HomeMy WebLinkAbout87-0930 Management Services % _Cn3
=I Management
Services, Inc.
September 30 , 1987
Mr. Michael A. Sarro
Purchasing Director
City of Elgin
150 Dexter Court
Elgin, IL 60120-5555
RE : Claims and Loss Control Service Agreement
Dear Mike :
We are very pleased that the City of Elgin has elected to use
Management Services , Inc . to handle the claims and loss
control services for your self-insured workers ' compensation
program.
Enclosed , please find two copies of Management Services , Inc .
Claims and Loss Control Service Agreement, along with our
invoice for services. Please sign the Agreements and return
one copy to my attention.
If you should have any questions regarding the Agreement ,
please call me in Danville at 1 -800-252-5059 .
Sincerely ,
/2 & X2/9 � --
Michael J. Thorlton
Claims Manager
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Towne Centre Building, Suite 208 ❑ 2 East Main Street ❑ Danville, IL 61832 ❑ (217)446-1089
CLAIMS AND LOSS CONTROL SERVICE AGREEMENT
Management Services , Inc. agrees to provide the following Claims and Loss
Control services to the City of Elgin for a 12-month period beginning
October 1 , 1987 .
A. Review all Employers First Reports of Injury or Illinois Form 4+5s and
process each report in accordance with the rules of the Illinois
Industrial Commission.
B. Determine compensability of all reported claims as outlined in the
Illinois Workers ' Compensation Act.
C. Evaluate and establish reserves for all reported claims .
D. Develop a claim payment program utilizing an escrow account that will
meet with the needs of the City of Elgin.
E. Compute all disability benefits due injured employees and audit all
medical benefits as provided in the Illinois Workers ' Compensation
Act .
F . Negotiate settlements with injured employees in accordance with the
City of Elgin authorization.
G. Provide assistance and guidance, as necessary , in the use and
selection of attorneys that will be used to settle cases before the
Illinois Industrial Commission.
H. Monitor claims for subrogation.
I. Provide monthly computer reports detailing claims , payments and
reserves.
J. Provide reports required by excess insurors and fulfill the service
organization function as described by the excess insurance carrier as
well as the Illinois Industrial Commission and the Illinois
Department of Insurance.
K. Management Services will provide quarterly loss control inspections
as outlined in Management Services , Inc. February 26 , 1986 Proposal.
The above claim services will be provided to the City of Elgin at an
annual fee of $18 ,200 for up to 50 indemnity claims and 130 medical only
claims . Any indemnity claim in excess of 50 will be handled for $225 per
claim. Any medical only claim in excess of 130 will be handled at $35
per claim.
The above loss control services will be handled at an annual fee of
$ 1 ,760 .
The annual fees of $19 ,960 will be paid in quarterly installments as
follows, upon acceptance of this agreement.
10/1 /87 - $4 ,990
1 /1 /88 - $4 ,990
4/1 /88 - $4 ,990
7/1 /88 - $4 ,990
ACCEPTANCE
Management Services , Inc.
B Y : 0/ '� '/ZakiT_�
TITLE : C(Giins 712__
DATE : 004)
City of Elgin
BY : Aar
TITLE : /0111F
DATE :
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Claims
Administration
I and
Loss Control Proposal
for
The City of Elgin
Prepared by:
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Michael J: Thorlton
Claims Manager
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Greg Clapper
I' Loss Control Manager
February 27, 1987
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j Management
,_.„ W Services, Inc.
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Corporate Policyholders Counsel , Inc.
J 11460 Renaissance Drive
Park Ridge , IL 60068
:I ATTN: Steven A. Coombs
RE City of Elgin
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Dear Mr. Coombs :
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Enclosed please find our proposal for Claims Handling and Loss
Control for the City of Elgin. I have also enclosed a brochure
111 which outlines the various self-insured services availiable through
M.S. I.
I While we are assuming complete responsibility for Claims Handling
and Loss Control, we do want the appropriate personnel in the City
of Elgin to become familiar with our entire administrative process . _
1 We will work closely with the City of Elgin to insure proper
procedures and techniques are being used to obtain optimum results .
Overall supervision of the program will be controlled out of our
Oakbrook, Illinois office. The Claims and Loss Control Repre-
sentatives assigned to the City of Elgin will work out of our
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• Oak Brook, Illinois office . We will be available to personally
meet with the appropriate personnel to review the status and
progress of the program.
The quality and background of our staff who will service the
program represent a high degree of professionalism and extensive
individual experience . .
We feel we can add a high degree of creativity to the City of
Elgin's self-insured program. Our single intent would be to far
exceed the type of performance that the City of Elgin would expect
so as to develop a long-term and valued client relationship.
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Towne Centre Building, Suite 208 ■ 2 East Main Street • Danville, IL 61832 • (217)446-1089
1. ,„...mmuurommimminem,.....,_1
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Corporate Policyholders
Steven A. Coombs
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1 We are ready to begin claims handling and loss control services for
the City of Elgin 4/1 /87. If you have any questions on our
i proposal , please feel free to contact me at 312-571-2920 .
ISincerely, , S o Sy
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Michael J . Thorlton
1. Claims Manager
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Section I • - Claims Handling Service Agreement
Section II - Loss Control Service
Section III - Computerized Loss Reports
Section IV - Specimen Claim Reporting Outlines
Section V - References
Section VI - Fee
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CITY OF ELGIN
Claims Handling Service Agreement
Management Services , Inc . will perform the following Claims Handling
Services :
a) Provide an experienced claims staff for the complete
handling of the loss adjustment process to include prompt
investigations , filing of necessary reports in compliance
with any state or local law, compromise and settlement of
those claims which fall within the applicable self-insured
retentions .
b) Maintain a complete claim file on each claim and make each
claim file available to the City of Elgin upon request .
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c) Prepare all necessary precautionary reports to the excess
carrier(s) and present excess claims on behalf of the City
in a timely and proper manner.
17' d) Obtain approval from responsible City personnel prior to
engaging any attorney or legal firm in the defense of a
claim.
We will prepare a comprehensive report on each litigated
claim and submit it to the approved defense counsel along
with a copy of our complete investigation file.
e) Coordinate investigations with adjustors and/or attorneys of
any applicable excess insurance carrier as required.
f) Obtain approval from responsible. City personnel prior to
paying any claim in excess of $2, 500 .
All claim settlements will be made using accepted claims
handling procedures . Each settlement will be documented and
handled by an experiences staff member.
g) Prepare files for subrogation actions on behalf of the City
of Elgin.
Each claim will be reviewed for subrogation potential and
the proper party put on notice as to the City's subrogation
interest . We will make collection of any subrogation claim
at the City's direction.
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h) Obtain recoveries through salvage and subrogation where
feasible .
We will obtain recoveries for salvage property and dispose
We will obtain recoveries for salvage property and dispose
of salvage in accordance with the City of Elgin' s approval .
i) All claims will be handled from our Oak Brook, Illinois
office and claims personnel will be assigned and available
to handle claims for the City of Elgin.
• j ) Claims reserved in amounts of $10 , 000 or more will be
available for review by the City of Elgin.
k) Monthly loss reports will be provided for each line of
r coverage . The reports will detail claims payments and
reserves . Examples of the reports are attached.
1) All loss producing occurrences during the contract period
will be handled to conclusion without regard to any
subsequent renewals of the service contract. We will not be
responsible for claims which do not come within the scope of
a prior contract period .
m) We will be available to consult and discuss with the City on
any matters involving claims service function or any related
matters .
n) Prepare regular status reports on 3rd party liability claims
reserved in excess of $10, 000 including ultimate settlement
value and actions being taken to resolve the claim.
1 o) Index Bureau cards will be prepared on all injury claims .
It will be necessary for the City of Elgin to obtain an
Index Bureau reporting number.
The above services will be provided to the City of Elgin for a
minimum annual fee as outlined in the attached claims handling
service fee schedule . The coverage rate/claim will be as outlined in
iJ the claims handling service fee schedule.
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CITY OF ELGIN
LOSS CONTROL SERVICE
CAPABILITIES AND COSTS
February 27 , 1987 •
The Service Specifications for the City of Elgin indicate that Loss
Prevention and Control Services are to be on an "as required by the
City basis . " MSI is capable of providing any or all of the listed
possibilities , however we are unable to provide complete cost
figures without knowing which services are desired , and how often
they are needed .
`U We offer the following service capabilities :
Inspection services
Performance Audit/Evaluation
Accident Analyses With Summary Evaluation
Defensive Driving Course
Accident Review Board
( Core Loss Control Program Manual Development
Supervisory Training Sessions
Individual Loss Control Procedures Development
Industrial Hygiene Services
In addition , we offer administrative coordination of Loss Control
Programs , including Municipal Liability with Municipal Represen-
tatives .
All of the above services can be provided for an hourly rate of
$55. 00, with the exception of the Performance Audit, Core Loss
Control Program Development , the Defensive Driving Course , and the
Industrial Hygiene Services . The Performance Audit can be
�� performed for a flat charge of $1 , 500 . 00 . The development of a
core loss control program, the Defensive Driving Course, and the
industrial hygiene services depend heavily upon the amount of
activity desired .
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The hourly rate includes office, travel , and survey time.
I If specific services are desired , they should be indicated, and a
corresponding proposal will be developed .
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LOSS CONTROL PREVENTION AND CONTROL 0
-111 Normal Services are defined as quarterly inspection services invol-
- .I ving approximately 4 hours of on premesis survey time (includes
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avel between City locations) , 2 hours of travel time (to and from
the City of Elgin) and 2 hours of administrative time .
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Eight hours X $55 . 00 = $440 . 00 X four visits = $1 , 760 . 00
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fProposed inspection service hours may include our attendence at
administrative coordination meetings , if requested by the City ,
- rather than actual facility inspection time. It is conceivable
that our input may be requested regarding possible changes in
safety program efforts . The time required by this activity would I
be considered inspection time , when only inspection services are
contracted.
RegardinIndustrial Hygiene services , it is suggested that the
Illinois Department of Labor be contacted regarding their recentlyformed Advisory Service for municipalities . Leslie Nichols is the
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Area Manager for this function. She can be reached at (312) 793-
_ ! 1824 . It is possible that this service could be provided at no
cost to the City by the Department of Labor.
If this is not possible , these services can be provided by MSI . A
quote for such services will depend upon the nature of services
Idesired.
Loss Control fees are to be paid as contracted on an annual basis
for Normal (as defined) services. Specialized services are to be
paid as delivered .
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riCOMPUTERIZED REPORT SERVICES
Management Services , Inc . offers complete control and monitoring of
I your Workers' Compensation and Liability claims. We can provide the
following computer reports :
I1 . A detailed listing of all claims broken down by location,
policy year and line of coverage. See Exhibit A.
f 2 . A summary of all claims broken down by location, policy and
line of coverage. Loss ratios can be included , as in
Exhibit B-1 . ' See Exhibit B.1i 44 3. A check register listing all checks issued during a
reporting period . This can be prepared on a monthly,
quarterly or annual basis . See Exhibit C.
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L. 4 . Other reports are available upon request , including but not
limited to Claims Status Reports and Policy Loss Experience
- Listings .
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Reports 1 . , 2. and 3 . will be provided in triplicate on a monthly
• basis . The Analysis of Loss Experience reports will be provided on a
quarterly basis . The cost of these reports is included in our per
- claim fee.
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CLAIMS REPORT HISTORY
WORKER'S COMPENSATION
PRINTED ON: 09/15/86 16: 30:02
MANAGEMENT SERVICES CUSTOMER : 10 REPORT OF: 09-85
LOCATION : 2 POLICE DEPT REPORT. NO: 9
FOL PER : 01-01-85 THROUGH 12-31-85
POLICY : 10•-85
CURRENT PAYMENTS
LOSS DT TO DATE CURR RES CURR INC
CLAIM NO. 0 RPT DT NAME DESCRIPTION OF LOSS INDEMN. MEDICAL OTHER TOTALS PD THIS YR TO DATE
85100001 •C 01-16-85 D. COSTELLO LOW BACK STRAIN 0. 00 0. 00 0. 00 0. 00 796. 00 0. 00
01-22-85 270. 00 149. 00 0. 00 419. 00 419. 00 1,215. 00
85100002 C 01-15-85 T. BENNETT SPRAIN TO RIGHT HAND AND 0. 00 0. 00. 0. 00 0. 00 266. 00 0. 00
01-18-85 ANKLE 0. 00 235. 80 0. 00 233. 80 235. 80 501. 00
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,85100003 C 01-12-85 M. GARRETT CUT ON LEFT FOOT 0. 00 0. 00 0. 00 0. 00 350. 00 0. 00
01-18-85 0. 00 0. 00 0. 00 0. 00 0. 00 350. 00
85100004 0 01-18-85 S. EARLS BLURRED VISION 0. 00 0. 00 0. 00 0. 00 350. 00 0. 00
01-29-85 0. 00 0. 00 0. 00 0. 00 0. 00 350. 00
85100010 0 02-21-85 J. WILLIAMS LOW BACK STRAIN 0. 00 377. 00 0. 00 377. 00 10.896. 00 9,332. 00
03-04-85 5, 870. 79 1, 256. 75 0. 00 7, 127. 54 7. 127. 54 18.013. 00
85100014 C 03-02-85 K. SEELEY BACK STRAIN 0. 00 0. 00 0. 00 0. 00 340. 00 0. 00
03-19-85 0. 00 161. 60 0. 00 161. 60 161. 60 501. 00
85100016 C 03-15-85 J. FERDINAND EAR LACERATION AND BITE 0 0. 00 0. 00 0. 00 0. 00 157. 00 0. 00
04-03-85 N FINGER . 0. 00 93. 41 0. 00 93. 41 93. 41 250. 00
85100017 C 03-15-85 T. PRINCE HAND LACERATION 0. 00 0. 00 0. 00 0. 00 90. 00 0. 00
04-03-85 0. 00 260. 10 0. 00 260. 10 260. 10 350. 00
85100020 C 04-24-85 M. COOK FOREIGN OBJECT IN EYE 0. 00 0. 00 0. 00 0. 00 105. 00 0. 00
05-15-85 0. 00 46. 40 0. 00 46. 40 46. 40 151. 00
85100030 0 07-16-85 G. HILLYER FX R FIBULA 0. 00 0. 00 0. 00 0. 00 3.234.00 0. 00
07-19-85 693. 43 0. 00 0. 00 693. 43 693. 43 3,927. 00
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ACCOUNT ===> WC CE PRI '15 PAGE:. 1
Cbmrents:
This report gives details of all claims reported. This report is generated by line of
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coverage (i.e. work camp, auto, G.L. , property, inland marine, etc.) A separate report
can be provided for each location/department by policy year.
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CLAIMS REPORT HISTORY
AUTOMOBILE - LIABILITY
PRINTED ON: 09/16/86 12:21:36
MANAGEMENT SERVICES CUSTOMER : - REPORT OF: 09-86
LOCATION : 1 MASS TRANSIT REPORT. NO: 15 ,
POL PER : 07-24-85 THROUGH 07-24-86
POLICY : 13-85
CURRENT PAYMENTS
. LOSS DTTO DATE CURR RES CURR INC
CLAIM NO. 0 RPT DT NAME DESCRIPTION OF LOSS B. I. P. D. OTHER TOTALS PD THIS YR TO DATE
8513000017 C 09-22-85 H HOLLAND AUTO PD/IV STRUCK STAND- 0. 00 .0. 00 0. 00 0. 00 0. 00 0. 00
01-02-86 INO OV IN ROAD 0. 00 262. 58 0. 00 262. 58 0. 00 262. 00 1
8513000019 C 11-30-85 M. CHENAIL AUTO BI/INJURED ENTERING 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
12-06-85 /LEAVING 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
8513000025 C 12-17-83.J. AMES INFO ONLY/INJ. ENTER I NO/ 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
01-02-86 LEAVING 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00 )
8513000029 0 12-18-85 T. OSLER LIAR. BI/IV STRUCK PED. 0. 00 • 0. 00 0. 00 0. 00 0. 00 0. 00
03-17-86 NOT IN X WALK 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00 ,
8513000038 C 12-10-83 S. THOMAS LIAR. B I/INJURED ENTERING 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
01-30-86 /LEAVING 0. 00 0. 00 0. 00 0. 00 0.00 0. 00 ,
8513000045 C 02-11-86 L.WILSON LIAR. BI/PREMISES - SLIP 0. 00 0. 00 0. 00 0. 00 0. 00 0.00
02-13-86 OR FALL 0. 00 0.00 0. 00 0. 00 0. 00 0. 00 i
8513370204 C 08-07-85 A.KIRBY INFO ONLY/OV STRUCK- IV AT 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
09-1.9-85 INTER. - V'S IN MOTION 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00 1 ,
8513370233 C 12-28-85 W. I SOM AUTO PD/IV SIDESWIPED OV 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
01-06-86 AHEAD - V'S IN MOTION 0. 00 0. 00 0. 00 0. 00 0. 00 0.00 1
8513370448 C 02-21-86 M.VISHNY INFO ONLY/OV STRUCK REAR 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
02-27-86 OF IV - V'S IN MOTION 0. 00 O. CO 0. 00 0. 00 0. 00 0. 00
8513370935 C 01-03-86 C. HUNTER INFO ONLY/INJURED ENTER IN. 0. 00 0. 00 0. 00 0. 00 0. 00 0. 00
01-20-86 0 /LEAVING 0.00 0. 00 0. 00 0. 00 0. 00 0.00
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AUTOMOBILE - LIABILITY
PRINTED ON: 09/16/86 12:21:36 CLAIMS REPORT SUMMARY
MANAGEMENT SERVICES CUSTOMER REPORT OF: 09-86
LOCATION ALL LOCATIONS REPORT. NO: 3
POL PER : 07-25-86 THROUGH 08-05-87
POLICY : 13-86
PREVIOUS THIS REPORT TO DATE THIS YEAR
NUMBER OF OCCURRENCES 7 1 8 8
EXPERIENCE
PAYMENTS
B. I. 0. 00 0. 00 0. 00 0. 00
P. D. 557. 93 0. 00 557. 93 557. 93
OTHER 0. 00 0. 00 0. 00 0. 00
TOTAL PAYMENTS 557. 93 0. 00 557. 93 557. 93
RESERVES1. 500. 00 .. 0. 00 1. 500. 00 1. 500. 00
TOTAL EXPERIENCE 2.057. 93 0. 00 2.057. 93 2.057. 93 .
SUBROOAT ION 0. 00 0. 00 0. 00 0. 00
ADJUSTED EXPERIENCE 2.057. 93 0. 00 2.057. 93 2.057. 93
PREMIUM 0. 00 0. 00 0. 00 0. 00
LOSS FUND X 0. 000 0. 000 0. 000 0. 000
LOSS FUND DEVELOPED 0. 00 0. 00 0. 00 0. 00
LOSS RATIO (A. E. / PREMIUM ) 0. 00 0. 00 0. 00 0. 00
LOSS RATIO (A. E. / LOSS FUND) 0. 00 0. 00 0. 00 0. 00
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CLAIMS REPORT SUMMARY'
• WORKER'S COMPENSATION
PRINTED ON: 09/15/86 16:30:02
MANAGEMENT SERVICES CUSTOMER : 10 REPORT OF: 09-85
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LOCATION : 4 PUBLIC WORKS REPORT. NO: 9
POL PER : 01-01-85 THROUGH 12-31-85
POLICY : 10-85
PREVIOUS THIS REPORT TO DATE THIS YEAR
NUMBER OF OCCURRENCES 15 5 20 14
EXPERIENCE
PAYMENTS
INDEMN. 1. 209. 48 1, 565. 60 2.775. 08 2.775. 08
MEDICAL 2: 102. 37 406. 50 2, 508. 87 /. 508. 87
OTHER 0. 00 0. 00 0. 00 0. 00
• TOTAL PAYMENTS 3, 311. 85 1.972. 10 5.283. 95 5.283. 95
RESERVES 4, 093. 00 1,372. 00 5.465. 00 5.465. 00
TOTAL EXPERIENCE 7, 404. 85 3,344. 10 10. 748. 95 10. 748. 95 •
SUBROGATION 0. 00 0. 00 0. 00 0. 00
ADJUSTED EXPERIENCE 7, 404. 85 3,344. 10 10.748. 95 10.748. 95
'S:
This report summarizes all of the claims that are listed on the detailed
listing (Exhibit A) . This report is generated by line of coverage,
(i.e. work comp, auto, G.L., property, inland marine, etc.) A separate
report can be provided for each location/department by policy year.: •
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EXHIBIT C
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J (1) MANAEEMENT SERVICES, INC.
PRELIMINPJ CHECK REGISTE:1
ill,iED :N : 15:1833 09 SEP 1986
(3) : CHECKS
;.ELEST ISS DATE PAYEE PAYEE NAME ,:: S CO SL-NO OEPT SROSS ;,.mI DIECUNT AMI NET :! i'AT
. :ES NUMBER OPERiF,I Y;nER CS '40
....._ _
II13912 ) 1:ir)8 143 LINCOLN TRAIL CRT?-:PS:::: :1 33000: 35000 0.00 35.00
LC I
FOR; AAROLD CCSS
P.O. BOX 218
II CLAIM NO LIST --> 86030036
Ir$f 31.00 35.00
] 13713 09/07/36 308 CRAI6 1 CRAIS AITY AT LAW 3
800,„
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,., 0 147.54 -
0.0.0 14/. 4
LC /
FOR; VIRGINIA INNS
1807 BROADWAY AVE
ilCLAIM NO LIST --) 8503006
147.14 0.00 147.54
/
13915 09/09/86 137 CENTRAL IL PHYSICAL VERY 11 380000 564.50 0,00 564.50
I . LC /
FOR; ROGER : 1110S
BL83 102 RR 4
il CLAIM NO LIST --> 86030069
II
Fif 564.50 0.00 564.50
11 13916 09/09/86 143 LINCOLN TRAIL ORTHOPEDIC 11 380000 35.00
0.00 35,0;
LC /
11 FOR; ROHR c:,rmins
P.O. BOX 218,
CLAIR NO LIST --> 86030069
11 fff 35.00 0.00 35.00
11 13917 09/09/86
LC / 308 CRAI6 1 CRAIG ATTY AI LAI 3 380000 82.50 0.00 82.50
FOR; WILMA MURPHY
1801 BROADWAY AVE
11 CLAIM NO LIST --> 35030001
fff 82.50 0.00 82.50
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ACCT NAME ===> UC
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ANALYSIS OF LOSS EXPERIENCE EXHIBIT D
WORKER'S COMPENSATION
SUMMARY BY CLASS
FOR CLASS 110 THROUGH 800 .
FOR: CUSTOMER NO: 10
POLICY NO: 10-85
FROM: 07-01-85 TO: 09-30-85
PRINTED ON: 09/16/86 15: 57:21 PAGE: I
MEDICAL ONLY MEDICAL WITH INDEMNITY TOTALS
LOSS CLASS NUMBER INCURRED NUMBER INCURRED NUMBER INCURRED
EYES 2 139. 35 0 0. 00 2 139. 35
9. 09% 0. 25% 0. 00% 0. 00% 9. 09% 0. 25%
HEAD,NOC 2 202. 58 0 0. 00 2 202. 58
9. 09% 0. 37% 0. 00% 0. 00% 9. 09% 0. 37%
ARM 1 210.81 0 0. 00 1 210. 81
4. 54% 0. 397. 0. 00% 0. 00% 4. 54% 0. 39%
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ARM,MULT 1 143.70 0 0. 00 1 143.70
4. 54% 0. 26% 0. 00% 0. 00% 4. 54% 0. 26%
FINGERS 1 99. 51 0 0.00 1 99. 51 '
4. 54% 0. 18% 0. 00% 0. 00% 4. 54X 0. 18%
UP/EX/MULT 2 26.00 0 0. 00 2 26. 00
9. 09% 0. 04% 0. 00% 0. 00% 9. 09% 0. 04%
BACK 0 0. 00 2 34, 181. 97 2 34, 181. 97
0. 00% 0. 00% 9. 09% 63. 56% 9. 09% 63. 56%
LEGS 1 177. 90 1 16,811. 83 . 2 16,989.73
4. 54% 0. 33% 4. 54% 31. 26% 9. 09X 31. 59%
KNEE 1 164. 80 0 0. 00 1 • 164. 90
4. 54% 0. 30X 0. 00X 0. 00% 4. 54% 0. 30%
ANKLE 2 315. 15 1 750. 34 3 1,065. 49
9. 09% 0. 58% 4. 54% 1. 39% 13. 63% 1. 98%
FOOT 2 177. 53 0 0. 00 2 177. 53 '
9. 09% 0. 33% 0. 00% 0. 00% 9. 09% 0. 33%
L/EX/MULT 1 0. 00 0 0. 00 1 0. 00
4. 54% 0. 00% 0. 00% 0. 00% 4. 54% 0. 00%
MULT PARTS 1 41.99 0 0. 00 1 41.99
4. 54% 0. 07% 0. 00% 0. 00X 4. 54% 0. 07%
PARTS NOC 1 334.06 0 0. 00 1 334.06
4. 54% 0. 62% 0. 00% 0. 00% 4. 54X 0. 62%
COMMENTS:
An analysis report for use in the:safety and loss control program. This report is a su uary by
class of injury, (i.e. face, head, back, etc.) .
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REFERENCES
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CEP
The following is a list of major accounts for whom we have performed
various Risk Management services:
LI
Name: Illinois Municipal League
1220 South Seventh Street
L Springfield, IL 62708
Contact: Larry Frang, Risk Manager
Phone: (217) 525-1220
Activity: Developed a self-insurance program and act
L_ as risk management consultant for Illinois
Municipal League Risk Management Association.
The program includes over 250 municipalities
f at this time.
Cz
Name: Township Officials of Illinois
P.O. Box 517
L. � Astoria, IL 61505
Contact : George H. Miller, Executive Director
Phone : (309) 329-2101
a Activity: Developed an all lines property and casualty
self-insurance program to include development
. of coverage 'documents , excess insurance
coverages, and a risk management manual.
C 7
Presently handling all loss control and claims
administration for that group, T.O.I.R.M.A.
Name: Illinois Association of HousingAuthorities
tho ides
c/o Clark County Housing Authority
Marshall, IL 62441
Contact: Eileen DePasse
CaPhone: (217) 826-5541
Activity: Developed a property and liability self-
: -- insurance program to include development of
coverage document, excess insurance
coverages , and a risk management manual .
Presently handling all loss control and claims
administration for that group, A.H.R.M.A .
Ti
I
1 References (continued)
Name: MIMA (Midwest Industrial Management Assoc . )
111 2400 South Downing
Westchester, IL 60153
I Contact: John Surowiec
Phone : ( 312) 562-9063
r
Li Activity: Act as claims administration and loss control
service company for the MIMA Workers ' Compensa-
tion Trust and. the MIMA Group Benefit Trust .
gi
IName : Central Illinois Builders of AGC
Suite 500, Jefferson West
P.O. Box 2966
Springfield , IL 62708
Contact: Bill Mehlenbeck, Director
Phone : (217) 234-8811
III
Activity: Developed a complete loss control program
I • and manual for all members of the Association.
Developed and presently administering a group
self-insurance pool for all members . Presently
handling all loss control and claims l admini-
stration for that group , the Consolidated
r Construction Safety Fund of Illinois .
• Name: St. Louis County Government
41 South Central Avenue
Clayton, MO 63105
h InsuranceCoordinator
Jim Pohtos , Coo dinator
Phone: (314) 889-2099
Activity: Administration of their self-insured Workers '
Compensation program.
l
II
r
J
F- References (continued)
Name : Champaign County Government
lY 101 E. Main Street
Urbana, IL 61806
LContact : Gerrie Parr, Administrative Assistant
Phone : (217) 384-3763
Activity: Administration of their self-insured workers '
compensation program to include loss control
training and placement of excess insurance
coverage.
Name : Champaign-Urbana Mass Transit District
[. 801 E. University Avenue
Urbana, IL 61801
Contact: Bill Volk, Executive Director
[ Phone : (217) 234-8811
Activity: Administration of their self-insured auto-
mobile liability program.
[ . •
Name: City of Danville
C 402 N . Hazel
Danville, IL 61832
Contact: Ron Neufeld
Phone : (217) 431-2302
Activity : Act as claims administrator for their employee
health benefit program.
L,
L
1
-7
. _L References (continued)
IName: Intergovernmental Benefit Cooperative '
c/.o City of Carlyle
Carlyle , IL 62231
- . Contact: Jean Parsons
Phone : (618) 594-2468
—4 Activity: Developed a group health self-insurance
program to include development of by-laws ,
intergovernmental cooperation contracts ,
plan documents and excess insurance coverages .
Presently handling the administration of their
employee benefit claims .
: 11 Name: Independent Community Bankers of Illinois
300 W. Edwards
Springfield, IL 62704
Contact: Roy Pinnell
Phone : (217) 753-4331
iActivity: Presently acting as claims administration
company for their employee health benefit
_l trustee. Will perform a feasibility study
for them for D&0 and Blanket Bond coverages .
1
I Name: City of Decatur
One Civic Center Plaza
Decatur, IL 62523
Contact: Dan Sommerfeldt
Phone : (217) 424-2805
Activity: Act as claims administrator for their employee
health benefit program.
1
1
11
T,
: 1 .
il
References (continued)
' :
i Name: Madison County, Indiana
Anderson , IN 46016 ,
iContact: Jim Donahue, Commissioner
Phone : ( 317) 646-9212
-- Activity: optional Activit : Provide o tional life insurance benefits to
employees and elected officials .
•
Iitof Delphi .
Name: City p
Main & Union St .
• i Delphi , IN 46923
Contact: Arvilla Burge, Clerk/Treasurer
1 Phone : ( 317) 564-2097
Activity: Provide optional life insurance benefits for
employees and elected officials .
I
Name: City of Crown Point
104 E. Clark Street
L Crown Point, IN 46307
. Contact : Mayor James Forsythe
Phone: (219) 663-0257
Activity: Provide optional life insurance benefits for
[ I employees and elected officials .
LI
[ 2
LI
11]
[d
r
A 0221/ .
References (continued)
_ l I
Name: Missouri Highway Commission & Missouri
I
Highway Patrol
P.O. Box 270
Jefferson City, MO 65102
I
Contact : Ray McCray
William Trimm
Phone : (314) 751-2844
iActivity: Act as claims administrator for their
employee health benefit program.
Name : Association of Indiana Counties
120 Monument Circle
Indianapolis , IN 46204
Contact : Richard Cochrum, Executive Director
Phone: (317) 632-7453
Activity: Provide optional life insurance benefit for
the association membership. Assist in an
advisory capacity for their associate
. membership program.
Name: Grant County, Indiana
Marion , IN 46953
Contact: Ray Hickam, Auditor
Phone: (31,7) 668-8871 •
1Activity: Provide optional life insurance benefits for
employees and elected officials.
I
i
:I .
1
:I .
I
L .
J
1
_ i .
-1 General Liability Report
jAT THE DIRECTION OF COUNSEL, THE FOLLOWING INVESTIGATION WAS COMPLETED
ACCOUNT :
CLAIMANT:
D/A
ASSIGNMENT
Date received :
Date Contact - account & claimant :
COMMENT
Opinion as to the liability , exposure , tort immunity which may
apply.
Signature
Title
H'
i
) /
a
1
ACCOUNT :
CLAIMANT:
D/A
AT THE DIRECTION OF COUNSEL, THE FOLLOWING INVESTIGATION WAS COMPLETED
Enclosures
Photos , statement analysis , material from authority , medical bills ,
etc . . .
Account
Name and address of account , persons contacted , their titles .
Accident
Describe what occurred .
Give account ' s version and claimant ' s version if different .
Ownership and Control
Who owned premises?
Any defect?
Last inspection prior to accident , last repair?
Any notice of defect to authority?
Claimant and Injuries
Name , address , age , marital status , children, occupation employer,
salary, statement .
Describe injury - Hospital & Doctor, name and address .
Any disability?
1 Time and wage loss .
Attorney
Is claimant represented?
Was notice filed-written, 6 months?
Was any suit filed - within one year?
Any demand?
► Reserves •
Recommendations
Further investigation
New Report Date
Witnesses
1 Who saw the accident?
' Their relationship to claimant or to the authority.
1 Contact & statement of witnesses .
J
I Signature
Title
I
11
gj
ljI
1 AUTOMOBILE BODILY INJURY INVESTIGATION REPORT OUTLINE
JACCOUNT'S DRIVER
name - age - address - position - purpose of trip - scope of
permission - agency - bailment - statement - etc. - injuries - bills
J - reserve
DATE , TIME, PLACE & DESCRIPTION OF SCENE
Jday - date - time & place including city , town , county & state-
description of scene - diagram - points of reference - measurements
- weather
DESCRIPTION OF ACCIDENT
your version of the accident
ACCOUNT'S CAR
Jdescription of car - damage - mechanical defect - pictures - etc . -
i collision claim - estimates - inspection - betterment - settlement -
reserve
iOCCUPANTS IN ACCOUNT 'S CAR (use separate paragraph for each)
1 name - age - address - relation to driver - purpose of trip -
impression as a litigant - statement attached or why not - medical
authorization obtained - occupation - employer - other expenses -
demand - offer - reserve
CLAIMANT CAR
] description of car - damage - estimates - inspection - betterment -
pictures - name of insurer - coverage - etc.
1 RESERVES
J
CLAIMANT CAR OWNER AND/OR DRIVER
aname - age - address - purpose of trip - impression as a litigant -
r statement attached or why not - medical authorization obtained
occupation - employer - wage - nature & extent of injury - treatment
- hospital & doctor - medical bills - other expenses - demand -
offer - reserve
i
1
•
y
__I
_ •
- -
OCCUPANTS IN CLAIMANT CAR (use separate paragraph for each)
6 1 name - age - address - relation to driver - purpose of trip -
impression as a litigant - statement attached or why not - medical
D authorization obtained - occupation - employer wage - nature &
extent of injury - treatment - hospital & doctor - medical bills -
other expenses - demand - offer - reserve
OTHER CLAIMANTS (Pedestrians or those not previously discussed)
name - age - address - impression as a litigant - statement attached
I or why not - medical authorization obtained - occupation - employer
- wage - nature & extent of injury - treatment - hospital & doctor -
medical bills - other expenses - demand - offer - reserve
I POLICE REPORT
\
attach report - police photographs - skid marks - interview with
I officers - traffic charges against either driver - disposition
thereof - etc .
WITNESSES (use separate paragraph for each witness )
name - age - address - date of contact - impression as a witness -
E� position at time of accident - attitude toward insured driver -.
relative or other reference for relocation of witness - statement
E attached or why not
LJ LIABILITY
our position including reasoning and/or law applicable -
is making claim for PD or BI and does he have a lawyer -
claimant ' s position including reasoning and/or law relied upon -
r CONTRIBUTION AND/OR SUBROGATION .
L
1 how much - from whom - on what theory - agreement in writing
I FUTURE HANDLING
61 investigation to be completed -
settlement prospects -
Li remarks and proposed future strategy -
_ r9 Diary date -
1
•
._
. ,_ M/ SERVICE SPECIFICATIONS
(Continued)
1- VI. Service Fees Schedule
1 . Claims Handling
Anticipated Rate Minimum Overage •
- # Claim Claim Cost Rate/Claim
Gen . Liab. -BI 120 200 24 , 000 180
Gen. Liab. -PD 60 75 4 , 500 60
Auto-BI 15 200 3, 000 180
,_ Auto-PD 25 75 1 ,875 60
WC-Indemnity 50 250 12 , 500 225
-- WC-Medical only 130 40 5, 700 35
.
Total 400 51 , 075
How are fees to be paid and adjusted? The fee may be paid at
'- the inception of the contract or on a quarterly basis . The fee
for the overage will be paid at the end of the contract year.
L Name of Service Provider Management Services, Incorporated
2. Loss Prevention and Control .
` Hourly Expected
•
:f:
Cost Hours Total Cost
Normal Services 55
1 ,_ How are fees to be paid and adjusted? The fees may be paid
z
on the completion of services or on a quarterly basis .
The proposed service agreement is attached .
Claims/Service Provider: Management Services, Incorporated
L Address : 1420 Kensington Road
.P.
Suite 202
Oak Brook, Illinois 60521
Telephone: 312-571-2920
Signature
, , Date : February 27 , 1987 •
k
i
September 17, 1987
MEMORANDUM
•
TO: Mayor and Members of the City Council
FROM: City Manager
SUBJECT: Insurance
PURPOSE: The purpose of this memorandum is to approve all changes to the
City's insurance program for the period October 1 , 1987 through September 30,
1988.
BACKGROUND: At your August 26th Committee of the Whole meeting, the Council
approved several recommended changes to our insurance program for the period
October 1 , 1987 through September 30, 1988 as follows :
a . to name R.C. Hanchette & Associates of Elgin as our Agent of Record.
b. to accept their proposal for all lines of insurance (except excess
liability) , including "first dollar" liability coverage up to $1 ,000,000/
$2,000,000 as detailed in Corporate Policyholders Counsel ' s letter,
dated August 4, 1987; exhibits A through D of that letter are attached
for your information.
c. to select a claims handling and loss prevention service company for
Workers ' Compensation from those firms who had submitted proposals
several months ago.
In accordance with recommendation c. above, the various proposals were reviewed
and three of them, as noted on the attached exhibit F, were dropped from
further consideration for indicating that upon termination, open claims would
not be handled to conclusion at no additional cost as was required by our
specifications.
A committee, comprised of Mike Sarro, Bob Malm, Ery Jentsch, and Bill Beckmann
of R.C. Hanchette, then interviewed the three lowest remaining firms (Management
Services Inc. (MSI) $18,200, GAB Business Services Inc. $22,100, and Alexis
Risk Management $24,960 on September 9th.
These interviews, the subsequent review of their references, and comments
from Steve Coombs of CPC has resulted in the committee ranking the firms as
follows :
a. MIS and Alexis virtually even.
b. GAB somewhat lower; additionally, it was discovered that, upon
termination, they would continue to handle open claims to conclusion
for only 12 months at no additional cost.
G(7))
Insurance
September 17, 1987
Page 2
FINANCIAL IMPACT: While it has not yet been resolved if we can escape Hartford's
surplus lines tax which could affect some of the premium costs by as much as
3.2% and while Hanchette is still attempting to negotiate better coverages and
secure additional quotations for some of the other lines of insurance (as
detailed in their attached September 1st status letter) , the total cost for
this year' s insurance program should be in accordance with the premium costs
as detailed on the attached exhibit C.
There are sufficient funds in the 1987 Risk Managemend Fund to cover the first
3 months of our policy year, and sufficient funds will be included in the 1988
Risk Management Fund for next year' s expenses.
RECOMMENDATION: For the policy year beginning October 1 , 1987, the recommendations
are as follows :
a. to name R.C. Hanchette & Associates of Elgin as our Agent of Record.
b. to accept the proposal from R.C. Hanchette & Associates (except
liability) as detailed in CPC's letter, dated. August 4th, depicted on
exhibits A through D, and amended by the September 1st status letter.
c. based upon our results of our interviews of the claims handling and
loss prevention service companies , accept the proposal from Management
Services Inc. , who submitted the lowest responsive proposal for
Workers' Compensation.
11114-/4-14M
City nager
MAS/ck
Attachments
•
CITY OF ELGIN
ELGIN, ILLINOIS E%HIBIT A
LIMITS OF LIABILITY (1)
1
A. J. Gallagher R. C. Hanchette Arkwright-Bosto
10-1-86/87 (Proposed) HELP Pool
Real & Personal Property - All Risks 1.000,000 49,778,300 50,000,000
Excess Real & Personal Property various by N/A N/A
location
Flood 1.000.000 No Quote (3) 25,000,000
Earthquake 1.000,000 No Quote (3) 25,000,000
Boiler and Machinery 10,000,000 10.000.000 50,000,000
Employee Dishonesty 100.00050,000 (3) 1.000,000
Money and Securities 50.000 10.000 (3) 250,000
Depositors Forgery • 50,000 No Quote (3) 250,000
corkers' Compensation Statutory Statutory Statutory
Employers' Liability 1,000,000 1,000.000 1.00 00
Comprehensive General Liability 1.000,000(2) 1,000,000 (4) NIL
. utomobile Liability 1.000,000 1,000,000 NIL(66
)
.utomobile Physical Damage ACV ACV ACD
?olice Professional Liability 500,000(2) 1,000,000 (4) NIL(6)
?ublic Officials Liability 1.000,000 1,000,000 NIL(6)
,essees of Hemmens Building 500,000 500,000 500,000
?aramedic Liability 2,000,000 1,000.000 1,000,000
,iquor Liability 2,000,000 1,000,000 2,000,000
Excccc Liability NOT RECOMMENDED No- Quote 2,000,000 (5) 5,000,000(7
NOTES:
(1) Excess of self-insured retentions/deductibles for all
coverages other than "guaranteed cost" policies.
(2) Subject to $3,000,000 annual combined aggregate.
(3) Additional quotations and/or limits are currently being
sought.
(4) Subject to $2.000,000 annual combined aggregate.
(5) To apply as excess over comprehensive general liability,
police professional liability, public officials errors and
omissions liability and automobile liability. It would not
apply over athletic participants or paramedic liability.
(6) Fully self-insured until attachment of the High Level Excess
Liability Pool (HELP) over $1,000.000 per occurrence layer.
(7) The Pool currently provides a $1,000,000 limit of liability,
It is anticipated that at the July scheduled HELP board
meeting 1) the limit will be increased to $5.000,000 and 2)
the final policy form will be adopted. It is also
anticipated that the agreed upon policy form will exclude
general liability hazards associated with the parks.
CITY OF ELGIN
ELGIN, ILLINOIS
EXHIBIT B
DEDUCTIBLES/SELF-INSURED RETENTIONS
A. J. Gallagher R. C. Hanchette Arkwright-Boston
10-1-86/87 (Proposed) HELP Pool
Real & Personal Property 75,000(1) 50,000 25,000
Boiler and Machinery 1.000(2) 1,000 25,000
Employee Dishonesty 75,000(1) Nil 10,000
Money and Securities 75,000(1) Nil 10,000
Depositors Forgery 75,000(1) No Quot910,000
Workers' Compensation 200.000(3) 200,003) 200,000(3)
Employers' Liability 200,000(3) 200,000(3) 200,000(3)
Comprehensive General Liability 75,000(1) Nil 1,000,000
Automobile Liability 75.000(1) 1,000(4) 1,000,000
Automobile Physical Damage 75,000(1) 500/1,000(5) 25,000
Police Professional Liability 75,000(1) 500 1,000,000
Public Officials Liability 25,000 10,000 1.000,000
Lessees of Hemmens Building 500 500 500
Paramedic Liability Nil Nil Nil
Liquor Liability Nil Nil Nil
Exccs3 Liability NOT RECOMMENDED N/A Nil Nil
NOTES:
(1) Subject to a $300,000 aggregate in the deductible/SIR area.
(2) Higher deductibles are applicable as respects deep well
units, depending on depth and motor HP.
(3) These coverages are subject to a $1,060.313 aggregate in the
deductible/SIR area over a combined two year period.
(4) Applies to property damage only.
• (5) $500 applies to comprehensive perils and $1,000 applies to
collision.
•
ADDITIONAL NOTES:
(1) The A. J. Gallagher package program has additional
maintenance deductibles. A $500 deductible applies to each
claim involving property, inland marine, automobile physical
damage and crime. If the aggregate (see Note 1 above) is
breached, a $1,000 deductible will apply to all additional
claims involving the property, inland marine, automobile
physical damage and crime.
CITY OF ELGIN
ELGIN, ILLINOIS EXHIBIT C
ANNUAL
PREMIUM/COSTS
A. J. Gallagher R. C: Hanchette Arkwright-Boston
10-1-86/87 (Proposed) HELP Pool
Real & Personal Property 288,681(1) 39,381(1) 52,000
Boiler and Machinery 13,524(1) 6,265(1) Included
Employee Dishonesty Included(1) 1,118 7,950
Money and Securities Included(1) Included Included
Depositors Forgery Included(1) N/A Includel
Workers' Compensation 69,440(1) 69,440(1) 69,4401/41)
Employers' Liability Included(1) Included(1) Included(1)
Comprehensive General Liability Included(1) 290,420 N/A(1)
Automobile Liability Included(1) 72,756(1) N/A(i)
Automobile Physical Damage Included(1) 37,550 s1) Included(1)
Police Professional Liability Included(1) 79,951`1) N/A(1)
Public Officials Liability 50,600(1) 82,459(1) N/A(1)
Lessees of Hemmens Building 2.605 2.605 2,605
Paramedic Liability 9,660 Included 6,160
Liquor Liability2,222(4) 2.222(3) 2.222(4)
Gallagher-Bassett Service Fee(2)
74,724 18.000 74.724
Self-Insurance Bond 750 750 750
Flood, Earthquake and Crime Excess N/A 11.000 N/A
Estimated Internal Legal Expense 50.000(5) N/A(5) 50.000(5)
562,206(1) 713,917(1) 265.851 (1).
Excess Liability NOT RECOMMENDED No Quote 232,097 127,005 (cst)
NOTES:
(1) Plus losses within the deductibles and self-insured areas.
(2) Current costs adjusted to reflect estimated claim count
estimates (see Exhibit F).
(3) Estimated fee to handle workers' compensation claims only.
The claims handling cost of handling the other lines of
insurance is included in the premiums proposed.
(4) This assumes Gallagher-Bassett continues as the claims
handling/loss prevention provider. The figure also includes
an estimated fee of $10.000 for loss prevention and control
services.
(5) The City of Elgin currently handles specified general and
auto liability cases internally. as opposed to hiring more
costly outside legal counsel. The $50. 000 estimate
represents the internal cost to the City. Under the A. J.
Gallagher and Arkwright-Boston/Help Pool alternatives, it is
anticipated that this would continue; under the R. .C.
Hanchette proposal. the carrier is to provide for defense of '
covered claims.
CITY OF ELGIN
ELGIN. ILLINOIS EXHIBIT D
ANNUAL ESTIMATED COST(1)
A. J. Gallagher R. C. Hanchette Arkwright-Boston
10-1-86/87 (Proposed) HELP Pool
Real & Personal Property 448.981 55.881 68.900
Boiler and Machinery 14.524 6,665 Included
Employee Dishonesty Included 1. 118 8,750
Money and Securities Included Included Included
Depositors Forgery Included Included Included
Workers' Compensation 69.440 69.440 69.440
Employers' Liability Included Included Included
Comprehensive General Liability Included290187,000
Automobile Liability Included 84,7
.420 56(2) 59.000
Automobile Physical Damage Included 47.550 20,000
Police Professional Liability Included 80,951(3) Included
Lessees of Hemmens Building 2.605 2.605 2,605
Paramedic Liability 9.660 Included 6.160
Liquor Liability2.222 2.222 2.222
Gallagher-Bassett Service Fee 74.724(4) 18.000(5) 74,724(6)
Self-Insurance Bond 750 • 750 750
Flood, Earthquake and Crime ExcessN/A 11.000 N/A
Estimated Internal Legal Expense 50,000(7) N/A(7) 50,000(7)
672.906 671.358 549.551
•Excecc Liability NOT RECOMMENDED No Quote 232.097 14-7-7-0-G54-e-91÷-
NOTES:
27 005(-st`-NOTES:
(1) Including expected losses falling within applicable
deductible/self-insured areas, except as respects workers'
compensation and employers ' liability and lessees liability
(Hemmens Building), each of which would be the same under each of
the three alternatives. This exhibit does not include the cost of
public officials liability since expected losses can not be
readily estimated for this line of insurance.
(2) Includes expected losses of $12.000 in the deductible area.
(3) Includes expected losses of $1.000 in the deductible area.
(4) Current costs adjusted to reflect estimated claim count estimates
(see Exhibit F) ; includes estimated fees of $10.000 for loss
prevention and control services. •
(5) Estimated fee to handle workers' compensation claims only.
(6) This assumes Gallagher-Bassett continues as the claims
handling/loss prevention service provider; includes estimated fees
of $10.000 for loss prevention and control services.
(7) The City of Elgin currently handles specified general and auto
liability cases internally. as opposed to hiring more costly
outside legal counsel. The $50.000 estimate represents the
internal cost to the City. Under the A. J. Gallagher and
Arkwright-Boston/Help Pool alternatives. it is anticipated that
this would continue; under the R. C. Hanchette proposal. the
carrier is to provide for defense of covered claims.
CITY OF ELGIN
MGM, ILLINOIS
EmirsTT F
SfJ444RY OF SERVICE PEOPOSAIS(1)
Hourly Rates for
Estimated FePr. for Loss Prevention & Control Minimum Maximum Fee
Claims llnndlina Field Surveys Industrial hygiene Fees Fees Payment
WC & GL WC only
Alexis 68.610 24,9 6 0 60 90 70.000 None Quarterly
Crawford & Co. 75,074 2 7,4 5 8 65 110 None None Monthly
GAB Business Services. Inc. 67.700 22 ,100 (d) 68 100 67,700 None Monthly
Jardine Claims Management. Inc. 68.380 27,900(a) 65 100 None None Monthly
Management Services. Inc. 51.075 18,200 55 100(est) 51.075 None Quarterly
Martin Bcyer Company 99,750 - 63 120(est) None None At Inception
Fred L. Fool & Associates 58,650 17,650(b) 35 35 None None Monthly
Gallagher-Bassett(2) 64,724 - 63 110(est) 54.395 None Quarterly
Gates, McDonald - 22 ,220 (c)
Coroon & Black - 35,000
(1) Fees are based on the following claim cant estimates:
General Liability - bodily injury 120
General Liability - property damage 60
Auto Liability - bodily injury 15
Auto Liability - property damage 25
Workers' Caupensation - indemnity 50 CI
Workers' Canpensation - medical only 130
(2) Current costs adjusted to reflect estimated claim count estimates Hm
UPON TERMINATION: y
(a) Does not handle open claims to conclusion. tli
(b) Open claims handled to conclusion at a rate of $35/hour.
(c) Open claims handled to conclusion at some negotiated fee.
(d) After 12 months, open claims handled to conclusion at a rate of $250/claim.
R.C.Hanchette&Associates.Inc. t I Insurance Ronald S.Pavlik William E.Beckmann,C.P.C.U.
Robert M.Price,C.P.C.U. Jon E.Simpson
[JJ[1:7 ,Y' �I Roger J.Lenart John R.Stone,CIC
I •
I t-- l Robert J.Schumacher John D.Fay
i 'i `� Stephen T.Whipple
•
September 1 , 1'a7
Mr. Michael Sarro, Director of Purchasing
City of Elgin
150 Dexter Court
Elgin, IL 601E0
RE: Status of Account
Dear Mike:
Please be advised of the following:
A flood and earthquake quote has been secured by Penco
from Great American insurance Company. The alternate limits are
$1 , 000, 000 per occurrence, and $5, 000, 000 per occurrence; t h e
deductible is $50, 000; and the respective annual premiums are
$7, 000, and $9, 225. The first premium is within ;,'-:e pr:��ect ed
amount set by Steve Coombs, and the secrrnd }rov i des much more
coverage for just outside budgeted figures. v:e await your
decision on which limit to accept .
The p'r'emium calculation for Law Enforcement _iabil .tty in
Exhibit C of Steve Coomb' s r'epoor'., is for the Clas c. r'm •
with the Surplus Lines tax. Since the Comprehensive General
Liability was quoted on occurrence form in Exhibit C, and both
forms would be occurrence form, the Law Enforcement quote should
be increased 15% lute percentage to convert claims mare to
occurrence) . The revised premium should be $51 , 944.
We are still negotiating a premium reduction for Public
Officials Coverage based on the current $25, 000 deductible.
Since Penco can't rrtove back their retro date, I' m hopeful we can
save enough premium to pay for the Extended Reporting period of
the expiring National Union policy. Check with your Galiiber rep
to see if they will handle the purchase of the ERP. If not , we
certainly will.
Finally, we need a list of the Hemmers lessees who needed
to use the special liability coverage. If the list is innocuous
enough, I think Penco will add the lessees coverage to their
policy, and we can bill by certificate as we did before. In case
they aren' t willing to do this, I' m proceeding with a renewal
request from the Nautilus.
P.O.Box 544 Elgin,Illinois 60121 Offices Located 33 North Geneva Street 312/695-4700
• ^
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R.C.*anche,,o8:Associates,Inc. '/ ' Insura
nce Ronald S.Pavlik w0�m�Beckmann,C�/�U.|
Roh«�wiP,�^ C.P.C.U.
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i ! RogerJ.Lenart John FiSmno
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John lFay• I ‘\ ' ��� L._ SmnhonTvh�v�
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Once the Excess Worker' s Comp renewal app is complete we
will proceed with soliciting the renewal quotes from Safety
Mutual and Employers RE.
Sincerely,
Wivvy.%.4)%m,\,.
William E. Beckmann, CPCU
WE8: ibm
cc : Steve Coombs, Corporate Policyholders
P.O. •
Box 544 Elgin,Illinois 60121 Offices Located 33 North Geneva Street 312/695-4700