HomeMy WebLinkAbout2003-052 Agrmt - Pinnacle Risk Mgmt CLAIMS SERVICE AGREEMENT
WORKERS' COMPENSATION CLAIMS
THIS AGREEMENT is made and entered into as of March 1~ 2003, by and between the City of Ashland,
(Client) and Pinnacle Risk Management Services, Inc. (Pinnacle.)
RECITALS:
WHEREAS, Pinnacle provides workers' compensation claims adjusting and administrative services on
behalf of self-insured entities;
WHEREAS, Client maintains a self-insured program for its workers' compensation liabilities; and,
WHEREAS, Client desires to engage Pinnacle for claims adjusting and administrative services for its
self-insured program;
NOW, THEREFORE, in consideration of the promises and covenants contained herein, the parties agree
as follows:
1. Service Period
1.1. Pinnacle will provide Client with the services contained in this Agreement for a period of
one (1) 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 sixty
(60) days prior written notice.
2.2. Client 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 (7) days written notice from Client of
such default or breach.
2.3. Upon termination of this Agreement prior to the end of its term:
2.3.1. Client 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 service fee previously billed or due.
2.3.2. Client 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 Client pursuant to the requirements listed on Addendum
"A", Scope of Services, attached and incorporated by reference.
4. Compensation to Pinnacle
4.1. 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.
Claims Service Agreement 1
5. Loss Fund
5.1. Client 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 bill review, 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 Client 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. Client 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, Client 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 herein, Pinnacle will transfer
all files to the Client. 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 shah indemnify and hold harmless Client, 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, error or omission arising out of or in
connection with Pinnacle's obligations under the terms of this agreement, so long as the act,
error or omission was not a result of a request of the Client. 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 Client
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 hereunder. If Pinnacle is named as a party to any litigation because of its
actions on behalf of Client hereunder, Client agrees to employ counsel and to otherwise
defend Pinnacle in any such litigation if no allegation is made that Pinnacle failed to exercise
such care, and to hold harmless and indemnify Pinnacle if no finding is made to the effect
that Pinnacle failed to exercise such care. Client 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, violation of such laws.
8. Proprietary Information
Claims Service Agreement 2
8.1. Client agrees to not disclose to any third party, or use for Client's own benefit, any
information learned about Pinnacle and its services as a result of Pinnacle's services to the
Client, unless Client 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. Client shall not hire employees of Pinnacle, whether currently employed or formerly
employed, during the term of this Agreement, and for a period of two (2) years after the
termination of the Agreement, without the prior permission of Pinnacle.
9. No Unauthorized Practice of Law
9.1. Pinnacle will not perform any services that Pinnacle believes may constitute the
unauthorized practice of law.
10. Independent Contractor
10.1. Pinnacle is an independent contractor at all times during the performance of the
services specified, and not an employee of Client 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 herein, this Agreement shall be binding upon and inure to the
benefit of transferees and successors in interest of any kind to the parties hereto.
12. Notices
All notices shall be directed to the following addresses:
Client:
Lee Tuneberg
Finance Director
City Hall
Ashland, OR 97520
Pinnacle:
James W. Broyles, President
Pinnacle Risk Management Services, Inc.
PO Box 19990
Portland, OR 97280-0999
13. No Other Agreements
13.1. 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
14.1. 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.
15. Legal Enforcement
15.1. This Agreement shall be enforced in and governed by the laws of the State of
Oregon.
Claims Service Agreement 3
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.
16. Pinnacle hereby agrees to comply with the City of Ashland's 'Living Wage'
regulations which is attached as addendum 'C'.
IN WITNESS WHEREOF, the parties hereto have affixed their hands and seals the day and year first
above written.
CHent
Pinnacle Risk Management Services, Inc.
By:
Printed
Name:
Title:
Date: .
Printed
Claims Service Agreement 4
Addendum "A"
Scope of Services
During the period of this Agreement, Pinnacle shall represent and act for Client in matters
pertaining to the liability of Client for claims under the Workers Compensation Act, or similar law, in
the State(s) of Oregon. Pinnacle agrees to perform the following services on behalf of the Client.
1) Maintain the appropriate number of personnel with appropriate experience level to administer
adequately all claims for Client.
2) Receive and examine all claims reported to the Client.
3) Endeavor to make contact on all indemnity claims with the employee, the employee's supervisor
or the Client'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 Client'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 Client, and obtain the Client's approval of any settlements in excess of $10,000.
10) Notify the Client's primary insurer who is excess of its self-insured retention and/or the Client's
broker of all claims with respect to which potential losses may exceed the Client's self-insured
retention In providing such notice, Pinnacle is relying on information provided by the Client 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 Client's checking account.
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.
Claims Service Agreement 5
Addendum "B"
SCHEDULE OF FEES
I. FEES
A.
Client agrees to pay Pinnacle an annual administrative fee of $1,000.00 tc
at the beginning of each contract period.
Annual Administrative Fee:
The annual account coordination and administration fee includes tt
services:
Standard Computer Package
Maintenance of your on-line computer capabilities
Generation of your 1099 forms
Maintenance of your checking account
Captioned Reporting
Excess Cartier Reporting
Annual/Quarterly Reports
Self-Insured Tax calculations
g.
Administrative/claims handling pricing structure for life of the contract:
Client agrees to pay Pinnacle a monthly fee of $1,380.00.00 to administer all of the
existing and any new claims incurred by the client up to 85 claims for the period 3-1-
03 to 3-1-04.
Claims in excess of 85 for the period 3-1-03 to 3-1-04 shall be billed at the rate of $300.00 per
claim.
II. INVOICING AND PAYMENT
Pinnacle shall submit a written invoice to Client for services rendered and Client 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
Ashland, OR 97520
Claims Service Agreement 6
Addendum "C"
City of Ashland
LIVING
per hour effective June 30, 2{)02 .. i
For all hours worked under a
service contract between their
employer and the City of
Ashland if the contract
exceeds $15,345 or more.
For alt hours worked in a
month if the employee spends
50% or more of the
employee's time in that month
working on a project or portion of
business of their employer, if the
employer has ten or more
employees, and has received
, financial assistance for the project
i or business from the City of
Ashland in excess of $15,345.
If their employer is the City of
Ashland including the Parks
and Recreation Department.
In calculating the living wage,
employers may add the value of
health care, retirement, 40'1K and
IRS eligible cafeteria plans
(including childcare) benefits to
the amount of wages received by
the employee.
Call the Ashland City Administrator's office at 541-488-6002 or write to the City Administrator,
City Hall, 20 East Main Street, Ashland, OR 97520 or visit the city's website at www.ashland.or, us.
Risk Management Services
March 26, 2003
City of Ashland
Lee Tuneberg, Finance Director
City Hall
Ashland, OR 97520
RE: Service Agreement
Dear Mr. Tuneberg:
Enclosed is the revised Service Agreement. Please note the change on page four
number sixteen and addendum 'C'. If this contract meets with your approval, please
sign both contracts and return one original to our office.
Please let me know if you have any questions.
Sincerely, ,~
William 'Chip' Barrel
W.C. Claims Manager
503-977-5963
cbartel@pinnaclerisk.com
P.O. Box 19990 · Portland, OR 97280-0999 · Phone (503)245-9756 · Fax (503)246-1581
CITY OF ASHLAND
20 E MAIN ST.
ASHLAND, OR 97520
(541 ) 488-5300
CITY RECORDER'$ COPY
Page 1 / 1
PO NUMBER
04101
VENDOR: 005468
PINNACLE RISK MGMT SERVICES,
ATTN: ACCOUNTS RECEIVABLE
PO BOX 19990
PORTLAND, OR 97280
FOB Point:
Terms: Net
Req. Del. Date:
Special Inst:
SHIP TO: Ashland Finance Deartment
(541 ) 488-5300
20 E MAIN STREET
ASHLAND, OR 97520
Req. No.:
Dept.: FINANCE
Contact: Lee Tuneber.q
Confirming? No
Quantity Unit Description Unit Price Ext. Price
Workers' Compensation Claims 20,000.00
Administration
Annual Administration Fee $1,000.00
Monthly Fee $1,380.00 (Up to 85 claims)
Claims in excess of 85 shall be at
$300.00 per claim.
:
SUBTOTAL 20,000.00
BILL TO: Account Payable TAX 0.00
20 EAST MAIN ST FREIGHT 0.00
541-552-2010 TOTAL 20,000.00
ASHLAND, OR 97520
Account Number Amount Account Number Amount
E 720.03.00.00.607140 20,000.00
VENDOR COPY