HomeMy Public PortalAboutTristar Risk ManagementCLAIMS SERVICE AGREEMENT -WORKERS COMPENSATION
This CLAIMS SERVICE AGREEMENT ("Agreement") is made by and between
TRISTAR Risk Management, a California corporation, hereinafter referred to as
"TRISTAR," and/or "Administrator" with principal offices at 100 Oceangate, Suite 700,
Long Beach, CA 90802, and City of Carson, a general law city and municipal
corporation, hereinafter referred to as "Client", with principal offices located at 701 E.
Carson Street, Carson, CA 90745.
In consideration of the mutual covenants and promises of the parties, TRISTAR hereby
agrees to furnish to Client, and Client hereby agrees to receive from TRISTAR, those
certain claims handling services identified in this Agreement, all on the terms and
conditions set forth herein:
ARTICLE 1— TERM
1.1 The initial term of this Agreement shall commence on July 1, 2008, and shall
remain in effect continuously through June 30, 2011, unless terminated in
accordance with the provisions of this Agreement. Client, in its sole and
unfettered discretion, shall have the option to renew this Agreement, on the same
terms and conditions set forth herein, for up to two extended one-year terms
commencing on July 1, 2011 and again on July 1, 2012, by giving to TRISTAR
thirty (30) days advance written notice of its intention to do so. Each party has
the right to terminate this Agreement for its own convenience and without cause
by notifying the other party in writing of its intention to terminate this Agreement
at least sixty (60) days in advance of the termination date.
ARTICLE 2 — DEFINITIONS
As used herein and in the performance of services by TRISTAR for Client, the following
terms shall have the meanings described below:
2.1 Adjust or Adjustment: The process of handling and disposing of claims involving
injury, death damage or loss, in accordance and consistent with generally
accepted claims handling standards.
2.2 Administrative Agency: Any state, federal, or local governmental agency which
supervises or regulates the handling of claims, including, but not limited to,
industrial commissions, workers' compensation offices, bureaus, commissions,
and state insurance departments and boards.
2.3 Allocated Loss Adjustment_ Expenses (ALAE):
A. Except as provided in Subsection 2.3.13 below, the expenses arising out of
or connected with the handling and disposition of claims by TRISTAR cf .� :^•?
including, but not limited to:
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I. Fees of attorneys, including representation at hearings or pretrial
conferences.
2. Fees of court reporters;
3. Court costs, court fees and court expenses, service of process;
4. Costs of undercover operative and detective services;
5. Costs of employing experts for advice, opinions, or testimony
concerning claims under investigation or in litigation and costs of
appraisals;
6. Costs of independent medical examinations and/or evaluations for
rehabilitation and/or to determine the extent of Client's liability;
7. Costs of legal transcripts of testimony taken at coroner's inquests,
criminal proceedings, or civil proceedings;
8. Costs of copies of public records and/or medical reports;
9. Fees paid to witnesses and corresponding travel expenses;
10. Costs of photographs and photocopy services;
11. Electronic Index Bureau inquiry or reporting fees;
12. Interest paid as a result of litigation;
13. State -mandated electronic data interchange (EDI) costs.
B. "Allocated Loss Adjustment Expenses" shall not include (i) any of the
fees, costs, or expenses that are included in the claims service fees payable
to TRISTAR by Client as agreed to herein or (ii) any payment of benefits
to claimant or claimant's representatives.
2.4 Authority Limit: That sum of money set forth in this Agreement for which
TRISTAR shall have full and sole discretion and authority to adjust and make
payments on behalf of Client unless advised differently by Client in writing.
2.5 Claim: A single exposure of liability involving actual or potential injury, death,
loss or damage reported by Client to TRISTAR which might result in any
payment being made on behalf of Client and for which TRISTAR establishes a
claim file, with the following types:
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A. Indemnity Claim: Each separate claim where a reserve is established in
the indemnity category based on possible exposure, regardless of whether
or not any indemnity payment is ultimately made.
B. Medical -Only Claim: Each separate claim where an indemnity reserve is
never established, but a medical reserve is established based on possible
exposure.
C. Incident Report: A claim where no reserve of any kind is established.
2.6 Claim Adjustment File: Documentation of the claim adjustment process arising
from any single incident involving one or more claimants and containing the
relevant activity records, including written records of notices, investigations,
evaluations, and payments.
2.7 Incident Date: The date of an event as reported by Client or as later revised by
TRISTAR as the more appropriate date of occurrence.
2.8 Report Date of Claim: The date when Client first reports claim to TRISTAR.
2.9 Reserve: The monetary evaluation by TRISTAR of the estimated financial
exposure to Client with respect to a claim.
2.10 Services: Those services described in Article 3 of this Agreement and Exhibit A
hereto (which Exhibit is incorporated herein by reference) that are furnished by
TRISTAR to Client in accordance with the terms of this Agreement, the
applicable insurance policy if any, or in compliance with the laws of any state
having jurisdiction over the claim.
ARTICLE 3 — AUTHORITY AND RESPONSIBILITIES OF TRISTAR
3.1 Subject to all the terms and conditions of this Agreement, TRISTAR shall have
the authority and responsibility to provide claims adjusting and administration
services for the Client in connection with claims or losses adjusted during the
term of this Agreement. As a material inducement to Client entering into this
Agreement, TRISTAR represents and warrants that TRISTAR is a provider of
first class claims adjusting and administration services and TRISTAR is
experienced in performing the work and services contemplated herein and, in light
of such status and experience, TRISTAR covenants that it shall follow the highest
professional standards in performing the services required in this Agreement. For
purposes of this Agreement, the phrase "highest professional standards" shall
mean those standards of practice recognized by one or more first-class firms
performing similar work under similar circumstances.
3.2 In connection with its authority and responsibilities under this Agreement,
TRISTAR shall undertake the following services and in accordance with all
ordinances, resolutions, statutes, rules, and regulations of Client and any Federal,
State or local governmental agency having jurisdiction in effect at the time service
is rendered:
A. Receive and examine, on behalf of the Client, all claims reported to it and
initiate procedures for the proper servicing of each claim.
B. Investigate and adjust, settle or deny all claims in accordance with
applicable insurance laws and Client guidelines, as provided in Article 4
hereof.
C. Upon approval or at the direction of the Client, engage the services of
persons or firms outside its organization for work in connection with
investigations and adjustment of claims and to incur other "Allocated Loss
Adjustment Expenses" (as herein defined) at the Client's expense. Client
shall have the right to require TRISTAR to cease using the services of any
person or firm considered unsatisfactory by the Client.
D. Establish and adequately reserve each claim for which there is injury
and/or anticipated liability and/or a formal claim has been made and code
each claim in accordance with Client's statistical data requirements as may
be mutually agreed upon.
E. Make timely payments of valid claims for compensation, rehabilitation
expenses, and other required benefits payable under applicable insurance
laws, together with Allocated Loss Adjustment Expenses, out of funds
provided by the Client pursuant to Article 5 hereof subject to the
limitations and requirements of this Agreement. If an authorized
representative of the Client directs in writing that any payment not be
made, and if after receipt of such notice TRISTAR nevertheless makes
such payment, TRISTAR will reimburse Client for the payment(s).
F. Maintain an accurate and complete claim file on each reported claim
which shall be available during normal business hours for inspection by
the Client, its representatives or by appropriate regulatory authorities. The
Client shall have the right to copy any and all claims files or any
documents related to any claim. TRISTAR shall maintain and store closed
claim files for no less than one year after the expiration of the statute of
limitations applicable to each claim file or as otherwise directed by
governing state law.
G. Provide all forms necessary for efficient claims administration and prepare
and timely file all legally required forms and reports with the appropriate
state and federal agencies.
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H. In connection with the performance of its obligations under this
Agreement, provide licensed claims adjusters and perform the services to
be rendered in good faith, and in accordance with all applicable laws and
regulations.
I. Protect and pursue any subrogation rights of the Client which may arise
upon payment of claims and notify the Client of any subrogation rights
which, through litigation or otherwise, may be available to the Client.
J. Perform all administrative and clerical work in connection with reported
claims including the preparation of checks and/or drafts drawn on the loss
fund established herein.
K. Respond immediately to any inquiry, complaint or request received from
an Insurance Department, other Regulatory Agency, Client, claimant,
agent, broker, or other interested party relating to a claim serviced under
this Agreement; a copy of both the original inquiry and the TRISTAR's
response shall be provided in a timely manner to Client.
L. Upon prior approval of Client, engage the services of licensed and/or
Certified Health and Rehabilitation firms or individuals for Rehabilitation
Management as may be required by state regulations.
M. Report all cases involving suspected fraud to the appropriate state
mandated agency. Settlement authority is not permitted on cases of
suspected fraud unless TRISTAR receives written authority from Client.
When operating in states that require fraud to be reported to the state
insurance department, TRISTAR must maintain an internal special
investigative unit or contract with an entity to provide such services.
N. Provide first notice and status reports to excess insurers in accordance
with the criteria and reporting format dictated by that excess carrier.
ARTICLE 4 - CLAIM SETTLEMENT AUTHORITY
4.1 Unless otherwise advised by the Client or in cases of suspected fraud, TRISTAR
shall have authority to make payments on claim files with the following
limitations:
A. Any settlement on a single claim file shall first be approved in writing by
the Client.
B. Single payments of any allocated adjustment expense shall first be
approved in writing by the Client.
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C. Any settlement of a single claim file, which would involve an aggregate
expenditure (of loss and Allocated Loss Expenses) in excess of the
Client's SIR, must first be approved in writing by Excess Carrier.
4.2 Client shall have the option of taking over the handling and settlement of any
claim upon written notice to TRISTAR.
4.3 TRISTAR shall comply with claims procedures and guidelines as may be agreed
to by TRISTAR and the Client in writing from time to time.
ARTICLE 5 - CLAIM FUNDINGNOUCHER
5.1 All payments of benefits and allocated loss expenses will be made by the Client
based on vouchers received from TRISTAR in accordance with procedures
mutually agreed upon and subject to the Worker's Compensation Laws of
California. TRISTAR shall have no authority to make any payments directly.
5.2 When vouchers are received on a timely basis by Client from TRISTAR, any
penalties incurred due to late payment will be the responsibility of the Client.
5.3 Client acknowledges that at no time will TRISTAR be obligated to make any
claims payments out of TRISTAR funds.
5.4 Client will be responsible for 1099 reporting pursuant to IRS codes.
ARTICLE 6 — PROPRIETARY INTEREST
6.1 Ownership of Systems: All systems created or utilized by TRISTAR in the
performance of activities under this Agreement shall belong to, and shall remain
the property of, TRISTAR, and Client shall have no ownership interest therein.
The term "systems" as used herein shall include, but shall not be limited to,
computer programs, computer equipment, formats, risk data report formats,
procedures, documentation and internal reports of TRISTAR, but such term shall
not include claims adjustment file data.
6.2 Ownership of Files: TRISTAR shall be entitled to full and complete possession
of all files and materials prepared by TRISTAR in the course of investigating or
administering any claim under this Agreement, until this Agreement is otherwise
terminated in accordance with this Agreement. After termination of this
Agreement, Client shall be entitled to return of Client's files. During the course
of this Agreement, Client shall be entitled to review all files and materials
prepared by TRISTAR in the course of investigating or administering any claime
under this Agreement upon reasonable request to review or copy the same.
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6.3 Protection of Data: TRISTAR shall utilize its best efforts to ensure the
availability of the computer loss data and the operation of the computer hardware.
In the event of damage to or malfunction of the computer hardware or software,
TRISTAR will use reasonable efforts to obtain replacement alternative computer
hardware to restore service to an acceptable level in a timely manner. In the event
that computer loss data is not available for use by the computer system utilized by
TRISTAR, TRISTAR will attempt to reconstruct or recover such unavailable data
from computer data files stored at remote locations and from source records, in
order to restore service to an acceptable level in a timely manner.
6.4 Privacy of Data: TRISTAR shall utilize its best efforts to maintain the
confidentiality of the data supplied to and used by TRISTAR in the performance
of this Agreement. TRISTAR will not disclose such data or the contents of the
corresponding data files without the consent of Client. Notwithstanding the
foregoing, Client agrees that TRISTAR shall have the right to use such data for
the purpose of preparing and disseminating analytical reports inclusive of the
cumulative data of TRISTAR Clients, provided such use in no way specifically
identifies Client or its operations or expenses, nor individual claimant
information.
ARTICLE 7 — INDEPENDENT CONTRACTOR; AGENCY;
SUBCONTRACTING
7.1 In the performance of this Agreement, TRISTAR, its affiliated corporations and
the employees and officers of TRISTAR are independent contractors. Neither
Client nor any of its employees shall have any control over the manner, mode or
means by which TRISTAR, its agents or employees, perform the services
required herein, except as otherwise set forth herein. Except as otherwise
provided in this Agreement, Client shall have no voice in the selection, discharge,
supervision or control of TRISTAR's employees, servants, representatives or
agents, or in fixing their number, compensation or hours of service. TRISTAR
shall perform all services required herein as an independent contractor of Client
and shall remain at all times as to Client a wholly independent contractor with
only such obligations as are consistent with that role. TRISTAR shall not at any
time or in any manner represent that it or any of its agents or employees are
agents or employees of Client. Client shall not in any way or for any purpose
become or be deemed to be a partner of TRISTAR in its business or otherwise or
a joint venturer or a member of any joint enterprise with TRISTAR.
ARTICLE S — INDEMNIFICATION AND INSURANCE
8.1 TRISTAR agrees to indemnify Client, its officers, agents and employees against,
and will hold and save them and each of them harmless from, any and all actions,
suits, claims, damages to persons or property, losses, costs, penalties, obligations,
errors, omissions or liabilities, (herein "claims or liabilities") that may be asserted
or claimed by any person, firm or entity arising out of or in connection with the
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negligent performance of the work, operations or activities of TRISTAR, its
agents, employees, subcontractors, or invitees, provided for herein, or arising
from the negligent acts or omissions of TRISTAR hereunder, or arising from
TRISTAR's negligent performance of or failure to perform any term, provision,
covenant or condition of this Agreement, whether or not there is concurrent
passive or active negligence on the part of Client, its officers, agents or employees
but excluding such claims or liabilities arising from the sole negligence or willful
misconduct of Client, its officers, agents or employees, who are directly
responsible to Client, and in connection therewith:
(1) TRISTAR will defend any action or actions filed in connection with any
of said claims or liabilities and will pay all costs and expenses, including
legal costs and attorneys' fees incurred in connection therewith;
(2) TRISTAR will promptly pay any judgment rendered against Client, its
officers, agents or employees for any such claims or liabilities arising out
of or in connection with the negligent performance of or failure to perform
such work, operations or activities of TRISTAR hereunder; and
Consultant agrees to save and hold Client, its officers, agents, and
employees harmless therefrom;
(3) In the event Client, its officers, agents or employees is made a party to any
action or proceeding filed or prosecuted against TRISTAR for such
damages or other claims arising out of or in connection with the negligent
performance of or failure to perform the work, operation or activities of
TRISTAR hereunder, TRISTAR agrees to pay to Client, its officers,
agents or employees, any and all costs and expenses incurred by Client, its
officers, agents or employees in such action or proceeding, including but
not limited to, legal costs and attorneys' fees.
8.2 TRISTAR shall, at all times while obligations under this Agreement remain to be
performed by TRISTAR, maintain in force such insurances as are normal and
customary or required by law to protect itself and Client, including the following:
A. A policy of workers' compensation insurance on a state -approved policy
form providing statutory benefits as required by law with employer's
liability limits no less than $1,000,000 per accident for all covered losses.
B. A policy of commercial general liability insurance using Insurance
Services Office "Commercial General Liability" policy form CG 00 01,
with an edition date prior to 2004, or the exact equivalent. Coverage for
an additional insured shall not be limited to its vicarious liability. Defense
costs must be paid in addition to limits. Limits shall be no less than
$1,000,000 general aggregate. Including contractual liability and personal
injury for libel, slander and assault insuring this Agreement, which
policies shall name the Client as an additional insured.
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C. Automotive Insurance. A policy of comprehensive automobile liability
insurance written on a per occurrence basis in an amount not less than
$1,000,000 per accident, combined single limit. Said policy shall include
coverage for owned, non -owned, leased and hired cars.
D. An Errors and Omissions policy providing coverage in the amount of not
less than $3 million. Said policy shall remain in full force and effect
during the entire term of the Agreement and three (3) calendar years
thereafter.
E. A Fidelity bond providing coverage for all officers and other employees of
TRISTAR (including "money and securities" coverage) in the amount not
less than $1 million.
8.3 Client shall have the right to inspect each of the above-mentioned policies and
bonds and TRISTAR, upon Client's request, shall cause its insurers to provide
Client with a certificate of insurance or other evidence of coverage which
provides Client with 30 days notice of cancellation, and TRISTAR shall provide
evidence of the same to the satisfaction of Client which policies of insurance shall
name Client as an additional insured.
8.4 No work or services under this Agreement shall commence until the TRISTAR
has provided Client with Certificates of Insurance or appropriate insurance
binders evidencing the above insurance coverage and limits. In the event
TRISTAR is unable, after using its best efforts, to obtain any of the above-
mentioned coverage, it shall immediately notify the Client. Client shall then have
the right, but not the obligation, to terminate this Agreement effective upon giving
notice of the same.
8.5 All of the above policies of insurance shall be primary insurance and shall name
the Client, its officers, employees and agents as additional insureds. The insurer
shall waive all rights of subrogation and contribution it may have against Client,
its officers, employees and agents and their respective insurers. All of said
policies of insurance shall provide that said insurance may be not cancelled
without providing ten (10) days prior written notice by registered mail to Client.
In the event any of said policies of insurance are cancelled or amended, TRISTAR
shall, prior to the cancellation or amendment date, submit new evidence of
insurance to Client.
8.6 The insurance required by this Agreement shall be satisfactory only if issued by
companies qualified to do business in California, rated "A" or better in the most
recent edition of Best Rating Guide, The Key Rating Guide or in the Federal
Register, and only if they are of a financial category Class VII or better, unless
such requirements are waived by the Risk Manager of the City due to unique
circumstances.
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ARTICLE 9 — COMPENSATION
9.1 Exhibit A: Except as otherwise provided in this Agreement, Client shall
compensate TRISTAR in accordance with the terms of Exhibit A to this
Agreement. Fees will be for the term of the Agreement and any renewal subject
to Article 1.1.
9.2 Separate Claims Fund: The compensation payable to TRISTAR under this
Article 9 shall in no way include or affect the separate payment obligations of
Client as respects the claims fund described in Article 5 of this Agreement or the
direct payment for other services rendered by TRISTAR.
9.3 Payment Terms: All sums due TRISTAR are due and payable within twenty (20)
days of receipt by Client of TRISTAR invoice.
ARTICLE 10 -DEFAULT
10.1 The following are events of default under this Agreement:
A. Any material breach of this Agreement which is not cured by the
breaching party within ten (10) days of receipt of notice of such breach by
the other party.
B. Failure of Client to provide sufficient funds to Claim Fund for payments
on claims.
C. Failure of Client to pay Administration fees to TRISTAR as per
Agreement.
D. Dissolution, liquidation, voluntary or involuntary bankruptcy of a
substantial part or all of a party's business or entity.
10.2 The failure of either party to declare a default at the time of the defaulting event
shall not act as a waiver to declare a default at a later date.
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11.1 This Agreement may be terminated by Client or TRISTAR as follows:
A. Upon ten (10) days written notice in the event of a default as defined in
Article 11.
B. Upon sixty (60) days prior written notice as afforded in Section 1.1 of this
Agreement.
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C. Immediately with written notice in the event of fraud, abandonment, gross
or willful misconduct, insolvency, failure to provide require proof of
insurance by TRISTAR, or lack of legal capacity, by either party.
11.2 Termination by Client: In the event this Agreement is terminated by Client, then
any and all claims and unresolved recovery activities pending on the date of
termination shall, at Client's option, either:
A. Continue to be handled by TRISTAR until the expiration of the period in
which Client has paid the claims service fees, and thereafter on a time -
and -expense basis at TRISTAR's prevailing hourly rate and expense
method of billing when time and expenses are incurred, or
B. Thereafter be assumed and handled by Client or delegated by Client to
some third party, provided, however, that TRISTAR shall be entitled to all
fees earned or incurred prior to the effective date of termination without
offset or reduction.
Client shall inform TRISTAR in writing, prior to the termination date of the
contract, of the selected option. Should Client fail to inform TRISTAR or should
Agreement not be reached between TRISTAR and Client for the continued
handling of the open claims, then TRISTAR, on the termination date, shall
suspend all activity on Client's files, and TRISTAR thereafter shall have no
responsibility for the disposition of such matters.
ARTICLE 12 -PAYMENT OF PENALTIES/ RECONCILIATION
12.1 Though TRISTAR claims handlers make every effort to avoid penalties, some are
inevitable. All penalties are payable from the Claims Fund of Client. When
penalties are due to improper processing by TRISTAR, TRISTAR will reimburse
the Client or claims fund.
12.2 Recognizing that many penalties involve small amounts of money, the accounting
cost of reconciling can outweigh the amounts to be reconciled. For that reason,
TRISTAR performs reconciliation at the end of each service year, or quarterly for
accounts with annual administration fees in excess of $500,000. Client is supplied
documentation as to the reconciliation.
ARTICLE 13 - GENERAL PROVISIONS
13.1 The subject headings of the Articles of this Agreement are included for purposes
of convenience only and shall not affect the construction or interpretation of any
of its provisions.
13.2 This Agreement sets forth the entire understanding of the parties and supersedes
any prior Agreement or understanding relating to the subject matter hereof. No
supplement, modification or amendment of this Agreement shall be binding
unless executed in writing by all the parties. No waiver of any of the provisions
of this Agreement shall be deemed, or shall constitute, a waiver of any other
provision, whether or not similar, nor shall any waiver constitute a continuing
waiver. No waiver shall be binding unless executed in writing by the party
making the waiver.
13.3 In the event of any conflict or ambiguity between the terms and provisions of this
Agreement and any Exhibit attached hereto, the terms and provisions of the
Exhibit shall govern.
13.4 Nothing in this Agreement shall be construed to mean that either party has waived
any rights to seek a legal or equitable remedy for breach of this Agreement by the
other party.
13.5 Each of the Exhibits listed below is an essential part of the Agreement, which
governs the rights and duties of the parties:
Exhibit A- Relating to Fees payable to TRISTAR
Exhibit 13- City's Request for Proposal
13.6 TRISTAR may not assign, sell, transfer or otherwise convey, pledge or encumber
any of its rights, obligations or interests under this Agreement without the prior
written consent of the Client.
13.7 Except as otherwise provided herein, the provisions hereof shall inure to the
benefit of, and be binding upon, the successors, assigns, heirs, executors and
administrators of the parties hereto.
13.8 This Agreement shall be governed by and construed in accordance with the laws
of the State of California. In the event that any provision of this Agreement is
held by a court of competent jurisdiction to be unenforceable or void in any
jurisdiction, the other provisions of this Agreement shall remain in full force and
applicable law shall be construed in order to effectuate the purpose and intent of
this Agreement.
13.9 Each notice or other instrument referred to in this Agreement shall be in writing
and shall be deemed "given" to a party when delivered by hand, when given by
facsimile transmission during normal business hours or three (3) days after a
writing is deposited in the mail, postage prepaid and registered, addressed to each
party at the address set forth below or at such other address as such party, by
notice to the other party, may designate from time to time.
Client agrees to use Tristar Managed Care to provide all bill review, utilization
review, and case management services. Should the City decide to unbundle any of
these services in the future, then Tristar and the City agree to negotiate in good
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faith a new claims administration fee based on the Option 1 fees on page 47 of
TRISTAR's proposal.
13.10 Client reserves the right to approve, disapprove or select any and all service
providers, including medical case managers, rehabilitation counselors, primary
medical treatment, inpatient and outpatient facilities, physicians, specialist,
chiropractors, legal services, etc.
13.11 TRISTAR agrees to perform all services required to be performed as specified
and in the manner provided in the City's Request for Proposal (Exhibit "B").
A. Client shall not be liable to Administrator for personal injury of
Administrator's employees or property damage sustained by administrator
in the performance of the services of this Agreement.
B. Penalties and assessments arising from the failure of Client 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 Client and Client
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 Client. Administrative penalties arising
solely from the failure of Administrator to comply in the timely and proper
manner with its duties as the Administrator of Client's workers'
compensation claims shall be and remain the sole responsibility of
Administrator and Administrator hereby agrees to indemnify, defend and
hold harmless Client from all claims arising from the imposition of such
administrative penalties.
C. 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 Client's knowledge of
injury and generally imposed 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 aggress that unless Administrator is provided with a notice of the
claim within seven (7) days of Client's knowledge of the injury, the
above -referenced automatic penalty of ten (l0%) percent shall be and
remain the sole responsibility of the Client.
13.12 Nan -liability of Client Officers and Employees. No officer or employee of Client
shall be personally liable to the TRISTAR, or any successor in interest, in the
event of any default or breach by Client or for any amount which may become
due to TRISTAR or to its successor, or for breach of any obligation of the terms
of this Agreement.
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13.13 Conflict of Interest. No officer or employee of Client shall have any financial
interest, direct or indirect, in this Agreement nor shall any such officer or
employee participate in any decision relating to the Agreement which effects his
financial interest or the financial interest of any corporation, partnership or
association in which he is, directly or indirectly, interested, in violation of any
State statute or regulation. TRISTAR warrants that it has not paid or given and
will not pay or give any third party any money or other consideration for
obtaining this Agreement. When requested by Client, prior to Client's execution
of this Agreement, TRISTAR shall provide the City with an executed statement of
economic interest.
13.14 Covenant Against Discrimination. TRISTAR covenants that, by and for itself, its
heirs, executors, assigns, and all persons claiming under or through them, that
there shall be no discrimination against or segregation of, any person or group of
persons on account of race, color, creed, religion, sex, marital status, national
origin, or ancestry in the performance of this Agreement. TRISTAR shall take
affirmative action to insure that applicants are employed and that employees are
treated during employment without regard to their race, color, creed, religion, sex,
marital status, national origin, or ancestry.
13.15 Each notice or other instrument referred to in this Agreement shall be in writing
and shall be deemed "given" to a party when delivered by hand, when given by
facsimile transmission during normal business hours of three (3) days after a
writing is deposited in the mail, postage prepaid and registered, addressed to each
party at the address set forth below, or at such other address as such party, by
notice to the other party, may designate from time to time.
If to TRISTAR:
TRISTAR Risk Management
100 Qceangate, Suite 700
Long Beach, CA 90802
Attention: Thomas J. Veale
Telephone: (562) 495-6600
Fax: (562) 432-8619
If to Client:
City of Carson
701 E. Carson Street
Carson, CA 90745
Attention: Duane Munson
Telephone: (310) 952-1735
Fax: (310) 830-2471
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IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
in duplicate by their authorized representatives on the dates set forth below.
TRISTAR RISK MANAGEMENT
DateLY
10316K By:
Thomas J.
Title: Pres dent
Date: 073/0Oa By: .
Richard D. T ibault
Title: Corporate Secretary
CITY OF CARSON
ATTEST:
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Mayor Jim Dear
City Clerk Helen Kawago
APPROVED AS TO FORM:
///)• �4) �41Z —
City At ney
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EXHIBIT A
COMPENSATION
This Exhibit, effective July 1, 2008, is attached to and made part of the Two Party Claims
Servicing Agreement between TRISTAR Risk Management ("TRISTAR") and the City
of Carson ("City").
For services rendered pursuant to the attached Agreement, City will pay TRISTAR the
following fees:
CLAIM ADMINISTRATION
Annual
Monthly
Year One $ 81,700
$ 6,808.33
Year Two $ 84,600
$ 7,050.00
Year Three $ 87,600
$ 7,300.00
TRISTAR's proposed annual claims administration fee is based on 77 open indemnity
claims as of June 30, 2007 as indicated in the RFP and a maximum examiner caseload of
150 claims. Claims administration fees shall be payable in twelve (12) monthly
installments due each month, in advance. This Claims Administration Fee is premised on
an average open claims count of 77 indemnity files.
NOTE: Should the actual claims volume upon implementation be 15% (fifteen percent)
higher or lower than 77 claims, or increase or decrease by 15% (fifteen percent)
or more for more than 90 days during the contract period, and the staffing
described in our pricing proposal needs to be adjusted, then both parties,
TRISTAR and the City of Carson, agree to negotiate, in good faith, as to a
reasonable fee adjustment.
BILL REVIEW FEES
Bill Review Fees:
14% of savings for medical bill review
25% of savings for PPO Network Access
12% of savings for inpatient medical fee schedule
irg
UTILIZATION REVIEW FEES
$95.00 per hour
$200.00 .-- I" level peer review
$250.00-2 "d level peer review
CASE MANAGEMENT FEES
$95.00 per hour for Telephonic Case Management
$95.00 per hour plus travel expenses (mileage, parking, and tolls) for Field Case
Management
OTHER FEES
$95.00 per hour for safety and loss control services (optional)
In consideration of such compensation, TRISTAR shall handle all claims during the term
of the Agreement only.
17
CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT
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State of California
County of Lps t- (e
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Dale f + - Hera aAd Title of the er
personally appeared S �. Y QQ1�L CL Aird 1�
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Place Notary Seal Above
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who proved to me on the basis of satisfactory evidence to
be the person(s) whose name(s) Aare subscribed to the
within instrument and acknowledged to me that
+tlthey executed the same in 3tieAer/their authorized
capacity(ies), and that by Ws*w/their signature(s) on the
instrument the person(s), or the entity upon behalf of
which the person(s) acted, executed the instrument.
I certify under PENALTY OF PERJURY under the laws
71
of the State offAlifornia that the foregoing paragraph is
true and coorret.
WITNESS mann and official seal.
Signature) "' I "
--j�igr*ufi of Notary Pudic
OPTIONAL
Though the information below is not required by taw, it may prove valuable to persons retying on the document
and could prevent fraudulent removal and reattachment of this form to another document.
Description of Attached Document
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Document Date: 67t/0/ Og Number of Pages: / I
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Signer's Name
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❑ Partner — ❑ Limited ❑ General
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Signer's Name:_ (W_P!
❑, Individual
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OF SIGNER
02007 National Notary Association- 9350 De Soto Ave., P.O. Box 2402 • Chatsworth CA 91313.2402 • www.Nabona]Notary.org Item 115907 Reorder CaIITaB-Free 1.000-976-6827