Alternative Services Concepts (ASC) Worker's Compensation Claims Admin Services AgreementCity of Dubuque
ITEM TITLE:
SUMMARY:
SUGGESTED DISPOSITION:
ATTACHMENTS:
Description
Worker's Compensation
Agreement -MVM Memo
Staff Memo
Claims Service Contract
Insurance Schedule J
Copyrighted
November 20, 2017
Consent Items # 19.
Alternative Services Concepts (ASC) Worker's
Compensation Claims Administrative Services Agreement
City Manager recommending approval of an Agreement
with Alternative Services Concepts for services related to
the administration of the City's Worker's Compensation
Program effective October 1, 2017.
Suggested Disposition: Receive and File; Approve
Type
Claims Administrative Services City Manager Memo
Staff Memo
Supporting Documentation
Supporting Documentation
THE CITY OF
Masterpiece on the Mississippi
Dubuque
uFAwI p4
',TUNA VA,
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2007.2012
2013.2017
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Acceptance of Worker's Compensation Claims Administrative Services
Agreement
DATE: November 9, 2017
Personnel Manager Randy Peck recommends City Council approval of an Agreement
with Alternative Services Concepts for services related to the administration of the City's
Worker's Compensation Program effective October 1, 2017. On October 16, 2017, the
City Council approved the renewal rates for Worker's Compensation Claims Services
effective October 1, 2017 through September 30, 2018 with Alternative Services
Concepts.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
Mic ael C. Van Milligen'
MCVM:jh
Attachment
cc: Crenna Brumwell, City Attorney
Teri Goodmann, Assistant City Manager
Cori Burbach, Assistant City Manager
Randy Peck, Personnel Manager
Masterpiece on the Missi
Dubuque
2007.2012
2013.2017
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Personnel Manager
SUBJECT: Acceptance of Worker's Compensation Claims Administrative Services
Agreement
DATE: November 6, 2017
I received the attached Agreement between the City of Dubuque and Alternative
Services Concepts (ASC) for services related to the administration of the City's
Worker's Compensation Program. The effective date of the Agreement is October 1,
2017. On October 16, 2017, the City Council approved the renewal rates for Worker's
Compensation Claims Services effective October 1, 2017 through September 30, 2018.
ASC is proposing no increase in their fees for the contract period of October 1, 2017 to
September 30, 2018.
The Agreement has been reviewed by the Legal Department. I request that the City
Council pass a motion approving the Agreement and authorizing you to sign the
Agreement.
RP:alk
ASC
Alternative Service Concepts, LLC
CLAIMS SERVICE CONTRACT
THIS AGREEMENT is made and entered into with an effective date of October 1,
2017 between ALTERNATIVE SERVICE CONCEPTS, LLC, formed in Delaware, with
principal offices at 2501 McGavock Pike, Suite 802, P.O. Box 305148 Nashville,
Tennessee 37214-1213, hereinafter referred to as "ASC", and CITY OF DUBUQUE,
IOWA with principal offices in Dubuque, Iowa, hereinafter referred to as "Client".
WITNESS:
WHEREAS, "ASC" is in the claims service business; and
WHEREAS, "Client" desires to contract with "ASC" as its claims service company
to service the workers' compensation claims of "Client's" arising out of their facilities
located in Dubuque, Iowa.
NOW, THEREFORE, "ASC" and "Client" contract as follows:
"ASC" AGREES:
1. (a) To review all claims and/or losses reported during the term of this Contract
which involve workers' compensation claims against "Client".
(b) To investigate, adjust, settle or resist all such losses and/or claims within the
agreed payment authority limit of Two Thousand Five Hundred Dollars
($2,500).
(c) To investigate, adjust, settle or resist all such losses and/or claims as are in
excess of the agreed payment authority limit of Two Thousand Five Hundred
Dollars ($2,500) only with specific prior approval of "Client".
(d) To report excess claims to "Client's" excess carrier only if "Client" fulfills its
obligations under "Client Agrees" Section, 4c.
2. To furnish all claim forms necessary for proper claims administration.
3. To establish claim and/or loss files for each reported claim and/or loss. Such files
shall be the exclusive property of "Client". Such files are available for review by
"Client" at any reasonable time, with notice.
4. To maintain adequate Automobile Liability, Errors and Omissions, Fidelity Bond,
General Liability, and Workers' Compensation insurance coverage and to maintain
insurance as set forth in the attached Insurance Schedule for Professional Services.
5. To indemnify, defend and hold harmless "Client" with respect to any claims asserted
as a result of any errors, omissions, torts, intentional torts or other negligence on the
Dubuque/1017 Page 1 07269
ASC
Alternative Service Concepts, LLC
part of "ASC" and/or its employees, unless the complained of actions of "ASC" were
taken at the specific direction of "Client". .
"CLIENT" AGREES:
1. To make funds available that "ASC" may draw from at any time and from time to
time for claim and/or loss payments and for associated allocated expense within the
payment authority limit of Two Thousand Five Hundred Dollars ($2,500) and for
claim and/or loss payments in excess of the payment authority limit of Two
Thousand Five Hundred Dollars ($2,500) with the prior approval of "Client".
2. To pay "ASC" fees in accordance with the Fee Schedule attached to this Contract.
3. To pay "ASC" within thirty (30) days of the effective date of all invoices. All past due
invoices are subject to an interest penalty of one and one-half percent (1 1/2%) per
month. In the event "ASC" brings any action or proceeding to recover any part or all
of an outstanding indebtedness, "ASC" shall be entitled to recover as additional
damages any reasonable attorney fees not to exceed twenty percent (20%) of the
outstanding indebtedness.
4. (a) To pay all Allocated Loss Expenses in addition to the claim service fee to be
paid to "ASC" as prescribed in this Contract.
(b) "Allocated Loss Expenses" shall include but not be limited to attorneys' fees;
experts' fees (i.e. engineering, physicians, chemists, etc.); fees for independent
medical examinations; witnesses' fees; witnesses' travel expenses; court
reporters' fees; transcript fees; the cost of obtaining public records; commercial
photographers' fees; automobile appraisal or property appraisal fees; medical
cost containment services, such as utilization review, provider bill audit,
preadmission authorization, hospital bill audit, and medical case management;
all outside expense items; extraordinary travel expenses incurred by "ASC" at
the request of "Client"; and any other similar fee, cost or expenses associated
with the investigation, negotiation, settlement or defense of any claim
hereunder or as required for the collection of subrogation on behalf of "Client".
(c) To provide "ASC" with complete copies of all excess policies which apply to the
claims reported during the Contract period.
5. To relinquish authority to "ASC" in all matters relating to claims service within the
agreed payment authority limit of Two Thousand Five Hundred Dollars ($2,500).
Dubuque/1017 Page 2 07269
ASC
Alternative Service Concepts, LLC
6. To indemnify, defend and hold harmless "ASC" with respect to any claims asserted
as a result of any errors, omissions, torts, intentional torts, or other negligence on
the part of the "City" and/or its employees, unless the complained of actions of "City"
were taken at the specific direction of "ASC".
"ASC" AND "CLIENT" MUTUALLY AGREE AS FOLLOWS:
1. (a) The term of this Contract is continuous from its effective date for one (1) year.
This Contract may be terminated by either "ASC" or "Client" with cause by
providing sixty (60) days' prior written notice by certified mail.
(b) In the event that this Contract terminates or expires for any reason "Client" shall
have the option:
(i) to have "ASC" handle open files which have been reported for an
additional fee based on our prevailing annual rate per file.
(ii) to have "ASC" return the files to the client.
2. This Contract covers Claim Service for "Client" in the United States of America.
3. In the event any one or more of the provisions of this Contract shall be determined to
be invalid or unenforceable by any court or other appropriate authority, the
remainder of this Contract shall continue in full force and effect, as if said invalid and
unenforceable portion had not been included in this Contract.
4. This Contract shall be construed and interpreted in accordance with the laws of the
state of Iowa.
5. This Contract represents the entire understanding of "ASC" and "Client" and
supersedes all prior oral and written communications between "ASC" and "Client" as
to the subject matter. Neither this Contract nor any provisions of it may be
amended, modified or waived except in writing signed by a duly authorized
representative of "ASC" and "Client".
6. The failure or delay of either "ASC" or "Client" to take action with respect to any
failure of the other party to observe or perform any of the terms or provisions of this
Contract, or with respect to any default hereunder by such other party, shall not be
construed as a waiver or operate as a waiver of any rights or remedies of either
"ASC" or "Client" or operate to deprive either "ASC" or "Client" of its right to institute
and maintain any action or proceeding which it may deem necessary to protect,
assert or enforce any such rights or remedies.
Dubuque/1017 Page 3 07269
• ASC
Alternative Service Concepts, LLC
7. To not employ a person who has been employed by the other party at any time
during the term of this Contract, unless the person to be employed shall not have
been employed by the other party during the immediately preceding six (6) months
or unless the hiring party shall have the other party's prior written consent. This
provision shall survive the termination of this Contract for a period of one (1) year.
8. During the term of this Contract, "ASC" will store closed files for a period of three (3)
years from the date of closure, the date of the last payment of benefits, or the
retention requirements of "Client's" carrier. The storage cost is included in the
administrative fees. After the three (3) year period, files will either be returned to
"Client" or destroyed if permitted by Statute.
9. "ASC" will query and transmit information under MMSEA requirements to CMS.
IN WITNESS WHEREOF, "ASC" and "Client" have caused this Contract to be
executed by the person authorized to act in their respective names.
ALTERNATIVE SERVICE CONCE
WITNESS: BY:
TITLE:
DATE:
CITY OF DUBUQUE, IOWA
WITNESS BY:
)04:,frvair
/6.'1.1)
Michael C. Van Milligen
TITLE:
DATE:
City Manager
///a2e1/77
Dubuque/1017 Page 4 07269
ASC
Alternative Service Concepts, LLC
Alternative Service Concepts, LLC
City of Dubuque, Iowa
October 1, 2017 - October 1, 2018
Two -Year Claims Handling
New Claims
Estimated Number Per -Claimant Estimated
Of Claimants , Fee Total Fee
Workers' Compensation
Medical Only
Indemnity
Litigation fee
Run -In Claims
Indemnity
Medical Only
Incident Reports1
Catastrophic Claims2
Estimated Minimum Claims Fee
MMSEA- Annual Transmission
Fees(includes query & submissions)
Account Administration Fee
Systems Fee
Minimum & Deposit Claims Fee
4
20
$170
$780
TBD $300 + base fee
TBD $450
TBD $50
TBD $40
TBD
$ 680
$15,600
$16,280
$ 2,100
$ 3,000
$ 2,500
$23,880
Claims will be handled for two years from the date the loss is reported to ASC with
no additional per claim fee. Any claim remaining open after 24 months will be subject
to an annual maintenance fee of $450.00
ASC will handle the number of claims indicated for the minimum claims fee. If the fee for
the actual number of claims is more than the minimum claims fee, ASC will invoice the
client for the difference.
The account administration fee will be 7.5% of the claims fee or $3,000, whichever is
greater. The administration fee includes:
• Account Setup
• New Claim Setup
1 Recorded in claims system only. Must be specified as "Incident" at tinge of reporting.
'Catastrophic claims — Any event resulting in 10 or more claimants/suffixes will be treated as a catastrophe
and billed the quoted per claim rate for the first 10 claimants/suffixes and any claim/suffix over 10 will be
billed at a per claim rate of $350 per claim.
Dubuque/1017 Page 5 07269
ASC
Alternative Service Concepts, LLC
• Client Meetings (Frequency to be Determined)
• Excess Reporting
• State Reporting
• Storage Fees
At the conclusion of the contract, the following options are available for continued
handling of open claims:
• Negotiated annual fee per claim
• Claims returned to client
Subrogation Pursuit and Recovery
All parties will automatically be placed on notice if the potential for subrogation exists.
Pursuit of subrogation will be performed at the client's request. Pursuit of recovery fee
is 15% of recovery.
Additional Services and Fees3
Client Data Transmission $2,500 Per Release
Carrier Data Transmission $400 Per Release
State -Mandated EDI $3 Per Report/Bill
Computer Compatible Checks & Electronic Transfers At Cost
Data Conversion From Prior Administrator At Cost
On -Line Access (One User) No Charge
Additional Users $60 Per User Per
Month
Reports Produced by Client No Charge
Reports Produced by ASC $50 Per Copy
Systems Training T&E ($85 Per Hour)
Customized Programming T&E ($/Hour)
Actuarial Data Requests $50 Per Hour
Travel Over 100 Miles T&E ($85 Per Hour)
Outside Investigation T&E ($85 Per Hour)
Medical Cost Manaaement4
Fee Scheduling 28% of Savings
PPO Usage 30% of Savings
Invoicing and Payment Terms
Fees will be invoiced annually. Fees are payable upon receipt of the invoice. "ASC"
reserves the right to charge 11/2% per month or the maximum legal rate on unpaid
balances after 30 days.
Allocated Expenses
Allocated expenses will be charged to the claim file and include fees for:
• Legal services
• Medical records
• Index Bureau reporting
• Professional photographs
• Experts' / rehabilitation services
• Accident reconstruction
3 As required or requested. Most services are optional.
4 Pricing for additional managed care services is available upon request.
Dubuque/1017 Page 6
07269
ASC
Alternative Service Concepts, LLC
• Architects, contractors
• Police, fire, coroner, weather reports
• Surveillance
• Extraordinary travel at client's request
• Independent medical examinations,
MRIs, etc.
• Engineers, chemists
• Expert witness statements
• Official documents and transcripts
• Court reporters
• Managed care
Workers' Compensation Definitions (for billing purposes on per claim fee contracts)
Medical Only Claims - Work-related claims that require medical treatment only.
• Subrogation not required
• Investigation sufficient to determine claim type and compensability
• Lost days do not exceed statutory waiting period
• No loss notices, captioned reports, client meetings, or settlement authority required
• Payments do not exceed $2,500
• Two-point contact made
indemnity Claims - Work-related claims that involve disability or payment of medical and
other expenses in excess of $2,500. Claims that require investigation for subrogation
and settlement negotiations.
AH claims, regardless of type, will be investigated, evaluated, and adjudicated in
accordance with state statutory requirements and corporate guidelines.
WITNESS:
WITNES
ALTERNATIVE SERVICE CONC
Dubuque/1017
BY:
TITLE:
DATE:
CITY OF DUBUQUE, IOWA
T LLC
BY:
qtx.- 61ctir
Michael C. Van Milligen
TITLE:
City Ma
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Page 7 07269
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J
Alternative Services Concepts, LLC
shall furnish a signed certificate of insurance to the City of Dubuque, Iowa for
the coverage required in Exhibit I prior to commencing work and at the end of the project if the
term of work is longer than 60 days. Contractors presenting annual certificates shall present a
certificate at the end of each project with the final billing. Each certificate shall be prepared on
the most current ACORD form approved by the Iowa Department of Insurance or an equivalent
approved by the Finance Director. Each certificate shall include a statement under Description of
Operations as to why the certificate was issued. Eg: Project # or Project Location at
or construction of
2. All policies of insurance required hereunder shall be with an insurer authorized to do business in
Iowa and all insurers shall have a rating of A or better in the current A.M. Best's Rating Guide.
3. Each certificate shall be furnished to the Personnel Department of the City of Dubuque.
4. Failure to provide coverage required by this Insurance Schedule shall not be deemed a waiver of
these requirements by the City of Dubuque. Failure to obtain or maintain the required insurance
shall be considered a material breach of this agreement.
5. Contractors shall require all subconsultants and sub-subconsultants to obtain and maintain during
the performance of work insurance for the coverages described in this Insurance Schedule and
shall obtain certificates of insurances from all such subconsultants and sub-subconsultants.
Contractors agree that they shall be liable for the failure of a subconsultant and sub-
subconsultant to obtain and maintain such coverages. The City may request a copy of such
certificates from the Contractor.
6. All required endorsements shall be attached to certificate of insurance.
7. Whenever a specific ISO form is listed, required the current edition of the form must be used, or
an equivalent form may be substituted if approved by the Finance Director and subject to the
contractor identifying and listing in writing all deviations and exclusions from the ISO form.
8. Contractors shall be required to carry the minimum coverage/limits, or greater if required by law
or other legal agreement, in Exhibit I. If the contractor's limits of liability are higher than the
required minimum limits then the provider's limits shall be this agreement's required limits.
Page 1 of 4 Schedule J Professional Services July 2017
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
Exhibit I
A) COMMERCIAL GENERAL LIABILITY
General Aggregate Limit $2,000,000
Products -Completed Operations Aggregate Limit $1,000,000
Personal and Advertising Injury Limit $1,000,000
Each Occurrence $1,000,000
Fire Damage Limit (any one occurrence) $50,000
Medical Payments $5,000
1) Coverage shall be written on an occurrence, not claims made, form. The general
liability coverage shall be written in accord with ISO form CG0001 or business
owners form BP0002. All deviations from the standard ISO commercial general
liability form CG 0001, or business owners form BP 0002, shall be clearly
identified,
2) Include ISO endorsement form CG 25 04 "Designated Location(s) General
Aggregate Limit" or CG 25 03 "Designated Construction Project (s) General
Aggregate Limit" as appropriate.
3) Include endorsement indicating that coverage is primary and non-contributory.
4) Include Preservation of Governmental Immunities Endorsement. (Sample
attached).
5) Include an endorsement that deletes any fellow employee exclusion.
6) Include additional insured endorsement for:
The City of Dubuque, including all its elected and appointed officials, all its
employees and volunteers, all its boards, commissions and/or authorities and
their board members, employees and volunteers. Use ISO form CG 2026.
7) Policy shall include Waiver of Right to Recover from Others endorsement.
B) AUTOMOBILE LIABILITY
Combined Single Limit $1,000,000
C) WORKERS' COMPENSATION & EMPLOYERS LIABILITY
Statutory benefits covering all employees injured on the job by accident or disease as
prescribed by Iowa Code Chapter 85 as amended.
Coverage A
Coverage B
Statutory—State of Iowa
Employers Liability
Each Accident $100,000
Each Employee -Disease $100,000
Policy Limit -Disease $500,000
Policy shall include Waiver of Right to Recover from Others endorsement.
Nonelection of Workers' Compensation or Employers' Liability Coverage under Iowa
Code sec. 87.22
yes form attached
Page 2 of 4 Schedule J Professional Services July 2017
City of Dubuque Insurance Requirements for Professional Services
INSURANCE SCHEDULE J (continued)
D) UMBRELLA/EXCESS LIABILITY $1,000,000
Umbrella/excess liability coverage must be at least following form with the underlying
policies included herein.
E) PROFESSIONAL LIABILITY $1,000,000
Provide evidence of coverage for 5 years after completion of project.
F) CYBER LIABILITY $1,000,000
X yes no
Coverage for First and Third Party liability including but not limited to lost data and
restoration, loss of income and cyber breach of information.
Page 3 of 4 Schedule J Professional Services July 2017
City of Dubuque Insurance Requirements for Professional Services
PRESERVATION OF GOVERNMENTAL IMMUNITIES ENDORSEMENT
1. Nonwaiver of Governmental Immunity. The insurer expressly agrees and states that the purchase
of this policy and the including of the City of Dubuque, Iowa as an Additional Insured does not waive any
of the defenses of governmental immunity available to the City of Dubuque, Iowa under Code of Iowa
Section 670.4 as it is now exists and as it may be amended from time to time.
2. Claims Coveraae. The insurer further agrees that this policy of insurance shall cover only those
claims not subject to the defense of governmental immunity under the Code of Iowa Section 670.4 as it
now exists and as it may be amended from time to time. Those claims not subject to Code of Iowa
Section 670.4 shall be covered by the terms and conditions of this insurance policy.
3. Assertion of Government Immunity. The City of Dubuque, Iowa shall be responsible for asserting
any defense of governmental immunity, and may do so at any time and shall do so upon the timely written
request of the insurer.
4. Non -Denial of Coverage. The insurer shall not deny coverage under this policy and the insurer
shall not deny any of the rights and benefits accruing to the City of Dubuque, Iowa under this policy for
reasons of governmental immunity unless and until a court of competent jurisdiction has ruled in favor of
the defense(s) of governmental immunity asserted by the City of Dubuque, Iowa.
No Other Chanae in Policy. The above preservation of governmental immunities shall not otherwise
change or alter the coverage available under the policy.
SPECI
EN
(DEPARTMENT MANAGER: FILL IN ALL BLANKS AND CHECK BOXES)
Page 4 of 4 Schedule J Professional Services July 2017