HomeMy WebLinkAboutC-2102 - Worker's Compensation adjusting servicesCITY OF NEWPORT BEACH
TO: FINANCE DIRECIOR
FROM: City Clerk
sUB.TECr: Contract No. .2102
Description of'Camtnact
CALIFORNIA
City hall
7700 W. Newport Blvd.
Area Code 714
r
DATE July 10, 1979
Self- Insurance Service
Authorized by Resolution No. , adopted on
Effective date of Contract July 1, 1979
Contract with Fired S. James & Co.
Address
Irvine
Amount of Contract See Contract
City Clerk
SERVICE AGREEMENT
FOR ADMINISTRATION OF
SELF - INSURANCE PROGRAM
THIS AGREEMENT entered into on this 1st day of July , 197q by and
between Fred S James & Co /Irvine S lf- incuranra SPrviroc 1.(hereinafter
referred to as "James ") and City of Newport Beach 2.
(hereinafter referred to as "Self- Insurer ")
WHEREAS, Self- Insurer has indicated it is desirous of obtaining the services
of James to administer its workers' compensation insurance program; and,
WHEREAS, James is in the business of administering such programs;
NOW THEREFORE, the parties hereto agree as follows:
1. Obligations of James. James agrees to utilize experience qualified personnel
to perform the following services:
A. With regard to CLAIMS ADMINISTRATION, James shall:
1. Review and process all industrial injury cases in accordance with the
requirements of the State agency for reporting and notification;
2. Determine compensability of injuries and illness in accordance with
State Workers' Compensation Laws;
3. Determine eligibility for and authorize payment of medical benefits.
Authorize examination to determine the nature and extent of disability;
4. Determine eligibility for and authorize payment of temporary disability
compensation in coordination with medical advice and rehabilitation
efforts;
5. Determine the extent and degree of permanent disability, utilizing, as
necessary and desirable, advisory ratings of the State agency;
6. Authorize permanent disability compensation and death benefits in
accordance with advisory ratings, orders of the State appellate agency
or compromise and release agreements;
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7. Assist Self- Insurer's attorneys in the preparation of litigated cases
and negotiations of compromise and release settlements;
8. Maintain current estimates of the cost of all anticipated benefits
on each case;
9. Arrange for independent investigators or experts when, in James' judg-
ment, such action is deemed necessary to (a) properly process question-
able cases, (b) assist in determining the status of disabled employees,
or (c) prepare litigated cases.
B. With regard to MEDICAL CONTROL, James shall:
1. Develop and recommend a panel of physicians for the first treatment of
employee injury or illness and recommend a panel of medical specialists
for treatment requiring long term or specialty care;
2. Monitor treatment programs for injured or ill employees, including
review of all Doctor's First Reports of Work Injury;
3. Maintain close liaison with treating physicians;
4. Provide consultation on the most effective utilization of in -house
dispensary and medical facilities;
5. Provide guidance in the evaluation of physical capacity of injured
employees and their ability to return to work;
6. Assist in the development of medical standards and health requirements
for all jobs, and incorporate such standards in a program of pre-
employment and periodic examinations.
C. With regard to CONSULTATION, James shall:
1. Provide information and guidance to injured employees regarding the
benefits they will receive in accordance with Self- Insurer's policies;
2. Assist in solving employee non -legal problems arising out of industrial
injury cases;
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Work with the injured employees, Self - Insurer's personnel and other
agencies to provide rehabilitation, retraining or reassignment of
employees with physical or performance limitations arising out of
industrial injuries;
Consult, at Self- Insurer's direction, with employee groups on problem
cases;
Develop policies and procedures to insure that the return to work by,
or reassignment of injured employees is consistent with the findings
of any State appellate agency.
D. With regard to INFORMATION TO MANAGEMENT, James shall:
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Utilize computer programs to provide Self - Insurer's management with
continuing information on paid loss, incurred costs, the progress of
individual claims, and effectiveness of safety and other cost control
programs;
Submit monthly reports of losses accumulative throughout the contract
year and containing open claims from prior contract periods. This
report will contain information including: Employee name, date of
injury, description of injury, sex, age, loss paid this month, loss
paid to date, estimated future loss and total expected cost of each
claim, and, at management's request, shall segregate losses by plant,
unit, division, state or other categories;
Submit quarterly analyses of losses by type, part of body and nature,
segregated in a similar manner as the monthly report. Claims so cate-
gorized in this report will reflect losses paid, outstanding and total;
4. Provide, upon request, narrative or analytical reports of major cases;
5. Establish procedures and necessary documentation enabling Self-
Insurer to write checks for payment of benefits or to have James draw
checks for payment of benefits on an appropriate account of Self-
Insurer. C.P.O. Systems to City of Newport Beach.
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2. Obligations of Self- Insurer. Self- Insurer agrees to:
A. Pay to James:
1. A service fee in the amount of $15,000 payable quarterly in advance.
adjusted @ $100. per claim in excess of or less than 150 claims at
end of contract
plus,
2. All "allocated loss expenses" incurred by James in the performances of
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its obligations hereunder. "Allocated loss expenses" shall include all
costs, charges or expenses incurred by James, its agents and employees
properly and reasonably chargeable to the defense of claims or the per-
formance of James' other obligations hereunder.
B. The amounts payable to James under paragraph A immediately above shall be
paid as follows:
1. The service fee shall be paid quarterly in advance at $3,750 per
quarter ;5.
2. Allocated loss expenses shall be paid by Self- Insurer
C. This service fee set forth above is for the first year of this Agreement only.
Fees for each subsequent year shall be negotiated by the parties within 60 days
of each renewal date.
3. Geographic Limitations. This Agreement shall cover all operations of the Self -
Insurer in the following geographic areas or locations: State of California
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4. Renewal and Cancellation.
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A. This Agreement shall automatically be renewed on a year to year basis,
provided that, after the first nine months of the initial contract year,
this contract may be terminated ninety days after written notice of either
party, which notice shall be by certified or registered mail.
B. Any claims remaining open at termination of the contract will be handled
and adjusted to expiration by James. Self- Insurer shall make funds
available for the handling of these claims including any "allocated
expense" costs. The fee for this service shall be $100. per open file
per year service charge, plus all "allocated and unallocated expense"
costs should the contract be terminated or non - renewed for all claims
left with James - no charge except allocated and unallocated expense costs
should the contract be renewed. B•
5. Forms and Renewal of Program. James agrees where required to provide all
necessary renewal forms and to file all reports including renewal appli-
cations to the appropriate State agency for the renewal of the self -
insurance program which is the subject of this Agreement.
6. Practice of Law. It is understood and agreed that Jamesis not performing
legal services hereunder and James will not perform, and Self- Insurer will
not request performance of any services which constitute the unauthorized
practice of law.
7. Hold Harmless. James shall be fully responsible for exercising reasonable care
in the performance of its duties and obligations hereunder. However, should
James be named as a party to any litigation merely because of its actions on
behalf of Self- Insurer hereunder, Self- Insurer agrees to hold harmless,
indemnify and defend James in any such litigation.
B. Benefits. This Agreement shall be binding upon and inure to the benefit
of all transferees and successors in interest of any kind of the parties
hereto.
9. Headings. Headings herein are for convenience of reference only and shall
not be considered in any interpretation of this Agreement.
IN WITNESS WHEREOF, the parties have caused this contract to be executed
on the day and date first above written.
Signed this 1st day of Jul
19 79 .
Robert W. Hoel, Manager
Serf — Insurance Services
Fred, S. James & Co. /Irvine
City of Newport Beach
Name Robert L. Wynn
Title City Manager