07/21/2021 Agreement GJ�t CCUR"°
o: Kevin Madok, CPA
.. .... Clerk of the Circuit Court& Comptroller— Monroe Count Florida
•ROE COUNT. Y1
DATE: August 17, 2021
TO: Bryan Cook, Director
Employee Services
ATTN: Mark Gongre, Administrator
Safety & Security
FROM: Pamela G. Hancock, D.C.
SUBJECT: July 21s`BOCC Meeting
Attached is an electronic copy of the folloNN17iig item for your handling:
C22 Agreement with Relation Insurance Services of Florida, Inc. to provide Third Party
Claims Administration for the Monroe County Workers' Compensation Program at the annual
cost of$60,000.00 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 $300,000.00.
Should you have any questions please feel free to contact me at (305) 292-3550.
cc: County Attorney_
Finance
File
KEY WEST MARATHON PLANTATION KEY PK/ROTH BUILDING
500 Whitehead Street 3117 Overseas Highway 88820 Overseas Highway 50 High Point Road
Key West,Florida 33040 Marathon,Florida 33050 Plantation Key,Florida 33070 Plantation Key,Florida 33070
305-294-4641 305-289-6027 305-852-7145 305-852-7145
MONROE COUNTY
CONTRACTFOR
Workers Compensation Third Party Claims Administration Services
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.
Section 1. SCOPE OF SERVICES
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 CONTRACTOR' Proposal (Exhibit
B), both of which are attached hereto and made a part of this agreement.
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
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.
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
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 this
Agreement.
Section 4. COMPENSATION
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
monthly installments
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 recover
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
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
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,
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:
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
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 the
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.
Section 10. EMPLOYEES SUBJECT TO COUNTY ORDINANCE NO. 010-1990
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
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.
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.
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
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
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
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.
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.
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 VI I 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
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
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
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
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 with
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
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.
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
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
CONTRACTOR'S DUTY TO PROVIDE PUBLIC RECORDS RELATING
TO THIS CONTRACT, CONTACT THE MONROE COUNTY CUSTODIAN
OF PUBLIC RECORDS, BRIAN BRADLEY, AT -
, (305) 292-3470, 1111 12T" ST.,
KEY WEST, FL 33040.
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
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.
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
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
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
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.
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
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
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:
• 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.
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.
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
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
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.
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
2lst day of June 2021.
ABAL) MONROE COUNTY BOARD OF COUNTY
COMMISSIONERS
Attest: r��! 0zTY0RIDt,
" MADOK, CLERK
OF
By 'Vl by
�irnih egzuti
s Deputy Clerk Mayor/Chairman
Date: zl, 2o2I
(CORPORATE SEAL) Relation .
I/n orida, Inc.
ATTEST: "ekes`. . •
By SEE BELOW by i
Print Name: Edward Nathan Page
Title: President
Date: June 21, 2021
Approved as to legal sufficiency and form: --
Monroe County Attorney's Office
;y u
11
l ,T7
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.
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 day of jqne 2021.
(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:
(CORPO TE SEAL) Relation Insurance Services of Florida, Inc.
ATTES By by SEE ABOVE
Print Name: SEE ABOVE
Title: SEE ABOVE
Date'. SEE ABOVE
11
Exhibit A
Scope of Services
The Administrator will provide the following services.
➢ Initial contact with claimant within 24 hours.
➢ Recorded statements of the claimant.
➢ 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.
12
Exhibit B
Proposal from Relation Insurance Services in Response to RFP
13
l�
Relation...
� t
411 - s
t R,,
y 11", 2021
wY
k tit
Monroe County Workers'
n
i
Third r l ims Administration Ser i
y: Relation Insurance Services of Florida
700 SE Central Parkway
Stuart'. FL 34994
Contact- Tim McCreary
tim.mccreary rlti i sure c .c
(772) 919-8592
Relation...
,T a b o 4e, s t t
TAB 1 — General Information Page Number
irm's Name, Address and Contact
Statement of Services
vervievr of Firm's Experience
Explanation of fees, rates -14
Samples of claims and statistical reports
Other Terms Proposed
Resumes of Key Members
Relevant Exri nc r
Response to Relevant Experience -20
Services, Approach andAvailability rvic r
Response to Services, Approach and Availability 2 -33
Performance Standards
Litigation Page Number
Contacted Work
Judgements
Lawsuit or Arbitration
Litigation Against the County 34-35
Failed Services/Goods
Customer references
Credit References
Financial Statements
Loss Runs Page Number
Sample Copies 36-45
County Forms and Licenses Page Number
Florida Agency License
Certificate of Insurance
Proposal Response Form
Non-Collusion Affidavit
Drug-Free Workplace Form 46-59
Ordinance No. 10-1090 Ethics Clause
Entities Crime Statement
Local Preference Form
Indemnification Clause
Insurance Agent Statement
Vendor Certification Regarding Scrutinized Companies List
County Expectations Page Number
Lost Time Adjuster/Medical Only Statement
Maximum Number of Cases
New Adjuster Protocol
FCM
Legal Services
State Assessed Fin-es and Penalties 60-63
Access to Claims System
Monroe County Providers/PPO
Administrative Instruction 7440.4
AnnualFee
Additional Information Page Number
Insight, Knowledge, Skills, Abilities and Additional Services 64-65
Other Information r
Confirmation to Comply with Terms 66
TAB 10— Proposal Response Forms Page Number
Completed Proposal Response Forms 67-71
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
„vI L� Ffl efli�, ,bf s""e Si-,�r�,,J,ces ica ;,:f{;pr7 H of ,vri,. f I U:o. f r,s ,fit i,s j,f;ll,'l.
4 14ttt 4t 4 h {`t s 4t 4t 4t 1C [ £ T t '¢' s g`
t (: tf 't,�,`t 1.�,f l�, ? .. .Ic+:c !{t?I,,;°.Y'i:...,v�f 14b.� �t� �f l,v #fly t,v 0,,. t ;1L' ,
TAB 1-General Information
(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.
;E..
Tim.McCreary@relationinsurance.com
.s s ,..
(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
independentlyof any other service or benefit plan.
x e.:..,�...,.r 11 .[`.{.,.,�s[.,. ..,!:� `. s` .,.r..,.,r` .[,,, ,_r.[....[{.,t.:i.�h !.,.r.`s,,..` �,...;_r .,! f`,�,..,.r.'f i.L.�h ,,,� , �,. .`�
:f w( ,..,Ei`. .,t. 4�`4,t.[.,tE; tom,.[..�= ,.t,�:!,: t. .,tom;.[.., . .`.'.,
S.
(c) An overview of the firm's experience along with a summary of experience with Government
Entities. The overview should also include the length of time the firm has been providing claims
administration Services.
s tl
Imt. �., I .. h� �h. :� h „t � , .cd. ,,,J U,J t Sol
ME ME
v,...[:; t..[..,� `..[......t.rj .[,�vt: 5 .t.....,., .,.,�.... - t.`. .. [,I.. .[ ... ..e��;... �.[€. d.. `., �I�f.(£:"�f
.±ft. `... !.. .. . (I ..[£. , (1 s"! r....,It .. ,t i. t !,<t..,:H ;.,.,M. "i. I.,. .l
s-I V(s ,I.. .,
sJ..J.,,Ja, [0 ,.,,,ass. „[ 1 C .,,. ,ef [i. .,,i as ..,Ls's E;
€J w�., w,.,w ':L .[,�t,r W. .[,!!,z s.,. .,,.`.`. [ �,zt..f` [i. .,.,� .. `. ,:'C€ k.,
e,J; f:.[ .[ f k.,11SURDyt!.!. .[ .[,J f Im,J. €J ,J ac ,.
! (sV1
z '� .-z e 1 (h.a:��.. � z.. zz r� i rye:>
[s ,,. s[c [€,....[t.: ., ..,.' ., . ,..0 .
r ... ) .0 1 . ..L L.. .a' �,.,w_� .`. f t.. ,I , `.�.,.. ..,t.[� .. f�. r,t.!. C,". Llt, fJ .:f ,is'
�, ,�r`��h��C{. .�C..�..SE. !.�C ..,t ,.t,.�C�. `. ,��Ch t.!;� ..�C..,i ` t.,.,<<<. <<.. ,<< ..,,�f✓4 I.,., _ �h ,
..,,J . ,. [.J! t i,. i, 4 1 1ftU fit ..[:` ..[l .`. i., ,.,. � ( . Et .. ..[�' .J,. ...E'.„[z,r�,J„e.. ,JrI ea On ..s C�. .:st ., .t
1
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
..,�!,z,t .�,z ..�. t o �7p f..L,.,t ,�..,t Imp ..1.. .....ft. . �..[.. s f..Lt (1:1'1i..#'Ltz, a W....[ .,e f
. ., .. .. t.. .,z [.:
sss
` ,� t ,� ..( 1 �� e ,� e 1 r .� f ��.,
; [ w, w ..[.,., f .. w,.. .[€,,,fJ .... .. .. ... ... ,. w �.w,, .,t t.�.. [
'-Inv .,,d:f;., .. ;a "3 Oil IV lD.�''..
(d) Explanation of fees, rates.
(e) Samples of any claims and statistical reports.
a. ". . '. t. '. t. .k ;,.... .;t..y V j `..
(f) Other terms proposed. Please be specific regarding amounts and time schedule.
'es'-Lion f ...:ss I!,<i u,1 .. ,... `. ,�.�C€:,< .r.f€„a`.. .r.f..f,,,. ,". `.,t,., � .t.i. i 0 . .e:. ,t..:[ ....,i�., ..���.... .."3 !,<.... �...._,. We
(g) Resumes of all key members of the account team who will be assigned including professional
designations.
2
Relation Insurance Services
9, 112,21 Rix 17 2'1 _8, 87 f+_I o! t'o C,u r„Ire
Tim McCreary, CPCU, RPLU, CRIS & M.B.A
L,1{
�'�s' President—Relation Insurance Services of Florida, Inc.
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.
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
• 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.
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
methodologies; keeping in mind overall corporate profit objectives.
Education
University of Tampa 2000
Master of Business Administration
University of Tennessee 1994
Bachelor of Science - Political Science and Business Administration
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)
3
�F
e'iation Insurance Services
700 Cclt v,rA Rv V a iv,+ant, ir,1,ul o 1 11-9
Cortney Gomer, CWCL
Workers' Compensation Manager
Cortney's direct responsibilities are: Providing leadership and direction to the
workers' compensation team and is accountable for business results through
cost effective and timely resolution of claims. Interact with production, loss
�t control, actuarial, and policy administration/audit in achieving the best
- possible claim outcome and client satisfaction.
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.
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.
• Handled multiple jurisdictions: Florida, Georgia,Alabama, Mississippi,Tennessee, Virginia, South
Carolina, North Carolina and Kentucky.
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
4
Licensee Detail
Jimmy
Patronis
Licensee PDetail
Back to Search
License #:
D082459
Full Name:
GOMER, CORTNEY LYNNE WORLEY
Business Address:
700 CENTRAL PARKWAY
STUART, FL 34994
Mailing Address:
406 PENNOCK LANE
JUPITER, FL 33458
Email:
CORTNEY.GOMER@RELATIONINSURANCE.COM
Phone:
(800)431-2221 Ext. 8621
County:
Martin
NPN :
5325047
Continuing Education Statistics
CE Due Date:
9/30/2021
Continuing Education Status:
Compliant
Number of Hours Required:
20
Number of Hours Completed:
20
5
https://Iicenseesearch.fldfs.com/Licensee/471757[5/12/2021 4:52:22 PM]
Licensee Detail
Valid Licenses
Type Issue Date Qualifying Appointment
ADJUSTER-ALL LINES (0620) 12/24/2002 YES
Active Appointments
ADJUSTER -ALL LINES (0520)
Company Name Issue Date Exp Date
RELATION INSURANCE SERVICES OF FLORIDA INC 1/11/2010 9/30/2022
Invalid Licenses
Type Issue Date Status
ADJUSTER-ALL LINES (0520) 12/24/2002 INVALID
ADJUSTER-WORKERS COMP (0524) 7/17/2001 INVALID
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
6
https://Iicenseesearch.fldfs.com/Licensee/471757[5/12/2021 4:52:22 PM]
Licensee Detail
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
https://Iicenseesearch.fldfs.com/Licensee/471757[5/12/2021 4:52:22 PM]
�F
e'iation Insurance Services
700 Cclt v,rA Rv V a iv,+ant, ir,1,ul o 1 11-9
Christina Rodriguez
Workers' Compensation Claims Supervisor
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.
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.
Issues and Answers—Fort Pierce, FL 1999-2000
• The surveys completed were contracted by corporations that wanted information regarding
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.
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
s
Licensee Detail
Jimmy
Patronis
Licensee PDetail
Back to Search
License #:
P101281
Full Name:
RODRIGUEZ, CHRISTINA MARIE
Business Address:
700 CENTRAL PARKWAY
STUART, FL 34994
Mailing Address:
700 CENTRAL PARKWAY
STUART, FL 34994
Email:
CHRISTINA.RODRIGUEZ@RELATIONINSURANCE.COM
Phone:
(772) 287-7650Ext. 4483
County:
Martin
NPN :
9364031
Continuing Education Statistics
CE Due Date:
12/31/2021
Continuing Education Status:
Compliant
Number of Hours Required:
20
Number of Hours Completed:
20
9
https://Iicenseesearch.fldfs.com/Licensee/923780[5/12/2021 4:54:27 PM]
Licensee Detail
Valid Licenses
Type Issue Date Qualifying Appointment
ADJUSTER-ALL LINES (0620) 6/20/2007 YES
Active Appointments
ADJUSTER -ALL LINES (0520)
Company Name Issue Date Exp Date
RELATION INSURANCE SERVICES OF FLORIDA INC 6/20/2007 12/31/2021
Invalid Licenses
Type Issue Date Status
ADJUSTER-ALL LINES (0520) 6/20/2007 INVALID
Inactive Appointments
ADJUSTER -ALL LINES (0520)
Company Name Issue Date Exp Date Status Date
RELATION INSURANCE SERVICES OF FLORIDA, INC. 6/20/2007 12/31/2021 1/2/2020
10
https://Iicenseesearch.fldfs.com/Licensee/923780[5/12/2021 4:54:27 PM]
Relation Insurance Services
700 SE Central Parkway,Stuart,Florida 34994
office(800)431 2221<fax(772)287-1387 'rolationinsurance.coin
Michelle McMahon
Workers' Compensation Medical Only Claims Adjuster
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
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
appointments and following up for medical reports.
• 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.
• Managed and maintained claim files, gathered records, negotiated claims and medical bills.
Goldstein and Associates—Stuart, FL 2012-2015
• Paralegal
• Scheduled appointments.
• Drafted legal documents to file openings and settlement statements.
• Managed and maintained claim files, gathered records, negotiated claims and medical bills.
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
11
Licensee Detail
Jimmy
Patronis
Licensee PDetail
Back to Search
License #:
W327850
Full Name:
MCMAHON, MICHELLE LINDA
Business Address:
302 SE TRESSLER DR
STUART, FL 34994
Mailing Address:
302 SE TRESSLER DR
STUART, FL 34994
Email:
MMCMAHON30@YAHOO.COM
Phone:
(772)446-2131
County:
Martin
NPN :
18157261
Continuing Education Statistics
CE Due Date:
5/31/2021
Continuing Education Status:
Compliant
Number of Hours Required:
24
Number of Hours Completed:
24
https://Iicenseesearch.fldfs.com/Licensee/1553280[5/12/2021 4:59:56 PM]
Licensee Detail
Valid Licenses
Type Issue Date Qualifying Appointment
ADJUSTER-ALL LINES (0620) 10/17/2016 YES
Active Appointments
ADJUSTER -ALL LINES (0520)
Company Name Issue Date Exp Date
RELATION INSURANCE SERVICES OF FLORIDA INC 11/30/2016 5/31/2021
Invalid Licenses
Type Issue Date Status
PUBLIC ADJUSTER APPRENTICE LICENSE (T3120) 6/14/2016 INVALID
Inactive Appointments
ADJUSTER -ALL LINES (0520)
Company Name Issue Date Exp Date Status Date
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
https://Iicenseesearch.fldfs.com/Licensee/1553280[5/12/2021 4:59:56 PM]
Licensee Detail
INSURANCE CONSULTANTS GROUP, INC. 6/14/2016 12/14/2017 10/14/2016
•• • O • •. 0-0. •
https://Iicenseesearch.fldfs.com/Licensee/1553280[5/12/2021 4:59:56 PM]
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 2-Relevant Experience
A record of performance and professional accomplishments by Proposer and employees,
including professional accomplishments, and to the extent allowed, any work with large
companies or govern mententities.
Each year, we strengthen our balance sheet and reputation becouse of a conshumt trac* rycora
. ,J ur) ,rI.i0r(C< ('-Iti J [f iac",For the last Him years running, Relation was. th(c, to,"'p, 4S firms 1,C)n
J do„ „e2, , .�. ,.e�Ta�, Agsaxies. Dwinga time of evolulJori fo,, the ins ,e2,„.d.
!?" ,.o ,where sonic insurance are strugglUji to aoopt to new ways of a, ing bi.,`..:fess,.
,r,ae approach to connecting the acts between people, 2 .. technology „b•2s
a aTo p 10 0 P r a p e Q ,.;•2 s ub2,t y.a w,a'.;ae s I 'It;aae L.I.S. 2 19� „s u Y.2,,,e_o u Y,ab2a
,
�a< �,
� s.0 ,d,,,�� r ,.;•2 �b2,�y Agencies in '�;aae �. ._F, 2019- „,"6a.2,,,e Journal
a< �
� s.0 ,d,,,e r ,.;•2sub2,t fi 11 w,acaes,,, the L. S 2., s.� „,u .2,,,e_. u ,ab2a
Relation has also rocciveo the Elite Agency awaro from insurance Business America Or the last
5 .
...[ .!. ft;ar`„ r!h€hi..itn,fl r year insurance ,us<<[€.`.`. America surveys,ey`. As aE',scht.r`. to .u....o,s..E..
an impressive list of women w [,t`.(: '-Ind --idnievenumts have c,,;!..feo t e-n
'..�best. I n ,. .- � !. b: Benefits
�# 2 d.a2, , w„ 0�6��� , � �a,. s ,4d.a a w,:i.s ,d.�,o�a.. o,. .. o ,.w
1. I <.:I,ance B # ,,o s r ,,,o ,, a
a " � ,
.. ,., Elite� Agency", aa, InsuYance ?W u „d.ss e ,,,d.a a u
as
201E Elite Agency" by Inmaance Business AmerV-1
6 .. ,.fi. E d. Norna, Keri ,..e,s:,.w,.. by InsuYance ?.. #.w,,,o..ssaa� o..,,'„,a;
a .. ,.5 Elite c s d,, „e2,as Keri ,..e,s:,.w,.. by InsuYance
in 20,',19; Ea our Prvsioent and CCH)wrote and rnblishoo an articky The True Key To Sucans,
is Culture Wicle Attachoo) and in 202,,1; Was. fe,"ItUrYU on The insurance Coffee hOLOC POUCASt;
se,-i s,on 2 ,.s;iot. 16 o k,cus` ng cuMure in the f„ rk1,[);,I,., .", MajOrity O Our , cyu stet s have
15
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
Please find the list of similar contracts or agreements we currently have in force:
h""m 0 _8 1,
'say.. !. `.'`,i.,...'t Or .. .'.V,I .�f:"
'' ` .s s ;r8 9 21 I
[`.0 1ti:fi.
[".`f , t.. ..:'.`.`..t.[f.`c
a a.,.f.s, 230,,, V f...[.e�I v,..[u! ,r ,t:1. .t..,.,-r _ l`,.32
f f f f , .f ° , r- ..�r
..a " ,",.,,."o. . .;t" !.,t��,,."`. ..;t". !.SC`„f,.",t�C ,�"[€h _"E��J"""..,= ",�..."`� ..,t,,;[ ��., r ... ",t,E,!. ,t..
,.ti rfi.
aa .`.`, 4 0 Ml S;�w.."[
16
The True
Success
CULTURE
BY ED PAGE
"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.
more to success than does any other factor. Energized Here are 10 ways we have created a fun, high-performing
employees who are enthusiastic about the work they do,and
the environment in which they do it,will have a dramatically culture:
bigger impact than those who aren't.Whether they're 1.Walkthewalk.Senior leaders set the tone for any
creating a better customer experience,finding ways to organization.Your employees see everything you do—your
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
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 be an excellent one.
great culture,but rather how. At Relation,we do a number of the things to help demonstrate
I'm proud of what we've created at Relation Insurance the culture we want to have. For example,each employee gets
Services.Over the past five years,since I first joined, a handwritten note from myself and our CEO,Joe Tatum,to
we've transformed from a low-morale,low-performing celebrate 5, 10, 15 years and so on at the company.
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
17
y
1 Si{
ii
k } i
,.i•
x
w,
AWE sr
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
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
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
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
sincerity. If you are someone who can show you care about still working on improving many aspects of the business,and
an individual and what's going on in his or her life,you'll build this had a significant price tag as budgeted.Becausewe thought
the relationships that will ultimately help your organization itwas the right thing to do for ourteams,we funded it anyway.
reach its goals. People are far more energized when they The celebration was a huge hit,and it created tremendous
feel they are seen and valued as a person. However, nothing energy and enthusiasm throughout the business. Doing the
is more damaging than being disingenuous or insincere. Be right thing in this case was a small short-term sacrifice that
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
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-
referralbonus 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?
1 { 7 7 7
,fit
I 't G{ty71t��t� €• �-
42� i ws
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
well as announce new programs, initiatives,and . Hosting a kudos(d relation insurance.com email,allowing
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
•Answering anonymous"Ask Joe"questions candidly on our also share this wisdom with those around them. Don't be too
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
• Using the old-school method of walking around and talking add a handwritten note from senior leadership(which was
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.
34
1 AMA(,.L A to FERI..i Ana l,
19
I
i
i
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
j 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
regular check-ins around performance against the people who are sought after by an external audience.
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
Most recently,we created a salesperson "stoplight report": by walking around."Another technique is to do a series of
Those who are performing well are highlighted green,and 15-to 20-minute one-on-one meetings.When I visit other
those who are performing not so well in yellow and red.We offices, I have a sign-up sheet for individual time slots.These
also had an initiative to get our entire sales team on Linkedln meetings have no agenda,and the only ground rule is that
and tracked which producers were engaged on social media no subject is off limits. I 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
afterward. sense of what is going on in the organization.
8.Treat everyone with respect.One of my personal pet Also,whenever I go to a Relation location, I do my best to try
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.
I believe allowing that type of behavior destroys a productive talk to people—you learn a lot and it makes a big difference
culture.
when you make an effort to be present.
We've made it very clear that treating others with respect Most leaders understand how important having a great
is a requirement for success at Relation,and treating culture is,but many still struggle when it comes to creating
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
colleague call. is the single most important factor in driving performance—
it's the only thing that consistently drives outsized
9.Have fun and a sense of humor. Having fun and a sense of organizational performance and long-term competitive
humor is key to a productive work culture.We spend more advantage.
time working than we do anything else,so we may as well
enjoy it. It's also a great tool for leaders,as it can help diffuse Most properly motivated leaders can create aworld-class
culture if they are willing to put the effort in,and the skills
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
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
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.
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 3-Services,Approach and Availability of Service to County
The Proposer shall describe the philosophy, approach and methodology he/she will take
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
be assigned to the County's account.
J t f , , e,, a o,6 i ,td., a-.w ,d..a, s e2€d.,a g e cV >2,
VV,..e2, d.h<a w d.a„d. .2,e,,, wed., „e2, �s .. .�,z v,.. Im .,t. t.L.,,...[€.(h. .t..,€...,t:'C .�[.?i
tm z Jd.. - e. z z " z z e;s ,! z Jhe t;.a J, z e v z
,.,.t;z... z [f, t i e.�,..,.,,z S .,1.[IV m .[€,,, ..U) L ..., t .�,a w z, z, ,z s ,.,t ,.....[..:�h ..[ �:= !. `-f r z
,.,J.,. .,.'. HIV i ..' [; (:01 ..[ J ; V [t',r
i'C z�h€.,z..t.✓.[ ..,t ..�[€. ti !;�h.,.,,z. .d:`C., .,.z.. ,t. S V)I S I I(.s ..(i z, ....:(. ,z(hl z, z, ,ac ,zsz.,i s',.z....J1f J,J —,
CMS
ti``ti ....�,t�f ww �., .�[€. �z<<. z, =r`,z,�z,..,zzf.. z, .Fats..z, ..�C€. �, t.�h ,.,,zI .d�tP, ,��C€h
;...,tn.. €t. "o .�,tv rS.
t. .[..z,.. z .,tU:# ,.,e:,lr WC .€.s,VS V,;as, sz.[!,<S t..L,i s .. .. ...,.,e.
OA. ..[.. z, 12 , .. z...��.
21
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
€�A1 �� � €€r€s€"f it
Stuart,FL }}}}}}}}A\
€t jtr gmi�VI— q V, �""Tit
Stuart, FL
SRC.aO,FF
,,.`.,." ,in"e, ",-I d recovery , t.,.oures ,IBC€h c"'u,"flity controls, in --maiti n to the
to assist 4 reserving and oetermine length of oisability our? to nature of injury with the
The aUJUStCr maintains stea0y contmA with the employee, employer and nicob-11
provioer o..1,ing the life of the W„... .,,i,.€on works. closely with the oye r t�h€.tu
,,,.
Sub-contractors may be usoo for ancillary services. Monroe County can choose '-I
With quality as a priority, vie negotiate rnVerryo pricing Ath all our vendors,
22
t
l_t
v0
t �
ation
Performance Standards
ryt'S�,-Wt'
r, =
a
Workers'
Sr t }i1
t•
-- �,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
23
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
implemented a comprehensive internal claims system that unfolds the details of each one of the
following sections.
Mail Process:
Mail is delivered by the US Postal Service to the front desk during regular business hours. The
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
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:
• 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:
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.
24
• Once the claim is open a task is generated for a three-point contact to be
completed.
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.
Initial and Continuing Contact
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.
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
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.
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
processing system.
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
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.
Written or recorded statements are taken of injured employees, witnesses, and management
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
25
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
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.
In ernnity Benefit Pa meat
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,
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.
Requests for a one time change to another doctor will be responded to within 5 days from receipt
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
• Adjusters and/or nurse case managers fax or e-mail the DWC-25 to the
employer
• 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
26
o Medical supplies
o Durable equipment
o Orthoses, prostheses and other apparatus
o Work-hardening programs
o Pain management programs
o Chiropractic services not to exceed 24 treatments or rendered 12
weeks beyond the dated of the initial chiropractic treatment,
whichever comes first
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.
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.
The adjuster will authorize generic or generic equivalent medications unless brand named is
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.
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.
27
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,
utilization of the appropriate physicians, including specialists, second opinions (when feasible)
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
complicated medical issues arise, compensability issues arise due to pre-existing conditions or
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;
• Anticipated time span of rehabilitation efforts;
• Estimated rehabilitation costs;
• Recovery of rehabilitation costs under appropriate state programs;
• The timing and substance of rehabilitation reports.
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
accordingly.
Individual Case Reserves
For financial reporting and claim control purposes individual case reserves are estimated for all
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,
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
28
and at each subsequent review. This will ensure that all components of the claim are reviewed.
Litigation anagernent
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
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
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
The adjusters actively pursue recoveries from other parties.These include subrogation recoveries
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
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
injured employee is represented, his/her attorney should also be informed of the subrogation
lien.
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
29
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.
In the case of the Special Disability Trust Fund, the adjuster pursues SDF recoveries and ensures
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:
• 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.
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
"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
include the following:
• A brief description of the accident
• 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
• A timetable for resolution of the claim, and the adjuster's estimate of potential
future settlements
• The basis for these recommendations
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.
30
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
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.
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.
• 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.
• Responds to daily adjuster requests and questions.
• 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
and issues regarding EDI filings.
• Coordinate with IT to test new Assure Claims EDI updates before loading into
production data.
• 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.
31
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.
eceit, payrner�t are l filing of rnedical bills
The Florida Workers' Compensation Law requires all payments be made (mailed) within 45-days
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
• Checks are printed by the Accounting Dept. with an EOBR twice a week at
12:00 noon
• 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
indemnity Payments and Cornpen ability
Relation has implemented to following controls to ensure accurate and timely payments of
indemnity in order to avoid fines and penalties:
• 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
adjuster and/or supervisor, automated diary is generated to the Claims
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.
32
• 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.
• Claims Supervisor completes a comprehensive supervisory review report
addressing compensability, reserve adequacy, subrogation, timely payment
of medical and indemnity benefits, timely EDI filings, etc. Claim Supervisor
provides plan of action with direction to the adjuster.
Miscellaneous Controls
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.
33
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 4-Litigation
Pursuant to Section 2-347 of the Monroe County Code, all respondents must provide
answers to thefollowing questions regarding claims and suits:
(a) Has the Proposer ever failed to complete work or provide the goods for which it has
contracted? (If yes,provide details.)
(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
shareholder or major creditor of the Proposer was an officer, general partner,
controlling shareholder or major creditor of any other entity that failed to perform
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.
G t V 0 e V W e
e C J C e w. r u.L F.. _8�.
34
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
C.t V o f, (..ts" % :)
1 sr ,_)2 s 3,0
, :} f .. s .L."d .0 [was; /. s& W. 3a
sf s f ,s s :;2 6 4 ..�r
(g) Credit references (minimum of three), including name, current address, and current telephone
number.
Not
(h) Financial statements for the prior three years for the responding entity or for any entity that is
asubsidiary to the responding entity.
35
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 5-Loss Runs
Sample copies of all loss runs that will be provided to the County for no additional charge must
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.
P t v e e
,. ,.,...
,.....
f,
CS I
t,_mnt {onm t
11
w n n 0
36
M
U N
L L N
0 > O N
O O O O
0 0 a
C C N E
O O Q
j U j O m
N C v YO O L �
C C U N O mc
O C C C_ Q "O
N W N .N Y 'o E E
Y C O N N Y
_ O L 0N L N
v
O o 0 0 0 0 0
U N N N N N N
N N N N N N
Gl
j
U N
O O W O N W O
N m .N- co r V m N:.
c V EA CO V c
G M M M p
Q C1 4i 4i M� EA EA �,.
® C
N O) O W O N W O
T
T '6 V EA CO V O)
N t0 m N m m N'...If
U o
o 0 0 0 0 0
O ® �
U ® o
0
L nj E En En En En En
T m m m m m m m
N U LL J J J J J J
N E O
E __ � of
a O a E > E O ;
LL fn LU n d U fn Q (n W J LL
C rn rn O
O O N
16
O N N O C N
Gl N N CO N N V
jp N CO N
E v
� T
y C) M C) M C2 V
E o 0 0 0 0 o q
Z rn rn rn rn rn rn U
R � rn rn rn rn rn rn �.
V U 0J U
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
Total $74,642.09 $1,520,955.89 $1,595,597.98 115 19i
Pagel of 1
38
N
M
a) V)
M
0 O O sZ N N N w o sZ Q
E V
N C C
N (6 C !Z U '3 y O U N
E N O
O a) O N !Z C N
(6 12 2) � -0 0) - 4 N C
`°
c 3 0 C 3 0 y m
`° E n
w 3 O O Y N ._
p)U .2 ._ i —
cu o > a N
rn m 3 m
+' 4 r Y 'Q 'T In U
to N N m a) a) a 3 N O
3 t y
w 3 N N w (n 3
> 3 w
3 3
e3 LWL� m w w Lw w
m w `Y' 'v�� rn O1 o ff N
0
0 0 0 0 3 3 o
_ o _rn _rn
y (A (A 0 J w W J LL Y W
E �
Y U U O O O O O O O U
U y
cN0 V c00 C'M 7
w o
CC N W N 0 (O 0W N o0 O (00 M
lO N O O I'- N N M O N �..
C 7 V r t` 00 N M W M N U) M..'...
C14 C EA EA N EA EA EA EA EA
N _ e3 e3 v
e»
3 O V O O N N N
y 00 V O (O O O I` 00 N O
p 0 0 0 O O w M w r
lO N O t` 00 oc O N O N
cr d I` N 'IT 0Il- N O V � V M
LU 'IT I-- O 0N N O N W M'
L EA EA EA EA EA EA EA EA EA ..
0
a
m E O O V N Lo I-- O 0 N O OD
L C 3 O O O (M O 7 N t` I` O *"
O O O O N — — N N O N
..�+ w EA EA V N � � N M
L � _
7 v�i c00 OOi 6) � N EA EA Qf
O K EA EA EA EA cj
L 7,,
V —
� 3
LL N N N N N N N N N N
(a �v LL LL LL LL LL LL LL LL LL LL
++ E
N N N N N N N N N N
U Z J J J J J J J J J J
L
0 O O O N O N
Q 7 O N N O O N O N O N
N O O N N O N O N O
-0C O N N O O N N N N N
a) No r N N w V _ N
N A O
N M DO c0 N O N
D J M M c0 N r N
0
—i E a
U
L
(a N M N O N O o0
J M (O W V a1 N O W W
N O O N N N M M M M
N P2 M M M M O
9 N 02 O t` t` t` t` t` t` t` ••
E O O O O O O O O O O
QD p N N N N N N N N N N 0
Z N N N N N N N N N N
Z '� U U U U U Ucy—
+r ,
V V V 3: 3: 3: 3: 3: 3: 3: 3: 3: 3:
O
c� c�
q IR � N Pt
it
.E
o
E 45 C) > Lu Lu
0 0 C)
0
.E E E E
-E -E
FT lo lo lo lo 0 0
i E E E E
U m m m m
C) C) C) C) C) C)
Im Im Im Im
I
o
Im g m 0
-
I
E
al< Q ml m E C) u o U I
CV L C 3
O
O
L 0 C C f0 Ul L fl-
N O
y0 N Y N
O O N U LL
U Z
U LL U Ul 00 '0o N
Q - ` o E
'O C
a o o
r >. 3
m Y o
L_ o N J
Ul (0 O m E 'O > 3
O o 3 C - O E N m(0 o a�
U C ,'' .� L LL o N N L L
- -
Q V N m o
o O_ Y E m m - . m m
C U O `O m O >. 3
O O- N 'O C L O L o
o
o 01 'O .L SZ U (0 N
y (0 E o
L m C w
O L o LLl J U) a O J
o L C f0 N L Ul L
E m=
'm O O O O O U U U O O O
U to
E m o 0 0 0 0 0 0 0 0 0
3 N O O O O O O O O O O
v �M
M O O N O c W M Q
C m
EA EA EA EA EA EA EA EA EA EA EA ''..
to O O m CO CO CO N
N p M M CO N CO M M N O W p
W N W W Cr CO N Cr Cr CO W
a' N M V N V M COO
U
a
i
LL 3 N N N N N CO
y
E
U)
LL
N LL LL LL LL LL LL LL LL LL LL LL ''...
E_ E
N N N N N N N N N N N N N ''...
U Z J J J J J J J J J J J
N N N N N N N N
16 N O O O O N O O N O O
N O N N N N O N N O N N
�p G N N M N M N M
E v
N T J n n J J J J
�
�- N �-
�
V O N V CO Cr I� M V V V T.
y M M M M M M N M M M M
� Zo 0 0 0 0 0 0 0 0 0 o p
N N N N N N N N N N N
Cr Cr Cr Cr Cr Cr Cr Cr Cr Cr Cr
m Cr Cr Cr Cr Cr Cr Cr Cr Cr Cr mm
E rn rn rn rn rn rn rn rn rn rn rn
1100,
no
V U
c N
c-I Ln
CL
cl
<L
ci
ra
N
c-�
E
Q
Ln
o ! o ao
`tr o ;= a
00 0
CL Ln
o
1 Q CLn
o
U Q 1-0 Ln m N cs
o O
o
I—
�� � v p
In
�5
."o N Ln m
fi } I1{fS��fffffff co
d
4
¢ t} Ln N
cl
a O
44
Ln
m
6
a % R n o O fl
n 2
u u
� I
v.
vo
o
\ \ \\} \\\w \\\\\
2 - - - - - -
2 � -
o
2 2
; + :
§ `
d
§ En10
J /
\ \ -( o
� \ OE - -
k
�
G } } ) } } }{
z \ / \§
�� )
O o
v
v
U
U
N w
N N
3
x
0 U U U U U U U U U
� �ja_°i
w w w w w w w w
y 0 m U U U U U U U U U
O O O O O O O O w
w
w � o O � c rn 'ITO 0
c
N 3 O In O M �p O uj � O O
w £ O OA OM') V) O V n 00 00
C 3 Q O EA N 61) N N V a) a)
C w M• M• M•
a Z
0
w
pCO CO 0 N
N U 7 N N c t r, 4f1 r, "'. r 0 r'.
O OO 00 r 0 �tg r� � fie„ r L' ""i' c"r co O 0 �
> LO
W i? t✓j �7 P,4 &"t ra'r n (D : In
N H v3 a _7) i»
p w
N w
O
SO
N N N N N N N N N N N
O O O O O O O O O O O c
++ N N N N N N N N N N N tv
W 7- 7- 7- 7- 7 7 7 7 7 O O S
a � �
O O O O O O O O O O O qy
r 0 W Q N N N N N C (6 V) N
(/) N N > u u u E u u
w F
_ °- a°i °- a°i °- a°i °-
w w w 5 J w
W N
Vr 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
E _ I- A (O
W •E C-14 O C(o O O
v^ O
W ccO O O 0r V w O 0 O 0 1 O 0 O m ! r
N N N N N N r 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 M 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
co co
r r r r
O cq
Z ONE 0) ONE ! a) 0 a) 0 0) ONE
E
i� LL LL LL LL
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
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
LOB Outstanding Claim Claim
Fiscal Code Claim Type Desc Reserves Paid to Date Total incurred Count Count
2020 WC Became Lost Time $37,876.06 $71,439.55 $109,315.61 12 12
WC Lost Time $38,028.33 $102,297.88 $140,326.21 22 8
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
$595,559.41 $1,016,968.61 $1,612,628.02 83 49,
Pagel of 1
45
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 6-County Forms and Licenses
Proposers shall complete the execute the forms specified below and located in this RFP as well
as copies of all professional and occupational licenses and shall include them in this section, i.e.
Tab 6:
L [`J,
C e'i ;eS!
.`.J...J",rI ,.Js
..�. .Ei t. /.0i ,I . swwv..
5,
ML
( `.c?
Statea a�,�.a # .2,a�-i V"Ig a a e a a,
46
v
O
U
U
� U
Y
CD
N O U 's Lo
� U p
tL
w
Y
T,
CIA
Y
Y
1-�Y
DATE(MWDD/YYYY)
A�" CERTIFICATE OF LIABILITY INSURANCE 08/16/2021
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:
RISI dba Pan American Insurance Services pAH/CNN. Ext: (925)407-0417 a/c,No): (925)322-6655
1277 Treat Blvd E-MAIL miriam.fox@relationinsurance.com
ADDRESS:
Suite 400 INSURER(S)AFFORDING COVERAGE NAIC#
Walnut Creek CA 94597 INSURERA: Valley Forge Insurance Company 20508
INSURED INSURER B: Continental Insurance Co. 35289
AQ Sunshine Parent,LLC and its subsidiaries INSURER C: American Casualty Company of Reading,Pennsylvania 20427
Relation Insurance Inc.,Relation Insurance Services,Inc. INSURERD: Capitol Specialty Insurance Corporation 10328
1277 Treat Blvd.Ste.400 INSURER E
Walnut Creek CA 94597 INSURER F
COVERAGES CERTIFICATE NUMBER: 21/22 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
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 TYPE OF INSURANCEAUULbUbK POLICY EFF POLICY EXP
LTR 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 oNcurDrence $ 100'000
MED EXP(Any one person) $ 15,000
A Y 7014962316 06/18/2021 06/18/2022 PERSONAL&ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000
JECT LOC PRODUCTS-COMP/OPAGG $POLICY El PRO 2,000,000P1
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
ANYAUTO BODILY INJURY(Per person) $
B OWNED SCHEDULED 7014962333 06/18/2021 06/18/2022 BODILY INJURY(Pe r accide nt) $
AUTOS ONLY AUTOS
X HIRED �/ NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY X AUTOS ONLY Per accident
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LAB CLAIMS-MADE AGGREGATE $
DED I I RETENTION $ $
WORKERS COMPENSATION X1 STER ATUTE EORH
AND EMPLOYERS'LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000
B-C OFFICER/MEMBER EXCLUDED? ❑ N/A WC7 14962364/WC7 14962347 06/18/2021 06/18/2022
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under 1,000,000
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
ERRORS&OMISSIONS
D IA20171124-05 04/30/2021 04/30/2022 Each Claim $10,000,000
Aggreagate $10,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
Insured: 1'
Relation Insurance Services of Florida,Inc. a
700 SE Central Parkway
Stuart FL 34994 By
1 . 2 21
Monroe County BOCC has been included as additional insured when required by written contract.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN
Monroe County BOCC ACCORDANCE WITH THE POLICY PROVISIONS.
1100 Simonton Street
AUTHORIZED REPRESENTATIVE
Key West FL 33040
fi
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS
REQUEST FOR PROPOSALS
FOR
WORKERS'COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES
SECTION III
PROPOSAL RESPONSE FORM
Please complete this proposal response form and attach behind Tab 10 in the Proposal.
Additional information can be attached to the forms.
Name of Third Party Administrator? Relation Insurance Services of Florida
Address: 700 SE Central Parkway
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
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
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
Preparation of all State mandated reports? Yes x No
Notification of all potential excess claims
to insurer? Yes x No
Quarterly meetings with the County? Yes x No
49
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
If any of the above responses are no, please explain • 25%of PPO /Audit savings
and include the full pricing for the services.
• 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?
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
Will the TPA be responsible for all State imposed
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
50
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
What fee will be charged for accessing the TPA's
PPO networks? 25%
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
run-off fee.
Will the proposer charge any initial or maintenance
fees? Yes No x
If so, please explain:
Please explain required banking arrangements. As County sees fit; maintain current
_arrangement.
Does the proposer have an approved safety program
filed with the State of Florida? Yes No x
Does the proposer agree with the handling of
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.
51
Quoted Price:
Claims Administration
Cost Per Claim Cost Per Run-Off Claim
Workers Compensation
Medical Only Claims $200.00 $100.00
Indemnity Claims $1,200.00 $600.00 _
Flat Annual Fee $60,000.00
Charge for Reducing Medical Bills to State Fee
Schedule
Flat Annual Fee (payable
in month) installments Included in above
Cost to reduce bills in accordance with PPO
Arrangements (flat annual fee strongly preferred)
Is an alternative pricing structure proposed? Yes _ x No
If so, please describe The incentive is stronger with a percentage of
savings structure. awarded, 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
If so, please specify
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.
r
r
Sidnature of Authorized representative Date
Printed Name: Tim McCreary
End of Section III.
52
NON-COLLUSION AFFIDAVIT
according to law on my oath, and under
of
penalty of perjury, depose and say that;
1) | ,the bidder making the
Proposal for the project described asfollows:
2) The prices in this bid have been arrived at independently without collusion,
consultation, communication or agreement for the purpose of restricting competition, aa
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 openinQ, d|nac±|y or indirect|y, to any other bidder orbo any
competitor; and
4\ No attempt has been made or will be made by the bidder to induce any other
person, partnership or corporation to submit, or not to submit, a bid for the purpose of
restricting competition;
5) The statements contained in this affidavit are true and ooneot, and made with
full knowledge that Monroe County relies upon the truth of the statements contained in
this affidavit In awarding omntnonto for said project.
STATE OF
(Signature of Bidder)
COUNTY OF— �
DATE
PERSONALLY APPEARED BEFORE ME, the undersigned authority,
who, after first being sworn bv me, (name 0f
individual signing) affixed his/her signature In the space provided above on this
� l
day of '20
K8v commission expires:
mu/AV ruuL/C ^
0K8B - MCP #1
JAM[KOCIJAN
Commission#HH004286
' Expires May 2*.8024
Bonded mm Budget woUry SmINm
53
DRUG-FREE WORKPLACE FORM
The undersigned vendor in accordance with Florida Statute 287.087 hereby certifies that:
(Name of Business)
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. In the statement specified in subsection(1),notifies the employees that,as a condition of working on the
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.
Bidder's Signature
Date
54
SWORN STATEMENT UNDER ORDINANCE NO.10-1990
MONROE COUNTY,, FLORIDA
ETHICS CLAUSE
warrants that he/it has not employed, retained or otherwise had act on
his/its behalf any former County officer or employee in violation of Section 2 of Ordinance No.10-1990 or any County
officer or employee in violation of Section 3 of Ordinance No. 10-1990. For breach or violation of this provision the County
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
Date: i wa1
STATE OF F 0
COUNTY OF
PERSONALLY APPEARED BEFORE ME,the undersigned authority,_ . ' r'" i - ` kf t (. _ who,after first
being sworn by me, affixed his/her signature (name of individual signing) in the space provided above on this
day of
NOTARY PBLIC d
My commission expires:
OMB-MCP FORM#4
JAMI KOCIJAN
"0
Commission#HH 004286
Expires May 28,2024
"'Pt t.* SoMedTlruB*ot Notary SwkN
55
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
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
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
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."
I state that this Proposer complies with the above.
Signed: 6A-4-t-Jt __
Printed Name: ,
Date:
56
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.
RESPONDENT'S STATEMENT
I understand the insurance that will be mandatory if awarded the contract and will comply in full with all the requirements.
Respondent Signature
57
INSURANCE AGENT'S STATEMENT
| have reviewed the above requirements with the bidder named above. The following deductibles apply tothe
corresponding policy.
POLICY DEDUCTIBLES
Liability pm||ciaa are ocurranoa Claims Made
Insurance Agency @|Qnmtuno
Print Name: Ok
58
VENDOR CERTIFICATION REGARDING SCRUTINIZED COMPANIES LISTS
Project Descriptlon(s): i
Respondent Vendor Name: : } p t"ar ,4t e Vi
Vendor FEIN: � - ,�?9
Vendor's Authorized Representative Name and Title:-w '°���_ I "'. r..6W I M
Address: ", l -A �
city: TT. Stater w: _.. Zip t' le
� .�. � _ ... a
Phone Number r, ... Email Address r <° a #.,... `
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
Sudan List, the Scrutinized Companies with Activities in the Iran Petroleum Energy Sector List, or engaged in business
operations in Cuba or Syria.
I 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: y' , rr i,. who is authorized to sign on behalf
of the above referenced company.
Authorized Signature:_ to C . ..
Print Name: �. C",
Title: Q r ,�� " ;r ' .._ .....
Note: The List are available at the following Department of Management Services Site:
htt--://www.dms.m flarida.com/business o erations/state }urchasin_)vendor information/convicted suspended discrimin
_ --
atory eompJaints vendor lists
59
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 7-County Expectations
The Proposers shall describe their ability to meet each of the following County expectations
regarding the administration of its claims as indicated below.
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. ( f...r s'`f,we one €,ht t
e-i's.,. tom,.f...We ,I. ,.r.[,w..=J ,I i.. *z.,".`..`3:.,i.[.. ...Ct;l ,".`..` ` " ft `. . Vt,r , . f C F,(t .,.t...Sc"-I
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.
i€. .`. .. .. � 0m ., i . t. t !;a�. I ,L[ .t .UI c .,e vice, ` . ..`. ,
r"a _ ,.,�,�<< I,C!h;I `� e.(h[6.,,�� .)�[�`,f n
.hlv.,s.. .< <[,3:. t �;t;;...�.t.�h w!'_ ,.,L-dn_ �
V,.. ..`. .e. c.,rf..s`,r Izzit-,n a ..,_ 1. /.L,./E' �.,./x.i.fi.,r ,.,..I � —1 0 0 f"V'
OA ..[.. .,to`. t `. . 'aia .. 1411 (J,"Hh,!"—
V 0 ,IU, , e - ' e a "
. . nt .,t:I`. ..t I(,: .`.
3. If the administration of the County's claims must be re-assigned to a new adjuster, the County
should be advised of the change 30 days prior to the change taking effect. Such notification
should include thename of the new adjuster,the new adjuster's qualifications and the approach
the new adjuster will take in becoming familiar with the County's claims.
. ,3..,I.��,.e �... ... ,:; .J...,I.�., ..J. .. J .�s. �:.. �J, ..,.; ii..) , .4 ,r .: .J e.......J ....e:I .J.� ..,i...;e
eN
. = � � h v t .e � . (q . . t f . ,0L0 V, „-I c"-I,i0 V1 `., 1; ..,t e. .. , .,.._i, ,?V[thI
Lo a v. a..l 11 I. KI S[r fm999
.? .J.VJE;�,z �Jr C£. �I�,a wes e, Im....[ [t' Se.�Ie, .[°wi.. �Je, ,t. ,.,..I..° e, �!.[€.,. [t... Ei` e.....0
f,I�,.,e;:`„ ,_e.. .r.,.r.�f �,a ..:.'f�.`,`, `„ it. !...* .L. ,,;!sf .t,,,e.s`..e..f., (I . ... ., I r so re.( ..,.r ....
<< c 0 V e e , ,o aa a n e a e stano a point,
+r` ,l.`. .`i /t, !.�' .. ,I..f..�I..[ .,i f. .e.ve. ,i. ..a.,..[ v �.t'-v a t:f0..l. ut`...,I.[€.,z::�[�, r...�. ,I.f€:,:�,ze.�,z..,e�I.l I[
o r .r r
,J"'d '-ik , ...[t. cn( I ai,ei, 0i, I.[ ,!� 1 `. n '-in 'a ou f v(..� t r s ,!.C€,h �. I k.v e.., ,t;
.,rr .., account into consioeyation. Ouy goal is to, aalw e arol,, affect: to ouy
when a bansition „b2s oy neeos to o'., u Ouy clients' „ee os b2„off ,,,2h. .. �[,��[th<<<[, �:�;....�.�. . ,I° .
r, I z
60
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
always ",-It ..[£. forchront of our
below .s ,a summary of our transition[sition rOtO,::Ol ., careassignment o ,in ,atzl wz, to ,in account is
necessary:
A:conference is se., with thee o, by On claNn's mqnndmr, This call is ,o, smplaN the cu ,e n't:
changes to staff,ana the plan for a new aajuster to ..,,a.,. for ..,[€..� ;.,,,a,,. z .d,t..-c.
and . 'fit.,s" e abic';
• :=- .,,a.[€.,zio a..,. is, tza..[tifie.t„ ,a fd ,a follow w-.F ,a. is t.£mt with ...[c. .,;stir,., c, o ...[c.
a0uster with a brief bio, he employer m.,vic Imz, ..h[€. ,,.t.ur !. ,and is ,affor ca the opp r .unit, to
e ,.,.tit. any r {& .ions tc+e able,
• A phone[t:..t .,.tnfe ..C..,,. .s t...[a.au.e a to ..[....tOV . the ,aalus..,.. ,as well ,as ,a Can to Ewe ., e ct and
greet. During the phone ..,.tnfe .,[..,.._; a !ht.ta lea plan for this ...,-Insition is . . follow
.'r ,a.. .s ,also sent with a act tiled ciewription of the ..ran sir. orL target o,ttes and ,.,,tn..,s;.....
inforrm-Ition -for the aajuster and client. Below f is an overview of the keyitems'f =< On a
this process:
41 The Workers,' Com.,,:,, su-Iff; ",-Is, well th(c., claims handling office, is wifica of the changc,,
E"+ The acyuster .s introaucoa to ...[€. ,a,cz t.,[€ a team and p rovi ea contact ..f...r ,s...ort A team is,
lthe. w F of ..h[ca„ � a� t,[ ` 'laims Manger, fi sSupervisor, ,, �eth,. , aCh
he. client prAle o tn..... .,',a.., z handling r ,.. .., tmts is .,.vie.f.00 in act a. with the ,aaptt,..,..
by the supervisor ,i d l..[c., is rovia.a :a copy,
The ahlu ., , is given the time toproperly r v. t and a^„... a T
on ,.,a,., l ...t. bu.,t:.e..
being ass ..[€ a the clientand actively work in,"," ..,[c., a. .,,tti.nt,
• During the claims .,.us& fm the acyuster will , .ner a,.,. ,a letter to the ,,.se E• rova in,","
• The tasks and legal ,a . t..[..mE.nts ,as`.t..,atc-'a idn ...[a. ..,:cairn ,arc,•
=n is ,a.s,.,7 tent to the aa..,..[t.e a......rrn ,, .:,`z .,....rl" .,., m iny; ,:I d ,Iny proviati..
.f a, ne.cas to be ., ithd1 1 Ma".._., J. th(c., a.[t,.tion,
' intc... , ly we have a wh t v . t a _tia ay, , hd� ,a h Fw h,�d review of ,Lf the employee
,s,
A ndling the onset of the ..lair t., C., "I ls..I a.Jw..,.[ ,-.teat.e f iU[ ..,[€., client to .. ,a,,,.. su rc, tinc ...,a.[`ss.ion
E.. a..[s c t [a.sivE...
4. The County currently utilizes Raquelin Fat for all Field Case Management activities. The County
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.
-:1-, ra Iz_. 1a e e E:.,ati f ,.e ,�a,,a �€< Iz c, ra ,a e e .at
has - _
.[e:at ,.,,t.C:...[we.�,. s..[.,. ,:�',, ,..,.,, �/:�,. ,a.,. also e.s� e as,a.�h with ...[�. stir. ,..,,.;, tiff. .. r .tv.at.<. ,,-Ind
.ftiFa..la agree to c t.[....fU ,....a,a.. on of her services on current ,ae'Cd future cl,"- rns, ...[,aa s r ,.. field:
61
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
,.;t `, .. ,�'[ �,.. .._�.�[.. ..,�C(. �`. Im�:.�[,t , e:� �h tom„✓:. ,� ,.t(.�[�- �.. .� ..�[€. .,t�.� E f OV ..�[�.<< ., ,�... `. .. [ I.. . ,!- ..
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
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.
t' - ( ; 'I Y sylnert i ,)p1p. rc,)ves� )y T' e U,.'Si,1J-tv, issues c ;fl vc.) l . er pbt,',fJtY�
.,.a,)u t. T 1 4,/,)y11 ( �� ,,1tY'7�.lta� pt)Cl( ',,l (`'(`dl .( �,1€': .,1,1(1.l (,CS ,,l fl e
SIR,
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.
,Y t1 (2 i`,f(, ("A tp c S,ll plY S��7f 1.t'Y° �l'„i }�'�,�T1�7�'i 11 ves.un lJ ,t;.p
d- ,.,)ruce If 41,, ,Itf tp (� Y �.;�1 Y_,;:.< <7p }����,=T1�y�',_ 4/ 1.,,3' fl e
p(�e tc fl T,.=fig:.
7. The County currently has direct access to their TPA's computerized claim system. This permits
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 when
changes are made. Access to the TPA's computerized claim system should be through the
internet and access should be available 24 hours a day and 7 daysa week. Any fees associated
with access to the TPA's computerized claim system should be clearly stated in the proposals.
_U,S t, t, vv i..s" i" t c.(`I" e t..
�;tc ,i b;•',a`1 "Y ('t(' 1S: 1 7 c.". ,i p(' �y,;:.1�1 S �J'J1t S: ,,.,.� '��(' �7'i r tt`�ll 11 0t �'7�u ;;:.11( Y u;
i te yst ' r ; ; c',`(21t v,/e c)u< Y t :
ii,l l lf,=1Yi11 ,. v,,1( ll = viciec.) i 1.
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
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
62
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
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
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
IMEs, MSAs and Medical Review experts.
+I�'.i,. ,I., she t...., e�I f ,I, s ,a. ...[�. v's:[ �.�,ti �..t..f .°.`. ..[ .. [�. '-swim-1 ! ,rz °� .[i. ... ::,�..., t.:C. ,t. M s
z-�'s.;.,.z,z, ..,_r .e.,".�-.��,< .[£,..f. r..,z, ,... ..[i. `. ...[�:= .t....:` .,t :,iv.!,<e. .fm�...,tM is ove..e��,.,.. '.d�...,. .[£,..�tm
. . ,, .e [.zf .. z _ z �co .z.w 'z.ion .S ( zzJRrie (, tO t` (,Cs w . . f.`,i..,z, .n i..[0::#�
e.....v lv.,<<s�,z ...,t.f z, .[...._.'. f.HI i�h ..[..,i ,t v.,. .[ :..�fm,t.., :C€t. z. t` .z, ,tv.: z .t.....`. r .�,z n.. ,z.[€, s(IV I i,fm
(�4.• ,Jrt ,.a ,.n n .t.Ie.. � #�,.z,.[,J.�,.zr ,J#� °J...Ie.: . ..Ir-.�sV ...J.Iz,:�,a..r�....Jf'C`, ..'C ..,,J Uw.I.,:...t.I f.
.. �M.....r st,z __,..r� .fe...Im,_ .,, .€„a U.... .r. .'., f.,: I.f..,.,(I t..: ....,.rz ,t..... .f£. fm,.... z zz ,.z zz z
., E. .,
•'°"` z t zt.:e;�, eMC.. ,i. ,.t,t..I f ,zI[,.,...e�z ,l.f€:,: �.�[,tz t I z fit...z, Cent ,z..c. [st.. ,.,,� v.,. :�,z M ,t .tiz, .e;;.....v.._..
. z, . / e z „ t..,c=
r ,d. ; OILS[ , .[
i
wd \.t,:�fm ., ,t. .,.`,`, t.[. the. r �5 [t.. <<<. �.. .a is
t u n to ;tt0`,:' t.'Fc a..`,°;
,_:
9. The County has issued Monroe County Administrative Instruction 7400.4 (Workers'
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.
"es"Ition e. t ...., ...�,: .�,h.. ..t < ... �z,.ae, ......,,'� 1 o-0,4,.
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
reductions associated with PPO networks that the TPA has established.
... ,V:cs o z..,. .e z,c s[f:.:��,.w.e. s ..[..w�,z(.�,. .V °le. ..,:z ,z.[V I-I z.. �a. ,z�,..�'...Lz, z.z...v ds
.. s a sss �� . � tvt� ^1(' J , 6 f t I a , .�s V
..i.�Cs . e..Y€.h;tu z, ,In .rv.nt ,t. .. ;.r f£. , ('s ,z.,. :fez.... r ,..r ,.te. ,!Usk. ,_ ,t..,.: ct .(,z v.;......r V f ...�[�
is
L,z, .,,t,f..., ,.,... ..L.z, .`- fzL,z. ,_i [�.� ;.,,t..,z,.t,t:e:z...,t.t ctstu ,.. ,t.
✓�. Im .e.:f .sV ,..,z.. ,t.[ ,z�f€.,: [€. `.....;i Ls UV,
.......[.,,. ..e� .[z� ,iv ..�[e z. .,,t��[.. Im,. °[,M s'(1(1 ,. ,fh .. 0
Is
W('s ,t..,.e. .f ,z ��.e. ,t, s,zt ..[z.< :,t. i..,t ct.,., ,t. .:f. ..[...o ,z ..,zi. .10e.s ,t.;,"LS.
�tv.,�. ,.te.r f'-•.�[ U lk' ,t � L .._. ,.n€.a :n
rvIUII ,� IUtU,.,`,..`, zv<<[,.`, �.�,i,.�,z�.<'t, �..�[,� z.H.,.s[..ez,.e. ,t. r3 zi <<[i."o, ,tf (s V('s s, fme's zir,.
63
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 8-Additional Information
Proposer shall provide any additional information which will present evaluators with insight
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
through the Proposer that could enhance the County's workers' compensation and safety
programs or otherwise improve efficiency.
WE our f('cert u <'sIode to Asawe ChUns there is ,)1" opticri ft71 ol-h1 ( ,`I,.,)h-n r('p c tlr
irn c rts (slf( ,,:U a No our s'„q nL which 4 b lY g t e '1 lopwf ,S tt) ,"t€ irnj,fler e( ted it
2021,
'I'miatiorr's claim system, Assuve ',',-Ia4,re;, is pavt of DX,',-, which is the aud-rovity in cutting e0ge
..('(.hn"-) ,J, ; in .. [(. .isk s U.f,lrn e nt arena,na, .. .< aea .nea< to capture all cost a:f€.,< a,<t. aile.az history
those ..
on ,o,,,-„d. d.�',,,,d., Azure�s,t �,a•2,,,, , cove processing d... ,,n„v.:, areas AxWoe ,,, ko„t reportin& „K<
in ng ,sd,n<ev , ,�e,a d.,,:,a ,d„,, podlicy aaministration . na evalualJory fov ,.f,s,,,- ,compliance.
� -ae
Utiking poweOul tools frorn Business Cbjxts, Business intelligence is a rof%sl easy-toow,
repwing enone that allOWS users Of all WON skill levels to easily create rqmqk charts, "Ina,
,s I . s tie.me;a to analyze oa a. Repom are ..,,..a oo by selecting thma ele.,.wnts and fora ts.
art os d s d, your organizatiMs d d> s. Results . ta„o> w2, er `-t �C. .� �t<< � t� .s
"-it your '-It ",-III tirne's-
r, variety of ...r nn.... policy ana clabi mpoqW as Well as Cust(,)ill on ..hf
unique neeas of the client, at no aaaea cost. With quer-y capability and systern accYnA via the
tm.eV o : ...e. is .an ,"I llyz. ..,.,urns, n ,--ma ition, wob reports a... Milab:t uz..ng our
r .in ..,.a es f.. idn translates ` stern reports into excel for easy us.. and analysis. Assure,
.,. ,,,,s integrates b2„ typeso, claims together, ,,,.., �.� � �� .,,,��a , ,�,,a w ,,b2�, b2.a general
li",-Ibility; ",-Ind property Relation utilizes a bLMtdn report writer uh,"A allows custorniz'ation to
.oqs as neeaea, We also ..,,IBC various reports th1r r,ls. t our Control
the a...me..[.. .,f,., ,a ..[r t,,.e..: ..[,.,.. nucadication r u.i. I...t. ; .t oa< history ,I d of (c.�`
:.
„� .2l,d,a', >�b2'l;a�, capability is further enhanceo to senve you by the use of our ,,,,,d, l, e ,e,..eD
Master
4 , n<eY
-, ,v,ahe.s you `+gym,..,[ .:h[€. „[:ct,,. s.: ,t,[ ,[e;....`,`„s:y to ,Isz,..z,z, ...[€. performance of your ..`;<;.
nnnagmymt prograrn ,ana A: ..�,.r,.,...`,`.- at...f,,,.", rnaae in ..,..rn .11in,,., tm a
liability it sill show you , ceo you ;...o . ,sry fm th ,i..,[.., ,._wnic , lilies o .on .m,able4 siun Pleasc,
...(c., follc oin, :.,) z,'-I .e.z, for rI ..z, #[,. of various nmnHAj quarVnly, a.I ual and aa,: ho,,,...
reports that s-Irc., "'wail'-Ible '-It mc) cost to our clic"rits-
64
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
,J�d... ..,,.t.["s ".[...# w .€,,, �..E; twA .,,sa.nt s On '+...LAJ .,.r�z,".�."�s r�.I4..k c'-I". . ."-I I,m ..€,,,i:�....." rVs W(... �"� ., t..".,i:[ I
0(hw rI..E. ..F I�. �,kw �.. .(1 fm... �. rye,... .J z...le <<tM.."3 u[f
65
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 9-Other Information
If the Proposer cannot fully comply with any of the terms contained in the Request for
Proposal, all deviationsto the terms must be spelled out in this section, i.e.Tab 9.
:,,J)V fz,�.,.„s f. �.,e s e, 0, .,.�` .�.,. �aS(Uk..z,..rl.ff„i z, �.',.,�I H,.,�!:i, ,. .,��.,.f.. .)u),:1 U U) ,.,��.
66
1 wf Monroe County Workers' Compensation
Third Party Claims Administration Services
TAB 10-Proposal Response Forms
The Proposal Response Forms in Section III shall be completed and submitted behind Tab
10 in the response.Full consideration may not be given to Proposals not including the
required Proposal Forms.
e e
67
MONROE COUNTY
BOARD OF COUNTY COMMISSIONERS
REQUEST FOR PROPOSALS
FOR
WORKERS'COMPENSATION THIRD PARTY CLAIMS ADMINISTRATION SERVICES
SECTION III
PROPOSAL RESPONSE FORM
Please complete this proposal response form and attach behind Tab 10 in the Proposal.
Additional information can be attached to the forms.
Name of Third Party Administrator? Relation Insurance Services of Florida
Address: 700 SE Central Parkway
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
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
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
Preparation of all State mandated reports? Yes x No
Notification of all potential excess claims
to insurer? Yes x No
Quarterly meetings with the County? Yes x No
68
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
If any of the above responses are no, please explain . 25%of PPO/Audit savings
and include the full pricing for the services.
• 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?
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
Will the TPA be responsible for all State imposed
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
69
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
What fee will be charged for accessing the TPA's
PPO networks? 25%
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
run-off fee
Will the proposer charge any initial or maintenance
fees? Yes No x
If so, please explain:
Please explain required banking arrangements. As County sees fit; maintain current
_arrangement.
Does the proposer have an approved safety program
filed with the State of Florida? Yes No x
Does the proposer agree with the handling of
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.
70
Quoted Price: _
Claims Administration
Cost Per Claim Cost Per Run-Off Claim
Workers Compensation
Medical Onl Claims $200.00 $100.00
Indemnity Claims $1,200.00 $600.00
Flat Annual Fee 60 000.00
Charge for Reducing Medical Bills to State Fee
Schedule
Flat Annual Fee (payable
in monthly instalimentsL Included in above
Cost to reduce bills in accordance with PPO
Arrangements (flat annual fee strongly preferred)
Is an alternative pricing structure proposed? Yes x No
If so, please describe The incentive is stronger with a percentage of
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.
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
If so, please specify
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 4
l ' 5
Signature of Authorized Peresentative Date
Printed Name: Tim McCreary
End of Section III.
71
Exhibit
Required Insurance Coverages
Coverage Minimum Limits For
Commercial General Liability $1,000,000 GL3
Vehicle Liability $1,000,000 VL3
Workers' Compensation Statutory
WC1
Employers Liability $1,000,000/$1,000,000/$1,000,000
Professional Liability $1,000,000 PRO3
14