HomeMy WebLinkAboutContract 26923 CITY SECRETARY
CONTRACT NO.
arron
Risk Management Services
CONTRACT FOR ADMINISTRATION OF
THE CITY OF WORTH WORKERS' COMPENSATION BENEFIT PLAN
THE STATE OF TEXAS §
COUNTY OF TARRANT §
THIS CONTRACT is made and entered into by and between the CITY OF FORT WORTH
(hereinafter "City"), a municipal corporation of the State of Texas, acting herein by and through
Charles Boswell, duly authorized assistant city manager, and UICI and its wholly owned subsidiary,
Barron Risk Management Services, Inc., a corporation authorized to do business in the State of Texas
(hereinafter referred to as UICI), acting herein by and through Bart Griffin, its duly authorized vice
president.
WHEREAS, in 1973, the Texas Legislature made certain changes in the State Workers'
Compensation Act which brought the State and its political subdivisions under the Act as covered
employers, thus providing their employees the benefits as stipulated in the Act for injuries or disease
incurred while working on the job; and
WHEREAS, the City Council of the City of Fort Worth has authorized a Workers'
Compensation self-insurance plan for the City of Fort Worth and authorized the City Manager to
contract for the claims and administration service and catastrophic reinsurance for the self-insurance
plan; and
WHEREAS, the City has issued a Request for Proposal ("RFP") pursuant to the applicable
Statutes of the State of Texas; and
WHEREAS, UICI has submitted its response to the RFP; and
WHEREAS, the City of Fort Worth desires to award the contract for such services to UICI
pursuant to the terms and conditions expressed herein;
NOW, THEREFORE, KNOW ALL BY THESE PRESENTS:
That the City of Fort Worth, a home rule municipal corporation located in Tarrant and Denton
Counties, Texas and UICI and its wholly owned subsidiary, Barron Risk Management Services, Inc.,
in consideration of the terms, recitals and conditions expressed herein, do hereby covenant and agree
as follows:
5 KofT ! V o
5815 Callaghan Road • Suite 100 • San Antonio, Texas 78228 • Tel(210)68.1-605" • )800-3795
Third Party ClaimsAdministration•Medical Cost Containment•LossPm ration 9 Multi-LinesAdjusting
GENERAL CONDITIONS
A. UICI shall perform the following services for workers' compensation benefit administration:
1. Examine on behalf of the City all reports of job-related injury to or job-related diseases of
City employees.
2. Conduct and coordinate with the City the necessary investigation of such cases by competent
and qualified personnel, including such investigation as is usual and customary for the type of case
involved by companies writing Workers' Compensation insurance policies; prepare a thorough
investigative file, to include statements of available witnesses, if any, for the City's use in evaluating
such case.
3. After a full and final investigation, recommend to the City what benefits, if any, should be
paid or rendered under the state Workers' Compensation Act in each reported claim. Advise the City
if claims may be questionable or when a basis for denial of liability exists. Any matter that involves
litigation against the City will be defended by the Department of Law or other City approved counsel.
Final decisions regarding acceptance or denial of liability or litigation procedures will be made by the
City.
4. When necessary and with prior approval from the City, and at City expense, engage the
services of persons or firms outside its organization for special work in connection with
investigations and defense of claims.
5. Pay compensation, medical expenses, and allocated loss expenses from funds provided by the
City.
6. Evaluate the propriety of medical treatment and the costs of the same prior to the payment of
medical and drug bills, and provide expert medical review with narrative report when appropriate.
7. Provide computerized audits of medical bills where required and appropriate.
8. Handle all necessary investigation and payment of claims of any employee leaving City
employment,regardless of such employee's place of residence.
9. Maintain an investigative claim file on each reported claim which shall be available to the
City at all times. Such files shall contain all data pertinent to the claim to support its disposition.
These files will be subject to audit during regular business hours upon reasonable notice by City
auditors.
10. From claim files, provide the City, at no additional cost, with copies of significant-medical
reports, initiation and suspension of compensation reports, and records of Texas Workers'
Compensation Commission hearings.
OFFICIA tECOID
CLAIMS ADMINISTRATION cc rV IC P:,�y UW IIS U
WORKER'S COMPENSATION BENEFIT PLAN
Page 2 of 22 a�}Ullo �Vy���L�il L�Ca
11. File all forms, documents and papers as required by the Texas Workers' Compensation
Commission and/or Act and necessary for the defense of the claim Specify all forms to be provided
to the City of Fort Worth(e.g.,TWCC-1, etc.)
12. Provide all City employees prompt, courteous, and professional claims service. When
necessary to contact injured employees, the initial contact must be made within two (2)working days
of receipt of notice of claim.
13. Assign the work involved under the contract to persons who are capable, competent and
experienced in servicing Workers' Compensation claims.
14. Consult with and advise the City on any matter, including the plan administration and
employee safety factors that are relevant to the City Workers' Compensation program. All such
matters shall be coordinated through the person or persons designated by the City.
15. Investigate as to the liability and determine the lawful beneficiaries in the cases involving
fatal claims.
16. With City input and approval, prepare for and represent the City at all proceedings before the
Texas Workers' Compensation Commission. The City will have representatives present when
appropriate at these proceedings and will provide attorney representation when necessary.
17. Provide the City in writing with all materials, reports, and assistance necessary for recovery in
subrogation claims. Advise the City in writing of any claim that it considers subrogation efforts to be
feasible. Any funds collected through subrogation, whether collected by the City or by UICI, will be
credited to the City's loss fund account.
18. Provide the City Legal Staff with all necessary services including, but not limited to,
continued investigation in preparation for and during any Texas Workers' Compensation Commission
proceedings, court actions, and post trial matters which may arise from Workers' Compensation
claims against the City.
19. When requested, assist the City in analyzing all proposed Workers' Compensation related
legislation and in developing a position for support or opposition.
20. Provide the City's excess insurance carrier(s) all required or requested reports to include, but
not limited to, initial and supplemental reports of injury (as specified by the excess carrier(s)),
medical reports, and medical and indemnification financial information.
21. Cause to have performed an independent audit of claims by a casualty actuary at the end of
the first year of the contract and at least biannually thereafter. Such audit shall be made available to
the City's representative no later than 180 days after the end of each audit period. The study shall
indicate total expected liability, IBNR and projected cash requirements to pay the current portion of
claims for the next two(2)years. Cost of audits will be paid for by the City of Fort Worth.
IOrf��jO�1CIAL [GQ���ORD
CLAIMS ADMINISTRATION ,1011 U�C)�(^If�,EUWG U
WORKER'S COMPENSATION BENEFIT PLAN �+
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22. Barron will provide Safety and Loss Prevention Services, as needed, upon request by the City
which shall include personnel approved by the Texas Workers'Compensation Commission to resolve
all matters required in the event the City might at some time during the contract be designated as a
Hazardous Employer by the Commission at a rate as identified in Section C of this Contract. Should
professional engineering services be required, Barron will coordinate these services, as needed, upon
request by the City AT COST to the City.
23. When appropriate and with the prior approval of the City, provide case management and/or
rehabilitation services or referrals to rehabilitation agencies including the Texas Rehabilitation
Commission, to maximize recovery and contain costs. The City reserves the right to establish its own
case management or rehabilitation services at any time during the Contract for Service.
24. Provide administrative services for the maintenance of all books, documents, papers,
accounting records and other evidence pertaining to the claim costs incurred. The contractor shall
make such materials available to the City at all reasonable times during the term of the contract and
for three (3) years from the date of closure of the last claim under this contract for inspection and
audit by the City. Upon termination or expiration of the contract and until the final disposition of all
claims, the Contractor will continue to provide claims services and maintain files on all cases
reported to it under during the term of this contract, and any renewal hereof. Files created under this
contract are and remain the property of the City of Fort Worth. Files closed after final disposition of
the claim shall not be destroyed but instead returned to the City of Fort Worth on microfilm meeting
standards as outlined in Microfilming Standards and Procedures, Texas Administrative Code, Title
13, Chapter 7(or the legal standards in effect at that time) or in any other manner as may be agreed to
in writing by the parties and indexed by employee name, social security number and date of injury in
a form specified by the City. The Contractor shall prepare and submit monthly reports in paper and
microfiche form to the City listing:
a. the number of claims;
b. the names of claimants;
C. the amount of payment for each claim;
d. the amount of reserves set up for future payments for each claim;
e. the date of each injury;
f. the department of the City in which the claimant is employed;
g. a distinction between the types of indemnification payments, medical payments; and
h. accident and injury analysis.
The Contractor shall also provide a monthly invoice for services and a statement of the City's
account. All costs for microfilming will be paid by the City.
25. Provide data processing and management information services by computer-to-computer link.
27. Provide the Risk Management Department access to query automated claims information at
908 Monroe and 1000 Throckmorton, Fort Worth, Texas. Additionally, provide training and
documentation for use of automated access for current Risk Management Department staff and at any
other time such may be requested by the City staff.
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CLAIMS ADMINISTRATION PC"ETd��,f Y
WORKER'S COMPENSATION BENEFIT PLAN Page 4 of22
28. Provide assistance in drafting discovery responses to Interrogatories, responses to Requests
for Admissions, and Production responses at the request of the City's legal representative.
29. Although this contract may expire or be terminated, provide full service at no additional
charge for any open claims for the duration of the benefits authorized and/or to the final conclusion of
the claim The cost to the City for such services shall be at the prices in erect at the time the injury
was incurred. No additional costs shall be imposed during the life of any claim regardless of the time
factor involved,prior to the final disposition of the claim.
30. In the performance of this contract, use only those agents whose qualifications and experience
are acceptable to the City, and who maintain offices in Dallas/Fort Worth metroplex throughout the
life of this contract, unless parties mutually agree in writing to an amendment of this condition.
31. Provide the City with a computerized audit of all medical bills, where required and
appropriate, to insure that the billing for each provided medical service is within the fee schedule
established by the Texas Workers' Compensation Commission. Said audit shall include bills, surgical
bills, bills of other medical treatment providers, and drug bills, such analysis to determine the
accuracy of charges, level of services reported, evaluations conducted, and compliance with the
Commission's established fee schedule.
32. Upon request by the City, provide expert witness testimony at all levels of legal proceedings
with respect to any medical bill reviewed and analyzed pursuant to Paragraph 30 above, such expert
testimony to be for the purpose of supporting the results of such audit and analysis.
33. Have personnel available during normal working hours capable of responding to detailed
questions concerning medical provider billing and the proposed adjustments to such bills by UICI
pursuant to Paragraph 30 above.
34. The computerized audit and analysis service described in Paragraphs 30, 31 and 32 of this
contract shall be provided to the City at costs outlined in paragraph C2 of this contract. It is expressly
agreed by the parties hereto that said costs prescribed herein shall remain as stated in Paragraph C2 of
this contract throughout the term of this contract, as well as any renewal hereof. It is expressly agreed
that all moneys saved the City as a result of said audit shall belong to the City.
35. The audit and analysis services described in Paragraphs 30, 31, 32 and 33 of this contract
shall continue throughout the term of this contract provided, however, the City shall have the right
and the option, at any time, to cancel said audit and analysis services in the event said services, in the
City's sole discretion, prove not to be cost effective with respect to the cost savings expected by the
City. This right and option to terminate is exclusive as to the City and is not affected by and shall not
affect the contract termination rights prescribed in this contract.
36. UICI shall invoice City monthly for one-twelfth (1/12) of the annual items contained in
paragraph C. hereof. In addition, UICI shall invoice the City monthly for such other services
performed during the prior month. Payment by City shall be made within fifteen(15) days from the
date of receipt of the invoice.
FIR
NRCIA G?SCORD
CLAIMS ADMINISTRATION CRY CMCU?I R Y
WORKER'S COMPENSATION BENEFIT PLAN VJ1.�)U,�Mp ��o
Page S of 22 �Ci `. tl u U
B. CITY AGREES:
1. The City will make funds available on which UICI may draw at any time and from time to time
for payment of benefits or services to or for injured or deceased employees, or to their dependents in the
event of claims involving death and for associated loss expenses. The funds furnished to UICI by the
City will remain the property of the City. It is the intent of the City to minimize cash balances held by
UICI or to realize any gains accrued by fund balances held by UICI. Claims funding procedures will
include:
a. UICI drafts will be issued in payment of claims and allocated expenses.
b. The City of Fort Worth will maintain a deposit with UICI sufficient to cover all
payments. This deposit will be equal to the average two week period for which payments are
reimbursed. Initially, a two week escrow balance will be established and adjusted as needed.
Weekly, the City will wire a designated sum to ensure the continuity of payments.
C. All UICI drafts of $10,000 or more will be subject to a "cash call" request for
reimbursement by the City of Fort Worth to UICI. In this event, UICI will immediately notify
the City in writing so that reimbursement will be made prior to the issuance of the instrument.
It is further understood that UICI will make no disbursement of any funds in excess of the
amount of escrow held by UICI.
3. The City will coordinate with UICI in all matters pertaining to the adjustment, handling,
investigation, and administration of claims and losses. At no time shall UICI draw from such funds
for payment of claims or losses without prior approval from the City.
C. THE CITY OF FORT WORTH AND UICI MUTUALLY AGREE:
1. This contract shall be effective for a seven(7) month term commencing at 12:01 a.m., June 1,
2001, and terminating at 12:01 a.m., January 1, 2002 with six (6) options to renew for additional one
year periods.
2. This contract pricing is based on laws and rules of the Texas Workers' Compensation
Commission in effect on the date of signing. Any changes in these laws or rules that affect the contract
pricing maybe incorporated herein by written amendment to this contract.
3. City shall have the right to renew this contract on a yearly basis for up six annual renewals under
the same terms and conditions and charges as provided for herein.
4. During the term of this contract and for such time as City has renewed this contract, City will
pay to UICI,the following service fee per claim assigned for the following services set out in UICI's
Proposal and this Agreement:
RICK RKORD
CLAIMS ADMINISTRATIONj M�1LSW�Q�
WORKER'S COMPENSATION 13ENEFIT PLAN
Page 6 of22 Rn I IUlraittlpy To
FOR JUNE 1, 2001,THROUGH DECEMBER 31, 2001:
Claims administration for seven months of claims handling, City will pay seven monthly installments
of$29,772.00 each, for a total payment of$208,406.00. The claims handling charges are based on the
following estimates of claims per year: 400 Indemnity, 1,053 Medical Only, 831 Record Only. If in
any one contract year the total number of claims exceeds these estimates, the City will be billed on a
per claim basis for those claims in excess of the estimates at the following rates:
No Claim Reports $20.00 each
Medical Only Claims $99.00 each
Indemnity $591.00 each
(Lost Time Claims Requiring Indemnification)
Conversion $79.00 each
(From a No Claim Report to a Medical Only Claim)
Conversion $571.00 each
(From a No Claim Report to an Indemnity Claim)
Conversion $492.00 each
(From a Medical Only Claim to an Indemnity Claim)
Additionally, City will pay the following service fees:
Administrative Services $2,100.00 Seven Months
(TWCC Representative)
Rehabilitation Services AT COST
Case Management Services
Telephonic $60.00 per hour
On-Site AT COST
Loss Control $75.00 per hour
Safety Engineering AT COST
Computerized Medical Audit (Includes $54,282.00 annual fee
Pre-Certification Services) plus physician fees at cost
NOTE:Pre-authorization and computerized medical
Audit charge if number of indemnity
and medical only exceeds 1,453. $64.00 per claim
CLAIMS ADMINISTRATION G1� ORD
WORKER'S COMPENSATION BENEFIT PLANPage 7 of 22
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Data Processing:
Computer to Computer Dial In and
Read Capability NO CHARGE
Ad Hoc Reports NO CHARGE
Litigation Preparation(optional) No Charge. Expenses will be Allocated
Utilization Reviews/Peer Reviews
Desk Audits $60.00 per hour plus Physician Fees at Cost
Allocated Expenses See Allocated Expense Sheet
Additional Medical Reduction For any medical service provided through UICI
preferred provider network,any reduction below the TWCC fee schedule shall be shared between the
parties on the basis of 75/25. For example, for each$100 of savings to the City, City shall pay UICI
$25.
Other approved networks AT COST
TWCC Hearings
BRCS No charge
Attendence at CCHs $150.00 per CCH
Annual and Biannual Audits At cost(no mark up)
Surety Bond At cost(no mark up)
FOR JANUARY 1. 2002 THROUGH DECEMBER 31. 2002:
Claims administration for twelve months of claims handling, City will pay twelve monthly
installments of$30,665.00 each, for a total payment of$367,984.00. The claims handling charges are
based on the following estimates of claims per year: 400 Indemnity, 1,053 Medical Only, 831 Record
Only. If in any one contract year the total number of claims exceeds these estimates, the City will be
billed on a per claim basis for those claims in excess of the estimates at the following rates.
No Claim Reports $20.00 each
Medical Only Claims $102.00 each
Indemnity $609.00 each
(Lost Time Claims Requiring Indemnification)
Conversion $82.00 each
(From a No Claim Report to a Medical Only Claim)
OFFMAL PEW RD
CLAIMS ADUMSTRATION { PE"' IN
WORKER'S COMPENSATION BENEFIT PLAN
Page 8 of 22 ^�:O llo ) �Mb Uy Va.-
Conversion $589.00 each
(From a No Claim Report to an Indemnity Claim)
Conversion $507.00 each
(From a Medical Only Claim to an Indemnity Claim)
Additionally, The City will pay the following service fees:
Administrative Services $3,600.00 Annually
(TWCC Representative)
Rehabilitation Services AT COST
Case Management Services
Telephonic $60.00 per hour
On-Site AT COST
Loss Control $75.00 per hour
Safety Engineering AT COST
Computerized Medical Audit (Includes $95,850.00 annual fee
Pre-Certification Services) plus physician fees at cost
NOTE: Pre-authorization computerized medical
Audit charge if number of indemnity
and medical only exceeds 1,453. $64.00 per claim
Data Processing:
Computer to Computer Dial In and
Read Capability NO CHARGE
Ad Hoc Reports NO CHARGE
Litigation Preparation(optional) No Charge. Expenses will be Allocated
Utilization Reviews/Peer Reviews
Desk Audits $60.00 per hour plus Physician Fees at Cost
Allocated Expenses See Allocated Expense Sheet
Additional Medical Reduction For any medical service provided through UICI
preferred provider network, any reduction below the TWCC fee schedule shall be shared between the
parties on the basis of 75/25. For example, for each$100 of savings to the City,City shall pay UICI $25.
Other approved networks AT COST
CLAMTION
WORKE'SCOMPEI NS TIIONBENEFITPLAN �rOU U L5'�ItchUWWU
Page 9 of 22 Ta I
TWCC Hearings
BRCS No charge
Attendence at CCHs $150.00 per CCH
Annual and Biannual Audits At cost(no mark up)
Surety Bond At cost(no mark up)
FOR JANUARY 1. 2003 THROUGH DECEMBER 31. 2003:
Claims administration for twelve months of claims handling, City will pay twelve monthly
installments of$31,585.00each, for a total payment of$379,023.00. The claims handling charges are
based on the following estimates of claims per year: 400 Indemnity, 1,053 Medical Only, 831 Record
Only. If in any one contract year the total number of claims exceeds these estimates, the City will be
billed on a per claim basis for those claims in excess of the estimates at the following rates.
No Claim Reports $21.00 each
Medical Only Claims $105.00 each
Indemnity $627.00 each
(Lost Time Claims Requiring Indemnification)
Conversion $84.00 each
(From a No Claim Report to a Medical Only Claim)
Conversion $606.00 each
(From a No Claim Report to an Indemnity Claim)
Conversion $522.00 each
(From a Medical Only Claim to an Indemnity Claim)
Additionally, City will pay the following service fees:
Administrative Services $3,600.00 Annually
(TWCC Representative)
Rehabilitation Services AT COST
Case Management Services
Telephonic $60.00 per hour
On-Site AT COST
Loss Control $75.00 per hour
Safety Engineering AT COST om msa u c/�oo b
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CLAIMS ADMINISTRATION (�.n,r���
WORKER'S COMPENSATION BENEFIT PLAN R. `�A`1�,I�;til � ,
Page 10 of 22 u A U
Computerized Medical Audit (Includes $98,726.00 annual fee
Pre-Certification Services) plus physician fees at cost
NOTE: Pre-authorization computerized medical $64.00 per claim
Audit charge if number of indemnity
and medical only exceeds 1,453.
Data Processing:
Computer to Computer Dial In and
Read Capability NO CHARGE
Ad Hoc Reports NO CHARGE
Litigation Preparation(optional) No Charge. Expenses will be Allocated
Utilization Reviews/Peer Reviews
Desk Audits $60.00 per hour plus Physician Fees at cost
Allocated Expenses See Allocated Expense Sheet
Additional Medical Reduction For any medical service provided through UICI
preferred provider network, any reduction below the TWCC fee schedule shall be shared between the
parties on the basis of 75125. For example, for each $100 of savings to the City, City shall pay UICI
$25.
Other approved networks AT COST
TWCC Hearings
BRCs No charge
Attendence at CCHs $150.00 per CCH
Annual and Biannual Audits At cost(no mark up)
Surety Bond At cost(no mark up)
FOR JANUARY 1, 2004 THROUGH DECEMBER 31, 2004:
Claims administration for twelve months of claims handling, City will pay twelve monthly
installments of$32,375.00 each, for a total payment of$388,499.00. The claims handling charges are
based on the following estimates of claims per year: 400 Indemnity, 1,053 Medical Only, 831 Record
Only. If in any one contract year the total number of claims exceeds these estimates, the City will be
billed on a per claim basis for those claims in excess of the estimates at the following rates.
No Claim Reports $21.00 each
Medical Only Claims $108.00 each
OFFICIA PEC'o 0
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CLAIMS ADMINISTRATION �
WORKER'S COMPENSATION BENEFIT PLAN
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Page 11 of 22
Indemnity $643.00 each
(Lost Time Claims Requiring Indemnification)
Conversion $87.00 each
(From a No Claim Report to a Medical Only Claim)
Conversion $622.00 each
(From a No Claim Report to an Indemnity Claim)
Conversion $535.00 each
(From a Medical Only Claim to an Indemnity Claim)
Additionally, The City will pay the following service fees:
Administrative Services $3,690.00 Annually
(TWCC Representative)
Rehabilitation Services AT COST
Case Management Services
Telephonic $61.00 per hour
On-Site AT COST
Loss Control $77.00 per hour
Safety Engineering AT COST
Computerized Medical Audit (Includes $101,194.00 annual fee
Pre-Certification Services) Plus physician fees At Cost
NOTE: Pre-authorization charge if number of indemnity
and medical only exceeds 1,453. $66.00 per claim
Data Processing:
Computer to Computer Dial In and
Read Capability NO CHARGE
Ad Hoc Reports NO CHARGE
Litigation Preparation(optional) No Charge. Expenses will be Allocated
Utilization Reviews/Peer Reviews
Desk Audits $61.50 per hour plus Physician Fees AT COST
Allocated Expenses See Allocated Expense Sheet
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CLAIMS ADMIATISTRAITON
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WORKER'S COMPENSATION BENEFIT PLAN ] �(
Page 12 of 22 a �j^J'II tl Up U�a
Additional Medical Reduction For any medical service provided through UICI preferred
provider network, any reduction below the TWCC fee schedule shall be shared between the parties
on the basis of 75/25. For example, for each$100 of savings to the City, City shall pay UICI $26.
Other approved networks AT COST
TWCC Hearings
BRCS No charge
Attendence at CCHs $154.00 per CCH
Annual and Biannual Audits At cost(no mark up)
Surety Bond At cost(no mark up)
FOR JANUARY 1, 2005 THROUGH DECEMBER 31, 2005:
Claims administration for twelve months of claims handling, The City will pay twelve monthly
installments of$33,184.00 each, for a total payment of$398,211.00. The claims handling charges are
based on the following estimates of claims per year: 400 Indemnity, 1,053 Medical Only, 831 Record
Only. If in any one contract year the total number of claims exceeds these estimates, the City will be
billed on a per claim basis for those claims in excess of the estimates at the following rates.
No Claim Reports $22.00 each
Medical Only Claims $110.00 each
Indemnity $659.00 each
(Lost Time Claims Requiring Indemnification)
Conversion $88.00 each
(From a No Claim Report to a Medical Only Claim)
Conversion $637.00 each
(From a No Claim Report to an Indemnity Claim)
Conversion $549.00 each
(From a Medical Only Claim to an Indemnity Claim)
Additionally, The City will pay the following service fees:
Administrative Services $3,782.00 Annually
(TWCC Representative)
Rehabilitation Services AT COST
Case Management Services
Telephonic $63.00 per hour
CLAIMS ADMINISTRAnON FO# U:EC005,DWORKER'S C�ENSATION BENEFIT PLAN
MPago 13 of 22 �l5 Wi11l n
On-Site AT COST
Loss Control $79.00 per hour
Safety Engineering AT COST
Computerized Medical Audit (Includes $103,724.00 annual fee
Pre-Certification Services) Plus physician fees At Cost
NOTE: Pre-authorization charge if number of indemnity
and medical only exceeds 1,453. $67.00 per claim
Data Processing:
Computer to Computer Dial In and
Read Capability NO CHARGE
Ad Hoc Reports NO CHARGE
Litigation Preparation(optional) No Charge. Expenses will be Allocated
Utilization Reviews/Peer Reviews
Desk Audits $63.00 per hour plus Physician Fees AT COST
Allocated Expenses See Allocated Expense Sheet
Additional Medical Reduction For any medical service provided through UICI preferred
provider network, any reduction below the TWCC fee schedule shall be shared between the parties
on the basis of 75/25.For example, for each$100 of savings to the City, City shall pay UICI $26.
Other approved networks AT COST
TWCC Hearings
BRCs No charge
Attendence at CCHs $158.00 per CCH
Annual and Biannual Audits At cost(no mark up)
Surety Bond At cost(no mark up)
FOR JANUARYI, 2006, THROUGH DECEMBER 31, 2006:
Claims administration for twelve months of claims handling, City will pay twelve monthly
installments of$34,013.00 each, for a total payment of$408,166.00. The claims handling charges are
based on the following estimates of claims per year: 400 Indemnity, 1,053 Medical Only, 831 Record
Only. If in any one contract year the total number of claims exceeds these estimates, the City will be
billed on a per claim basis for those claims in excess of the estimates at the following rates.
No Claim Reports $22.00 each
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CLAIMS ADMBQISTRAnON
WORKER'S COMPENSATION BENEFIT PLAN
Page 14 of 22 e J I J�. ➢ a
Medical Only Claims $113.00 each
Indemnity $675.00 each
(Lost Time Claims Requiring Indemnification)
Conversion $91.00 each
(From a No Claim Report to a Medical Only Claim)
Conversion $653.00 each
(From a No Claim Report to an Indemnity Claim)
Conversion $562.00 each
(From a Medical Only Claim to an Indemnity Claim)
Additionally, The City will pay the following service fees:
Administrative Services $3,877.00 Annually
(TWCC Representative)
Rehabilitation Services AT COST
Case Management Services
Telephonic $65.00 per hour
On-Site AT COST
Loss Control $81.00 per hour
Safety Engineering AT COST
Computerized Medical Audit (Includes $106,317.00 annual fee
Pre-Certification Services) Plus physician fees At Cost
NOTE: Pre-authorization charge if number of indemnity
and medical only exceeds 1,453. $69.00 per claim
Data Processing:
Computer to Computer Dial In and
Read Capability NO CHARGE
Ad Hoc Reports NO CHARGE
Litigation Preparation(optional) No Charge. Expenses will be Allocated
Utilization Reviews/Peer Reviews
Desk Audits $65.00 per hour plus Physician Fees AT COST
Allocated Expenses See Allocated Expense Sheet
CLAM AD11"STRATION
WORKER'S COMPENSATION BENEFIT PLAN
Page 15 of 22
u
Additional Medical Reduction For any medical service provided through UICI preferred
provider network, any reduction below the TWCC fee schedule shall be shared between
the parties on the basis of 75125. For example, for each$100 of savings to the City, City shall pay
UICI $27.
Other approved networks AT COST
TWCC Hearings
BRCS No charge
Attendence at CCHs $162.00 per CCH
Annual and Biannual Audits At cost(no mark up)
Surety Bond At cost (no mark up)
FOR JANUARY 1, 2007, THROUGH DECEMBER 31,2007:
Claims administration for twelve months of claims handling, The City will pay twelve monthly
installments of$34,864.00 each, for a total payment of$418,370.00. The claims handling charges are
based on the following estimates of claims per year: 400 Indemnity, 1,053 Medical Only, 831 Record
Only. If in any one contract year the total number of claims exceeds these estimates, the City will be
billed on a per claim basis for those claims in excess of the estimates at the following rates.
No Claim Reports $23.00 each
Medical Only Claims $116.00 each
Indemnity $692.00 each
(Lost Time Claims Requiring Indemnification)
Conversion $93.00 each
(From a No Claim Report to a Medical Only Claim)
Conversion $669.00 each
(From a No Claim Report to an Indemnity Claim)
Conversion $576.00 each
(From a Medical Only Claim to an Indemnity Claim)
Additionally, The City will pay the following service fees:
Administrative Services $3,974.00 Annually (TWCC
Representative)
Rehabilitation Services AT COST
Case Management Services
?CM WORD
21,
CLAIMS ADMINISTRATION 1d It�r Billow
WORKER'S COMPENSATION BENEFIT PLAN
Page 16 of 22
Telephonic $66.00 per hour
On-Site AT COST
Loss Control $83.00 per hour
Safety Engineering AT COST
Computerized Medical Audit (Includes $108,975.00 annual fee
Pre-Certification Services) Plus physician fees At Cost
NOTE: Pre-authorization charge if number of indemnity
and medical only exceeds 1,453. $71.00 per claim
Data Processing:
Computer to Computer Dial In and
Read Capability NO CHARGE
Ad Hoc Reports NO CHARGE
Litigation Preparation(optional) No Charge. Expenses will be Allocated
Utilization Reviews/Peer Reviews
Desk Audits $66.00 per hour plus Physician Fees
Allocated Expenses See Allocated Expense Sheet
Additional Medical Reduction For any medical service provided through UICI preferred
provider network, any reduction below the TWCC fee schedule shall be shared between the parties
on the basis of 75/25. For example, for each$100 of savings to the City, City shall pay UICI $27.
Other approved networks AT COST
TWCC Hearings
BRCS No charge
Attendence at CCHs $166.00 per CCH
Annual and Biannual Audits At cost(no mark up)
Surety Bond At cost(no mark up)
5. In the event this contract is terminated, or when it expires, the City has the option, on a
month-to-month basis, to utilize the services provided for in the contract, for a period not to exceed
six (6) months, under the terms and conditions of this contract that are in effect at the time said
contract is terminated or expires.
6. Upon termination of the contract, a timely final accounting will be made of the services fees
and Allocated Loss Expense, if any, owing to UICI or to the City, and any funds belonging to the
City in possession of UICI. Any balance due will be promptly paid.
11-41CIA1 iKORD
CLAIMS ADMINISTRATION � Q (Q(�� PERRY
WORKER'S COMPENSATION BENEFIT PLAN vK b U��d�.I IaC�u
Page 17 of 22 }�j.9A1�}1j;' �y a.
7. Upon termination of the contract, any claim(s)or loss(es)reported or unreported pending on the
date of the contract termination will be handled and adjusted to conclusion by UICI consistent with the
terms of the contract; and sufficient funds of the City shall remain available to UICI to liquidate such
outstanding claims or losses including sufficient funds to satisfy anticipated loss adjustment expense.
Should the City of specify in writing to UICI that pending claims and losses are to revert to control of
and become the responsibility of the City upon date of contract termination, final accounting pursuant to
paragraph C. 3 above shall include any amount due either party on account of such pending claims and
losses including allocated loss expense.
8. "Allocated Loss Expense" shall mean all court cost and fees; attorneys and hearing
representatives; trial/hearing attendance; court reported and transcript fees; witness fees and related
travel expenses; expenses to obtain copies of public records; cost of surety bonds required by this
contract; all outside activities where personal contact, investigation, or litigation involvement is
necessary; auto and property appraisal fees;professional photographers and photocopy services; private
investigation, surveillance, video statements, or depositions; narrative caption reports; litigation
management; subrogation investigation and recovery services; additional services of account manager;
express carrier reports and notification; expenses chargeable to the defense of a particular claim;
protection and pursuit of subrogation/recovery rights; other extraordinary services performed by
administrator at the City's request; banking fees; and indexing reports; outside audit services; check
stock;data transfers at contract termination, off-site closed file storage; IBNR or other actuarial audits;
microfilming of claims files;special reports.
All "Allocated Loss Expenses" incurred in the adjustment, handling, settlement or resistance of
claims(including litigation) as authorized by the City, shall be borne by the City.
9. The contract entered into by the City and UICI may be terminated under any one of the
following circumstances:
a. City's authorization to self-insure is rescinded.
b. City purchases Workers'Compensation Insurance.
C. UICI violates any of the laws of the United States, State of Texas, or ordinances of the
City.
d. Mutual agreement and consent of the parties.
e. Unsatisfactory performance by UICI, in the sole determination of the City.
f. UICI violates any of the terms and conditions of this contract, in the sole
determination of the City.
g. Failure by the Fort Worth City Council to appropriate for its fiscal year beginning
October 1 of each year) sufficient funds designated to pay for services furnished under
this contract for that fiscal year.
In the event of termination under this paragraph, City shall give UICI thirty (30) days prior written
notice of termination and notice of the City's desire to exercise the month-to-month option specified
in paragraph C. 2 above.
In the event of termination upon any of the conditions set forth above, or upon expiration of the terms
of this contract, UICI shall make a timely final accounting as to the fees payable to UICI and any
CLAIMS ADM USTRATIONWORKE �Q�SIS G�1� �� �
R'S COMPENSATION BENEFIT PLAN (v�U U/�l��v N;ISIIW��
hip I8 of22
funds due the City but in the possession of UICI. Any balance due either party shall be promptly paid
by the debtor party. The final accounting is subject to City audit and UICI shall make its business
records available to the City for such accounting and audit. In the event of termination or expiration,
UICI shall not be entitled to lost or anticipated profits.
10. Commission and fees paid by UICI, if any, must be approved by the City prior to UICI
incurring same.
D. OTHER TERMS AND CONDITIONS:
1. UICI shall perform all work and services hereunder as an independent contractor and not as an
officer, agent, servant or employee of the City. UICI shall have exclusive control of, and the exclusive
right to control, the details of its work and services performed hereunder, and all persons performing
same, and shall be solely responsible for the acts and omissions of its officers, agents and employees.
Notwithstanding City's duty to cooperate and assist in certain duties as set out above, nothing herein
shall be construed as creating a partnership or joint enterprise between the City and the UICI, its officers,
agents and employees;and the doctrine of respondent superior shall have no application hereunder.
2. UICI covenants and agrees to indemnify, hold harmless and defend City, its officers and
employees, from and against any and all suits or claims for damages or injuries, including death, to
any and all persons or property, whether real or asserted, arising out of or in connection with any act
or omission on the part of UICI, its officers, agents, servants, employees or subcontractors in the
performance, attempted performance or nonperformance of this Contract; and UICI will assume all
liability and responsibility for such injuries, claims or suits for damages. UICI further covenants and
agrees to indemnify the City against damage or destruction of City property, arising out of or in
connection with any negligent act or omission or allegations of any negligent act or omission on the
part of UICI, its officers, agents, servants, employees or subcontractors, and UICI assumes all
liability for any such damage or destruction.
UICI further will reimburse and hold the City harmless for any illegal conversion, fraudulent
payment, unauthorized use, or loss whatsoever of any fund deposited into or withdrawn from the
claims escrow account resulting from any act, omission or negligence on the part of UICI,its officers,
agents, employees or subcontractors, and will indemnify the City for any loss which the City might
sustain as a result thereof.
To the extent permitted by law, except as otherwise provided herein, City covenants and agrees to be
responsible for all claims, demands, costs, damages and expenses caused by the negligence of any
officer, agent, servant or employee of the City. Nothing contained herein shall require City to assess,
levy or collect any tax to fund this indemnification provision.
3. Venue and jurisdiction of any suit, right or cause of action arising under or in connection with
this contract shall lie exclusively in Tarrant County, Texas. This contract shall be construed pursuant
to the laws of the state of Texas.
4. The parties hereto acknowledge and agree that UICI will furnish the basic management
information Services Reports as contemplated in UICI's Proposal and in this Agreement, but that the
CLAIMS ADMINISTRATION
F� YIL
WWOORKER'S COMPENSATION BENEFIT PLAN 19 of 22 oJIS WIVWY
H, YR.
City may expand such reporting service in the future under terms, conditions and rates mutually
acceptable to the City and UICI.
5. The Rehabilitation Services to be performed by UICI shall be within the scope described by
UICI in its Proposal. Such services shall be performed only on a case-by-case basis and shall be
performed for each case only after approval by the City.
6. For purposes of describing the services to be performed hereunder, the parties hereto adopt and
incorporate by reference UICI's Bid Form for Claims Administration and Service Bid submitted to the
City on April 10, 2001, a copy of which is on file and available for inspection in the office of the Risk
Manager of the City of Fort Worth and an additional copy of which shall be prepared and placed on file
with this contract in the office of the City Secretary of the City of Fort Worth within ten (10) days
following the execution of this contract. In event of any inconsistency between the terms of this
Agreement and the terms of UICI's Proposal,the terms of this Agreement shall prevail.
7. Any changes in the scope of services or conditions of this Contract which the parties agree
shall be incorporated by written amendment to the contract.
In witness whereof; the parties have caused this contract to be executed by the persons authorized to
act in their respective name this the day of , 2001.
Lq
-ATTEST: CITY OF FORT WORTH
By:
4:�L
loria Pe on 7-�8 !?/ Charles Boswell
City Sec tary Assistant City Manager
Approved as to Form and Legality
Contract Authorization
Gary Steinberger Date
Assistant City Attorney
ATTEST: UICI and its wholly owned subsidiary
BARRON RISK MANAGEMENT
a- k
'Vwit ss Name: f4-
Title: Vice-presa"
OFECBad
CLAIMSADMITIISTRATION CAY MCC-11,1�WrURll
WORKER'S COMPENSATION BENEFIT PLAN 20 of U 'Ic
Page 22 11'I� �Vr
15
arron
Risk Management Services
CONTRACT ALLOCATED EXPENSES
The following are considered as allocated expenses and are not part of our quoted fee.
These costs will be paid from the client's loss fund, unless other arrangements are made.
Court costs and fees .................................................................................At Cost
Attorneys and hearing representatives ............................................................At Cost
Trialattendance .......................................................................................*T&E
Court reporter and transcript fees .............................................................At Cost
Witness fees and travel expense .............................................................At Cost
Expense to obtain copies of public records ........................................................*T&E
Private investigation, surveillance, video statements,or depositions ........................At Cost
Expenses chargeable to the defense of a particular claim ...............................At Cost
Other extraordinary services performed by administrator at client's request ................At Cost
Other extraordinary expenses, including but not limited to photocopying,
travel, express mail;public records, and similar expenses as may be incurred
by Barron Risk Management Services,Inc. in fulfilling its obligation beyond
the normal level ................................................................................At Cost
Outside Investigations ................................................................................*T&E
CCH/SOAWAppeals Panel Reviews/APA Services ................................Pass through cost
of attorney
of your choice
Medical Cost Containment fees ....................................... . At price quoted in RFP response
These costs will be billed directly to the client, unless other arrangements are made.
Outside audit services ................................................................................At Cost
Dedicated computer,telephone equipment &other furniture and Fixtures ..................At Cost
CheckStock ..........................................................................................At Cost
Data Transfer ...............................................$100 per hour/maximum charge$2,500
Bonds or other policies required by client/customer .......................................... At Cost
Off-Site closed file storage ...................................................... ................. At Cost
Rekey of medical bills if Barron's MCC not chosen to review bills.................... $0.75 per bill
IBNR or other actuarial audits .................................................................... At Cost
Microfilming of claims files ...................................................................... At Cost
TWCC Representative .................................................................... $300.00/Month
Special Reports ............................................................................... $100.00/Hour
* SEE BARRON'S TIME AND EXPENSE SHEET IN THIS SECTION
OFFI�V8AI
CLAIMS ADMINISTRATIONr
WORKER'S COMPENSATION BENEFIT PLAN
Page 21 of 22
10 arron
Risk Management Services
CLAIMS ADJUSTING/INVESTIGATIVE SERVICES
Time and Expense Claims Investigative Service Charges
Time and Expense Services $55.00 Per Hour
CHARGE ADDITIONAL TO HOURLY RATE:
Photos- $2.25 each
Mileage - $ .45 per mile
Recorded Statement Transcriptions- $3.50 per page
Long Distance Cost,Fax- $2.00 per page
Express Mail, Certified Mail—at cost
Photocopying - $ .25 per page
Public Records—at cost
Cassettes Tape-$3.00
MVD - $10.00 each
Q,CDED
CLAIMS ADMINISTRATION11�LS W/UU��
WORKER'S COMPENSATION BENEFIT PLAN
Pa®e 22 of 22
City of Fort Worth, Texas
"near and Council Communication
DATE REFERENCE NUMBER LOG NAME PAGE
5/22/01 **C-18593 15BARRON 1 of 1
SUBJECT CONTRACT FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATION
SERVICES WITH BARRON RISK MANAGEMENT SERVICES, INC., A WHOLLY-
OWNED SUBSIDIARY OF UNITED INSURANCE COMPANIES, INC. (UICI) FOR THE
RISK MANAGEMENT DEPARTMENT
RECOMMENDATION:
It is recommended that the City Council authorize the execution of a seven-month contract with Barron
Risk Management Services, Inc. for the period June 1, 2001, through December 31, 2001, with six
options to renew for one-year periods.
DISCUSSION:
A Request for Proposal was prepared and sent out to solicit provision of workers' compensation claims
administration services from an outside vendor with services to begin June 1, 2001. Five responses
were received and evaluated by a selection committee comprised of representatives from the Police,
Water and Risk Management Departments. The committee recommends that Barron Risk
Management Services, Inc. (Barron), a wholly-owned subsidiary of UICI, be awarded a contract for an
initial seven-month period to begin June 1, 2001, and expire December 31, 2001, with six options to
renew for one-year periods.
The estimated cost for the initial seven-month period is $264,788, based on Barron's prices for claim
services/fees and the City's estimated volume of claims for 2001. The estimated cost for calendar year
2002 is $467,434. There is a 3% increase for the year 2003. The cost for the years 2004, 2005, 2006
and 2007 each is increased by 2.5%.
Barron is the existing administrator for these claims and its services have been excellent. To continue
utilizing the services of this firm would assure the City of high quality claims adjusting services to
minimize City-paid losses during the next year.
FISCAL INFORMATION/CERTIFICATION:
The Finance Director certifies that funds are available in the operating budget, as appropriated, of the
Workers' Compensation Fund.
CB:k
Submitted for City Manager's FUND ACCOUNT CENTER AMOUNT CITY SECRETARY
Office by: (to)
APPROVED
Charles Boswell 8511 CITY COUNCIL
Originating Department Head:
MAY 22 2001
Susan Bulla 8513 (from)
FE73 534600 0157310 $264,788.00
Additional Information Contact: City Secretary of the
City of Fort Worth,Texas
Susan Bulla 8513