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Item C22 C.22 i�` County of Monroe �y,4 ' ?, "tr, BOARD OF COUNTY COMMISSIONERS Mayor Michelle Coldiron,District 2 �1 nff `_ll Mayor Pro Tem David Rice,District 4 -Ile Florida.Keys Craig Cates,District 1 Eddie Martinez,District 3 w Mike Forster,District 5 County Commission Meeting July 21, 2021 Agenda Item Number: C.22 Agenda Item Summary #8456 BULK ITEM: Yes DEPARTMENT: Employee Services TIME APPROXIMATE: STAFF CONTACT: Mark Gongre (305) 292-4559 none AGENDA ITEM WORDING: Approval of an agreement with Relation Insurance Services of Florida, Inc. to provide Third Parry Claims Administration for the Monroe County Workers' Compensation Program at the annual cost of$60,000 per year. Agreement is initially for three years with two one-year renewal options, which would bring the total expected cost over five years to $300,000. ITEM BACKGROUND: In accordance with purchasing policy and BOCC approval on February 17, 2021, a Request for Proposals (RFP) was issued for Workers' Compensation Third Party Claims Administration. Four proposals were received and reviewed by the selection committee on May 24, 2021. The selection committee recommended Relation Insurance Services of Florida, Inc. at an annual cost of $60,000. Relation Insurance is the incumbent vendor, previously known as Employers Mutual, Inc. The company changed their name to Relation Insurance during the term of the currently existing contract. The selection committee members were Mark Gongre, Safety and Security Officer; Maria Slavik, Risk Administrator; Bryan Cook, Employee Services Director. The advisors were Sid Webber, Insurance Consultant and Cynthia Hall, Assistant County Attorney. PREVIOUS RELEVANT BOCC ACTION: September 2016 BOCC executed a five-year agreement with Employers Mutual, Inc. at an annual cost of$73,500. Previous 2009 RFP also awarded the bid to Employers Mutual, Inc. at the annual cost of $70, 918. This agreement with Employers Mutual, Inc. expired on September 30, 2016. CONTRACT/AGREEMENT CHANGES: Contract with Relation Insurance for Workers' Comp TPA STAFF RECOMMENDATION: Approval. Packet Pg. 1124 C.22 DOCUMENTATION: Final 2021 Relation Signed Summary of RFP process TPA Scoring Sheets Exhibit B Relation Proposal FINANCIAL IMPACT: Effective Date: 9/21/2021 Expiration Date: 09/20/2026 Total Dollar Value of Contract: $300,000. Total Cost to County: $300,000. Current Year Portion: 0.00 Budgeted: Yes Source of Funds: Primary Ad Valorem -Internal Service Fund. CPI: No Indirect Costs: 0.00 Estimated Ongoing Costs Not Included in above dollar amounts: 0.00 Revenue Producing: No If yes, amount: Grant: No County Match: No Insurance Required: Workers' Compensation: Statutory Employers' Liability: $1 million General Liability: $1 million Vehicle Liability: $1 million Professional Liability: $1 million Additional Details: Annual Contract amount is $60,000. REVIEWED BY: Bryan Cook Skipped 07/06/2021 9:31 AM Mark Gongre Skipped 07/06/2021 9:31 AM Christine Hurley Skipped 07/06/2021 9:31 AM Bryan Cook Skipped 07/06/2021 9:41 AM Cynthia Hall Completed 07/06/2021 9:42 AM Assistant County Administrator Christine Hurley Skipped 07/06/2021 9:41 AM Purchasing Completed 07/06/2021 9:58 AM Budget and Finance Completed 07/06/2021 4:22 PM Purchasing Skipped 07/06/2021 9:47 AM Maria Slavik Completed 07/06/2021 6:06 PM Budget and Finance Skipped 07/06/2021 9:46 AM Packet Pg. 1125 C.22 Liz Yongue Completed 07/07/2021 9:57 AM Board of County Commissioners Pending 07/21/2021 9:00 AM Maria Slavik Skipped 07/06/2021 9:46 AM Packet Pg. 1126 MONROE COUNTY CONTRACTFOR Workers Compensation Third Party Claims Administration Services CL THIS AGREEMENT is made and entered into this 21 st day of September 2021 by MONROE COUNTY ("COUNTY"), a political subdivision of the State of Florida, whose address is 1100 Simonton Street, Key West, Florida 33040 and Relation Insurance Services of Florida, Inc. ("CONTRACTOR"), whose address is 700 SE Central Parkway, Stuart, FL 34994. 0 Section 1. SCOPE OF SERVICES 0 CONTRACTOR shall do, perform and carry out in a professional and proper manner certain duties as described in the Scope of Services (Exhibit A) and CONTRACTORRs Proposal (Exhibit B), both of which are attached hereto and made a part of this agreement. c CONTRACTOR shall provide the scope of services in Exhibit A for COUNTY. CONTRACTOR warrants that it is authorized by law to engage in the performance of the activities herein described, subject to the terms and conditions set forth in these Agreement documents. The CONTRACTOR shall at all times exercise independent, professional judgment and shall assume professional responsibility for the services to be provided. Contractor shall provide services using the following standards, as a minimum requirement: A. The CONTRACTOR shall maintain adequate staffing levels to provide the services required under the Agreement resulting from this RFP process. B. The personnel shall not be employees of or have any contractual relationship with the County. To the extent that Contractor uses subcontractors or independent contractors, this Agreement specifically requires that subcontractors and independent contractors shall not be an employee of or have any contractual relationship with County. C. All personnel engaged in performing services under this Agreement shall be fully c qualified, and, if required, to be authorized or permitted under State and local law to perform such services. .� Section 2. COUNTY'S RESPONSIBILITIES 2.1 Provide all best available information as to the COUNTY'S requirements for the scope of services described in Exhibit A to this Agreement. 2.2 Designate in writing a person with authority to act on the COUNTY'S behalf on all matters concerning said services. 2.3 Provide a schedule that is mutually agreeable to the COUNTY and CONTRACTOR. cv Section 3. TERM OF AGREEMENT 3.1 The initial Agreement will be for a three (3) year term beginning the 21 st day of September, 2021 and renewable at the County's option for two (2) additional consecutive one year terms. 3.2 The Contractor must provide at least ninety (90) days' notice of intent to terminate. The County must provide the Contractor with at least thirty (30) days' notice of intent to 1 Packet Pg. 1127 terminate. If either party desires to modify this Agreement, it shall notify the other in writing at least thirty (30) days prior to the effective date of such modification. In the case of proposed modification the party receiving the notification of the proposed modification shall itself notify the other party within ten (10) days after receipt of notice of its agreement to the proposed modification. Failure to do so shall terminate thisCL Agreement. Section 4. COMPENSATION c Compensation to CONTRACTOR shall be as shown in the Proposal submitted by the Contractor (attached as Exhibit B), including the following: Claims Administration Cost Per Claim Cost Per Run-off Claim Workers' Compensation Flat Annual Fee (inclusive of $60,000.00 all medical claim and indemnity claim handling) Charge of Reducing Medical Bills to State Fee Schedule Flat Annual Fee (payable in Included in above U- 4- monthly installments) c Other Savings to Monroe County as Minimum of 25% off the state fee schedule a result of using TPA network Injury Hel line: $50 per call Subrogation: 10% of recoveryv c Section 5. PAYMENT TO CONTRACTOR 5.1 Payment will be made according to the Florida Local Government Prompt Payment Act. Any request for payment must be in a form satisfactory to the Clerk of Courts for Monroe County (Clerk). The request must describe in detail the services performed and the - payment amount requested. The CONTRACTOR must submit invoices to the appropriate offices, addressed to Mark Gongre, Safety & Security Administrator, c/o Gato Building, 1100 Simonton St., Key West FL 33040. Employee Services will review a, the request, note his/her approval on the request and forward it to the Clerk for payment. 5.2 Continuation of this Agreement is contingent upon annual appropriation by Monroe County. Section 6. CONTRACT TERMINATION Either party may terminate this Agreement because of the failure of the other party to perform its obligations under the Agreement. COUNTY may terminate this Agreement with or without cause upon thirty (30) days' notice to the CONTRACTOR. CONTRACTOR may terminate this Agreement with or without cause upon ninety (90) days' notice to the COUNTY. COUNTY shall pay CONTRACTOR for work performed through the date of termination. 2 Packet Pg. 1128 Section 7. CONTRACTOR'S ACCEPTANCE OF CONDITIONS A. CONTRACTOR hereby agrees that he has carefully examined the Request for Proposal for Workers' Compensation Claims Administration Services (RFP), its response, and this Agreement and has made a determination that he/she/it has the personnel, equipment, CL and other requirements suitable to perform this work and assumes full responsibility therefore. The provisions of the Agreement shall control any inconsistent provisions contained in the specifications. All specifications have been read and carefully considered by CONTRACTOR, who understands the same and agrees to their sufficiency for the work to be done. Under no circumstances, conditions, or situations shall this Agreement be more strongly construed against COUNTY than against CONTRACTOR. B. Any ambiguity or uncertainty in the specifications shall be interpreted and construed by COUNTY, and its decision shall be final and binding upon all parties. C. The passing, approval, and/or acceptance by COUNTY of any of the services furnished by CONTRACTOR shall not operate as a waiver by COUNTY of strict compliance with the terms of this Agreement, and specifications covering the services. D. CONTRACTOR agrees that County Administrator or his designated representatives may visit CONTRACTOR'S facility (ies) periodically to conduct random evaluations of services during CONTRACTOR'S normal business hours. E. CONTRACTOR has, and shall maintain throughout the term of this Agreement, appropriate licenses and approvals required to conduct its business, and that it will at all times conduct its business activities in a reputable manner. Proof of such licenses and approvals shall be submitted to COUNTY upon request. Section 8. NOTICES Any notice required or permitted under this agreement shall be in writing and hand delivered or mailed, postage prepaid, to the other party by certified mail, returned receipt requested, to the following: c To the COUNTY: Mark Gongre, Monroe County Safety and Security Administrator 1100 Simonton Street, Suite 2-268 Key West, Florida 33040 With a copy to: Monroe County Attorney's Office 1111 121h St., Suite 408 Key West, FL 33040 To the CONTRACTOR: Tim McCreary Relation Insurance Services of Florida, Inc. 700 SE Central Parkway Stuart, FL 34994 With a copy to: Relation Insurance Services of Florida, Inc. Attn: Legal Department 9225 Indian Creek Parkway, Suite 700 Overland Park, KS 66210 Section 9. RECORDS 3 Packet Pg. 1129 CONTRACTOR shall maintain all books, records, and documents directly pertinent to performance under this Agreement in accordance with generally accepted accounting principles consistently applied. Each party to this Agreement or their authorized representatives shall have reasonable and timely access to such records of each other party to this Agreement for public records purposes during the term of the agreement and for five years following theCL termination of this Agreement. If an auditor employed by the COUNTY or Clerk determines that monies paid to CONTRACTOR pursuant to this Agreement were spent for purposes not authorized by this Agreement, the CONTRACTOR shall repay the monies together with interest calculated pursuant to Section 55.03 of the Florida Statutes, running from the date the monies were paid to CONTRACTOR. 0 Section 10. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NO. 010-1990 0 The CONTRACTOR warrants that it has not employed, retained or otherwise had act on its behalf any former County officer or employee subject to the prohibition of Section 2 of Ordinance No. 010-1990 or any County officer or employee in violation of Section 3 of Ordinance No. 020-1990. For breach or violation of this provision the COUNTY may, in its discretion, terminate this agreement without liability and may also, in its discretion, deduct from the agreement 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. Section 11. CONVICTED VENDOR A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on an Agreement with a public entity for the a, construction or repair of a public building or public work, may not perform work as a CONTRACTOR, supplier, subcontractor, or CONTRACTOR under Agreement with any public entity, and may not transact business with any public entity in excess of the threshold amount provided in Section 287.017 of the Florida Statutes, for the Category Two for a period of 36 months from the date of being placed on the convicted vendor list. c Section 12. GOVERNING LAW, VENUE, INTERPRETATION, COSTS AND FEES This Agreement shall be governed by and construed in accordance with the laws of the State of Florida applicable to Agreements made and to be performed entirely in the State. In the event that any cause of action or administrative proceeding is instituted for the enforcement or interpretation of this Agreement, the COUNTY and CONTRACTOR agree that venue shall lie in the appropriate court or before the appropriate administrative body in Monroe County, Florida. cv Section 13. SEVERABILITY If any term, covenant, condition or provision of this Agreement (or the application thereof to any circumstance or person) shall be declared invalid or unenforceable to any extent by a court of competent jurisdiction, the remaining terms, covenants, conditions and provisions of this Agreement, shall not be affected thereby; and each remaining term, covenant, condition and provision of this Agreement shall be valid and shall be enforceable to the fullest extent permitted by law unless the enforcement of the remaining terms, covenants, conditions and provisions of this Agreement would prevent the accomplishment of the original intent of this Agreement. The COUNTY and CONTRACTOR agree to reform the Agreement to replace any stricken provision 4 Packet Pg. 1130 with a valid provision that comes as close as possible to the intent of the stricken provision. Section 14. ATTORNEYS FEES AND COSTS The COUNTY and CONTRACTOR agree that in the event any cause of action or administrative CL proceeding is initiated or defended by any party relative to the enforcement or interpretation of this Agreement, the prevailing party shall be entitled to reasonable attorney's fees, and court costs, as an award against the non-prevailing party. Mediation proceedings initiated and c conducted pursuant to this Agreement shall be in accordance with the Florida Rules of Civil Procedure and usual and customary procedures required by the Circuit Court of Monroe County. Section 15. BINDING EFFECT The terms, covenants, conditions, and provisions of this Agreement shall bind and inure to the benefit of the COUNTY and CONTRACTOR and their respective legal representatives, successors, and assigns. Section 16. AUTHORITY Each party represents and warrants to the other that the execution, delivery and performance of this Agreement have been duly authorized by all necessary County and corporate action, as required by law. Section 17. ADJUDICATION OF DISPUTES OR DISAGREEMENTS COUNTY and CONTRACTOR agree that all disputes and disagreements shall be attempted to be resolved by meet and confer sessions between representatives of each of the parties. If no resolution can be agreed upon within 30 days after the first meet and confer session, then any party shall have the right to seek such relief or remedy as may be provided by this Agreement or by Florida law. This Agreement shall not be subject to arbitration. c Section 18. COOPERATION In the event any administrative or legal proceeding is instituted against either party relating to the formation, execution, performance, or breach of this Agreement, COUNTY and - CONTRACTOR agree to participate, to the extent required by the other party, in all proceedings, hearings, processes, meetings, and other activities related to the substance of this Agreement or provision of the services under this Agreement. COUNTY and CONTRACTOR specifically agree that no party to this Agreement shall be required to enter into any arbitration proceedings related to this Agreement. CD cv Section 19. NONDISCRIMINATION The parties agree that there will be no discrimination against any person, and it is expressly understood that upon a determination by a court of competent jurisdiction that discrimination has occurred, this Agreement automatically terminates without any further action on the part of any party, effective the date of the court order. The parties agree to comply with all Federal and Florida statutes, and all local ordinances, as applicable, relating to nondiscrimination. These include but are not limited to: 1) Title VII of the Civil Rights Act of 1964 (PL 88-352), which prohibit discrimination in employment on the basis of race, color, religion, sex, and national 5 Packet Pg. 1131 origin; 2) Title IX of the Education Amendment of 1972, as amended (20 USC §§ 1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; 3) Section 504 of the Rehabilitation Act of 1973, as amended (20 USC § 794), which prohibits discrimination on the basis of handicaps; 4) The Age Discrimination Act of 1975, as amended (42 USC §§ 6101- 6107), which prohibits discrimination on the basis of age; 5) The Drug Abuse Office and Treatment Act of 1972 (PL 92-255), as amended, relating to nondiscrimination on the basis of drug abuse; 6) The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act of 1970 (PL 91-616), as amended, relating to nondiscrimination on the basis of alcohol abuse or alcoholism; 7) The Public Health Service Act of 1912, §§ 523 and 527 (42 USC §§ 690dd-3 and 290ee-3), as amended, relating to confidentiality of alcohol and drug abuse patent records; 8) Title VIII of the Civil Rights Act of 1968 (42 USC §§ 3601 et seq.), as amended, relating to nondiscrimination in the sale, rental or financing of housing; 9) The Americans with Disabilities Act of 1990 (42 USC §§ 1201), as amended from time to time, relating to nondiscrimination in employment on the basis of disability; 10) Monroe County Code Chapter 13, Article VI, which prohibits discrimination on the basis of race, color, sex, religion, national origin, ancestry, sexual orientation, gender identity or expression, familial status or age; and 11) any other nondiscrimination provisions in any federal or state statutes which may apply to the parties to, or the subject matter of, this Agreement. Section 20. COVENANT OF NO INTEREST 4- 0 COUNTY and CONTRACTOR covenant that neither presently has any interest, and shall not acquire any interest, which would conflict in any manner or degree with its performance under this Agreement, and that only interest of each is to perform and receive benefits as recited in this Agreement. Section 21. CODE OF ETHICS COUNTY agrees that officers and employees of the COUNTY recognize and will be required to comply with the standards of conduct for public officers and employees as delineated in Section c 112.313, Florida Statutes, regarding, but not limited to, solicitation or acceptance of gifts; doing business with one's agency; unauthorized compensation; misuse of public position, conflicting employment or contractual relationship; and disclosure or use of certain information. Section 22. NO SOLICITATION/PAYMENT ) The COUNTY and CONTRACTOR warrant that, in respect to itself, it has neither employed nor retained any company or person, other than a bona fide employee working solely for it, to solicit or secure this Agreement and that it has not paid or agreed to pay any person, company, corporation, individual, or firm, other than a bona fide employee working solely for it, any fee, commission, percentage, gift, or other consideration contingent upon or resulting from the award or making of this Agreement. For the breach or violation of the provision, the CONTRACTOR agrees that the COUNTY shall have the right to terminate this Agreement without liability and, at its discretion, to offset from monies owed, or otherwise recover, the full amount of such fee, commission, percentage, gift, or consideration. Section 23. PUBLIC ACCESS/ PUBLIC RECORDS The COUNTY and CONTRACTOR shall allow and permit reasonable access to, and inspection of, all documents, papers, letters or other materials in its possession or under its control subject 6 Packet Pg. 1132 to the provisions of Chapter 119, Florida Statutes, and made or received by the COUNTY and CONTRACTOR in conjunction with this Agreement; and the COUNTY shall have the right to unilaterally cancel this Agreement upon violation of this provision by CONTRACTOR. Pursuant to Section 119.0701, Florida Statutes, the contractor at all times must comply withCL Florida public records law, specifically, to: 1. Keep and maintain public records required by the public agency to perform the service. 2. Upon request from the public agency's custodian of public records, provide the public agency with a copy of the requested records or allow the records to be inspected or copied within a reasonable time at a cost that does not exceed the cost provided in this chapter or as otherwise provided by law. 3. Ensure that public records that are exempt or confidential and exempt from public records disclosure requirements are not disclosed except as authorized by law for the duration of the contract term and following completion of the contract if the contractor does not transfer the records to the public agency. 4. Upon completion of the contract, transfer, at no cost, to the public agency all public records in possession of the contractor or keep and maintain public records required by the public agency to perform the service. If the contractor transfers all public records to the public agency upon completion of the contract, the contractor shall destroy any c duplicate public records that are exempt or confidential and exempt from public records disclosure requirements. If the contractor keeps and maintains public records upon completion of the contract, the contractor shall meet all applicable requirements for retaining public records. All records stored electronically must be provided to the public agency, upon request from the public agency's custodian of public records, in a format that is compatible with the information technology systems of the public agency. y c A request to inspect or copy public records relating to a COUNTY contract must be made directly to the COUNTY, but if the COUNTY does not possess the requested records, the W COUNTY shall immediately notify the CONTRACTOR of the request, and the CONTRACTOR must provide the records to the COUNTY or allow the records to be inspected or copied within a reasonable time. - If the CONTRACTOR does not comply with the COUNTY's request for records, the COUNTY shall enforce the public records contract provisions in accordance with the contract, notwithstanding the COUNTY's option and right to unilaterally cancel this contract upon violation of this provision by the CONTRACTOR. A CONTRACTOR who fails to provide the public records to the COUNTY or pursuant to a valid public records request within a reasonable time may be subject to penalties under section 119.10, Florida Statutes. The CONTRACTOR shall not transfer custody, release, alter, destroy or otherwise dispose of any public records unless or otherwise provided in this provision or as otherwise provided by law. IF THE CONTRACTOR HAS QUESTIONS REGARDING THE APPLICATION OF CHAPTER 119, FLORIDA STATUTES, TO THE Packet Pg. 1133 CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING TO THIS CONTRACT, CONTACT THE MONROE COUNTY CUSTODIAN OF PUBLIC RECORDS, BRIAN BRADLEY, AT (305) 292-34709 1111 12T" ST., CL KEY WEST, FL 33040. 0 Section 24. NON-WAIVER OF IMMUNITY Notwithstanding the provisions of Sec. 768.28, Florida Statutes, the participation of the COUNTY and the CONTRACTOR in this Agreement and the acquisition of any commercial c liability insurance coverage, self-insurance coverage, or local government liability insurance pool coverage shall not be deemed a waiver of immunity to the extent of liability coverage, nor shall any Agreement entered into by the COUNTY be required to contain any provision for waiver. 0 Section 25. PRIVILEGES AND IMMUNITIES All of the privileges and immunities from liability, exemptions from laws, ordinances, and rules and pensions and relief, disability, workers' compensation, and other benefits which apply to the activity of officers, agents, or employees of any public agents or employees of the COUNTY, when performing their respective functions under this Agreement within the territorial limits of c the COUNTY shall apply to the same degree and extent to the performance of such functions and duties of such officers, agents, volunteers, or employees outside the territorial limits of the COUNTY. Section 26. LEGAL OBLIGATIONS AND RESPONSIBILITIES Non-Delegation of Constitutional or Statutory Duties. This Agreement is not intended to, nor shall it be construed as, relieving any participating entity from any obligation or responsibility imposed upon the entity by law except to the extent of actual and timely performance thereof by any participating entity, in which case the performance may be offered in satisfaction of the obligation or responsibility. Further, this Agreement is not intended to, nor shall it be construed �-- as, authorizing the delegation of the constitutional or statutory duties of the COUNTY, except to the extent permitted by the Florida constitution, state statute, and case law. Section 27. NON-RELIANCE BY NON-PARTIES No person or entity shall be entitled to rely upon the terms, or any of them, of this Agreement to enforce or attempt to enforce any third-party claim or entitlement to or benefit of any service or program contemplated hereunder, and the COUNTY and the CONTRACTOR agree that neither the COUNTY nor the CONTRACTOR or any agent, officer, or employee of either shall have the authority to inform, counsel, or otherwise indicate that any particular individual or group of individuals, entity or entities, have entitlements or benefits under this Agreement separate and apart, inferior to, or superior to the community in general or for the purposes contemplated in this Agreement. Section 28. ATTESTATIONS CONTRACTOR agrees to execute such documents as the COUNTY may reasonably require, 8 Packet Pg. 1134 including, but not being limited to, a Public Entity Crime Statement, an Ethics Statement, and a Drug-Free Workplace Statement, Lobbying and Conflict of Interest Clause, and Non-Collusion Agreement. Section 29. NO PERSONAL LIABILITY No covenant or agreement contained herein shall be deemed to be a covenant or agreement of any member, officer, agent or employee of Monroe County in his or her individual capacity, and c no member, officer, agent or employee of Monroe County shall be liable personally on this Agreement or be subject to any personal liability or accountability by reason of the execution of this Agreement. E Section 30. EXECUTION IN COUNTERPARTS This Agreement may be executed in any number of counterparts, each of which shall be regarded as an original, all of which taken together shall constitute one and the same instrument and any of the parties hereto may execute this Agreement by signing any such counterpart. Section 31. SECTION HEADINGS Section headings have been inserted in this Agreement as a matter of convenience of reference only, and it is agreed that such section headings are not a part of this Agreement and will not be used in the interpretation of any provision of this Agreement. Section 32. INSURANCE POLICIES 32.1 General Insurance Requirements for Other Contractors and Subcontractors. As a pre-requisite of the work governed, the CONTRACTOR shall obtain, at his/her own expense, insurance as specified in Exhibit C, which is made part of this contract. The CONTRACTOR will ensure that the insurance obtained will extend protection to all Subcontractors engaged by the CONTRACTOR. As an alternative, the CONTRACTOR may c require all Subcontractors to obtain insurance consistent with Exhibit C; however CONTRACTOR is solely responsible to ensure that said insurance is obtained and shall submit proof of insurance to COUNTY. Failure to provide proof of insurance shall be grounds for termination of this Agreement. The CONTRACTOR will not be permitted to commence work governed by this contract 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 CONTRACTOR to provide satisfactory evidence of 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 commenced on the specified date and time, except for the CONTRACTOR's failure to provide satisfactory evidence. The CONTRACTOR 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 all work until the required insurance has been reinstated or replaced and/or termination of this Agreement and for damages to the COUNTY. Delays in the completion of work resulting from the failure of the CONTRACTOR 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 9 Packet Pg. 1135 suspended, except for the CONTRACTOR's failure to maintain the required insurance. The CONTRACTOR shall provide, to the COUNTY, as satisfactory evidence of the required insurance, either: CL • Certificate of Insurance 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. E All insurance policies must specify that they are not subject to cancellation, 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. 0 The acceptance and/or approval of the Contractor's insurance shall not be construed as relieving the Contractor from any liability or obligation assumed under this contract or imposed by law. Monroe County Board of County Commissioners, its employees and officials will be included as "Additional Insured" on all policies, except for Workers' Compensation (including Employers' Liability and Professional Liability). Section 33. INDEMNIFICATION The CONTRACTOR does hereby consent and agree to indemnify and hold harmless the COUNTY, its Mayor, the Board of County Commissioners, appointed Boards and Commissions, Officers, and the Employees, and any other agents, individually and collectively, from all fines, suits, claims, demands, actions, costs, obligations, attorneys' fees, or liability of any kind arising out of the sole negligent actions of the CONTRACTOR or substantial and unnecessary delay c caused by the willful nonperformance of the CONTRACTOR and shall be solely responsible and answerable for any and all accidents or injuries to persons or property arising out of its performance of this contract. The amount and type of insurance coverage requirements set forth hereunder shall in no way be construed as limiting the scope of indemnity set forth in this paragraph. Further the CONTRACTOR agrees to defend and pay all legal costs attendant to ) acts attributable to the sole negligent act of the CONTRACTOR. At all times and for all purposes hereunder, the CONTRACTOR is an independent contractor and not an employee of the Board of County Commissioners. No statement contained in this agreement shall be construed so as to find the CONTRACTOR or any of his/her employees, contractors, servants or agents to be employees of the Board of County Commissioners for Monroe County. As an independent contractor the CONTRACTOR shall provide independent, professional judgment and comply with all federal, state, and local statutes, ordinances, rules and regulations applicable to the services to be provided. The CONTRACTOR shall be responsible for the completeness and accuracy of its work, plan, supporting data, and other documents prepared or compiled under its obligation for this project, and shall correct at its expense all significant errors or omissions therein which may be 10 Packet Pg. 1136 disclosed. The cost of the work necessary to correct those errors attributable to the CONTRACTOR and any damage incurred by the COUNTY as a result of additional costs caused by such errors shall be chargeable to the CONTRACTOR. This provision shall not apply to any maps, official records, contracts, or other data that may be provided by the COUNTY or other public or semi-public agencies. CL The CONTRACTOR agrees that no charges or claims for damages shall be made by it for any delays or hindrances attributable to the COUNTY during the progress of any portion of the services specified in this contract. Such delays or hindrances, if any, shall be compensated for by the COUNTY by an extension of time for a reasonable period for the CONTRACTOR to complete the work schedule. Such an agreement shall be made between the parties. 0 IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on the 21st day of June 2021. (SEAL) MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Attest: KEVIN MADOK, CLERK OF MONROE COUNTY, FLORIDA By by As Deputy Clerk Mayor/Chairman Date: (CORPORATE SEAL) Relation In as S 'ruices ar fAbrida, Inc. ATTEST: c By SEE BELOW by Print Name: Edward Nathan Page Title: President Date: June 21, 2021 cv CD cv 76 LL 11 Packet Pg. 1137 disclosed. The cost of the work necessary to correct those errors attributable to the CONTRACTOR and any damage incurred by the COUNTY as a result of additional costs caused by such errors shall be chargeable to the CONTRACTOR. This provision shall not apply to any maps, official records, contracts, or other data that may be provided by the COUNTY or CL ether public or semi-public agencies. e® 0 The CONTRACTOR agrees that no charges or claims for damages shall be made by it for any delays or hindrances attributable to the COUNTY during the progress of any portion of the services specified in this contract. Such delays or hindrances, if any, shall be compensated for by the COUNTY by an extension of time for a reasonable period for the CONTRACTOR to complete the work schedule. Such an agreement shall be made between the parties. IN WITNESS WHEREOF, the parties hereto have caused these presents to be executed on the 21st clay of une 2021. ca (SEAL) MONROE COUNTY BOARD OF COUNTY COMMISSIONERS Attest: KEVIN MADOK, CLERK — OF MONROE COUNTY, FLORIDA By SEE ABOVE by SEE ABOVE As Deputy Clerk Mayor/Chairman Date: (CORRO TE SEAL) _ Relation Insurance Services of Florida, Inc. ATTES ; By by SEE ABOVE - Print Name: SEE ABOVE Title: SEE ABOVE Date: SEE ABOVE cv CD cv 11 Packet Pg. 1138 Exhibit A Scope of Services The Administrator will provide the following services. CL ➢ Initial contact with claimant within 24 hours. ➢ Recorded statements of the claimant. c ➢ Contact with the treating physician within 24 hours. ➢ Narrative summaries on major claims every 3 months. ➢ Medical bills reduced to State fee schedule. ➢ All subrogation and Second Injury Fund activities. ➢ Preparation of all State mandated reports. ➢ Notification of all potential excess claims to insurer(s). ➢ Quarterly meetings with the County. ➢ Provide monthly loss reports to the County. ➢ Provide monthly loss reports to the County's consultant. ➢ Provide (or contract to provide) staff to receive incoming calls to the Monroe County Injury Helpline and complete all necessary First Report of Injury paperwork and forward same as appropriate. 4- 0 c r- cv cv 12 Packet Pg. 1139 Exhibit B Proposal from Relation Insurance Services in Response to RFP CL 0 0 c c 4- 0 c cv cv 76 13 Packet Pg. 1140 Exhibit C Required Insurance Coverages CL Coverage Minimum Limits For Commercial General Liability $1,000,000 GL3 Vehicle Liability $1,000,000 VL3 0 Workers' Compensation Statutory WC1 0 CJ Employers Liability $1,000,000/$1,000,000/$1,000,000 Professional Liability $1,000,000 PRO3 0 4- 0 0 0 0 0 0 0 0 0 0 cv CD cv m 0 14 Packet Pg. 1141 C.22.b InteriskCorporation Risk Mgt.&Employee Benefits Consultants 1101 Red Maple Circle N.E.,St. Petersburg, Florida 33703-6318 — telephone: 813-287-1040 www.interisk.net CL May 24, 2021 0 Mr. Mark A. Gongre Workers' Compensation Administrator Monroe County 1100 Simonton Street Suite 2-268 0 Key West, Florida 33040 U Re: Workers'Compensation TPA RFP Mark, Monroe County is a State approved Self-Insurer for their Workers' Compensation claims. As such the County assumes the first $500,000 of each claim with the Florida Municipal Insurance Trust (FMIT) providing excess coverage for claims that exceed $500,000. The County has 0 contracted with Relation Insurance Services of Florida to administer the claims that are valued lower than the County's $500,000 retention. Relation has been providing the County's Third 2 Parry Claims Administration Services since September 21, 2016. Their services include: v) ➢ Administer each claim in accordance with Florida Statute §440. ➢ Pay benefits in accordance with Florida Statute §440. ➢ Reduce medical bills in accordance with the Florida State Fee Schedule. ➢ Provide a Medical Network that offer pricing below the Florida Fee Schedule. ➢ Pursue subrogation where appropriate. ➢ Coordinate the legal defense of claims where appropriate. ➢ Maintain a computer system that provides the County with 24/7 access to their claims and provide the County with monthly loss runs. ➢ Coordinate Managed Care as appropriate. ➢ Pursue settlement of claims were appropriate. c 0. CL The projected annual cost of Relation's current services is estimated at $124,508. It is believed that the County is well pleased with Relation's services. LN To comply with the County's Purchasing protocols a Request for Proposals (RFP)was developed M and posted on Demand Star on March 27, 2021. Proposals were received until May 13, 2021 E when they were publically opened. The County received proposals from the following four (4) � firms. Relations Insurance Services of Florida Johns Eastern Claim Adjusters & Third Parry Administrators Corvel Corporation Cannon Cochran Management Services The County established an Evaluation Committee to review the proposals. The Committee consisted of: Packet Pg. 1142 C.22.b Mr.Mark Gongre May 24,2021 ✓ Mark Gongre ✓ Maria Slavik ✓ Brian Cook The Committee met on May 24, 2021 to discuss the proposals and to rank each proposer in CL accordance with the rating that was specified in the RFP. It was the Committee's unanimous opinion that Relation Insurance Services of Florida submitted the proposal that best served the E County. I concur with the Evaluation Committee's ranking of proposals. c 0 Cordially, 0 INTERISK CORPORATION 0 Sidney G. 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GJ a u ; ; M W 41 W O Packet Pg. 1147 Relation... t f ,,r: 77, r }t E y 1 ', 2021 t" Monroe County Workers' z } CompensationI Third rty Claims Administration Ser m F � ,`- U y: Relation Insurance Services of Florida 700 SE Central Parkway Stuart, FL 34994 4 o tact- Tim McCreary tim.mccreary rlti i sure c .c (772) 1 0. L. CL Packet Pg. 1148 C.22.d Relation... a b o 4e, s t t CL C� 0 U General n r I n Page Number irm's Name, Address and Contact Statement of Services Overview of Firm's Experience 1-14 Explanation of fees, rates Samples of claims and statistical reports Other Terms Proposed Resumes of Key Members W- 0 Ch Relevant Exri nc rCD Response to Relevant Experience -20 Services, Approach andAvailability rvic r Response to Services, Approach and Availability 2 ® 33 Performance Standards '✓ 0 0. 0 Litigation Page Number Contracted Work Judgements Lawsuit or Arbitration X Litigation Against the County ® 5 Failed Services/Goods Customer references Credit References Financial Statements Packet Pg. 1149 C.22.d Loss Runsr Sample Copies -4.5 CountyCL Forms and Licensesr 0 Florida Agency License Certificate of Insurance Proposal Response Form Non-Collusion Affidavit Drug-Free Workplace Form 0 Ordinance No. 10-1090 Ethics Clause 46 5 � Entities Crime Statement Local Preference Form Indemnification Clause 0 Insurance Agent Statement Vendor Certification Regarding Scrutinized Companies List Countyc i n r Lost Time Adjuster/Medical Only Statement Maximum Number of Cases New Adjuster Protocol FCM 0. Legal Services 0. State Assessed Fines and Penalties 60®63 Access to Claims System Monroe County Providers/PP Administrative Instruction 7440.4 Annual Fee Additional Information Page Number Insight, Knowledge, Skills, Abilities and Additional Services 64-65 Packet Pg. 1150 C.22.d Other Information r Confirmation to Comply with Terms 66 CL TAB 10— Proposal Response Forms Page Number 0 Completed Proposal Response Forms 6 - 0 0 0 4- 0 CL 0 0 0 0 0 0 0 Packet Pg. 1151 1 wf Monroe County Workers' C 22 d Third Party Claims Administ . fli t,r,If e r,;,�r e s tr F,,{;pr7 F 1 1��,£` =r ,vriw. r I Uo V £ £,'°' r U ,rt 't,<junL ,, CL 4 14ttt 4t 4 h {� t '� 4t 4t 4t £ l��lr t £ T t '¢' r 3.F }tS ..,, v6,. ?,.,6.,., �, �'X )6 ..a-,,,.. r .s .£....,v .$.l, h... 1, ��°t (.,v. I i I�,.<1 F.I b,vf lala c`a L' v #`f t y. t £fl L, 4 t,< ,£fL ., O f/$ TAB 1-General Information O (a) The name of the firm submitting proposal, address, contact person's name,telephone numbers, email address and the name of the individual authorized to sign for the proposing organization. 11 .[. . . [ ,,. a .. ,. 0 s,s sl O ca , 0 �. ..It ?:. rm S.. .;w;4 Tim.McCreary@relationinsurance.com € r O (b) A clear statement of what services are being proposed. If more than one type of service or plan is proposed, separate proposals must be made for each one so that they can be reviewed y independentlyof any other service or benefit plan. e.:..,�...,.r 11 .[`.{.,.,�s[.,. ..,!:� ,.,.,,.`. s` .,.r..,.,r` .[,,, ,_r.[....[{.,t.:i.rh !.,.r.`s,,..` �,...;_r .,! f`,�...,.r.'f i.L.�h ,',,� , (. .`� "�"< O V O (c) An overview of the firm's experience along with a summary of experience with Government Entities. 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[�,, ` t........ ..........� ..,t f✓( a.,., ..,.�,z ,1 'F ..,,J ,J.t. �.. [.J! r i,. i, 4 1 1f[ fit ...[:` ..[l .`. i., ..,. � €.,. ( . Et . ..[�' .J.. ...E'.,.[z,r�,J..e.. ,JrI ea On ..s C�. .:st ., .t Packet Pg. 1152 1 wf Monroe County Workers' C 22 d Third Party Claims Administ - CL iac-) .. .a .ter �26; s ll:.,s f ,I<<,t fmS J! ..<-ne �.�[.. "o�fm�[,t ,�� (h:,I�.:[,t`. a�fm:..�[ .,(,s..,dn ,.;t .[,.,(..`3:. .r .., [�,z.s,��.t.....`.r ;_r. �,a.,:�...[ �Jt..[ti, ...`. ;..,iv�...[,i t...,,� f..`. ` .`F ( [ jW t �,, 1 t �I r� 1 �� e ,� e 1 �h�.� t ,��= o [ w, w ..L,.,i t .. w,...� fJ .,., .. .. ... .(. [ ,E.. f!9 (d) Explanation of fees, rates. �t.,1z.(. z.�.t. �.,� .,z.,�� ,<<z,(. , n o (e) Samples of any claims and statistical reports. 0 t. ". . '. t '. !. t. . ; ...'. .;t..r '.. 0 (f) Other terms proposed. Please be specific regarding amounts and time schedule. 0 '17 rl r f -t i s-I..c., f fJ,Iz l- e'., Pq ," 0 U (g) Resumes of all key members of the account team who will be assigned including professional designations. 0 0 0 0. 0 L. CL 0 X LU Packet Pg. 1153 C.22.d Relation Insurance Services 70ii SE[ F`I`t,J 7....%R�RIrk N'f l lrn!,, 34 I'M `a C,) 9, 112,21 Rix iTY2'1 _8, 87 f+_I o! t'o C,u r„Ire Tim McCreary, CPCU, RPLU, CRIS & M.B.A �. I President—Relation Insurance Services of Florida, Inc. E Tim s direct responsibilities as President are: Analyzes and placement of larger, more complex insurance programs for risk sharing pools and individual commercial accounts. Provide clients with financial discipline and capital management tools to maintain properly funded self-insurance programs. o Design and implement innovative solutions to optimize insurance program's return on investment. Ensure that internal quality controls and processes are being maintained to provide highest service standards to clients. Accountable for achieving strategic objectives, ensuring effective enterprise management and profitability for Ascension Benefits & Insurance Solutions of Florida. Experience Relation Insurance Services of Florida, Inc. -Stuart, FL 2005 to present 0 • Administrator for controlling total cost of risk for several municipal insurance pools in Florida. • Design and negotiate multi-billion dollar layered property programs • Drive performance improvements for operations, finances, strategy and organizational development in a collaborative effort with all clients and internally. 0 General Reinsurance—Atlanta, GA 2002 to 2005 • Developed creative alternative risk programs for national account casualty business. • Evaluated financial risk in conformance with underwriting policies, procedures and y methodologies; keeping in mind overall corporate profit objectives. 0 Education University of Tampa 2000 W Master of Business Administration University of Tennessee 1994 Bachelor of Science - Political Science and Business Administration CL Chartered Property Casualty Underwriter-CPCU Registered Professional Liability Underwriter—RPLU Construction Risk Insurance Specialist—CRIS 220 Licenses—General Lines (Property and Casualty) Series 3 - NASD Registered Commodities Representative Florida Real Estate License Professional Associations Chartered Property Casualty Underwriter(CPCU) Risk& Insurance Management Society (RIMS) Public Risk Management Association (PRIMA) Florida Educational Risk Management Association (FERMA) Florida Association of Insurance Agents (FAIA) Florida Government Finance Officers Association (FGFOA) Packet Pg. 1154 C.22.d �F e'iation Insurance Services 700 5 F Cclt v,rA Rv V a iv,+ant, iol,Ul i 3 ,494 CL Cortney Gomer, CWCL 0. Workers' Compensation Manager <<' Cortney's direct responsibilities are: Providing leadership and direction to the workers' compensation team and is accountable for business results through o cost effective and timely resolution of claims. Interact with production, loss , 0 control, actuarial, and policy administration/audit in achieving the best f possible claim outcome and client satisfaction. A "r 0 Experience Relation Insurance Services of Florida-Stuart, FL 2010 to present • Oversees workers' compensation claims to ensure action plans are timely and appropriate. • Provides direction to claim consulting team on claims management expectation and strategies. • Manage compliance for Florida EDI and CPS filing. • Maintains up-to-date knowledge of workers' compensation best practices, statutes, and legislative changes. • Senior Lost Time Adjuster-Managed claims of any variety or complexity such as no lost time, lost time, litigated, death and catastrophic. • Medical bill supervisor- Review performance data for billing team and maintain knowledge of fee schedule and filing changes. 0 Cambridge/Xchanging—Pompano Beach, FL 2009-2010 • Senior Lost Time Adjuster-Managed claims of any variety or complexity such as no lost time, lost time, litigated, death and catastrophic for Third Party Administrator. y • Handled multiple jurisdictions: Florida, Georgia,Alabama, Mississippi,Tennessee, Virginia, South 0. Carolina, North Carolina and Kentucky. CL AmComp/Employers Ins- North Palm Beach, FL 1999—2009 • Senior Lost Time Adjuster-Managed claims of any variety or complexity such as no lost time, lost time, litigated, death and catastrophic for Carrier. • EDI Compliance Coordinator for Employers East,which included 10 jurisdictions. • Intake Coordinator/Claims Assistant/Customer Service Representative Education Palm Beach State College 1999 Associate in Arts WCCP—Worker's Compensation Claims Professional Certified Notary Public bonded through National Notary Association. Florida All Lines -520 license Packet Pg. 1155 Licensee Detail C.22.d Jimmy Patronis 0 Licensee PDetail CJ i� Back to Search 0 License #: 0 D082459 Full Name: 0 GOMER, CORTNEY LYNNE WORLEY Business Address: 700 CENTRAL PARKWAY 0 STUART, FL 34994 4- 0 Mailing Address: 406 PENNOCK LANE > JUPITER, FL 33458 0 0 Email: CORTNEY.GOMER@RELATIONINSURANCE.COM y Phone: 0 (800)431-2221 Ext. 8621 County: Martin y 0 0. NPN 5325047 Continuing Education Statistics CE Due Date: 9/30/2021 LU Continuing Education Status: m Compliant Number of Hours Required: 20 Number of Hours Completed: 20 Packet Pg. 1156 https://Iicenseesearch.fldfs.com/Licensee/471757[5/12/2021 4:52:22 PM] Licensee Detail C.22.d Valid Licenses Type Issue Date Qualifying Appointment ADJUSTER-ALL LINES (0620) 12/24/2002 YES 0 0 Active Appointments ADJUSTER -ALL LINES (0520) Company Name Issue Date Exp Date 0 RELATION INSURANCE SERVICES OF FLORIDA INC 1/11/2010 9/30/2022 0 Invalid Licenses 0 0 Type Issue Date Status 0 ADJUSTER-ALL LINES (0520) 12/24/2002 INVALID ADJUSTER-WORKERS COMP (0524) 7/17/2001 INVALID 0 0 0. 0 0 Inactive Appointments ADJUSTER -ALL LINES (0520) Company Name Issue Date Exp Date Status Date PINNACLE BENEFITS INC (PBI) 1/1/2003 9/30/2009 7/14/2009 CAMBRIDGE INTEGRATED SVCS GRP INC/TPA 2 8/6/2009 9/30/2011 6/7/2010 RELATION INSURANCE SERVICES OF FLORIDA, INC. 1/11/2010 9/30/2020 9/5/2018 Packet Pg. 1157 https://Iicenseesearch.fldfs.com/Licensee/471757[5/12/2021 4:52:22 PM] Licensee Detail C.22.d ADJUSTER -WORKERS COMP (0524) Company Name Issue Date Exp Date Status Date PINNACLE BENEFITS INC (PBI) 8/1/2001 9/30/2003 12/24/2002 CL 0 0 0 0 0 4- 0 CL 0 0 0 0 0 0 x m Packet Pg. 1158 https://Iicenseesearch.fldfs.com/Licensee/471757[5/12/2021 4:52:22 PM] C.22.d �F e'iation Insurance Services 7005 FeCclt'r A PiroV ,r v,v f.�iolUli3 19 CL c s Christina Rodriguez E l t� ` Workers' Compensation Claims Supervisor /o Christina's direct responsibilities are: Working with the Claims Manager to provide leadership and direction to the workers' compensation team and is accountable for business results through cost effective and timely resolution of claims. Employee education/training. Interacts with production, loss control, and policy administration in achieving the best possible claim outcome and client satisfaction. 0 Experience Relation Insurance Services of Florida -Stuart, FL 2002 to present • Oversees workers' compensation claims to ensure action plans are timely and appropriate. • Provides direction to claims team on management expectation and strategies. • Completes file review audits of adjuster files. • Runs/reviews data reports for compliance. • Provides education and maintains up-to-date knowledge of workers' compensation best practices, statutes, and legislative changes. • Senior Lost Time Adjuster-Managed claims of any variety or complexity such as no lost time, lost time, litigated, death and catastrophic. Liberty Medical Supply—Port St. Lucie, FL 2000-2002 • As an Order Processing Agent handled initial and refill of diabetic supplies. • Telephonic representative; handled inbound/outbound calls for diabetic supply orders. • Customer Service; explained supply usage to patients and handled any account complications. `6 0 Issues and Answers—Fort Pierce, FL 1999-2000 0. • The surveys completed were contracted by corporations that wanted information regarding CL their products and services. • Outbound calls were made to obtain public opinions on information such as products, politics, and demographics. • Monitored phone calls to make sure employees were completing the surveys correctly and not biasing or skewing opinions. x Education Indian River State College 2010-2014 All Lines Adjuster License (520) Florida All Lines-520 license 2007 Fort Pierce Central High School Graduate 2000 Health Occupations Students of America - Patient Care Assistant Certification 1999 Packet Pg. 1159 Licensee Detail C.22.d Jimmy Patronis 0 Licensee PDetail CJ i� Back to Search 0 License #: 0 P101281 Full Name: 0 RODRIGUEZ, CHRISTINA MARIE Business Address: 700 CENTRAL PARKWAY 0 STUART, FL 34994 4- 0 Mailing Address: 700 CENTRAL PARKWAY > STUART, FL 34994 0 0 Email: CHRISTINA.RODRIGUEZ@RELATIONINSURANCE.COM y Phone: 0 (772) 287-7650Ext. 4483 County: Martin y 0 0. NPN 9364031 Continuing Education Statistics CE Due Date: 12/31/2021 LU Continuing Education Status: m Compliant Number of Hours Required: 20 Number of Hours Completed: 20 Packet Pg. 1160 https://Iicenseesearch.fldfs.com/Licensee/923780[5/12/2021 4:54:27 PM] Licensee Detail C.22.d Valid Licenses Type Issue Date Qualifying Appointment ADJUSTER-ALL LINES (0620) 6/20/2007 YES 0 0 Active Appointments ADJUSTER -ALL LINES (0520) Company Name Issue Date Exp Date 0 RELATION INSURANCE SERVICES OF FLORIDA INC 6/20/2007 12/31/2021 0 Invalid Licenses 0 0 Type Issue Date Status 0 ADJUSTER-ALL LINES (0520) 6/20/2007 INVALID 0 Inactive Appointments ADJUSTER -ALL LINES (0520) y 0 0. Company Name Issue Date Exp Date Status Date RELATION INSURANCE SERVICES OF FLORIDA, INC. 6/20/2007 12/31/2021 1/2/2020 x m Packet Pg. 1161 https://Iicenseesearch.fldfs.com/Licensee/923780[5/12/2021 4:54:27 PM] C.22.d Relation Insurance Services 700 SE Central Parkway,Stuart,Florida 34994 office(800)431 2221<fax(772)287-1387 'rolationinsurance.coin CL Michelle McMahon Workers' Compensation Medical Only Claims Adjuster o CJ Michelle's direct responsibilities are: Working closely with clients and their Lost Time Claims Adjuster to provide outstanding care for injured workers and be the liaison for their treatment. As part of our Workers' compensation team, she is accountable for business results through cost effective and timely resolution of claims. Michelle's goal is to achieve the best possible claim outcome and client satisfaction. Experience 0 CJ Relation Insurance Services of Florida -Stuart, FL 2016 to present • Medical only adjuster • Manages all aspects of claims handling at a medical only level. • Responsible for managing initial medical and follow up care, scheduling and authorizing 4- appointments and following up for medical reports. o • Responsible for investigation, review of compensability, reserving, subrogation and bill approval. Kogan, Disalvo and Schmitt—Stuart, FL 2015-2016 • Paralegal • Scheduled appointments. • Drafted legal documents to file openings and settlement statements. y • Managed and maintained claim files, gathered records, negotiated claims and medical bills. 0 Goldstein and Associates—Stuart, FL 2012-2015 • Paralegal • Scheduled appointments. • Drafted legal documents to file openings and settlement statements. o • Managed and maintained claim files, gathered records, negotiated claims and medical bills. CL Education All Lines Adjuster License (520) Florida All Lines-520 license 2016 Florida Atlantic University, Boca Raton, FL 2007-2009 - Degree: Bachelor's, Criminal Justice Indian River State College, Fort Pierce, FL 2004-2006 - Degree: Associates in Arts, Paralegal Packet Pg. 1162 Licensee Detail C.22.d Jimmy Patronis 0 Licensee PDetail CJ i� Back to Search 0 License #: 0 W327850 Full Name: 0 MCMAHON, MICHELLE LINDA Business Address: 302 SE TRESSLER DR 0 STUART, FL 34994 4- 0 Mailing Address: 302 SE TRESSLER DR > STUART, FL 34994 0 0 Email: MMCMAHON30@YAHOO.COM y Phone: 0 (772)446-2131 County: Martin y 0 0. NPN 18157261 Continuing Education Statistics CE Due Date: 5/31/2021 LU Continuing Education Status: m Compliant Number of Hours Required: 24 Number of Hours Completed: 24 Packet Pg. 1163 https://Iicenseesearch.fldfs.com/Licensee/1553280[5/12/2021 4:59:56 PM] Licensee Detail C.22.d Valid Licenses Type Issue Date Qualifying Appointment ADJUSTER-ALL LINES (0620) 10/17/2016 YES 0 0 Active Appointments ADJUSTER -ALL LINES (0520) Company Name Issue Date Exp Date 0 RELATION INSURANCE SERVICES OF FLORIDA INC 11/30/2016 5/31/2021 0 Invalid Licenses 0 0 Type Issue Date Status 0 PUBLIC ADJUSTER APPRENTICE LICENSE (T3120) 6/14/2016 INVALID 0 0 0 0 Inactive Appointments ADJUSTER -ALL LINES (0520) Company Name Issue Date Exp Date Status Date 0 MCMAHON, MICHELLE LINDA 11/30/2016 5/31/2019 12/6/2016 RELATION INSURANCE SERVICES OF FLORIDA, INC. 11/30/2016 5/31/2021 5/28/2019 PUBLIC ADJUSTER APPRENTICE LICENSE (T3120) Company Name Issue Date Exp Date Status Date Packet Pg. 1164 https://Iicenseesearch.fldfs.com/Licensee/1553280[5/12/2021 4:59:56 PM] Licensee Detail C.22.d INSURANCE CONSULTANTS GROUP, INC. 6/14/2016 12/14/2017 10/14/2016 •• • O • •. ®-0. • CL 0 0 0 0 0 4- 0 CL 0 0 0 0 0 0 x m Packet Pg. 1165 https://Iicenseesearch.fldfs.com/Licensee/1553280[5/12/2021 4:59:56 PM] 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 2-Relevant Experience CL A record of performance and professional accomplishments by Proposer and employees, including professional accomplishments, and to the extent allowed, any work with large O companies or govern mententities. i� Each year, we strengthen our balance sheet and reputation becouse of a cons iste'r(t tr'-Ick recora O of gww,�Ji ano Over the yean we've also receivea reco,"f"nition frorn Various For the last Him yews running, .elation was na ea a ,.r.f,,,." ...f£. ..,_ 4S firms< on .f`.o.,.,I.fcc., � !n ,..or, where sonic .:Cso.,. �.[.,�.:: �.t.,.r.,�i: �, `.are strugglUji to a a,.rp.. ..,.r .f£.i.w ways of!,<,.ring business, Cb 'R.,,elal,Jon's agile approach to connecting . acts between wee w ess ano technology has O a To p 10 0 P r a�,�� e .;" b", fi. w,a.;a ,,, '�;a a F � "6 .",,, ,ab2a a � ,I,— "Tor) 100 P �, a e 0 y a< � s. �,�� e .;" b",tfi. w,a.,a �,,, '�;aa F by "6 .",,, ,ab2a a Relation has also ryceivea the Elite Agency awara from insurance Business America for the last U) th(re'e, yc',--irs- i`.aditionally, owl year insurance Business Anunica surveys its to cultivate O an impressive list of women it hc).(: '-Ind s`f"'wc., th(c.,-n. �.. r . ' e"� Idea ,. �- � !. -b: x ._ # 2 d a2, , w„ 0�6�"� � � .a,. , ,4daa wti.� ,d ",o�� o„ ., o w ?,w..w„�,� "-it was honoroa as one of thic., indus.hy's "Elite Ar`onr�en.- a "2017 Elite Agency" by I„ u air „��a � Business ... e ic,,—1 t8 Agency" y 0. C. O "'f 2 - Ea a s ent a wrote and rnklishea ana e The TrueKey To SuccessO U Packet Pg. 1166 1 wf Monroe County Workers' C 22 d Third Party Claims Administ Please find the list of similar contracts or agreements we currently have in force: !`„, Gtv ol ,' ;,5 CL .�... . ' !."� , 1 ram, ir9 `e 2- 0 ` �_". !.,.r:`'.,,..`. ..AAS .,t.St`„�,....r:11 ,�. D, ...t� .t .. �. ,�...°`� ..,t.,,; , ... .,.±±tit. ,t..[�: �`: U ..S . ,.,..,. .. .r. .� . ... ; _349 u32 Q 0 ..a •,,.. � ... ,.,.,,.".. .U) ` ."r.. ..!.SC`.,�... 1..1e .t I I HUY ,�..".°`� ..,.±.,,i,s N 0 0. 0 CL X U Packet Pg. 1167 ,C.22.d The True Success 0 0 CULTURE 0 BY ED PAGE c "Being is ii a good company and a great ." —Brian Kristofek,, president and CEO of Upshot, in Entrepreneur In almost 30 years of working with and leading many profitability and last year had the best financial performance different organizations, I have seen that culture matters in our company's history. cu more to success than does any other factor. Energized W Here are 10 ways we have created a fun, high-performing employees who are enthusiastic about the work they do,and culture: the environment in which they do it,will have a dramatically y bigger impact than those who aren't.Whether they're 1.Walkthewalk.Senior leaders set the tone for any 0. creating a better customer experience,finding ways to organization.Your employees see everything you do—your CL improve profitability,or helping recruit other energized and work habits,the way you treat people,your consistency(or enthusiastic employees,they create a virtuous cycle that lack thereof),and the behaviors you demonstrate every c continually builds upon itself. day.While words matter,leaders'actions matter far more. This is not new or original thinking.The question then is not Culture is always set from the top and created by example— so much why business leaders should focus on building a so strive to bean excellent one. great culture,but rather how. At Relation,we do a number of the things to help demonstrate the culture we want to have. For example,each employee gets I'm proud of what we've created at Relation Insurance LU a handwritten note from myself and our CEO,Joe Tatum,to Services.Over the past five years,since I first joined, celebrate 5, 10, 15 years and so on at the company. we've transformed from a low-morale,low-performing organization into a high-morale,high-performing one.We We recently introduced a sales training program that wasn't measure ourselves through quarterly internal employee an easy thing to learn but has tons of value when fully surveys and external metrics,such as our Glassdoor embraced.The head of our sales teams and I committed to rating, both of which have consistently and significantly handwriting the key program from memory every day for improved over time. Not surprisingly,our financial results 10 days and emailing it to the sales team to show we did it. have also dramatically improved—we've nearly doubled our It's highly unlikely that I will ever be in a position to use the Packet Pg. 1168 u " C.22.d �ar C' 7 j {j Itt 0 77 a. . .F+ c �,W., ,wn 0 1 ew l y1� & � t 9 � f JJ 0 EL 4— program myself,but it was important to demonstrate how creating a company that will last for hundreds of years and important we thought it was and how committed senior act accordingly.Always try to do the right thing,no matter W leadership is to it. how painful it is. Similarly,although I have an assistant, I do my own Severalyears ago,we created a task force to find ways to expenses.Since we require all employees to use our improve the experience of our customer service and support U expense-management system, I think it's only fair that I teams.It was driven by members of those teams,and they deal with the same system they do,so I can share their came up with the idea of a week-long celebration to saythank y frustrations and also help drive improvements. you to the service teams,which are often underappreciated in 2.Be authentic. Nothing kills culture quicker than a lack of our business.We were having a tough financial year,as we were still working on improving many aspects of the business,and sincerity. If you are someone who can show you care about CU this had a significant price tag as budgeted.Because we thought an individual and what's going on in his or her life,you'll build itwas the right thing to do for ourteams,we funded it anyway. the relationships that will ultimately help your organization reach its goals. People are far more energized when they The celebration was a huge hit,and it created tremendous y feel they are seen and valued as a person. However, nothing energy and enthusiasm throughout the business. Doing the 0. is more damaging than being disingenuous or insincere. Be right thing in this case was a small short-term sacrifice that CL true to yourself,and don't force yourself into an inauthentic produced a big return;the next year,we had record-breaking position.The more you can find real ways to connect with financial performance. I like to think there was some cause people in your organization,the better. and effect at play. We sincerely care about our people,and one waywe We continue this event annually,and it's my favorite work- demonstrate this is by sponsoring company-wide programs week of the year because I get to hang out with the people that promote healthfulness.We subsidize the purchase of on the front lines,trying to make them feel as appreciated as Fitbits and hold competitions.We also provide wellness they truly are.The level of thanks and appreciation that I get LU seminars on nutrition, healthy habits,and mindfulness and back is multiplied tenfold. assist employees with their individual personal finances 4.Communicate,be transparent,and listen. Most senior through a 401(k)-matching program,as well as an employee- referral bonus program. leadership teams can do better at communicating with their employees.Almost all can improve their listening skills. 3.Playthe long game. In the midst of the day-to-day,you When leaders are fully transparent about the good and the may be tempted to hit the easy button or think about what's bad developments at a company,people are much more needed immediately,especially if the short-term decision engaged and helpful because they know what and why conflicts with the long-term.Adopt the mindset that you're something is happening.So why not tell them? 1AaAR :RI.Y °+ i.. 133 Packet Pg. 1169 yC V� C..22.d i " ( s V II 5+ i _,vAv t Y.;,f4 (``�Y e s}� t' CL Y� E 4 0 1 f M 1,1' li�F 0 Listening is a critical part of building culture.You will only be At Relation,we're driven by results and make it a priority to able to improve things if you hear what's really going on and recognize and reward the hard work of our colleagues in how people are genuinely feeling.You can't fix what you don't various ways,including the following: know about. • Rewarding service teams for producers' performance Relation has 33 offices across nine states. Five years ago, .Showing a leaderboard of the top sales producers we did quarterly all-colleague calls that weren't terribly useful or transparent.We changed to monthly calls and now • Recognizing top service team members and inviting two of share the full financial performance of the organization,as them to our annual top sales producers'retreat U well as announce new programs, initiatives,and • Hosting a kudosfd relation insurance.com email,allowing W policy changes. both colleagues and clients to recognize team members We've also implemented an employee engagement team, •Celebrating client wins in our employee newsletter which we've named the President's Council.The group is diverse and includes top performers, people who've b.Be humble/admit mistakes.In a high-performance been with the company for years,and newer hires who've culture,leaders give credit and never take it,while also shown potential.They help evaluate and prioritize employee taking blame and never giving it.Admitting that you made engagement initiatives,improve the work culture,and even a mistake(especiallywhen it's obvious)creates a culture revise company policies. of learning in which people are not afraid to try new things. This is imperative to helping an organization improve and We also take steps to help the senior leadership team hear grow.Successful leaders can admit their mistakes and see from our colleagues,such as: opportunities to anticipate the unexpected more quickly.They 0. •Answering anonymous"Ask Joe"questions candidly on our also share this wisdom with those around them. Don't be too CL monthly all-colleague call proud to recognize mistakes as valuable teachable moments for yourself and others. • Doing quarterly employee experience surveys comprising both multiple-choice and open-ended questions Soon after I joined Relation, it was the holiday season. The salespeople in one of our business units had a long • Holding all-office town halls/lunches for Q&As with senior tradition of giving bonuses to their service teams out of leadership their own pockets.We thought it would be a nice touch to x • Using the old-school method of walking around and talking add a handwritten note from senior leadership(which was Lu to people approximately 125 notes).We didn't realize it at the time, but this made it appear as if senior leadership was generating 5.Recognize contributions. Recognition is important: It and taking credit for the bonuses—not the salespeople. It drives behavior by rewarding the good and discouraging the took us too long to realize it and fix it, but we took our lumps bad. People who feel appreciated end up experiencing more and made profuse apologies to try to remedy the situation. self-worth and positivity about their ability to contribute to The bonus mix-up was not our finest hour, but we were the company.The result is a happier and more productive sincerely humble and apologetic in explaining how badlywe employee. had screwed up. w 3 1 AMA taFERI..i Packet Pg. 1170 7.Be accountable.As an accountable leader,you don't blame On our monthly all-colleague calls,in addition to in-company others when things go topsy-turvy. Rather,you work to build announcements,we make a point of recognizing individual an accurate understanding of where your organization excels anniversaries, new hires, promotions,and other personal and where it has opportunities to grow.Accountable leaders milestones,such as weddings and babies.We end every also step up to champion initiatives to help their organization call with a trivia question that allows employees to submit succeed. their answers in real-time.The winner receives lunch for jCL The senior leaders at Relation meet weekly to review the everyone in his or her office. decisions and processes that shape our organization.They 10.Be visible and accessible.When people choose jobs,they also assume ownership for the performance of their teams, base part of their decision on the prestige of the company ask and answer questions of each other,and work to find the they're joining. Leadership's external engagement can be best answers. one reason a prospective employee joins a firm or stays with t,because employees like to see their leaders being talked Every employee writes down his or her yearly objectives about in the news. It can build pride if they are identified with and reviews them with his or her supervisor,who provides people who are sought after by an external audience. regular check-ins around performance against the objectives. Formal reviews are done annually for every In addition to being visible outside the office,leaders also employee,and bonuses and raises are directly tied to need to be available and approachable within the office. those reviews. One way to do this is the good old-fashioned "management c by walking around."Another technique is to do a series of Most recently,we created a salesperson "stoplight report": 15-to 20-minute one-on-one meetings.When visit other Those who are performing well are highlighted green,and offices, Ihave asign-up sheet for individual time slots.These those who are performing not so well in yellow and red.We meetings have no agenda,and the only ground rule is that also had an initiative to get our entire sales team on Linkedln and tracked which producers were engaged on social media no subject is off limits. find them both powerful and fun — versus those who weren't. Both of these reports were shared because 1)you get to build a bit of a personal connection with with all sales producers,and we saw marked improvements someone and learn about them,and 2) it can give you a real y afterward. sense of what is going on in the organization. U 8.Treat everyone with respect.One of my personal pet Also,whenever I go to a Relation location, I do my best to try W to walk around and at least say hello to everyone,not just to ) peeves is when someone powerful(or perceived to be the senior people.Joe,our CEO, is the same way. It's fun to powerful) picks on someone who is unable to defend himself. talk to people—you learn a lot and it makes a big difference I believe allowing that type of behavior destroys a productive culture. when you make an effort to be present. Most leaders understand how important having a great We've made it very clear that treating others with respect culture is,but many still struggle when it comes to creating is a requirement for success at Relation,and treating others poorly is a fatal flaw.We make a point to acknowledge and shaping it.They aren't motivated to put forth the effort and appreciate individual colleagues who demonstrate required to do so,they don't feel they have the skills and .... kind actions both individually and publicly on the all- capabilities,or they simply don't know where to start.Culture y colleague call. is the single most important factor in driving performance- 0. it's the only thing that consistently drives outsized c 9.Have fun and a sense of humor. Having fun and a sense of organizational performance and long-term competitive CL humor is key to a productive work culture.We spend more advantage. time working than we do anything else,so we may as well Most properly motivated leaders can create a world-class enjoy it. It's also a great tool for leaders,as it can help diffuse culture if they are willing to put the effort in,and the skills W stressful situations and garner respect. and capabilities needed to do so can be learned. I believe that At Relation,we put significant effort into not taking ourselves every leader should prioritize creating a great culture as a too seriously and having fun. During our annual NCAA top individual objective. If you already have a great culture,it bracket contest,we pit the combined picks of myself and our requires constant work and attention to keep it there. If you Lu CEO,Joe,against anyone else in the company who wants to don't have one,you have a tremendous opportunity waiting participate.Whoever gets the most bracket points wins a top for you to go after it. FA prize,and whoever gets a higher score than we do also wins U a prize.This year,Joe and I were almost near the bottom in Edward Nathan Page is president and COO of Relation Insurance Services, terms of our picks,which meant we gave out a lot of prizes. an insurance brokerage that offers risk-management and benefits- Regardless of the final score,there is always a fair amount of consulting services through its familyof brands across the U.S.He can well-intended trash talking throughout the competition,and be reached on Linkedln.Visit www relationinsurance.com for more everyone has a good time with it. information. Packet Pg. 117'1 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 3-Services,Approach and Availability of Service to County CL The Proposer shall describe the philosophy, approach and methodology he/she will take 0. to accomplish the services defined herein.This shall include information on schedule and availability, staffing, whether sub-contractors are used, and any other relevant information explaining how the services will be accomplished. In particular, please describe your firm's philosophy on managing the case loads of their adjusters and the current case load for both the Lost Time adjuster and the Medical Only adjuster that will O be assigned to the County's account. O €..h "". d,€ , ,, O ."C �...[,� ! �., z.. - ,zz.`.�.,.�:z:[.,�. `...�:z:[€.,z,1.�,z5 ..,t .. ,zs, `.�.,. t�.,. `...,�:z.[€. ,"H(1V ,z.[€., Czaz, s-Ia`. ,z. r✓E .[i. � O t r (1(1 � (1 ,� z ,i'.` � . ..v. 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'r tvirx' ..1...[r.F the life of the ,.,.,a..... , ..,a.ion woks closely Pith die ernployer to ot.v .,tx,, CL ev= a implanent P g v=•• ..,t ..�.!hw. ., ,...,�..._ cost; E;l, t.!h....._. �', ,at,... �.,.._ :F'+ e „ CL Sub-contractors niay be usoo for ancillary services. Monroe County can choose '-I With quality as a priority, vie negotiate p0erryo pricing Ath all our vendors, Packet Pg. 1173 t . h l t t t�s v iss C CL 0 AI t' \ 0 " NORelation � 0 S47 ht 0 Performance Standards t, 0 fWorkers' s 4151X, ' g 0 0. 0 L. CL x -- �,This manual may not contain all procedures and processes and may not be current. Some of the procedures and processes may have changed due to Relation revisions, carrier requirements,client requirements and the ever-changing rules and statutes of the state of Florida, and other internal and external influences. This document is a"living document",to be considered a work in progress Packet Pg. 1174 C.22.d i t t t r The following guidelines have been established to assure that an efficient and effective program is maintained throughout the entire claims process. In addition to these guidelines, Relation has CL CL implemented a comprehensive internal claims system that unfolds the details of each one of the following sections. Mail Process: 0 Mail is delivered by the US Postal Service to the front desk during regular business hours. The 0 administrative assistant receives the mail and signs all certified mail. The mail room clerk performs the following functions: • Picks up mail at the front desk • Separates legal, medical, First Report Injuries, and miscellaneous mail • All documents are scanned into image right and indexed to the specific files. • All medical bills are scanned to an FTP site where Service First (S1) our billing 0 company retrieves and processes for payment. Claim Process: The First Report of Injury(FROI) is received via email. The FROI's are emailed to FLWCNOTICE@RELATIONINS.COM, once emailed to this address it is imported into Image Right and assigned to the correct adjuster automatically based on the subject with the employer's code. The adjusters initially review all First Reports of Injury. If additional support is needed, the adjuster will involve other claim professionals in the review. Once approved, the FROI is tasked to an individual designated to open claims: CL • Sets up the claim in Assure Claims • Assigns claim to the designated adjuster in Assure Claims and Image Right • Creates, attaches and prints the following documents: ca o Introduction letter o Fraud statement letter o Employee Notification Letter o Authorization to furnish medical records o Reimbursement mileage form • Mails out the documents along with the employee brochure and a self- stamped envelope • Documents date mailed in the Assure Claims claim notes and in Image Right. Packet Pg. 1175 C.22.d • Once the claim is open a task is generated for a three-point contact to be completed. CL A claim file is then established, including a diary to allow the WC adjuster to make the initial temporary disability payment within fourteen days of the date disability begins and to file the proper EDI filings with the state. If it has already been ascertained that the disability will exceed the waiting period,disability payments are inputted, or claim is placed on a diary to ensure timely payment and EDI filings. 0 Initial and Continuing Contact 0 The adjusters will contact the injured worker shortly after having knowledge of the accident where disability will be longer than seven days. The adjuster will continue to remain in constant communication with the injured worker and be in position to answer any questions the employee may have. The adjusters will also closely monitor the injured worker's satisfaction with medical treatment. 0 This early contact provides additional control over the claim and allows the WC adjusters to accumulate important information that will be useful for claim management purposes. If disability continues,the WC adjusters will contact the employee at least every two to three weeks .2 to verify the employee's condition, to determine if modified duty can be arranged, and to maintain rapport with the employee. In addition, if disability continues, the WC adjusters will contact the appropriate client department manager to investigate the availability of modified duty. The authorized attending physician(s) are also contacted frequently to verify disability. o Temporary disability benefits are not to be paid without disability verification. All conversations with the injured employee, management personnel, and/or medical providers are documented within the claim file, either in writing or by entering the information into Relation's claim y processing system. 0. 0 CL Invetiation Investigation of a claim is initiated at the time of the initial contact as described above. Comprehensive investigations are performed when there is questionable compensability, severe ca or catastrophic injuries and/or complicated by personal health conditions or non-work injuries, and severe injuries and/or injuries where disability in excess of 30 days is anticipated. LU Written or recorded statements are taken of injured employees, witnesses, and management o personnel in these situations. In addition, the WC adjuster has the discretion to require a statement in other circumstances as warranted. Certain injuries require a written or recorded statement. These include spinal cord injuries, severe burns, fatalities, and loss of limb. They are also taken for questionable claims, such as un-witnessed accidents and claims reported in excess Packet Pg. 1176 C.22.d of 24 hours after an accident. Recorded statements should contain all information necessary to support the claim actions. General facts such as the date and time of the interview and the employee's information is to be CL taken, as well as all relevant information related to the accident e.( g., witnesses). In addition, medical care information, physician contact information and related items are captured in the statement. lnernnity Benefit Parnent As noted, the initial disability benefit shall be paid within 14 days of the date disability begins. The medical provider shall be contacted prior to the payment of indemnity benefits to verify continuing temporary disability. Subsequent disability payments will be made at intervals required by law and scheduled by use of a diary to ensure timely payments. File Documentation The file should contain documentation of all actions taken, including: written or recorded statements, conversations with the injured employee, employer, witnesses, medical providers, Ch attorneys,or other summaries of conversations and opinions/conclusions drawn,documentation by supervisory adjuster that would be useful references for future actions. Medical Care and Authorization Medical treatment to the injured worker is authorized by the adjuster upon determination of "medical necessity." Diagnostic treatment will be authorized, if necessary, to determine if an injured worker's complaints are related to the industrial accident. Chiropractic services cannot exceed twenty-four treatments or cannot be rendered twelve weeks beyond the date of the initial chiropractic care, whichever comes first, unless under special circumstances deemed appropriate by the adjuster/supervisor or in catastrophic cases. 0. Requests for a one time change to another doctor will be responded to within 5 days from receipt c q g p Y p of the request. Referrals to other doctors will be authorized within 3 days from receipt of request for referral. The DWC-25 and authorization process is as follows: • DWC-25 are received from providers by fax or e-mail CO • Adjusters and/or nurse case managers fax or e-mail the DWC-25 to the employerLU • DWC-25 is reviewed by the adjusters and/or nurse case managers • Authorization is provided for medical benefits that are compensable and medically necessary such as: o Remedial treatment o Attendant care o Medicines Packet Pg. 1177 C.22.d o Medical supplies o Durable equipment o Orthoses, prostheses and other apparatus o Work-hardening programs CL o Pain management programs o Chiropractic services not to exceed 24 treatments or rendered 12 0 weeks beyond the dated of the initial chiropractic treatment, whichever comes first 0 As stated above authorization is provided for diagnostic testing. Referrals are responded to by the close of the third business day after receipt of request. The adjusters and/or nurse case managers document receipt of DWC-25 and response to the requested received for medical benefits in the Assure Claims claim notes. 0 Medical Treatment and Control The WC adjuster will ensure that the Employer takes full advantage of its privilege in selection of medical providers.The physician providing treatment must be a "certified health care provider". The health care provider must be a licensed medical doctor, osteopathic, chiropractic, podiatric physician, optometrist, or dentist. The adjusters and/or nurse case managers will not authorize experimental, investigative, or research treatment. Diagnostic testing will be authorized when the original purpose is to determine if the injured employee's complaints are related to the industrial accident. If diagnostic testing ultimately shows an unrelated medical condition, treatment for the unrelated condition will not be authorized, except in exceptional circumstances that will need to be discussed and authorized by the client and claims manager. Chiropractic services cannot exceed twenty-four treatments or cannot be rendered twelve weeks beyond the date of the initial chiropractic care, whichever comes first, unless authorized by the client or the employee is catastrophically injured. 0. 0 The adjuster will authorize generic or generic equivalent medications unless brand named is CL medically necessary. The injured employee may choose his own pharmacy. S1 provides for mail order medications to be delivered directly to the injured employees at a significant savings and the adjusters should take advantage of this service whenever feasible. The adjusters will respond within 5 days of the receipt of the request by the injured employee for a one time change in physicians. Referrals are authorized by the adjusters within 3 day upon receipt. LU Medical information is requested from the medical provider(s) when the claim is initially established, and medical reports are requested after each subsequent treatment. If the medical provider's report is unavailable at the time a scheduled indemnity payment is required, the WC adjuster shall call the medical provider to verify that disability is continuing. Additionally, physician(s) will be informed of the availability of modified duty and asked to provide detailed information concerning the employee's capabilities. Packet Pg. 1178 C.22.d inability ar�aerner�t Disability management involves many of the points already addressed, including sustained contact with the employee, the employer/supervisor, and the medical provider. In addition, CL utilization of the appropriate physicians, including specialists, second opinions (when feasible) 0. and Independent Medical Evaluations provide greater control over and knowledge about the claim and its probable eventual outcome. The proper use of in-house Telephonic Nurse Case Managers may also be implemented if 0 complicated medical issues arise, compensability issues arise due to pre-existing conditions or 0 the employee's inability to return to his/her regularjob in a timely manner and/or if a permanent modification is required. If an independent rehabilitation vendor is utilized, the vendor should provide the following details: • Specific rehabilitation steps recommended, including referrals to other providers • Assistance in modification of position to accommodate restrictions and/or changing capabilities; 0 • Anticipated time span of rehabilitation efforts; • Estimated rehabilitation costs; 0 0 • Recovery of rehabilitation costs under appropriate state programs; Q • The timing and substance of rehabilitation reports. 0 Medical Cost Containment Medical bills are reviewed for adherence to applicable fee schedules and/or reasonable and necessary guidelines. Medical charges are audited for hospital charges in excess of $5,000.00, that do not include charges for an implant, treatment for conditions other than those caused by the on-the-job injury or any back related injuries. Other medical charges may also require an audit. The claims manager will determine when those circumstances exist and will act 0. accordingly. CL Individual Case Reserves — For financial reporting and claim control purposes individual case reserves are estimated for all ca claims. Within 72 hours of receiving the First Report of Injury, the WC adjuster will establish an initial case reserve. The reserve should at any given time express the adjuster's best estimate of the ultimate value of the claim at the time it will be closed, including indemnity, medical, LU rehabilitation, and expense costs on a completed worksheet to be retained in the file. Reserves will be reviewed every 90 days, at a minimum,to ensure that appropriate reserves have been established. If necessary, reserves will be increased or decreased whenever the adjuster becomes aware of a change in the claim status that has a probable impact on the ultimate cost of the claim. Reserve worksheets are used at the time the initial reserve estimate is established Packet Pg. 1179 C.22.d and at each subsequent review. This will ensure that all components of the claim are reviewed. Litigation anagernent CL If possible, litigation should be avoided. However, the presence of compensability issues and other issues sometimes require determination by the commission and/or court. If litigation is c required,the WC adjuster and/or claims managerwill complete all investigations and provide the pertinent file materials to the defense attorney. The attorney should not perform any investigations that can be performed by the adjuster or another claim professional. The WC adjuster will discuss with the defense attorney the steps necessary on the case and caution not to exceed the specific instructions. Settlement 0 The WC adjuster and/or claims manager will manage the claim to ensure that information concerning maximum medical improvement (MMI) and the appropriate permanent impairment ratings are received from the physician(s) at the earliest possible point. This will help avoid _ unnecessary temporary disability benefits. Upon receipt of the rating information, the adjuster will evaluate the claim relative to the impairment and/or restrictions pertinent to the evaluation, as well as the statutory requirements and case law if necessary. The adjuster will then submit written proposals to the client for review and approval prior to contact with the employee and/or the employee's attorney. Once approval is obtained, the settlement will be promptly offered. Upon settlement of the case, the appropriate hearing will be scheduled promptly so that the agreement may be consummated without delay. Potential Recoveries 0 0. The adjusters actively pursue recoveries from other parties.These include subrogation recoveries CL from responsible third parties and recoveries from Excess Insurance Carrier(s). When it comes to subrogation, the adjusters will actively pursue all cases involving potential recoveries from responsible third parties. All First Reports are reviewed for subrogation Ca possibilities. Potential subrogation cases will then be promptly investigated to evaluate the facts of the accident. If a third party is found to be responsible, a notice letter will be sent. If the LU injured employee is represented, his/her attorney should also be informed of the subrogation lien. E Proof of damages will be documented and should be presented to the responsible third party and/or the third party's insurer when requested. If the third party ignores the notice letter or refuses to acknowledge responsibility, referral to an attorney will be considered. If an attorney Packet Pg. 1180 C.22.d represents the injured employee, the adjuster will consider using that attorney if in the best interest of the client. Settlement offers for less than the full statutory recovery must be discussed with the client prior to acceptance. CL In the case of the Special Disability Trust Fund, the adjuster pursues SDF recoveries and ensures0. e® that the file contains documentation of consideration of the SDTF and provides documentation of the information gathered to apply for SDTF relief. This includes, but is not limited to the following: 0 0 • Investigations including statements, indicating the presence of pre-existing disability and/or applicable health conditions; • Medical evidence substantiating this disability; • Appropriate personnel records and/or affidavits indicating the employer's knowledge of the previous disability and/or the employer's accommodation to meet restrictions imposed by this pre-existing disability. 0 Finally, in the case of excess carrier coverage, the carrier must be notified at the appropriate trigger point and required documentation must be submitted on a timely basis. The adjuster will review reports designed to capture information relative to potential excess claims, including Q "Large Loss" Reports and other reports designed to display specific injuries and/or conditions for which the excess carrier(s) require reports. Relation has a designated senior adjuster as the excess adjuster that will monitor and request recovery from the excess carriers if the retention is exceeded. Additional euirernent The WC Adjuster may provide a narrative report to the client whenever the total incurred costs of a claim exceed a certain amount or based on the circumstances of the case. This report shall y include the following: 0 • A brief description of the accident CL • A summary of the status of the claim, including a description of the steps that are being taken to resolve the claim • The success of recent efforts to resolve the claim CO • A timetable for resolution of the claim, and the adjuster's estimate of potential future settlements • The basis for these recommendations 0 The approval of the client is also required for the utilization of any independent contractor, including but not limited to rehabilitation counselors, private investigators, defense attorneys, independent adjusters, and experts required for expert testimony. Packet Pg. 1181 C.22.d CL Relation's goal is to deliver outstanding value to our clients and business partners. This is accomplished through the application of advanced technology in claims administration, experienced staff, operational flexibility, innovation and implementation of performance controls that deliver quality service and eliminate the exposure of fines and penalties. The e following is an outline of the controls that have been implemented in every facet of the Workers' Compensation Dept. to ensure timely and accurate processing of claims, indemnity/medical payments and required EDI filling for medical and non-medical. 0 Non-Medical I- 3 Filings Relation is currently R3 compliant with the states Electronic Data Interchange. Our go live date was November 17, 2008. We are above state average on all state accepted filings and below the _ state average on all state rejections. Relation has implemented the following control to ensure the proper handling and timely filing of state required information: Relation has a designated experienced EDI Coordinator to perform the following tasks that will ensure accurate and timely acceptance of non-medical EDI filings by the state, thus avoiding fines: • Daily monitors the state EDI warehouse and responds to all state inquires. c • Daily monitors our EDI vendor, who performs data validation according to the state requirements. • Daily updates and monitors the EDI spreadsheet which reflects all the adjusters' EDI-R3 filings. 0. • Responds to daily adjuster requests and questions. CL • Adjusters' meetings are held to educate and ensure proper compliance with EDI requirements. • Contacts the state,vendors and other Assure Claims users to resolve questions ca and issues regarding EDI filings. • Coordinate with IT to test new Assure Claims EDI updates before loading into production data. LU • Continues to keep updated on the state EDI-R3 changes. • Helps monitor EDI vendor's billing ensuring proper billing for services rendered. • Keeps supervisors informed of EDI progress and performs individual training as needed with adjusters. Packet Pg. 1182 C.22.d An EDI report which reflects the status of all EDI filings is run on a regular basis by the adjusters, EDI Coordinator and Claims Manager to ensure all EDI filing have been accepted by the state. CL eceit, payrner�t are l filing of rnedical bills The Florida Workers' Compensation Law requires all payments be made (mailed) within 45-days 0 of receipt. Additionally, medical bills must be electronically submitted to the Dept. of Financial Services within 45 days of the Insurer's disposition (payment, disallowance, denial) of the bill. The Dept. of Financial Services will assess fines and/or penalties if bills are not paid, filed and accepted timely. Hence, Relation has implemented the following controls: • Incoming bills are scanned to S1 Medical daily to their ftp site • Adjusters review bills daily and approve in S1's bill review system, CareWorks • Bills are sent to PPO network, repriced and imported into Assure Claims 0 4- • Checks are printed by the Accounting Dept. with an EOBR twice a week at y 12:00 noon Q • Printed checks, along with EOBR's, are folded, stamped and mailed on the same day they print • Non-medical WC checks are given to the adjusters to mail out the same day they print • EDI transmission is completed by S1 Medical c indemnity Payments and Cornpen ability 0 Relation has implemented to following controls to ensure accurate and timely payments of0. indemnity in order to avoid fines and penalties: CL • Assure Claims generates automated diaries, 10 days from the date of accident, to both the adjuster and Supervisor to ensure compensability has been established, all required claim requisites have been completed and to check if indemnity is due to the claimant. If the diary is not completed by x adjuster and/or supervisor, automated diary is generated to the Claims LU Manager for review. • Assure Claims generates automated 30-and 90-day diaries for file review to the Adjuster and Claims Supervisor on every open and re-opened claim. If diaries are not completed by either, a diary is automatically generated to the Claims Manager. Packet Pg. 1183 C.22.d • The diary dates for payment of indemnity benefits are scheduled for check issuance ten (10) calendar days, which is 4 days prior to the due date. Diary dates that fall on weekends or holidays are moved to the last business day prior to the due date. CL • Claims Supervisor completes a comprehensive supervisory review report addressing compensability, reserve adequacy, subrogation, timely payment c of medical and indemnity benefits, timely EDI filings, etc. Claim Supervisor provides plan of action with direction to the adjuster. 0 Miscellaneous Controls 0 Relation has created the following Business Objects reports and implemented to ensure proper claims handling. • Report reflecting any and all claims with no reserves. • Report identifying all claims that have reached or are close to reaching half the self-insured retention. Hence need to be reported to the excess carrier. • Management reports reflecting adjusters' caseloads; number of new claims opened and closed on a monthly basis; claims opened and closed that are older than five years. Q c 0 0. 0 CL LU Packet Pg. 1184 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 4-Litigation CL Pursuant to Section 2-347 of the Monroe County Code, all respondents must provide 0. answers to thefollowing questions regarding claims and suits: 0 U (a) Has the Proposer ever failed to complete work or provide the goods for which it has contracted? (If yes,provide details.) 0 0 (b) Are there any judgments, claims, arbitration proceeding or suits pending or outstanding against theProposer, or its officers or general partners? (If yes, provide details.) (c) Has the Proposer,within the last five(5)years, been a party to any lawsuit or arbitration with regard toa contract for services, goods or construction services similar to those requested in the RFP?(If yes,the Proposer shall provide a history of any past or pending claims and litigation in which the Proposer is involved as a result of the provision of the same or similar services which are requested or described herein.) (d) Has the Proposer ever initiated litigation against the county or been sued by the county in connectionwith a contract to provide services, goods or construction services? (If yes, provide details.) (e) Whether, within the last five (5) years, an officer, general partner, controlling y shareholder or major creditor of the Proposer was an officer, general partner, 0. controlling shareholder or major creditor of any other entity that failed to perform CL services or furnish goods similar to those sought in the request for bids. (f) Customer references (minimum of three), including name, current address and current telephone number. Preference will be given to Florida government clients. LU G t V 0 e V W e 5 Packet Pg. 1185 1 wf Monroe County Workers' C 22 d Third Party Claims Administ 1 s1 S 3)2 s 3,0 0. 0 irq PS 15 �q V (g) Credit references (minimum of three), including name, current address, and current telephone number. 0 i`~=ot (h) Financial statements for the prior three years for the responding entity or for any entity that is asubsidiary to the responding entity. _ u- pe .�s ' rd a . r,aww a � h e � financial � ed 0 0. 0 L. CL LU Packet Pg. 1186 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 5-Loss Runs CL Sample copies of all loss runs that will be provided to the County for no additional charge must 0. be providedwithin this Tab. Also, any additional reports that are available for an additional fee should also be included. These additional reports must be clearly identified and reflect the additional charge that will be imposed for the reports. 0 P t v e e 0 2, C o v t.. .. 0 ° ,t C,Sn O `.`. 0 U U 0 0. 0 CL LU Packet Pg. 1187 ao;;oe luoo*oul`epljolj do saoimag eoueansul uol;ela ) lesodoad uol3ela llglt4x3 :;uauayoe;by m v' w N' r N_= r a a� f'il t1 a U N � � N O O 00 O LllE C O E O O C y C N N N W N Y .a E E Y M s C N L N C N C 0 >, C m s OJ ii Q Y Lll Q 2 (n E E d O o 0 0 0 0 0 L.7 N N N N N N N N N N N N N E j U y rn o m o N rn CO m N,,, � C N O) O N O N O1 0 r y M CO V ' O ro � N W O) N O) O) N If N N a O U £ c , O O O O O o 0 0 0 0 0 0 00 N V o 0 L N c E o r £ Z E LL E LL Lf LL N U LL04 J J J J J J 04 N O N r £ O7 N N U1 z c c O O m y J N T Y N ` 0. O Q O E > E LL o Co W Z) d U CO Q CO UJ J LL r O O) O N N N N CO N N d W T J J F J 47 d o2 r2 o2 r2 o2 v ., Z U U: � r D £ d V 0 0J U �: ?: C.22.d i Coverage Report � j. Relation-, Client Name All Claims as of 4/30/2021 12:00:00 AM Total Open LOB Outstanding Claim Claim Code Claim Type Desc Reserves Paid to Date Total incurred Count Count WC Became Lost Time $33,015.70 $528,098.18 $561,113.88 17 9 Lost Time $41,515.48 $100,473.40 $141,988.88 67 3 Medical Only $110.91 $892,384.31 $892,495.22 31 7 _ B Total $74,642.09 $1,520,955.89 $1,595,597.98 115 19'; E O U N i, O O O w V C O U V C t4 .L O W w O y O O .y i, O U) O O C O N C C O w y O O IL C O CD w 1a ,Q x X W C O E O B Pagel of 1 Packet Pg.1189 JOI 43 a4 O °a l 'BP!JOI_q 10 S031AJOS a3uejnsul og l ) lesodOJd uogejoU4' ' x :4u8wg3B44 c N- � N r U � ry 7 N � L O_ O N 0 —O N V 0 C O a N N 6 N O 0_ fn T 6 L Q E N Q N m p C O C t6 C a U '3 y U <6 E 'L T O NO C N Q1 r 0 (>3 Q C (6 (6 O C O) � d O O C .c 3 o m C 3 s O1 m T O C E o N 0 C C: U O U Q1 -O E N Y fn N L 7 C C C 2- 5 'Q m 3 cmm M O T C a C C N "O to N N Q O O a 3 N O 3 L d N 3 w CL = 3 LW m w w _j Lw w wV w .N 0) cm o ff m 0 0 L Y � r 0 0 N o 3 o o 6 0 0 - 3 o a) o U) m m t L L O N C fn (n (n (n J W Of J LL Y Of E � m m U U O O O O O O O U U y m N6 v C°o 0 � o t ° P 0 O -6 co m co o w N o m u C i N O O I` LQ N M 61 L 7 I- t` _N N M w M N � M LO C w [A EA [A N w w [A W [A n Nco — < F— E N cO N N N I— O M 7 N N 6 c6 7 O 6) Lq Lq Lq t` 7 I— RS In co 7 O co c6 co I� N N 6 � -6 OJ LO M O O O co co ��.. a. 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'N c r, . r r � C7 O LO > rMD "!, c; n0 i r ao Lo � p N O N N N N N N N N N N N O O O O O O O O O O O O ++ N N N N N N N N N N N W 7 O O S aO O O O O O O O O O O qy o r 0 W Q N N N V) C (6 0) N (� N N > u u u E u u w F ° °- ai °- a°i °- a°i °- W N Ur O w v z N w U Q T— w a V C LV I- w O O O o O o rn m r `~ f6 0 0 0 0 0 0 0 0 0 0 N N N N N N N N N N 'W^ E In •E N_ N 7— E N N O C O O v I U O W O O O 0 O O O 0 � V w O 0 O 0 1 O 0 O) m ! r N N N N N N - N N 0 O 0 O 0 O 0 O 0 O 0 N N : N N N N N N N N N C In l5 O 0 V 1 (O w (O w N w N N Q 10 N N O C N N W O C O O O 0 O 0 O 0 N co V to w N N N N r r r 00 co +:, I- A r A r Ar W w -0 F3 r r r r O Z ONE � ONE ! � 0 � 0 � ONE E .E U U U U U U U U U U N N N N N (6 i (6 ',, (6 ',, (6 ',, (6 10, z J J J J J .9�f £ lL lL lL LL lL '� N N N : N N (•� U U J C.22.d i Summary Loss Report � j. Relation-, Client Name All Claims as of 4/30/2021 12:00:00 AM Total Open LOB Outstanding Claim Claim Fiscal Code Claim Type Desc Reserves Paid to Date Total incurred Count Count 2019 WC Became Lost Time $180,097.48 $426,341.99 $606,439.47 9 5 WC Lost Time $310,074.25 $339,217.03 $649,291.28 10 3 WC Medical Only $10,193.90 $68,360.02 $78,553.92 10 5 _ 2019 $500,365.63 $833 919.04 $1,334,284.67 29 13 Total Open E LOB Outstanding Claim Claim O Fiscal Code Claim Type Desc Reserves Paid to Date Total incurred Count Count V N 2020 WC Became Lost Time $37,876.06 $71,439.55 $109,315.61 12 12 CD WC Lost Time $38,028.33 $102,297.88 $140,326.21 22 8 `O WC Medical Only $19,289.39 $9,312.14 $28,601.53 20 16 2020 $95,193.78 $183,049.57 $278,243.35 54 36 V $595,559.41 $1,016,968.61 $1,612,628.02 83 49 O V v c ro .L O W w O y O O .y CD O 07 O O c N c c O CD w m y O O IL c O CD w ca ,Q x x W c O E O B Pagel of 1 Packet Pg.1196 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 6-County Forms and Licenses Proposers shall complete the execute the forms specified below and located in this RFP as well CL CL as copies of all professional and occupational licenses and shall include them in this section, i.e. Tab 6: O CJ i� O L [`J, C a"i ;ei! `„..,)V,'-d ` . „ `.'. Cab \I r t !v 5. O W 0 ,I,.,e ',t.`V. O Irai -in,.,�. N,,%. ELK—,, ,� `. f.,tM �L ... t.. L U Ct:V .�....t::f€. <e:' 0 O Ch O U O O U O O O O O CU O O 0. O CL O O O O U Packet Pg. 1197 JOI 43 a4 o as l 'BP!JOI_q 10 S031AJOS a3uejnsul og l ) lesodOJd uogejoU4' ' x :4u8wq3B44V co ' N- � N r U � tQ CD a d U tC rl � O U U � U Y N /1 ^7 LO N bA rn Y CIA Y Y 1-�Y DATE(P C.22A AC"R"® CERTIFICATE OF LIABILITY INSURANCE 03/23/2021 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Miriam Fox NAME: CL RISI dba Pan American Insurance Services p CONNo Ext: (925)407-0417 (FAX ,No): (925)322-6655 F® 1277 Treat Blvd EMAILss: miriam.fox@relationinsurance.com ' ADDRESuite 400 INSURER(S)AFFORDING COVERAGE NA IC# Walnut Creek CA 94597 INSURERA: The Travelers Property Casualty of America 25674 U7 INSURED INSURER B: Travelers Indemnity Company of Connecticut 25682 Relation Insurance Inc. INSURER C Relation Insurance Services of Florida,Inc. O INSURER D 700 SE Central Parkway INSURER E: O Stuart FL 34994 INSURER F: COVERAGES CERTIFICATE NUMBER: 20/21 GL BA WC REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS O CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AUUL SUL3K POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FX OCCUR PREM SDAMAGES Ea oNT�ED nce $ 1,000,000 '0 O MED EXP(Any one person) $ 5,000 A Y Y 6308F426365TIL20 06/18/2020 06/18/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2'000'000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 Ea accident ANYAUTO BODILY INJURY(Per person) $ B OWNED SCHEDULED Y BA1 N27929A2014G 06/18/2020 06/18/2021 BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS X HIRED �/ NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ O EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X PER STATUTE EERH wr AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? ❑ NIA Y UB6K6788432014G 06/18/2020 06/18/2021 N (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 O CL DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Orlando Utilities Commission and their partners,commissioners,directors,officers,agents and employees have been included as additional insured with respect to general liability and auto liability when required by written contract.Waiver of subrogation applies to GL Auto and Work Comp. ¢ UJ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Orlando Utilities Commission ACCORDANCE WITH THE POLICY PROVISIONS. 100 West Anderson Street AUTHORIZED REPRESENTATIVE Orlando FL 32801 r� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Packet-Pg. 1199 C.22.d MONROE COUNTY BOARD OF COUNTY COMMISSIONERS REQUEST FOR PROPOSALS CL CL FOR WORKERS'COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES i� SECTION III 0 PROPOSAL RESPONSE FORM 0 Please complete this proposal response form and attach behind Tab 10 in the Proposal. Additional information can be attached to the forms. 0 Name of Third Party Administrator? Relation Insurance Services of Florida Address: 700 SE Central Parkway 4- 0 Stuart, FL 34994 Telephone Number: 800-431-2221 Are the following services included within the price quoted? Initial contact with claimant within 24 hours? Yes x No c Recorded statements of the claimant? Yes x No Contact with the treating physician within 24 hours? Yes x No Narrative summaries on major claims? Yes x No 0 0 Medical bills reduced to State fee schedule? Yes x No CL Medical bills reduced in accordance with PPO Provider discounts? Yes No x Subrogation and Second Injury Fund activities? Yes No x Preparation of all State mandated reports? Yes x No Lu Notification of all potential excess claims to insurer? Yes x No Quarterly meetings with the County? Yes x No Packet Pg. 1200 C.22.d Provide monthly loss reports to the County? Yes x No Provide monthly loss reports to Consultant? Yes x No Provide staff for Injury Helpline? Yes _ No x CL C If any of the above responses are no, please explain o and include the full pricing for the services. • 25/oof PPO /Audit savings • Injury Helpline: $50 per call • Subrogation: 10% Percent of Recovery Will one Lost Time adjuster and one Medical Only adjuster be assigned to the County's Account? Yes x No d Are resumes of adjusters attached? Yes x No What is the maximum caseload that will be assigned to each of the County's adjusters? 0 Lost Time 125 Medical Only 175 Is the TPA agreeable to providing 30 day notice before any changes to adjusters are made? Yes x No Will the County be able to continue using Raquelin Fals as their Field Case Manager? Yes x No Will the County be able to continue contracting .� and paying directly for all legal defense services? Yes x No v, 0 Will the TPA be responsible for all State imposed0. fines and penalties caused by the negligence of the TPA? Yes x No Will the County have 24/7 access to the TPA's claim system? Yes x No What charge will be made for accessing the TPA's claim system? 0.00 Will the TPA conduct an onsite (in Key West) demonstration of the County's use of the TPA's claim system prior to implementation? Yes x No Will the TPA develop a user manual on the Packet Pg. 1201 C.22.d operations of the TPA's claim system? Yes x No Will the TPA update the user manual when any changes to their claim system are made? Yes x No -� CL Has information regarding the PPO networks established by the TPA been provided as requested? Yes x No 0 What fee will be charged for accessing the TPA's PPO networks? 25% 0 Does price quoted include processing claims until their conclusion? Yes No x If not, explain duration included in fee: Life of contract. We will negotiate 0 run-off fee. 0 Will the proposer charge any initial or maintenance fees? Yes No x o 0 If so, please explain: 0 0 Please explain required banking arrangements. As County sees fit; maintain current arrangement. -- o Does the proposer have an approved safety program filed with the State of Florida? Yes No x 0. 0 Does the proposer agree with the handling of CL claim payments in accordance with the County's Administrative Instruction 7400.4? Yes x No Please describe how claims will be classified as Lost Time and Medical Only for administration billing purposes. Relation uses statutory definitions. X 0 Packet Pg. 1202 C.22.d Quoted Price: Claims AdministrationCL ~� Cost Per Claim Cost Per Run-Off Claim Workers Compensation Medical Only Claims $200.00 $100.00 c Indemnity Claims $1,200.00 $600.00 _ Flat Annual Fee $60,000.00 a c Charge for Reducing Medical Bills to State Fee Schedule c Flat Annual Fee (payable in month) installments) Included in above Cost to reduce bills in accordance with PPO Arrangements (flat annual fee strongly preferred) 4- 0 Is an alternative pricing structure proposed? Yes _ x No If so, please describe The incentive is stronger with a percentage of savings structure. aware , Re a ion will gladly negotiate a flat fee schedule. With no Bill Review Fee the net cost savings is well below fair market value. Will a minimum fee apply to the contract? Yes No x If so, please specify Are there any exceptions to the specifications? Yes No x y If so, please specify 0. CL The Proposer stated below is the authorized agent of the company or companies proposed, and is authorized to commit the proposing company to the terms and conditions stated above. Sidnature of Authorized representative Date w Printed Name: Tim McCreary End of Section III. Packet Pg. 1203 C.22.d NON-COLLUSION AFFIDAVIT of so, v ,a � � according to law on my oath, and under penalty of perjury, depose and say that; E 0 1) I am t tr ,the bidder making the Proposal for the project described as follows: 0 0 2) The prices in this bid have been arrived at independently without collusion, consultation, communication or agreement for the purpose of restricting competition, as to any matter relating to such prices with any other bidder or with any competitor; 3) Unless otherwise required by law, the prices which have been quoted in this bid have not been knowingly disclosed by the bidder and will not knowingly be disclosed by the bidder prior to bid opening, directly or indirectly, to any other bidder or to any competitor; and _ 4- 4) No attempt has been made or will be made by the bidder to induce any other c person, partnership or corporation to submit, or not to submit, a bid for the purpose of 0) restricting competition; 5) The statements contained in this affidavit are true and correct, and made with full knowledge that Monroe County relies upon the truth of the statements contained in this affidavit In awarding contracts for said project. STATE OF ffr - y E (Signature of Bidder) COUNTY OF '` 'r ; t F.4 °2.t DATE 0. 0 PERSONALLY APPEARED BEFORE ME, the undersigned authority, CL t ,. . �, ° who, after first being sworn by me, (name of individual signing) affixed his/her signature In the space provided above on this E day of ,20 t My commission expires: NOTAIY PUBLIC OMB - MCP FORM #1 titer pue JAM[KOCIJAN °��° Commission 8 HH 004286 �, of Expires May 28,2024 'IFOF FLOQ Bonded TW Budget Netery SWICu Packet Pg. 1204 C.22.d DRUG-FREE WORKPLACE FORM CL The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that: 0 yCj)a _ ( Ck- ... (Name of Business) 0 I. Publishes a statement notifying employees that the unlawful manufacture,distribution,dispensing, possession,or use of a controlled substance is prohibited in the workplace and specifying the actions that will be taken against employees for violations of such prohibition. 2. Informs employees about the dangers of drug abuse in the workplace,the business's policy of maintaining a drug-free workplace,any available drug counseling,rehabilitation,and employee assistance programs,and the penalties that may be imposed upon employees for drug abuse violations. 3. Gives each employee engaged in providing the commodities or contractual services that are underbid a copy of the statement specified in subsection(1). 4- 0 4. In the statement specified in subsection(1),notifies the employees that,as a condition of working on the y commodities or contractual services that are under bid,the employee will abide by the terms of the statement and will notify the employer of any conviction of,or plea of guilty or nolo contendere to,any violation of Chapter 893(Florida Statutes)or of any controlled substance law of the United States or any ) state,for a violation occurring in the workplace no later than five(5)days after such conviction. 5. Imposes a sanction on, or require the satisfactory participation in a drug abuse assistance or rehabilitation program if such is available in the employee's community,or any employee who is so convicted. 6. Makes a good faith effort to continue to maintain a drug-free workplace through implementation of this section. As the person authorized to sign the statement, I certify that this firm complies fully with the above requirements. 0 ],� I c fieCL Bidder's Signature ( ( Date Packet Pg. 1205 C.22.d SWORN STATEMENT UNDER ORDINANCE NO.10-1990 MONROE COUNTY,, FLORIDA ETHICS CLAUSE .� t warrants that he/it has not employed, retained or otherwise had act on CL CL his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No.10-1990 or any County 0. officer or employee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County o may, in its discretion,terminate this contract 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. (signature 0 Date: i 0 CJ STATE OF '` ` COUNTY OF PERSONALLY APPEARED BEFORE ME,the undersigned authority,_ . ' r'" i - ` "K F (. _ who,after first being sworn by me, affixed his/her signature (name of individual signing) in the space provided above on this day of t NOTARY PUBLIC r' ) My commission expires: OMB-MCP FORM#4 " n a JAMI KOCIJAN o ,, Commission#HH 004286 r Expires May 28,2024 soaaarwue*a Notary Swk" 0 0. 0 x Lu Packet Pg. 1206 C.22.d PUBLIC ENTITY CRIME STATEMENT "A person or affiliate who has been placed on the convicted vendor list following a conviction for public entity crime may not submit a bid on a CL CL contract to provide any goods or services to a public entity, may not submit a bid on a contract with a public entity for the construction or repair of a public c building or public work, may not submit bids on leases of real property to public entity, may not be awarded or perform work as a contractor, supplier, subcontractor, or consultant under a contract with any public entity, and may c not transact business with any public entity in excess of the threshold amount provided in Section 287.017, Florida Statutes, for CATEGORY TWO for a period of 36 months from the date of being placed on the convicted vendor list." 0 1 state that this Proposer complies with the above. Signed: Wt U- Printed Name: ce C4, L Date: 0) c 0 0. 0 CL LU Packet Pg. 1207 C.22.d Respondent's Insurance and Indemnification Statement Indemnification, Hold Harmless and Defense. The CONSULTANT covenants and agrees to indemnify, hold harmless and defend Monroe County, its Commissioners, officers, employees, agents and servants from any and all claims for bodily injury, including death, personal injury, and property damage, including damage to property owned by Monroe County, and any other losses, damages, and expenses of any kind, including attorneys' fees, costs and expenses, which arise out of, in connection with, or by reason of services provided by the CONSULTANT or any of its Subconsultant(s) in any tier, occasioned by the negligence, recklessness, or intentionally wrongful conduct of the CONSULTANT, or its Subconsultant(s)in any tier,their officers, employees, servants or agents. In the event that the completion of the project(to include the work of others) is delayed or suspended as a result of the CONSULTANT's failure to purchase or maintain the required insurance, the CONSULTANT shall indemnify the COUNTY from any and all increased expenses resulting from such delay. Should any claims be asserted against the COUNTY by virtue of any deficiency or ambiguity in the plans and specifications provided by the CONSULTANT, the CONSULTANT agrees and warrants that CONSULTANT shall hold the COUNTY harmless and shall indemnify it from all losses occurring thereby and shall further defend any claim or action on the COUNTY's behalf. The first ten dollars ($10.00)of remuneration paid to the CONSULTANT is consideration for the indemnification provided for above. The extent of liability is in no way limited to, reduced, or lessened by the insurance requirements contained elsewhere within this agreement. This indemnification shall survive the expiration or earlier termination of the _ Agreement. 0 RESPONDENT'S STATEMENT .2 I understand the insurance that will be mandatory if awarded the contract and will comply in full with all the requirements. 46, 114AAJAVI ., w ° _ Respondent Signature 0 0. 0 CL Lu Packet Pg. 1208 C.22.d INSURANCE AGENT'S STATEMENT I have reviewed the above requirements with the bidder named above. The following deductibles apply to the corresponding policy. POLICY DEDUCTIBLES ®®0y VuJ Liability policies are a `{ Occurrence Claims Made ry G� fi�� .4 Insurance Agency Signature..- U- 4- 0 Print Name: d � 0 0 0 Packet Pg. 1209 C.22.d VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS Project Descriptlon(s): i Respondent Vendor Name: : } t"ar '4t _ CL Vendor's Authorized Representative Name 0 Vendor FEIN: ,� p and Title: vv\ I "'. �..r�,. }i „I a r Address: 1,)(3 _ :, City �..£ State r . Zip: Ve o Phone Number r, l ... Email Address r d V# ..e. 1 c z�cx, . .�a i ,. r 0 Section 287.135, Florida Statutes prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of any amount if, at the time of contracting or renewal, the company is on the Scrutinized Companies that Boycott Israel List, created pursuant to Section 215.4725, Florida Statutes, or is engaged in a Boycott of Israel. Section 287.135, Florida Statutes, also prohibits a company from bidding on, submitting a proposal for, or entering into or renewing a contract for goods or services of $1,000,000 or more, that are on either the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector Lists which were created pursuant to s.215.473, Florida Statutes, or is engaged in business operations in Cuba or Syria. _ As the person authorized to sign on behalf of Respondent, I hereby certify that the company identified above in the Section entitled "Respondent Vendor Name" is not listed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel and for Projects of$1,000,000 or more is not listed on either the Scrutinized Companies with Activities in 2 Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaged in business operations in Cuba or Syria. understand that pursuant to Section 287.135, Florida Statutes,the submission of a false certification may subject company to civil penalties, attorney's fees, and/or costs. I further understand that any contract with the COUNTY may be terminated, at the option of the COUNTY, if the company is found to have submitted a false certification or has been placed on the Scrutinized Companies that Boycott Israel List or engaged in a boycott of Israel or placed on the Scrutinized Companies with Activities in Sudan List or the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List or been engaged in business operations in Cuba or Syria. Certified By: zt� �� ri,.��. who is authorized to sign on behalf o of the above referenced company. 0 .nCL Authorized Signature:_ t . .. Print Name: �. C", Title: Q r ,��j ; r ' ..__ ..... Note: The List are available at the following Department of Management Services Site: x htt�u /f .dms,_m flarida.com/business o erations/state�}urchasin_)vendor information/convicted suspended discrimin _ -- ator y complaints vendor lists Packet Pg. 1210 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 7-County Expectations The Proposers shall describe their ability to meet each of the following County expectations CL CL regarding the administration of its claims as indicated below. 0. 0 1. One Lost Time adjuster and one Medical Only adjuster will be assigned to the County's account. These adjusters will be held responsible for all activities associated with the administration of the claims. We .,u..( [..., s "we ,.r'[£. €, ,.r.[£. "t. .,.,,� L, �'�`€ lo.,`,.. .. �zz .a[(. ,_r ...[fi' -i's.;. tom,.f...We . ,.r.[,WE.' i ,.,., ...*`„",`,.`3:.,i.[.. ...Ct;l,.,".`..` ..`. ,.t,.r..s`[ ...[e. [€„a `. ,t,!�,alu f ...[t .,.(? .,.,,I? Cb f� 0 U 2. The County strongly believes that the number of claims assigned to individual adjusters will have adirect impact on the quality of attention given to issues as they arise.All proposals shall specify the maximum number of cases assigned for both the Lost Time adjuster and the Medical Only adjusterthat will be used for the County's account. _ 4- 0 `. ..�C€. .� �........._i ,t. ,,. ��..�,t11 HC`.w� ��'C,.... .,e.�a�,.,,.`, m �,t<<!he@ �,t� � ._;t`,.. <«< t. .€h1 `,,.. .. ..,i �Ct.. :;t;:...,.e;?h a _ ,.,.,�.� `. ,�,C!h;� `� e.Jh[6.,,�. .d.[�`,, ,Jhl ,i,. .. .[,3:. t ,;t;�...,.e.Jh w!'_ ,.,.,�...:,� 2 ;' . U e I e - ' e � ` 3. If the administration of the County's claims must be re-assigned to a new adjuster, the County W should be advised of the change 30 days prior to the change taking effect. Such notification 76 should include thename of the new adjuster,the new adjuster's qualifications and the approach 0. the new adjuster will take in becoming familiar with the County's claims. CL [..� ..,t ..L...:l ,�.f` .. - t �.,`..,t.. e.� , "I" ' .0," h .O �, e `..[ ,�,J`,....[. aue ..,t ..� [€.`,`3� �ht... VIM: ml ,�,. oll; .. .,.f,i�+�m.[r fm.9. U�� .t.,JE;�,. J, C£ ��,a wV V Im....[ [� a.��z, .[°wi.. ,Je, a. ,.,.��..: z, �!.[€.,. [�... ....0 z, ... ; _ r. rf., , , . r i /[, e `„ � e ` t �, .... [e'7 .� X .. . , , ,o,aaa e , e a `v 4,%t, We .. ,i..f..'-d.[ ow .t.ve. ,i. a.,..[")Ve ,J'-s,.a 0 0..l. ut`,..,I.[€.,z::�[,. ,...�. ,�.f€:,:at.(,z..,e�I...,) f � U Jd �.,E, �. ,., C [i.e: ,i. ,i.[ ,:! 1 `, On ,i:C ei. .,,t :f VON ...t rj , ,l.C€,h �. ,. „`a " °.., ,t; ...�[�' .,n .., account into consioeyation. Ouy goal is to, aalw e arol,, affect: to ouy when a bansition „b2s oy neeos to a.,'., u Ouy clients' „ee o, b2„off ,,b2,.. ., .[,�.[Eh..�[, �:�;......�. , ,�° . r, 3 z Packet Pg. 1211 1 wf Monroe County Workers' C 22 d Third Party Claims Administ always ",-It ..[£. forchront of our IL below ,s ,a summary of ourtransition[sition ,oto,::ol ,. e:a reassignment o --in ,athl wt...-i. to --in account is c� O `+ A conference is set withthe emphyer by On claNn's mWendsor.This call is ,o, e t ain the . uny bird,, t� changes to `.firs.. ,ana the plan for a new aajuster to ..,,a.,. for ...[€� ..,.,a.., s and a a abic, O • :k .,,a.[€.,zio a..,. is, tza..[tific.,a; ,a fd ,a follow .,.,-. ,a. is t.£mt with ...[c. .,;s.,.,., e, a0 tiff,,, with a brie.. `sift. he employer m.,vi .(mz, .. [€. .,.z.o.,., e. and is affo.aea Ow oppoquRy ..; � • A phone[e .,.t.Lfe ..C..,,. .s t..,.[eaule a to ..[....tOU . the aajuster ,as well ,as ,a Can to Ewe E: n ere;€. and greet. During the phone ..,.tnfe .,[..,.._; a !ht.ta lea plan for is transition is . follow ur,, Cb c.'rn'-d! .s also sent with i [ a act i e..a ciewription of the transition, target oates and contact , a tf.,t,,. ,I..,,t,[for the ,aalut... .= e:a,[€h .,,ei,.[.. ,e.€,rfm is an overview of.: [ . key items we t.,ut,on au ring 'O this process: 41 The .t.`:,,.. ...,r.. ... ; well th(c., claims handling[€ ...[„office, ..... ruAidea of the change,C, O The - e. acyuster .s introaucoa to ...[€. assignea team ,and p rovi he a .r.f..ac! ..f...r ,s...on, A ..,.,sm .s 0 '�"t or?up o the Claims � s�C�? r, Claims s . �.,"-erroisor, �.l,s<<'.':z .C"U ..,. , ��'`e.thi..,,s;',)r[ly -ea1�.,z... ; Ind r , �(U O U he client prnfile of tn..... .,',a.., z handlingrequirements is rovie.flea in act,"-. with ..:[a. ,a!,zluz.te � by the supervisor --d.[€,h [a at,,l£.,t .s r,, ae a -a copy, O O he. aajuster is given the time to properly rl review and .a nili a..l.i. [£.., s ..o,.s on a,., f file. bt fore` being assignea the client and actively f ork [,. ..,[C-.� a. .,ou t, 0 During the. claims .,.v c tm the acyuster will generate ,a Nter to the employee tva ..[t[. O ,,-Ind contact The tasks ,and legal a :. t..[..me.nts ,as`. ..,a.. a idn ...[€. ..,:cairn ,a.E. ...,a.[t,.E).ma, O 0. O `='n is raft,,.,7 sent to the ae..,..[se attorney, .:,`4 .,....ri, conjoany, and any another proviaei.. CL .f a, ne.Ei,as to be ., ath Ma",.., J. th(c., 1nsi.. ,Jn, r- O ntc...[,a l we have a wh t e t a 0 !,zay, ,t, t ay ,a. a, „r a,,,-i, review of how the employee is handling the onset of the ..,.,-. . s, C., ,a.t.,.i ..,tL,..,.[ ,-.teat.e with the client to make so.,. . the ...,a.[z. don ow 1..[s c o.[£.s i v E.. .F+ 4. The County currently utilizes Raquelin Fat for all Field Case Management activities. The CountyLU has been extremely pleased with the services Raquelin Fat has provided and wants to continue using herfor all Field Case Management needs. If the TPA does not have a business relationship with RaquelinFals, the County will expect that such a relationship will be developed. ela � ,e als ,.< Case ,a.e t t .. ...,t:'C .�.,.. .:'C.., .[, . , .[ excellent ..,,t,[s.[,,.with ., €..�,�,....[ .. ..�. .... .[ ,riff .. ..f:.that . has - _ .[e-at ,.,,t.C....[�,e.�,z `...[.,. ,:�', ,..,.,. �/:",. ,a.,. also e.�� e as,-.�h with ...[€. se... ,..,,.;, tiff. ..r .rn.ae.` ,,-Ind .foFa..la agree to;. t.[....fU tiliz,a.. on of her services on current ,a;'Cd future ..,.,a...:`, ...[,at .a r ,.. fie la Packet Pg. 1212 1 wf Monroe County Workers' C 22 d Third Party Claims Administ ,.;t 0 H.. .._(.n.. ..,h((. Im , e:I a tom,✓:. ,I ,.t(.�[�- �.. .� ..�[€. .,t�.� E f OV U[e<< ., ,d.. `. .. [ I.. . ,!- .. (I CVJ zOWSU �. CL 5. The County has stringent protocols that must be followed when hiring outside legal services. While theCounty will consider recommendations for the hiring of defense counsel, the County o will have to select and contract directly with the legal firm. In addition, the County will have to directly pay the legal firm's bills.The TPA will be notified when such payments are made and the TPA will be responsible for capturing these costs in the appropriate claim. v � , d t �Y :( tf �� ;?I Yy,)'�,iltt('Y'1 1 ,tlbtp.f�y11� S 11�, T �. U,.5i,11,�.�, } �, fl� l l��;i,l� �'it .� �'f pt, ltY( YiT li ' (' Tl 1 4,1 ',( fOr ec,,,I (`'(`dl .( ,;::,1 �,1€' .,1.11�.1 ��i ,,1 .�'7�,lYT.f±ylJ,t �sS: fl—e SIR, � 0 U 6. The County will expect the TPA to pay any and all fines and penalties imposed by the State caused by the negligence of the TPA. The County will remain responsible for all fines and penalties caused by theCounty's negligence. 0 �Y tf (2 i`,f(, ("A tf c S,ll 11 '1esi`.l<' 0 (7 u r rc).1 _,S d- ,.,take if 41,, ,ID 41( 0 e r(.;:.1Iy T:'y f- e ,t,,)te 0 7. The County currently has direct access to their TPA's computerized claim system. This permits o the County to view the financial aspects of individual claims and to review the adjusters claim notes.The County will need similar access to the TPA's computerized claim system. The County expects that if a new TPA is selected, they will conduct a training session for the County's Workers' Compensation Department on the effective use of the system. In addition,the TPA will be responsible for the production of a user manual on the use of their computerized claim system. The TPA will be held responsible for providing timely notification of any changes made to their computerized claim system and the implications of these changes on the operation of �-- the system. In addition, the TPA will be held responsible for updating the user manual when76 changes are made. Access to the TPA's computerized claim system should be through the 0. internet and access should be available 24 hours a day and 7 daysa week. Any fees associated CL with access to the TPA's computerized claim system should be clearly stated in the proposals. 0 �;tc ,i b;•',a`1 "Y ('t(' 1S: 1 7 ,'S ( ,i �(' �'y,;:.1�1 S ��'J1tf tf 1S: ,,.,.� '��(' (7'ff( ll ll <> t �'7�,it ;;:.he u, (yt "',�J l.y ,,,.(,:.t JJtr) i tf e >>r u-).r Puri ; ; Cc',`('Y t. r <;I ,�i' v,/ t '��t (' S (,7,)u X LU 8. During the period of 10/1/19 through 9/30/20, the County's TPA processed 1,767 medical bills on behalfof the County. The cumulative amount of the bills totaled $2,376,885. The TPA m reduced the bills by$1,293,388 in accordance with State Fee Schedule. In addition,the bills were further discounted by $204,033 in accordance with PPO agreements the TPA has with various medical facilities. The County desires to continue taking advantage of PPO network discounts. Proposals should reflect the PPO networks the TPA has Packet Pg. 1213 1 wf Monroe County Workers' C 22 d Third Party Claims Administ established reflecting the number of physicians, by major discipline(such as General Practitioner and Chiropractor) participating in the network. Specific information regarding the number of medical facilities located in Monroe County should also be provided. In addition, the average CL CL percentage of discounts being offered by these networks should be provided. All proposals should reflect other arrangements the TPA has arranged for ancillary medical services such as o IMEs, MSAs and Medical Review experts. i� W,. ,I., (I t...., e�I W,I.,) ,a. ... a uc, 111c.,rf .?.`. .V .. [£. 0 ri 1 !c.,Vs 1°( .[i.t c.,II...,1 t.:C.01 0 .f,=Et..,,..s. !.,. *[,�vE; ,zt.t,,..,t .!.�,z t ,�.[£. ,t. .,`. �,z tv.�,zE..`. .. f��.. ,.f€.,zt..`. �.f WWI ('sp c,� � E' .[£.t.� S .r. f �z �z t e� 0 - . , . . . .'i .. r ! tvt lc z z t . t r _� � t ,� d .[ Cs z rI C csnts -f. <z 0 t f 0 1 .. ( .....,.r.'f%`. ('...L..f i� ..f.:,_ ,_r,.,. .f :..'L,.).., 11a..,1.,.,sf` .`. ,JLs , r.....`.1 ,r ..,� ,�.[€. .(IV I(.1.= 0 DIM`., ,J,l ,.�,. ..I 4'f .. .t.I�t. I #,.`..[,J.�,.`r .,J# °J...It.: ....Ir..�sV .,.J.[`..�,a..r�....Jf'C`, ..'C ..,,J Uw.I.,:.:OV f. .. M.....r 11 1 r� .f�...Im,_�.,, .€„a�,:.... .r I f,�.'., f.,: IV ..,.,(I t..: ....,.r` ,t..... .f£. fm,.... � zz .1zz z � � w, ..,t ..0 [[- a ,� .� ,� �, LL 0,., N t,i.Im �. .,t. .,.z< f .,.,a� Ls .�h #,. y to ;t f e.(,,-. t u t P n to ;It0`.:' t.;t":a..`.sk � 9. The County has issued Monroe County Administrative Instruction 7400.4 (Workers' y Compensation Third Party Administrator (TPA) Direct Payment System). A copy of the Administrative Instruction is included as an attachment to this RFP. The successful proposer must agree with the provisions of this Administrative Instruction. 9 9 76 91 0 10. The County would prefer to pay an annual fee, in monthly installments, for all bill reduction services to include reducing bills to the State Fee Schedule and all fee CL reductions associated with PPO networks that the TPA has established. ,... . . :cs to st e '...,.��:� �..��h(I ..� ..��t. ..,�:. ,�.�.��,� �:,. ,�� .�...�.z....��...v�� p/�pry 'i. ,..,,.s.. [�. #[ .w",: �J .. ,.u?�. Im ...J ts-I e .,.t. ",..,f C�.(,.w.t.:.. Im...sss ",CIu,. [�-. ..Jw.C...� ,: W � . . a( 0 . � 0s,� [. � t i . tf.., ,, [ ,te : X is✓c...Im I!.:f .,..,�JOH ,1HU [€. '......J ,. UV, ws.Mcc. U.I .[i, ov,.� ..�[�-:� I. .,,t �[.. Im,. °[,�vt. �E'(h�.,. ,(h ..�[�" .E+ U rvIUII ,� IUI,U.,`...`. �v<<[,.`. �.�,i,.�,��.<'t, �..�[,� "ie.H.,.s[..e�,.'. ,t. r3 �i <<[i."o, ,tfmE'v fine is,,. Packet Pg. 1214 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 8-Additional Information Proposer shall provide any additional information which will present evaluators with insight CL CL about the knowledge, skills and abilities of the Proposer. Also describe any additional services, reports, information, training materials, software, or capabilities provided by or available o U through the Proposer that could enhance the County's workers' compensation and safety programs or otherwise improve efficiency. 0 (,,)u f('1`(1" Jt <)1—1,, t� j1�.s�"�urc). Ck-iirn t" erc). 1 ar �71.1tlIlY" ft71 '(DI-H1 ( ,`Dirt r('p�,71 tlr 0 irips)rts. tslf( lY t::l (,,,)ilf sly,;f rn, vJ'J l,` l,t; �tf lY �'> t e ' ek' .)pwf ,i ,tl,t 1s)(")kh ; lt? ;t€ irnj,fler e( tc(i 11- 0 I.,,elad ' U d b�2 ��' .� � �ab•2a, �, 2,� �, ,�, ��,,,,,, �„� b2,t ,d,,, �"6t w t„ dada , �.�6� w , ,� � @'(.,.LC.J ,J, r in .. [(. ..`."s M SI.f,'c .... 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Es, Packet Pg. 1215 1 wf Monroe County Workers' C 22 d Third Party Claims Administ al�f... ..,..I.I�3..r�.I...! w €,,, �..E: JwA .,,sF.nts On '+...LAJ .,.r�",",�.�3 r�.I�..k ..,��, .iI f=. ..€,,,i:�.....", rVs W(... r�.3 ., t..",.J%� I .. t hw.rI..E.. F[�.�.. ,t, z...r�..i.t z. ��c Im... .[t .[€.,..t. ..,:r�.., z.. 6.[�. ..a,i. ...�hw.r�.....a (m... ., r�e�... ,t z.,te <<tME ..�� q� tJ P... .. .:',�... ". �t €h... IIH ...J... E�i I ..... ' t t.. ". �,.t. (h t..tu"E'. J..3.. LL 1"q� ®0 W q� V q� V q ®0 W q V q W q� V 0. V CL LU Packet Pg. 1216 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 9-Other Information If the Proposer cannot fully comply with any of the terms contained in the Request for CL CL Proposal, all deviationsto the terms must be spelled out in this section, i.e.Tab 9. O . ...,.11'f .fz,�.,.„s f. ...t.� u.. < ,.,�.� .,.r..�,a c? Ls Py s's U k..z,L I f .f.,.A:i, 4, )Ls f..`-r .)u),:1 U U) U)Ls f..�'Y t� O county, O U O O U O O 4- O O U O O U O O O O O O O 0. O L. CL O O X LU O U Packet Pg. 1217 1 wf Monroe County Workers' C 22 d Third Party Claims Administ TAB 10-Proposal Response Forms The Proposal Response Forms in Section III shall be completed and submitted behind Tab CL CL 10 in the response.Full consideration may not be given to Proposals not including the required Proposal Forms. O i� e e O O O O O tJ O O 4- O O O O O O O O O O 0. O L. CL O x O O Packet Pg. 1218 C.22.d MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CL REQUEST FOR PROPOSALS h® FOR WORKERS'COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES i� SECTION III PROPOSAL RESPONSE FORM 0 Please complete this proposal response form and attach behind Tab 10 in the Proposal. 2 Additional information can be attached to the forms. 0 d Name of Third Party Administrator? Relation Insurance Services of Florida Address: 700 SE Central Parkway 4- 0 Stuart, FL 34994 Telephone Number: 800-431-2221 Are the following services included within the price quoted? 2 Initial contact with claimant within 24 hours? Yes x No c Recorded statements of the claimant? Yes x No Contact with the treating physician within 24 hours? Yes x No 76 Narrative summaries on major claims? Yes x No 0. CL Medical bills reduced to State fee schedule? Yes x No Medical bills reduced in accordance with PPO Provider discounts? Yes No x Subrogation and Second Injury Fund activities? Yes No x X Preparation of all State mandated reports? Yes x No Lu Notification of all potential excess claims to insurer? Yes x No Quarterly meetings with the County? Yes x No Packet Pg. 1219 C.22.d Provide monthly loss reports to the County? Yes x No Provide monthly loss reports to Consultant? Yes x No Provide staff for Injury Helpline? Yes No x CL CL 0 If any of the above responses are no, please explain a and include the full pricing for the services. • 25/oof PPO/Audit savings • Injury Helpline: $50 per call • Subrogation: 10% Percent of Recovery Will one Lost Time adjuster and one Medical Only adjuster be assigned to the County's Account? Yes x No Are resumes of adjusters attached? Yes x No What is the maximum caseload that will be assigned to each of the County's adjusters? 0 Lost Time 125 Medical Only 175 Is the TPA agreeable to providing 30 day notice before any changes to adjusters are made? Yes x No Will the County be able to continue using Raquelin Fals as their Field Case Manager? Yes x No Will the County be able to continue contracting and paying directly for all legal defense services? Yes x No 6 0 Will the TPA be responsible for all State imposed fines and penalties caused by the negligence of CL the TPA? Yes x No Will the County have 24/7 access to the TPA's claim system? Yes x No What charge will be made for accessing the TPA's claim system? 0.00 LU Will the TPA conduct an onsite (in Key West) demonstration of the County's use of the TPA's claim system prior to implementation? Yes x No Will the TPA develop a user manual on the Packet Pg. 1220 C.22.d operations of the TPA's claim system? Yes x No Will the TPA update the user manual when any changes to their claim system are made? Yes x No Has information regarding the PPO networks established by the TPA been provided as requested? Yes x No 0 What fee will be charged for accessing the TPA's PPO networks? 25% 0 Does price quoted include processing claims until their conclusion? Yes No x If not, explain duration included in fee: Life of contract. We will negotiate 0 run-off fee d 0 Will the proposer charge any initial or maintenance fees? Yes_ No x v, 0 If so, please explain: 0 0 Please explain required banking arrangements. As County sees fit; maintain current _arrangement. 0 Does the proposer have an approved safety program y filed with the State of Florida? Yes No x o 0 Does the proposer agree with the handling of claim payments in accordance with the County's Administrative Instruction 7400.4? Yes x No 0 Please describe how claims will be classified as Lost Time and Medical Only for administration billing purposes. Relation uses statutory definitions. x m Packet Pg. 1221 C.22.d Quoted Price: _ Claims AdministrationCL Cost Per Claim Cost Per Run-Off Claim e® Workers Compensation 0. Medical Onl Claims $200.00 $100.00 Indemnity Claims $1,200.00 $600.00 Flat Annual Fee 60 000.00 0 Charge for Reducing Medical Bills to State Fee Schedule uA 0 Flat Annual Fee (payable in monthly installments) Included in above Cost to reduce bills in accordance with PPO Arrangements (flat annual fee strongly preferred) 4- 0 Is an alternative pricing structure proposed? Yes x No The incentive is stronger with a percentage of If so, please describe 9 p g � savings structure. awarded, Relation will gladly negotiate a flat fee schedule. With no Bill Review Fee the net cost savings is well below fair market value. v, Will a minimum fee apply to the contract? Yes No x If so, please specify Are there any exceptions to the specifications? Yes No x __ y If so, please specify 0. CL The Proposer stated below is the authorized agent of the company or companies proposed, and is authorized to commit the proposing company to the terms and conditions stated above. F y _ Signature of Authorized Peresentative Date w Printed Name: Tim McCreary E End of Section III. Packet Pg. 1222