HomeMy WebLinkAboutbocc.con.012.2003 CHECK LIST
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SERVICE AGREEMENT FOR PITKIN COVN: NTRAcT #D/2
WORKERS' COMPENSATION
SELf-aSSURANCE PROCaAM 2003
THIS AGREEMENT is effective the 1st day of January 2003, between Cannon Cochran
Management Services Inc. ("CCMSI"), Pitkin County ("Client").
WHEREAS, Client currently self-insures its workers' compensation risks and desires to have
CCMSI provide specific services in connection with such self-insurance program; and
WHEREAS, CCMS! is willing to provide such services on the following terms and conditions.
THEREFORE, the parties agree as follows:
Section 1. Definitions - When used in this Agreement, the following terms shall have
the meanings set forth below.
1.1 Allocated Loss Expenses - Expenses payable by the Client to third
parties as a result of claim services, including but not limited to the
following fees: witness fees and mileage allowances; fees for
detective services; and fees for attorneys, commercial photographer
fees; expert witness fees; fees for claim-related medical opinions and
diagnostic services including: rehabilitation, consulting and medical
management intervention fees except fees for actual medical or
hospital treatment. Allocated Loss Expenses may also include
Medical Case Management, Provider Network Access, and Medical
Review fees paid to CCMSI.
1.2 Claim - A request for workers' compensation benefits. A claim
includes all potential or actual workers' compensation liability of
Client for the illness or injury of an employee, including medical,
disability, and/or other benefits.
1.2.1 Indemnity Claim
a. lost time as defined statutorily, or
b. Permanent physical impairment, or
c. fatality, or
d. denial of benefits, or
e Settlements
1.2.2 Medical Claim- Claims for medical benefits only, whether
or not any medical benefits are actually paid.
1.3 Employee - Person who is eligible under state law to receive
workers' compensation benefits from Client.
1.4 Medical Industrial Fee Schedule - The workers' compensation
medical services fee schedule, as may be amended from time to
time, established by the state of Colorado.
1.5 Network Provider - A health care provider who has entered into a
contract with CCMSI or a PPO contracted by CCMSI to provide
medical services to Employees.
Pitkin WC contract 2003,doc 1 Rev, Nov 15 2002
1.6 Network Reimbursement Rate - The fee for medical services
established by the contract between CCMSI and a Network Provider,
or the PPO and the network provider.
1.7 Record-Only Claim - The record of an incident for which medical
treatment is not anticipated and which is identified as such by the
employer at the time it is reported.
1.8 Tail Claim - Claims reported prior to the effective date of this
Agreement.
Section 2. Obligations of CCMSI
2.1 Claims Administration - CCMSI shall:
2.1.1 Review all claims, including tail claims, received from the
Client on or after the effective date of this Agreement.
CCMSI shall create and maintain files for each claim.
2.1.2 Investigate all claims as required in CCMSI discretion to
determine their compensability.
2.1.3 Provide Client with compensability recommendations. The
final determination of compensability of any claim shall be
the responsibility of Client.
2.1.4 Subject to §2.1.3, determine benefits and pay according to
applicable statutory and administrative regulations.
2.1.5 Pay medical bills submitted by network providers at the
lowest of the Network Reimbursement Rate, the Medical
Industrial Fee Schedule, or billed charges. Medical bills
submitted by non-network providers shall be paid by
CCMSI at the lower of the Medical Industrial Fee Schedule
or billed charges.
2.1.6 Seek approval of Client when making any single payment
of $2500.00 or more. CCMSI shall have full authority,
discretion, and control to determine and pay, process, and
administer claims which fall below this limit.
2.1.7 After consulting with Client, CCMSI shall have full
authority, discretion and control to settle claims which fall
below the authorized limit. Failure of CCMSI to settle a
claim within this limit shall not subject CCMSI to liability
to any party, whether by adverse judgment entered by any
court, settlement or otherwise.
2.1.8 CCMSI shall comply with all excess insurer reporting
requirements and provide client and insurer with all copies
of correspondence with excess insurer. CCMSI will rely on
information provided by Client to identify the appropriate
excess insurer(s) and the requisite information to be
provided to such insurer(s). CCMSI shall not be liable for
any damage or injury to Client for any inadequate or
defective notice to an excess insurer where such notice was
based upon lack of, inadequate, or defective information
from Client for new and Tail Claims.
Pitkin WC contract 2003.doc 2 Rev. Nov 15 2002
2.1.9 Provide assistance to counsel selected by Client to defend
litigated cases, as requested by Client.
2.1.10 Maintain a current estimate of the expected total cost of
each Claim.
2.2 Cost Containment - CCMSI shall provide:
2.2.1 Preferred Provider Networks - Maintain a network of
health care providers within the state of Colorado.
a. The composition of the CCMSI network shall be the
sole discretion of CCMS1. Neither this nor any other
provision of this Agreement shall be construed to
require CCMSI to include within its network any
particular medical provider or type of medical
provider or to maintain a specific size or geographical
area network.
b. CCMS! retains the sole authority to negotiate
Network Reimbursement Rates with Network
Providers. Client understands and agrees that such
rates may vary among providers, and are subject to
change at any time. Nothing contained in this
Agreement shall be construed to require CCMSI to
obtain any specific discount from the Network
Providers.
2.2.2 Medical and Disability Case Management Services -
Medical case management services may be used to return
the Employee to his prior employment or employment
appropriate with the Employee's physical restrictions as
quickly as possible, and may be provided through
registered nurses and may consist of the following:
a. Review and evaluation of employer's first reports of
injury, medical records, and evaluation of the
appropriateness of medical care;
b. Develop recommendations and execute case
management objectives, which may include:
(i) utilization of contracted providers, possibly at
discounted rates;
(ii) assistance to providers in developing and
coordinating a treatment plan among facilities and
other professional providers;
(iii) utilization of industry-standard medical
treatment guidelines;
(iv) coordination of the Employee's return to work
with appropriate physical restrictions;
(v) review for appropriateness of vocational
rehabilitation services.
c. Telephone and/or personal meetings with the Client,
medical providers, and the injured Employee as
appropriate to communicate medical management
Pitkin WC conlract 2003.doc 3 Rev. Nov 15 2002
recommendations.
2.2.3 Utilization Management Services - Provide utilization
management services to help ensure appropriate, quality,
and cost-effective treatment which may consist of one or
more of the following processes:
a. Pre-certification/pre-authorization - Pre-
certification/pre-authorization of services for
Employee inpatient hospital admissions, unusual or
expensive diagnostic tests, and/or treatments and
surgical procedures.
b. Concurrent review - Review of services to determine
the appropriateness of treatment and/or treatment
facility and progress within the treatment plan.
c. Retro review - Following the injured worker's
hospital stay and/or surgical procedure, an evaluation
of medical services to assess medical necessity,
appropriateness, and cost-effectiveness of the care
rendered.
d. Follow rules of procedure as dictated by state-
mandated rules.
2.3 Data Protection - CCMSI shall take steps necessary to safeguard
claims data. Liability for any costs or expenses of replacing data, or
damage resulting from the loss of such data, shall be borne by
CCMSI, unless at the time of loss such data was in the exclusive
custody of Client, or was otherwise caused by Client's negligence.
2.4 Loss Control Services - Subject to agreement on cost, CCMSI may
provide the following loss control services, if requested in writing by
Client:
2.4.1 Information and recommendations with respect to:
a. State and federal rules and regulations
b. General safety and accident-prevention programs
c. Human actions/ergonomics
d. Accident reporting, investigation techniques, and
procedures
e. Training services
2.4.2 Loss control reports shall consist of findings and
recommendations to help control, minimize, and/or
eliminate loss-producing hazards and exposures.
2.4.3 Cost of such services shall be mutually agreed upon.
Section 3. Obligations of Client
3.1 Client shall:
3.1.1 Be solely responsible for determining the compensability of
any illness or injury, subject to the discretion granted to
CCMSI in Section 2
Pitkin WC contract 2003.doc 4 Rev. Nov 15 2002
3.1.2 Designate a person as the principal contact who shall have
the authority to approve payment for services or treatment
on any Claim as recommended by CCMSI.
3.1.3 Comply with compensation funding as stated in Attachment
#1.
3.1.4 Provide complete copies of all excess insurance policies
and the reporting requirements for each.
3.1.5 Comply with state-regulated rules of procedure.
Section 4. Audits
4.1 CCMSI shall provide Client access to all of Client's claims data
with seven (7) days advanced written notice.
4.2 The Client and auditor shall maintain the confidentiality of any
information obtained during the course of the audit.
4.3 Client shall indemnify and hold CCMSI harmless for any and all
loss, costs, damages, and expenses due to its negligent or
intentional misuse of information obtained from the audit.
4.4 The Client and auditor shall not remove CCMSI documentation
from the premises of CCMSI without written authorization from
CCMSI.
4.5 CCMSI shall be furnished a copy of the audit report.
4.6 Client is solely responsible for the costs of any audit.
4.7 This provision shall survive the termination of this contract for a
period of ninety (90) days.
Section 5. Term of Agreement and Cancellation
5.1 The term of this Agreement shall run from January l, 2003 through
December 31,2003. If not cancelled in accordance with the terms
specified in Section 5, this Agreement shall be renewed
automatically for successive twelve (12) month periods thereafter.
5.2 This Agreement may be renewed by agreement of both parties.
Notice of any request for increased fees or material changes in
services shall be given by the requesting party to the other at least
60 days prior to the effective date of the change.
5.3 If Client fails to timely reimburse CCMSI as required in Agreement
Attachment #1, CCMSI shall have the right to assess Client a late
penalty of two percent per month of the unpaid amount and to
immediately suspend claims processing. Through facsimile CCMSI
shall immediately notify Client of Client's alleged breach (with
specificity). That notice shall also itemize the sums outstanding
from Client. Client shall remain liable for all amounts payable
under this Agreement.
Pitkin WC contract 2003.doc .5 Rev. Nov 15 2002
5.4 If Client fails to timely reimburse CCMSI as required in Agreement
Attachment #1, CCMSI shall have the right to immediately cease
performance under this Agreement, and to suspend all Claims
processing. CCMSI shall notify Client at time of cessation of
performance hereunder via facsimile, that Client has failed to
comply. That notice shall also itemize the sums outstanding from
Client. Client shall remain liable for all amounts payable under this
Agreement, and CCMSI specifically reserves all additional legal
rights and remedies available.
5.5 CCMSI may offset against the Client's deposit to cover any
amounts unpaid under this Agreement.
5.6 If either party defaults in the performance of its obligations under
this Agreement, the non-defaulting party shall give the defaulting
party a written notice of default and right to cure. If the default is
not cured to the satisfaction of the non-defaulting party within
forty-five (45) days of the date of the written notice, then the non-
defaulting party shall notify the defaulting party that it intends to
terminate the contract. Once this notice of intent to terminate is
given, the Agreement shall terminate at 12:00 midnight on the tenth
(10th) calendar day after notice, unless a later date is specified in
the notice. Nothing in this Section 5.6 shall affect the right of
CCMSI to cease all performance including Claim processing and
payment, as set forth in paragraph 5.3 and paragraph 5.4.
5.7 Upon termination of this Agreement, Client shall be entitled, if it so
requests, to have returned the files CCMSI has maintained for
Claims (but not including any computer hardware, software, or
other proprietary information of CCMSI); provided, however, that
CCMSI or its agents, Employees, or attorneys shall continue to be
entitled to inspect such files and make copies or extracts therefrom
either before or after returning same. If Client does not request
these files, they will be retained or destroyed at CCMSI'S option
and Client shall have no recourse against CCMSI for failure to
retain them.
5.8 Upon termination, if Client does not make an affirmative election
under 5.9, and if all sums due to CCMSI under this Agreement
have been paid, CCMSI shall return any remaining deposit to Client
within one hundred twenty (120) days of the effective date of
term ination.
5.9 Following termination of this Agreement, Client may elect to have
CCMSI continue to handle Claims reported or incurred during the
term of this Agreement, for an additional period, provided that
Client (a) shall maintain the deposit set forth in Agreement
Attachment #1 until such time as all Claims processed hereunder
have been paid, (b) shall timely pay all amounts required under the
terms of Agreement Attachment #1, and (c) that fees for these
administrative services shall be mutually agreed upon.
Pitkin WC contract 2003.doc 6 Rev. Nov 15 2002
5.9.1 Client must notify CCMSI of its election under subsection
5.9 at least thirty (30) days prior to the effective date of
termination.
5.10 This Agreement may be terminated by either party at any time upon
giving 90 days advance written notice to the other party. In the
event Client terminates this Agreement without cause, prior to the
end of the term off (l) a one year agreement, Client agrees to pay
CCMSI all remaining fees from the date of termination to the end
of the term; or (2) a multi-year agreement, Client agrees to pay
CCMSI all remaining fees for the lesser of 12 months or the
balance of the term. Any and all fees due and owing as a result of
Client's early termination shall be paid in full within 30 days of the
date of termination.
Section 6. Service Marks - CCMSI and Client agree that neither will use the names,
symbols, trademarks, or service marks of the other party without prior written
consent.
Section 7. Trade Secrets - The parties agree that during the term of this Agreement
each will receive trade secrets and confidential information from tile other,
including without limitation, information relating to their respective business
practices, fees, personnel, provider, customer or consumer lists, marketing
research developments, marketing data and statistics, and production and data
processing methods. During the term of this Agreement and thereafter, each
party agrees not to disclose such confidential or trade secret information
either directly or indirectly to any other person, firm, or organization except
as is reasonably necessary for the performance of its duties under this
Agreement. To the extent such information is requested by a third party
pursuant to statutes, court order, subpoena, or other legal process, CCMSI or
Client must give the other party notice of the request ten (10) days prior to
complying with such statutes, court order, subpoena or other legal process
unless the time specified by law for compliance is less.
Section 8. Confidentiality - CCMSI agrees that information from medical records of
Employees shall be kept confidential and shall not be disclosed without the
written consent of the Employee, except that disclosure may be made to a
provider, the Employee or his/her representative, the employer or its
representative, Colorado Division of Workers Compensation, and as
otherwise may reasonably be necessary for the performance oftbis
Agreement.
Pitkin WC contract 2003.doc 7 Rev. Nov 15 2002
Section9. Indemnification - CCMSI (including, by definition here and
hereinafter, its officials, employees, agents and representatives, subcon-
tractors and suppliers), shall and hereby does release, discharge,
indemnify and hold harmless the County of Pitkin and its officials,
employees, agents and representatives from and against liability for any
claim, demand, loss, damages, penalty, judgment, expenses, costs (in-
cluding costs of investigation and defense), fees (including reasonable
attorney and expert witness fees) or compensation in any form or kind
whatsoever for any bodily injury, death, personal injury or property
damage arising out of or in connection with any negligent act, intentional
act, error or omission by the Contractor, and for any consequential
liability alleged to accrue against the County on account of the
Contractor's acts, errors or omissions; provided, however, that such
indemnity shall not be construed as an indemnity for bodily injury or
property damage arising from the sole negligence of the County or its
employees.
CCMSI further shall investigate, process, respond to, adjust, provide
defense for and defend, pay or settle all claims, demands, or lawsuits
related hereto at its sole expense and shall bear all other costs and ex-
penses related thereto, even if the claim, demand or lawsuit is
groundless, false or fraudulent.
Section 10. Notice required to be given under this Agreement to CCMSI shall be
provided to: CCMSI, 700 Broadway, Suite 1132, Denver, Colorado
80273, Attention: State Director. Notice required to be given under this
Agreement to Client shall be provided to Pitkin County, 530 E. Main
Street, Suite 202, Aspen, Colorado 81611, Attention: Amy Barwick,
Human Resources & Risk Management Director. All notices or
requests required by or otherwise provided for in this Agreement shall
be in writing and shall be delivered in one of the following manners:
(1) hand delivered; (2) facsimile; or (3) U.S. first class mail, certified,
postage prepaid. Any such notice is effectively given upon the date of
hand delivery, one (1) business day after the date ora completed
facsimile transmission, or three (3) business days after the date of a
mailing. Any notice mailed to Client shall be deemed effective notice
by CCMSI to each Employee.
Section 11 Successors - This Agreement shall be binding upon and shall inure to
the benefit of all assigns, transferees, and successors in interest of any
kind of the parties hereto; provided, however, that this Agreement may
not be assigned without prior written consent.
Pitkin WC contract 2003.doc ~1 Rev. Nov 15 2002
Section 12. Entire Agreement and Modification or Amendment - This
Agreement represents the entire and exclusive statement of the
agreement o£the parties, and, except as otherwise provided herein, may
be modified or amended only by a written statement signed by both
parties.
Section 13. Headings - Headings used in this Agreement are for convenience of
reference only and shall not be considered in any interpretation of this
Agreement.
Section 14. Governing Laws - This Agreement is made and delivered in the State
of Colorado, and will be interpreted and enforced so as to remain in
compliance with Colorado statutes and regulations. Should any
provision of this Agreement in any way contravene the laws of the
State of Colorado or of the United States of America, such provision
shall not be deemed a part of the Agreement. However, the Agreement
shall otherwise be enforceable.
Section 15. Enforcement of the Agreement - Failure of either party to enforce any
of the provisions of this Agreement shall not constitute a waiver of
rights for that or subsequent breaches.
Section 16. Subcontracts - CCMSI may subcontract any or all of its obligations
hereunder to a third party. No such subcontract shall relieve CCMSI of
its obligations to Client under this Agreement.
Section 17. Independent Contractor- CCMSI agrees that it in performing all
services hereunder, it or its designee is acting as an independent
contractor, and not as an employee of Client.
Section 18. Disputes - Ifa dispute or grievance between the parties arises with
respect to the obligations of the parties under this Agreement or as a
result of this Agreement, and such dispute or grievance cannot be
resolved in an informal fashion, the parties shall submit their dispute to
arbitration in accordance with the rules for arbitration of commercial
matters of the American Arbitration Association ("AAA"). Any
arbitration shall be held in Denver, Colorado. The decision of the
Arbitrator(s) shall be final and binding upon the parties, and may be
enforced by any court having jurisdiction thereof. Each party shall bear
its own costs, attorney fees, and shall share equally in the AAA
administrative fee and arbitrator(s)' fee(s) if any, unless otherwise
assessed by the arbitrator(s).
IN WITNESS WHEREOF, the parties hereto have executed this Agreement.
CANNON COCHRAN MANAGEMENT
SERVICES, INC. (CCMSI)
Pitkin WC contract 2003.doc 9 Rev. Nov 15 2002
Pitkin County
B
Human Resources & Risk Management Director
Date:
John Ely~...~--"~
CouI~AR~
Date:
Pitkin WC contract 2003.doc 1 0 Rev. Nov 15 2002
Service Agreement for Pitkin County Workers Compensation Self Insurance Program
2003
Attachment #1
Compensation Schedule/Agreement 2003
Compensation
1. Claims Management:
An annual Claims administration fee of $11,352.60, payable in twelve (12)
monthly installments of $946.05, and A telephonic case management fee of
$170.00 per indemnity claim. This case management includes services for the
first 60 days of the claim. After 60 days, a joint decision between the Client
and CCMSI will be made determining if case management will continue at a
time and expense rate. All medical case management has been assigned and
approved by the client for "medical only" cases, will be provided at a time
and expense rate of $75.00 per hour, $.37 mileage.
Record only claims that are clearly identified by Client where CCMSI only
issues correspondence and does no investigation will be charged at $25.00
per claim.
2. Preferred Provider and Medical Cost Contaiment:
2.1 The preferred provider network access fee shall be 25% of the difference, if
any, between the Provider billed amount for a given service or treatment,
and the amount actually paid by Client for such service or treatment (Bill to
paid).
2.2 Medical Fee Review service fees shall be:
25% of the difference, if any, between the Provider billed amount for a given
service or treatment, and the amount actually paid by Client for such service
or treatment;
2.3 Medical & Disability Case Management
& early RTW services
Professional services $75.00 ~ hr
mileage $.37 / mile
Pitkin WC Serv. Agreement Attachment
Page 1 Revised Nov 2002
3. Risk and Safety Management Services
3.1 Professional Services as agreed upon with Client
mileage $.37 / mile
4. Reporting:
4.1 Furnish to Client the following reports on a monthly Basis for no additional
fee:
Claim Register, Case Log, Claim Composite, Check Register, Cost
Containment, Loss Analysis Report, and Lag Time Report
4.2 Furnish to Client the following reports on an annual and biannual basis for no
additional fee:
Provide claim information required for annual state report and provide or
submit claim data to broker or NCCI for experience modification factors.
4.3 Additional Reports: Provide custom reports at the request of client for a fee
of $150.00 per hour
5. Additional Meetings:
Participate in and attend quarterly claims status meetings. Hourly charges for
additional meetings are:
Adjuster $75.00 per hour
Nurse $75.00 per hour
Management $85.00 per hour
Mediation or Trials $75.00 per hour
Mileage $.37 per mile
Other Expenses Expenses as actual
6. Additional Services:
Data conversions at $150.00 per hour.
Provide and bill for additional services as mutually agreed upon by CCMSI and the
Client.
7. Taxes:
Pitkin WC Serv. Agreement Attachment Revised Nov 2002
Page 2
All applicable sales tax, service, and/or use or receipts taxes shall be the
responsibility of Client and shall be in addition to the fees described in this
Addendum.
8. Invoice Payment Requirements:
8.1. CCMSI shall submit to Client on or before the 10~h day of each month, an invoice
for all service fees payable under this Agreement. Such invoice shall reflect the
basis for the calculation of the fees due.
Client agrees to allow CCMSI to transfer the amount invoiced from Client's
designated bank account through Electronic Funds Transfer (EFT) seven (7) days
following the date of invoice. Client agrees to pay any fees imposed by Client's
bank for the use of EFT.
8.2 For fees that are invoiced by CCMSI that are paid as allocated loss expenses on a
claim file, CCMSI shall issue an invoice with a check register for claims fund
reimbursement.
8. Claims Expense Fund Requirements:
CCMSI ACCOUNT: CCMSI shall maintain its own bank account and issue all
payments made on behalf of Client under this agreement, from this account.
Client agrees to maintain a deposit of $31,000.00 to cover monthly claims
payments and administration funds for the duration of this Agreement. Regularly,
depending on the volume of claims paid, CCMSI may require an additional
deposit. Client shall pay any additional deposit required by CCMSI within 7 days
of the invoice date.
Client agrees to allow CCMSI to transfer the amount invoiced form Client's
designated bank account through Electronic Funds Transfer (EFT) seven (7) days
following the date of invoice. Client agrees to pay any fees imposed by Client's
bank for the use of EFT.
Pitkin WC Serv. Agreement Attachment
Page 3 Revised Nov 2002