HomeMy WebLinkAbout2002-103 Agrmt - Pinnacle Risk Mgmt CLAIMS SERVICE AGREEMENT
WORKERS COMPENSATION CLAIMS
AGREEMENT made and entered into as of March 1, 2002, between the City of Ashland, Oregon,
(City) and Pinnacle Risk Management Services, Inc. (Pinnacle).
RECITALS:
A. Pinnacle provides workers' compensation claims adjusting and administrative services on
behalf of self-insured entities;
B. City maintains a self-insured program for its workers' compensation liabilities; and,
C. City desires to engage Pinnacle for claims adjusting and admit tive services for its self-
insured program;
City and Pinnacle agree:
1. Service Period. Pinnacle will provide City with the services contained in ~: ,s Agreement for a
period of one year, commencing as of the date written above.
2. Termination.
2.1. Either party may terminate this Agreement for any reason upon giving the other party 60
days prior written notice.
22. City may terminate this Agreement for cause, without prejudice to any right or remedy,
in the event Pinnacle fails to perform under the terms and conditions set forth in this Agreement,
and fails to cure any default after seven days written notice from City of such default or breach.
2 3. Upon termination of this Agreement prior to the end of its term:
2.3.1. City shall be responsible for an administrative fee based on the actual claims
established in Pinnacle's computer system on the date of the termination as
evidenced by a loss report from that system, plus any account coordination fee
previously billed or due.
2.3.2. City or its designated agent shall assume responsibility for possession,
management, and adjusting services, for all claims, including open, active, and/or
pending files.
3. Scope of Services
3.1. Pinnacle shall furnish all labor, materials, and equipment necessary to complete the
services required by this Agreement.
3.2. Pinnacle shall provide services to City pursuant to the requirements listed on Addendum
"A", Scope of Services, attached and incorporated by reference.
1- Claims Service Agreement G:~legal~PAULV~GREE~pinnade k 3-2.doc
4. Compensation to Pinnacle. For such services, Pinnacle shall be paid as specified in
Addendum "B", Schedule of Fees, attached and incorporated by reference, and which may be
modified due to negotiations or renewal without effecting the remaining terms of this Agreement.
5. Loss Fund.
5.1. City shall at all times provide funds adequate for the payment of all claims or losses, and
of all allocated loss adjusting expenses (ALAE). For purposes of this Agreement, ALAE means
all defense costs and adjusting expenses, and shall include, without limitation, all fees and
charges of attorneys, investigators, witnesses, experts, independent medical examiners,
physician or nurse reviews, case managers, court reporters, transcription services or other third
parties providing services related to a claim, and the cost of obtaining records, transcripts, field
investigations, recorded statements, photocopies, photographs, certified postage, providing
discovery, shipping expenses, travel expenses, and any other expense related to the defense or
adjusting of a claim. Allocated loss adjusting expenses are to be allocated to the claim file to
which the expenses are related.
5.2. If City fails to provide adequate funds to pay claims costs, including ALAE, Pinnacle
shall have no responsibility whatsoever to advance any funds to pay such claims costs or
expenses.
6. Claims Files.
6.1. Pinnacle will maintain a file on each claim reported to Pinnacle. For purposes of this
Agreement, a file may consist of paper documents or computer-generated images of documents
that are maintained on computer media.
6.2 City will maintain ownership of the claim files regardless of how the files are created,
whether by computer generated image, hard copy, or otherwise. Except in the case of files
maintained as a computer image, City shall be responsible for storage of files that have been
closed for two years or more.
6.3 Upon termination of this agreement, or as otherwise provided in this Agreement,
Pinnacle will transfer all files to the City. Files maintained as a computer generated image will
be transferred on computer media in the format maintained on Pinnacle's computer systems.
7. Indemnification.
7.1 Pinnacle shall indemnify and hold harmless City, its officers, directors, employees and
agents from and against all claims, damages, demands, actions, costs and charges, including
attorneys' fees, arising out of or by reason of any act or failure to act under this Agreement, or
the operation of Pinnacle's business. Pinnacle shall be responsible for compliance with all laws,
ordinances, regulations and rules of the Federal, State, County, and local governments that may
be applicable to its operations. Pinnacle shall hold City harmless from any and all liability arising
out of or in connection with, violations of such laws.
7.2 Pinnacle shall be responsible for exercising reasonable care at all times in the
performance of its obligations under this Agreement. However, if Pinnacle is named as a party
to any litigation because of its actions on behalf of City under this Agreement, City agrees to
employ counsel and to otherwise defend Pinnacle in any such litigation if no allegation is made
that Pinnacle failed to exercise such reasonable care, and to hold harmless and indemnify
2- Claims Service Agreement G:UegaNPAULWGREEIpinnade k 3-2.doc
Pinnacle if no finding is made to the effect that Pinnacle failed to exercise such reasonable care.
City shall be responsible for compliance with all applicable Federal, State, County, and local
laws, rules and regulations, and shall hold Pinnacle, and its directors, officers, and employees
harmless from any and all liability arising out of, or in connection with, violations of such laws.
8. Proprietary Information .
8.1. City agrees to not disclose to any third party, or use for City's own benefit, any
information learned about Pinnacle and its services as a result of Pinnacle's services to the City,
unless City obtained the information independently from a third party with a legal right to the
information, or unless the information is generally available in the public domain.
8.2. City shall not hire employees of Pinnacles, whether currently employed or formerly
employed, during the term of this Agreement, and for a period of two years after the termination
of the Agreement, without the prior permission of Pinnacle.
9. No Unauthorized Practice of Law. Pinnacle will not perform any services that Pinnacle
believes may constitute the unauthorized practice of law.
10. Independent Contractor. Pinnacle is an independent contractor at all times during the
performance of the services specified, and not an employee of City for any purpose whatsoever.
11. Successors and Assigns.
11.1. This Agreement shall not be assigned by either party without the prior written consent
of the other.
11.2. Except as provided in this Agreement, this Agreement shall be binding upon and inure
to the benefit of transferees and successors in interest of any kind to the parties.
12. Notices. All notices shall be directed to the following addresses:
City: Pinnacle:
Lee Tuneberg James W. Broyles, President
Finance Director Pinnacle Risk Management Services, Inc.
City Hall PO Box 19990
20 East Main Street Portland, OR 97280-0999
Ashland, OR 97520
13. No Other Agreements. This Agreement, and its Addendum, embodies the entire agreement
between the parties, supercedes any prior agreements, and shall not be altered except in writing
signed by both parties.
14. Waiver. The waiver of any breach of any provision by either party to the Agreement shall not
be construed as a waiver of any subsequent breach by either party, and shall not operate to
prevent enforcement of any provision thereafter.
3- Claims Service Agreement G:Vega11PAULWGREE\pinnade k 3-2.doc
15. Legal Enforcement.
15.1. This Agreement shall be enforced in and governed by the laws of the State of Oregon.
15.2.The prevailing party in any legal action to enforce the terms of this Agreement against
the other party, by a law suit or otherwise, shall be entitled to reimbursement from the other
party of the costs and expenses related to such legal action, including attorney's fees.
City of Ashland Pinnacle Risk Management Services, Inc.
By: u ' By:
Printed Name: Z-,!V- %u'/L 6 Printed Name: J',-4-v ?/ S'
Title:iN?N[r Title:
,??f,
Date: S1,1162-- Date: z
4- Claims Service Agreement G:11ega11PAULWGREEIpinnacle k 3-2.doc
Addendum "A'
Scope of Services
During the period of this Agreement, Pinnacle shall represent and act for City in matters
pertaining to the liability of City for claims under the Workers Compensation Act, or similar law,
in the State of Oregon. Pinnacle agrees to perform the following services on behalf of the City.
1) Maintain the appropriate number of personnel with appropriate experience level to administer
adequately all claims for City.
2) Receive and examine all claims reported to the City.
3) Endeavor to make contact on all indemnity claims with the employee, the employee's
supervisor or the City's personnel manager or similar position, and the authorized treating
physician or that physician's office.
4) Conduct an investigation of each reported claim to the extent deemed necessary by Pinnacle
in the performance of its services.
5) Establish and maintain a reserve for each claim for which there is an injury and/or anticipated
liability.
6) Determine the benefits and services payable under the law of the jurisdiction applicable to the
claim, and issue payments in a timely manner in accordance with the applicable laws and
regulations.
7) Coordinate returning the injured worker to work through the City's return-to-work program.
8) Arrange for independent investigators, medical evaluations, or other third party services, to
the extent deemed necessary by Pinnacle to process and evaluate any claim or loss.
9) Provide adequate advance notice of hearings, mediations, arbitrations, or settlement
conferences to the City, and obtain the City's approval of any settlements in excess of $10,000.
10) Notify the City's primary insurer who is excess of its self-insured retention and/or the City's
broker of all claims with respect to which potential losses may exceed the City's self-insured
retention. In providing such notice, Pinnacle is relying on information provided by the City or its
broker to identify appropriate excess insurer(s.)
11) Produce a check register after the end of each month containing the detail of all checks
written during that month on the City's checking account. Provide a copy of the City of Ashland
trust bank account on a monthly basis.
12) Prepare all data related to the claims files in the form necessary to satisfy state
requirements for quarterly and/or annual reports.
13) Provide other information as necessary to maintain compliance with any applicable laws,
including but not limited to, annual filing of Internal Revenue Service Form 1099.
5- Claims Service Agreement GAegaWAULIAGREEIpinnacle k 3-2.doc
Addendum "B"
SCHEDULE OF FEES
FEES
$1250/month
II. INVOICING AND PAYMENT
Pinnacle shall submit a written invoice to City for services rendered and City shall pay the
invoiced fee within thirty (30) days after receipt of the invoice.
Invoices shall be submitted to:
Lee Tuneberg, Finance Director
City Hall
20 East Main Street
Ashland, OR 97520
6- Claims Service Agreement G:Uega11PAULIAGREEIpinnade k 3-2.doc
81AR-28-2002 17:47 FROM-SIMS
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CERTIFICATE OF LIABILITY INSURANC?VVYS
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ACORD 25S J7197) It)ACORO CORPORATION 1988
07/19/2002 PO: 03437
::~ '~ (541) 488-5300
VENDOR: 005468 Slim TO: Ashland Finance Deartment
PINNACLE RISK MGMT SERVICES, (541) 488-5300
ATTN: ACCOUNTS RECEIVABLE 20 E MAIN STREET
PO BOX 19990 ASHLAND, OR 97520
PORTLAND, OR 97280
FOB Point: Req. No.:
Terms: Net Dept.: FINANCE
Req. Del. Date: 07/01/2002 Contact: Lee Tuneber.q/Cindy Hanks
Special Inst: Confirming? NO
Quantity Unit 1 ' Description Unit Price Ext. Price
i BLANKET PURCHASE ORDER
Workers Comp Claims 15,000.00
' July 1,2002 to June 30, 2003
Agreement dated: 03/01/2002
One year agreement
Insurance required
SUBTOTAL 15,000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 15,000.00
ASHLAND, OR 97520
Account Number Amount Account Numbe~ Amount
E 720.0300.00.607140 15,000.00
------------------------------------
Note: Workers Comp Claim Services
Worker's Comp
Workmans Comp
Workman's Comp
Workers' Comp
CITY OF
-ASHLAND
REQUISITION FORM
THIS REQUEST IS A:
? Change Order(existing PO # )
Vendor Name:
Address:
City, State, Zip:
Phone:
Fax Number
Deliver Location
Services Only
Description
Date of Request: y y1? ?
Required Date of Delivery/Service: F?
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/,.
Total Cost
oY11 C G s f i 1S
Exempt
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3 Written
El Quote.
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(cop
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El Sole Source ? Invitation to Bid
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$ (j . (?O(? ? Less than
$5000
t
E] Request for
Proposal (copies on file)
Account Number aGCh ,i? D. 0 _:=L -L0 ? [qG
*Please attach the Original signed contract and Insurance certificate.
Materials Only
Item #
Account Number___-__-__
*Please attach the quotes.
Employee Signature: okSupervisor/Dept. Head Signature:
NOTE: By signing this requisit n form, I certify that the above request meets the City of Ashland Solicitation Process requirements and can be provi
when necessary.
Solicitation Process: Cfyv, r( rict
Quantity Unit Description Unit Cost Total Cost