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HomeMy WebLinkAboutReso. 1987 - 287 - Approving the self-insured workers compensation service agreement between the city of redidng and fleming & associates and authorizing the mayor to sign RESOLUTION NO. 37-.227 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF REDDING APPROVING THE SELF-INSURED WORKERS' COMPENSATION SERVICE AGREEMENT BETWEEN THE CITY OF REDDING AND IIFLEMING & ASSOCIATES, AND AUTHORIZING THE MAYOR TO SIGN ALL NECESSARY DOCUMENTATION. BE IT RESOLVED by the City Council of the City of Redding as ii follows : 1 . That the City Council of the City of Redding hereby approves the Self-Insured Workers ' Compensation Service Agreement dated September 1 , 1987 , between the City of Redding and Fleming & Associates, a true copy of which is attached hereto. ', 2 . That the Mayor of the City of Redding is hereby authorized and directed to sign said Agreement and all necessary documentation on behalf of the City of Redding in ' connection therewith, and the City Clerk is hereby authorized and directed to attest the signature of the Mayor and to impress the official seal of the City of Redding on the aforesaid documents, when appropriate. I HEREBY CERTIFY that the foregoing Resolution was adjourned introduced and read at a regular/meeting of the City Council of the City of Redding on the 29th day of September , 1987 , and was duly adopted at said meeting by the following vote: AYES: COUNCIL MEMBERS: Carter, Gard, Johannessen and Datil NOES : COUNCIL MEMBERS : None ,I ABSENT: COUNCIL MEMBERS: Fulton ABSTAIN: COUNCIL MEMBERS : None (11-2d7k_424_,(_) ,I MIKE DAHL, Mayor City of Redding ATTEST: FORM PPROVED: 4c4. 41 it ETHEL A. NICHOLS , City Clerk RA DALL A. HAYS, C ty Attorney II 4 • !j SELF-INSURED WORKERS' COMPENSATION SERVICE AGREEMENT This AGREEMENT, made this September 1, 1987, between the CITY OF REDDING, hereinafter referred to as CITY, and Fleming & Associates , a California Corporation, hereinafter referred to as the ADMINISTRATOR. RECITALS WHEREAS the CITY desires to self-insure its liability to its employees pursuant to the Workers' Compensation Laws of the State of California. WHEREAS the ADMINISTRATOR is engaged in the business of supervising and administering Self-Insured Workers' Compensation Programs for self-insured employers. WHEREAS the CITY desires to retain the services of the ADMINISTRATOR to supervise and administer a Self-Insured Workers' Compensation 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 render its services for the CITY on the terms and conditions of this AGREEMENT. LEGAL STATUS OF ADMINISTRATOR 1. The ADMINISTRATOR is a validly existing corporation in the State of California, with power to own property and carry on its business as it is now being conducted . TERM OF AGREEMENT II 2 . This AGREEMENT shall become effective as of September 1, 1987, and shall continue in effect for a period of three years (3) beginning September 1, 1987 and ending August 31, 1990. 1 • • i. PROGRAM DEVELOPMENT SERVICES TO BE PERFORMED BY ADMINISTRATOR 3 . ADMINISTRATOR agrees to perform and provide all the program development services necessary to maintain a PROGRAM which achieves the objectives of cash savings to the CITY and full benefits to the employees. Said services shall include , but not be limited to, the following: A. Analyze with personnel of the CITY, the need for modification and implementation of procedures , practices, and coordination to meet the requirement of the State of California and the needs of the CITY. B. Develop and provide procedures, practices , and coordination in relation to, not by way of limitatin, the reporting of industrial injuries , the role of the supervisor, medical referral , personnel-payroll responsibilities in prociessing industrial injuries , and employees consultative services. !1 C. Orientate those personnel of the CITY involved directly in the processing of industrial cases of the procedure , practices , and coordination have been prepared by ADMINISTRATOR. D. Design and provide all forms necessary for the efficient operation of the PROGRAM, excluding printed checks and vouchers. Said forms shall include , not by way of limitation, documents for the reporting of industrial injuries and illnesses, general processing of Workers' Compensation matters, I doctors' reports, claims administration, coordination of benekits, and fiscal reports. E. Inform the CITY in writing of the adoption, amendment, or repeal of all statutes, rules and regulations, and decisions of administrative agencies which could directly or indirectly affect the PROGRAM. F. Consult and advise the CITY on any matters arising in connection with the business of the CITY which involves the subject matter of this AGREEMENT. i ADMINISTRATIVE AND IMPLEMENTATION SERVICES TO BE PERFORMED BY THE ADMINISTRATOR 4 . ADMINISTRATOR further agrees to perform and provide any and all administrative and implementation serviii es necessary to achieve the desired objectives of the CITY. Said services shall include, but not be limited to, the following A. Administer the PROGRAM of the CITY in full compliance with all laws , rules, and regulations governing the administration of self-insurance . B. Review and process all reports and cases of industrial injury to or disease of employees in accordance with the requirements of the appropriate State agencies. it C. Determine the compensability of injuries and illnesses in accordance with State Workers' Compensation Laws and decide what benefits , if any, should be paid or rendered in each case. D. Effect the payment of medical benefits and arrange and authorize medical examinations to determine the nature and extent of an alleged disability. E. Decide the eligibility for and effect payment of temporary disability compensation, in coordination with medical advice , rehabilitation efforts , and salary continuation programs. F. Determine the extent and degree of permanent disabil- ity, utilizing , as necessary and desirable , any medical sources of advisory bodies available, provided , however , all the findings shall be reported to the CITY before any action is taken. G. Effect payments of permanent disability compensation and death benefits in accordance with Advisory Ratings, Findings and Awards , or settlement agreements , all which have been approved by the CITY in advance . A. Maintain on each claim, current estimates of the future anticipated costs of all benefits , i .e. , reserves. I. Establish and maintain all records and claim files on each claim which shall be available to the CITY at all times for inspection for a minimum period of five (5) years. MEDICAL CONTROL SERVICES TO BE PERFORMED BY ADMINISTRATOR 1 5. ADMINISTRATOR further agrees to perform and provide any and all medical control services necessary to ensure a high quality of medical treatment for injured employees,) prompt and complete medical reports , necessary to the determination of compen- sability in the providing of benefits, and the regulation of medical costs. Said services shall include , but not be limited to, the following: A. Maintain a current roster of physicians for the first treatment of employees with industrial injuries or illness requiring long-term or specialty care. This roster i shall be reviewed periodically for quality and cost of medical treatment. is B . Monitor treatment programs for injured employees, including , not by way of limitation, review of all riledical reports. Copies of all pertinent medical reports shall be forwarded to the CITY. II C. Provide continuing medical control of i employee injury cases so that the employee may be returned to the job as early as is consistent with the medical conditioL D. Audit all medical bills prior to payment to confirm its relationship to the disability and accepted fee schedules. E. Establish standards for the evaluation of physical i capacity of the injured employees to return to work;, and provide guidance for the application of standards in determining the existence of any permanent disability. F. Make all necessary arrangements for consultation with and examinations by physicians for the review of the employees' medical problems . G. Supervise the furnishings of medical treatment to injured employees. H. Administer and process all lifetime medical cases. CLAIMS INVESTIGATIVE SERVICES TO BE PERFORMED BY ADMINISTRATOR 6. ADMINISTRATOR further agrees to arrange for all claims inves- tigative services necessary to conduct a thorough investigation of any claim or dispute arising out of or related t'o the PROGRAM. Said services shall include , but not be limited to, the following: A. Determine liability of questionable claims and arrange all necessary investigations as deemed necessary by the CITY with regard to individual cases , to confiriln whether or not the injury of the illness arose out of and occurred during the course and scope of employment. B. Provide all records , medical files, and other data, and perform all tasks and research as the CITY or designated legal counsel of the CITY may request or require concerning any claim, dispute , liability, loss costs, or obligation on account of, or arising out of , the PROGRAM. C. Monitor all cases for potential subrogation recoveries and arrange subrogation investigations. Investigations and other assistance shall be performed as the CITY mayrequest or require where necessary to effect collection from third parties. _ II I EMPLOYEE CONSULTATIVE SERVICES TO BE PERFORMED BY ADMINISTRATOR 7. ADMINISTRATOR further agrees to perform and proide any employee consultative services necessary to supply employees with full and complete information and guidance regi;rding their rights and benefits, and the operation of the PROGR 4M. Said services shall include , but not be limited to, the hollowing: A. Provide consultation and recommendations concerning the development of policies and procedures for employees' consul- tative service activities. II II • B. Supply information and guidance to all injured employees relative to their rights and benefits. C. Identify and attempt to solve employee problems arising out of work-incurred disabilities. D. Meet with employee groups, at the direction of the CITY, to discuss the Workers' Compensation systli n and related matters . E. Develop policies and procedures to ensure that the return to work or reassignment of injured employees is consistent with the findings of State administrative agencies . F. Assist the CITY and employees in solving employee nonlegal problems arising out of industrial injury ases. REHABILITATION SERVICES TO BE PERFORMED BY ADMINISTRATOR 8. ADMINISTRATOR further agrees to arrange for any rehabili- tation services necessary to develop and maintain agood, sound rehabilitation system. Said services shall include but not be limited to, the following: II A. Work with the employees , the personnel staff of the CITY, and other groups or agencies to provide for the rehabili- tation , retraining, or reassignment of employees with physical or performance limitations arising out of industrial injuries. The costs for rehabilitation of employees shall be the responsibility of the CITY. B . Develop and administer a rehabilitation system for the CITY pursuant to applicable State laws, rules and regula- tions, and decisions of administrative agencies thereto. C. Develop and closely monitor plans which are submitted to the Rehabilitation Bureau for Vocational Rehabilitation. STATISTICAL AND REPORTING SERVICES TO BE PERFORMED BY ADMINISTRATOR i 9. ADMINISTRATOR further agrees to perform and provide any and all statistical services necessary to maintain ciontrol of self-insurance costs and continue the efficient opeiration of the PROGRAM. Said services shall include , but not Abe limited to, the following: A. Provide a monthly loss report, on or before the thirtieth (30th) day of each calendar month, for th:i preceding month, containing, not by way of limitation, the following infor- mation: The location, the description of the loss, the nature of the injury, the number of days lost from work, reserves and payments made during the given months. B. Submit a comprehensive monthly report, for the preceding month, on or before the thirtieth (30th) day of each succeeding calendar month, delineating a "year to date" complete run of all incurred reserves and payments. C. Furnish a complete monthly breakdown, on or before the thirtieth (30th) calendar day of each month, of all claims as well as a "year to date" breakdown by location and department. D. Maintain all records and statistical data on losses arising from employee injuries as may be required under the appropriate laws of the State of California, and rules and regula- tions thereto. E. Supply data and information relative to the establish- ment of a reserve dollar amount of each and every claim after ADMINISTRATOR' s analysis of said claim, monitor eacl. and every claim, at a minimum quarterly, to determine if a change in the reserve dollar amount is required , and provide an analysis of the reserve fund at such times at the CITY may require, in order to ensure the adequacy of said fund in light of anticipated and accrued costs, expenses, and claims. F. Provide a quarterly narrative status rIeport on all major claims with a total expected cost of ten thousand dollars ($10 , 000) or more. LITIGATION MANAGEMENT 10 . ADMINISTRATOR further agrees to perform and provide litigation management services which shall include , but not be limited to, the following: A. Retain, on the CITY' s behalf ,when dee','med necessary, attorneys who specialize in the defense of Workers" Compensation litigation, when an employee files an Application for Adjudication before the Workers' Compensation Appeals Board. B. Inform the CITY of all hearings scheduled before the Workers' Compensation Appeals Board. C. Cooperate fully with the City Attorney or any other attorney engaged on the CITY' s behalf , and prlovide all records , medical files, and provide any nonlegal preliminary work as the CITY's counsel may request. D. Legal expenses are to be paid by the (CITY through the Trustee Account administered by the ADMINISTRATOR. QUALIFIED AND TRAINED PERSONNEL 11 . Qualified and trained personnel directly employed and supervised by the ADMINISTRATOR will perform all the services required by the terms and conditions of the AGREEMENT. ADMINISTRATOR agrees that each of its employees shall have an extensive background in the Workers ' Compensation field and will be properly trained and will use reasonable care in the performance of their duties. Furthermore, each employee shall be provided with continued education to ensure that they are up to date on recent court decisions , proposed legislation, and are able to take the necessary action that may be indicated or required to continue and maintain control of the PROGRAM. COMPENSATION OF THE ADMINISTRATOR 12. As compensation for services rendered under this AGREEMENT, ADMINISTRATOR shall be entitled to receive the amounts outlined below. Said compensation is based upon an average of 188 claims per year . Any underage or overage of the actual cl i ims count will be adjusted at the end of each fiscal year . • • CONTRACT YEAR PRICE/CLAIM ANNUAL FEE MONTHLY BILLING 1987-88 $125 $23, 500 $1 ,958. 33 1988-89 $145 $27, 260 $2 ,271. 66 1989-90 $165 $31, 020 $2 , 585. 00 CITY agrees to pay ADMINISTRATOR monthly in advance. All payments should be mailed to Fleming & Associates , 1150 Foothill Blvd. , Suite E, La Canada, CA 91011 . INDEMNIFICATION 13. The ADMINISTRATOR shall indemnify, hold harmless, and defend the CITY from all liability, loss, damage , or injury arising out of or incident to the performance of this AGREEMENT, including without limitation, all consequential damages. II CANCELLATION 14 . This AGREEMENT may be cancelled by the CITY and/or ADMINISTRATOR at any time with or without cause after six (6) months of service upon giving written notice to either party at least sixty (60) days prior to the date of terminilation. NOTICES II II 15 . All notices , demands , requests , or approvals which are required under this AGREEMENT, or which either CITY or ADMIN- ISTRATOR may desire to serve upon the other , shall be in writing and shall be conclusively deemed served when deliver d personally, or forty-eight (48) hours after the deposit thereof lin the United States mail , postage prepaid, registered or certified. Addresses are hereinafter provided . All notices , demands , requests , or approvals from ADMINISTRATOR to CITY shall be addressed to CITY OF BEDDING, Personnel Office , 760 Parkview Avenue , Redding, California 96001. Excluding payment for services , all notice �g , demands , requests, or approvals 1s from CITY to ADMINI TQT R shall be addressed to Fleming & Associates, 150 Cayuga St. , Suite 14 , Salinas, CA 93901. WARRANTY AGAINST COLLUSION AND CONFLICT OF INTEREST 16 . ADMINISTRATOR hereby represents , warrants, and agrees as follows: A. Neither it nor its agents , servants , or employees has any financial interest in any insurance company law firm, or self-insurance administrator (excluding ADMINISTRATOR) , which could , in any manner , benefit from the results of ADMINISTRATOR' s recommendations. B. Neither it nor its agents , servants , or employees has in the past received, or is presently receiving ; income from any of the above said organizations . C. Neither it nor its agents , servants , or employees has had , or is presently having , any part in setting or fixing the prices for insurance , legal costs , or outside consulting services with reference to the matters relating to tihe subject matter of this AGREEMENT. D. Neither it nor its agents , servants, or employees has agreed with any person with regard to the results or proposed results of the services contemplated by this AGREEMENT, and any recommendations shall reflect the totally independent judgement of ADMINISTRATOR. E. Each provision of this AGREEMENT and 4ch provision of this warranty , representation, and agreement is expressly for the benefit of the parties hereto and any other person , firm, corporation, or class of persons, firms, or corporations which could be affected by a violation of said AGREEMENT, warranty, or representation. F. In rendition of its services , hereunder , ADMINISTRATOR shall act solely as an independent contractor and shall not act or purport to act as an Agent with any authority to represent or bind the CITY. II • ENTIRE CONTRACT 17 . This instrument contains the entire AGREEMENT between the parties relating to the rights herein granted in the obligations herein assumed . Any oral representations or modifications concerning this instrument shall be of no force or effect except a subsequent modification in writing, signed by the part to be charged . PARTIAL INVALIDITY 18 . If any provision of this AGREEMENT is held by any ii competent court to be invalid , void, or unenforceable , the remaining provisions shall nevertheless continue in full force and effect . GOVERNING LAW 19 . The validity of this AGREEMENT and of any of its terms and provisions, as well as the rights and duties , shall be inter- preted and construed pursuant to the laws of the State of Califor- 1 nia. iI INTERPRETATION 20 . The terms and conditions of this AGREEMENT shall be construed pursuant to their plain and ordinary meaning and shall not be interpreted against the maker . r II ATTORNEY'S FEES II 21 . If any action at law or inequity, including an action for declaratory relief , is brought to enforce or interpret the provisions of this AGREEMENT, the CITY shall be entitled to a reasonable attorney' s fee if it prevails, which may be set by the court in the same action or in a separate action brought for that purpose , in addition to any other relief to which it may be entitled . EXECUTED at Redding, California, on the date and year first above written. Fleming & Associates , Inc . BY � � i/-,2-twn 7 /CQ �/Wil Tarn Edward Fng president 1 ATTEST: I City Clerk CITY OF REDDING BY Mayor Date