` 5
.ry authorized Administrator to exercise in Client's behalf, Administrator's sole y �;
' judgement and discretion to pay, settle, or resist all claims within Administrator's
discretionary settlement authority as stated in Section (5.0) above. Client reserves
the right to advise Administrator to not pay any particular claim or to pay a lessor
amount even within Administrator's discretionary settlement authority, if any. r'
(b) To pay to Administrator the fees prescribed in Section 4. If client fails to pay '� '
�x
Administrator the fees prescribed in Section 4 and/or in accordance with the time �J<;A
frames set forth therein, Administrator may tenninate this Agreement immediately, sr •: rre,t`°''
notwithstanding the sixty(60)days prior written notice set forth in Section 3. In the
1? event of such immediate Agreement tenmination,the options upon tennination asset
forth in Section 3, shall not be available to Client but instead Administrator shall
7
return to Client all Claims and/or losses pending on the date of such termination fora.
the Client to handle to a conclusion,and such handling shall not result in any expense . ft
or reduction of fees to Administrator.
i.:. :;. (c) To pay all Allocated Loss Adjustment Expense, as defined herein, in addition to the j'' i_•t r
s: fees to be paid to Administrator as prescribed in Section 4 hereof: ru
(d) To indemnify, protect, save, defend and hold Administrator and Administrator'suJ �'.;
�r,4
directors, officers, attorneys, employees, shareholders agents and other
yi,' xY
representatives wholly harmless from and against any and all loss, cost, damage or
expense(including attorney's fees and costs incurred by Administrator in connection
therewith) arising out of the administration or handling of any claims by reason of } 7< :
any negligent, grossly negligent or willful act or omission of Client or of Client's
directors, officers, shareholders attorneys, employees, agents or other
representatives, taken or omitted to be taken pursuant to this Agreement, including,
without limitation any such loss costs damage or expense incurred by reason of the
,f}, following:
i. Any act or omission or Administrator or any of Administrators directors, r '
officers attorneys, employees, a ents or other representatives taken or
omitted to be taken at he irection of Client or any of Client's directors, {:
officers, shareholders, agents, or other representatives;
tl,
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irk ,,,� ,t,•
ii. Administrators being named in litigation as the insurer of record or other 4
°rltt7 capacity based upon its present or past relationship with Client;
., iii. The failure of Administrator or Administrator's directors,officers,attorneys,
s shareholders,employees,agents or other representatives to settle a claim that
could have been settled within Administrator's Authority Limit so lon 'as
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.t, fiy,,y,tq,.,,�, ..,}-� n .Y. .t L ,i,, a' ,+. .s .t, Sd� E•T ,TC������}�4�.
yaiY+et::iu r ..1.�..:.,+,{.M.wr1Ni�.•w w#•wcit!�`tskY.[S�4Y124L'h..'s„'�,'`r4.�...'S,F.�'r a '7 /,�
such failure to-settle does not result from a negligent, grossly negligent, or
! willful act, error or omission by Administrator or by any of Administrator's
directors, officers, shareholders, attorneys, employecs, agents or other
,t 1� representative); or
>i iv. The failure of Administrator or Administrator's directors officers, ;:, ?+,.��, _•:•; .
•,, shareholders,attorneys,employees,agents or other representative to pay an y
:�,r:�u��;.E(��s};•._ _
Claim or Allocated Loss Adjustment Expense on a timely basis due to thee`"•�r7 -�
J p Y
failure of Client or Client's directors officers, shareholders attorneys,
attorne
��:;• employees, agents or other representatives to comply with Section 6,
subparagraphs (e) and (f) hereunder.
In the event Administrator or any of its directors, officers, shareholders, attorneys,
employees, agents or other representatives, is named as a defendant in, or is otherwise
obligated to defend,any such action asserting any Claim indemnified hereunder,Client will "
assume, at Client's expense, the defense of such actions on behalf of Administrator and its 'w
directors,officers,shareholders,attorneys,employees,agents or other representatives,as the y, '���;F�!�`!{,F , ;
case may be. Client shall have the sale discretion to select the attorneys who will defend anys; ;u-x,�r,�x _
such action, provided, however, that Client shall exercise such discretion reasonably.
�. foregoing, '
Notwithstanding the nothin herein shall waive an of an Y p art hereto to
X, contributory negligence claims or defenses with respect to any indemnity provided herein. , ' rl....Y
This indemnity shall survive termination of this Agreement. ht
e To provide sufficient funds to the Claims Payment Account to enable Administrator
�a • at all times to pay Claims and Allocated Loss Adjustment Expenses in accordance
with the terms and conditions contained herein. s'',
` To authorize and hereby does authorize Administrator to issue payments as may be ' �
(�
necessary to enable Administrator to pay Claims. Administrator may also payments
as may be necessary to enable Administrator to a all Allocated Loss Adjustment �y ,
i, Y rY pay Jw4>°
is Expenses. 4°
i •�'dj},tvsv'�'1''
Section 7. Covenants and Agreements of Administrator
Administrator covenants and agrees as follows: Fu•' rt ' r..'n
(a) 'To Client's right to assume the control and handling of any Claim at any time, and t.tt;`
' .Administrator agrees to deliver promptly any Claim file to Client which it may
request,but without any off-set or deduction from any of the fees or charges paid or
a able b Client to Administrator tinder Section 4 above. The parties agree that at ',
Y &4
all times prior to and after the cancellation of this Agreement, all Claim files are "' `
owned by and are the property of Client. Claim files are subject to review by Client
).: t 6{dry:
m ' and its employees and authorized agents during Administrators# regular business 1r' fk
hours, with reasonable prior notice.
` (b) To exercise reasonable efforts to manage the services provided hereunder in such a ;;,
way and in such manner as to insure that every adjuster, claims investigator, and/orr1
y,r employee used by the Administrator or subcontracted to by the Administrator will g r,
adjust and/or investigate every alleged Claim or matter covered by this Agreement 4' 'v.l
' in accordance with this Agreement and any claim handling instructions asi. i
implemented from time to time.
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.x.4.y�tfC�,dlRr'.,,rk•. .tF��'�+:° '.3:' F �",+7i '.l t c. 't.- aL t P}�+4,.'L`',"rtYT?i i �"
`: '.',c;,7•.t.t� ti. t ii* ,+.4� wr`,uln:ry�c•nt,r>�rvrra r-' 6Ya sq�. .:�� i'ay . , ci i,(..L � t.t,F f., :ssx..,.�'1 4:- `� �r
t. fi;rt, ,t fs w ,�rF •f�•'Yjet�;X�l�'wa.t.'#.�i+Cart,9h?cil'4�i�3htt�i�;"BnNatttrrtY+k�.4+�.r.=a>u.:.i:zi�..• •...+L';�t'�'° ��ia��iti t r n4�•I
To provide to Client, upon written request, certificate of insurance evidencing
' jam'.�,��fv}�,'t�?{������'.�'�•
adequate General Liability Insurance, Automobile Liability Insurance, Workers' tt y t 5t�,
Compensation Insurance, Fidelity Coverage (Bond) and Errors and Omissions
Insurance (Professional Liability Coverage)
(d) To provide all necessary personnel to perform the services agreed upon herein.
(e) To indemnify, protect, save, defend and hold Client and Client's directors, officers, kf';
shareholders,attorneys,employees,agents and other representatives wholly harmless
from any and all loss, cost, darnage or expense arising out of the administration or
handling of any claims by reason of any negligent, grossly negligent or willful act or t .. .
omission of Administrator or of Administrators directors, officers, shareholders,
attorneys, employees, agents or other representatives, taken or omitted to be taken '
pursuant to this Agreement; provided, however, that Administrator shall have no
obligation to indemnity anyone pursuant hereto with respect to the following:
J i. Any act or omission of Administrator or any of Administrator's directors, r� zs
officers, shareholders, attorneys, employees, agents or other representatives '' �:: 7'u;` =
taken or omitted to be taken at the direction of client or any of Client's � ;�''r',�rf,rrr:
directors, officers, shareholders, attorneys, employees, agents or other
representatives, a}j
ii. Administrator being named in litigation as the insurer of record
The failure of Administrator or Administrator's directors officers:
{ shareholders, attorneys, employees, agents or other representatives to settle
i a Claim that could have been settled within Administrator's Authority Limit } s,V' t. '
(so long as such failure to settle does not result from a grossly negligent or
willful act, error or omission by Administrator or by any of Administrators .
directors, officers, shareholders, attorneys, employees, agents or other f'
representatives), or, 9t
f aY 1•+
iv. The failure of Administrator or Administrator's directors, officers, ; : f a• ;,';' �
shareholders attorneys,employees,agents or other representatives to payany
' Claim or Allocated Loss Adjustment Expense, on a timely basis due to
Client, to the failure of Clients directors, officers, attorneys, employees,
agents or other representatives to comply with Section 6, subparagraphs (e) r ". ;
C and (f) of this Agreement
In the event Client or any of its directors, officers, attorneys, employees, agents or other n�, •r�°4
representatives, is named as a defendant in, or is otherwise obligated to defend, any such
action asserting any Claim indemnified hereunder, Administrator will assume, at
Administrators expense, the defense of such actions on behalf of Client and its directors '
officers, attorneys, employees, agents or other representatives, as the case may be. taa
Administrator has sole discretion to select the attorneys who will defend any such action
provided however, that Administrator shall exercise such -discretion reasonably.
Notwithstanding the foregoing, nothing herein shall waive any rights of any party hereto to
contributory negligence claims or defenses with respect to any indemnity provided herein. ,fi
8. Miscellaneous: ,? �
(a) This Agreement shall be governed and constructed in accordance with the laws of the
State of Missouri. :
" - (b) If any provision of this Agreement shall be held to be invalid or unenforceable for
an reason, such invalidity or unenforceabilit s fa ,'
Y y y hall not affect any other provisions
of this Agreement. '
f,
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(c) No waiver or modification of this Agreement or of any covenant, condition or
11 limitation contained shall be valid unless in writing and duly executed by the Parties, tk���,���••. ',�
11 jjs��a�t�
(d) The failure of either Party to insist, in any one or more instances, upon performance ,
of the terms or conditions of this Agreement shall not be construed as a waiver or
41 a relinquishment of any right granted hereunder or of the fiuture performance of any
such term, covenant, or condition. 't`V
(e) This Agreement is personal to the Parties and may not be assigned by either Party in
whole or in part without prior written consent of the other Party.
(f) Any notice to be given hereunder shall be deemed sufficient if in writing and
delivered either personally or by certified mail return receipt requested, to the
'
following: `Y
If to Administrator: Michael D. Greco, President `
Corporate Claims Management, Inc.
Y { 782 Spirit 40 Park
p
Chesterfield, Missouri 63005af4'"� 1 ,
1 If to Client: B. Allen Garner, City Counselor = ,
The City of Jefferson City, Missouri
320 E. McCarty Street
Jefferson City, Missouri 65201
t.,g
(g) The headings of this Agreement are intended solely for convenience of reference and ';+;
shall have no effect on the construction or interpretation of this Agreement. i 4,+, ` ;
r,. r?'Y, rl �
(h) In the event of any litigation between the Parties the prev aiIin art steal l be entitled > '
to recover from the non- revailinb party any attorney's fees and expenses incurred.
rri ,
i. This Agreement shall be binding upon and inure to the benefit of each party
hereto and their respective permitted successors and permitted assigns.
,l;a,' d • ,i,�'
'r R, IN WITNESS WHEREOF, the parties by their authorized agents have caused this Agreement to beer •
}: executed as of the date first written above.
On Behalf of On Behalf of tt{t y���"55555'E"
The City Jefferson C'ty, M' sour' Corporate Claims Mapagement, Inc.
BY/ BY:
l ers — -- Micha 6l D. G eco
t LE: Mayor — TITLE: President
DATE: lD -,23 ZOrJ/ DATE:
ATTEST: ATTEST:
,
iy Cletk Title:
APPROVED AS TO FOR
? City CounseloF
Yt1� H,\Contract riles\Professional 8erviceo\Corporate Claims Management\Jefferson City TPA Agreemament 7001.wpci .y
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�3 �MV
CITY OF JEFFERSON
i CLAIMS ADMINISTRATION AGREEMENT
THIS AGREEMENT is made as of November 1, 2003,between Corporate Claims Management,
Inc., a corporation organized and existing under the laws of the State of Missouri, (hereinafter
"Administrator") and The City of Jefferson City, Missouri (hereinafter"Client").
WITNESSETH:
WHEREAS, Administrator is engaged in the business of the administration, investigation and
payment of claims arising from self-insured workers' compensation and casualty programs for its
clients; and
WHEREAS, Client requires the services of an independent contractor to administer its self-insured
property/casualty program up to its self-insured retention; and
WHEREAS, Client desires to retain Administrator for the provision of its services for Client's
claims for its self-insured property/casualty program to the extent- as set forth in the following
articles of this Agreement;
NOW THEREFORE; in consideration of the mutual promises and covenants hereinafter
• contained, and other good and valuable consideration, the receipt and sufficiency of which is hereby
acknowledged,the parties hereto,'intending to'be legally bound,hereby agree as follows:
1. Definitions
As used in this Agreement,the following terms shall have the following meanings:
(a) "Agreement" shall mean this Agreement, as originally executed and amended or
supplemented from time to time.
(b) "Allocated Loss Adjustment Expense" shall mean such of the following items of
expense incurred or authorized by Administrator on behalf of Client as may be
reasonable and necessary in connection with Administrator's rendition of services in
accordance with this Agreement:
i. Medical examinations of claimants, including the reasonable and necessary
transportation expenses of claimants.
ii. Reports from attending or examining physicians.
iii. Attorneys'fees and disbursements.
• iv: Court reporter services and transcripts.
1
V. Stenographic services and transcripts.
vi. Witness attendance fees.
vii. Court costs.
viii. Appeal bonds.
ix. Printing costs related to trials and appeals.
X. Testimony, opinions, appraisals, reports, surveys, and analyses of
professionals and experts.
xi. Automobile and Property appraisals.
xii. Trial and hearing attendance fees.
xiii. Reports from government agencies or branches.
xiv. Credit bureau reports.
xv. Private investigators.
• xvi. Photographs.
xvii. Medical or vocational rehabilitation.
xviii. Medical cost containment services including but not limited to hospital bill
audit, provider bill audit, and medical case management incurred with the
consent of Client.
xix. Extraordinary claim investigation and/or travel expense incurred with the
consent of Client.
xx. Fees for services provided by any investigation or adjusting firm other than
Administrator related to the investigation and defense of a particular claim.
xxi. Any similar service related to the investigation and defense of a particular
Claim, or the protection of and collection of the subrogation rights of the
Client, for which Client shall have given prior approval.
xxii. Costs, fees and expenses incurred by Administrator for services above and
beyond those covered by this agreement.
•
2
(C) "Claim" shall mean any occurrence from which injury, damage, or expenses are
• sustained or asserted or from which liability under various Missouri Tort Statutes
is alleged.
(d) "Claimant" shall mean any person alleging or having a right to file a claim against
the client for damages as a result of client's duty or breach of duty under any various
Civil laws.
(e) "Client Program" or the "Program" shall mean the Client's self-insured
property/casualty program as the context requires.
W "Claims Payment Account" shall mean a bank account to be established by Client
and to which Client will contribute the amounts agreed hereunder and from which
Administrator may draw funds to pay claims and Allocated Loss Adjustment
Expenses required in the administration of Client's Program covered by this
Agreement.
(g) "Party" shall mean Client or Administrator as the context requires, and the term
"Parties" shall mean both Client and Administrator.
(h) "Loss Run" shall mean a computer generated listing of claims that have been posted
to Administrator's Claims Administration Information System.
• (i) "Loss Payment Accounting Record" means a computer generated listing of
accounting activity in the Claims Payment Account, as described below, during the
preceding month that has posted to the Administrator's Claims Administration
Information System.
(j) "Administrator's Authority Limit" shall mean the amount of claim settlement
authority provided by the Client to Administrator for each claimant, set forth in
writing from time to time, which Administrator may utilize in its sole judgement to
settle claims as described herein.
2. Term
Administrator agrees to provide all services set forth herein to Client in connection with its
self-insured claims exposures occurring during the period commencing November 1, 2003,
and ending October 3.1, 2004,unless earlier terminated pursuant to Section 3 hereof.
3. Termination
Unless explicitly renewed by the Parties in writing, this Agreement shall terminate on
October 31, 2004. Any continuation or renewal of this Agreement shall be the subject of
further negotiation between Client and Administrator. If renewed or continued,the price for
Claims Administration Services for the period of November 1, 2004 through October 31,
2005 will be based on the current year's frequency of Claims reported, calculated at the per
Claimant rates established in this agreement plus an amount not to exceed the lesser of(i)
• the change in the Broad Based Consumer Price Index during the term of this agreement plus
3
two percent (CPI + 2%) or (ii) six percent (6%). This Agreement may be canceled at any
time with or without cause by either Party giving the other Party written notice of
cancellation sixty(60)days prior to the effective date of such cancellation.
If this Agreement is canceled by Client before October 31, 2004 for any reason, Client shall
exercise one of the following options:
(a) Client may require Administrator to conclude the handling of all claims occurring
during the term of this Agreement whether reported before or after the term of this
Agreement, subject, however, to the terms, conditions and limitations of this
Agreement.No further compensation shall be owed to Administrator for its handling
of Claims reported prior to the Termination of this Agreement to their conclusion.
(b) Client may require Administrator to return all open and/or finalized files to the
Client. Such return of open and/or finalized files shall not result in a reduction in fees
for all Claims referred to Administrator but not finalized prior to the effective date of
termination.
4. Compensation
Client shall pay Administrator fees as follows as compensation for the administrative
services Administrator herein agrees to perform:
Administrator shall provide all claims administration services as detailed in this
• Agreement for an annual fee of$34,328.00 for new claims reported during the term of
the agreement.
Administrator reserves the right to offer Guaranteed Cost renewal pricing for subsequent
years of this program contingent upon claim frequencies reported during the most recent
past year. Pricing for subsequent years claims administration fees will be based upon the
last year's actual frequency, times the per-claimant flat-rates detailed below, plus an
amount equal to the change in the broad-based Consumer Price Index (CPI-U) plus 2
percent(2%) during the previous 12 month period.
All fees will be billed quarterly during the Term of the Agreement, except as detailed
below in this section.
Guaranteed Cost Renewal pricing for subsequent years renewal of this program shall
utilize the following price schedule as a basis for such pricing (plus the change in the
CPI-U plus two percent during the previous 12 month period):
• 4
Type of Case Expected Flat Rate Projected
Frequency Per Claimant Total
General Liability --- x $437.00 = $ --------
Auto Liability --- x $437.00 = $ --------
Auto Phys. Damage --- x $362.00 = $ --------
Errors & Omissions --- x $437.00 = $ --------
Personal Injury --- x $437.00 = $ --------
Quarterly Management Claim Reviews = $No Charge
Monthly Loss Runs/Special Reports = $No Charge
Total Claims Administration Expected Cost-New Claims $ 34,328.00
ADDITIONAL FEES:
NONE APPLICABLE
Client agrees to pay Administrator all fees as outlined in this section. Fees for claims
handling shall be billed on the first of the month of each calendar quarter during the
Term of this agreement, and such billings will be paid by Client within thirty(30) days of
such billing.
5. Services To Be Performed
Administrator shall adjust, supervise, and administer fully the Client's Program in a
manner so that such Program is at all times in full compliance with all current and future
applicable laws, rules and regulations governing such self-insured programs; and, in
fulfilling the foregoing obligations, Administrator will act as the independent contractor
and/or representative of Client in all matters related to the administration of the Program.
In addition to the foregoing obligations, Administrator hereby agrees to perform fully all
of the following duties:
(a) To review all claim and/or loss reports with claim and/or dates incurred during
the term of this Agreement for all losses involving the hereinabove stated
exposures to the Client.
• (b) To establish a file with respect to each claim.
5
(c) To investigate, to the extent deemed necessary in the mutual judgement of the
Parties, all reported Claims as defined in Section 1 above.
(d) To provide each Claim file with a written chronology of all actions taken with
respect to the underlying Claim.
(e) To furnish all claim forms necessary for proper claims administration.
(f) To investigate, adjust, settle or resist all such losses and/or Claims as defined in
Section 1 above within the per claim discretionary settlement authority limit of
the Administrator as agreed upon by Administrator and Client.
(g) To investigate, adjust, settle or resist all such losses and/or claims as defined in
Section 1 in excess of the discretionary settlement authority limit of the
Administrator with specific prior approval of the Client.
(h) To assist in all litigation or other proceedings involving any Claim as directed by
Client.
(I) To retain all Claim files for a period of two (2) years after the applicable statute
of limitations has expired. After this period, files will be returned to the Client or
destroyed as Client requests.
(j) To recommend adequate reserves and provide to Client a continuous review of
such reserves and any required changes to such reserves.
(k) To monitor all treatment programs recommended to a Claimant by any care
provider.
(1) To furnish to Client and/or its designees on a monthly basis, a Loss Run and Loss
Payment Accounting Record Report. Administrator also shall furnish to Client
and/or designees on an as requested basis ad-hoc reports as may be available
within its claims administration system.
(m) To pay on claims check stock provided by Client, all payments required to be
made in the administration of Client's Program and provide to Client a daily
record of all such payments.
(n) To prepare and file all reports required by any current or future applicable law,
rule or regulation.
(o) Discretionary settlement authority, as referred to in Section (F) & (G) above is
$0.00 per claimant.
6. Covenants and Agreements of Client
• Client covenants and agrees as follows:
6
(a) Client appoints Administrator as its claims management company, as its agent
• and authorized Administrator to exercise in Client's behalf, Administrator's sole
judgement and discretion to pay, settle, or resist all claims within Administrator's
discretionary settlement authority as stated in Section (5.0) above. Client
reserves the right to advise Administrator to not pay any particular claim or to pay
a lessor amount even within Administrator's discretionary settlement authority, if
any.
(b) To pay to Administrator the fees prescribed in Section 4. If client fails to pay
Administrator the fees prescribed in Section 4 and/or in accordance with the time
frames set forth therein, Administrator may terminate this Agreement
immediately, notwithstanding the sixty (60) days prior written notice set forth in
Section 3. In the event of such immediate Agreement termination, the options
upon termination as set forth in Section 3, shall not be available to Client, but
instead Administrator shall return to Client all Claims and/or losses pending on
the date of such termination for the Client to handle to a conclusion, and such
handling shall not result in any expense or reduction of fees to Administrator.
(c) To pay all Allocated Loss Adjustment Expense, as defined herein, in addition to
the fees to be paid to Administrator as prescribed in Section 4 hereof.
(d) To indemnify, protect, save, defend and hold Administrator and Administrator's
directors, officers, attorneys, employees, shareholders, agents and other
representatives wholly harmless from and against any and all loss, cost, damage
or expense (including attorney's fees and costs incurred by Administrator in
connection therewith) arising out of the administration or handling of any claims
by reason of any negligent, grossly negligent or willful act or omission of Client
or of Client's directors, officers, shareholders, attorneys, employees, agents or
other representatives, taken or omitted to be taken pursuant to this Agreement,
including, without limitation, any such loss, costs, damage or expense incurred by
reason of the following:
i. Any act or omission of Administrator or any of Administrator's directors,
officers, attorneys, employees, agents or other representatives taken or
omitted to be taken at the direction of Client or any of Client's directors,
officers, shareholders, agents, or other representatives;
ii. Administrators being named in litigation as the insurer of record or other
capacity based upon its present or past relationship with Client;
iii. The failure of Administrator or Administrator's directors, officers,
attorneys, shareholders, employees, agents or other representatives to
settle a claim that could have been settled within Administrator's
Authority Limit (so long as such failure to-settle does not result from a
negligent, grossly negligent, or willful act, error or omission by
7
Administrator orby any of Administrator's directors, officers,
• shareholders, attorneys, employees, agents or other representative); or
iv. The failure of Administrator or Administrator's directors, officers,
shareholders, attorneys, employees, agents or other representative to pay
any Claim or Allocated Loss Adjustment Expense on a timely basis due to
the failure of Client or Client's directors, officers, shareholders, attorneys,
employees, agents or other representatives to comply with Section 6,
subparagraphs (e) and(f)hereunder.
In the event Administrator or any of its directors, officers, shareholders, attorneys,
employees, agents or other representatives, is named as a defendant in, or is
otherwise obligated to defend, any such action asserting any Claim indemnified
hereunder, Client will assume, at Client's expense, the defense of such actions on
behalf of Administrator and its directors, officers, shareholders, attorneys,
employees, agents or other representatives, as the case may be. Client shall have
the sole discretion to select the attorneys who will defend any such action,
provided, however, that Client shall exercise such discretion reasonably.
Notwithstanding the foregoing, nothing herein shall waive any rights of any party
hereto to contributory negligence claims or defenses with respect to any
indemnity provided herein. This indemnity shall survive termination of this
Agreement.
(e) To provide sufficient funds to the Claims Payment Account to enable
Administrator at all times to pay Claims and Allocated Loss Adjustment
Expenses in accordance with the terms and conditions contained herein.
(f) To authorize and hereby authorizes Administrator to issue payments as may be
necessary to enable Administrator to pay Claims. Administrator may also make
payments as may be necessary to enable Administrator to pay all Allocated Loss
Adjustment Expenses.
7. Covenants and Agreements of Administrator
Administrator covenants and agrees as follows:
(a) To Client's right to assume the control and handling of any Claim at any time, and
Administrator agrees to deliver promptly any Claim file to Client which it may
request, but without any off-set or deduction from any of the fees or charges paid
or payable by Client to Administrator under Section 4 above. The parties agree
that at all times prior to and after the cancellation of this Agreement, all Claim
files are owned by and are the property of Client. Claim files are subject to review
by Client and its employees and authorized agents during Administrator's regular
business hours,with reasonable prior notice.
• 8
(b) To exercise reasonable efforts to manage the services provided hereunder in such
a way and in such manner as to insure that every adjuster, claims investigator,
and/or employee used by the Administrator or subcontracted to by the
Administrator will adjust and/or investigate every alleged Claim or matter
covered by this Agreement in accordance with this Agreement and any claim
handling instructions as implemented from time to time.
(c) To provide to Client, upon written request, certificate of insurance evidencing
adequate General Liability Insurance, Automobile Liability Insurance, Workers'
Compensation Insurance, Fidelity Coverage (Bond) and Errors and Omissions
Insurance(Professional Liability Coverage).
(d) To provide all necessary personnel to perform the services agreed upon herein.
(e) To indemnify, protect, save, defend and hold Client and Client's directors,
officers, shareholders, attorneys, employees, agents and other representatives
wholly harmless from any and all loss, cost, damage or expense arising out of the
administration or handling of any claims by reason of any negligent, grossly
negligent or willful act or omission of Administrator or of Administrator's
directors, officers, shareholders, attorneys, employees, agents or other
representatives, taken or omitted to be taken pursuant to this Agreement;
provided, however, that Administrator shall have no obligation to indemnify
anyone pursuant hereto with respect to the following:
i. Any act or omission of Administrator or any of Administrator's directors,
officers, shareholders, attorneys, employees, agents or other
representatives taken or omitted to be taken at the direction of client or
any of Client's directors, officers, shareholders, attorneys, employees,
agents or other representatives,
ii. Administrator being named in litigation as the insurer of record,
iii. The failure of Administrator or Administrator's directors, officers,
shareholders, attorneys, employees, agents or other representatives to
settle a Claim that could have been settled within Administrator's
Authority Limit (so long as such failure to settle does not result from a
grossly negligent or willful act, error or omission by Administrator or by
any of Administrator's directors, officers, shareholders, attorneys,
employees, agents or other representatives), or,
iv. The failure of Administrator or Administrator's directors, officers,
shareholders, attorneys, employees, agents or other representatives to pay
any Claim or Allocated Loss Adjustment Expense, on a timely basis due
to the failure of Client or Client's directors, officers, attorneys, employees,
agents or other representatives to comply with Section 6, subparagraphs
(e) and(f) of this Agreement.
9
In the event Client or any of its directors, officers, attorneys, employees, agents or other
• representatives, is named as a defendant in, or is otherwise obligated to defend, any such
action asserting any Claim indemnified hereunder, Administrator will assume, at
Administrator's expense, the defense of such actions on behalf of Client and its directors,
officers, attorneys, employees, agents or other representatives, as the case may be.
Administrator has sole discretion to select the attorneys who will defend any such action,
provided, however, that Administrator shall exercise such discretion reasonably.
Notwithstanding the foregoing, nothing herein shall waive any rights of any party hereto
to contributory negligence claims or defenses with respect to any indemnity provided
herein.
8. Miscellaneous:
(a) This Agreement shall be governed and constructed in accordance with the laws of
the State of Missouri.
(b) If any provision of this Agreement shall be held to be invalid or unenforceable for
any reason, such invalidity or unenforceability shall not affect any other
provisions of this Agreement.
( c) No waiver or modification of this Agreement or of any covenant, condition or
limitation contained shall be valid unless in writing and duly executed by the
Parties.
• d The failure of either P to insist in an one or more instances upon
( ) �Y � Y � p
performance of the terms or conditions of this Agreement shall not be construed
as a waiver or a relinquishment of any right granted hereunder or of the future
performance of any such term, covenant, or condition.
(e) This Agreement is personal to the Parties and may not be assigned by either Party
in whole or in part without prior written consent of the other Parry.
(f) Any notice to be given hereunder shall be deemed sufficient if in writing and
delivered either personally or by certified mail, return receipt requested, to the
following:
If to Administrator: Michael D. Greco, President
Corporate Claims Management, Inc.
782 Spirit 40 Park
Chesterfield, Missouri 63005
If to Client: Nathan M.Nickolaus
The City of Jefferson City, Missouri
320 E. McCarty Street
Jefferson City, Missouri 65101
10
(g) The headings of this Agreement are intended solely for convenience of reference
and shall have no effect on the construction or interpretation of this Agreement.
(h) In the event of any litigation between the Parties, the prevailing party shall be
entitled to recover from the non-prevailing party any attorney's fees and expenses
incurred.
(i) This Agreement shall be binding upon and inure to the benefit of each party
hereto and their respective permitted successors and permitted assigns.
IN WITNESS WHEREOF, the parties by their authorized agents have caused this Agreement to
be executed as of the date first written above.
On Behalf of On Behalf of
The City of Jefferson City, Missouri Corporate Claims Management, Inc.
r
BY: BY:
Michael D. Greco
TITLE: or TITLE: President
DATE: Slehlr. DATE:
•
ATTEST: ATTEST:
. 41
TITLE: City Clerk Tit e: _ (2c-r j;
APPROVED AS TO FORM:
TITL : City Counselor
11 o
t,