CONTRACT 5504A Amendment CLOSED Agreement No. 5504A
Agreement No. 5504A
FIRST AMENDMENT TO
PROFESSIONAL SERVICES AGREEMENT
BETWEEN
THE CITY OF EL SEGUNDO AND
ADMINSURE INC.
This First Amendment is entered into this 1St day of May, 2018, by and between the CITY
OF EL SEGUNDO, a municipal corporation and general law city ("CITY") and ADMINSURE
INC., a California Corporation("CONSULTANT"). The parties agree as follows:
1. This amendment is to add services as described in Exhibit`B,"which is incorporated
into the Agreement by this reference, and increase the total amount of the Agreement
by$25,652.40, so that the total,not-to-exceed amount of the Agreement is$60,000. In
the event of a conflict between Exhibit `B" and the Agreement, the Agreement will
control.
2. The term of this Amendment is May 1, 2018 to June 30, 2018.
3. This Amendment may be executed in any number or counterparts, each of which will
be an original, but all of which together constitutes one instrument executed on the
same date.
4. Except as modified by this Amendment, all other terms and conditions of Agreement
No. 5504 remain the same.
[Signatures on next page]
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Agreement No. 5504A
Agreement No. 5 5 04A
IN WITNESS WHEREOF the parties hereto have executed this Amendment the day and
year first hereinabove written.
CITY L SEGUNDO ADMINSURE INC.
Greg0 e'lltlelj/ Ai�itihiaVarg'as-F ores
iag
City;7 er President/CFO
ATTEST:
Taxpayer ID No. 95-3773318
I ry"!Wc' ver,
Ci y rCl6rk
A 1"PR( VED AS TO FORM: ..........
Q.
� ,µ,op M A
Mark D.
Hensley
City Attorney
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Agreement No. 5504A
Exhibit "B"
SCOPE OF SERVICES,ADDITIONAL TERMS
1. TERM: This Agreement shall become effective May 1, 2018 and shall continue
through June 30, 2018, or unless terminated by the cancellation provision set forth herein.
2. PERIODIC MEETINGS: The Administrator shall meet with the Client and staff
periodically to:
A. Assist in developing internal procedures.
B. Provide orientation and training to personnel involved in the
administration of the Program.
C. Discuss specific claims and general trends in the Program.
3. ADVISORY SERVICES: The Administrator shall provide the Client information
regarding the adoption, amendment or repeal of all Statutes, Rules and Regulations, et
cetera,which may directly affect the Program.
4. REQUIRED FORMS: The Administrator shall provide the Client with all forms
required by the State in connection with the Program.
5. COMPLIANCE WITH LAW: The Administrator shall administer the Program in full
compliance with all laws, rules and regulations governing Workers' Compensation and
Self-Insurance.
6. CLAIMS ADMINISTRATION: The Administrator shall comply with all performance
standards of the Client's excess insurer. The Administrator shall also comply with the
Administrator's Workers' Compensation Claims Administration Standards, but under no
circumstances are they to be construed as having precedence over the performance
standards of the Client's excess insurer. The Administrator shall also have the authority
and responsibility to provide claims administration services,which include:
A. Establishing an electronic claim file and computer database record upon
receipt of an injury report.
B. Setting and updating reserves.
C. Initiating and maintaining contact with injured workers or their attorneys.
D. Arranging for investigation.
E. Determining compensability.
F. Preparing and issuing benefit notices, if applicable.
G. Arranging for medical treatment and medical services from clinics,
facilities, pharmacies, hospitals, specialists, and other vendors as
necessary.
H. Performing all utilization review services through MedReview;
communicating decisions to approve, modify, delay or deny medical
treatment in accordance with State law.
I. Monitoring disability status by reviewing medical reports and contacting
doctors for updates.
J. Auditing and reviewing all medical bills through MedReview and paying
all properly adjusted medical bills in a timely and accurate manner.
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Agreement No. 5504A
K. Paying mileage or medical reimbursements to injured workers.
L. Paying temporary disability compensation when appropriate to do so or
advising the Client of the need to adjust payroll records when salary
continuation is applicable.
M. Arranging medical exams in conformance with State law to determine
whether an injured worker's medical condition is permanent and stationary
(reached Maximum Medical Improvement/MMI) and what, if any,
permanent disability exists.
N. Paying the permanent disability compensation in accordance with the law.
O. Arranging for attorney representation of the Client whenever the need
arises.
P. Monitoring attorneys and assisting them in preparing cases.
Q. Auditing and paying legal expenses.
R. Arranging for vocational rehabilitation services when appropriate,
monitoring vocational rehabilitation consultants and assisting them as
necessary.
S. Auditing and paying vocational rehabilitation expenses.
T. Preparing and issuing Supplemental Job Displacement Benefits (SJDB)
notices and benefits.
U. Preparing and issuing the permanent disability compensation notices.
V. Pursuing subrogation when there is a viable third party.
W. Notifying the Client and excess insurers of all claims which exceed or may
exceed the self-insurance retention; maintaining a liaison between the
Client and their excess insurers on matters affecting the handling of such
claims and arranging for reimbursement to the Client of losses in excess of
its self-insurance retention.
X. Obtaining settlement authority and negotiating settlement on appropriate
claims.
Y. Attending all hearings that are required by law.
Z. Closing claim files when appropriate to do so.
7. OBLIGATIONS OF THE CLIENT: The Client shall:
A. Submit all information and reports of work incidents and work injuries to
the Administrator in a timely manner not to exceed 24 hours of the
Client's knowledge of the incident or injury.
B. Respond to the Administrator's requests for information and authority
within five days of such requests.
C. Provide information that is accurate and is in a form specified by the
Administrator.
D. Grant settlement authority to the Administrator in advance of WCAB,
Rehabilitation, and legal hearings, or be available by phone or in person
during same.
8. CHECKING ACCOUNT: The client and the Administrator agree that:
A. The Client shall establish and maintain a checking account from which all
Workers' Compensation benefits and expenses are to be paid.
B. The Administrator shall prepare checks and issue those checks directly to
payees without delay.
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Agreement No. 5504A
C. The Administrator shall sign checks with a facsimile signature or
manually.
D. The Administrator shall secure checks in a locked area accessible to a
limited number of personnel.
E. The Client shall maintain an adequate balance in their checking account to
meet all Workers' Compensation obligations without delay.
F. The checking account may be used to pay penalties in which case the
Administrator shall reimburse the Client within fifteen (15) workdays for
any amount of the penalty which the Administrator caused.
9. ELECTRONIC DATA PROCESSING: The Administrator shall provide the Client
with electronic data processing services that will allow for the production of loss
experience and transaction reports within ten (10) days following the close of each
calendar month.
10. REGULATORY REPORTING: The Administrator shall prepare all reports required
by State and Federal regulatory agencies (if any) in connection with the Program,
including the Self-Insurer's Annual Report required by the Department of Self-Insurance
Plans.
11. RECORDS: The Administrator shall establish and maintain electronic claim files,
claim logs, transaction documents and all other records associated with the Program.
These records shall be the property of the Client. Unless this Agreement is cancelled,
closed hard files, if any, shall be stored by the Administrator for five (5) years and shall
thereafter become the responsibility of the Client. Upon cancellation of this Agreement,
if any, the Client shall be responsible for maintaining and storing all data, records, et
cetera. The Administrator shall not dispose of or destroy hard files, if any, without prior
authorization of the Client.
12. CONSIDERATION: For each month, May 1, 2018 through May 31, 2018, and
June 1, 2018 through June 30, 2018, of this Agreement, the Client shall pay the
Administrator $12,246 each month. Should this Agreement not expire on July 1, 2018,
the Client shall continue to pay the Administrator $12,246 each month from July 1, 2018
through June 30, 2019. Beginning July 1, 2019 and each July 1 thereafter, increases shall
not exceed a 3% increase each year. Future years shall automatically renew from year to
year subject to termination by either party during the life of this Agreement upon at least
ninety (90)days written notice.
Administrator shall perform all Medical Bill/Bill Review Services through MedReview at
the flat rate of$9.75 per bill (e-bill: plus .60 cents when applicable). Preferred Provider
Organization (PPO)/Negotiated fees shall not exceed 25%of savings when applicable.
Administrator shall perform all Utilization Review Services through MedReview at 5%
of billed medical charges up to a maximum fee of$750. Utilization review by a physician
is billed separately at the rate of$200 per hour.
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