R18-174jj
'7
1
20
2.;i
21
24
25
27
28
19
30
RESOLUTION NO. RIS -174
A RESOLUTION OF THE CITY OF BOYNT'ON BEACH,
FLORIDA, APPROVING THE RANKING AND
AUTHORIZING THE CITY MANAGER TO SIGN A
THREE YEAR AGREEMENT IN A. FORM APPROVED
BY THE CITY ATTORNEY FOR THIRD PARTY
ADMINISTRATION OI+ WORKE RS COMPENSATION
CLAIMS WITH COMMERCIAL, RISK TMANAGEMENT,
INC..; AND PROVIDING AN EFFECTIVE DATE.
WHEREAS, a on November. 2, 2018 the City opened and tabulated thiv,G (3)
subraitrals in response to RFP #1004-1710-19/IT for Third 1 -arty Administration of Workers'
Corrpf,rrsaticry, ;''roperty and Casualty Claims; and
N�JIE; EAS, an eva:ivation committee was established and has analyzed the respor..se,,
and is recommending a three year Agreement for Third Party Administrator ser iccs of
V'orkcrs' Con'�pensation (WC) claims with Commercial Risk Management, Inc.; and
WHEREAS, the City Cornrnission of the City of Boynton Beach deems it in the lies.
interest, hea th, safety and vvelfare of the citizens and residents of Boynton Beach to enter into
a ;llree year A.greenterit for Third Partyladministration of Workers' Compensation Ciaims
�tivitfi Coy arriercial Fisk Management, Inc.
NOM, THEREFORE, BE IT RESOLVED BY THE CITY CO1VTMISSiffN OF
ITHE CITY OF BOYNTON BEACH, FLORIDA, THAT.
section 1. Each Whereas clause set forth above is true and corre;,L- and
(incorporated herein by this reference.
Section J. The City Commission. of the City of Boynton Beach, Florida herc.by
approves the ranking and authorizes the City Manager to sign a three-year Agreement in a
form approved by the City Attomey for Third Party Administration of Workers'
i
C::fusers'Stanzione'TApp Data' LocallMicrosoft;Windows\Temporary Internet Files\Content.IE5\SATN0> VN\Rcso_-
_3rd_ Party_Admin_tNgrk:ers_C;orrip.doc
31
32
33
34
Compensation with Commercial Risk Management, Inc., a copy of said Agreement is
attached hereto as Exhibit "A".
Section 3. That this Resolution shall become effective immediately upon passage.
PASSED AND ADOPTED this 4t' day of December, 2018.
35 1
CITY OF BOYNTON BEACH, FLORIDA
36
37 11
YES NO
3&
39
Mayor — Steven B. Grant
40
41
Vice Mayor - Christina L. Romelus
m
rt 2
43
Commissioner — Mack McCray
�
t,
44
45
Commissioner - Justin Katz
'
46
47
Commissioner -Aimee Kelley
48
49
VOTE
50 ATTEST:
51
52
f
53
54 Judith A. Pyle, CMC
55 Citv�61erk
56
57
;8 (Corporate Seal)
59
a
t ie �
t%
a
r �,a
e
a 4) {{
a
iUserslStanzione-RAppllaaLocal\NlicrosoftRVindows\Temporary Internet FileslContent.IE5\SATN0EVN',Reso_-
rd_Party_ Admin_Workers_Comp.doc
: • 0:
- -
THIS AGREEMENT is entered into between the City of Boynton Beach, hereinafter referred to as
"the City and COMMERCIAL RISK MANAGEMENT, INC., hereinafter referred to as "Firm", in
consideration of the mutual benefits, terms, and conditions hereinafter specified.
1. PROJECT DESIGNATION. The Firm is retained by the City to perform professional third
party administration of workers' compensation claims in connection with the RFP No. 004-
1710-19/IT for THIRD PARTY ADMINISTRATION FOR WORKERS'COMPENSATION FOR
PROPERTY AND CASUALTY CLAIMS
2. SCOPE OF SERVICES. Firm agrees to perform the services, identified in Section II — Scope
of Services and attached hereto as Exhibit A.
3. TIME FOR PERFORMANCE. Work under this agreement shall commence upon written
notice by the City to the Firm to proceed. Firm shall perform all services and provide all work
product required pursuant to this agreement upon written notice to proceed.
4. TERM: This Agreement shall commence upon award by City Commission and shall terminate
three (3) years from that date. The City may renew this Agreement for two (2) additional one-
year renewals at the discretion of the City and based upon mutually agreeable rates.
5. PAYMENT: The City will pay the Firm the fees as set forth in Exhibit B, Fees and Payments,
which is attached hereto and made a part hereof.
These fees will be paid by the City for completed work and for services rendered under this
agreement as follows:
a. Payment for the work provided by Firm shall be made promptly on all invoices submitted
to the City properly, provided that the total amount of payment to Firm shall not exceed
the total contract price without express written modification of the Agreement signed by
the City Manager or her designee.
b. The Firm may submit invoices to the City once per quarter during the progress of the work
for partial payment for project completed to date. Such invoices will be reviewed by the
City, and upon approval thereof, payment will be made to the Firm in the amount approved.
c. Final payment of any balance due the Firm of the total contract price earned will be made
promptly upon its ascertainment and verification by the City after the completion of the
work under this Agreement and its acceptance by the City.
d. Payment as provided in this section by the City shall be full compensation for work
performed, services rendered and for all materials, supplies, equipment and incidentals
necessary to complete the work.
e. The Firm's records and accounts pertaining to this agreement are to be kept available for
inspection by representatives of the City and State for a period of three (3) years after the
termination of the Agreement. Copies shall be made available upon request.
6. OWNERSHIP AND USE OF DOCUMENTS. All documents, drawings, specifications and
other materials produced by the Firm in connection with the services rendered under this
Agreement shall be the property of the City whether the project for which they are made is
executed or not. The Firm shall be permitted to retain copies, including reproducible copies,
of drawings and specifications for information, reference and use in connection with Firm's
endeavors.
7. COMPLIANCE WITH LAWS. Firm shall, in performing the services contemplated by this
Agreement, faithfully observe and comply with all federal, state and local laws, ordinances
and regulations that are applicable to the services to be rendered under this agreement.
8. INDEMNIFICATION. Firm shall indemnify, defend and hold harmless the City, its offices,
agents and employees, from and against any and all claims, losses or liability, or any portion
thereof, including fees and costs, arising from injury or death to persons, including injuries,
sickness, disease or death to Firm's own employees, or damage to property occasioned by a
negligent act, omission or failure of the Firm.
9. INSURANCE. The Firm shall secure and maintain in force throughout the duration of this
contract comprehensive general liability insurance with a minimum coverage of $1,000,000
per occurrence and $1,000,000 aggregate for personal injury; and $1,000,000 per
occurrence/aggregate for property damage, and professional liability insurance in the amount
of $1,000,000 per occurrence to $2,000,000 aggregate with defense costs in addition to limits;
workers' compensation insurance, and vehicular liability insurance.
Said general liability policy shall name the City of Boynton Beach as an "additional named
insured" and shall include a provision prohibiting cancellation of said policy except upon thirty
(30) days prior written notice to the City. Certificates of coverage as required by this section
shall be delivered to the City within fifteen (15) days of execution of this agreement.
10. INDEPENDENT CONTRACTOR. The Firm and the City agree that the Firm is an independent
contractor with respect to the services provided pursuant to this agreement. Nothing in this
agreement shall be considered to create the relationship of employer and employee between
the parties hereto. Neither Firm nor any employee of Firm shall be entitled to any benefits
accorded City employees by virtue of the services provided under this agreement. The City
shall not be responsible for withholding or otherwise deducting federal income tax or social
security or for contributing to the state industrial insurance program, otherwise assuming the
duties of an employer with respect to Firm, or any employee of Firm.
11. COVENANT AGAINST CONTINGENT FEES. The Firm warrants that he has not employed
or retained any company or person, other than a bona fide employee working solely for the
Firm, to solicit or secure this contract, and that he has not paid or agreed to pay any company
or person, other than a bona fide employee working solely for the Firm, any fee, commission,
percentage, brokerage fee, gifts, or any other consideration contingent upon or resulting from
the award or making of this contract.
For breach or violation of this warranty, the City shall have the right to annul this contract
without liability or, in its discretion to deduct from the contract price or consideration, or
otherwise recover, the full amount of such fee, commission, percentage, brokerage fee, gift,
or contingent fee.
12. DISCRIMINATION PROHIBITED. The Firm, with regard to the work performed by it under
this agreement, will not discriminate on the grounds of race, color, national origin, religion,
creed, age, sex or the presence of any physical or sensory handicap in the selection and
retention of employees or procurement of materials or supplies.
13. ASSIGNMENT. The Firm shall not sublet or assign any of the services covered by this
Agreement without the express written consent of the City.
14. NON -WAIVER. Waiver by the City of any provision of this Agreement or any time limitation
provided for in this Agreement shall not constitute a waiver of any other provision.
15. TERMINATION.
a. The City reserves the right to terminate this Agreement at any time by giving ten
(10) days written notice to the Firm.
b. In the event of the death of a member, partner or officer of the Firm, or any of its
supervisory personnel assigned to the project, the surviving members of the Firm hereby
agree to complete the work under the terms of this Agreement, if requested to do so by
the City. This section shall not be a bar to renegotiations of this Agreement between
surviving members of the Firm and the City, if the City so chooses.
16. DISPUTES. Any disputes that arise between the parties with respect to the performance of
this Agreement, which cannot be resolved through negotiations, shall be submitted to a court
of competent jurisdiction in Palm Beach County, Florida. This Agreement shall be construed
under Florida Law.
17. NOTICES. Notices to the City of Boynton Beach shall be sent to the following address:
Lori LaVerriere, City Manager
City of Boynton Beach
P.O. Box 310
Boynton Beach, FL 33425-0310
Notices to Firm shall be sent to the following address:
COMMERCIAL a
ATTN: SUSAN E. THEIS
P.O. BOX 18366
TAMPA, FL 33679
18. INTEGRATED AGREEMENT. This agreement, together with attachments or addenda,
represents the entire and integrated agreement between the City and the Firm and
supersedes all prior negotiations, representations, or agreements written or oral. This
agreement may be amended only by written instrument signed by both City and Firm.
19. PUBLIC RECORDS. Sealed documents received by the City in response to an invitation are
exempt from public records disclosure until thirty (30) days after the opening of the Bid unless
the City announces intent to award sooner, in accordance with Florida Statutes 119.07.
The City is public agency subject• Chapter 119, Florida Statutes. The Contractor
comply with Florida's Public Records Law. Specifically, the Contractor shall:
A. Keep and maintain public records required by the CITY to perform the service;
B. Upon request from the CITY's custodian of public records, provide the CITY with a copy
of the requested records or allow the records to be inspected or copied within a
reasonable time at a cost that does not exceed the cost provided in chapter 119, Fla.
or as otherwise provided R
C. Ensure that public records that are exempt or that are confidential and exempt from
public record disclosure requirements are not disclosed except as authorized by law for
the duration of the contract term and, following completion of the contract, Contractor
shall destroy all copies of such confidential and exempt records remaining in its
possession once the Contractor transfers the records in its possession to the CITY; and
D. Upon completion of the contract, Contractor shall transfer to the CITY, at no cost to the
CITY, all public records in Contractor's possession All records stored electronically by
Contractor must be provided to the CITY, upon request from the CITY's custodian of
public records, in a format that is compatible with the information technology systems of
the CITY.
E. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE
APPLICATION OF CHAPTER 119, FLORIDA STATUES, TO THE
CONTRACTOR'S • PROVIDE RECORDS
PUBLICRELATING TO THIS CONTRACT, CONTACT THE CUSTODIAN OF
•
JUDY .
YLE, CITY CLERK
3301 QUANTUM 1
BOYNTONFLORIDA, 33426
561-742-6061
20. SCRUTINIZED COMPANIES -- 287.135 AND 215.473
By execution of this Agreement, Contractor certifies that Contractor is not participating in a
boycott of Israel. Contractor further certifies that Contractor is not on the Scrutinized
Companies that Boycott Israel list, not on the Scrutinized Companies with Activities in Sudan
List, and not on the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector
List, or has Contractor been engaged in business operations in Syria. Subject to limited
exceptions provided in state law,the City will not contract for the provision of goods or services
with any scrutinized company referred to above. Submitting a false certification shall be
deemed a material breach of contract. The City shall provide notice, in writing, to Contractor
of the City's determination concerning the false certification. Contractor shall have five (5)
days from receipt of notice to refute the false certification allegation. If such false certification
is discovered during the active contract term, Contractor shall have ninety (90)days following
receipt of the notice to respond in writing and demonstrate that the determination of false
certification was made in error. If Contractor does not demonstrate that the City's
determination of false certification was made in error then the City shall have the right to
terminate the contract and seek civil remedies pursuant to Section 287.135, Florida Statutes,
as amended from time to time.
DATED this// day of 2c-e , 20 /? .
CITY OF BOYNTON BEACH COMMERCIAL RISK MANAGEMENT, INC.
CD
Lori LaVerriere, l'ty Manager ignature of Authorized Official
Printed Name of Authorized Official
Attest/Authenticated: / 'e c e ale.-77 / CEO
Title
1/6,
IL
(Corporate Seal)
Judy Pyle, Ci r Cle .
m:
Approve• as to orm:� Attest/Authenticated:
James A. Chero roy Attorney Secretary
EXHIBIT Y;
The City of Boynton Beach is seeking proposals for Third Party Administration services
for its self-insured Workers' Compensation and for its Property & Casualty programs. The
City's anticipated contract start date is January 1, 2019.
The Proposer shall perform all third party administrator services for Workers'
Compensation for Property & Casualty claims, or for both inclusive of claims handling,
information technology services, settlement coordination, management of claim records,
Medicare reporting, handling of claims in process and all other items necessary or proper
for, or incidental to, performing third party administrator services as identified herein.
The City of Boynton Beach has most recently utilized the following companies as its third
party administrators: Commercial Risk Management for workers' compensation and
Gallagher Bassett Services Inc. for property/casualty. The City will transfer the
administration for all active claims (run-off/tail claims) as of January 1, 2019 to the awarded
Proposer. The City is self-insured.
The City carries excess workers' compensation coverage with a SIR of $500,000 per
occurrence and excess liability coverage with a SIR of $200,000/300,000 per occurrence
with Preferred Governmental Insurance Trust (PGIT).
The TPA(s) will be required to manage the claims with a comprehensive database system
which allows computer access to adjuster notes, adjuster correspondence and other
pertinent information needed by the City to generate analytical data reports upon demand;
which will allow secure web based communication between the City and the TPA and
Adjusters. This program should also allow the City to add information to the adjuster notes
section of the computer systems.
All proposers are to assume the complete handling of all pending claims for dates
of loss prior to January 1, 2019. The information provided in this RFP regarding
the volume and type of pending claims to be assumed, is based on the latest
information provided to the City by their current TPA and within the current self -
administrated Property and Casualty program. It is the responsibility of the
proposer to determine the additional cost to the City to take over these existing
claim files. It is required that the claims data associated with all claims occurring
prior to January 1, 2019 be transferred to the new computer information system so
that future loss runs will contain a complete history of all claim years. The transfer
of all claims data must be completed by January 1, 2019.
WORKERS2. COMPENSATION ADJUSTING AND INVESTIGATION
SERVICES
Upon receipt or notice of all workers' compensation claims, the TPA, on behalf of the
City, will perform the following services:
The City requires that the TPA hire and retain competent, qualified,
experienced professionals who are licensed in Florida.
2. The TPA is responsible for obtaining recorded statements from the claimant
and any witnesses.
employeeThe City will maintain contact with injured employees to assist the
and/or
employee.the injured
3. The TPA will be responsible for filing all the appropriate forms with the
State (DWC1, etc.)
4. The TPA is responsible for ensuring compliance with all reporting
requirements by regulatory agencies including but not limited to Medicare
Secondary Reporting Act of 2007 and all subsequent revisions.
5. The TPA will assist the City with any written correspondence that the City
requests them to send to the injured worker or medical provider regarding
the benefits.
6. The TPA will accept or deny all reported claims for employees' injuries on
behalf of the City in accordance with the applicable Workers' Compensation
Statutes. The decision to controvert a claim must first be discussed with
and approved by the City.
All lost time claimant's checks will be issued by the TPA on a weekly basis
from the City of Boynton Beach fund. The verification of any checks for
wage loss must be received by the City before 5:00 P.M. on the Tuesday of
a City payroll week.
8. Currently, the City requires that all medical or ancillary service providers
submit their bills to the TPA bill review unit for processing and payment. All
provider payments will be reviewed weekly by the City via the weekly TPA
check register before the provider checks can be released.
9. The TPA will be responsible for identifying any outside Firms such as
surveillance companies and field case management experts to assist in the
investigation and medical coordination of claims. Payment of the bills will
be made by the TPA from the loss fund as an allocated expense but not
without prior approval by the City.
10. The TPA and/or Bill Review unit shall review all medical bills and other
services for which a claim is being made for reasonableness and conformity
to appropriate medical and surgical fee schedules and network discounts.
11. The TPA will assist the City with light duty cases and for those City
employees who are losing time by providing a report indicating all
employees that are not working in a full duty unrestricted capacity.
12. The designated adjusters or team from the TPA will meet with the City on a
quarterly basis to discuss summary reports on all open and active claims.
13. The Director of Human Resources and Risk Management, and/or designee
will attend all mediation conferences and may ask the TPA for reports prior
to mediation in order to facilitate any settlement.
14. The TPA shall prepare and maintain files necessary for legal defense of
claims and/or other litigation (such as actions for subrogation) or other
proceedings.
15. The TPA shall pay in a timely fashion, per Florida Medical E.D.I. guidelines,
all claims and expenses from the loss fund account established by the City,
which will be maintained by the TPA. Fees, interest and civil penalties
incurred due to late payments or adjuster mishandling are to be paid by the
TPA unless caused by late reporting from the City.
16. The TPA shall pursue all possibilities of subrogation and liens. The
Manager of Risk and Wellness must be copied on all such correspondence
relating to these issues.
17. The City will assign the attorneys that provide the defense of claims. The
TPA is to provide the defense attorney a complete copy of the file in
question at the time an assignment is made. The TPA will provide a
monthly report to the City regarding all legal assignments and the costs
associated with them.
.. -
Floridai IN 1
with applicable
State Statutes.
18. The TPA will timely report all claims in accordance with Florida State
Statutes to the City's excess carriers, as required by the carrier's reporting
criteria. For any late reporting penalties imposed by the carrier due to late
reporting by the TPA, the TPA will reimburse the City for those amounts.
19. The TPA will provide all necessary status reports as required by the City's
excess carriers.
20. The TPA will submit requests to the excess carrier for all payments above
each claim's SIR to obtain the proper reimbursement for the City. The
reimbursement checks will be forwarded to the City and the amount
recovered will be entered into the claims information system.
21. The City will assign Field Case Managers (Qualified Rehabilitation Provider
(QRP)) to its cases as needed.
22. The City maintains an exclusive list of providers developed specifically for
the use of the City, which is part of the TPA provider network. The City will
use the TPA provider network as a back-up network for ancillary providers.
23. The TPA must provide the City with a toll-free telephone number.
24. In all dealings, the City requires the TPA to be courteous, responsive and
sensitive to the injured employee. The TPA is required to return an injured
employee's telephone call within 24 hours, preferably the same day that
they called the TPA.
25. Identify claims subject to second injury relief fund (if reinstated during the
contract term or currently applicable), at -fault party subrogation and pursue
such recoveries on behalf of the City of Boynton Beach.
26. Provide reports to the City of Boynton Beach's Director of Human
Resources and Risk Management and Manager of Risk and Wellness as
requested or provide for system access for ad hoc reporting. Reports shall
include:
• Loss experience
• Summary of claim and loss experience, broken down by injury type,
injury cause, department, and location of injury
• Cost, frequency and severity report
• Claim activity summary (new, re-open/closed/disputed, etc.)
• Claim master file listing
• Detail list of claimants including current and prior claim activity
• Retention level analysis
• Reserve analysis detailing rationale and total cost
• OSHA 300 Log
• Lost time analysis
• PPO penetration
• Average cost by medical provider
• Number of Days from DOA Date to MMI Date
1. The TPA shall use its best judgment in managing claims and in setting reserves
for future payment and shall perform the following functions with regard to
claims:
A. Within one (1) working day of receipt of a new claim, all data
shall be entered into the information system, assigned the proper
codes and initial reserves.
B. Within 24 hours respond to inquiries from employees
and/or injured parties regarding the status of their claim.
C. Clearly document each file all phone conversations, discussions,
and meetings held on the case.
D. Promptly enter into the computer system all pre -approved
payments, reserve revisions, and file closings.
E. The TPA shall maintain emergency response procedures with the
ability to establish a catastrophic operation center within 48 hours.
F. The TPA is expected to be familiar with applicable laws
regarding potential liability for injury or damage or other loss to
members of the public (e.g. familiarity with Florida's sovereign
immunity statutes, Federal law regarding governmental liability,
etc.).
G. Firefighters and Police are subject to Occupational Disease
Claims and FS 112.181. City of Boynton Beach requires that
adjusters handling these types of claims be educated
in the different statutory requirements associated with these
claims.
H. Written status reports shall be provided to the City prior to these
quarterly claim reviews.
I. The TPA shall maintain claim review procedures in place for
supervisors or auditors within its firm.
J. The TPA shall have established standard reserving practices
to assist City in establishing reserves. Reserves shall be
reviewed at a minimum of every 90 days. File notes should
reflect reserves were reviewed.
K. The TPA shall coordinate a claims funding arrangement that is
acceptable to the City of Boynton Beach.
L. Prepare and /or assist City staff with all appropriate responses to
and inquiries of all regulatory agencies.
M. The TPA is responsible for ensuring compliance with all reporting
requirements by regulatory agencies including but not limited to
Medicare Secondary Reporting Act of 2007 and all subsequent
revisions.
1. The TPA must prepare, maintain, and file statistical data, records, or reports as
required by excess insurers, City actuaries, and the State.
2. The TPA must prepare, maintain and file statistical information required by the
workers' compensation rating bureaus, including all data required for the
promulgation of the City's experience modification and state assessments.
3. The TPA must prepare and file any other reports as required by the City and the
State relating to claims experience, payments, etc. (i.e., DWC-51, Aggregate
Defense Attorney Fee Report due to the state by March 31 of each year).
4. All charges related to these services identified herein are to be included in the
pricing provided for each option. Any costs associated with programming
changes that are necessary to create a report required by the City (any report
listed in the Scope of Services) are the responsibility of the TPA.
5. Specialty reports available beyond those identified in the Scope of Services or
requested by the City are to be provided and the City will request a cost
proposal for each report based on the fee structure in the price proposal.
6. All claims data is the property of the City and any data and media will be
provided to the City upon request or upon termination of this agreement at no
additional cost to the City.
1. The selected TPA, at their expense, will ensure all claims and payment data is
included in their loss runs. Historical data from our current TPA's database
cannot be purged. Claims data for all open and closed claims must be
transferred.
2. Loss runs are to be provided on a monthly basis sorted separately by policy
year and department/location. Loss runs should list each claim separately.
Specific summary reports also must be provided. The following reports are
required:
• Claims listing by Department
• Check register
• Cumulative report by line of coverage by year
• Annual summary reports
• Location report
• Large loss or severity report
• Safety report
• Excess insurance report
• Litigation report
• Legal payments report
• Pharmacy Penetration report
• Care Management report (Telephonic/Field)
3. All claims, expense and legal payments will be made by the TPA on checks
drawn on an account set up by the TPA and funded bi-weekly by the City. It is
understood that all funds in this account are City funds and are to be returned
to the City upon request or at termination of this contract.
4. The monthly reconciliation statement submitted by the TPA to the City will
include the following:
• Balance at inception of statement period
• Total disbursements which cleared, by date and claimant/payee
• Balance at close of statement period.
.3
5. The TPA will submit an invoice to the City on a monthly basis which provides
an Itemized listing of all banking fees related to the bank account set up by th(t
TPA on behalf of the City of Boynton Beach.
JUZOU � A
Claim: Any report of an accident (first or third party) alleging or resulting in
injury, damage, or loss which could give rise to a demand for the payment
of money. The claim charge is applicable on a per occurrence, per claimant,
per line of coverage basis.
.14, MID "MIN ft" IN 0 lose. 0
Qualified claim or loss: The TPA shall investigate and adjust any loss or
claim reported within the service term, provided the loss or claim type is
identified.
Allocated expenses: Will be the responsibility of the City of Boynton Beach
2nd include, but not be limited to:
• legal fees
• professional photographs
• medical record
• experts' rehabilitation costs
• accident reconstruction
• architects, contractors
• engineers
• police, fire, coroner, weather, or other such reports
• property damage appraisals
• extraordinary costs for witness statements
• official documents and transcripts sub rosa investigations
• medical examinations
• extraordinary travel made at City of Boynton Beach's request
• court reporters
• fees for service of process
• - .•. ••- T --M VOTOO
• chemists
• any other similar cost, fee or expense reasonably chargeable to the
investigation, negotiation, settlement or defense of a claim or loss
which must have the explicit prior approval of the City of Boynton
Beach.
LIABILITYIII
The TPA shall perform the following services:
1. Review each claim and loss report submitted by the City of
Boynton Beach during the term of this Contract.
2. Assign a qualified, experienced, Florida licensed adjuster within
24 hours of receipt of claim.
3. Contact claimant within 48 hours of assignment of claim.
4. Conduct an appropriate investigation of each qualified claim or
loss.
5. Maintain a file for each qualified claim or loss which shall be
available for review by the City of Boynton Beach.
6. Adjust, settle or resist all qualified claims or losses with the
specific approval of the City of Boynton Beach.
7. Perform necessary and customary administrative and clerical
work in connection with each qualified claim or loss, including the
preparation of checks or vouchers, releases, agreements, and/or
other documents to manage and finalize a claim.
8. Promptly establish and update claim reserves at least every ninety
(90) days.
9. Timely notify City of Boynton Beach, City of Boynton Beach agent,
and excess insurer(s), as designated by the City of Boynton
Beach, of all qualified claims or losses which may exceed the City
of Boynton Beach retention and, if requested, provide information
on the status of those claims or losses.
10. Coordinate investigations on litigated claims with attorneys
representing the City of Boynton Beach and with representatives
of the excess carrier, as required. It is expressly understood that
all legal costs and loss payment will be charged to the City of
Boynton Beach.
11. Have internal product support staff review large and unusual
claims at no additional cost to the City of Boynton Beach, unless
specified.
12. Maintain an automated loss and information system, and provide
the City of Boynton Beach with electronic access to claim reports.
13. Assist the City of Boynton Beach in selecting appropriate experts
or specialists as the claims may require.
14. Provide personnel needed to perform the services agreed to
herein.
15. Maintain a comprehensive database of all claims reported. This
data shall belong to the CITY OF BOYNTON BEACH and shall be
made available to the CITY OF BOYNTON BEACH at any time.
Upon termination of the Contract, the TPA shall provide the CITY
OF BOYNTON BEACH with an electronic copy of the data in
ASCII format.
M ' •
1. The TPA is required to provide monthly and annual summaries of
claims by type of risk and shall recap each year's experience,
including prior years, to date. The reports shall be on a fiscal year
basis (October 1st - September 30th) in a format acceptable to the
City of Boynton Beach, and shall be prepared in accordance with
the provisions below:
a. Claims Experience Reports should be provided within 15
days of the end of the period for which each report applies.
b. Adjusting Service shall provide a report of accounts for
aggregate loss experience analysis.
C. City of Boynton Beach requires the ability to provide a
breakdown of experience for each department.
Supplemental claims documentation shall provide, in plain
English, sufficient information to indicate what happened, to
whom or what and how much has been paid or is expected
to be paid.
2. Online and real time access to the administrator's claim system,
including all adjusters notes is critical to the City of Boynton Beach.
TPAs must have a software product that the City of Boynton Beach
can access to view the administrator's automated claim files,
including adjusters' notes, payments, claim notes, imaging of
invoices and messaging capabilities.
3. OSHA reporting capabilities shall include the ability to separate
OSHA reportable claims from Record Only claims.
4. TPA shall have staff available that can create reports when
requested by the City.
I-MIE �01 I
1. City of Boynton Beach reserves the right to direct the TPA regarding
settlement of all claims.
2. Legal Services: The City of Boynton Beach reserves the right to
assign legal counsel to all claims.
3. City of Boynton Beach shall have the right to inspect or audit the
files, including the right to utilize an outside auditor for these
functions on City of Boynton Beach's behalf. The City of Boynton
Beach requires the TPA files to be electronically stored with access
provided to City of Boynton Beach of all stored document images,
faxes, incoming email attachments, and all documents generated by
the Claims Management System.
4. Claims Records as Property of City of Boynton Beach:
All claims files and other records, documents, lists, supplies, etc.,
pertaining to claims are the property of City of Boynton Beach and
will be delivered to City of Boynton Beach upon contract
termination with no additional fee to the City,
EXHIBIT B
FEES AND PAYMENTI
REQUEST • PROPOSALS
THIRDFOR
PARTY
FOR •
EI I'
EMEM09A=
2018 Projected
No. of Claims Claim Rats}
1) ' COMPENSATION:
MEDICAL ONLY 76
INDEMNITY 14
—FLATMO LYFEE
$2,656.00
ADDITIONALSERVICES:
$5.00 quexyl50.0® Initial/$25.00 final
MEDICARE REPORTING (MbnMlyFee)
Allocated to claim fit
PER CLAIM COST FOR PRIOR CLAIMS FILES
lxIcluded
Comercial Risk Nauagt, Inc. is not offering
a Proposal on the ALIGL -Services.
) PROPERTY AND CASUALTY:
AUTO LIABILITY BODILY INJURY
4
AUTO LIABILITY PROPERTY DAMAGE
1
AUTO PHYSICAL DAMAGE
0
GENERAL LIABILITY BODILY INJURY
4
GEN. LIABILITY PROPERTY DAMAGE
4
PROFESSIONAL LIABILITY
0
PROPERTY 1 --
THIS PAG@ TO BE SUBMITTID FOR PROPOSAL TO BE CONSIDERED 31
COMPLETE AND ACCEPTABLE.
RFP No. 004-1710-19/IT
REQUESTiPROPOSALS
FOR
THIRD PARTY
■! ! "! #
FOR PROPERTY AND CASUALTY CLAIMS
RFP No.: 004-1710-19AT
l l ! ^ •MIM29,
1 �5
2018 Projected
o. o Llai s Claim ate
ELECTRONIC INCIDENTS o —ELL -
0 R
— FLAT MQbLTHLY FEE —ELL -
ADDITIONAL
iTiSERVICES;
MEDICARE REPORTING(Monthly Fes) N/A /MO,
PER CLAIM COST FOR PRIOR CLAIMS IL NIA
to the same or ► • .3
Commercial Risk Management, Inc.r � }
COMPANY6 AUT Z SI T
819 289-9900 Susan E Theis
TELEPHONE NO. PRINTED NAME
sthei0erm-su.com President/CEO
E-MAIL ADDRESS TITLE
COMPLETE AND ACCEPTABLE.
RFP No. 004-1710-19/IT
m