11-169e Resolution No. 11-169
RESOLUTION
ACCEPTING THE PROPOSALS
FOR THE CITY OF ELGIN'S INSURANCE PROGRAM
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN,ILLINOIS,that
pursuant to Elgin Municipal Code Section 5.02.020B(9) the City Council hereby finds that an
exception to the requirements of the procurement ordinance is necessary and in the best interest of
the city; and
BE IT FURTHER RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN,
ILLINOIS,that Sean R. Stegall,City Manager,be and is hereby authorized and directed to accept the
proposals on behalf of the City of Elgin for the city's insurance program commencing October 1,
2011 as follows:
a. To accept Travelers' renewal proposal for liability and crime insurance for
an annual premium of$458,345.
b. To accept Public Entity Property Insurance Program's(PEPID)proposal for
property, inland marine and cyber liability insurance for an annual premium
of$188,233.
C. To accept Safety National's renewal proposal for excess workers'
compensation insurance for an annual premium of$95,107.
d. To accept Indian Harbor's renewal proposal for pollution liability insurance
for a three year premium of$63,984.
e. To accept Claim Management's renewal proposal for workers'compensation
claims administration for an estimated annual cost of$45,000.
BE IT FURTHER RESOLVED BY THE CITY COUNCIL OF THE CITY OF ELGIN,
ILLINOIS,that Sean R. Stegall,City Manager,be and is hereby authorized and directed to execute a
service agreement with Claim Management Consultants, LLC dated October 1, 2011, a copy of
which is attached hereto and made a part hereof by reference.
s/David J. Kaptain
David J. Kaptain, Mayor
Presented: September 28, 2011
Adopted: September 28, 2011
Omnibus Vote: Yeas: 7 Nays: 0
Attest:
s/Kimberly Dewis
Kimberly Dewis, City Clerk
SERVICE AGREEMENT
This Agreement is hereby made and entered into this 1St day of October 2011, by and between
Claim Management Consultants, LLC, an Illinois limited liability company(hereinafter referred to
as the"Service Agent")and The City of Elgin,Illinois, a municipal corporation (hereafter
referred to as the"Client").
NOW THEREFORE, in consideration of the promises and covenants contained herein, the
sufficiency of which is hereby mutually acknowledged, the parties hereto agree as follows:
SECTION t: SERVICE AGENT
The Service Agent shall provide the following Illinois workers'compensation claim management
services to the client:
• Administer and manage all of the workers' compensation claims during the period of this
contract.
• Determine the liability, if any, the settlement thereof, and issue all payments, with funds
provided by the Client.
• Prepare and file all claim reports in accordance with established administrative procedures
and state guidelines and by law.
• Establish a separate claim file on each reported claim with appropriate documentation.
• Provide computerized monthly loss reports disclosing pertinent claims data.
• Coordinate all litigation activity with outside legal counsel.
• Establish initial claim reserves and reserve changes for each claim file.
• Provide 4 four meetings per year to review mutually agreed upon claim files or other issues.
• Provide Managed Care Services at the rate of$90 per hour.
• Coordinate Provider Bill Review Services at a fee of 35%of savings. (No savings/no fees).
• Select, assign and coordinate any outside field investigations/surveillance.
• Coordinate all subrogation activities.
• Make prompt payments of all medical bills to avoid late payment consequences.
• Communicate in a timely manner with employees involved in lost time claims in order to
advise them promptly of their rights and benefits.
• Prepare any Federal 1099 tax forms where required.
• Coordinate and cooperate with any applicable excess carrier(s)in their investigation and
defense of any applicable claims.
• Provide medical cost containment services including, but not limited to, medical bill review
and pharmacy bill review.
• Assume all existing open claims.
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• Provide the appropriate notification to excess insurers as required by policy reporting
requirements.
• Provide the client with the necessary investigation of each claim using competent and
qualified personnel.
• Conduct the necessary investigation of each claim using competent and qualified personnel.
• With reasonable prior notice, the Client has the right to designate a representative to visit
CMC's premises for file audits and have access to all data which relates to payment of non-
payments made by CIVIC and charged to the Client as well as general claims handling review.
• Review all claims against the Client and make recommendations to the Client as to the
denial, delay, or settlement of claims on behalf of the Client. Client approval is necessary for
any and all claims settlements in excess of$5,000.
• Provide detailed loss reports on a monthly basis showing all claims including claimant's
name, claim number, occurrence data, expenditures paid to date, outstanding reserves for
each case, status(open/closed). Report must include a check register detailing monthly
financial activity including payments issued, payee, amount of check, type of payment, claim
number, and claimant name.
• Designate one specific representative to handle all client claims.
• Coordinate legal defense of litigated claims, including subrogation issues. The Client
reserves the right to select legal counsel. Ensure that, for employees who are represented
by legal counsel, their attorneys receive copies of reports and correspondence, as
appropriate and/or required.
• Initiate and coordinate vocational rehabilitation services for qualified injured workers. The
client reserves the right to select the rehabilitation vendor.
• Provide a monthly reconciliation of the Workers' Compensation checking account, listing all
checks, vouchers, and voids, in numerical sequence, stating date issued, claim number,
claimant name, payee and amount.
• Provide detailed AD HOC reports regarding safety loss analysis data to be used for loss
prevention activities.
• Determine the extent and degree of permanent disability based upon medical evidence.
• Maintain insurance of the type and amount detailed in Attachment A(Certificate of
Insurance), incorporated by reference herein.
SECTION II: CLIENT
The Client Agrees to:
• Provide the Service Agent with timely, accurate and complete accident reports and
correspondence on all claims and related claim matters.
• Cooperate fully in the claim administration process, disposition, payment, etc. of all claims
and related claim matters/and expenses.
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• Provide the Service Agent with timely and up to date written information on any changes in
insurance carriers, insurance coverage's, claim reporting requirements, brokers, consultants,
etc.
• Establish or have the Service Agent establish on the Client's behalf an Escrow Loss Fund
from which to pay all claims and related claim expenses on a timely basis. The account will
be reviewed periodically to determine any under funding. If the account if under funded the
Client will increase the deposit in a timely manner based on supportive documentation from
the Service Agent. The Service Agent will not issue, hold or distribute any checks/payments
without adequate funds. The Service Agent will not be responsible for any penalties, lack of
provide discounts, etc. due to inadequate funds. Reconciliation of the escrow bank statement
will be the responsibility of the Client. The untimely replenishment of the escrow account
may be considered a breach of this Agreement. Client will pay for all check stock.
• Provide written notice as to any changes in the distribution of Loss Reports, Changes in Loss
Report Format, Data Tapes, etc.
• Provide thirty(30)days prior written notice of the setting up of any claim reviews, meetings,
audits beyond the four meetings the Service Agent is required to attend.
• Pay the Service Agent's fee in accordance with this Agreement.
• Set forth in writing to the President of the Service Agent, any requested changes in service
procedures.
• The Client, as Self-Insured, agrees to be responsible for the full compliance of the USA
Patriot Act(Section 326)of October 1, 2003. The USA Patriot Act(Section 326) has ordered
financial institutions, including insurance companies, TPA's and self-insurers, as well as their
employees including US citizens and permanent resident aliens employees by non-US
insurers, to be responsible for checking claims and payments against a master list published
by the Office of Foreign Assets Control(OFAC) of the US Department of Treasury.
The intention of this screening is to ensure that money is not paid to persons or organizations
involved in terrorism, international drug trafficking, or activities related to the proliferation of
weapons of mass destruction (i.e. transactions with"enemies" of the United States as defined
by various Executive Orders of Congress). As a Self-Insured it is your responsibility to
comply with this Act, and to notify the Service Agent, in writing, if any payments are to be
withheld.
SECTION III: GENERAL CONDITIONS
The Client agrees that it will indemnify and hold harmless the Service Agent and its directors,
officers, employees, parents, subsidiaries and affiliates from and against any and all claims, loss,
liability, costs, and damages incurred by the Service Agent as the direct or indirect results of any
misconduct, claim instructions or omission of the Client, or any of its directors, officers or
employees, taken in connection with the furtherance or performance of any provision of this
agreement, provided that said misconduct error or omission have not been directly caused by the
Service Agent, its directors, officers, and employees.
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The Service Agent agrees that it will indemnify and hold harmless the Client and its directors,
officers, employees, parents, subsidiaries and affiliates from and against any and all claims, loss,
liability, costs, damages and reasonable attorneys' fees incurred as the direct or indirect result of
any misconduct, error omission of the Service Agent or any of its directors, officers, employees,
parents, subsidiaries or affiliates taken in connection with the furtherance or performance of any
provision of this agreement, provided that said claims, loss liability, costs, damages and
reasonable attorneys'fees have not been directly caused by any misconduct or omission of the
Client, its directors, officers and employees.
This contract shall be interpreted and construed in accordance with the laws of the State of
Illinois. Venue for the enforcement of any rights and the resolution of any disputes arising out of
or in connection with the provisions of performance of this Agreement shall be in the Circuit Court
of Kane County, Illinois.
This agreement shall not be construed so as to create a joint venture, employment, partnership or
other agency relationship between the parties hereto except as specifically provided for herein.
This agreement is the sole agreement between the parties hereto regarding the subject matter
hereof. There are no other agreements, either oral or implied, between the parties hereto
regarding the subject matter hereof.
This agreement shall be construed as having been drafted by the Service Agent.
SECTION IV: FEES/SERVICE PERIOD
This agreement shall terminate October 1, 2014.
The Client agrees to pay the Service Agent a fee of$240 for each new Workers'
Compensation claim plus$500 per month for Loss Reports and Special Status Reports
plus an Annual Administrative Fee of$5000 (payable at inception). Invoices to be issued
monthly based on actual claim counts. The above rates/fees are guaranteed for each of
three years.
Such fee is due and payable by no later than thirty-(30)days from the date of the invoice. Any
additional services requested and/or any service modification by the Client must be in writing and
addressed to the President of the Service Agent. If acceptable to the Service Agent, such
services will be provided on a time and expense basis and/or a negotiated fee. This agreement
may not be modified or amended except in writing by both parties hereto.
The Service Agent also reserves the right to review with the Client, and adjust its service fees if,
within the service agreement period, the Client, Client's broker, excess carrier, fronting company,
insurance consultant, etc. materially changes the basic services provided, or requests additional
modifications in EDP systems, reports, magnetic tapes, etc.
In addition to the Service Agents'fees the Client also agrees to pay all Allocated Expenses as
defined below:
Allocated Loss Expenses means any cost or expense we incur on your behalf as a result
of our engaging the service of firms or persons outside our organization, for work in
connection with the investigation, medical case management, cost containment, provider
bill review, adjustment, settlement of defense of a Claim. Allocated Loss Expenses
includes, but is not limited to the automobile or other physical damage appraisal; all court
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costs, fees and expenses; fees for services of process; fees to attorneys; the cost of
services of undercover operations, detectives fees, independent adjusters, or attorneys
for investigation or adjustment of Claims; the cost of employing experts for the purpose of
preparing maps, photographs, diagrams, chemical or physical analysis, expert advise of
opinion; the cost of depositions and court reporters, or recorded statement, the indexing
of claims, the cost to tape transfers, etc.
SECTION V: CANCELLATION
The cancellation or non-renewal of this Agreement by the Service Agent, shall be given to the
Client, in writing, sixty(60) days prior to the actual effective date of such cancellation/non-
renewal. Upon cancellation/non-renewal, the Service Agent will not be required to provide any
further services to the Client since such services were provided only for the life of the contract
and not for the life of the claim. The Service Agent may also cancel this Agreement with ten (10)
days written notice, for the untimely or non-payment of service fees, or the untimely
replenishment of claim payment funds to the Escrow Account.
The cancellation of non-renewal of this Agreement by the Client shall be given to the Service
Agent, in writing, thirty(30)days prior to the actual effective date of such cancellation on non-
renewal.
In the event of cancellation and/or non-renewal of this Agreement, for any reason whatsoever, the
Client shall designate, in writing, one of the following options:
Option I:
Require the Service Agent to return all open/pending or closed files to the Client
on the effective date of the termination at the Client's expense.
Option II:
Require the Service Agent to continue to provide all services as previously
outlined in this Agreement, at a fee to be negotiated between the Client and the
Service Agent.
Both parties acknowledge that all claim files are property of the Client. In the event of
cancellation and/or non-renewal of this Agreement, for any reason whatsoever, all claim files shall
be promptly returned to the Client or as directed.
This agreement may be terminated and cancelled by either party hereto for any reason as
provided above.
SECTION VI: AGENCY AUTHORVATION/WAVER
The undersigned duly authorizes the Service Agent, when an Escrow Bank Account is
established for the Client, to act as its agency (fiduciary), for the purpose of endorsement and
deposits of items, payable totally or in part to the undersigned), to, or withdrawal from any
account, at Harris Bank entitled for the purpose of claim payments and related expenses.
The undersigned agrees to waive any and all claims it may have against the Service Agent, its
parent company, its directors, officers, employees, subsidiaries and affiliated as a direct result of
any failure of the Harris Bank which makes it impossible for the Service Agent to fulfill its
financial obligations to the undersigned.
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SECTION VII: TRANSFER OF OPEN FILES
It is hereby agreed, that upon inception of this Agreement, if the Service Agent is requested by
the Client to assume the servicing of any open files from another service company, open
indemnity (wage loss) files will be priced in accordance with the fee structure for new claims. No
cost shall be charged for medical only claims. The Service Agent is only responsible for the claim
activities and management of same from the inception date of the transfer through the expiration
of this Agreement. The Service Agent is not responsible for any management activities, decision,
services, liabilities, procedures, etc. that occurred prior to the transfer.
SECTION VIII: SIGNATORY PARTIES
IN WITNESS WHEREOF, the parties have caused this agreement to be executed on their behalf
by the undersigned duly authorized persons.
CITY OF N/CLIENT CMC/SERVICE AGENT
By 5eVn Stegall Diane M. Huggins)W,Ta44�—
pity Manager
Title Title
October 11, 2011 � (?-a
Date Date
t UDaa A,
Witnes Witnes
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