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HomeMy WebLinkAbout001240 Original Contract The City of Part Angeles Record # 0©1 240 77-777-7 7 ul►aWng�k�n t!IclSplta �i3 � , Ct��l �1 Port r twx " C rine Ctairxiii tlrlar►egmerrt,, 71 An eles This Service Agreement is made and entered into as of the 1st day of May 2017 by and between City of Port Angelus(the "Olent"), and United Claims Management("UCM") a'1CU`ashington fee-for-service entity that is a division of Washington Hospital Services, Incorporated, and a Washington corporation. It is agreed between the parties hereto as follows: A.APPOINTMENT OF UNITED CLAIMS MANAQEMENT.The Client hereby appoints UCM and UCM hereby agrees to serve, as the Third Party Administrator ("Administrator") of the Clients self-insured workers compensation claims management program. B. FUNCTIQNS OF UNITED CLAIMS MANAGEMENT. During the term of this. Agreement, the regular functions of UCM as the Clients Administrator shall include the following: 1. Claims Administration. (a) Claim Managgment and Administration. UCM will manage and administer the Client's self-insured Workers'Compensation tall claims(those claims open as of the start date of this agreement and any claims that may reopen during the period of this agreement)for the life of the agreement. All claim payments shall be made with Client funds. UCM will act on behalf of the Client in handling, monitoring, investigating,overseeing and adjusting all such actual and alleged claims. (b) Claim Settlement. UCM will settle claims of the Client with Client funds in accordance with reasonable limits and guidelines established with the Client. (c) Claim Reserves. UCM will recommend reserves for claims and expenses. (d) Allgoated_Claim Expenses.UCM will pay all Allocated Claim Expenses with Client Funds,The Client will establish a bank account with adequate funds to be drawn upon to pay the Allocated Claim Expenses. Allocated Claim Expenses are charges billed by third parties for services performed in connection with the management of a specific claim. These expenses include but are not limited to investigation, medical management, disability benefits, vocational services, settlement and legal services and other claim related expenses. Some of which are detailed below: 1. Medical provider and Independent medical examinations charges; . Fraud detection expenses, such as surveillance,detection, reporting and prosecution of fraudulent claims, including legal fees; 3. Client approved specialty providers (nurse case managers, vocational counselors,attorneys, medical experts and special process servers, investigation and subrosa services). 4. Court costs,fees„ interest and expenses; 5. Depositions, court reporters and recorded statements; 1 6. Independent adjusters and appraisers-, 7. Index bureau; 8. Electronic Data Interchanges, EDI, and any other charges if required by State Law; 9. UCM Personnel, at their customary rate of charge, with respect to claims outside the State is communicated to the Client prior to incurring such cost', 0.Actual reasonable expenses (pre-approved by the client) incurred by UCM employees outside the State for meals,travel,and lodging in conjunction with claim management; 11. Police,weather and fire report charges that are related to claims being administered under Client's program-, 12. Charges associated with accident reconstruction, cause and origin investigations,etc.; 13.Charges for medical records, personnel documents, and other documents necessary for adjudication of clients under Client's program; 14. Charges associated with MMSEA Section 111 reporting, Medicare set-aside allocations, settlement allocations and lien research. (e Subrogation. UCM will monitor, adjust and collect 31d party claims for subrogation. (f Provision of reports, UCM agrees to provide reports to the client as mutually agreed. C. Client Rgsponsibilities. 1. Report all claims, incidents, reports or correspondence relating to potential claims in a timely manner. 2. Reasonably cooperate in the disposition of all claims. 3. Establish a bank account with adequate Client Funds to be drawn upon by UCIVI to pay all claims and expenses in a timely manner. 4. Respond to reasonable information requests in a timely manner. 5. Provide a complete copy of current excess or other insurance policies, including endorsements and audits, applicable to Client's insurance program. & Promptly pay UCIVI's fees. 2 D, OPERATINQ EXPENSES. The Client agrees to be responsible for and pay all of its own operating expenses other than service obligations of UCM. Such operating expenses shall include but not be limited charges for the following.- 1. All costs associated With Client meeting its State security and licensing requirements; 2. Outside consultants, actuarial services or studies and State audits; 3. Independent payroll audits; 4. All applicable regulatory fees and taxes-, 5,, Excess and other insurance premiums; 6. Costs associated with the development, record keeping and filing of fraud statistics and plans, but only if required by any State or regulatory authority having jurisdiction over Client; 7. Other operating costs as normally incurred by the Client. E. BOOKS AND RECORDS (a) UCM shall maintain all claim. information necessary under this Agreement. The Records shall remain at all times the sole property of the Client. (b) The Records shall not include any manuals, forms, files and reports, documents, customer lists, rights to solicit renewals, computer records and tapes, financial and strategic data, or information which documents UCM's processes, procedures and methods, or which UCM .employs to administer programs other than theClient. (c) During the term of this Agreement, UCM shall provide the Client with copies of the Records, if so requested by the Client.Any reasonable costs of reproduction of the Records shall be borne by the Client. In the event this Agreement is terminated or non-renewed, Client Records will be turned over to the Client or to a successor administrator designated by the Client. (d) UCM shall make the Records available for inspection by any duly authorized representative of the Client, or any governmental or regulatory authority having jurisdiction over UCM or the Client. F. NON-SOLI CITATION OF EMPLOYEES During the term of the Agreement and for two (2) years thereafter, the Client and UCM mutually agree not to recruit, solicit or hire any employee of the other without written permission. 3 TERMANDIgIRMINATIM 1. Term of Agreement', The term of this Agreement shall commence on May 1,2017 and shall continue for a period of one year, terminating on April 30, 2018. At least (90) days prior to the expiration of the term of this Agreement, the parties shall enter into good-faith negotiations regarding any proposed change in Agreement Terms or extension of the term. 2. T§rmination of Agreement. This Agreement may be terminated: (a) Upon expiration of the current term of this Agreement if either party has given the other at least (90)days written notice of its intention to terminate; (b) Upon dissolution of the Client's self-insurance program due to $0 in claim payments reported on four(4) consecutive quarterly reports submitted to the Department of Labor and Industries; (c) Upon dissolution of the Client's self-insurance program due to Client insolvency or bankruptcy: or (d) Upon (90) days written notice by either party if the other party is in material breach of any term, covenant or condition contained herein. The terminating party shall give written notice to the other party, who shall have sixty (60) days from the date of such notice to correct the grounds for termination. If the grounds for termination are not corrected during the sixty (60) days period, this Agreement may be terminated on the termination date specified in the notice, but not prior to the expiration of the (90)day period described herein. 3. Services Following Termination of Agreement. Should this Agreement be terminated or non-renewed for any reason, at the Client's request UCM will cease providing services and turn over to the Client all Client files in UCM's possession, which shall include all open and closed files. UCM shall cooperate with any successor administrator in the orderly transfer of all functions, including providing a runoff listing of open claim files If desired by the Client and any other records reasonable and necessary for a successor administrator,and provide an electronic transfer of data if such is feasible, with the cost of providing such borne by the Client. The electronic transfer of data will be subject to a fee of$9,500.00, H. SERVICE FES PAYMENIS. The Client shall pay United Claim Management a claim management fee as outlined in the Fee and Payment Schedule attached as Exhibit A and incorporated by this reference. 4 1, MEDIATION/ARBITRATION. If an irreconcilable difference of opinion or claim should arise between the Client and UCM as the interpreters of any matter relating to this Agreement, such matter will be submitted to mediation. If mediation is unsuccessful arbitration shall be the sole remedy available to both parties. Any such mediation or arbitration will take place in King County, State of Washington and will be conducted in accordance with the then-current rules of the American Arbitration Association. King County Superior Court shall have jurisdiction over any appeals therefrom. J. RELATIONSHIP OF PARTIE:9,. With respect to the services provided by UCM in this Agreement, UCM is considered an independent contractor. Nothing in this Agreement shall be construed to create a relationship of employer/employee,partners car joint ventures between the Client and UCM. This Agreement is non-exclusive, and UCM shall have the right to perform services on behalf of other individuals, firms, corporations and entities. K. INDEMNIFICATION. 1. Indemnification by Client, The Client agrees that it will indemnify and hold harmless UCM and UCM's, directors, officers, employees, agents, shareholders, subsidiaries and other affiliates from and against any and all claims, losses, liability, costs, damages and reasonable attorney's fees incurred by UCM as a result of breach of this Agreement by the Client, or misconduct, error or omissions by the Client, or by any of the Client's trustees, directors, officers, employees, agents, shareholders,subsidiaries and other affiliates in connection with the performance of this Agreement. 2. Inogmnification by UCM,UCM agrees that it will indemnify and hold harmless the Client and the Client's directors, officers, employees, agents, shareholders, subsidiaries and other affiliates from and against any and all claims, losses, liability, costs, damages and reasonable attorneys fees Incurred by the Client as a result of breach of this Agreement by the UCM, or misconduct, error or omissions by UCM or by any of the UCM's trustees, directors, officers, employees, agents, shareholders, subsidiaries and other affiliates in connection with the performance of this Agreement. L. CHANGE IN CIRCUMSTANCES. In thii event the adoption of any statute, rule or regulation materially changes the nature of the relationship between the parties hereto or the legal or economic premises upon which this Agreement is based, the parties hereto shall undertake good faith negotiations' to amend the terms of this Agreement to account for such changes In a reasonable manner. [Signature Page Follows) UCM CLIENT UNITED CLAIMS MANAGEMENT E T (UCM) City of Port Angeles By a, � - Zborowrski Authorized Representative Executive Director City of Part Angeles Washington Hospital Services Date: :� p Date: // 7/ / -7 Washington Hospital Services City of Port Angeles United Claims Management 321 E. yah Street 999 Third Avenue, Ste. 1400 Port Angeles, WA 98362 Seattle,WA 93104 SIGNATURE PAGE TO THE MASTER SERVICE AGREEMENT 6 Exhibit A Fee and Payment Schedule Claims Management Fee: $26,000.00 Annual Claim Management Fee is$26,000.00. Accepted in twelve equal payments of$2,166.67 each. UCM will forward an invoice for this amount to the client following the VI of each month. initial payment is due May 1, 2017. The annual fee is based on the handling of all existing open claims. New claims filed or reopened during the life of the contract will be charged the stated rate. The annual fee is inclusive of administration and RMIS services noted below. Existin Claims Claim Type No. of Claims Medical Only claims Indemnity,Claims 9 Flat Rate Fee Per New or Reop ned Claim Claim Type Cost pf'r Claim Medical Only claims $1,400.00 lndemnitClaims Rep2rtinaflncldent Claims. Reported claims which require only input into RMI S system and no required claim management activity. Medical 0rd ly.Claims which have no issue of lost time, no evidence of other indemnity benefit exposure, -- no obvious question of compensability, no evidence of subrogation or second injury recovery, and no evidence of proble matic medical issues. Open less than 160 days with costs that do not exceed $10,000.00. IndemLilly Claims. Claims involving lost-time, questionable oDmpensability, legal involvement, subrogation, second injury fund, probably permanent impairment, jurisdictional issues, coverage issues, complex medical issues,or medical only claims with a cost greater than $10,000 and/or are open greater than 180 days. Claims Manggement Fees LnejLu - All claims management functions - State filings and reporting - Claims investigation - Litigation management - Subrogation - SlU handling(inside) Imcalerrrentation No additional Fee—Existing Client Ad min istration Servicers Annual Fee —Included in Annual Fee Annual Administration Fee includes: * Designated Account Manager • Preparation and participation in quarterly claims reviews • Quarterly client scorecard evaluations * Annual stewardship meeting • Maintenance of the loss fund account and all bank charges . Filing of all required state forms • Reporting to excess carrier . File storage RMIS Services Annual Fee—Included in Annual Fee Annual RMJS Fee includes: • Risk Management Information System(ERIC)cost to include: 5 User IDs. Internet access to claim files; the ability to email your adjuster and account manager, access to our library of template risk management reports together with initial training and ongoing support. Monthly loss runs and loss fund activity reports Data M!gratlon No fee—existing client Data migration fees are associated with migrating all historical data into the RMIS/Eric Systems Software Data Base. Data migration averages 90— 125 hours to complete. 2A@,F"ds Hourly rate: $150.00 per hour. Data feeds relate to developing and executing monthly data extracts to other sources if necessary. Fees are charged at a cost of$150.00 per hour. Required EDI to department of Labor and Industries and ►SMS are included in the claim management fee. Other Services and Fees Services Fee Index Bureau $12.00 Bill Review $7.50 Hospital Bill $10M PPO/Professional Review 28%of saviNs Pharmacy Benefit Pro ram ...... No extra fee Safety Resource Research No extra fee Sp2cialty Vendor Out sourced to client choice Field Case Management Out sourced to client choice Telephonic Case Management Out sourced to client choice Field Case Investigation Conducted internally or Out sourced to client choice Utilization Review Program $95.00 per review, $240 per Physician review Claim lntakejRep�q5j2gNo extra fee Subrogation Conducted internally/Outsourced to client choice SIC:QRS Reporting No Extra Fee MMSEA CMS Section 111 ReportiN No Extra Fee Quarterly Report No"Extra Fee Annual Report. No Extra Fee $150 per hour for system programming time, United Claims Management)AAR provide special reports, (reports not currently programmed). We currently have over 450 standard reports you can choose from, therefore it is highly unlikely a customized report would need to be developed. 9