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03/20/1996 Agreement Jaann!, I. .elblllt BRANCH OFFICE 3117 OVERSEAS lllGHWAY MARATHON, FLORIDA 33050 TEL. (305) 289-6027 FAX (305) 289-1745 CLERK OF THE CIRCUIT COURT MONROE COUNTY 500 WHITEHEAD STREET KEY WEST, FLORIDA 33040 TEL. (305) 292-3550 FAX (305) 295-3660 BRANCH OFFICE 88820 OVERSEAS lllGHWA Y PLANTATION KEY, FLORIDA 33070 TEL. (305) 852-7145 FAX (305) 852-7146 HI;M.2BAH.l2YM TO: Division of Management Services c/o County Administrator Attn: Nancy Cohen, Employee Benefits Isabel C. DeSantis, Deputy Clerk ~.C.t). FROM: DATE: March 28, 1996 As you know, at the March 20, 1996 meeting, the Board granted approval and authorized execution of a Contract between Monroe County and Insurance Servicing & Adjusting Company (ISAC) for third party administration of Workers' Compensation Program. Attached hereto is a duplicate original of the subject document for return to ISAC. cc: County Attorney Finance Risk Management, w/o document /File I, ~ .' ;/i SERVICE AGREEMENT THIS AGREEMENT is entered into this 1st day of April, 1996, by and between INSURANCE SERVICING & ADmSTING COMPANY, a Florida corporation, hereinafter referred to as "ISAC", and County of Monroe hereinafter referred to as "THE COUNTY". -.", ~ -q L..:. Z :- :;:. ~_ :r r...-, CJ A. ::z ;:c:. :::0 THE COUNTY wishes to retain the services of ISAC to provide claims Mariagement s~ces fciiit's ;r: . .. _:::.: Workers' Compensation risks and desires to have ISAC provide specific se~ices in co~ction(;ith - 1-- (;; ~, N I. RECITALS :-J_ - such claims program. B. ISAC is willing to provide such services on the terms and conditions hereinafter stated. II. TERM This Agreement shall be effective for a period of One (1 ) year from April 1, 1996 through March 31, 1997 and shall remain in full force and effect except as amended or terminated as hereinafter provided. THE COUNTY at its sole option, will have the right to renew the contract for an additional two ( 2 ) one ( 1 ) year periods. III. CANCELLATION Either party shall have the right to terminate the Agreement by giving to the other Party written notice of such termination at least Ninety (90) days in advance. THE COUNTY'S failure to pay the ISAC service fee as provided in Item IV, Section B of this Agreement shall be construed as a breach of the Agreement and, in such event, ISAC shall have the right to terminate the Agreement by giving THE COUNTY ten (10) days' written notice of its intention to terminate. Upon termination of this Agreement, neither Party shall have any further responsibility or obligation hereunder except as provided in Item IV, Section D of this Agreement. -1- IV. AGREEMENT A. Services to be Performed by ISAC. ISAC agrees to perform the following services: 1. With regard to CLAIMS ADMINISTRA nON, ISAC shall: a. Review all claim and loss reports submitted by THE COUNTY to ISAC during the term of this Agreement and process each submitted claim or loss report in accordance with Florida Statutes. b. Conduct an investigation of each reported claim or loss under subparagraph "a" above (hereinafter referred to as a "qualified claim or loss") consistent with industry standards and in sufficient detail to determine the compensability of each claim. c. Maintain a file for each qualified claim or loss which shall be available for review by THE COUNTY at any reasonable time. d. Adjust, settle or resist all qualified claims or losses arising therefrom within the stated discretionary settlement authority limit and, with specific prior approval of THE COUNTY, adjust, settle or resist all other qualified claims and losses resulting therefrom in excess of the discretionary settlement authority limit. No claim shall be settled without the prior approval of THE COUNTY. -2- e. Perform reasonable and necessary administrative and clerical work in connection with each qualified claim or loss, including the preparation of checks or vouchers, compromises, releases, agreements and any other documents to fmalize a claim. f. Recommend claim reserves and provide a continuous review and updating of these to reflect changes. g. ISAC will assist THE COUNTY in arranging a loss and expense payment account as set out in Section B, Paragraph 2. h. Provide notice of claims and routine status reports to THE COUNTY'S Excess Insurer in accordance with the Excess Insurer's standard reporting requirements. THE COUNTY will provide ISAC with the name, address and telephone number of its Excess Insurer. ISAC will fully cooperate with THE COUNTY'S Excess Insurer and take no action, or lack of action that will jeopardize THE COUNTY'S rights to recovery under the policy. i. Coordinate investigations on litigated claims with attorneys approved by THE COUNTY and with adjusters and attorneys of the excess insurance carrier as required. This includes the negotiation of settlements and preparation of subrogation and contribution actions. It is expressly understood by the Parties to this Agreement that all legal costs and loss payments will be charged to THE COUNTY'S Loss Fund. -3- J. All sizable and unusual claims will be reviewed by ISAC's staff at no additional cost to THE COUNTY, to ensure efficient and proper administration is provided. k. ISAC will furnish one set ofloss and information reports (as specified in ISAC's proposal) to: THE COUNTY, THE COUNTY'S Insurance Agent, THE COUNTY'S Risk Management Consultant and THE COUNTY'S Excess Insurer. l. Additional optional and ad hoc information and analysis reports and services can be provided on a time and expense basis, as mutually agreed upon by ISAC and THE COUNTY. m. Provide THE COUNTY with narrative or analytical reports on all qualified claims with a total incurred in excess of $50,000, every ninety (90) days. n. Provide THE COUNTY with claim and other forms mandated by the State of Florida's statutes and regulations to ensure efficient administration of THE COUNTY'S self-insured Workers' Compensation program. o. Investigate and pursue all subrogation and Second Injury Disability Trust Fund possibilities (to the extent permitted by law) on behalf of THE COUNTY. THE COUNTY will receive the benefit of all recoveries associated with these activities. -4- p. Provide all personnel necessary to effectively perform the services agreed to herein. 2. With regard to WORKERS' COMPENSA nON and MEDICAL CONTROL, ISAC shall: a. Arrange for independent medical or other experts in connection with processing qualified claims or losses as is mutually agreeable to ISAC and THE COUNTY. b. Pay medical and death benefits, temporary and permanent disability compensation and other losses and expenses but only if in the judgment of ISAC, such payment would be prudent for THE COUNTY and the anticipated amount thereof does not exceed the stated settlement authority or, in any case, THE COUNTY specifically approves or directs such action. c. Assist in THE COUNTY'S selection of a panel of physicians or other providers of health care to initially treat employees and a panel of medical specialists to provide long-term or specialty care. d. Consult with THE COUNTY in order to develop ways of using any medical facility more effectively. -5- e. Monitor the treatment programs recommended for employees by physicians, specialists and other health care providers by reviewing medical reports so prepared and by maintaining contact with the providers as is consistent with industry standards. f. As THE COUNTY directs, assist in interpreting medical reports to consider the circumstances under which an injured employee who desires to do so could return to work in the shortest period of time. g. Assist THE COUNTY in arranging for rehabilitation or retraining of employees in appropriate cases; charges for these programs shall be considered allocated expense and charged to THE COUNTY. h. Represent THE COUNTY at all hearings. mediations and trials at no additional costs. With the specific approval of THE COUNTY, which will be provided on a case by case basis, such representation may be conducted by telephone. i. Conduct quarterly meetings (at no charge) with THE COUNTY officials to review the claim activity and develop methods for reducing the claim costs. Such meetings shall take place at THE COUNTY'S offices in Key West, Florida. -6- 3. With regard to PROGRAM DEVELOPMENT, ISAC shall, to the extent appropriate: a. Consult with key personnel of THE COUNTY on the establishment and coordination of necessary procedures and practices to meet any applicable state requirements and the needs of THE COUNTY. b. Participate in the orientation of THE COUNTY'S personnel who are directly or indirectly involved in the processing of qualified claims or losses. c. Review the development of THE COUNTY'S program periodically with representatives of THE COUNTY in order to identify problems and recommend corrective action. B. Obligations of THE COUNTY. 1. THE COUNTY shall pay ISAC for services rendered herein in accordance with Attachment A which is incorporated as part of this Agreement. 2. THE COUNTY shall at all times provide funds adequate for the payment of qualified claims or losses and of allocated loss expenses. For this purpose, allocated loss expenses shall mean all costs, charges or expenses of third parties incurred by ISAC, its agents or its employees, which are properly chargeable to a qualified claim or loss including, without limitation, court costs, fees and expenses of attorneys, independent investigators, experts and witnesses, and fees for obtaining diagrams, reports, documents and photographs. -7- a. THE COUNTY will establish procedures to make timely payments of loss and expense vouchers submitted by ISAC during the course of their claims management program. 3. It is expressly understood that ISAC shall not be required to advance its own funds to pay losses, allocated loss expenses or banking charges hereunder, or to perform any services hereunder if THE COUNTY fails to provide adequate funds as herein set forth. C. Discretionary Disbursement Authority Limit. The limit on any discretionary payment by ISAC for a qualified claim or loss, or for allocated loss expenses, as the case may be, shall be Five Thousand DOLLARS ($ 5,000.00 ) initially. This amount may be changed at any time by THE COUNTY upon written notice to ISAC. It is agreed that ISAC shall have full authority and control in all matters pertaining to the payment, processing, investigation and administration of qualified claims or losses within the limit established by this paragraph. Failure of ISAC to settle a qualified claim or loss within such limit, however, shall not subject ISAC to liability to any party in the event of an adverse judgment entered by any court or the settlement of such claim or loss for an amount in excess of such limit. ISAC will make no payment in excess of the Discretionary Disbursement Authority Limit without obtaining prior approval of THE COUNTY. D. Terms of Agreement and Cancellation. 1. In the event of cancellation or non-renewal of this Agreement, THE COUNTY, at its sole option, may require that all open claims be transferred to its new administrator or require ISAC to continue administering the claims to conclusion. If THE COUNTY elects that ISAC is to continue administering the claims, a service fee of One Hundred Dollars ($100.00) per file per year will be paid for as long as the claim remains open. -8- a. ISAC will treat as confidential all data furnished by THE COUNTY or generated as a result of the processing services performed under this Agreement and any other information so designated in writing by THE COUNTY, and ISAC will make the same effort to safeguard such information as it does in protecting its own confidential data. b. ISAC reserves the right to gather and utilize, as it sees fit, statistical information from the data base; provided, however, that THE COUNTY'S name and proprietary and/or confidential data are adequately protected and not disclosed. 2. In the event of cancellation or non renewal, ISAC shall provide, at no charge to THE COUNTY, detail history of all claims processed during the term of this Agreement on Electronic Data Processing Media. ISAC will cooperate with THE COUNTY or its new Administrator with all reasonable requests regarding the method and format of the information to be provided. E. Practice of Law. It is understood and agreed that ISAC will not perform, and THE COUNTY will not request performance of, any services which may constitute the unauthorized practice of law. F. Indemnification. ISAC shall be fully responsible for exercising reasonable care at all times in the performance of its obligations hereunder. However, if ISAC is named as a party to any litigation because of its actions on behalf of THE COUNTY hereunder, THE COUNTY agrees to defend ISAC in any such litigation ifno allegation is made that ISAC failed to exercise such reasonable care, and -9- to hold harmless and indemnify ISAC, pursuant to Florida Statute 768.28, if no fmding is entered to the effect that ISAC failed to exercise such reasonable care. G. Notices. Any notice required to be given under this Agreement shall be sent by certified mail to the following in the case ofISAC: Mr. Joseph P. McCurdy Insurance Servicing & Adjusting Company 9690 Doral Boulevard (NW 41st Street) Miami, FL 33178 and to the following in the case of THE COUNTY: Monroe County, Florida Attn: Manager Workers' Compensation Public Service Building 5100 College Road Stock Island Key West, FL 33040 (305) 292-4449 H. Successors. This Agreement shall be binding upon and shall inure to the benefits of all assigns, transferees and successors in the interest of any kind of the Parties hereto. I. Entire Agreement and Modification or Amendment. This Agreement represents the entire and exclusive statement of the agreement of the Parties and, except as otherwise provided in Item IV, Section C, may be modified or amended only by a written statement signed by both Parties. Such modification or amendment shall be attached to, and shall thereupon become a part of this Agreement. J. Headings. Headings herein are for convenience of reference only and shall not be considered in any interpretation of this Agreement. -10- K. Inde.pendent Contractor. It is understood and agreed that ISAC is engaged to perform services under this Agreement as an independent contractor and not as an agent of THE COUNTY. The Parties hereto agreed that neither Party has any relationship with, or contractual liability to, the other with respect to the subject matter of this Agreement, other than as set forth herein. L. ISAC will not discriminate against any person on the basis of race, creed, color, religion, sex, age, national origin, or any other characteristic which is not job-related in its recruiting, hiring, promoting, terminating or any other area affecting employment under this agreement. ISAC agrees to abide by federal or state laws regarding non-discrimination, including but not limited to, Executive Order 11246, Executive Order 11365 and US Department of Labor regulations. M. ISAC warrants that it has not employed, retained or otherwise had acted on his behalf any former COUNTY officer subject to the prohibition in Sec. 2 of Ordinance No. 10-1990 or any COUNTY officer or employee in violation of Sec. 3 of Ordinance 10-1990 , and that no employee or officer of THE COUNTY had any interest, fmancially or otherwise, in ISAC except for such interest, permissible by law and fully disclosed by affidavit attached hereto. For breach or violation of this paragraph, THE COUNTY may, in its discretion, terminate this agreement without liability and may also, in its discretion, deduct from the contract or purchase price, or otherwise recover, the full amount of any fee, commission, percentage, gift or consideration paid to the former COUNTY officer or employee. N. ISAC assures THE COUNTY that, to the best of its knowledge, information and belief, the signing of this Agreement does not create conflict of interest and that during the time of this agreement ISAC will not undertake representation of any parties to or before THE COUNTY seeking to obtain contracts or other benefits from THE COUNTY. -11- O. All documents which are prepared in the performance of this Agreement are to be, and shall remain, the property of THE COUNTY and shall be delivered to the Workers' Compensation Manager at any time upon request and no later than thirty (30) days after termination of this Agreement. P. ISAC shall indemnify and hold THE COUNTY harmless from and against any and all losses, penalties, damages, professional fees, including attorney fees and all costs or litigation and/or judgement arising out of any willful misconduct or negligent act, error or omission of ISAC arising out of any or incidental to the performance of this Agreement or work performed thereunder. Q. ISAC is required to maintain the types and limits of insurance identified in Attachment "B". R. ISAC shall not assign or sub-contract this Agreement, except in writing and with the prior written approval of THE COUNTY. S. . The. following defmitions shall apply for Medical Only and Lost Time Claims: "Medical Only Cases" means injuries that require medical treatment for which charges will be incurred, whether or not they are submitted to THE COUNTY, but which does not result in the disability of the employee (as defmed by Florida Statute 440.02 (11) , for more than seven days as a result of the injury. "Lost Time Cases" means injuries which result in the disability of the employee (as defmed by Florida Statute 440.02 (11), for more than seven days. T. This contract is governed by the laws of the State of Florida and venue for any litigation between THE COUNTY and ISAC arising under this contract must be in Monroe County, Florida. -12- IN WIlNESS WHEREOF, the Parties hereto have caused this Agreement to be executed on the day and date fIrst above written. ~.~ :~~/~2:~ / Jose P. McCurdy Title: PRESIDENT COUNTY OF MONROE, FLORIDA ~~j-F~ Title: m,or,l ~hQ,'rmQ n (SOQ ATTEIt -L--,ClIII BY ~ ~J404:i..o1 -13- Contract for Workers' Compensation Claims Administration Services Between Insurance Servicing & Adjusting Company and Momoe County, Florida Attachment A Fee Schedule THE COUNTY agrees to pay ISAC based on the following fee schedule: Claims with a date of accident between April 1 , 1996 and March 31, 1997 Medical Only Claims as defmed In Paragraph "s" Lost Time Claims $110.00 $415.00 Claims with a date of accident before April 1, 1996 Medical Only Claims as defmed in Paragraph "s" Lost Time Claims $110.00 $415.00 It is agreed that any claim with a date of accident before April 1, 1996 and which requires the processing of ten (10) or fewer medicaVpharmacy payments will be classfied and charged as a Medical Only Claim. In the event THE COUNTY elects to renew this agreement with ISAC, the following rates will apply to claims with a date of accident between April 1 , 1997 and March 31, 1998. Medical Only Claims as defmed in Paragraph "s" Lost Time Claims $110.00 $415.00 In the event THE COUNTY elects to renew this Agreement with ISAC, the following rates woll apply to claims with a date of accident between Aptill, 1998 and March 31, 1999. Medical Only Claims as defined in Paragraph "s" Lost Time Claims $130.00 $420.00 THE COUNTY will pay ISAC twelve monthly payments of $5,727.50 as a deposit for services rendered in accordance with this Agreement. Within six (6) months of the expirationof the Agreement, ISAc will submit a reconciliation of the actual nymber of claims administered. THE COUNTY will promptly pay ISAC any additional fees owed based on the above rates. If the deposit paid by THE COUNTY is in excess of the actual fees earned, ISAC will include with the reconciliation, the difference between the deposit and the earned fees. -14- April 22. 199J Isll'rilllin~ "ATTACHEKENT B" MONROE COUNlY, FLORIDA INSURANCE GUIDE TO CONTRACT ADMINISTRATION General Insurance Requirements for Suppliers of Goods or Services As a pre-requisite of the work governed, or the goods supplied under this contract (including the pre-staging of personnel and material), the Vendor shall obtain, at his/her own expense. insurance as specified in any attached schedules. which are made part of this contract. The Vendor will ensure that the insurance obtained will extend protection to aH Subcontractors engaged by the Vendor. As an alternative. the Vendor may require all Subcontractors to obtain insurance consistent with the attached schedules. The Vendor will not be permitted to commence work governed by this contract (including pre- staging of personnel and material) until satisfactory evidence of the required insurance has been furnished to the County as specified below. Delays in the commencement of work, resulting from the failure of the Vendor to provide satisfactory evidence of the required insurance, shaH not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work commenced on the specified date and time. except for the Vendor's failure to provide satisfactory evidence. The Vendor shall maintain the required insurance throughout the entire term of this contract and any extensions specified in the attached schedules. Failure to comply with this provision may result in the immediate suspension of aH work until the required insurance has been reinstated or replaced. Delays in the completion of work resulting fTom the failure of the Vendor to maintain the required insurance shall not extend deadlines specified in this contract and any penalties and failure to perform assessments shall be imposed as if the work had not been suspended. except for the Vendor's failure to maintain the required insurance. The Vendor shall provide, to the County, as satisfactory evidence of the required insurance, either: . Certificate ofInsurance or . A Certified copy of the actual insurance policy. The County. at its sole option, has the right to request a certified copy of any or all insurance policies required by this contract. All insurance policies must specifY that they are not subject to canceHation. non-renewal. material change, or reduction in coverage unless a minimum of thirty (30) days prior notification is given to the County by the insurer. The acceptance and/or approval of.the Vendor's insurance shall not be construed as relieving the Vendor from any liability or obligation assumed under this contract or imposed by law. Administrative JnslnJclion #4709.1 17 April 22. 199:1 illl I'rinting The Monroe County Board of County Commissioners, its employees and officials will be included as" Additional Insured" on all policies, except for Workers' Compensation. Any deviations from these General Insurance Requirements must be requested in writing on the County prepared form entitled "Request for Waiver of Insurance Requirements" and approved by Monroe County Risk Management. Administrative InslnK.1ion #4709.1 18 April 22. 199J 11lII'rinling GENERAL LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT WORK roMP TPA BETWEEN MONROE COUNTY~ FLORII)A AND ISAC, INC. Prior to the commencement of work governed by this contract, the Contractor shall ohtain General Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum: · Premises Operations · Products and Completed Operations · Blanket Contractual Liability · Personal Injury Liability · Expanded Definition of Property Damage The minimum limits acceptable shall be: $300,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $100,000 per Person $300,000 per Occurrence $ 50,000 Property Damage An Occurrence Fonn policy is preferred. If coverage is provided on a Claims Made policy, its provisions should include coverage for claims filed on or ailer the eflective date of this contract. In addition, the period for which claims may be reported should extend for a minimum of twelve (12) months following the acceptance of work by the County. The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfY the above requirements. Adminilllralivc Im1ruclion 114709.1 GLl 54 April 22. 199] I sllnuting VEHICLE LIABILITY INSURANCE REQUIREMENTS FOR CONTRACT WOlu{ COHP TPA BETWEEN MONROE COUNTY, FLORIDA AND I SAC , INC. Recognizing that the work governed by this contract requires the use of vehicles, the Contractor, prior to the commencement of work, shall obtain Vehicle Liability Insurance. Coverage shall be maintained throughout the life of the contract and include, as a minimum, liability coverage for: · Owned, Non-Owned, and Hired Vehicles The minimum limits acceptable shall be: $100,000 Combined Single Limit (CSL) If split limits are provided, the minimum limits acceptable shall be: $ 50,000 per Person $100,000 per Occurrence $ 25,000 Property Damage The Monroe County Board of County Commissioners shall be named as Additional Insured on all policies issued to satisfY the above requirements. Administrative InstnlClion H4109.1 VLl 75 April 22. 199] 151 l'ri.lI ing WORKERS' COMPENSA 1'ION INSURANCE REQUIREMENTS FOR CONTRACT WORK COMP TPA BElWEEN MONROE COUNTY, FLORIDA AND ISAC, INC. Prior to the commencement of work governed by this contract, the Contractor shall obtain Workers' Compensation Insurance with limits suflicient to respond to Florida Statute 440. In addition, the Contractor shall obtain Employers' Liability Insurance with limits of not less than: $100,000 Bodily Injury by Accident $500,000 Bodily Injury by Disease, policy limits $100,000 Bodily Injury by Disease, each employee Coverage shall be maintained throughout the entire term of the contract. Coverage shaH be provided by a company or companies authorized to transact business in the state ofFJorida and the company or companies must maintain a minimum rating of A-VI, as assigned by the A.M. Best Company. If the Contractor has been approved by the Florida's Department of Labor, as an authorized self- insurer, the County shall recognize and honor the Contractor's status. The Contractor may be required to submit a Letter of Authorization issued by the Department of Labor and a Certificate of Insurance, providing details on the Contractor's Excess Insurance Program. If the Contractor participates in a self-insurance fund, a Certificate of Insurance will be required. In addition, the Contractor may be required to submit updated financial statements from the fund upon request from the County. Administrath.e Instruction /;/4709.1 WC' Sf . - April 22. 199.1 h1/'rin'inG EMI)LOYEE DISIIONESTY INSURANCE REQUIRI~lVlENTS FOR CONTRACT WORI{ COMP TPA UETWfGEN MONROE COUNTY, FLOIUl>A ISAC, I~~I) The Contractor shall purchase and maintain, throughout the term of the contract, Employee Dishonesty Insurance which will pay for losses to County properly or money caused by the fraudulent or dishonest acts of the Contractor's employees or its agents, whether acting alone or in collusion of others. The minimum limits shall be: $100,000 per Occurrence Admilli.~lralivc [nslrudinn 114709.1 ED2 50