HomeMy Public PortalAboutCA-ICA, INC. WORKERS COMPENSATION CLAIM2
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AGREEMENT NO. 05 -
This Agreement is made and entered into this 15 th day of IthLuary, 2005 by
and between city of Carson a municipal corporation, hereinafter referred to
as "City", and CA -ICA, INC., a California corporation, hereinafter referred to as
"Administrator", with its principal place of business located at 3547 Voyager - Street, Suite
104, Torrance, California 90503 -
WHEREAS, City is self-insured in the area of its liability .,under the Workers'
Compensation Laws of the State of California; and
WHEREAS, City has been informed that its prior Claims Administrator Fleming &
Associates will be closing its California offices on or about February 18� 2005 and no
longer able to assist the City; and
WHEREAS, City anticipates issuing or participating in a request for proposals (Kthe
RFP process") for workers'compensation claims administration prior to the end of calen ar
year2005;and
WHEREAS, Administrator represents itself as being capable and qualified to
provide such services in a manner commensurate with the highest professional standards
and in accordance with all applicable legal standards,
NOW, THEREFORE, IN CONSIDERATION OF THESE PREMISES, THE PARTIES
HERETO AGREE AS FOLLOWS:
ARTICLE 1 — SCOPE OF SERVICE
A. Administrator agrees to perform all services required to be performed as
specified and in the manner provided for in City's Request for Proposal (Exhibit"A7).
In the event of any conflict between this Agreement and the terms and conditions of Exhibit
"A," the terms and conditions of this Agreement shall prevail.
B. Claims Administration:
Administrator shall perform all services required to resolve claims
arising from City's self-insured workers' compensation program and
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to act as representative for City in all matters relating to City's
obligations under the Workers' Compensation laws of the State of
California. Such services shall include, but are not limited to, the
following- claims administration services; program administration
services; medical management services-, litigation management
services; and management information services more particularly set
forth herein after and pursuant to City satisfaction and in accordance
with state law and industry standards.
(a) When appropriate, refer litigated cases to attorneys utilizing
the City defense panel, assist in the preparation of litigated
cases and negotiations of settlements and subrogation
actions.
(b) Notification to City's excess workers' compensation carrier of
all claims which meet the reporting requirements of the carrier -
Maintain liaison between the carrier and City on matters
affecting the adjusting of such claims.
(c) Maintain close contact with treating physicians to assure that:
(1) employees receive proper medical treatment.
(2) avoid over treatment situations.
(3) are provided transitional duty when appropriate, and
(4) are returned to full employment at the earliest possible
date -
(d) Administrator shall contact by telephone all indemnity
claimants within 24 hours of report of the claim to
Administrator.
(e) Administrator shall appraise City of major developments
arising in the investigation, adjustment and settilement oll
significant claims. City agrees that the terms "majoi
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developments" and "significant claims" as used in this Article
are solely defined within Administrator's discretion.
2. Program Administration- .
(a)
Assist City in the development of rules, procedures and practices
involving employee injuries.
(b)
Attend City Council meetings if requested.
(c)
Provide a claim review meeting with the City monthly. Provide a
w itten claim summary of all cases to be discussed at least one week
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prior to the meeting.
(d)
Coordinate all temporary disability payments in coordination with the
City's salary continuance and benefit plans.
(e)
Provide City with necessary or required Workers' Compensation
forms and provide necessary advice and guidance as to the proper
utilization of these forms. As necessary, provide training to City staff
on the use of these forms.
(f)
At least once per year and as requested, provide staff training on the
Workers' Compensation system and related topics.
(g)
Keep City informed of new legislation, regulations, and other
information pertinent to Workers' Compensation.
(h)
City or any agent thereof shall have reasonable rights during normal
business hours and upon reasonable notice to inspect or audit the
records pertaining to any claim for which services are provided under
the Agreement provided that City shall reimburse Administrator for the
cost of making such records available for any audit undertaken by
City more frequently than once each year during the term hereof. Any
such inspection or audit shall be conducted in a manner so as to not
unnecessarily interfere with the business of Administrator.
3. Management Information Systems.
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(a) Provide City with monthly reports itemizing monthly expenditures,
reserve status, claim inventory status, claim costs, and potential
subrogation recovery in a format approved by City.
(b) Prepare and provide to the City no later than February 1 st of each
year the Annual OSHA Log Summary, including notification to post
during the month of February.
(c) Prepare and provide to City no later than September 1 of each year
the Self -insurer's Annual Report.
(d) Upon request of the City, provide on-line access to the Administrator
system, including training in its use at no additional charge. The cost
of the computer and the telephone time to be borne by the City.
(e) Provide 1099 forms to all appropriate vendors no later than January
31 st of each year as required by the Internal Revenue Service.
(f) Administrator shall provide computer back-up off site updated weekly.
C. Administrator and City agree to operate and administer the trust account to
be used for the payment or benefits to employees in accordance with the procedures
mutually agreed upon and subject to the Workers' Compensation Laws of the State of
California.
D. Administrator agrees to assign the work involved only to persons who are
specially trained, experienced and competent in the administration of public sector
workers' compensatior't claims. In conjunction therewith, City shall have the right,
reasonably exercised, to direct Administrator not to use persons who, in the opinion of the
City, are not so specially trained, experienced and competent to render the required
services.
ARTICLE 2 — COMPENSATION
City agrees to pay and Administrator agrees to accept as compensation for its
services, the SUM Of $ 78,000 , annually, for services rendered for all new claims, as
well as services on all existing claims continued from or assumed for prior years.
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Additionally, City agrees to pay Administrator at the rate of $ 23.00per hour to
manually input existing claims and contact information Into Administrators worker's
compensation system. Administrator agrees that in no event shall payment to
Administrator for this initial inputting exceed $ 2,500.
Administrator shall invoice City monthly in advance. City shall process and pay said
invoices as soon as practicable after receipt, in the ordinary course of City business.
ARTICLE 3 — TERM
The term of this Agreement shall commence on February2l,2005and shall end on
July 31, 2005 provided that -
1 . City may terminate this Agreement at any time upon sixty dayS'written notice
to the Administrator. Upon such termination, Administrator shall be entitled to a pro rata
fee based upon work actually accomplished as of the effective date of such termination,
and a final accounting will be made of the fees of Administrator and of any funds belonging
to City in the possession of the Administrator, and any balance due either party will be
promptly paid. Upon termination, pending claim files and lawsuits shall revert to the
control of and become the responsibility of the City.
ARTICLE 4 — INSURANCE
Administrator shall procure and maintain for the duration of this Agreement,
insurance as required below against claims for bodily injuries, property damage or loss that
may arise from or in connection with the performance or non-performance of this
Agreement by Administrator or any of its officers, agents, employees or subcontractors.
City, its governing body, the individuals thereof, and all officers, agents, employees,
representatives and volunteers shall be named as additional insureds on the general
liability policies. A "third party clause" covering the interest of City should be endorsed
onto the crime policy. The coverages shall contain no special limitations on the scope of
protection afforded by City, its governing body, the individuals thereof, and all officers,
agents, employees, representatives, and volunteers. The Administrator shall furnish City
with certificates of insurance and with original endorsements effecting coverage required
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by this Agreement. The certificates and endorsements for each insurance policy are to be
signed by a person authorized by that insurer to bind coverage on its behalf and shall
specifically reference this Agreement. All certificates and endorsements are to be received
and approved by City before work commences. City reserves the right to require complete,
certified copies of all required insurance policies at any time. If any insurance is written
on claims made forms, such insurance shall be endorsed to provide an extended reporting
period of not less than five years following termination of this Agreement- All insurance
shall be placed with insurers admitted in the State of California and having a Best's rating
of no less than ANIL
All certificates of insurance and policies shall state clearly that the City shall be
I notified by registered mail at least thirty (30) days prior to cancellation of the policy for any
reason.
Administrator shall maintain these policies and shall cause all parties supplying
services, labor or materials to maintain the following insurance in amounts not I essthan
those specified in this section.
A. Public Liability and Property Damage Insurance. Administrator shall maintain
commercial general liability insurance in an amount not less than one milliondollars
($ 1,000,000-09 combined single limit for bodily injury and property damage per
occurrence and one milliodollars($ 1, 000, 000. opcombined single limit aggregate which
shall be primary over any other insurance carried by the City, including City's self-insured
retention. Certificates of insurance issued to Administrator shall name the City as an
additional insured.
B. Errors and Omissions Insurance. Administrator shall maintain Errors and
I Omissions Insurance in an amount not less thanone milliondollars ($ 1,,000,000-01.
C. Workers' Compensation Insurance. Administrator shall maintain
I Workers' Compensation insurance in compliance with the laws of the State of California.
D. Blanket Fidelity Bond. Administrator shall maintain a blanket fidelity bond
in an amount not less than one million dollars ($ i, 000, 000. ) with an approved
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corporate surety covering any and all principals, officers, and employees involved in
performance of the Agreement and the trust (imprest) account.
ARTICLE 5 — HOLD HARMLESS/INDEMNIFICATION
A. Administrator agrees to defend, indemnify, save, and hold harmless City, its
governing body, the individuals thereof, and all officers, agents, employees,
representatives, and volunteers from all loss, costs, and expense (including, but not by
way of limitation, attorneys fees and court costs) resulting from any penalty or penalties
assessed by an authorized body pursuant to statutes, rules or regulations governing
workers' compensation claims or arising out of any liability or claim of liability for injury,
damage or loss sustained or claimed to have been sustained arising out of, or incidental
to activities in connection with the furtherance or performance of any provision of this
Agreement. The terms of this Article shall survive termination.
B. Administrator further agrees to waive all rights of subrogation against City.
The provisions of this Article do not apply to loss, cost, and expense (including, but not by
way of limitation, attorneys fees and court costs) resulting from any penalty or penalties
assessed by any authorized body pursuant to laws, rules, or regulations governing
workers' compensation or claims caused solely by the negligence of City or to the extent
that Administrator's act or failure to act was at the specific direction of City.
C- City shall indemnify, hold harmless and defend Administrator, its agents,
employees, officers and directors against any and all loss, damage, fines, liability, costs
and expenses (including, but not limited to, attorney fees, court costs and reasonable
investigative and delivery costs) and other such sums which Administrator, its agents,
servants, employees, officers and/or directors may reasonably pay or become obligated
to pay'on account of acts or negligence of City, its agents or employees, officers or
directors. Administrator agrees to notify City promptly in writing in the event such a claim,
demand, assertion of liability or action is brought to Third Party Administrator's attention.
D. City shall not be liable to Administrator for personal injury of Administrator's
I employees or property damage sustained by Administrator in the performance of the
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services specified in this Agreement.
E. Penalties and assessments arising from the failure of City to provide timely
notice of claims or other such employer obligations as provided under the California
Workers' Compensation Reform Act of 1989, as amended shall be and remain the sole
responsibility of City and City hereby agrees to indemnify, defend, and hold harmless
Administrator for all claims arising from the imposition of such penalties and assessments
resulting from such actions by City. Administrative penalties arising solely from the failure
of Administrator to comply in the timely and proper manner with its duties as the
Administrator %of City's workers' compensation claims shall be and remain the sole
responsibility of Administrator and Administrator hereby agrees to indemnify, defend and
hold harmless City from all claims arising from the imposition of such administrative
penalties.
F. The parties acknowledge that the California Workers'Compensation Reform
Act of 1989 as amended, requires first payment of temporary disability indemnity within
fourteen (14) days of City's knowledge of injury and generally imposes the automatic
penalty of ten (10%) percent of the amount delayed for indemnity payments which shall
be payable directly to the injured employee without application. Furthermore, the parties
agree that unless Administrator is provided with a notice of the claim within seven (7) days
of City's knowledge of the injury, the above -referenced automatic penalty of ten (10%)
percent shall be and remain the sole responsibility of City.
ARTICLE 6 — FINDINGS CONFIDENTIAL
All of the reports, findings and conclusions prepared or assembled by
I Administrator under this Agreement are confidential and Administrator agrees that they
shall not be made available to any individual or organization without prior written approval
of City.
All reports and findings shall become the property of City; however, no
I conclusions, opinions or studies provided by Administrator shall be made available to any
other party except in connection with the original purpose of the assignment, without prior
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written approval of the City.
ARTICLE 7 - NOTICES
Notices pursuant to this Agreement shall be given by United States Postal Service,
postage prepaid, addressed to the parties as follows -
1 City
City of Carson
City Hall
C/o Administrative Services General Manager
701 East Carson Street
Carson, CA 90745
2. Administrator
Marilyn E. Murata, President
CA -ICA, INC.
3547 Voyager Street, Suite 104
Torrance, CA 90503.
Notices shall be deemed given as of the time and date of mailing, if the party
mailing,the notice has complied with the provisions of this Article.
ARTICLE 8 - NON ASSIGNABILITY
Administrator shall not assign any interest in this Agreement and shall not transfer
any interest in the same whether by assignment or novation without prior written approval
of City.
ARTICLE 9 - EQUAL EMPLOYMENT
Administrator agrees that during the performance of this Agreement, it will not
discriminate against any employee or applicant for employment because of race, creed,
color, sex, age, sexual orientation, disability or handicap, religion or national origin.
ARTICLE 10 - GENERAL CONDITIONS
A. This Agreement shall be interpreted in accordance with the laws of the State
of California.
B. This Agreement may be modified or amended only by a written amendment
signed by both parties. No waiver of one or more provisions of this
Agreement shall constitute a waiver of any other provision.
C. In the event Administrator fails to perform in accordance with the
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indemnification and insurance requirements clauses of this Agreement, or
otherwise breaches any other provision of the Agreement, the City shall be
entitled to recover all legal fees, costs, and other expenses incident to
securing performance or incurred as a consequence of nonperformance.
D. While performing the specified services, Third Party Administrator is an
independent contractor and not an officer, agent or employee of the City.
ARTICLE 11 — ATTORNEY'S FEES
If any action at law or in equity, including an action for declaratory relief, is brought
to enforce or interpret the provision of this Agreement, the City shall be entitled to a
reasonable attorney's fee if it prevails, which may be set by the court in the same action
or in a separate action brought for that purpose, in addition to any other relief to which it
may be entitled.
ARTICLE 12 - FORCE MAJEURE
Neither party shall be responsible for the delays orfailures in performance resulting
from acts- beyond the control of such parties. Such acts shall include, but not limited to,
acts of God, strikes, lockouts, riots, acts of war, epidemics, governmental regulations
superimposed after the fact, fire, communication lines failure, earthquakes, or other
disasters.
ARTICLE 13 - APPROPRIATION OF FUNDS
Payments to be made to Administrator by City for services performed within the
current fiscal year are within the current fiscal budget and within an available, unexhausted
and unencumbered appropriation of City- In the event City does not appropriate sufficient
funds for payment of Administrator's services beyond the current fiscal year, this
Agreement shall cover payment for Administrator's services only up to the conclusion of
the last fiscal year in which City appropriates sufficient funds and shall automatically
terminate at the conclusion of such fiscal year.
ARTICLE 14 - ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between the parties and shall
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supersede any other notes, records, memoranda or oral understanding in existence at the
time of execution, as well as all prior and contemporaneous negotiations. In the event of
any conflict between the terms, conditions and provisions of this Agreement and any prior
agreement, document or instrument, the terms, conditions and provisions of this
Agreement shall prevail. The parties agree, that in the event this Agreement is subject to
judicial. or quasi-judicial Interpretation, any such interpretation shall be without regard to
the identity of the party drafting this Agreement.
In witness whereof the parties hereto have executed this Agreement on the date
and year first above written. -.I- -?
I CITY OF
Mayor
,I ATTEST-
t'lly UlelK
APPROVED AS TO FORM:
Wit
I , U y Attorney
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EO
CITY OF CARSON
WORKER'S COMPENSATION CLAIM ADMINISTRATION SERVICES
REQUEST FOR PROPOSALS
For the period July 1, 2005 — June 30, 2008
Prepared by:
fl�di B N
014r,
Ed Holton
Sr. Risk Management Analyst
FEBRUARY 2005
Exhibit "All
REQUEST FOR PROPOSAL
FOR
WORKERS' COMPENSATION
CLAIMS ADMINISTRATOR
A. INTRODUCTIONIBACKGROUND
The City of Carson ("City") is soliciting request for proposals ("RPF") from qualified third
party claim administrators ("TPA") for administration of the City's self-insured worker
compensation program.
The City's Human Resources Division is responsible for management of the City's
worker compensation program, including contract administration of the TPA contract.
The City's Human Resources Division coordinates all aspects of the workers'
compensation program with the TPA. This includes: reporting of injuries; employee
contact; providing lost time and salary information; training for managers, supervisors
and employees; early return to work program; claimant service evaluation and
maintenance of the City's worker compensation claim files.
The City is self-insured for workers' compensation benefits under Certificate Number
7237 and has been self-insured since July 1, 1981. The City maintains a self-insured
retention level of $1 M and excess insurance coverage up to the State statutory limits.
The City's total salaries (excluding benefits) for the 2003-2004 fiscal year was
approximately $25,036,607.
Provided as Exhibit 1, is the City's current loss run summary as of December 31, 2004.
This loss run reflects 102 open claims of which 61 are indemnity.
Provided as Exhibit 2, is the City's Public Self -Insurer's Annual Report for fiscal year
end June 30, 2004.
FISCAL YEAR
YEAR END CLAIMS TOTAL
1999-2000
101
2000-2001
114
2001-2002
ill
2002-2003
141
2003-2004
96
B. SCOPE OF WORK
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The City seeks a third party claim administrator who will be able to meet the following
service objectives:
Claim administration and adjustment of all existing claims, open and closed, and all
new claims during the contract term. Conversion and/orestablishment of loss run data
and transference of claim files from the previous third party claim administrator.
Proposer will indicate in the proposal if there is any fee for conversion of data or transfer
of claim files from the previous third party claim administrator.
Claims administrator shall have a minimum of five (5) years experience administering
claims as a claims administrator and hold a Self -Insurance Certificate or become
certified within one year of inception of the contract. The City shall be notified when the
claims administrator's caseload exceeds 150 open indemnity files at any one time.
Non -City claim files are to be included in the 150 total.
Claims Management Services:
Make initial contact with the employee and establish a claims file within 24 hours of
receipt of the Employers' First Report of Injury for the City. Claim files will be
available for review by the City at anytime during the third party claim administrator's
regular business hours.
Contact City employees to explain Department of Workers' Compensation (DWC)
benefit notices and other required letters and forms. In addition, the claims
administrator will provide guidance and information regarding workers'
compensation benefits to City employees.
Respond to City staff inquiries within twenty hours (24) hours and critical issues on
the same day.
Monitor treatment programs for injured employees to ensure that they receive proper
care and to avoid over treatment situations.
Establish claim reserves and provide a continual review and update of reserves to
reflect changes during the life of the claim.
0 Administer workers' compensation benefits in accordance with the Labor Code.
All penalties incurred because of failure of the TPA to comply with statutory laws
and/or administrative regulations shall be the sole responsibility of the third party
claim administrator.
Maintain accurate and timely loss runs in a format and system acceptable to the
city.
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In accordance with the Labor Code, reduce medical bills, other than medical legal
expenses, based on the Relative Value Schedule (RVS) and recommended rates
set by the Administrative Director, Division of Workers' Compensation.
The City will select defense and subrogation counsel with input from the third party
claim administrator.
The third party claim administrator is responsible for proceeding against responsible
persons, agencies, and/or agents in subrogation actions to recover losses suffered
by the City due to employee injuries.
The City reserves the right to approve, disapprove or select any and all service
providers including medical case managers, rehabilitation counselors, primary
medical treatment in-patient and out patient facilities, physicians, specialists,
chiropractors, legal services, etc.
Investigate and recommend special, outside investigations for questionable claims
with the coordination and assistance of Human Resources.
Provide advance notice and explanation to the Human Resources Division of any
claim for workers' compensation benefits that is contested and maybe denied by the
third party claims administrator.
The City and/or excess insurer reserve the right to conduct an annual independent
Claims Audit paid for by the City and/or excess insurer.
Closing of Claims:
E Maintain closed files in accordance with Labor Code provisions.
All claims files remain the property of the City and will not be disposed of without the
City's prior authorization.
N Close files that meet closing criteria in a timely manner.
Additional Services:
Attend Workers' Compensation Appeals Board hearings, status conferences and
trials along with depositions, conferences with legal defense counsel, and meetings
with City staff as required.
Provide all forms, posters, and pamphlets as required by the Labor Code and the
Administrative Director that are necessary for the processing of claim and benefit
information at your own expense.
M Prepare the Public Entities Self -Insured Annual Report.
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Report all claims meeting the City excess insurance carrier's reporting criteria as
established by the excess insurance carrier.
0 Work with the City's Safety Committee as necessary.
E Demonstrate knowledge of a Early Return to Work Program
Medical Cost Control:
Provide details of medical service cost savings resulting from your Preferred
Provider Network.
N Provide details of medical facility cost savings from your Preferred Provider Network.
Provide details of cost savings from your third party claims administrator operation or
contracted bill review activities.
Litigation:
• Discuss medical control on litigated claims with the City before allowing defense
counsel to select a physician.
• Closely monitor litigation efforts and communicate regularly with the City. The City
must authorize all depositions, investigations and subrosa activities.
• The City must approve settlement authority on all claims.
Prior to any settlement conference, hearing or trial, the claims administrator and
defense counsel will provide a written analysis of the case, including options and
recommendations for settlement. All permanent disability ratings must include the
rating formula and dollar amount.
E Establish controls and procedures to manage and contain claim defense costs.
Financial/Accounting:
A copy of all vouchers created by the claims administrator to pay benefits shall be
provided to the City with supporting documentation.
0 Provide a monthly voucher register of all transactions made for the period.
Data Processing/Loss Reporting:
Provide a computer generated loss run analysis/summary report for each month
covering activity on all new claims reported, open and closed claims for the period.
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This report will be customized to meet City needs and will provide as a minimum,
the following information by claim year:
a) Monthly listing of open claims by department.
b) Monthly listing of open claims alphabetically by claimant.
c) Summaries of all open and closed claims by department and the City as a whole.
d) Special reports on demand, at no additional charge, such as injury analysis by
age, site, occupation, cause, body part, years of service, etc.
Records, File and Transcripts:
All records, files, transcripts, computer tapes, including loss run data files and other
materials related to the management and administration of the City's worker
compensation claims are the property of the City and must be relinquished in good
order and condition upon termination of the contract with the third party claims
administrator.
The City will not pay additional costs or fees for the transfer of such property to the
City or its agent.
Insurance Requirements:
General Liability: $1M combined single limit per occurrence for bodily injury,
personal injury and property damage. City shall be named as an additional insured.
Workers' Compensation and Employer's Liability: Workers' Compensation limits as
required by the Labor Code of the State of California and Employers Liability of $1M
per occurrence. The Contractor's insurer shall agree to waive all rights of
subrogation against the City, its officers, officials, employees and volunteers for
losses arising from work performed by the Contractor for the City.
E Errors and Omissions Liability: $1M combined single limit per occurrence.
0 Professional Liability: $1 M combined single limit per occurrence.
Proposal will include the name of the third party claim administrator's insurance
carrier, the policy coverage and limits, exclusions and expiration dates.
Insurance coverage: Each insurance policy required shall be endorsed to state that
coverage shall not be canceled, except after thirty (30) days' prior written notice by
certified mail, return receipt requested, has been given to the City. All certificates
and endorsements are required to be received and approved by the City before work
commences. The City reserves the right to require complete, certified copies of all
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required insurance policies, including endorsements effecting coverage required by
these specifications at any time.
C. FORM OF PROPOSAL
The following. information states the terms and conditions that will govern the
submission, content, and evaluation of the proposals submitted to the City in response
to this RFP.
Acceptance of Terms and C)nditions
Submission of a proposal pursuant to this RFP shall constitute acknowledgment
and acceptance of all the terms and conditions hereinafter set forth in this RFP
otherwise expressly stated in proposal
2. Ri_qht of Reiecfion b -t-h-e--U-I!Y
Y
Notwithstanding any other provisions of this RFP, the City reserves the right to
reject all proposals and to waive any informality in a proposal when to do so
would be to the advantage of the City or its taxpayers.
3. Financial Re�ij��
The City shall have no financial responsibility for any costs incurred by the
Proposer in responding to this RFP -
4. Award of Contract
The Proposer to whom the contract for any or all of the desired services is
awarded shall be required to enter into a written contract with the City of Carson
in a form approved by the City Attorney. This RFP and the proposal, or any part
thereof, may be incorporated into and made a part of the final contract.
However, the City reserves the right to further negotiate the terms and conditions
of the contract with the selected Propoier.
5. Conference During the Evaluation Period
After the deadline to submit proposals and continuing until a contract has been
awarded, all City personnel involved in the administration of the City's Workers'
Compensation Program will have been specifically directed against holding any
meetings, conferences or technical discussions with any bidder except as
needed for the evaluation of the RFP or as needed in the regular course of
business. Failure to comply with this requirement will automatically terminate
further consideration of that firm or individual's proposal.
6. Adherence to RFE _Format
Responses to this RFP must be made in accordance with the format set forth in
the RFP. .. Failure to adhere to this format may be cause for rejection of the
proposal as being non-responsive.
7. Preparation of Pr)posal
Each proposal will be prepared simply and economically, avoiding the use of
elaborate promotional materials beyond those sufficient to provide a complete,
accurate and reliable presentation.
8. Number of Copies Required
The Proposer must submit six (6) copies of the proposal, including one clearly
marked "ORIGINAL." If discrepancies are found between copies, the "ORIGINAL"
copy will provide the basis for resolving such discrepancies. If one copy of the
proposal is not clearly marked "ORIGINAL" and there is a discrepancy, the City
will reject the proposal.
9. Deadline and Address for Submission
Due Date — The Proposer shall submit three (6) copies of the proposal in a
sealed envelope plainly marked in the upper left-hand corner with the name and
address of the Proposer and the words "Request for Proposal for Workers'
Compensation Claims Administrator." All proposals are due no later than
6:00p.m., March 31, 2005, and should be directed to:
Ed Holton
Sr. Risk Management Analyst
City of Carson
701 E. Carson Street
Carson, CA 90745
10. Proposal Conditions or Limitations
Proposals which impose conditions or limitations to those set forth in this RFP
may be considered not responsive and be rejected.
11. Proposal interpretations and Addenda
Any changes to or interpretation of the RFP will be sent by the City to each firm
or individual to whom an RFP has been sent and any such changes or
interpretations shall become a part of said RFP and may be incorporated into any
contact awarded pursuant thereto. -
12. Execution of Proposals
If the Proposer is a partnership, the proposal must be signed in the name of the
partnership by a General Partner thereof. If the Proposer is a corporation, the
proposal must be signed on behalf of the corporation by two authorized officers
(a Chairperson of the Board, President or Vice -President and a Secretary,
7
Treasurer or Chief Financial Officer) or an officer authorized by the Board of
Directors to execute such documents on behalf of the corporation. All Signatures
above must be original and in ink.
13. Packaging of Proposal
The proposal shall be enclosed in a sealed package(s), marked "Request for
Proposal for a Workers' Compenation Claims Administrator," with the name and
address of the Proposer in the upper left corner.
14. Terms of Withdrawal
All proposals shall be firm offers and may not be withdrawn for a period of one
hundred twenty (120) days following the deadline date for submission of
proposals noted therein.
15. Modification gLEfqpq§�Ll
Any Proposer may modify his proposal by written request any time prior to the
scheduled closing date and time for receipt of proposal, provided such written
request is received by the City prior to said closing time and further provided that
the City receives a full, written confirmation of the written request, such
confirmation having been mailed prior to said closing time.
16. Disposition of Proposals
All proposals submitted in response to this RFP shall become the property of the
City of Carson and a matter of public record. Proposers must identify all
copyrighted material, trade secrets and other proprietary information and the
specific page or pages that the Proposers claim are exempt from the California
Public Records Act (California Government Code Section 6250, et seq.). In the
event a Proposer claims such an exemption, the Proposer is required to state in
the proposal that:
"The proposer will indemnify the City and hold it harmless from any claim
or liability and defend any action brought against the City for its refusal to
disclose copyrighted material, trade secrets, or other proprietary
information to any person making a request therefore."
Failure to include such 'a statement shall constitute a waiver of the proposer's
right to exemption from disclosure.
1*1
IS
D. INSTRUCTIONS FOR THE WRITTEN PROPOSAL
I . Proposals shall be presented on 8 Y2" by 11 " recycled paper made on both sides of
each sheet of paper with no specific page number requirement, other than being
clear and concise.
2. Describe the claim administration firm completing this proposal, including
background and years of experience in workers' compensation claims management
and administration.
3. The Proposer shall spell out the cost of the contract, including any possible "add-on"
charges that may not be included in the fixed price contract fee. For example, bill
review fees.
4. Provide a list of ten of your current and previous clients, including all clients serviced
in the last three years. Provide the company name, telephone number, address,
contact person and number of years servicing the account.
5. Provide your firm's managerial and technical (claim administrator) turnover
percentage for the past three years.
6. Submit samples of any cards, letters, pamphlets, etc. that would be provided to City
employees.
7. Describe your company's mechanism(s) for keeping current with changes in
workers' compensation laws, statutes and regulations.
8. Describe your company's philosophy and procedures for the establishment of case
reserves.
9. Provide a sample of the monthly loss reports you provide to clients.
10. Describe the firm's philosophy regarding. denied and contested claims. What
investigative techniques are in place to defend against these types of claims?
11. Provide procedures, timetable, and costs, if any, for the initial set-up and integration
of the City's claim into your system.
12. Provide the location and address where the City's claim files will be located and
managed.
13. Proposer must quote an annual fee for the three-year contract.
14. Please describe the workers' compensation experience of the staff that will process
the City's workers compensation claims.
QQ
15.The third party claim administrators whose proposals are selected as finalists for
consideration.may be asked to appear, at their own expense, before an evaluation
panel to discuss their proposal.
16. Please describe any services not previously covered which you believe may be of
particular value to the City, such as bill review, provider and facility networks, on-line
access to claims files, litigation management, etc. Also, indicate if additional costs
are associated with any of these services.
17. Please describe your philosophy and experience with Early Return to Work
Programs.
18.The proposal must indicate that the Proposer agrees to be bound by the proposal
and shall enter a contract to provide services in a form approved by the City.
19. The proposal must be valid for 120 calendar days from the final submission date of
the bids.
20. Please provide the biographies of the claims assistant, claims examiner, and claims
supervisor who would be assigned to the City's account.
21. Submit a cover letter that contains the name, title, address and telephone number of
the individual(s) with authority to bind the proposal during the period in which the
City is evaluating the proposal.
22.A principal of the firm shall sign the cover letter or other person fully authorized to
act on behalf of the firm.
23. Provide evidence that the Proposer has a valid Certificate to Administer Self -Insured
Employer claims as set forth in the Labor Code.
24. Samples of loss runs and other compute r-ge nerated reports must accompany the
proposal.
E. SELECTION CRITERIA
The proposal evaluation team (PET) will be responsible for evaluation and ranking the
proposals. The selection criteria to be used to select the successful bidder will include,
but is not limited to, the following:
Established record of consistent professional service and reputation within the
industry.
• Ability to meet the requirements in the Scope of Work section.
• High quality references from public entities, particularly cities.
ift
N Staffing, experience levels and commitment to training.
0 Cost effectiveness of medical and legal cost containment programs.
Overall cost -benefit advantages.
Proposal Evaluation Criteria and Scoring:
Each Proposer will receive a rating of one (1) to five (5) points for each item listed
below; with five (5) being the highest score:
E Cost/Price proposal
0 Personnel qualifications and commitment to training
a References
0 Ability to perform the contract requirements as outlined in the Scope of Work
0 Claim management approach
z Early Return to Work approach
0 Medical and legal cost control approach
F. SELECTION AND CONTRACT NEGOTIATION
The Proposers, whose written proposals are determined to be within the competitive
range by the PET, may be asked to enter contract negotiations. Upon evaluation of the
proposals and outcome of the negotiations, PET will make a recommendation for the
contract award to the City Council.
The City may:
• Reject any or all proposals or make no award.
• Issue subsequent request for proposals.
• Cancel the request for proposal.
• Appoint alternate member(s) of the PET.
• Approve or disapprove the use of particular vendors.
• Establish a short list of Proposers eligible for interviews after review of the written
proposals by the PET and consideration of its recommendations.
11
Modify any requirement contained in the RFP and request revised submittals from
Proposers determined to be within the competitive range.
M Negotiate with any, all, or none of the Proposers.
E Solicit best and final offers from all, some, or none of the Proposers.
0 Award a contract to one or more Proposers.
Accept the written proposal as an offer, without negotiation and issue a notice to
proceed.
H Waive any informality on any proposal.
The RFP does not commit the City to negotiate a contract, nor does it obligate the City
to pay for any costs incurred in preparation and submission of proposals or in
anticipation of a contract.
The City reserves the right to issue a contract with any of the firms responding to this
RFP based solely upon its judgment of the qualifications and capabilities of that firm.
No information related to the results of the RFP process will be released until after the
recommendation by the PET.
Firm's Responsibility:
The Firm selected will appoint and make known to the City the personnel who will be
responsible for all coordination and communication between the City and the successful
third party claim administrator.
Within ten (10) days of the City mailing the Notification of Award of Contract and the
Contract Form, the Proposer shall provide the City with all the required insurance
certificates.
The City reserves the right to investigate the qualifications of all firms under
consideration and to confirm any part of the information furnished by the Proposer.
Moreover, the City may require evidence of managerial, financial or technical
capabilities that are considered necessary for the successful performance of the
contract.
Non -Discrimination — In the performance of this Contract, Contractor shall not
discriminate in recruiting, hiring, promotion, demotion, or termination practices on the
basis of race, religious creed, color, national origin, ancestry, sex, age, physical or
mental disability.
12
Estimated Timetable:
Issuance of the Request for Proposal (RFP)
Deadline for Submission of Proposals
Review of Proposals and TPA Interviews
Date of the Contract Award
Contract Start -Up date
February 16, 2005
March 31, 2005
March 31— May 31, 2005
June 1, 2005
July 1, 2005
Questions concerning this Request for Proposal should be directed to Ed Holton, Senior
Risk Management Analyst, at (310) 952-1700, extension 1160 between the hours of
7:00 a.m. and 6:00 p.m., Monday through Thursday.
13
CITY OF CARSON
AFFIDAVIT OF NON -COLLUSION
The undersigned, as Proposer, declares that this proposal is made without collusion
with any other person, firm or corporation and that the only person or parties interested
as principals are named herein. Having carefully examined the Request for Proposal
for Workers' Compensation Claim Administrator, the Terms and Conditions, we do
hereby propose and agree in event of acceptance hereof, to enter into the required
agreement with the City of Carson.
Dated this day of . 2005,
I certify (or declare) under penalty of perjury
That the foregoing is true and correct.
NAME OF COMPANY
SIGNATURE
TITLE
14
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Exhibit 2
Public Self -insurer's Annual Report
Fiscal Year 2003 - 2004
NOTE. Claim3Administr2tor Page 2
Complete this pagefor AU reports ucept item B Fiscal Year Ending June 30, 2004
EmploymentlWages. which is completed by
Sey'insured employer.
11. CONSOLIDATED LIABILITIES
CcrtiricatcNumbcr: El- - M21 - =
Name of Mastcr Certificate Holder: city of Carson
Type of Report:
ElOriginal Report (Due October I each year) El Interim/Amcnded Report for the Period ofi.
F - ------- I Mmth Day ym to Month Day Yen
4. Total Benchis pain ciuring r x imuj-- , - � --- -------
S. Number of MEDICAL -ONLY cases reported in FY 2003-2004: ....................
6. Number of INDEMNITY cases reported in FY 2003-2004: ........................
7. TOTAL of 5 and 6 (also enter in 2c above): ...............................
8. TOTAL number or open Indemnity cases (all years): ........................
9. Number of Fatality cases reported in FY 2003-2004: ........................
10. (a) Number of FY 2003-2004 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 200 3-2004: ....
(b) Number of non -FY 2003-2004 claims for which the employer or administrator was
notified or representation by an attorney or legal representative In FY 2003-2004: ....
B. TOTAL EMPLOYMENT AND WAGES PAID IN FISCALYEAR 2003-2004
FOR THIS SELF INSURER:
(a) NUMBER OF EMPLOYEES 1017
(Number ofindividual emp!oyces listed on Form DE -6 for year ending June 30,2004)
(b) TOTAL WAGES AND SALARIES PAID S 25,036,607.39
(As repurictl 409, ieim 1-*orm DE. -6 Uite M for it[] four quarlers)
33
26
59
73
0
0
2
Fiscal Year
03/04
Incurred Liability
Paid to Date
Future Liability
Nornba S Indemnity
S Medical
S Indemnity
S Medical
S Indemnity
S Medical
I. C:,c=
W4
to Fy 1999-00
13 686,746
663,143
564,926
545,500
121,820
117,643
2. Op.. & CI -114 C -l":
A. FY I"9 -0Q
Total -
fe0oncd
61
252,330
304,129
236,461
-
281,149
15,869
22,980
NE -111-=
3
16,983
82,000
1,114
59,020
-
It. FY 2000-01
T.W "
1
88
134,947
-
228,975
82,154
171,264
--
52,793
57,711
F 2
Y
an
Cgs= Open
12
102,815
134,705
50,022
77, 439
c. FY 2001-2002
Total cam
r - d
so
182,432
267,535
116,873
232, 370
-
65,559
35,165
FY 001-2002
C�oa qn
5
148,422
113,973
82,863
78,808
d. FY 2002-2003
Total CaVA
ncd
68
426,017
649,823
219,529
466, 421
206,488
183,402
C"cs.r.n
24
414,456
594,464
207,960
411,062
FY 2003.2W4
ToW cws
t d
59
211,595
287,684
56,948
89, 639
154,647
190,04r,
.Z2
39
211, 510
273,239
56,871
75,194
SUBTOTAL
3. ESTTMATED FUTURE LIABILITY (Indemnity plus . Medical) TOTAL
S Indemnity S Medical
617,176 614,946
1,232,122
---
S Indemnity S Mcdicall
261,2981 661,626
4. Total Benchis pain ciuring r x imuj-- , - � --- -------
S. Number of MEDICAL -ONLY cases reported in FY 2003-2004: ....................
6. Number of INDEMNITY cases reported in FY 2003-2004: ........................
7. TOTAL of 5 and 6 (also enter in 2c above): ...............................
8. TOTAL number or open Indemnity cases (all years): ........................
9. Number of Fatality cases reported in FY 2003-2004: ........................
10. (a) Number of FY 2003-2004 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 200 3-2004: ....
(b) Number of non -FY 2003-2004 claims for which the employer or administrator was
notified or representation by an attorney or legal representative In FY 2003-2004: ....
B. TOTAL EMPLOYMENT AND WAGES PAID IN FISCALYEAR 2003-2004
FOR THIS SELF INSURER:
(a) NUMBER OF EMPLOYEES 1017
(Number ofindividual emp!oyces listed on Form DE -6 for year ending June 30,2004)
(b) TOTAL WAGES AND SALARIES PAID S 25,036,607.39
(As repurictl 409, ieim 1-*orm DE. -6 Uite M for it[] four quarlers)
33
26
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Fiscal Year
03/04
City of Carson
Report to Mayor and City Council
February 15, 2005
New Business Consent
SUBJECT: AWARD OF INTERIM WORKERS' COMPENSATION THIRD PARTY
ADMINISTRATOR CONTRACT
Sub i ed b acquellyn Acosta Appro�`A�erWKe G. Groomes
I IV V
Ad�' ' istrati e Services General Manager City Manager
1. SUMMARY
The City has been self-insured for its Workers' Compensation Program since
July 1, 1981. The City has contracted its workers' compensation claims
administration with Fleming and Associates, a Third Party Administrator (TPA).
Fleming and Associates plans to cease operations on February 18, 2005. The
City plans to issue a Request for Proposal (RFP) for Third Party Claims
Administration services in the next 30 days. The RFP process may take up to
six months to complete. Consequently, the City will need to obtain an interim
TPA to provide claim administration services until a new TPA can be selected.
11. RECOMMENDATION
TAKE the following actions:
1. AWARD an interim TPA contract to Integrated Claims Administrators, Inc.
(CA -ICA) on a month-to-month basis pending completion of the RFP
process.
2. AUTHORIZE staff to release the attached Request for Proposal for
Workers' Compensation Third Party Claims Administration services.
III. ALTERNATIVES
None
IV. BACKGROUND
Fleming and Associates contracted with the City to provide claims administration
services through June 30, 2006. However, Fleming and Associates notified the
City on January 24, 2005 that the firm plans to close its Southern California
operation on February 18, 2005. The City needs to complete the RFP process to
find a new TPA, but the RFP process may take up to six months to complete.
Therefore, the City needs to find an interim' TPA to provide claims
administration services until the RFP process can be completed. The interim
TPA contract will be on a month-to-month basis.
Integrated Claims Administrators, Inc. (CA -ICA) is willing to assume the Cityl(o a
City of Carson Report to Mayor and City Council
February 15, 2005
claims under Fleming and Associates contract pricing. The current pricing is
$6,500 per month. There is an additional fee of $23 per hour, up to a maximum
of $2,500, to input the City's current claim data into the CA -ICA computer
system.
Due to the short notice given by Fleming and Associates, staff does not have
time to research multiple TPAs to provide the interim claims administration
service. References contacted by staff found that CA -ICA provides very good
claim administration service.
According to CA -ICA clients, i.e., Pomona Unified School District, Western
Waste Industries, Shepherd and Angelus Block, they provide timely response to
calls and requests for information, have a state-of-the-art computer system,
claims administration staff with public entity experience and a return to work
program. CA -ICA will allow the City to continue to use its own bill review and
legal vendors. Use of City vendors is important for cost control.
V. FISCAL IMPACT
Funds for the interim TPA contract are available in the FY 2004/05 Human
Resources -Workers' Compensation budget in account number 01-60-690-003-
6005.
V1. EXHIBITS EXHIBITS 2 & 3 UNDERSEPARATE COVER
1 .
2.
3.
DocumentlO
Prepared by:
sf:Rev061902
Reviewed bv:
Fleming & Associates Contract Cancellation letter (pages 1-2)
CA -ICA interim contract (pages 3-13)
Request for Proposal Third Party Claim administrator (pages 14-43)
Ed Holton, Sr. Risk Management Analyst -
City Clerk
City Treasurer
Administrative Services
Develppment Services
I
Economic Development Services
Public Services
Action taken by City Council
CiC-3r-)=C:;
Ment
January 20, 2005
Ed Holton
City of Carson
701 E. Carson Street
Carson, CA 90745
Re: WC Contract Cancellation
Dear Mr. Holton:
After nearly twenty-nine years of service to the self insured industry, it is with mixed
emotions that we announce the cessation of our claims administration services. All of us
at Fleming & Associates have been privileged in serving the City of Carson.
There are several factors that have led to this decision. First, we all realize that cutting
edge data technology is required to not only meet the informational needs of all clients,
but also to track the �myriad complex components that comprise the workers'
compensation system. In the early 1980s, we designed and created our own proprietary
system that was state of the art. While the system served us and our licensees well for
nearly 20 years, it could not compete with web -based systems in the marketplace.
Two years ago we began developing a web -based system that could respond to all
foreseeable state, client and internal requirements. However, changing rules and
regulations frustrated the process. This resulted in continuous time and cost overruns.
The ongoing investment cannot be supported by our current fee structure (We had
decided to not increase fees until we had a product that would justify such.). But with the
completion date constantly being pushed forward, we have concluded that the entire
project has become an unsustainable financial challenge.
Having been in the claims industry since the 1960s and being a part of Fleming &
Associates since 1976, retirement has crossed my mind a time or two. The decision was
made to sell the Company, which was nearly consummated. But before a final agreement
could be negotiated, word of the transaction was unfortunately made public, resulting in
some staff departures, various rumors, and keen competitive interest in our client base.
While we have added new stafl� we have been faced with incurring Temp Agency costs,
which are at a minimum $48 per hour ($99,840 per year) for examiners. To further
aggravate the problem, we have not generally been satisfied with the use of "temps" in
the past. But even if we -were fortunate to locate effective temps, it would take them 3
months to learn their caseload, only to have the permanent replacement go through a
similar learning curve before claims could be effectively handled, which is not in our
client's best interest.
4250 Pennsgivania Avenue. l5lenclale. CallFornia 91214
Telephone: [8181 249-1999 Facsimile: [818] 249-7951
wvvw.FlemingA5sociates.net
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After nearly twenty-nine years of service to the self insured industry, it is with mixed
emotions that we announce the cessation of our claims administration services. All of us
at Fleming & Associates have been privileged in serving the City of Carson.
There are several factors that have led to this decision. First, we all realize that cutting
edge data technology is required to not only meet the informational needs of all clients,
but also to track the �myriad complex components that comprise the workers'
compensation system. In the early 1980s, we designed and created our own proprietary
system that was state of the art. While the system served us and our licensees well for
nearly 20 years, it could not compete with web -based systems in the marketplace.
Two years ago we began developing a web -based system that could respond to all
foreseeable state, client and internal requirements. However, changing rules and
regulations frustrated the process. This resulted in continuous time and cost overruns.
The ongoing investment cannot be supported by our current fee structure (We had
decided to not increase fees until we had a product that would justify such.). But with the
completion date constantly being pushed forward, we have concluded that the entire
project has become an unsustainable financial challenge.
Having been in the claims industry since the 1960s and being a part of Fleming &
Associates since 1976, retirement has crossed my mind a time or two. The decision was
made to sell the Company, which was nearly consummated. But before a final agreement
could be negotiated, word of the transaction was unfortunately made public, resulting in
some staff departures, various rumors, and keen competitive interest in our client base.
While we have added new stafl� we have been faced with incurring Temp Agency costs,
which are at a minimum $48 per hour ($99,840 per year) for examiners. To further
aggravate the problem, we have not generally been satisfied with the use of "temps" in
the past. But even if we -were fortunate to locate effective temps, it would take them 3
months to learn their caseload, only to have the permanent replacement go through a
similar learning curve before claims could be effectively handled, which is not in our
client's best interest.
4250 Pennsgivania Avenue. l5lenclale. CallFornia 91214
Telephone: [8181 249-1999 Facsimile: [818] 249-7951
wvvw.FlemingA5sociates.net
It is with deep regret that effective February 18, 2005, Fleming & Associates will cease
operating as a TPA. In an effort to ensure continuity of service for your claims program
we have found that ICA, SCRMA and Dynamic Claims Systems can offer an effective
PMS system and qualified staff who are eager to assume your claims program as soon as
practical and can meet the same contractual terms., Choosing one of them will allow you
to verify their credentials without being pressed to immed . iately go out to bid.
I sincerely apologize for any disappointment this news may bring to you. However, it is
best for all parties concerned.
Sincerely,
Ed Fleming, CEd
Fleming & Associates
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AGREEMENT NO. 05 -
This Agreement is made and entered into this 15th dayof February 2005by
and between City of CarsD'U a municipal corporation, hereinp-fter referred to
as 'Cit)r, and CA -ICA, INC., a California corporation, hereinafter leferred to as
"Administrator', with its principal place of business located at 3547 Voyager Street, Suite
104, Torrance, California 90503.
WHEREAS, City is self-insured in the area of its liability tunder the Workers'
Compensation Laws of the State of California-, and
WHEREAS, City has been informed that its prior Claims Administrcitor Fleming &
Associateg will be closing its California offices,on or about February -14� 2005 and no
longer able to assist the City-, and
WHEREAS, City anticipates issuing or participating in a request for proposals ("the
RFP process") for workers'compensation claims administration pnor to the end of calendar
year 2005; and
WHEREAS, Administrator represents itself as being capable and qualified to
provide such services in a manner commensurate with the highest professi�:)nal standards
and in accordance with all applicable legal standards-,
NOW, THEREFORE, IN CONSIDERATION OF THESE PREMISES, THE PARTIES
HERETO AGREE AS FOLLOWS -
ARTICLE 1 — SCOPE OF SERVICE
A. Administrator agrees to perform all services required to be performed as
specified and in the manner provided for in City's Requestfor Proposal - (Exhibit 'W).
In the event of any conflict between this Agreement and the terms and cond tions of Exhibit
'A" the terms and conditions of this Agreement shall prevail.
B. Claims Administration -
Administrator shall perform all services required to resolve claims
arising from Citys self-insured workers' compensation program and
No. 2,
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to act as representative for City in all matters relating to Citys
obligations under the Workers' Compensation laws of the State of
California. Such services shall include, but are nol limited to, the
following, claims administration services; program administration
services; medical management services; litigation management
7 7
services; and management information services more particularly set
forth herein after and pursuant to City satisfaction and in accordance
with state law and industry standards.
(a) When appropriate, refer litigated cases to attDrneys utilizing
the City defense panel, assist in the preparation of litigated
cases and negotiations of settlements arid subrogation
actions -
(b) Notification to Citys excess workers' compea5ation carrier of
all claims which meet the reporting requirements of the carrier -
Maintain fiaison between the carrier and C ity on matters
affecting the adjusting of such claims.
(c) Maintain close contact with treating physicians to assure that:
(1) employees receive proper medical treatment.
(2) avoid over treatment situations -
(3) are provided transitional duty when appropriate, and
(4) are returned to full employment at the earliest possible
date,
(d) Administrator shall contact by telephone all indemnity
claimants within 24 hours of report of the claim to
Administrator.
(e) Administrator shall appraise City of majo- developments
arising in the investigation, adjustment and seldement of
significant claims- City agrees that the terms amajor
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developments" and 'significant claimsm as Used in this Articl(
are solely defined within Administrators discrIation.
2- Program Administration:
(a) Assist City in the development of rules, Procedure�; and practices
involving employee injuries,
(b) Attend City Council meetings if requested.
(c) Provide a claim review meeting with the City monlhly. Provide a
written claim summary of all cases to be discus*;ed at least one week
prior to the meeting.
(d) Coordinate all temporary disability payments in coordination With the
City's salary continuance and benefit plans -
(e) Provide City with necessary or required Workers' Compensation
forms and provide necessary advice and guidance 9's to the proper
utilization of these forms- As necessary, peovide training to City staff
on the use of these forms.
(f) At least once per year and as requested. Provide staf, � training on the
Workers' Compensation system and related topics.
(9) Keep City informed of new legislation, regulaticns, and other
information Pertinent to Workers' Compensation -
(h) City or any agent thereof shall have reasonable right.,; during normal
business hours and upon reasonable notice to insp:mt or audit the
records pertaining to any claim for which services are provided under
the Agreement provided that City shall reimburse Adm nistratorfor the
cost of making such records available for any audit undertaken by
City more frequently than once each year during the te rm hereof. Any
such inspection or audit shall be conducted in a manner so as to not
unnecessarily interfere with the business of Administrator-
3- Management Information Systems.
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(2) Provide City vAth monthly reports itemizing monthly expenditures
reserve status, claim inventory status, claim costs, and potentia
subrogation recovery in a format approved by City.
(b) Prepare and provide to the City no later than February 1 st of each
year the Annual OSHA Log Summary, including not fication to post
during the month of February.
(c) Prepare and provide to City no later than September 1 of each year
the Self -insurer's Annual Report.
(d) Upon request of the City, provide on-line access to the Administrator
system, including training in its use at no additional charge- The cost
of the computer and the telephone time to be borne by the City.
(e) Provide 1099 forms to all appropriate vendors no fator than January
31st of each year as required by the Internal RevenUe Service.
(f) Administrator shall provide computer back-up off site Lpdatedweekly.
C. Administrator and City agree to operate and administer the trust account t
be used for the payment or benefits to employees in accordance with te procedures'
mutually agreed upon and subject to the Workers' Compensation Laws of the State of
California.
D- AdMinistrator agrees to assign the work involved only to persons who are
specially trained, experienced and competent in the administration oF public sector
workers, compensation claims. In conjunction therewith, City shall have the right,
reasonably exercised, to direct Administrator not to use persons who, in th a opinion of the
City, are not so specially trained, experienced and competent to render the required
services.
ARTICLE 2 — COMPENSATION
City agrees to Pay and Administrator agrees to accept as componsation for its
;erVices, the sum ' of $ 7-8-�.000 annually, for Services rendered for all new claims, as
iell as services on all existing claims continued from or assumed for pricr years,
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Additionally, City agrees to Pay Administrator at the rate Of $ * 23. 00per hour tc
manually input existing claims and contact information into Administrator's worker's
compensation system. Administrator agrees that in no event shall payment to
Administrator for this initial inputting exceed $ 2, 500.
Administrator shall invoice City monthly in advance. City shall process and pay said
invoices as soon as practicable after receipt, in the ordinary course of City business.
ARTICLE 3 — TERM
The term of this Agreement shall commence on February2l,2.003 arid shall end on
JulY.31, 2005 -providedthat-
1. City may terminate this Agreement at any time upon sixty day3'wriften notice
to the Administrator. Upon such termination, Administrator shall be entitled to a pro rata
fee based upon work actually accomplished as of the effective daie of such termination,
land a firial accounting will be made of the fees of Administrator and of any f inds belonging
to City in the Possession of the Administrator, and any balance due either party mfill be
Promptly Paid. Upon termination, pending claim files and lawsuits sheill revert to the
control of and become the responsibility of the City.
ARTICLE 4 — INSURANCE
Administrator shall Procure and maintain for the duration of this Agreement,
insurance as required below against claimsfor bodily injuries, property darpage or lossthat
may arise from or in connection with the performance or non-performance of this
Agreement by Administrator or any of its officers ' agents, employees or subcontractors.
City, its governing body, the fndividuals thereof, and all officers, agerds. employees,
representatives and volunteers shall be named as additional insureds Dn the general
liability Policies- A "third party clause" covering the interest of City shou d be endorsed
Dnto the crime policy- The coverages shall contain no special limitations on the scope of
Drotection afforded by City, its governing body, the individuals thereof, and all officers,
igents, employees, representatives, and volunteers. The Administrator shall furnish City
vith certificates of insurance and with original endorsements effecting coy erage required
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by this Agreement. The certificates and endorsements for each insurance policy are to bf
signed by a person authorized by that insurer to bind coverage on its behalf and shal
specifically reference this Agreement. All certificates and endorsements areto be receivec
and approved by City before work commences. City reserves the right to require complete,
certified copies of all required insurance Policies at any time. If any insurance is written
on claims made forms, such insurance shall be endorsed to provide an extended reporting
period of not less than five years following termination of this Agreement Allinsurance
shall be placed with insurers admitted in the State of California and having a Best's rating
Of no less than A. -VII.
All certificates of insurance and policies shall state clearly that the City shall be
notified by registered mail at least thirty (30) days prior to cancellation of the Policy for any
reason.
Administrator shall maintain these policies and shall cause all Parties supplying
services, labor or materials to maintain the following insurance in amounis not less than
those specified in this section.
A. Public Liability and Property Damage Insurance- Administrator shall maintain
commercial general liability insurance in an amount not less than one mi.1liandollars
($ 1,000,000 -OP combined single limit for bodily injury and properh, damage per
occurrence and one m:Uliodollars ($''l, 000. 000. OPcombined single limit aggregatewhich
shall be primary over any other insurance carried by the City, including Cit"t's self-insured
retention. Certificates of insurance issued to Admin istrator shall name . the City as an
additional insured.
B. Errors and Omissions Insurance. Administrator shall mainfain Errors and
Dmissions Insurance in an amount not less thanone milliondollars ($ I., jOO., 000. 00.
C- Workers' Compensation Insurance. Administrator shall maintain
Vorkers' Compensation insurance in compliance vAth the laws of the State of California.
D- Blanket Fidelity Bond- Administrator shall maintain a blan:�et fidelity bond
i an amount not less than one million dollars ($1, 000, 000.) wit.h an approved
6 A\
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Corporate suretY covering any and all principals, officers, and employpes involved ir
performance of the Agreement and the trust (iMprest) account.
ARTICLE 5 — HOLD HARMLESS/INDEMNIFICATION
A Administrator agrees to defend, indemnify, save and hold harmless City, its
governing body, the individuals thereof, and all officers, agent3, employees,
representatives, and volunteers from all loss, costs, and expense (including, but not by
Way Of limitation, attorneys fees and court costs) resulting from any penalty or penalties
assessed by an authorized body- pursuant to statutes, rules or (egulations governing
workers' compensation claims or arising out of any liability or claim of licibility for injury,
damage or loss sustained or claimed to have been sustained arising Out of, or incidental
to activities in connection with the furtherance or performance of any provision of this
Agreement. The terms of this Article shall survive termination.
8- Administrator further agrees to waive all rights of subrogation against City.
The provisions of this Article do not apply to loss, cost, and expense (inclu Jing, but not by
Way Of limitation, attorneys fees and court costs) resulting from any penalty or penalties
assessed by any authorized body pursuant to laws, rules, or regulat.ons governing
workers' compensation or claims caused solely by the negligence Of City or to the extent
that Administrator's act or failure to act was at the specific direction of Cify.
C- City shall indemnify, hold harmless and defend Administrator, its agents,
employees, officers and directors against any and all loss, damage, finex-, liability, costs
and expenses (including, but not limited to, attorney fees, court costs end reasonable
investigative and delivery costs) and other such sums which Administrc-4or, its agents,
servants, employees, officers and/or directors may reasonably pay or beco me obligated
to pay' on account of acts or negligence of City, its agents or emploYms, officers or
directors. Administrator agrees to notify City promptly in writing in the event such a claim,
Jemand, assertion of liability or action is brought to Third Party Administrator's attention.
D. City shall not be liable to Administrator for personal injury of Administrator's
)mployees or property damage sustained by Administrator in the Perkmance of the
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services specified in this Agreement -
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E. Penalties and assessments arising from the failure of City to provide timely
notice of claims or other such employer obligations as p m-vided under the Calibmia
Workers' Compensation Reform Act of 1989, as amended shall be and r3main the sole
responsibility of City and City hereby agrees to indemnify, defend, and hold harmless
Administrator for all claims arising fmm the imposition of such penalties and assessments
resulting from such actions by City- Administrative penalties arising solely from the failure
of Administrator to comply in the timely and proper manner with its duties as the
Administrator, of Citys workers' compensation claims shall be and remain the sole
responsibility of Administrator and Administrator hereby agrees to indemnify, defend and
hold harmless City from all claims arising from the imposition of such administrative
penalties.
F. The parties acknowledge thatthe California Workers, Compensation Reform
Art of 1989 as amended, requires first payment of temporary 6isability indemnity Within
fourteen (14) days Of City's knowledge of injury and generally imposes the automatic
penalty of ten (10%) percent of the amount delayed for indemnity payments which shall
be payable directly to the injured employee without application- Furthermore, the parties
agree that unless Administrator is provided with a notice of the claim within seven (7) days
of City's knowledge of the injury, the above -referenced automatic'penall y of ten (10%)
percent shall be and remain the sole responsibility of City,
. . ARTICLE 6 — FINDINGS CONFIDENTIAL
All of the reports, findings and conclusions prepared or assembled by
Administrator under this Agreement are confidential and Administrator agrees that they
shall not be made available to any individual ororganization without prioryrritten approval
of City.
All reports and findings shall become the property of Cit�r; however, no
conclusions, opinions or studies provided by Administrator shall be made available to any
Dther Party except in connection with the original purpose of the assignment, without prior
�-J
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written approval of the City -
ARTICLE 7 - NOTICES
Notices pursuant to this Agreement shall be given by United States Postal Service,
postage prepaid, addressed to the parties as follows -
C2
IV
C1 y Of Carson
City Hall'
C/O Administrative Services General Manager
701 East Carson S.trLiet
Car8oni CA, 90745
2. Administrator
Marilyn E_ Murata, President
CA -ICA, INC -
3547 Voyager Street, Suite 1 G4
Torrance, CA 90503.
Notices shall be deemed given as of the time and date 'of maik-ig, if the party
mailing -the notice has complied with the provisions of this Article.
ARTICLE 8 - NON ASSIGNABILITY
Administrator shall not assign any interest in this Agreement and shall not transfer
any interest in the same whether by assignment or novation Without prior written approval
of City.
ARTICLE 9 - EQUAL EMPLOYMENT
Administrator agrees that during the performance of this Agreement, it will not
discriminate against any employee or applicant for employment because of race, creed,
color, sex, age, sexual orientation, disability or handicap, religion or natkinal origin.
ARTICLE 10 - GENERAL CONDITIONS
A. This Agreement shall be interpreted in accordance with the kiws of the State
of California.
13- This Agreement may be modified or amended only by a written amendment
signed by both parties. No waiver of one or more provisions of this
Agreement shall constitute a waiver of any other provision -
C. In the event Administrator fails to perform in accordance With the
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indemnification and insurance requirements clauses of this Agreement, or
otherwise breaches any other provision of the Agreement. tle City shall be
entitled to recover all legal fees, costs, and other expenses incident to
securing performance or incurred as a consequence of norperformance.
D- While performing the specified services, Third Party Administrator is an
independent contractor and not an officer, agent or employDe of the City,
ARTICLE I I — ATTORNEY'S FEES
If any action at law or in equity, including an action for declaratory relief, is brought
to enforce or interpret the provision of this Agreement, the City shall be entitled to a
reasonable aftomey's fee if it prevails, which may be set by the court in the same action
or in a separate action brought for that purpose, in addition to any other relief to which it
may be entitled -
ARTICLE 12 - FORCE MAJEURE
Neitherparty shall be responsible for the delays orfailures in performance resulting
from acts,beyond the control of such parties. Such acts shall include, bLt not limited to,
acts of God, strikes, lockouts, riots, acts of war, epidemics, governmental regulations
superimposed after the fact, fire, communication lines failure, earthquakes, or other
disasters.
ARTICLE 13 - APPROPRIATION OF FUNDS
Payments to be made to Administrator by City for services performed within the
currentfiscal year are within the currentfiscal budget andwithin an availablia, unexhausted
and unencumbered appropriation of City- In the event City does not appropriate sufficient
funds for payment of Administrator's services beyond the current fiscal year, this
Agreement shall cover Payment for Administrator's services only up to the conclusion of
the last fiscal year in which City appropriates sufficient funds and shall automatically
terminate at the conclusion of such fiscal year.
ARTICLE 14 - ENTIRE AGREEMENT
This Agreement constitutes the entire agreement between the Parties and shall
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supersede any other notes, records, memoranda or oral understanding in existence at the
time of execution, as well as all prior and contemporaneous negotiations. In the event of
any conflict between the terms, conditions and provisions of this AgrOeme nt and any prior
agreement document or instrument, the terms, conditions and prc-visions of this
Agreement shall prevail. The parties agree, that in the event this Agreement is subject to
judicial or quasi-judicial interpretation, any such interpretation shall be without regard to
the identity of the party drafting this Agreement.
In witness whereof the parties hereto have executed this Agreerrent on the date
and year first above written -
I CITY O`F
1.4 - ymayor—
ATTEST
City UFeTr—
APPROVED AS TO FORM-
. City Attorn—ey
11
CA -ICA, INC.
Marilyn L. Murata, PresicFe–nUCEO
CITY OF CARSON
WORKER'S COMPENSATION CLAIM ADMINISTRATION SERVICES
REQUEST FOR PROPOSALS
For the period July 1, 2005 — June 30, 2008
Prepared by:
Ed Holton
Sr. Risk Management Analyst
FEBRUARY 2005
F, Y,(+, *0 - -5 Am
REQUEST FOR PROPOSAL
FOR
WORKERS' COMPENSATION
CLAIMS ADMINISTRATOR
A. INTRODUCTION/BACKGROUND
The City of Carson ("City") is soliciting request for proposals ("RPF") from qualified third
party claim administrators ("TPA") for administration of the City's self-insured worker
compensation program.
The City's Human Resources Division is responsible for management of the City's
worker compensation program, including contract administration of the TPA contract.
The City's Human Resources Division coordinates all aspects of the workers'
compensation program with the TPA. This includes: reporting of injuries; employee
contact; providing lost time and salary information; training for managers, supervisors
and employees; early return to work program; claimant service evaluation and
maintenance of the City's worker compensation claim files.
The City is self-insured for workers' compensation benefits under Certificate Number
7237 and has been self-insured since July 1, 1981. The City maintains a self-insured
retention level of $1 M and excess insurance coverage up to the State statutory limits.
The City's total salaries (excluding benefits) for the 2003-2004 fiscal year was
approximately $25,036,607.
Provided as Exhibit 1, is the City's current loss run summary as of December 31, 2004.
This loss run reflects 102 open claims of which 61 are indemnity.
Provided as Exhibit 2, is the City's Public Self -Insurer's Annual Report for fiscal year
end June 30, 2004.
FISCAL YEAR
YEAR END CLAIMS TOTAL
1999-2000
101
2000-2001
114
2001-2002
ill
2002-2003
141
2003-2004
96
B. SCOPE OF WORK
The City seeks a third party claim administrator who will be able to meet the following
service objectives:
Claim administration and adjustment of all existing claims, open and closed, and all
new claims during the contract term. Conversion and/or establishment of loss run data
and transference of claim files from the previous third party claim administrator.
Proposer will indicate in the proposal if there is any fee for conversion of data or transfer'
of claim files from the previous third party claim administrator.
Claims administrator shall have a minimum of five (5) years experience administering
claims as a claims administrator and hold a Self -Insurance Certificate or become
certified within one year of inception of the contract. The City shall be notified when the
claims administrator's caseload exceeds 150 open indemnity files at any one time.
Non -City claim files are to be included in the 150 total.
Claims Management Services:
Make initial contact with the employee and establish a claims file within 24 hours of
receipt of the Employers' First Report of Injury for the City. Claim files will be
available for review by the City at anytime during the third party claim administrator's
regular business hours.
Contact City employees to explain Department of Workers' Compensation (DWC)
benefit notices and other required letters and forms. In addition, the claims
administrator will provide guidance and information regarding workers'
compensation benefits to City employees.
Respond to City staff inquiries within twenty hours (24) hours and critical issues on
the same day.
Monitor treatment programs for injured employees to ensure that they receive proper
care and to avoid over treatment situations.
Establish claim reserves and provide a continual review and update of reserves to
reflect changes during the life of the claim.
0 Administer workers' compensation benefits in accordance with the Labor Code.
All penalties incurred because of failure of the TPA to comply with statutory laws
and/or administrative regulations shall be the sole responsibility of the third party
claim administrator.
Maintain accurate and timely loss runs in a format and system acceptable to the
city.
"A010
In accordance with the Labor Code, reduce medical bills, other than medical legal
expenses, based on the Relative Value Schedule (RVS) and recommended rates
set by the Administrative Director, Division of Workers' Compensation.
The City will select defense and subrogation counsel with input from the third party
claim administrator.
The third party claim administrator is responsible for proceeding against responsible
persons, agencies, and/or agents in subrogation actions to recover losses suffered
by the City due to employee injuries.
The City reserves the right to approve, disapprove or select any and all service
providers including medical case managers, rehabilitation counselors, primary
medical treatment in-patient and out patient facilities, physicians, specialists,
chiropractors, legal services, etc.
Investigate and recommend special, outside investigations for questionable claims
with the coordination and assistance of Human Resources.
Provide advance notice and explanation to the Human Resources Division of any
claim for workers' compensation benefits that is contested and maybe denied by the
third party claims administrator.
The City and/or excess insurer reserve the right to conduct an annual independent
Claims Audit paid for by the City and/or excess insurer.
Closing of Claims:
N Maintain closed files in accordance with Labor Code provisions.
All claims files remain the property of the City and will not be disposed of without the
City's prior authorization.
N Close files that meet closing criteria in a timely manner.
Additional Services:
Attend Workers' Compensation Appeals Board hearings, status conferences and
trials along with depositions, conferences with legal defense counsel, and meetings
with City staff as required.
Provide all forms, posters, and pamphlets as required by the Labor Code and the
Administrative Director that are necessary for the processing of claim and benefit
information at your own expense.
0 Prepare the Public Entities Self -Insured Annual Report.
in
Report all claims meeting the City excess insurance carrier's reporting criteria as
established by the excess insurance carrier.
E Work with the City's Safety Committee as necessary.
N Demonstrate knowledge of a.Early Return to Work Program
Medical Cost Control:
Provide details of medical service cost savings resulting from your Preferred
Provider Network.
• Provide details of medical facility cost savings from your Preferred Provider Network.
• Provide details of cost savings from your third party claims administrator operation or
contracted bill review activities.
Litigation:
Discuss medical control on litigated claims with the City before allowing defense
counsel to select a physician.
E Closely monitor litigation efforts and communicate regularly with the City. The City
must authorize all depositions, investigations and subrosa activities.
X The City must approve settlement authority on all claims.
Prior to any settlement conference, hearing or trial, the claims administrator and
defense counsel will provide a written analysis of the case, including options and
recommendations for settlement. All permanent disability ratings must include the
rating formula and dollar amount.
N Establish controls and procedures to manage and contain claim defense costs.
Financial/Accounting:
A copy of all vouchers created by the claims administrator to pay benefits shall be
provided to the City with supporting documentation.
0 Provide a monthly voucher register of all transactions made for the period.
Data Processing/Loss Reporting:
Provide a computer generated loss run analysis/summary report for each month
covering activity on all new claims reported, open and closed claims for the period.
Z If\,
This report will be customized to meet City needs and will provide as a minimum,
the following information by claim year:
a) Monthly listing of open claims by department.
b) Monthly listing of open claims alphabetically by claimant.
c) Summaries of all open and closed claims by department and the City as a whole.
d) Special reports on demand, at no additional charge, such as injury analysis by
age, site, occupation, cause, body part, years of service, etc.
Records, File and Transcripts:
All records, files, transcripts, computer tapes, including loss run data files and other
materials related to the management and administration of the City's worker
compensation claims are the property of the City and must be relinquished in good
order and condition upon termination of the contract with the third party claims
administrator.
The City will not pay additional costs or fees for the transfer of such property to the
City or its agent.
Insurance Requirements:
General Liability: $1M combined single limit per occurrence for bodily injury,
personal injury and property damage. City shall be named as an additional insured.
Workers' Compensation and Employers Liability: Workers' Compensation limits as
required by the Labor Code of the State of California and Employers Liability of $JM
per occurrence. The Contractor's insurer shall agree to waive all rights of
subrogation against the City, its officers, officials, employees and volunteers for
losses arising from work performed by the Contractor for the City.
0 Errors and Omissions Liability: $1 M combined single limit per occurrence.
0 Professional Liability: $1 M combined single limit per occurrence.
Proposal will include the name of the third party claim administrators insurance
carrier, the policy coverage and limits, exclusions and expiration dates.
Insurance coverage: Each insurance policy required shall be endorsed to state that
coverage shall not be canceled, except after thirty (30) days' prior written notice by
certified mail, return receipt requested, has been given to the City. All certificates
and endorsements are required to be received and approved by the City before work
commences. The City reserves the right to require complete, certified copies of all
ri-I
required insurance policies, including endorsements effecting coverage required by
these specifications at any time.
C. FORM OF PROPOSAL
The following information states the terms and conditions that will govern the
submission, content, and evaluation of the proposals submitted- to the City in response
to this RFP.
Acceptance of Terms and Conditions
Submission of a proposal pursuant to this RFP shall constitute acknowledgment
and acceptance of all the terms and conditions hereinafter set forth in this RFP
otherwise expressly stated in proposal
2. Rip t of Reiection by the City
Notwithstanding any other provisions of this RFP, the City reserves the right to
reject all proposals and to waive any informality in a proposal when to do so
would be to the advantage of the City or its taxpayers.
3. Financial Re-----ibilitv
The City shall have no financial responsibility for any costs incurred by the
Proposer in responding to this RFP. -
4. Awa d of Contract
The Proposer to whom the contract for any or all of the desired services is
awarded shall be required to enter into a written contract with the City of Carson
in a form approved by the City Attorney. This RFP and the proposal, or any part
thereof, may be incorporated into and made a part of the final contract.
However, the City reserves the right to further negotiate the terms and conditions
of the contract with the selected Proposer.
5. Conference Durinq the Evaluation Period
After the deadline to submit proposals and continuing until a contract has been
awarded, all City personnel involved in the administration of the City's Workers'
Compensation Program will have been specifically directed against holding any
meetings, conferences or technical discussions with any bidder except as
needed for the evaluation of the RFP or as needed in the regular course of
business. Failure to comply with this requirement will automatically terminate
further consideration of that firm or individual's proposal.
6. Adherence to RFP Format
Responses to this RFP must be made in accordance with the format set forth in
the RFP. Failure to adhere to this format may be cause for rejection of the
proposal as being non-responsive.
7. Preparation of Proposal
Each proposal will be prepared simply and economically, avoiding the use of
elaborate promotional materials beyond those sufficient to provide a complete,
accurate and reliable presentation.
8. Number of Copies Required
The Proposer must submit six (6) copies of the proposal, including one clearly
marked "ORIGINAL." If discrepancies are found between copies, the "ORIGINAL"
copy will provide the basis for resolving such discrepancies. If one copy of the
proposal is not clearly marked "ORIGINAL" and there is a discrepancy, the City
will reject the proposal.
9. Deadline and Address for Submission
Due Date — The Proposer shall submit three (6) copies of the proposal in a
sealed envelope plainly marked in the upper left-hand corner with the name and
address of the Proposer and the words "Request for Proposal for Workers'
Compensation Claims Administrator." All proposals are due no later than
6:00p.m., March 31, 2005, and should be directed to:
Ed Holton
Sr. Risk Management Analyst
City of Carson
701 E. Carson Street
Carson, CA 90745
10. Proposal Conditions or Limitations
Proposals which impose conditions or limitations to those set forth in this RFP
may be considered not responsive and be rejected.
11. Proposal interpretations and Addenda
Any changes to or interpretation of the RFP will be sent by the City to each firm
or individual to whom an RFP has been sent and any such changes or
interpretations shall become a part of said RFP and may be incorporated into any
contact awarded pursuant thereto.
12. Execution of Proposals
If the Proposer is a partnership, the proposal must be signed in the name of the
partnership by a General Partner thereof. If the Proposer is a corporation, the
proposal must be signed on behalf of the corporation by two authorized officers
(a Chairperson of the Board, President or Vice -President and a Secretary,
lzrtl
Treasurer or Chief Financial Officer) or an officer authorized by the Board of
Directors to execute such documents on behalf of the corporation. All Signatures
above must be original and in ink.
13. Packaging of Proposal
The proposal shall be enclosed in a sealed package(s), marked "Request for
Proposal for a Workers' Compenation Claims Administrator," with the name and
address of the Proposer in the upper left corner.
14. Terms of Withdrawal
All proposals shall be firm offers and may not be withdrawn for a period of one
hundred twenty (120) days following the deadline date for submission of
proposals noted therein.
-F 0�
15. Modification -F 0�--- al
Any Proposer may modify his proposal by written request any time prior to the
scheduled closing date and time for receipt of proposal, provided such written
request is received by the City prior to said closing time and further provided that
the City receives a full, written confirmation of the written request, such
confirmation having been mailed prior to said closing time.
. III
16. DislDosition of Proposals
All proposals submitted in response to this RFP shall become the property of the
City of Carson and a matter of public record. Proposers must identify all
copyrighted material, trade secrets and other proprietary information and the
specific page or pages that the Proposers claim are exempt from the California
Public Records Act (California Government Code Section 6250, et seq.). In the
event a Proposer claims such an exemption, the Proposer is required to state in
the proposal that:
"The Proposer will indemnify the City and hold it harmless from any claim
or liability and defend any action brought against the City for its refusal to
disclose copyrighted material, trade secrets, or other proprietary
information to any person making a request therefore."
Failure to include such a statement shall constitute a waiver of the proposer's
right to exemption from disclosure.
D. INSTRUCTIONS FOR THE WRITTEN PROPOSAL
1. Proposals shall be presented on 8 Y2" by 11 " recycled paper made on both sides of
each sheet of paper with no specific page number requirement, other than being
clear and concise.
2. Describe the claim administration firm completing this proposal, including
background and years of experience in workers' compensation claims management
and administration.
3. The Proposer shall spell out the cost of the contract, including any possible "add-on"
charges that may not be included in the fixed price contract fee. For example, bill
review fees.
4. Provide a list of ten of your current and previous clients, including all clients serviced
in the last three years. Provide the company name, telephone number, address,
contact person and number of years servicing the account.
5. Provide your firm's managerial and technical (claim administrator) turnover
percentage for the past three years.
6. Submit samples of any cards, letters, pamphlets, etc. that would be provided to City
employees.
7. Describe your company's mechanism(s) for keeping current with changes in
workers' compensation laws, statutes and regulations.
8. Describe your company's philosophy and procedures for the establishment of case
reserves.
9. Provide a sample of the monthly loss reports you provide to clients.
10 -Describe the firm's philosophy regarding denied and contested claims. What
investigative techniques are in place to defend against these types of claims?
11. Provide procedures, timetable, and costs, if any, for the initial set-up and integration
of the City's claim into your system.
12. Provide the location and address where the City's claim files will be located and
managed.
13. Proposer must quote an annual fee for the three-year contract.
14. Please describe the workers' compensation experience of the staff that will process
the City's workers compensation claims.
in
15. The third party claim administrators whose proposals are selected as finalists for
consideration may be asked to appear, at their own expense, before an evaluation
panel to discuss their proposal.
16. Please describe any services not previously covered which you believe may be of
particular value to the City, such as bill review, provider and facility networks, on-line
access to claims files, litigation management, etc. Also, indicate if additional costs
are associated with any of these services.
17. Please describe your philosophy and experience with Early Return to Work
Programs.
18. The proposal must indicate that the Proposer agrees to be bound by the proposal
and shall enter a contract to provide services in a form approved by the City.
19. The proposal must be valid for 120 calendar days from the final submission date of
the bids.
20. Please provide the biographies of the claims assistant, claims examiner, and claims
supervisor who would be assigned to the City's account.
21 . Submit a cover letter that contains the name, title, address and telephone number of
the individual(s) with authority to bind the proposal during the period in which the
City is evaluating the proposal.
22. A principal of the firm shall sign the cover letter or other person fully authorized to
act on behalf of the firm.
23. Provide evidence that the Proposer has a valid Certificate to Administer Self -Insured
Employer claims as set forth in the Labor Code.
24. Samples of loss runs and other computer-generated reports must accompany the
proposal.
E. SELECTION CRITERIA
The proposal evaluation team (PET) will be responsible for evaluation and ranking the
proposals. The selection criteria to be used to select the successful bidder will include,
but is not limited to, the following:
Established record of consistent professional service and reputation within the
industry.
a Ability to meet the requirements in the Scope of Work section.
0 High quality references from public entities, particularly cities.
• Staffing, experience levels and commitment to training.
• Cost effectiveness of medical and legal cost containment programs.
• Overall cost -benefit advantages.
Proposal Evaluation Criteria and Scoring:
Each Proposer will receive a rating of one (1) to five (5) points for each item listed
below; with five (5) being the highest score:
• Cost/Price proposal
• Personnel qualifications and commitment to training
• References
• Ability to perform the contract requirements as outlined in the Scope of Work
• Claim management approach
• Early Return to Work approach
• Medical and legal cost control approach
F. SELECTION AND CONTRACT NEGOTIATION
The Proposers, whose written proposals are determined to be within the competitive
range by the PET, may be asked to enter contract negotiations. Upon evaluation of the
proposals and outcome of the negotiations, PET will make a recommendation for the
contract award to the City Council.
The City may:
• Reject any or all proposals or make no award.
• Issue subsequent request for proposals.
• Cancel the request for proposal.
• Appoint alternate member(s) of the PET.
• Approve or disapprove the use of particular vendors.
• Establish a short list of Proposers eligible for interviews after review of the written
proposals by the PET and consideration of its recommendations.
• Modify any requirement contained in the RFP and request revised submittals from
Proposers determined to be within the competitive range.
• Negotiate with any, all, or none of the Proposers.
• Solicit best and final offers from all, some, or none of the Proposers.
• Award a contract to one or more Proposers.
• Accept the written proposal as an offer, without negotiation and issue a notice to
proceed.
0 Waive any informality on any proposal.
The RFP does not commit the City to negotiate a contract, nor does it obligate the City
to pay for any costs incurred in preparation and submission of proposals or in
anticipation of a contract.
The City reserves the right to issue a contract with any of the firms responding to this
RFP based solely upon its judgment of the qualifications and capabilities of that firm.
No information related to the results of the RFP process will be released until after the
recommendation by the PET.
Firm's Responsibility:
The Firm selected will appoint and make known to the City the personnel who will be
responsible for all coordination and communication between the City and the successful
third party claim administrator.
Within ten (10) days of the City mailing the Notification of Award of Contract and the
Contract Form, the Proposer shall provide the City with all the required insurance
certificates.
The City reserves the right to investigate the qualifications of all firms under
consideration and to confirm any part of the information furnished by the Proposer.
Moreover, the City may require evidence of managerial, financial or technical
capabilities that are considered necessary for the successful performance of the
contract.
Non -Discrimination — In the performance of this Contract, Contractor shall not
discriminate in recruiting, hiring, promotion, demotion, or termination practices on the
basis of race, religious creed, color, national origin, ancestry, sex, age, physical or
mental disability.
"I
Estimated Timetable:
Issuance of the Request for Proposal (RFP)
Deadline for Submission of Proposals
Review of Proposals and TPA Interviews
Date of the Contract Award
Contract Start -Up date
February 16, 2005
March 31, 2005
March 31— May 31, 2005
June 1, 2005
July 1, 2005
Questions concerning this Request for Proposal should be directed to Ed Holton, Senior
Risk Management Analyst, at (310) 952-1700, extension 1160 between the hours of
7:00 a.m. and 6:00 p.m., Monday through Thursday.
"I
CITY OF CARSON
AFFIDAVIT OF NON -COLLUSION
The undersigned, as Proposer, declares that this proposal is made without collusion
with any other person, firm or corporation and that the only person or parties interested
as principals are named herein. Having'carefully examined the Request for Proposal
for Workers' Compensation Claim Administrator, the Terms and Conditions, we do
hereby propose and agree in event of acceptance hereof, to enter into the required
agreement with the City of Carson.
Dated this
day of.
.2005,
I certify (or declare) under penalty of perjury
That the foregoing is true and correct.
NAME OF COMPANY
SIGNATURE
TITLE
F, A`.
Exhibit 1
December 31, 2004 Loss Run
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A 41
Exhibit 2
Public Self -Insurer's Annual Report
Fiscal Year 2003 - 2004
A'OTE.' Claims Administrator
Complete this Page for dLL reports exceptitemB Page 2
EmPloYmentlWages, which is completed by Fiscal Year Ending June 30, 2004
SeVinsuredemploy,
IL CONSOWJJAI ED LIABILITIES
Cerlificalc Number: Fil-=2 7 121 - M2.1 - =2
Name of Master Certificate Holder: City OE Carson
Type of Report:
2 Original Report (Due October I each year) lnterini/Amcndcd Report ror the Period of.
A. CASES AND BENEFITS (to nearest dollar) 11== ED=
Incurred Liability Paid to Date Month &y —Y,�, to Month Day War
N-b� $ Indemnity S Medi -i S Indc.nity Future Liability
1. C",= S Wdical S Ind—nity S Medical
.or .
mfmdcd pri� 13 686,746 663,143
to FY 1999.00 564,926 545,500 121,820 117,643
SUBTOTAL
3. ESTIMATED FUTURE LIABILITY (Indemnity Plus Medical) TOTAL
4. Total Benefils paid during FY 2003-2004 (include 211 case expenditures): ..........
5. Number or MEDICAL -ONLY cases reported in FY 2003-2004: .....................
6. Number of INDEMNITY cases reported in FY 2003-2004:
7. TOTAL or 5 and 6 (also enter in 2c above):
S. TOTAL number of open Indemnity cases (all years): . . . . . . . . . . . . . . . . . . . . . . . .
9. Number of Fatality cases reported in FY 2003-2004:
10. (a) Number of FY 2003-2004 claims for which the employer or administrator was
notified Of representation by an attorney or legal representative in FY 2003-2004: ....
(b) Number of non -FY 2003-2004 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 2003-2004: ....
3. TOTAL EMPLOYMENTAND WAGES PAID IN FISCALYEAR 2003-20 4
FOR THIS SELF INSURER:
00 NUMBER OF EMI'I,OYEES 1017
(Number ofindividual enip!oyces listed on Form DE -6 for year ending June �30, 2004)
(b) TOTAL WAGES AND SALARIES PAID S 25,036,607.39
(As rcpor1cd4)j, EDD Forni DE -6 Line Al for all fourquiorlers)
617,176
2�6 1, �29 8
33
26
59
73
0
0
2
jMod,col
614,946
1,232,122
S Medical -
661,626
F i s c a I "Ve a r
fiA
VMT
OEM==
Dun
FBI'.
649,823
—14
5 Ai 174
ltll�
SUBTOTAL
3. ESTIMATED FUTURE LIABILITY (Indemnity Plus Medical) TOTAL
4. Total Benefils paid during FY 2003-2004 (include 211 case expenditures): ..........
5. Number or MEDICAL -ONLY cases reported in FY 2003-2004: .....................
6. Number of INDEMNITY cases reported in FY 2003-2004:
7. TOTAL or 5 and 6 (also enter in 2c above):
S. TOTAL number of open Indemnity cases (all years): . . . . . . . . . . . . . . . . . . . . . . . .
9. Number of Fatality cases reported in FY 2003-2004:
10. (a) Number of FY 2003-2004 claims for which the employer or administrator was
notified Of representation by an attorney or legal representative in FY 2003-2004: ....
(b) Number of non -FY 2003-2004 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 2003-2004: ....
3. TOTAL EMPLOYMENTAND WAGES PAID IN FISCALYEAR 2003-20 4
FOR THIS SELF INSURER:
00 NUMBER OF EMI'I,OYEES 1017
(Number ofindividual enip!oyces listed on Form DE -6 for year ending June �30, 2004)
(b) TOTAL WAGES AND SALARIES PAID S 25,036,607.39
(As rcpor1cd4)j, EDD Forni DE -6 Line Al for all fourquiorlers)
617,176
2�6 1, �29 8
33
26
59
73
0
0
2
jMod,col
614,946
1,232,122
S Medical -
661,626
F i s c a I "Ve a r
fiA
VMT