HomeMy WebLinkAboutC-2316WORKERS' COMPENSATION SELF - INSURANCE
SERVICE AGREEMENT
THIS AGREEMENT is entered into this 9th day of July , 1990
between the CITY OF ARCADIA, hereinafter referred to as the "City," and
COLEN & LEE, INC., a California Corporation, hereinafter referred to as
the "Administrator."
WHEREAS, the City has undertaken to self- insure its Workers
Compensation obligation; and
WHEREAS, the Administrator is engaged in the business of
administering Workers' Compensation self- insurance programs; and
WHEREAS, the City desires to retain the services of the
Administrator to administer a Workers' Compensation self - insurance
program, hereinafter referred to as the "Program," for the City;
NOW, THEREFORE, the City hereby retains the services of the
Administrator and the Administrator agrees to perform services for the
City under the terms and conditions of this Agreement.
I. TERM: This Agreement shall become effective as of July 1, 1990
and shall continue in effect until terminated by the cancellation
provision set forth herein.
2. PERIODIC MEETINGS: The Administrator shall meet with City
staff no more than four times per year to:
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A. Assist the City in developing internal procedures.
B. Provide orientation and training to City personnel involved in
the administration of the Program.
C. Discuss specific claims and general trends in the Program.
3. ADVISORY SERVICES: The Administrator shall provide written
advisory bulletins to inform the City of the adoption, amendment or
repeal of all statutes, rules and regulations which directly affect the
Program.
4. REQUIRED FORMS: The Administrator shall provide the City with
all forms required by the State in connection with the Program.
5. COMPLIANCE WITH LAW: The Administrator shall administer the
Program in full compliance with all laws, rules and regulations
governing Workers' Compensation and self- insurance.
6. AIMS ADMINISTRATION: The Administrator shall have the
authority and responsibility to provide claims administration services
which include:
A. Entering claim information on a log and establishing a claim
file upon receipt of an injury report.
B. Setting and updating reserves.
C. Arranging for investigation.
D. Determining compensability.
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E. Preparing and issuing benefit notices and pamphlets.
F. Arranging for medical treatment from specialists, as necessary.
G. Initiating and maintaining contact with employees or their
attorneys.
H. Monitoring disability status by reviewing medical reports and
calling doctors for updates
I. Auditing and paying medical bills.
J. Paying mileage reimbursement to employees.
K. Paying temporary disability compensation when appropriate to do
so or advising the City of the need to adjust payroll records when
salary continuation is applicable.
L. Arranging medical exams in conformance with State law to
determine whether an employee's medical condition is permanent and
stationary and what, if any, permanent disability exists.
M. Paying permanent disability compensation in accordance with the
law.
N. Arranging for attorney representation of the City whenever the
need arises, selecting attorneys from a list approved by the City.
0. Monitoring attorneys and assisting them in preparing cases.
P. Auditing and paying legal expenses.
Q. Arranging for vocational rehabilitation services when
appropriate.
R. Monitoring vocational rehabilitation consultants and assisting
them as necessary.
S. Auditing and paying vocational rehabilitation expenses.
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T. Attending all hearings that are required by law.
U. Preparing and issuing vocational rehabilitation notices.
V. Preparing and issuing permanent disability compensation
notices.
W. Pursuing subrogation when there is a viable third party.
X. Notifying the City's excess insurers of all claims which exceed
or may exceed the City's self- insurance retention, maintaining liaison
between the City and its excess insurers on matters affecting the
handling of such claims and arranging for reimbursement to the City of
losses in excess of its self- insurance retention.
Y. Obtaining settlement authority and negotiating settlement on
appropriate claims.
Z. Closing claim files when appropriate to do so.
7. OBLIGATIONS OF EMPLOYER: The City shall:
A. Submit all reports of work injury to the Administrator within
one day of the City's knowledge of the injury, serializing each report
with an ascending incident number.
B. Respond to Administrator requests for information and authority
within five days of such requests.
C. Provide information that is accurate and is in a form specified
by the Administrator.
D. Grant settlement authority to the Administrator in advance of
vocational rehabilitation and legal hearings or be available by phone or
in person during those hearings.
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8. CHECKING ACCOUNT: The City and Administrator agree that:
A. The City shall establish a checking account from which all
Workers' Compensation benefits and expenses are to be paid.
B. The Administrator shall prepare checks and issue those checks
directly to payees without delay.
C. The Administrator shall sign checks with a facsimile check
signing machine.
D. The Administrator shall secure both checks and check signer
in a locked room accessible to a limited number of personnel.
E. The City shall maintain an adequate balance in the checking
account to meet all Workers' Compensation obligations without delay.
F. The Administrator shall order the checks.
G. The checking account may be used to pay civil penalties in
which case the Administrator shall reimburse the City within fifteen
days for any amount of the penalty which the Administrator caused.
9. STATISTICAL REPORTS: The Administrator shall provide monthly
statistical reports to assist City management in monitoring the Program.
These reports shall include, at a minimum:
A. A monthly loss experience report, on or before the fifteenth
(15) day of each calendar month, for the preceding month, containing the
following information: employee's name, injury date, closing date,
department, location, cause of injury, type of injury, days lost from
work, OSHA coding, reserves and payments.
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B. A monthly transaction report, on or before the fifteenth (15)
day of each calendar month for the preceding month, containing the
following information: check number, transaction date, amount, payee,
name of employee and claim number.
10. REGULATORY REPORTING: The Administrator shall prepare all
reports required by State regulatory agencies in connection with the
Program, including the Self- Insurer's Annual Report required by the
Department of Self- Insurance Plans.
11. RECORDS: The Administrator shall establish and maintain claim
files, claim logs, transaction documents and all other records
associated with the Program. These records shall be the property of the
City and shall be available, on five (5) days notice, for review or for
transfer to another custodian. Unless this Agreement is cancelled,
closed files shall be stored by the Administrator for five (5) years and
shall thereafter become the responsibility of the City. Upon
cancellation of this Agreement, the City shall be responsible for
maintaining and storing all records. The Administrator shall not
dispose of or destroy these records without the prior, written
authorization of the City.
12. CONSIDERATION: The City shall pay the Administrator $5,075.00
per month for services rendered under this Agreement. Once a year after
the first year of this Agreement, the Administrator may increase or
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decrease the service fee, subject to City Council approval, by giving
written notice of the change to the City at least sixty (60) days prior
to the change.
13. ALLOCATED EXPENSES: The City shall pay for check printing,
Index Bureau membership, field investigation, defense attorneys, legal
costs, remote photocopy, engineering experts, accident reconstruction
experts, process service, messenger service, court reporters, vocational
rehabilitation consultants, structured settlement consultants and
translators.
14. PENALTIES: The Administrator shall be responsible for paying
or appealing penalties unless the penalty results from the City's
failure to:
A. Provide an Employee Claim Form to an injured employee within 24
hours of knowledge of the injury.
B. Date stamp the returned Employee Claim Form.
C. Provide an Employer's First Report of Work Injury to the
Administrator within five days from the date of knowledge of an injury.
D. Provide a wage statement within ten days from the date of
knowledge of an injury where the employee is entitled to less than the
maximum temporary disability rate.
E. Provide information requested by the Administrator within a
timely manner.
F. Provide accurate information to the Administrator.
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G. Follow a written recommendation of the Administrator.
15. INDEMNIFICATION: The Administrator shall indemnify, hold
harmless, and defend the City from all claims, legal actions, losses,
expenses, injuries or damages arising out of the Administrator's actual
or alleged negligence or intentional wrongdoing incident to the
performance of this Agreement except when such claims, legal actions,
losses, expenses, injuries or damages are due to the sole negligence of
the City, its officers, agents or employees.
16. INSURANCE: The Administrator shall:
A. Maintain in force at all times General Liability and Errors and
Omissions Insurance in the amount of One Million ($1,000,000) Dollars
per occurrence, combined single limit.
B. Maintain in force at all times a Fidelity Bond in the amount of
Five Hundred Thousand ($500,000) Dollars.
C. Maintain in force at all times Workers' Compensation Insurance
for employees of the Administrator, as required by law.
D. Notify the City, in writing, thirty (30) days prior to any
cancellation or reduction in the above coverages.
E. Maintain evidence of the above coverages on file with the City
throughout the term of this Agreement.
17. TICES: All notices, demands, requests, or approvals which
are required under this Agreement, or which either the City or the
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Administrator may desire to serve upon the other, shall be in writing
and shall be conclusively deemed served when delivered personally, or
forty -eight (48) hours after the deposit thereof in the United States
Mail with postage pre -paid.
18. CANCELLATION: This Agreement may be cancelled by either party
giving to the other, in writing, notice of its intention to cancel this
Agreement at least sixty (60) days prior to the date of termination.
Upon the date of termination of this Agreement, or the date on which
records are transferred to another custodian, whichever occurs first,
the Administrator shall no longer be responsible for administration of
the City's claims.
19. PARTIAL INVALIDITY: If any provision of this Agreement is
held by a competent court to be invalid, void or unenforceable, the
remaining provisions shall nevertheless continue in full force and
effect.
20. GOVERNING LAW: The validity of this Agreement and of any of
its terms and provisions shall be interpreted pursuant to the Laws of
the State of California.
21. INTERPRETATION: The terms and conditions of this Agreement
shall be construed pursuant to their plain, ordinary meaning and shall
not be interpreted against the maker.
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22. ATTORNEY FEES: If any action at law or equity, including an
action for declaratory relief, is brought to enforce or interpret the
provisions of this Agreement, the prevailing party shall be entitled to
reasonable attorney fees in addition to any other relief to which it may
be entitled.
23. ASSIGNMENT: The Administrator shall not assign, sublet or
transfer by operation of law or otherwise any or all of its rights,
burdens, duties or obligations of this Agreement without the prior,
written consent of the City.
24. CONFLICT OF INTEREST: The Administrator agrees not to accept
any employment during the term of this Agreement from any other person,
firm or corporation if that employment is likely to result in a conflict
between the interests of the City and the interests of any third
parties.
25. ENTIRE CONTRACT: This instrument contains the entire
Agreement between the parties relating to the rights herein granted and
obligations herein assumed. Any oral representations or modifications
concerning this instrument shall be of no force or effect. Subsequent
modifications shall be made in writing with the agreement of both
parties.
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EXECUTED at Arcadia, California, on the date and year first above
written.
CITY OF ARCADIA
by h
George J,. Watts
City Manager
ATTEST:
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by
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COLEN 6 LEE, INC.
by
I
APPROVED AS TO FORM:
by � , //l —6;-
'f" 7 / ^ n'r'i' /
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PYR
LIABILITY SELF - INSURANCE
SERVICE AGREEMENT
THIS AGREEMENT is entered into this 9th day of July , 1990
between the CITY OF ARCADIA, hereinafter referred to as the "City," and
COLEN & LEE, INC., a California corporation, hereinafter referred to as
the "Administrator."
WHEREAS, the City has undertaken to self - insure its general and auto
liability; and
WHEREAS, the Administrator is engaged in the business of
administering general and auto liability self- insurance programs; and
WHEREAS, the City desires to retain the services of the
Administrator to administer a general and auto liability self- insurance
program, hereinafter referred to as the "Program," for the City;
NOW, THEREFORE, the City hereby retains the services of the
Administrator and the Administrator agrees to perform services for the
City under the terms and conditions of this Agreement.
1. TERM: This Agreement shall become effective as of July 1. 1990
and shall continue in effect until terminated by the cancellation
provision set forth herein.
2. SCOPE OF SERVICES: The Administrator agrees to supervise and
administer the Program for the City and shall act as the City's
representative in connection with the investigation, adjustment and
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administration of all general and auto liability claims asserted by third
parties against the City. The administrator further agrees to provide
the City, during the term of this Agreement, all services more
parti.cui.arly set forth herein.
3. C{}EENCES: The Administrator shall meet with City staff as
needed to discuss claims and general procedures.
4. CLAIMS ADMNISTRATIQN: The Administrator agrees to provide
supervisory, administrative and adjustment services on liability claims
asserted against the City. Such services shall include:
A. Screening accident reports for potential claims and initiating
contact with claimants.
B. Establishing files and setting reserves on new cases.
C. Maintaining contact with claimants or their attorneys.
D. Deciding upon and initiating a proper course of investigation.
E. Periodically reviewing cases for disposition and proper
reserving.
F. Determining fault.
C. Seeking contribution or indemnity from responsible third
parties.
H. Evaluating damages and determining settlement value.
1. Preparing written reports when recommending settlement in
excess of the Administrator's authority or when recommending rejection
or denial of a claim.
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J. Negotiating Settlements,
K. Taking releases from claimants.
L. Initiating payment of settlements and expenses.
M. Sending denial letters to claimants or their attorneys when
appropriate.
N. Notifying the City's excess liability insurers of all claims
which exceed or may exceed the City's self- insurance retention,
maintaining liaison between the City and its excess liability insurers on
matters affecting the adjustment of such claims and arranging for
reimbursement to the City of losses in excess of its self - insurance
retention.
0. Closing files when appropriate to do so.
5. INVESTIGATION: The Administrator agrees to provide investi.
gative services as follows:
A. The Administrator shall conduct office investigation, through
the mail and over the phone, which shall include: obtaining written
questionnaires or telephone recorded statements from City employees,
claimants and witnesses; obtaining police and other official reports;
obtaining medical reports from claimants, their doctors or their
attorneys; obtaining wage loss information from claimants, their
employers or their attorneys; and all. other investigation that can be
handled effectively from the office.
B. The Administrator shall engage, on behalf of the City, the
services of independent, outside investigators to conduct all field
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investigation that is needed to properly handle general and auto
liability claims. The selection of outside investigators shall be made
from a list approved by the City.
C. The Administrator shall, without compromising the quality of
investigation, make every attempt to conduct as much investigation from
the office as possible before engaging the services of outside
investigators and, in the event that outside investigation is necessary,
shall closely control outside investigators to minimize expense.
D. Outside investigation fees shall, be, considered an allocated
expense,
b. LITIGATION NANAGEMENT; The Administrator agrees to provide the
following services with regard to litigated claims:
A. Upon service of a law suit against the City with respect to a
liability claim, the Administrator shall refer the claim to a defense
attorney who is acceptable to and approved by the City.
R. The Administrator, in coordination with the City, shall
supervise and confer with defense attorneys during all stages of
litigation to assist attorneys in preparing cases and to ensure optimal
return on legal effort.
C. The Administrator shall audit and approve all legal expenses,
D. The Administrator shall continue all claims administration and
investigation functions.
7. STATISTICAL REPORTS: The Administrator agrees to provide,
during the term of this Agreement, the City with a monthly statistical
report showing the status of each claim reported to the Administrator,
the details of each claim, the remaining reserves for each claim and the
details of all claims payments made to date and during the month. This
report shall be delivered to the City within twenty (20) days of the
close of each calendar month.
8. RECORDS: The Administrator shall establish and maintain claim
files, claim logs, transaction documents and all other records
associated with the Program. These records shall be the property of the
City and shall be available, on five (5) days notice, for review or for
transfer to another custodian. Unless this Agreement is cancelled,
closed files shall be stored by the Administrator for five (5) years anc
shall thereafter become the responsibility of the City, Upon
cancellation of this Agreement, the City shall be responsible for
maintaining and storing all records. The Administrator shall not
dispose of or destroy these records without the prior, written
authorization of the City.
9. CONSIDERATION: The City shall pay the Administrator $1,500.00
per month for services rendered under this Agreement. Once a year after
the first year of this Agreement, the Administrator may increase or
decrease the service fee., subject to City Council approval, by giving
written notice of the change to the City at least sixty (60) days prior
to the change.
10. ALLOCATED EXPENSES: The City agrees to pay for check
printing, Index Bureau membership, outside adjusters, outside
investigators, defense attorneys, legal costs, police and other official
reports, remote photocopy, professional photographers, map makers, film
makers, medical experts, engineering experts, accident reconstruction
experts, process service, messenger service, court reporters, vocational
rehabilitation experts, structured settlement consultants and
translators.
11. INDEMNIFICATION: The Administrator shall indemnify, hold
harmless, and defend the City from all claims, legal, actions, losses,
expenses, injuries or damages arising out of the Administrator's actual
or alleged negligence or intentional wrongdoing incident to the
performance of this Agreement except when such claims, legal actions,
losses, expenses, injuries or damages are due to the sole negligence of
the City, its officers, agents or employees.
12. INSURANCE: The Administrator shall:
A. Maintain in force at all times General Liability and Errors anc
Omissions Insurance in the amount of One Million ($1,000,000) Dollars
per occurrence, combined single limit.
B. Maintain in force at all times a Fidelity Bond in the amount of
Five Hundred Thousand ($500,000) Dollars.
C. Maintain in force at all times Workers' Compensation Insurance
for employees of the Administrator, as required by law,
D. Notify the City, in writing, thirty (30) days prior to any
cancellation or reduction in the above coverages.
E. Maintain evidence of the above coverages on file with the City
throughout the term of this Agreement.
13, NR _1CFS : All notices, demands, requests, or approvals which
are required under this Agreement, or which either the City or the
Administrator may desire to serve upon the other, shall be in writing
and shall be conclusively deemed served when delivered personally, or
forty -eight (48) hours after the deposit thereof in the United States
Mail with postage pre. -paid.
14. �.NCELIATION: This Agreement may be cancelled by either party
giving to the other, in writing, notice of its intention to cancel this
Agreement at least sixty (50) days prior to the date of termination.
Upon the date of termination of this Agreement, or the date on which
records are transferred to another custodian, whichever occurs first,
the Administrator shall no longer be responsible for administration of
the City's claims.
15, PARTIAL IM %LIDITY: If any provision of this Agreement is
held by a competent court to be invalid, void or unenforceable, the
remaining provisions shall nevertheless continue in full force and
effect.
16, GOVERNING LAW: The validity of this Agreement and of any of
its terms and provisions shall be interpreted pursuant to the Laws of
the State of California,
17, INTERPRETATION: The terms and conditions of this Agreement
shall be construed pursuant to their plain, ordinary meaning and shall
not be interpreted against the maker,
ig. 611983EY FEES: If any action at law or equity, including an
action for declaratory relief, is brought to enforce or interpret the
provisions of this Agreement, the prevailing party shall be entitled to
reasonable attorney fees in addition to any other relief to which it may
be entitled.
19- AU-19-N—MEN-1: The Administrator shall not assign, sublet or
transfer by operation of law or otherwise any or all of its rights,
burdens, duties or obligations of this Agreement without the prior,
written consent of the City.
M CONFLICT GNTERMST: The Administrator agrees not to accept
any employment during the term of this Agreement from any other person,
firm or corporation if that employment is likely to result in a conflict
between the interests of the City and the interests of any third
parties,
21. This instrument contains the entire
Agreement between the parties relating to the rights herein granted and
obligations herein assumed. Any oral representations or modifications
concerning this instrument shall be of no force or effect. Subsequent
modif ica r forts shall be made Jn writing with the agreement of both
parties,
FMCUTED at Arcadia, California on the date and year first above
Written,
i'JTY OP 1, rClID-111A
by
COLEN & LEE, INC.
by
:, ity Man d, �-er,
ATTEST,
by
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