HomeMy WebLinkAboutContract 44004 (2)CITY SECRETARY
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PROFESSIONAL SERVICES AGREEMENT
FOR WORKERS' COMPENSATION CLAIMS ADMINISTRATION AND RELATED SERVICES
STATE OF TEXAS §
COUNTY OF TARRANT §
This Professional Services Agreement for Workers' Compensation Claims Administration and Related Services
(Agreement) is made and entered into by and between the CITY OF FORT WORTH, TEXAS, a home -rule municipal
corporation of the State of Texas ("CITY"), acting by and through its duly authorized Assistant City Manager, and
CORVEL ENTERPRISE COMP, INC., a Delaware corporation ("CORVEL"), acting by and through its Vice President,
who is duly authorized to act on its behalf. CITY and CORVEL may be referred to herein individually as a "party" and
collectively as the "parties".
In consideration of the mutual covenants and provisions contained herein and other good and valuable consideration,
the receipt and sufficiency of which are hereby acknowledged, the parties agree, and by the execution hereof are
bound, to the mutual obligations herein contained and to the performance of the tasks hereinafter described.
1.1 SCOPE OF SERVICES
1.1 2
1.1.3
CORVEL agrees to provide the following services:
Account Representative - CORVEL shall designate an executive or senior -management -level employee as
the Account Representative to serve a single point -of -contact to service CITY's account. The Account
Representative shall be available at reasonable times to CITY staff to field and answer questions that may
arise from time -to -time and to expedite all aspects of CORVEL's performance under this Agreement. The
Account Representative shall not be in the chain of command of claims adjusters, claims supervisors, or
claims managers.
Transition Plan - Immediately upon award of a contract by the Fort Worth City Council, and upon execution
of this Agreement, CORVEL shall prepare, coordinate with CITY, and fully implement a transition plan to
ensure the smooth transfer of claims data, information and claim files from the previous third party
administrator and to establish necessary computer system interfaces. CORVEL shall work with CITY and
the prior third party administrator to ensure all state statutory and regulatory requirements are met with
regards to timely payment of indemnity and medical benefits during the transition period.
Hours of Service - During the hours of 8:00 am to 5:00 pm Central Time, Monday through Friday, CORVEL
will provide one or more licensed adjusters to respond to inquiries, questions or concerns of CITY
employees who have an active or closed claim for which the CORVEL is providing service. During an
emergency situation, CORVEL shall provide an emergency contact person at other times to respond as
appropriate to CITY needs.
1.1.4 Account Service Meetings - The Account Representative shall arrange for and facilitate meetings as
required by CITY to discuss contract and performance issues.
1.1.5 Account Information and Protocols - CITY shall prepare and maintain an "Account Information and
Protocols" (AIP) document containing account information, procedures and processes with respect to
CITY's account with CORVEL. The AIP shall include, but not necessarily be limited to, the following
information, procedures, and best rractices: description of services provided; contacts; locations; financial
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management; insurance; information systems management; standard and customized reports; claims
handling and adjusting, medical cost containment medical case management disability management
vocational rehabilitation; return -to -work; subrogation; litigation management; CITY salary supplementation;
CITY civil service Tine -of -duty -injury leave of absence pay; City retirement; scanning, imaging indexing; and
records retention. The initial AIP shall be provided to CORVEL on or before January 1, 2013, so that it can
be used in providing and monitoring services under this Agreement and shall be attached to this Agreement
as an addendum. The AIP may be amended from time to time, with each revised version being attached to
this Agreement as an addendum
1.1.6 Trustee Bank Account — CORVEL will establish a Well's Fargo account under the name and tax id of the
CITY The account will be pre -funded with amount of Six Hundred and Twenty Thousand Dollars
($620,000). CORVEL will provide invoice to CITY for the prefunding. Copy of collateralization agreement
must be provided prior to funding. Thereafter, CORVEL will invoice the CITY every two weeks to replenish
the account. CORVEL will provide the CITY with the appropriate document to authorize specific CORVEL
personnel to have signature authority on the CITY's account. The CITY will also have specific individuals
with signature authority. CORVEL will provide monthly, bank statement, bank reconciliation and check
registers within ten (10) days of the end of the month.
1.1.7 Standards of Quality — CITY is very demanding with respect to quality services, responsiveness timeliness,
accuracy and cost control. CITY desires to provide quality, efficient and effective workers' compensation
claims administration services to CITY and CITY employees in the most cost-effective manner. CITY
generally defines such services as timely and accurate filing, processing, adjusting and administration of
claims, all of which meet or exceed the state statutory requirements in a manner that exemplifies superlative
customer service CITY has achieved and maintained a 'high performer" status on Texas Department of
Insurance / Division of Workers' Compensation (TDI-DWC) Performance Based Oversight audits since
1997. CITY expects full cooperation from its workers' compensation third party administrator to continue
meeting these standards of quality.
1.2 CARRIER'S AUSTIN REPRESENTATIVE
1.2.1 CORVEL shall arrange for TDI-DWC 'Carrier's Austin Representative' services, in accordance with the
Texas Administrative Code, Title 28, Chapter 156, to be provided to CITY and CORVEL as the third party
administrator. Such Carrier's Austin Representative services shall be provided by a third party
subcontractor and charged to the CITY by CORVEL at cost with no markup or overhead, with such cost to
be commensurate with the standard rate for such services at the time services are rendered. CITY shall
approve such Carrier's Austin Representative prior to initiation of such work on behalf of CITY's self -insured
workers' compensation plan CITY reserves the right, in its sole discretion, to terminate the Agreement as
to these services and to independently contract directly with a Carrier Representative for such services.
1.3 CLAIMS ADMINISTRATION SERVICES
The following claims administration services will be required of CORVEL to support the CITY's self -insured
workers' compensation program.
1.3.1 Legal Compliance - AD workers' compensation claims adjusting, claims handling, and claims administration
services shall be provided in compliance with the requirements of all applicable statutes, including, but not
limited to: Texas Labor Code, Chapters 401 — 451 and Chapter 504 Texas Insurance Code, Chapter
4151 • Texas Local Government Code, Chapter 143; Texas Government Code (Chapter 607); Texas Health
& Safety Code, Chapter 81; and Texas Administrative Code, Title 28, Parts 1 2 and 6.
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1.3.2 Description of Services - CORVEL shall provide CITY with the full range of basic claims administration and
claims handling/adjusting services that is usual and customary under industry standards for an exemplary
TPA. Specific claims administration and claims adjusting standards and procedures for all services
provided under this Agreement shall be included in the "Account Information and Protocols" document
(Section 1.1.5 above) along with a schedule of all service providers and all charges and costs to be paid by
CITY. Such claims administration services may be amended as necessary upon mutual written agreement
of the parties.
1.3.3 Claims Adiustina - Claims are to be adjusted in strict compliance with the Texas Workers' Compensation
Act, administrative rules enacted by TDI-DWC and Exhibit Al which is attached hereto and incorporated
herein for all purposes as though it were set forth at length
1.3.4 Team Member Reauirements —_CORVEL will provide qualified personnel to perform claims adjustment and
claims administration services for the CITY in accordance with the following requirements:
1.3.4.1 Claims Adiustina Team — CORVEL shall supply a team of claims adjusters and claims support
personnel dedicated specifically and solely to the handling of CITY claims, and shall use reasonable efforts
to provide at least one of whom can provide services in Spanish
1.3.4.2 Types of Adiusters All claims adjusters shall be "indemnity" adjusters; no medical -only claims
adjusters may be assigned to the CITY account.
1.3.4.3 Adiuster's License — Assigned claims adjusters must possess and maintain a valid Texas Type 03
or all lines adjuster's license during the term of this Agreement and any renewals. CORVEL shall provide
current licensure information to the CITY on request.
1.3.4.4 Adiustina Experience - All adjusters shall have a minimum of three (3) years of experience
adjusting indemnity claims in the Texas workers compensation system. CORVEL shall provide
documentation of adjusters' experience to the CITY on request.
1.3.4.5 Claims Assistants - CORVEL shall provide one or more claims administrative assistants sufficient
to provide complete administrative support to the claims adjusters and allow the adjusters to devote one
hundred percent of their time to the claims adjusting process.
1.3.4.6 Team Member Backaround - CORVEL will supply the CITY with a list of all potential team
members who will handle or in any way be involved in handling CITY claims. Resumes shall be provided to
CITY for all personnel involved in the CITY's account, with such resumes to include a summary of
education, experience, licenses and languages spoken/written CITY reserves the right to request removal
of any person assigned to the CITY team who in the sole discretion of the CITY, is not performing
satisfactorily under the Agreement. Such person shall be replaced with equally knowledgeable and qualified
personnel. Prior to adding any personnel to the CITY claims handling team during the term of this
Agreement or any renewal CORVEL shall provide CITY with resumes for review and approval
1.3.4.7 Claim Case Loads - CORVEL shall provide sufficient staff at all times to maintain average claims -
to -adjuster ratios as follows.
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Average Case Load Limit
per Adjuster
Indemnity Medical Total
60 110 170
70 100 170
80 90 170
90 1 80 1 170
100 1 70 1 170
110 160 1 170
120 J 50 (170
130 140 1170
CORVEL shall provide documentation of actual case loads and ratios to the CITY on request.
1.3.5 Claim File Reviews — The Account Representative shall arrange for and facilitate claims review meetings on
a monthly basis, the purpose of which is to identify areas of concern or issues that are preventing the return -
to -work of CITY employees, progress toward maximum medical improvement, and/or full medical recovery
from an injury.
1.3.6 Trainina and Continuing Education — CORVEL shall make available to CITY staff Texas Department of
Insurance approved continuing education opportunities that are provided to CORVEL's adjusting staff.
1.3.7 Claims Accident Investigations — CORVEL shall, at CITY's request or with CITY's approval provide or
engage in accident investigation services for a specific accident or claim Such accident investigation
services shall be provided by experts in the fields of accident reconstruction, biomechanical analysis,
biomedical analysis or other qualified specialty fields. The primary purpose of such services is to determine
causality. Fees for claims accident investigation services shall be billed to the specific claim as an allocated
loss adjustment expense.
1.4 MEDICAL COST CONTAINMENT SERVICES
1.4.1 Provision of Cost Containment Services. CORVEL shall provide the full range of medical cost containment
services that is usual and customary of an exemplary medical cost containment services company, which
services shall include, but not be limited to, the following: 24/7 nurse hotline; medical bill auditing; review
and repricing; preauthorization; determinations of medical necessity and relatedness; utilization reviews;
peer reviews; maximum medical improvement/impairment rating reviews, designated doctor reviews;
designated doctor determination letters; required medical exam coordination; medical case management
(telephonic and field) pharmacy benefits management; vocational rehabilitation; on line access; reports
and document imaging indexing, and electronic records management CORVEL shall bring forward to the
CITY other cost containment programs and services that may become available and that potentially may
enhance or improve current cost containment services and programs.
1.4.2 Compliance — CORVEL shall provide workers' compensation medical cost containment services to CITY in
a manner that is in full compliance with the Texas Labor Code (Texas Workers' Compensation Act), Texas
Insurance Code, and Texas Department of Insurance Administrative Rules.
1.4.3 Treatment Guidelines — It is the expressed intent of CITY that, in its administration and handling of CITY
claims, CORVEL shall fully implement and maximize the use of the Texas Administrative Code, Title 28,
Chapter 137, Sub -Chapter C, Rule 137.100, "Treatment Guidelines" and the other authorities referenced
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therein. CORVEL shall routinely consult the Treatment Guidelines and actively engage health care
providers and injured CITY employees in discussions that are intended to provide high quality medical care
within the Guidelines. CORVEL shall request treatment plans from treating physicians and consulting
physicians as necessary to effectively manage medical treatment of the claimant.
1.4.4 Pharmacy Benefits Manaaement - CORVEL shall arrange for and provide comprehensive pharmacy
benefits management services for injured CITY employees to include pharmacy reviews of frequently
prescribed and high cost prescriptions.
1.4.5 Loss Adiustment Expense -Medical expenses and medical cost containment services that are not priced as
flat contract fees in Attachment A, Schedule of Services and Fees, shall be billed to the specific claim as an
allocated loss adjustment expense.
1.4.6 Workers' Compensation Healthcare Network — In the event that CITY contracts for workers' compensation
medical care or other occupational health care services for its employees through: (a) a preferred provider
of occupational healthcare services (b) a TDI-certified Workers' Compensation Healthcare Network, and/or
(c) a custom -developed healthcare benefits delivery system under the provisions of the Texas Labor Code,
Section 504.053(b), it shall be mutually agreed upon by both CORVEL and CITY that CORVEL shall
cooperate in the implementation and provision of such medical services occupational healthcare services
and/or healthcare network services as applicable.
1.5 LEGAL SERVICES
1.5.1 Attorney Representation - CITY typically provides its own legal representation at workers compensation
administrative hearings and in the courts by using its own legal resources. However, CITY may from time -
to time determine that CITY s position and case would best be presented through outside attorney
representation. Therefore, at the request of CITY, CORVEL shall arrange for highly qualified attorney
representation to represent CITY s interests and shall assist CITY personnel in ensuring that any contracts
required between the CITY and the outside attorney are timely and fully executed. Such outside attorney
representation shall be billed to the specific claim as a legal expense.
1.5.2 Adiuster Participation in Leaal Proceedinas - CORVEL claim adjusters shall attend TDI-DWC Administrative
Hearings and Court appearances to represent CITY at no additional cost to CITY.
1.5.3 Expert Witness Testimony - CORVEL may arrange for expert witness testimony upon approval by CITY.
Such expert witness testimony shall be billed to the claim file as an allocated loss adjustment expense.
1.5.4 Documents Exchange Service - Upon approval of CITY, CORVEL may arrange for a documents exchange
service to pick up copy, and deliver claim files for administrative and litigation proceedings. Such service
fees shall be billed to the specific claim as an allocated Toss adjustment expense.
1.6 RETURN -TO -WORK PROGRAM
1.6.1 Stav-at-Work/Return-to-Work - CITY provides an active return -to -work program administered by a
designated Return -To -Work Coordinator. CORVEL adjusters and medical case managers shall actively
work with and through the Occupational Health and Safety/Workers Compensation Division of the CITY s
Human Resources Department and with other designated CITY employees supervisors and managers to
maximize opportunities for injured CITY employees to stay -at -work and/or return -to -work as quickly as
medically feasible following injury.
1 6 2 Return -To -Work Guidelines - It is the expressed intent of CITY that, in its administration and handling of
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CITY claims, CORVEL shall fully implement and maximize the use of the Texas Administrative Code, Title
28, Chapter 137, and specifically Rule 137.10, 'Return to Work Guidelines." CORVEL shall routinely
consult the Return to Work Guidelines and actively engage health care providers and injured CITY
employees in discussions regarding return to work and disability duration expectancies contained within the
guidelines. CORVEL shall request treatment plans from treating physicians and consulting physicians as
necessary that include disability duration expectancies in order to effectively manage return to work of the
claimant
1.7 CASE MANAGEMENT SERVICES
1.7.1 Case Manaaement — All telephonic and field case management shall be at the direction and authorization of
CITY and shall conform to the standards and requirements set forth by the CITY in the Account Information
and Protocols document
1.7.2 Case Manaaement Billing The costs of telephonic case management services shall be billed as a monthly
flat fee Field case management services shall be billed to individual claim files as an allocated Toss
adjustment expense.
1.7.3 Case Management Reports — Reports summarizing the activities and costs of vocational rehabilitation case
management services shall be provided to CITY on a monthly basis. A quarterly summary report and
annual summary report shall be provided to CITY at the conclusion of each calendar quarter and Contract
Year (as defined herein).
1.8 VOCATIONAL REHABILITATION SERVICES
1.8.1 Vocational Rehabilitation Services - CORVEL adjusters and medical case managers shall actively look for
opportunities for vocational rehabilitation services to be provided to facilitate CITY's stay-at-work/return-to-
work efforts. CORVEL may, with CITY approval, arrange for the provision of appropriate vocational
rehabilitation services on a case -by -case basis Specific vocational rehabilitation services include, but are
not limited to, conducting vocational assessments, job analyses, transfer skills analysis, labor market
survey, job seeking skills survey, vocational testing, and job placement services. CORVEL shall utilize the
services of the Texas Department of Assistive and Rehabilitative Services to the greatest extent possible to
provide such vocational rehabilitation services.
1.8.2 Vocational Rehab Services Billing -- The costs of vocational rehabilitation services shall be billed to the
specific claim file as an allocated loss adjustment expense.
1.8.3 Vocational Rehabilitation Reports Reports summarizing the activities and costs of vocational rehabilitation
services shall be provided to CITY at the conclusion of each calendar quarter and Contract Year.
1.9 SAFETY, ACCIDENT PREVENTION AND LOSS CONTROL SERVICES
1.9.1 Provision of Services — CITY provides in-house safety, accident prevention and loss control services
utilizing in-house resources. However, at the request of CITY, CORVEL shall arrange for specific safety,
accident prevention and/or loss control services at the expense of the CITY as detailed in Attachment A.
1.9.2 General Safety. Accident Prevention and Loss Control Services - Services include, but are not limited to:
providing safety engineering services; evaluating high -risk activities; conducting ergonomic evaluations;
conducting safety program evaluations; conducting job safety/hazard analyses on specific work activities;
safety training; and general consulting on safety, accident prevention and loss control issues Fees for
Safety, Accident Prevention, and Loss Control Services shall be invoiced directly to CITY and shall not
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exceed the amounts specified in Schedule 2 of Attachment A.
1.10 CLAIMS MANAGEMENT SYSTEM; ON-LINE ACCESS; DATA; REPORTS
1.10.1 CORVEL shall maintain all claim records on a secure risk management information/claims management
system (RMIS/CMS), and shall allow specific CITY -designated staff access to all CITY information via a
secure, password -protected web portal.. CITY information includes all CITY claims information, claim
forms, medical bill audit and review information, case management information, standard reports, scanned
images, and any other captured data.
1.10.2 CORVEL shall provide adequate training to designated CITY staff regarding CITY access and use of all
RMIS/CMS systems.
1.10.3 All RMIS/CMS on-line access, standard reports and training shall be provided to CITY at no cost as
specified in Attachment A, Schedule 1
1.10.4 Should CITY desire additional custom -designed reports or data downloads, CORVEL shall provide CITY
with a separate cost estimate and shall not commence any customization work unless and until the estimate
is approved by the CITY. Customization costs shall be billed directly to CITY and shall not exceed the
amounts specified in Schedule 2 of Attachment A.
1.10.5 Upon expiration or termination of this Agreement, all CITY claim information, records, and any other
captured data shall be returned to the custody and control of CITY at no additional cost to the CITY. In
addition, CITY shall be provided with online access for a reasonable transition period that is mutually
agreeable to the parties in order to ensure that an orderly transition of claim files, records and information
occurs.
1.10.6 In cooperation with the CITY, CORVEL shall develop an interface with the City's enterprise resource
planning system (PeopleSoft release version 9 1). CORVEL shall work with CITY through a requirements -
gathering process to determine the data and format to be encompassed by the interface CORVEL shall
develop a document detailing the structure of the interface and files to be transferred The interface must be
tested and validated in a test environment using CITY -supplied test data before being moved into
production. The final interface must be interoperable and include a loadable/importable comma -separated -
value (CSV) file transfer between CORVEL and CITY. The interface must be completed and in production
by January 1 2013, so that it can be used in providing and monitoring services under this Agreement.
1.10.7 Claims Activity Reporting — CORVEL shall submit the following claims activity information to CITY on a
monthly basis: loss runs (including, but not limited to, indemnity, medical, legal, and allocated loss
adjustment expenses charged to individual claim files) and check register, bank statement, and
reconciliation for the Trustee Bank Account.
1.11 DOCUMENT MANAGEMENT; SCANNING & INDEXING; RECORDS RETENTION AND STORAGE
1.11.1. In addition to the RMIS/CMS, CORVEL shall provide and maintain a document management system
capable of scanning and indexing claim file documents and of attaching the indexed documents to the
specific computerized claim file.
1.11.2 Each scanned document shall undergo a quality review or check to ensure the scanned image is legible, is
not subject to alteration, and represents an accurate facsimile of the original document.
1.11.3 At a minimum, original documents shall be maintained until such time as the quality review confirms a
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legible and complete scanned image.
1.11.4 Original claim file information and documents shall be maintained and disposed of in accordance with
applicable CITY policy and applicable CITY record retention schedules.
1.11.5 CORVEL shall provide an interface to CITY's electronic records retention client (LaserFiche) and shall
provide a monthly download of closed claim files indexed in accordance with CITY specifications.
1.12
CLAIMS AUDIT
1.12.1 Self -Audits — CORVEL shall schedule and conduct periodic self -audits of internal claims handling and
adjusting processes and procedures including its current SSAE16 (SOC1) Report to ensure the highest
quality claims handling and adjusting are being provided. The parameters and schedule of such current
self -audits shall be submitted to the CITY for review and approval within sixty (60) days of execution of this
Agreement, and a copy of the current audit report shall be provided to CITY within thirty (30) days of the
completion of each audit. CORVEL has its SSAE16 (SOC1) Report performed by a third party vendor
annually in June and July and the results are available by the end of September annually.
1.12.2 Independent Audits — CITY may cause independent audits to be conducted by its contracted broker of
record for workers compensation excess insurance, and/or by the City Auditor. Such audits may be either a
performance -based audit or a financial audit of claim payments and/or bank records. City shall provide
CORVEL at least thirty (30) days' advance written notice of commencement of such audits. Corvel shall, at
no cost to the CITY, provide the independent auditor with full access to claim files, data, and reports and
otherwise cooperate in completion of all audits Independent audits (other than TDI-DWC audits) shall be
conducted no more than twice per Contract Year.
1.12.3 TDI-DWC Audits — On receipt of notice from TDI that any performance or compliance audit will be
performed on CITY claims, CORVEL shall immediately notify CITY of the audit. Draft and final audit reports
shall be provided to CITY within thirty (30) days of the audit's completion.
1.13 ACTUARIAL STUDY AND VALUATION
1.13.1 CITY may cause an independent actuarial study and valuation of claims and the workers compensation
claims fund to be conducted through its contracted broker of record for workers' compensation excess
insurance. CITY shall provide at least thirty (30) days' advance written notice to CORVEL of the
commencement of such actuarial study and valuation. CORVEL shall, at no cost to the CITY, promptly
provide complete claim file data in order for the actuarial study and valuation to be timely prepared. An
actuarial study and valuation shall be conducted no more than once per Contract Year.
1.14 TDI ADMINISTRATIVE VIOLATIONS; OTHER PENALTIES & FINES
1.14.1 Administrative Violations - In the event that either CITY or CORVEL is notified by the Texas Department of
Insurance that an administrative violation may have occurred that could adversely impact CITY claims
and/or either party's standing with TDI, the receiving party shall immediately notify the other party
1 14 2 Administrative Penalties — Administrative penalties or fines imposed by TDI or any other entity that relate to
CITY claims or to CITY as a workers' compensation self -insured political subdivision and that result from
violations of the Texas Labor Code or Texas Insurance Code attributable to the negligence, error or
omission of CORVEL, its employees, agents or authorized vendors shall be paid by CORVEL.
Administrative penalties or fines imposed by TDI or any other entity that relate to CITY claims or CITY as a
workers' compensation self -insured political subdivision and that result from violations of the Texas Labor
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Code or Texas Insurance Code attributable to the negligence, error or omission of CITY or its employees
shall be paid by CITY. Administrative penalties or fines imposed by TDI or any other entity that result from
violations of the Texas Labor Code or Texas Insurance Code attributable to the negligence, error or
omission of both parties shall be paid equally by both parties.
1.15 STATUTORY AND REGULATORY CHANGES
CORVEL shall monitor the activities of state regulatory agencies and the Texas Legislature for regulatory or
statutory changes that would affect the administration of the CITY's workers' compensation program. Upon
adoption or passage of such changes, CORVEL shall provide a briefing to CITY describing the nature of all
changes to the rules or statutes and an assessment of the anticipated financial and operational impact upon
the CITY's self -insured workers' compensation program.
1.16 LIFE OF CONTRACT SERVICES
The parties agree that services provided by CORVEL for claims administration, claims handling and
adjusting, and medical cost containment services are 'life of contract" services. Upon expiration or
termination of this Agreement, CORVEL shall no longer be responsible to CITY for the provision of such
services, and all CITY workers' compensation claims information, including computerized records, data and
images shall revert to the custody and control of CITY in accordance with Section 1.10.5.
2.0 NO LIMITATION OF AUTHORITY AND RESPONSIBILITY
2.1 In accordance with Chapter 4151 of the Texas Insurance Code, this Agreement does not limit in any way
CITY's authority or responsibility, including financial responsibility, to comply with each statutory or
regulatory requirement.
2.2 As required by Chapter 4151 of the Texas Insurance Code, CORVEL shall comply with each statutory or
regulatory requirement relating to a function assumed by or carved out by CORVEL as a third party
administrator.
3.0 LICENSES AND CERTIFICATIONS
CORVEL warrants and certifies that CORVEL and any other person or firm designated to provide services
hereunder has the requisite training, license and/or certification to provide said service. Documentation of
such training, license, or certification shall be provided to the CITY on request.
4.0 TERM AND RENEWAL
4.1 The term of this Agreement shall be for a period of three (3) years beginning January 1, 2013 and ending
December 31, 2015, unless renewal and extension or earlier termination occurs pursuant to any other
provision contained in this Agreement.
4.2 This Agreement may be renewed and extended for two (2) additional one (1) year periods (each a "Renewal
Term") under the same terms and conditions on mutual agreement of the parties Should the parties agree
to renew this Agreement, the parties shall execute an agreement in writing establishing such mutual assent
and the dates of the Renewal Term.
4.3 For purposes of this Agreement, the term "Contract Year" shall refer to a one-year period beginning January
1 and ending December 31.
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5.0 PAYMENT FOR SERVICES
5.1 Fees — The parties agree that all fees for services provided to CITY by CORVEL under this Agreement are
specified in Attachment A.
5.2 Base Services and Fees
5.2.1 As compensation for: (i) all claims handling and adjusting services, (ii) medical bill auditing, (iii)
telephonic case management, (iv) Section 111 Reporting, and (v) 1,400 preauthorization requests
per Contract Year, CITY shall pay CORVEL a Base Fee of Nine Hundred and Eighty -Nine
Thousand, Nine Hundred and Sixty -Six Dollars and No Cents ($989,966.00) per Contract
Year, as outlined in Attachment A.
5 2 2 The allocation of the Base Fee among these categories of services is detailed in Schedule 1 of
Attachment A.
5.2.3 In the event more than 1,400 preauthorization requests are required in a Contract Year, each
additional request shall be billed to the specific claim file as an allocated loss adjustment expense
in accordance with Schedule 3 of Attachment A.
5.3 "Pass Through" Services and Fees
5.3.1 Pass through services, including: (i) loss control services of no more than five hundred (500) hours
per Contract Year, (ii) scanning, imaging and indexing historical closed claim files, and (iii) TDI-
DWC Austin Representative services, shall be billed to the CITY "at cost" as Pass Through Fees
5,3,2 Pass Through Fees shall be approved by the CITY prior to initiation of the service and shall not
exceed the amounts specified in Schedule 2 of Attachment A, without CITY authorization.
5.3.3 The allocation of Pass Through Fees among these categories of services is detailed in Schedule 2
of Attachment A
5.4 Allocated Loss Adiustment Services
5.4.1 CORVEL shall develop, maintain and provide to the CITY upon request a schedule of all services
that will be billed and expensed to individual claim files The schedule of services shall include the
following information: (i) a brief description of each service being provided; (ii) the name of the
company or name and title of the individual providing the service; (iii) tax identification number of
the service provider; (iv) State of Texas license or certification number of the service provider if
applicable; and (v) fee schedule for each service to be provided. CITY reserves the right to
approve/disapprove external service providers and fees for services.
5 4 2 All allocated loss adjustment services listed in Schedule 3 of Attachment A shall be billed and
expensed to the appropriate claim files and paid from the Trustee Bank Account.
5.4.3 CORVEL shall provide data regarding allocated loss adjustment expenses billed to claim files as
part of the claims activity reportina submitted in accordance with Section 1.10.9
5.5 No Additional Cost Services
CORVEL shall provide services specified in Schedule 4 of Attachment A at no additional cost.
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5.6 Invoicing
5.6.1 CORVEL shall invoice the CITY for base services and pass through services specified in Sections
5 2 and 5.3 An invoice for services shall be provided to the CITY at the end of each calendar
month and upon completion and delivery of services.
5.6.2 Invoices for loss control services and scanning, imaging and indexing historical claim files shall
include the following information for each service provided during the preceding month: (i) a brief
description of each service; (ii) the name and title of the individual who provided the service; (iii) the
date on which service was provided, (iv) the amount of time spent providing each service
calculated and billed in quarter-hour increments; (v) the total number of service hours (calculated to
the quarter hour) that were provided during the month; and (vi) the cumulative total of service hours
(calculated to the quarter hour) that have been provided to the City during that Contract Year.
5.6.3 Invoices for TDI-DWC Austin Representative services shall include: (i) a brief description of each
service; (ii) the name and title of the individual who provided the service; (iii) the month for which
service was provided; and (iv) per month flat fee cost
5.6.4 All invoices shall be sent to Human Resources Manager - Workers' Compensation Program, 1000
Throckmorton Street, Fort Worth, Texas 76102. Invoices are due and payable within 30 days net
of receipt.
5.7 Additional Documentation — If CITY requires additional reasonable information related to any requested
payment, CITY shall request the same promptly after receiving an invoice, and CORVEL shall provide such
additional reasonable information to the extent the same is available. All invoices and documentation shall
be subject to CITY s approval.
5.8 Unsatisfactory Services; Contested Billing. — All services shall be performed to CITY's satisfaction, and CITY
shall not be liable for any payment under this Agreement for services which are unsatisfactory or which
CITY has not approved and has not been cured by CORVEL pursuant to Section 15 or resolved pursuant to
Section 20 of this Agreement. In the event of a disputed or contested billing, only the portion being
contested will be withheld from payment, and the undisputed portion will be paid CITY will exercise
reasonableness in contesting any bill or portion thereof. No interest will accrue on any contested portion of
the billing until the contest has been mutually resolved.
5.8 No Third Party Payments — All payments under this Agreement shall be made solely to CORVEL CITY
shall not be obligated or liable under this Agreement to any party other than CORVEL for payment of any
monies or provision of any goods or services.
5.9 Notwithstanding anything to the contrary herein, the CITY shall not be liable to CORVEL for payment
of fees or any other compensation hereunder in an aggregate amount greater than One Million
Eighty -Seven Thousand Four Hundred and Sixteen Dollars and No Cents ($1 087,416 00) per
Contract Year during the Initial Term and any Renewal Term for Flat Fee and 'Pass Through"
Services as specified in Schedule 1 and 2 of Attachment A.
6.0 AMENDMENT
6.1 Except as otherwise provided in subsection 6.2, no amendment to this Agreement shall not be binding on
the parties unless such amendment be in writing, executed by both CITY and CORVEL
6.2 It is understood and agreed by the parties hereto that changes in local, state and federal rules, regulations
PSA — City of Fort Worth and Corvel Page 11 of 23
or laws applicable hereto may occur during the term of this Agreement and that any such changes, unless
either party objects in writing, shall be automatically incorporated into this Agreement without written
amendment hereto, and shall become a part hereof as of the effective date of the rule, regulation or law.
7.0 CONFIDENTIALITY
7.1 For purposes of this Section, "Confidential Information" includes all employee -specific data regarding CITY
claimants and all information specifically identified by CORVEL as being proprietary or confidential.
7.2 Subject to the limitations in Section 7.3 each party shall hold the Confidential Information of the other in
strict confidence; will not make any voluntary disclosures (including methods or concepts utilized in the
Confidential Information) without the express written consent of the other, except to employees or
consultants who agree to be bound by the terms of this agreement; and will take all reasonable steps to
maintain the confidentiality of all Confidential Information.
7.3 CORVEL understands and acknowledges that CITY is a public entity under the laws of the State of Texas,
and as such, the following information is subject to disclosure under Chapter 552 of the Texas Government
Code, the Texas Public Information Act (the "Act') - 1) all documents and data held by the CITY, including
information obtained from the CORVEL and 2) information held by CORVEL for or on behalf of CITY that
relates to the transaction of CITY's business and to which CITY has a right of access. If the CITY receives
a request for any documents that may reveal any of CORVEL s Confidential Information under the Act, or by
any other legal process, law, rule, or judicial order by a court of competent jurisdiction, CITY will utilize its
best efforts to notify CORVEL prior to disclosure of such documents. CITY not be liable or responsible in
any way for the disclosure of information not clearly marked as "Proprietary / Confidential Information' or if
disclosure is required by the Act or any other applicable law or court order. In the event there is a request
for such information, it will be the responsibility of CORVEL to submit reasons objecting to disclosure. A
determination on whether such reasons are sufficient will not be decided by the CITY, but by the Office of
the Attorney General of the State of Texas, or by a court of competent jurisdiction.
8.0 OWNERSHIP OF DOCUMENTS
8.1 All claim documents (electronic and hard copy), reports, information and other data provided by prepared or
assembled by or on behalf of CORVEL under this Agreement in whatsoever form and character produced
shall become the sole property of CITY without restriction on future use.
8.2 All such claim documents, reports, information and other data shall be delivered to CITY upon termination or
expiration of this Agreement at CORVEL's sole cost and expense.
8.3 No such claim documents, reports, information or other data shall be the subject of any copyright or
proprietary claim by CORVEL.
9.0 SUBCONTRACTING
9.1 CORVEL shall not sub -contract any services under this Agreement without the express consent of CITY.
With the CITY's written consent, CORVEL may engage a subcontractor to perform services provided
however that such subcontracting shall be by written agreement only and unless specific waiver is granted
in writing by CITY, such subcontractor agreement shall include language by which subcontractor agrees to
be subject to each and every provision of this Agreement. Compliance by a subcontractor with the
provisions of said agreement shall be the responsibility of CORVEL
9.2 CITY shall in no event be obligated to any third party, including any subcontractor of CORVEL, for
PSA — City of Fort Worth and Corvel Page 12 of 23
performance of services or payment of fees.
9.3 CORVEL will subcontract a portion of account services to its minority partner, The Jenkins Agency, for five
percent (5%) of CORVEL's annual fee.
9.4 In accordance with the Fort Worth City Code the CITY has goals for business diversity in CITY contracts
CORVEL acknowledges the diversity goal established for this Agreement and its commitment to meet that
goal. Any misrepresentation of facts (other than a negligent misrepresentation) and/or the commission of
fraud by CORVEL may result in the termination of this agreement and debarment from participating in CITY
Agreement s for a period of time of not less than three (3) years.
10.0 INSURANCE
10.1 Prior to the commencement of any work by CORVEL under this Agreement, CORVEL shall furnish one or
more Certificate of Insurance forms to CITY s Risk Management Division and Office of the City Secretary
evidencing insurance coverage in the types and amounts required under this Section. Each certificate shall
indicate the types of coverage, liability limits, and termination provisions applicable to the underlying
insurance policy. Each form must indicate the name, address, and telephone number of the insurance
company issuing coverage.
10 2 CITY reserves the right to review the insurance requirements of this Section during the Initial Term and any
Renewal Term and to modify insurance coverage types and limits when deemed necessary and prudent by
CITY's Risk Manager based on changes in statutory law, administrative regulations, court decisions or
circumstances surrounding the Agreement, provided however that in no instance will CITY allow
modification whereupon the CITY may incur increased risk
10.3 CORVEL's financial integrity is of interest to CITY; therefore, subject to CORVEL's right to maintain
reasonable deductibles in such amounts as are approved by CITY, CORVEL shall obtain and maintain in full
force and effect for the duration of this Agreement, and any extension hereof at CORVEL's sole expense
insurance coverage written on an occurrence basis, by companies authorized and admitted to do business
in the State of Texas and rated A- or better by A.M. Best Company and/or otherwise acceptable to CITY, in
the following types and amounts:
10.3.1
TYPE OF COVERAGE AMOUNT AND LIMITS OF COVERAGE
Workers' Compensation
Employers' Liability
10.3.2 Commercial General (public)
Liability Insurance to include the
following coverage's:
a. Premises/Operations
b. Independent CORVELs
c. Products/completed operations
d. Personal Injury
e. Contractual Liability
10.3.3
Business Automobile Liability
a. Owned/Leased vehicles
b. Non -Owned vehicles
c. Hired Vehicles
Statutory
$500,000 / $500,000 / $500,000
Combined Single Limit for Bodily Injury and
Property Damage of $1,000,000 per
Occurrence or its equivalent with a
$2,000,000 Aggregate
Combined Single Limit for Bodily Injury and
Property Damage of $1,000,000 per
Occurrence
PSA — City of Fort Worth and Corvel Page 13 of 23
10.3.4 Commercial Umbrella
10.3.5 Errors and Omissions Insurance
$1,000,000 per occurrence with a
$1,000,000 Aggregate
$5,000,000 per Claim, $5,000,000 Annual
Aggregate (Claims made form)
10.4 The CITY shall be entitled on request and without expense to receive copies of the policy declarations and
all blanked additional ensured endorsements thereto as they apply to the limits required by the CITY.
10.5 CORVEL agrees that with respect to the above required insurance, all insurance contracts and Certificates
of Insurance will contain the following required provisions and will include blanket additional insured
endorsements specific to its General Liability and Automobile Liability policies:
10.5.1 Endorsement or other provision naming CITY and its officers, employees, volunteers, and elected
representatives as additional insured with respect to operations and activities of, or on behalf of,
the named insured performed under Contract with the CITY. (This requirement is not applicable to
BROKER's Workers' Compensation or Errors and Omissions policies.)
10.5.1 Language specifying that CORVEL 's insurance shall be deemed primary with respect to any
insurance or self-insurance carried by CITY for liability arising out of operations under the
Agreement with CITY.
10.5.2 Endorsement or other provision specifying that the 'other insurance" clause shall not apply to the
CITY where CITY is an additional insured shown on the policy.
AND
10.5.3 A waiver of subrogation in favor of CITY. (This requirement applies only to CORVEL's Workers'
Compensation, General Liability, Automobile Liability and Property and Employers' Liability
policies.)
10.6 CORVEL shall notify the CITY in the event of any notice of cancellation non -renewal or material change in
coverage and shall give such notice not less than thirty (30) days prior to the change with the exception of
cancellation due to nonpayment of premiums, for which notice shall be provided at least ten (10) days prior
to the change with notice being accompanied by a replacement Certificate of Insurance.
10.7 All insurance related notices shall be given to CITY at the following address: Human Resources Manager -
Workers' Compensation Program, 1000 Throckmorton Street, Fort Worth, Texas 76102 with a copy to Risk
Manager at the same address.
10.8 If CORVEL fails to maintain the aforementioned insurance or fails to secure and maintain the
aforementioned endorsements, the CITY may obtain such insurance and deduct and retain the amount of
the premiums for such insurance from any sums due under the Agreement however, procuring of said
insurance by the CITY is an alternative to other remedies the CITY may have, and is not the exclusive
remedy for failure of CORVEL to maintain said insurance or secure such endorsement. In addition to any
other remedies the CITY may have for CORVEL's 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
CORVEL to stop work hereunder and/or withhold any payment(s) that become due to CORVEL hereunder
until CORVEL demonstrates compliance with the requirements hereof
10.9 Nothing herein contained shall be construed as limiting in any way the extent to which CORVEL may be
PSA — City of Fort Worth and Corvel Page 14 of 23
held responsible for payments of damages to persons or property resulting from CORVEL's or its
subcontractors' performance of the work covered under this Agreement.
11.0 LIABILITY AND INDEMNITY
11.1 CORVEL shall be liable and responsible for any and all loss, damage, and/or personal injury (including
death) to any and all persons (including the CITY) of any kind or character whether real or asserted, to the
extent caused by the negligent act(s) or omission(s), malfeasance, or intentional misconduct of CORVEL, its
officers, agents, servants, or employees. CORVEL shall not be responsible or liable for the negligent acts
or omissions to the extent caused by the CITY under this Agreement
11 2 CORVEL covenants and agrees to FULLY INDEMNIFY and HOLD HARMLESS the CITY and the elected
officials, employees, officers, directors, volunteers and representatives of the CITY, individually and
collectively, from and against any and all third party costs claims, liens damages, losses, expenses, fees
fines, penalties, proceedings actions, demands, causes of action, liability and suits of any kind and nature,
including, but not limited to personal or bodily injury or death and property damage, made upon the CITY
directly arising out of, resulting from or related to CORVEL's activities under this Agreement, including any
negligent acts or omissions of CORVEL, any agent, officer, director, representative employee, consultant,
or subcontractor of CORVEL, and their respective officers, agents, employees, directors and
representatives while in the exercise or performance of the rights or duties under this Agreement. In the
event of joint and concurrent negligence of both CORVEL and the CITY, responsibility if any, shall be
apportioned comparatively in accordance with the laws of the State of Texas. CORVEL shall not be
responsible or liable for the negligent acts or omissions caused solely by the CITY under this Agreement
11.3 Nothing herein shall be construed as a waiver of any governmental immunity available to the CITY under
Texas Law or as a waiver of any defenses of the parties under Texas Law. The provisions of the
INDEMNITY are solely for the benefit of the parties hereto and not intended to create or grant any rights,
contractual or otherwise, to any other person or entity The parties' indemnification obligations under this
Section are contingent upon: (i) the indemnified party giving prompt written notice to the indemnifying party
of any claim under this Section (provided, however, that failure to give such notification shall not affect the
indemnification provided hereunder except to the extent, and only to the extent, that the indemnifying party
shall have been actually prejudiced as a result of such failure), and (ii) at the indemnifying party's request
and expense, the indemnified party cooperating in the investigation and defense of such claim(s). If the
indemnifying party assumes the defense of any claim hereunder the indemnified party shall be entitled to
participate in (but not control) such defense and to retain its own counsel, at its own expense The
indemnifying party shall not settle or consent to an adverse judgment in any such claim that adversely
affects the rights or interests of the indemnified party or imposes additional obligations on the indemnified
party without the prior express written consent of the indemnified party.
12.0 INDEPENDENT CONTRACTOR
It is expressly understood and agreed by the parties hereto that CORVEL provides services under this
Agreement as an independent contractor, responsible for its respective acts or omissions, and that CITY
shall in no way be responsible therefor. Neither party hereto has authority to bind the other or to hold out to
third parties that it has authority to bind the other.
13.0 COMPLIANCE
CORVEL shall provide and perform all services under this Agreement in compliance with all applicable
federal, state and local laws, rules and regulations.
PSA — City of Fort Worth and Corvel Page 15 of 23
14.0 RIGHT TO ASSURANCE
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Whenever the CITY has reason to question the CORVEL's intent to perform; the CITY may demand that the
CORVEL give written assurance of CORVEL's intent to perform. In the event a demand is made and no
assurance is given within ten calendar days, the CITY may treat this failure as an anticipatory repudiation of
the Agreement.
15.0 TERMINATION
15.1 For purposes of this Agreement, "termination" of this Agreement shall mean termination by expiration of the
Agreement term or earlier termination pursuant to any of the provisions hereof.
Fiscal Fundina Termination. In the event no funds or insufficient funds are appropriated by the CITY in any
fiscal period for any payments hereunder, CITY will notify CORVEL of such occurrence, and this Agreement
shall terminate on the last day of the fiscal period for which appropriations were received without penalty or
expense to CITY of any kind whatsoever, provided, however, that CORVEL shall be paid for all services
rendered up to the termination of the Agreement.
15.3 Termination Without Cause. Either party may terminate this Agreement by providing written notice to
the other party specifying the effective date of termination, which shall not be Tess than sixty (60) days
from the date notice is received. Such notice shall be given in accordance with Section 17.
15,4 Termination For Cause. In addition to any other provision of this Agreement, CITY may terminate this
Agreement upon thirty (30) days' written notice for any of the following:
15.4.1, Negligence, intentional misconduct, or failure by CORVEL to perform or observe any of the terms,
conditions, covenants or guarantees of this Agreement or of any amendment between CITY and
CORVEL; or
15.4.2 Violation by CORVEL of any law, rule, or regulation to which CORVEL is bound or shall be bound
under the terms of this Agreement.
15.5 CORVEL shall be provided thirty (30) days to cure any breach or default under any material provision of this
Agreement prior to CITY terminating this Agreement.
15.6 On a decision to terminate by CITY, written notice of such shall be promptly provided to CORVEL specifying
the effective date of termination and the extent to which performance of work under this Agreement will be
terminated.
15.7 On receipt of notice to terminate, all finished or unfinished documents, data, studies, surveys, charts, plans,
schedules, or other appended documentation, prepared by or on behalf of CORVEL under this Agreement
shall become the property of CITY and shall be delivered by CORVEL to CITY in a timely and expeditious
manner at CORVEL's sole cost and expense. CORVEL shall provide written certification that all documents
have been returned to the CITY.
15.8 In the event of termination, CORVEL shall fully cooperate with CITY and continue to perform all duties and
obligations under this Agreement up to the effective date of termination.
15.9 Within thirty (30) days of the effective date of termination (unless an extension is authorized in writing by
CITY), CORVEL shall submit to CITY its claim, in detail, for the monies owed by CITY for services
performed under this Agreement up to the effective date of termination, provided however that such
payment does not exceed the maximum amount set out in Section 5 hereof.
16.0 CONFLICT OF INTEREST
CORVEL warrants and certifies, and this Agreement is made in reliance thereon, that it, its individual
officers, employees and agents are neither officers nor employees of CITY or any CITY agencies, such as
PSA — City of Fort Worth and Corvel Page 16 of 23
CITY -owned utilities In the event that any conflicts of interest arise after the execution of this Agreement,
CORVEL hereby agrees to make full disclosure to the CITY in writing immediately upon learning of such
conflict.
17.0 NOTICE
Any notice required, permitted or appropriate under this Agreement shall be deemed sufficient if in writing
and sent certified mail, return receipt requested, postage prepaid to CITY or CORVEL at the respective
address set forth below, or to any other address of which written notice of changes is given:
If to CITY:
Ron Josselet, Human Resources Manager
City of Fort Worth
Occupational Health and Safety /
Workers' Compensation Division
1000 Throckmorton Street
Fort Worth, TX 76102
With a copy to:
City Attorney's Office
1000 Throckmorton
Fort Worth, Texas 76102
18.0 CAPTIONS
If to CORVEL:
Sharon O'Connor, Director of Legal Services
CorVel Corporation
2010 Main Street Suite 600
Irvine CA 92614
With a copy to:
Tamara Estes, Regional Vice President
CorVel Corporation
15301 Dallas Parkway, Suite 300
Addison, TX 75001
The captions contained in this Agreement are for convenience and reference only and shall in no way limit
or enlarge the terms and conditions of this Agreement.
19.0 SUCCESSORS AND ASSIGNS
This Agreement shall be binding upon and inure to the benefit of the parties hereto and their respective
heirs executors, administrators, successors and their assigns, provided however, CORVEL may not
assign this Agreement without prior written consent of CITY.
20.0 VENUE AND GOVERNING LAW
Venue for any legal action, claim or dispute arising directly or indirectly as a result of this Agreement shall
be in Tarrant County, Texas. This Agreement is made and is to be performed in Tarrant County, Texas and
is governed by the laws of the State of Texas.
21.0 AUTHORITY
The person signing this Agreement hereby warrants that he or she has the legal authority to execute this
Agreement on behalf of his or her respective party and that such binding authority has been granted by
proper order, resolution ordinance, or other authorization of the entity. The other party is fully entitled to
rely on this warranty and representation in entering into this Agreement.
PSA — City of Fort Worth and Corvel Page 17 of 23
22.0 SEVERABILITY
If any clause or provision of this Agreement is held invalid, illegal or unenforceable under present or future
laws during the term of this Agreement, including any extension and renewal hereof, it is the intention of the
parties hereto that the remainder of the Agreement shall not be affected hereby, and that in lieu of each
invalid clause or provision of this Agreement, a clause or provision as similar in terms to such illegal, invalid
or unenforceable clause or provision as may be possible shall be drafted to comply with all applicable laws
and shall replace the clause or provision held invalid, illegal or unenforceable.
23.0 RIGHT TO AUDIT
CORVEL agrees that CITY shall, during the Initial Term, any Renewal Term, and until the expiration of three
(3) years after final payment under this Agreement and at no additional cost to CITY have access to and
the right to examine any directly pertinent books, documents, papers and records of the CORVEL involving
transactions relating to this Agreement. CORVEL agrees that CITY shall have access during CORVEL's
normal working hours to all necessary CORVEL facilities and shall be provided adequate and appropriate
workspace in order to conduct audits in compliance with the provisions of this section. CITY shall give
CORVEL no less than thirty (30) days advance written notice of intended audits. If CORVEL subcontracts
any of its obligations under this Agreement, CORVEL shall include language in any subcontractor whereby
subcontractor agrees to be bound by the same rights, duties and obligations of the CORVEL under this
provision. In accordance with Section 1.12, independent audits (other than TDI-DWC audits) shall be
conducted no more than twice per Contract Year
24.0 ATTORNEY'S FEES
In the event a claim is brought pursuant to this Agreement, CITY shall be entitled to recover reasonable
attorney's fees from CORVEL.
25.0 WAIVER OF RIGHT
The CITY and CORVEL may waive an obligation or restriction on the other under this Agreement only in
writing A failure, refusal, neglect, delay, forbearance or omission of the CITY or CORVEL to exercise any
right or remedy under this Agreement or to insist on full compliance by the other with its obligations
hereunder shall not constitute a waiver of any provision of the Agreement in any other instance or
circumstance.
26.0 FORCE MAJEURE
If either party is unable either in whole or part, to fulfill its obligations under this Agreement due to acts of
God strikes, lockouts or other industrial disturbances; acts of public enemies; wars; blockades;
insurrections; riots' epidemics; public health crises, earthquakes; fires; floods; restraints or prohibitions by
any court board department, commission or agency of the United States or of any state; declaration of a
state of disaster or of emergency by the federal state, county, or City government in accordance with
applicable law' issuance of a Level Orange or Level Red Alert by the United States Department of Homeland
Security any arrests and restraints; civil disturbances; or explosions; or some other reason beyond the
party s reasonable control (each a "Force Majeure Event"), the obligations so affected by such Force
Majeure Event will be suspended only during the continuance of such event.
27.0 SOLICITATION OF EMPLOYEES
Neither CITY nor CORVEL shall, during the term of this Agreement and additionally for a period of one year
PSA — City of Fort Worth and Corvel Page 18 of 23
after its termination, solicit for employment or employ whether as employee or independent contractor, any
person who is or has been employed by the other party during the term of this Agreement without the prior
written consent of the person's employer.
28 REVIEW OF COUNSEL
The parties acknowledge that each party and its counsel have had the opportunity to review and revise this
Agreement and that the normal rules of construction to the effect that any ambiguities are to be resolved
against the drafting party shall not be employed in the interpretation of this Agreement or any attachments
or exhibits hereto.
29.0 ENTIRE AGREEMENT
This written instrument (together with any attachments, exhibits, and appendices) constitutes the entire
understanding between the parties concerning the work and services to be performed hereunder, and any
prior or contemporaneous, oral or written agreement that purports to vary from the terms hereof shall be
void.
[Signature Page Follows]
PSA — City of Fort Worth and Corvel Page 19 of 23
EXECUTED this the- �day oMth
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CITY OF FORT WORTH, TEXAS
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Susan Alanis
Assistant City Ma,Rger
Date: loC � ��� fa
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APPROVED AS TO FORM:
tit I,
Denis McElroy
Assistant City Attney
Date: � LI � I2° ( L
ATTEST:
EST:
Mary Kayser „ f
City Secretary
Date: I 1)4
RECOMMENDED FOR APPROVAL:
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Karen Marshall
Human Resources Director
Date: i f / f ) /
r
Contract Authorization
M&C: C-25912
Date Approved: October 9, 2012
PSA — City of Fort Worth and Corvel
, 2012.
CORVEL ENTERPRISE COMP, INC.
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Tamara Estes
Regional Vice Pre
Date:
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OFFICIAL RECORD
CITY SECRETARY
Pt WORTH, TX
Page 20 of 23
1
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1
Medical Bill Auditing
Preauthorization
Telephonic Case Management
*
ATTACHMENT A
SCHEDULE OF SERVICES AND FEES
SCHEDULE 1 FLAT FEE SERVICES
Services billed monthly to CITY by CORVEL
_SERVICE DESCRIPTION ANNUAL FLAT FEE PRICE
Claims Handling & Adjusting Claims set-up, conversion of $590,000.00
claims from record only to
medical to indemnity, claims
adjusting activities to include
takeover claims from prior TPA,
adjuster attendance at hearings
and court cases
Computerized medical bill $159,720.00
auditing and re -pricing to fee
schedule.
The Annual Flat fee is based on
19,300 bills annually. A variance
of 10% in total bill volume will
increase or decrease fee by $9.90
per bill. Reconsiderations and
duplicates are included in bill
count, but duplicates will not be
included for purposes of
calculating whether a charge or
refund is due as a result of a
variance.
Preauthorization for 1,400 $210,000.00
requests per Contract Year*
Telephonic case management for $3 0,246.00
up to 30 days for indemnity
claims exceeding 14 days of lost
time. The Annual Flat Fee is
based on 300 lost time claims. A
variance of 10% in total volume
will increase or decrease fee by
$89.00 per hour.
Preauthorization requests in excess of 1,400 will be charged to the claim files. See Schedule 3 below.
SCHEDULE 2 — "PASS THROUGH" COST SERVICES
Services to be passed through to vendor of Citv's choice. Billed monthly to CITY by CORVEL.
_SERVICE DESCRIPTION PASS THROUGH FEE PRICE_
Loss Control 500 hrs. of loss control services At Cost, not to exceed $55,000
to include: safety consultations, annually, without authorization
PSA — City of Fort Worth and Corvel Page 21 of 23
Scanning, Imaging & Indexing
TDI/DWC Austin Representative
"Ad Hoc" Reports
safety training, facility
inspections, safety engineering
services, ergonomic assessments
Scanning, imaging and indexing
of historical closed claim files
from the prior TPA
Division representation services
in accordance with TAC § 15 6.1
At Cost ($0.07 per page plus
shipping), not to exceed $35,000
annually
At Cost, not to exceed $7,200
annually, without authorization
Negotiated pricing based on the
nature of the request
SCHEDULE 3 — "ALLOCATED LOSS ADJUSTMENT EXPENSES"
Expenses to be charged to individual claim flies
_SERVICE
FNOL Call Center Telephonic
In -Take
Field Case Management
Preauthorization Requests in
excess of 1,400 requests*
Preauthorization Nurse Review
Preauthorization Physician
Review
Utilization Review
Peer Review
Network
Pharmacy
MSA
DESCRIPTION
First Notice of Injury In -Take via
telephone by staff in the FNOL
Call Center.
Nurse case management
activities involving field work
Preauthorization requests in
excess of 1,400 requests per
Contract Year
Nurse Review of health care
provider requests for
preauthorization
Physician Review of health care
provider requests for
preauthorization
Utilization review of health care
provider invoices
Full review by Physician Advisor
peer review to assess the
compensable injury, extent of
injury, maximum medical
improvement, impairment rating,
ability to return to work
Healthcare Certified Network
Retail:
Mail:
MSA Reviews
FEE
$35.00 per call
$89.00 per Hour
$150.00 Blended Rate
Or
$89.00 Nurse Review plus
$150.00 Physician Advisor
Review, when needed
$89.00 per Review
$150.00 per Review
$200.00 per Review
Not to exceed $600.00 per
Review
Network changes to be defined at
enrollment
Brand: AWP - 4% + $4.50
Generic: AWP — 8% + $4.50
Brand: AWP — 10% + $4.00
Generic: AWP — 18% + $4.00
I $175 per hour
* Each Contract Year. City shall be entitled to elect, prior to the completion of 1,400 pre -authorization
reviews, to elect the blended or non -blended rate for excess pre -authorizations during that Contract Year.
PSA — City of Fort Worth and Corvel Page 22 of 23
SCHEDULE 4
SERVICES PROVIDED AT "NO ADDITIONAL COST"
SERVICE
Electronic Data Transfer from
Prior TPA
Access to RMIS/Claims System
1 EDI Transmission to TDUDWC
Computer Interface
Early Claims Intake
Advocacy 24/7
FNOL In -Take
Mobile Apps
Treatment Authorization
Incident Report
Smart Triage
Scanning, Imaging & Indexing
Recorded Statement
Transcription; Cassette Tapes
Photos
Long Distance, Fax
Express, Certified Mail
Photocopying
ISO /SWIB / Public Records
Search
Bank Check Stock
Account Management
Section 111 Reporting
DESCRIPTION
Electronic transfer of all claims data from the prior TPA to CorVel
Access by CITY authorized users to CareMC
1 Electronic Data Interface for transmission of claims data to the State
Interface with City's PeopleSoft System for uploading claimant
information
Incident and injury reporting to 24/7 nurse triage center
Call center for employees at the time of incident to speak to a
registered nurse for evaluation and medical needs determination
24/7 Advocacy/ Nurse Line, CareMC or Mobile App for reporting
incidents has no charge.
Early intake reporting app for treatment authorizations, incident
reports, and for reviewing reports
Authorization form for injured worker to take to physician for initial
treatment and prescription fill
Report of injury/illness in CareMC with no expectation of medical
treatment
Electronic file sent to proprietary rules engine to identify/prioritize
claims; separation of simple from complex claims
Scanning, imaging and indexing of current, open claim file
documents
Transcription of recorded statements of claimants by adjusters
Claim and accident related photos
Phone service
Air or Land Express; Certified Mail through the United States Postal
Service, as appropriate
Photocopying of claims records upon request of the City
Claims record checks through Insurance Services Office (ISO),
Southwest Index Bureau (SWIB); Records search of public records.
Check stock for trustee bank account set up on behalf of the CITY
for payment of claims
'1 Administrative fees to manage CITY's account
I Reporting to the Center for Medicare & Medicaid Services
1
1
1
PSA — City of Fort Worth and Corvel Page 23 of 23
M&C Review
COUNCIL ACTION: Approved on 10/9/2012
Page 1 of 2
Official site of the City of Fort Worth, Texas
FORT WORTH
DATE: 10/9/2012 REFERENCE NO.: C-25912 LOG NAME: 14CORVEL
CODE C TYPE: NON -CONSENT PUBLIC HEARING: NO
SUBJECT: Authorize Execution of an Agreement with CorVel Enterprise Comp, Inc., for the
Administration of the Workers' Compensation Program in the Amount of $1,087,416.00
for the First Year (ALL COUNCIL DISTRICTS)
RECOMMENDATION:
It is recommended that the City Council authorize the execution of an Agreement with CorVel
Enterprise Comp, Inc., for the administration of the City of Fort Worth's workers' compensation
program, including claims administration and medical cost containment services, in the amount of
$1,087,416.00 for the first year with a three-year initial term and two one-year renewal options.
DISCUSSION:
The City of Fort Worth (City) currently contracts with CCS Consulting, L.P., to provide workers'
compensation claims adjusting, claims administration, medical cost containment and safety and loss -
control services The final renewal period with CCS Consulting will expire on December 31, 2012.
On May 2, 2012, a Request for Proposal (RFP) was issued requesting that interested vendors submit
proposals by May 31, 2012. The RFP was designed to solicit proposals on: (1) third party claims
administration services for a self -funded workers' compensation program, (2) medical cost
containment services (including medical bill review preauthorization, telephonic and field case
management), (3) safety and loss control services, (4) serving as Austin representative for the City at
the Texas Department of Insurance and the Texas Workforce Commission (5) Medicare and
Medicaid reporting for worker's compensation, (6) document scanning and indexing and (7) other
claims -related services.
The City received 12 competitive bids in response to RFPs (RFP No. 12-0182). Proposals were
thoroughly evaluated by a committee comprised of representatives from eight City Departments,
including civil service representatives from police and fire. The Committee considered several factors
in evaluating proposals, including price competitiveness, an organization's ability to administer the
workers' compensation program, qualifications of each organization's staff, M/WBE participation and
quality of service. The Committee unanimously agreed to recommend CorVel Enterprise Comp, Inc.
(CorVel) be awarded the contract. Overall, the expected total fixed administrative costs in the
amount of $1,087,416 00 for CorVel are within the requested budget for Fiscal Year 2013.
M/WBE - CorVel is in compliance with the City's M/WBE Ordinance by committing to eight percent
M/WBE participation. The City's goal on this project is five percent.
TERM AND RENEWALS - On City Council approval, services under this contract will commence on
January 1, 2013 for a three-year initial term. The Agreement may be renewed for two one-year terms
at the City's option This action does not require specific City Council approval provided that the City
Council has appropriated sufficient funds to satisfy obligations during the renewal term.
http://apps.cfwnet org/council_packet/mc review.asp7ID=17462&councildate=10/9/2012 1/2/2013
M&C Review Page 2 of 2
FISCAL INFORMATION/CERTIFICATION:
The Financial Management Services Director certifies that funds are available in the current operating
budget, as appropriated, of the General Fund.
TO Fund/Account/Centers
FROM Fund/Account/Centers
FE73 534830 0147310 $853.227.00
FE73 534600 0147310 $2341189.00
Submitted for City Manaaer's Office bv: Susan Alanis (8180)
Oriainatina Deoartment Head: Karen Marshall (7783)
Additional Information Contact: Ron Josselet (7767)
ATTACHMENTS
http://apps.cfwnet.org/council_packet/mc review.asp?ID=17462&councildate=10/9/2012 1/2/2013