HomeMy WebLinkAboutC2017-270 - 9/26/2017 - Approved .04038 eH
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SERVICE AGREEMENT NO. 1133
rasa Workers Compensation Third-Party
Administrator Services
THIS Workers Compensation Third-Party Administrator Services Agreement
( Agreement") is entered into by and between the City of Corpus Christi, a Texas
home-rule municipal corporation ("City") and York Risk Services Group, Inc.
("Contractor"), effective upon execution by the City Manager or the City
Manager's designee ("City Manager").
WHEREAS, Contractor has bid to provide Workers Compensation Third-Party
Administrator Services in response to Request for Bid/Proposal No. 1133
("RFB/RFP"), which RFB/RFP includes the required scope of work and all
specifications and which RFB/RFP and the Contractor's bid or proposal response,
as applicable, are incorporated by reference in this Agreement as Exhibits 1 and
2, respectively, as if each were fully set out here in its entirety.
NOW, THEREFORE, City and Contractor agree as follows:
1. Scope. Contractor will provide Workers Compensation Third-Party
Administrator Services ("Services") in accordance with the attached Scope
of Work, as shown in Attachment A, the content of which is incorporated by
reference info this Agreement as if fully set out here in its entirety, and in
accordance with Exhibit 2.
2. Term. This Agreement is for 12 months,with performance commencing upon
the date of issuance of a notice to proceed from the Contract Administrator
or Purchasing Division. This Agreement includes an option to extend the term
for up to four additional 12-month periods ("Option Period"), provided, the
parties do so prior to expiration of the original term or the then-current Option
Period. The decision to exercise the option to extend the term of this
Agreement is, at all times, within the sole discretion of the City and is
conditioned upon the prior written agreement of the Contractor and the City
Manager.
3. Compensation and Payment. The total value of this Agreement is not to
exceed$132,000.00, subject to approved extensions and changes. Payment
will be made for Services completed and accepted by the City within 30
days of acceptance, subject to receipt of an acceptable invoice. All pricing
must be in accordance with the attached Bid/Pricing Schedule, as shown in
City of Corpus Christi
2017-270 Page 1 of 8
9/26/17
M2017-154
York Risk Services Group Inc.
INDEXED
Attachment B, the content of which is incorporated by reference into this
Agreement as if fully set out here in its entirety.
4. Contract Administrator. The Contract Administrator designated by the City is
responsible for approval of all phases of performance and operations under
this Agreement, including deductions for non-performance and
authorizations for payment. The City's Contract Administrator for this
Agreement is as follows:
Gilbert Sanchez
Department: Legal
Phone: 367-826-3739
Email: GilbertS2@cctexas.com
5. Insurance; Bonds.
(A) Before performance can begin under this Agreement, the Contractor
must deliver a certificate of insurance ("COI"), as proof of the required
insurance coverages, to the City's Risk Manager and the Contract
Administrator. Additionally, the COI must state that the City will be given at
least 30 days' advance written notice of cancellation, material change in
coverage, or intent not to renew any of the policies. The City must be named
as an additional insured. The City Attorney must be given copies of all
insurance policies within 10 days of the City Manager's written request.
Insurance requirements are as stated in Attachment C, the content of which
is incorporated by reference into this Agreement as if fully set out here in its
entirety.
(B) In the event a payment bond, a performance bond, or both, are
required of the Contractor to be provided to the City under this Agreement
before performance can commence, the terms, conditions, and amounts
required in the bonds and appropriate surety information are as included in
the RFB/RFP or as may be added to Attachment C, and such content is
incorporated here in this Agreement by reference as if each bond's terms,
conditions, and amounts were fully set out here in its entirety.
6. Purchase Release Order. For multiple-release purchases of Services to be
provided by the Contractor over a period of time, the City will exercise its
right to specify time, place and quantity of Services to be delivered in the
following manner: any City department or division may send to Contractor
a purchase release order signed by an authorized agent of the department
or division. The purchase release order must refer to this Agreement, and
City of Corpus Christi Page 2 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/I/16
Services will not be rendered until the Contractor receives the signed
purchase release order.
7. Inspection and Acceptance. Any Services that are provided but not
accepted by the City must be corrected or re-worked immediately at no
charge to the City. If immediate correction or re-working at no charge
cannot be made by the Contractor, a replacement service may be
procured by the City on the open market and any costs incurred, including
additional costs over the item's bid/proposal price, must be paid by the
Contractor within 30 days of receipt of City's invoice.
8. Warranty. The Contractor warrants that all products supplied under this
Agreement are new, quality items that are free from defects, fit for their
intended purpose, and of good material and workmanship. The Contractor
warrants that it has clear title to the products and that the products are free
of liens or encumbrances. In addition, the products purchased under this
Agreement shall be warranted by the Contractor or, if indicated in
Attachment D by the manufacturer, for the period stated in Attachment D.
Attachment D is attached to this Agreement and is incorporated by
reference into this Agreement as if fully set out here in its entirety.
9. Quality/Quantity Adjustments. Any Service quantities indicated on the
Bid/Pricing Schedule are estimates only and do not obligate the City to order
or accept more than the City's actual requirements nor do the estimates
restrict the City from ordering less than its actual needs during the term of the
Agreement and including any Option Period. Substitutions and deviations
from the City's product requirements or specifications are prohibited without
the prior written approval of the Contract Administrator.
10. Non-Appropriation. The continuation of this Agreement after the close of
any fiscal year of the City, which fiscal year ends on September 30th annually,
is subject to appropriations and budget approval specifically covering this
Agreement as an expenditure in said budget, and it is within the sole
discretion of the City's City Council to determine whether or not to fund this
Agreement. The City does not represent that this budget item will be
adopted, as said determination is within the City Council's sole discretion
when adopting each budget.
11. Independent Contractor. Contractor will perform the work required by this
Agreement as an independent contractor and will furnish such Services in its
own manner and method, and under no circumstances or conditions will any
agent, servant or employee of the Contractor be considered an employee
of the City.
City of Corpus Christi
Service Agreement Standard Form Page 3 of 8
Approved as to Legal Form 7/1/16
12. Subcontractors. Contractor may use subcontractors in connection with the
work performed under this Agreement. When using subcontractors,
however, the Contractor must obtain prior written approval from the
Contract Administrator if the subcontractors were not named at the time of
bid or proposal, as applicable. In using subcontractors, the Contractor is
responsible for all their acts and omissions to the same extent as if the
subcontractor and its employees were employees of the Contractor. All
requirements set forth as part of this Agreement, including the necessity of
providing a COI in advance to the City, are applicable to all subcontractors
and their employees to the same extent as if the Contractor and its
employees had performed the work.
13. Amendments. This Agreement may be amended or modified only by written
change order signed by both parties. Change orders may be used to modify
quantities as deemed necessary by the City.
14. Waiver. No waiver by either party of any breach of any term or condition of
this Agreement waives any subsequent breach of the same.
15. Taxes. The Contractor covenants to pay payroll taxes, Medicare taxes, FICA
taxes, unemployment taxes and all other related taxes. Upon request, the
City Manager shall be provided proof of payment of these taxes within 15
days of such request.
16. Notice. Any notice required under this Agreement must be given by fax,
hand delivery, or certified mail, postage prepaid, and is deemed received
on the day faxed or hand-delivered or on the third day after postmark if sent
by certified mail. Notice must be sent as follows:
IF TO CITY:
City of Corpus Christi
Attn: Gilbert Sanchez
Title: Safety and Risk Manager
Address: 1201 Leopard St., Corpus Christi, TX 78401
Fax: 361-826-3697
IF TO CONTRACTOR:
York Risk Services Group, Inc.
Attn: Jody A. Moses
Title: Senior Vice President
Address: 333 City Blvd. West. Suite 1500, Orange, CA 92868
Fax: 512-346-9321
City of Corpus Christi Page 4 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
With a copy to:
Attn: Michael Krawitz
Title: Senior Vice President and General Counsel
Address: 1 Upper Pond Road, Bldg F 4th Floor, Parisappany, NJ 07054
17. CONTRACTOR AGREES TO INDEMNIFY, HOLD HARMLESS AND
DEFEND THE CITY OF CORPUS CHRISTI AND ITS OFFICERS,
EMPLOYEES AND AGENTS ("INDEMNITEES) FROM AND AGAINST
ANY AND ALL LIABILITY, LOSS, CLAIMS, DEMANDS, SUITS AND
CAUSES OF ACTION OF ANY NATURE WHATSOEVER ON ACCOUNT
OF PERSONAL INJURIES (INCLUDING DEATH AND WORKERS'
COMPENSATION CLAIMS), PROPERTY LOSS OR DAMAGE, OR ANY
OTHER KIND OF INJURY, LOSS, OR DAMAGE, INCLUDING ALL
EXPENSES OF LITIGATION, COURT COSTS, ATTORNEYS' FEES AND
EXPERT WITNESS FEES WHICH ARISE OR ARE CLAIMED TO ARISE OUT
OF OR IN CONNECTION WITH THIS AGREEEMENT OR THE
PERFORMANCE OF THIS AGREEMENT, REGARDLESS OF WHETHER THE
INJURIES, DEATH OR DAMAGES ARE CAUSED OR ARE CLAIMED TO
BE CAUSED BY THE CONCURRENT OR CONTRIBUTORY NEGLIGENCE
OF INDEMNITEES, BUT NOT IF BY THE SOLE NEGLIGENCE OF
INDEMNITEES UNMIXED WITH THE FAULT OF ANY OTHER PERSON.
CONTRACTOR MUST, AT ITS OWN EXPENSE, INVESTIGATE ALL
CLAIMS AND DEMANDS, ATTEND TO THEIR SETTLEMENT OR OTHER
DISPOSITION, DEFEND ALL ACTIONS BASED THEREON WITH COUNSEL
SATISFACTORY TO THE CITY ATTORNEY, AND PAY ALL CHARGES OF
ATTORNEYS AND ALL OTHER COSTS AND EXPENSES OF ANY KIND
ARISING FROM ANY SAID LIABILITY, DAMAGE, LOSS, CLAIMS,
DEMANDS, SUITS, OR ACTIONS. THE INDEMNIFICATION
OBLIGATIONS OF CONTRACTOR UNDER THIS SECTION SHALL
SURVIVE THE EXPIRATION OR EARLIER TERMINATION OF THIS
AGREEMENT.
18. Termination.
(A) The City Manager may terminate this Agreement for Contractor's failure
to perform the work specified in this Agreement or to keep any required
insurance policies in force during the entire term of this Agreement. The
Contract Administrator must give the Contractor written notice of the breach
City of Corpus Christi Page S of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
and set out a reasonable opportunity to cure. If the Contractor has not
cured within the cure period, the City Manager may terminate this
Agreement immediately thereafter.
(B) Alternatively, the City Manager may terminate this Agreement for
convenience upon 30 days advance written notice to the Contractor. The
City Manager may also terminate this Agreement upon 24 hours written
notice to the Contractor for failure to pay or provide proof of payment of
taxes as set out in this Agreement.
19. Assignment. No assignment of this Agreement by the Contractor, or of any
right or interest contained herein, is effective unless the City Manager first
gives written consent to such assignment. The performance of this
Agreement by the Contractor is of the essence of this Agreement, and the
City Manager's right to withhold consent to such assignment is within the sole
discretion of the City Manager on any ground whatsoever.
20. Severability. Each provision of this Agreement is considered to be severable
and, if, for any reason, any provision or part of this Agreement is determined
to be invalid and contrary to applicable law, such invalidity shall not impair
the operation of nor affect those portions of this Agreement that are valid,
but this Agreement shall be construed and enforced in all respects as if the
invalid or unenforceable provision or part had been omitted.
21. Order of Precedence. In the event of any conflicts or inconsistencies
between this Agreement, its attachments, and exhibits, such conflicts and
inconsistencies will be resolved by reference to the documents in the
following order of priority:
A. this Agreement and its attachments
B. the bid solicitation document, including addenda (Exhibit 1)
C. the Contractor's bid response (Exhibit 2)
22. Certificate of Interested Parties. Contractor agrees to comply with Texas
Government Code Section 2252.908, as it may be amended, and to
complete Form 1295 "Certificate of Interested Parties" as part of this
Agreement.
23. Governing Law. This Agreement is subject to all federal, State, and local laws,
rules, and regulations. The applicable law for any legal disputes arising out
of this Agreement is the law of the State of Texas, and such form and venue
for such disputes is the appropriate district, county, or justice court in and for
Nueces County, Texas.
City of Corpus Christi Page 6 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
24. Entire Agreement.This Agreement constitutes the entire agreement between
the parties concerning the subject matter of this Agreement and supersedes
all prior negotiations, arrangements, agreements and understandings, either
oral or written, between the parties.
(SIGNATURE PAGE FOLLOWS)
City of Corpus Christi Page 7 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
CONTRACTOR
Signature:
Printed Name: c ?fa*,
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Title: Sc. aide 4-
Date: - 28, aOl7
CITY OF CORPUS CHRISTI
Signature: Qom ,
Printed Name: 1-N\( . ��r -z
Title: Pr J c v_ I
Date: G - `). I I 1'1
ATTEST: '42' ie--Cie../ & _c1/ P..
RE ECCA HUERTA
CITY SECRETARY
Attached and Incorporated by Reference:
Attachment A: Scope of Work
Attachment B: Bid/Pricing Schedule
Attachment C: Insurance/Bond Requirements
Attachment D: Warranty Requirements
2.0n u l tl two-
Incorporated by Reference Only: ` 2-
SI CUNCIL
Exhibit 1: RFB/RFP No. 1 133 ........-
Exhibit 2: Contractor's Bid/Proposal Response gECRETAR�
City of Corpus Christi Page 8 of 8
Service Agreement Standard Form
Approved as to Legal Form 7/1/16
Attachment A: Scope of Work
1.1. General Requirements/ Background
A. The City of Corpus Christi is seeking qualified Third Party Administrators to provide
services to the Risk Management Division for Workers' Compensation Program.
B. The Contractor is to provide a broad representation of medical providers
included in any PPO network(s) made available to it by the Contractor, including,
but not limited to treating physicians, clinics, specialists, physical therapists,
rehabilitation services, and pharmacies. The Contractor is to provide a plan
allowing a reduction in fees in the event of failure to satisfy an agreed-upon
performance standard, consisting of standard industry performance criteria and
any special service criteria otherwise agreed upon.
C. Contractor must provide the services listed below.
1. Early intervention programs (medical case management)
2. Utilization review/pre-authorization services
3. Medical bill audits
4. Availability and use of PPO networks or other medical fee discount
arrangements
5. Rehabilitation services
---- ----6. Vocational case management services
7. Assistance with development of medical provider networks
8. On-line computer services
9. Attending DWC hearings (the adjuster is expected to attend all hearings)
10. Impairment ratings/review
11. Run-off (per-claim basis)
12. Run-in (per-claim basis)
13. Re-opened prior (per-claim basis)
14. Peer review
15. Attendance at mediation hearings
16. Surveillance
D. The Loss information provided is obtained from the current Claims Administrator
and is accurate to the best of the City's knowledge. See Exhibit A. The number of
- - -- -- ------ -- -------claims the City of Corpus Christi has processed from 2012-2017 totals at 3,006.
1.2. Scope of Work
A. Program Administration Requirements
1. The Contractor will appoint a senior account representative, line adjusters and
supervisory adjusters to serve solely in a management and administrative
capacity. This representative should have at least five years of experience in
RFP Template 04.06.17 Page 1 of 9
workers' compensation, and must have experience in insurance matters for
municipal entities. This person is to be available one month prior to the start of
the contract to ensure a smooth transition with the current Contractor. The
person is expected to be responsive to the City's administrative needs.
2. The Contractor must assign a minimum of one qualified senior workers'
compensation adjuster to this account to handle indemnity claim. This
adjuster should have at least five years of experience in workers'
compensation, and must have experience in insurance matters for
municipalities. In addition, one qualified, dedicated adjuster to handle
medical only claims is to be provided.
3. In the event an assigned adjuster be unable to perform the assigned duties
satisfactorily as determined by the City, immediate replacement of such
adjuster is required. The City's Risk Manager will be consulted in decisions
regarding adjusters who will be handling City claims.
4. The Contractor's hours of operation will be Monday through Friday 8:00 a.m. to
5:00 p.m.
5. The Contractor will collect and report data as required by Federal, State and
Local authorities, for the purpose of income filings for those claim payments
made by the Contractor.
6. The Contractor shall provide a full range of workers' compensation claims
administration services shall be provided in accordance with all requirements
of the Texas Labor Code, Texas Insurance Code, Texas Department of
Insurance Administrative Rules, and the Texas Workers' Compensation Act.
7. All administrative fines incurred as a result of the Contractor's or the
Contractor's subcontractor failure to comply with the Texas Workers'
Compensation Act and related rules shall be paid by the Contractor and not
the City.
8. The Contractor shall follow all rules applicable to HIPPA (any other similar law).
9. The Contractor shall follow all rules with respect to reporting claims for the
purposes of Medicare and such associated reporting is to be done by the
Contractor.
10. The Contractor will provide an on-line, web based computer claims services
and tracking system to the City that includes, but is not limited to diary
narrative, supervisor and adjuster notes, and electronic access to claims files.
The claim system must have a standard statistical reporting package.
RFP Template 04.06.17 Page 2 of 9
11. The claims system must be capable of generating IRS Form 1099 to vendors
and service providers as required by the Internal Revenue Code. The
Contractor will forward the Forms 1099 as required by applicable law to the IRS
electronically or magnetically based on IRS guidelines.
12. The claims system must be able to provide special reports, and the City must
be provided access to all claims data in order to generate its own reports. The
claim breakdown is to include, but not be limited to department; accident
type; claimant age, gender and occupation; claim severity; line of coverage;
claimant experience level; time of day, week and year of accident; and type
of equipment involved.
13. The claims system must allow the City to enter the first report of injury
electronically.
14. All claims are to be electronic/paperless.
15. The Contractor shall scan and attach all claim documents to the electronic
claim. Physical storage for historical workers' compensation claim files must be
provided.
16. The Contractor must have a comprehensive business continuity/disaster plan
for data recovery.
17. The Contractor will utilize the same injury codes, classification codes and
departmental codes as the City's current system.
18. The Contractor will meet with the City on a quarterly basis to review open
claims.
19. All claims reported under the contract, including records only, medical only,
indemnity claims, and subrogation will be administered until fully settled,
regardless of the period of time involved or required, in accordance with the
fee structures indicated in the contract for services.
20. The Contractor will be responsible for handling subrogation claims until settled
by all parties. Approval of the City's Risk Manager is required before
discounting any subrogation lien.
21. Settlement of any claim requires the approval of the City's Risk Manager.
RFP Template 04.06.17 Page 3 of 9
22. The Contractor will notify the City's Risk Manager via email within forty-eight
(48) hours that a Benefit Review Conference or Contested Case Hearing has
been scheduled.
23. Contesting the decision of any hearing officer requires the approval of the
City's Risk Manager.
24. Upon expiration or termination of the contract resulting from this RFP, within
thirty days of the City's request, at no additional cost to the City, the current
Contractor shall provide the new Contractor with all data requested by the
City.
B. Fund Requirements
1. The City will make funds available that the Contractor may draw from for
claims and/or loss payments. The City will hold all funds for outstanding claims
and reserves. A loss fund will be maintained in an amount agreeable to the
Contractor and to the City.
2. All payments made shall be made by issuance of checks from the designated
City-administer checking account established at the City's depository bank.
The Contractor shall electronically transmit a check register to the City's
Financial Services Department on a monthly basis. Such check register shall
be transmitted by the Contractor no later than the second business day of the
month following the month to which the check register refers.
3. The Contractor shall transmit,via email, the check number, check amount and
date of the check to the City's depository before a check is mailed. In lieu of
issuing stop payment requests, the Contractor shall void the check with the
City's depository so that the request to deny payment remains in effect
indefinitely. For each voided check the Contractor shall transmit to the City's
depository via electronic file transfer the check number, check amount and
the date of the check.
4. The City shall be responsible for balancing and reconciling this account
monthly, including processing of all unclaimed checks.
5. The City will advise the Contractor, at least quarterly, on the status of
outstanding checks so that the Contractor may determine whether
payment(s) to any payee should be voided and reissued, or be processed as
unclaimed property.
6. Duplicate payments of any type which are unrecovered by the Contractor
shall be reimbursed to the City by the Contractor.
RFP Template 04.06.17 Page 4 of 9
7. The Contractor will furnish the City with monthly summaries of the bank
account and expenditures, including a list of all checks, vouchers and voided
checks, in numerical sequence. The summaries must include the following:
• Claimant Name and Claim Number
• Date of Issue
• Amount
• Payee
• Type of Benefit Paid
• Benefit Period
8. The Contractor will review open reserves with the City's Risk Manager
monthly.
9. The Contractor will be subject to the approval of the excess workers'
compensation insurance company, if requested by the excess insurer, as may
be applicable.
C. Claims Administration
1. The Contractor will provide claims reporting services on a 24 hour basis.
2. The Contractor agrees to use claim forms provided by the City, or otherwise
to furnish the forms to the City as may be necessary.
3. The Contractor will investigate, reserve, adjust, settle or decline all reported
claims in accordance with state workers' compensation statutes and
generally accepted loss adjustment standards.
4. The Contractor shall assign a reported claim to an adjuster within 24 hours of
the Contractor's receipt of notice of injury.
5. The assigned adjuster will contact, or attempt to contact, all claimants within
24 hours of receiving notice of claim assignment.
6. The Contractor will contact the injured employee's department and medical
provider within two business days of notification of an injury.
7. The Contractor will obtain recorded statements from claimants within two (2)
business days of notification of injury. In addition, the Contractor will obtain
recorded statements from any witness when there is any lost time involved in
the claim.
8. The Contractor will obtain approval from the City prior to denying any claim
or prior to final disposition of any claim settlement that is outside the settlement
authority granted to the Contractor by the City. Any request for settlement
RFP Template 04.06.17 Page 5 of 9
authority or declinations will be submitted in writing to the City with the
following information:
• A description of the facts and nature of the incident
• A description of the damages and/or injuries
• An evaluation of the incident
• The claimant's demand
• The amount for which authority is requested
9. The City will reserve the right to direct the handling of any claim or to take over
the handling of any claim at any time during the life of the service agreement
and/or the life of the claim.
10.The Contractor will monitor medical treatment of injured employees and obtain
appropriate medical reports.
11.The Contractor will keep all open claims on a current diary system,which provides
for periodic review by the assigned adjuster. Each file shall be reviewed and
updates as necessary, but not less than once every 30 days.
12.The Contractor will audit medical, hospital and miscellaneous invoices prior to
approving for payment.
13.The City will retain the right to select its own medical service providers, as well as
others utilized for special claims handling procedures, inclusive of internal medical
resources; i.e., nurse practitioners.
14.The Contractor will authorize medical treatment and indemnity benefits
considered related, customary and necessary, issue checks or authorize
payments for treatment and benefits. The payment of indemnity and medical
benefits must be in accordance with the express authorization issued by the City
to the Contractor.
15.The Contractor will conduct an on-site investigation of any claim at the request of
the City within 24 hours of receiving the first notice of loss. At the discretion of the
City, claims with severe loss potential will be investigated on the same day the
claim is reported.
16.The Contractor will prepare and provide the City with narrative reports for serious
or contested injuries, when appropriate and as requested by the City.
17.The Contractor will be alert to the potential for subrogation and make every effort
to secure and pursue the City's rights of recovery.
RFP Template 04.06.17 Page 6 of 9
18.The Contractor will negotiate settlement with injured employees, their attorneys or
representatives within the discretionary settlement authority.
19.The Contractor will consult with the City and defense attorneys in the settlement
of litigated claims, and provide and monitor files for the defense and outcome of
these litigated claims.
20.The Contractor may assist in the recommendation and selection of defense
attorney(s); however, the City will retain the right to select the attorney(s) it
chooses.
21.The Contractor will be available to assist in the development and/or
implementation of written procedures and instructions to assure quality and
ongoing operation of the City's claims management program.
1.3. Quality Control
A. Contractors must have policies and procedures in place to ensure and measure
internal quality control. The policies and procedures should address all aspects of
the claims handling process, including, but not limited to:
1. Claims adjuster/supervisor caseloads for employers' liability and workers'
compensation
2. Claims file documentation requirements
3. Provide a web-based claims handling program
4. Investigation and communication
5. Initial contact with injured employee
6. Recorded statements
7. Reserving guidelines
8. Frequency of reviews of open claim reserves
9. Diary system maintained for all claim activities
10. Frequency of supervisor's review of each adjuster's claim files
11. Frequency of follow-up contacts with workers' compensation lost-time
claimants
12. Pursuing subrogation
13. Litigation/attorney management
14. Expense controls on other vendors
15. Special investigation or surveillance procedures
16. Compliance with excess insurance reporting requirements
17. General client servicing requirements and guidelines
18. Index bureau query and reporting guidelines
B. The Contractor will furnish administration manuals, including instructions and all
necessary forms within 30 days following the effective date of the awarded
contract
RFP Template 04.06,17 Page 7 of 9
1.4. Quality Assurance
A. The Contractor will be subject to periodic claims audits by an independent firm at
the discretion of the City. The purpose of such an audit is to measure compliance
with the agreed-upon claims administration servicing standards desired by the
City.
B. The City has the option to audit any or all files maintained by the Contractor and
requires adequate internal controls. The Contractor is required to provide
adequate internal control procedures to protect the City from any type of financial
loss.
RFP Template 04.06.17 Page 8 of 9
EXHIBIT A
Claim Type by Year No.of Claims Total Paid Outstanding Total Incurred
2012 668 $1,387,802.40 $51,128.44 $1,438,930.84
1 $19,210.00 $0.00 $19,210.00
Indemnity 44 $971,192.45 $51,128.44 $1,022,320.89
Medical Only 612 $336,736.86 $0.00 $336,736.86
Medical Only-Complex 11 $60,663.09 $0.00 $60,663.09
2013 603 $1,721,992.72 $16,352.04 $1,738,344.76
Indemnity 56 $1,463,035.43 $16,352.04 $1,479,387.47
Medical Only 533 $196,463.55 $0.00 $196,463.55
Medical Only-Complex 10 $61,649.80 $0.00 $61,649.80
Medical Only-Minor 3 $843.94 $0.00 $843.94
Reporting Purposes Only 1 $0.00 $0.00 $0.00
2014 549 $1,512,514.99 $65,445.04 $1,577,960.03
Indemnity 57 $1,284,778.81 $65,445.04 $1,350,223.85
Medical Only 478 $175,751.82 $0.00 $175,751.82
Medical Only-Complex 13 $51,332.70 $0.00 $51,332.70
Medical Only-Minor 1 $651.66 $0.00 $651.66
2015 523 $1,791,860.28 $341,494.52 $2,133,354.80
Indemnity 59 $1,545,829.63 $331,509.12 $1,877,338.75
Medical Only 362 $145,767.58 $0.00 $145,767.58
Medical Only-Complex 29 $100,263.07 $9,985.40 $110,248.47
Reporting Purposes Only 73 $0.00 $0.00 $0.00
2016 545 $743,247.87 $478,650.98 $1,221,898.85
Indemnity 41 $443,847.40 $437,109.88 $880,957.28
Medical Only 318 $233,684.45 $25,156.65 $258,841.10
Medical Only-Complex 23 $65,716.02 $16,384.45 $82,100.47
Reporting Purposes Only 163 $0.00 $0.00 $0.00
2017 118 $37,647.27 $257,110.32 $294,757.59
Indemnity 4 $8,543.23 $144,810.86 $153,354.09
Medical Only 78 $26,041.41 $97,503.34 $123,544.75
Medical Only-Complex 1 $3,062.63 $14,796.12 $17,858.75
Reporting Purposes Only 35 $0.00 $0.00 $0.00
Grand Total 3006 $7,195,065.53 $1,210,181.34 $8,405,246.87
ll
li RFP Template 04.06.17 Page 9 of 9
Attachment B: Bid/Pricing Schedule
CITY OF CORPUS CHRISTI
Pricing Form
PURCHASING DIVISION
RFP No. 1133
Workers Compensation Third-Party Administration Services
DATE: July 20. 2017 ''',,,sss
York Risk Services Group
PROPOSER 'w'" Jody A. Moses, Senior We President 11
AUTHORIZED SIGNATURE
1. Refer to"Instructions to Proposers"and Contract Terms and Conditions
before completing proposal.
2. Provide your best price for each item.
3. In submitting this proposal, Proposer certifies that:
a. the prices in this proposal have been arrived at independently, without
consultation, communication, or agreement with any other Proposer or competitor,for the
purpose of restricting competition with regard to prices;
b. Proposer is an Equal Opportunity Employer; and the Disclosure of Interest Information on
file with City's purchasing office, pursuant to the Code of Ordinances, is current and true.
c. Proposer has incorporated any changes issue through Addenda to the RFP in this pricing.
Item L.... Description ! Unit Fee .
Workers'Compensation 11
1 Indemnity Per claim $960
2 Medical -Only Per claim _$175
3 Report- Only Per claim $35
Rnaf Cost
4 Indemnity _]
S Medical- On! Per claim lime 0,,,1^F���•?n`
6 Other Per claim 0
Rauh Cost Per claim 0
7 Indemnity Per claim gilt- 9 — `l\
8 Medical - Only Per claim $0
9 Other
Per claim $0
10 Medical Case Management Per claim
$90.00/FCM $85.00/TCM
11 Utilization Review Services Per review $95 Nurse, $165 Physician,
12 Medical Bill Audits — -- Retrospective $165
13 Use of 504 Physician Panel Network er ll $8.00 per bi
P
14 Rehabilitation Services err claim $11.50e per bill*
* Item 13—Based on 504 Board approval Per claim $90 per hour
•
Page 1 of 3
Item Description Unit Fee
15 Vocational Case Management Services Per claim $90 per hour
Return to Work/Medical Provider
16 Programs Per claim $90 per hour
17 Online Computer Services Per user $Included
18 Attending DWC Hearings(BRC and CCH) Per hearing $Included
19 Attending Mediation Hearings Per hearing $Included
20 Impairment Rating Review Per review $250 Physician Review
21 Pursuing Subrogation Per claim $Included
22 Re-open prior claims Per claim $200 for FPC reopen
23 Peer Review _ Per review $ 250 - $650 per review
24 Attorney Fees Per hour $ Included
25 Precertification Per Precertification $ Included
26 Administrative Fee Per month $1200.00
Please refer to the following page for York's pricing notes and years 2 through 5 pricing
for claims and managed care services. We have also provided flat annual fee option for the
City's consideration.
Page 2 of 3
•
tvarc ti adminictratinn of all tZka � �� � _ _ - � �� � � � � �• '
nf[8r r'lnime and
,i+tn i'ti tra allntmc tha ('i a cnm
atuijwalayudjapiactaiLra
t ani int mry
rh , e
lan#h lloar that c_a lao bWtlgotoc{ cog^rdlocc of the
brraacaMarraacc in claim t/nit Imik
$131,$$7 $13g,C07 (442,0c0 $147,144
Fee per claim structure is challenging to support the City's request for a "dedicated" claim examiner. The
examiner will manage nothing but the City's claims regardless of any change in claim volume. Should the
volume decrease, York could be in the position with too few claims to support the cost of the fully
dedicated claim examiner. Therefore, the fee per claim pricing stated on the pricing page above requires
a fee for takeover claims at each anniversary during the contract term. York will remain open should the
City wish at some point to a "designated" examiner that we may reprice accordingly.
York's service is reliant on our employees, therefore we strive to provide competitive salaries, benefits,
and training to recruit and retain staff. As such, all proposed fee per claim pricing_above shall have 3%
annual increases to keep up with increase labor costs.
Managed Care Fees Years 2 through 5
I Bill Review Pricin
Year 2 Year 3 Year 4
I $8.24 $8.49 Year 5
$8.74 $9.00
Preauthorization Pricin• T_
Year 2 Year 3 Year 4 Year 5
Nurse$95.00 Nurse $98.00 Nurse $98.00 Nurse $99.00
Physician $170.00 Ph ician '.175.00 Ph ician ',175.00 Ph ician '.180.00
Retros•ective Utilization Review
Year 2 Year 3 Year 4
$170.00 $175.00 Year 5
$175.00 $175.00
Case Mena•ement
Year 2 Year 3 Year 4 Year 5
FCM $91.00 FC M$92.00 FCM $93.00 FCM $94.00
TCM $86.00 I TCM $87.00 TCM $88.00 TCM $89.00
Page 3 of 3
Attachment C: Insurance Requirements
A. PROPOSER'S LIABILITY INSURANCE
1. Proposer must not commence work under this agreement until all insurance required
has been obtained and such insurance has been approved by the City. Proposer must
not allow any subcontractor Agency to commence work until all similar insurance
required of any subcontractor Agency has been obtained.
2. Proposer must furnish to the City's Risk Manager and Director Human Resources, 2 copies
of Certificates of Insurance (COI) with applicable policy endorsements showing the
following minimum coverage by an insurance company(s) acceptable to the City's Risk
Manager. The City must be listed as an additional insured on the General liability and
Auto Liability policies by endorsement, and a waiver of subrogation is required on all
applicable policies. Endorsements must be provided with COI. Project name and or
number must be listed in Description Box of COI.
TYPE OF INSURANCE MINIMUM INSURANCE COVERAGE
30-written day notice of cancellation, Bodily Injury and Property Damage
required on all certificates or by Per occurrence - aggregate
applicable policy endorsements
Commercial General Liability $1,000,000 Per Occurrence
including:
1.Commercial Broad Form
2. Premises - Operations
3. Products/ Completed Operations
4. Contractual Liability
5. Independent Contractors
6. Personal Injury- Advertising Injury
AUTO LIABILITY (including) $1,000,000 Combined Single Limit
1. Owned
2. Hired and Non-Owned
3. Rented/Leased
PROFESSIONAL LIABILITY $1,000,000 Per Claim
(Errors and Omissions) (Defense costs not included in face value of
the policy) If claims made policy, retro date
must be prior to inception of agreement,
---- ---- have extended reporting period provisions
and identify any limitations regarding who is
insured.
CRIME/EMPLOYEE DISHONESTY $1,000,000 Per Occurrence
Contractor shall name the City of
Corpus Christi, Texas as Loss Payee
Page 1 of 3
WORKERS' COMPENSATION Statutory
EMPLOYER'S LIABILITY $500,000 /$500,000 /$500,000
3. In the event of accidents of any kind related to this agreement, Proposer must furnish
the Risk Manager with copies of all reports of any accidents within 10 days of the
accident.
B. ADDITIONAL REQUIREMENTS
1. Applicable for paid employees, Proposer must obtain workers' compensation coverage
through a licensed insurance company. The coverage must be written on a policy and
endorsements approved by the Texas Department of Insurance. The workers'
compensation coverage provided must be in an amount sufficient to assure that all
workers' compensation obligations incurred by the Proposer will be promptly met.
2. Proposer shall obtain and maintain in full force and effect for the duration of this
Contract, and any extension hereof, at Proposer's sole expense, insurance coverage
written on an occurrence basis, by companies authorized and admitted to do business
in the State of Texas and with an A.M. Best's rating of no less than A- VII.
3. Proposer shall be required to submit a copy of the replacement certificate of insurance
to City at the address provided below within 10 days of the requested change. Proposer
shall pay any costs incurred resulting from said changes. All notices under this Article
shall be given to City at the following address:
City of Corpus Christi
Attn: Risk Manager
P.O. Box 9277
Corpus Christi, TX 78469-9277
4. Proposer agrees that with respect to the above required Insurance,all insurance policies
are to contain or be endorsed to contain the following required provisions:
• List the City and its officers, officials, employees, volunteers, and elected representatives
as additional insured by endorsement, as respects operations, completed operation
and activities of, or on behalf of, the named insured performed under contract with the
City, with the exception of the workers' compensation policy;
• Provide for an endorsement that the "other insurance"clause shall not apply to the City
of Corpus Christi where the City is an additional insured shown on the policy;
• Workers' compensation and employers' liability policies will provide a waiver of
subrogation in favor of the City; and
• Provide thirty (30) calendar days advance written notice directly to City of any
suspension, cancellation, non-renewal or material change in coverage, and not less
than fen (10) calendar days advance written notice for nonpayment of premium.
Page 2 of 3
5. Within five (5) calendar days of a suspension, cancellation, or non-renewal of
coverage, Proposer shall provide a replacement Certificate of Insurance and
applicable endorsements to City. City shall have the option to suspend Proposer's
performance should there be a lapse in coverage at any time during this contract.
Failure to provide and to maintain the required insurance shall constitute a material
breach of this contract.
6. In addition to any other remedies the City may have upon Proposers failure to provide
and maintain any insurance or policy endorsements to the extent and within the time
herein required, the City shall have the right to order Proposer to remove the exhibit
hereunder, and/or withhold any payment(s) if any, which become due to Proposer
hereunder until Proposer demonstrates compliance with the requirements hereof.
7. Nothing herein contained shall be construed as limiting in any way the extent to which
Proposer may be held responsible for payments of damages to persons or property
resulting from Proposer's or its subcontractor's performance of the work covered under
this agreement.
8. It is agreed that Proposers insurance shall be deemed primary and non-contributory
with respect to any insurance or self insurance carried by the City of Corpus Christi for
liability arising out of operations under this agreement.
9. It is understood and agreed that the insurance required is in addition to and separate
from any other obligation contained in this agreement.
2017 Insurance Requirements
Legal Dept. - Risk Management
Worker's Compensation TPA Services
05/02/2017 sw Risk Management
Page 3 of 3
Attachment C: Bond Requirements
Section 5. )B) is null for this Service Agreement.
Page 1 of 1
Attachment D: Warranty Requirements
Section 8. Warranty is null for this Service Agreement.
Page I of I
CERTIFICATE OF INTERESTED PARTIES
FORM 1295
1 of 1
Complete Nos.1-4 and 6 if there are interested parties. OFFICE USE ONLY
Complete Nos.1,2,3,5,and 6 if there are no interested parties. CERTIFICATION OF FILING
1 Name of business entity filing form,and the city,state and country of the business entity's place Certificate Number:
of business.
2017-238465
York Risk Services Group,Inc
Parsippany, NJ United States Date Filed:
2 Name of governmental entity or state agency that is a party to the contract for which the form is 07/19/2017
being filed.
City of Corpus Christi Date,Ac Howled d:
UIj 71
1-1
3 Provide the identification number used by the governmental entity or state agency to track or identify the contr ct,and provide a
description of the services,goods,or other property to be provided under the contract.
1133
Workers'Compensation Third-Party Administrator Services
4 Nature of interest
Name of Interested Party City,State,Country(place of business) (check applicable)
Controlling I Intermediary
Moses,Jody Orange,CA United States X
Creasey,E.Harry Parsippany,NJ United States X
Taketa,Richard Parsippany, NJ United States X
Mukherjee,Saswata Parsippany,NJ United States X
5 Check only if there is NO Interested Party. ❑
6 AFFIDAVIT
I swear,or affirm,under penalty of perjury,that the above disclosure is true and correct.
USANNE M.THEVENET
NODIRY il1A,IC OF NEVI JERSEY )214
��l0 N Y460281 //tel/
!I�OI om Expires 107/2019
Signature of authorized a t of contracting business entity
AFFIX NOTARY STAMP/SEAL ABOVE
�Y1iGliael tries Z /IAA
Sworn to and subscribed before me,by the said .this the I Cl T►1 day of Su y
20 11 ,to certify which,witness my hand and seal of office.
J �
6-14 4//ire_/`f riles v ` Nck,,q 1;64/
Signature of officer administering oath Printed name of officer administering oath Title of officer administering oath
Forms provided by Texas Ethics Commission www.ethics.state.tx.us Version V1.0.883