Alternative Services Concepts - Workers' Compensation AdministrationCopyright 2014
City of Dubuque ITEM# 15.
ITEM TITLE: Alternative Services Concepts - Workers' Compensation Administration
Renewal Rates
SUMMARY: City Manager recommending approval of renewal rates with Alternative
Services Concepts for workers' compensation claims administration for
October 1, 2014 through September 30, 2015
SUGGESTED DISPOSITION: Suggested Disposition: Receive and File; Approve
ATTACHMENTS:
Description Type
❑ Renewal Rates for Worker's Compensation Claims Administration -MVM Cita Manager Meme
Memo
❑
Staff Memo Staff Memo
❑ ASC Renewal Rates
Supporting °acumenta#ion
Masterpiece on the Mississippi
Dubuque
2007.2012 .2013
TO: The Honorable Mayor and City Council Members
FROM: Michael C. Van Milligen, City Manager
SUBJECT: Acceptance of the Renewal Rates for Worker's Compensation Claims
Administration
DATE: September 22, 2014
Alternative Services Concepts has submitted the renewal rates for workers
compensation claims administration for October 1, 2014 through September 30, 2015,
and is proposing no increase in their fees. Personnel Manager Randy Peck
recommends City Council approval of the renewal rates.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
fir
Mic, al C. Van Milligen
MCVM:jh
Attachment
cc: Barry Lindahl, City Attorney
Cindy Steinhauser, Assistant City Manager
Teri Goodmann, Assistant City Manager
Randy Peck, Personnel Manager
TI IE CITY OF
MaSterpiCCC on tile "Mississippi
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Personnel Manager
SUBJECT: Acceptance of the Renewal Rates for Worker's Compensation Claims
Administration
1)tit-itic-itte
il-4min City
2,007 2012 :"011
DATE: September 18, 2014
I received the renewal rates from Alternative Services Concepts (ASC) for services
related to the administration of the City's Workers Compensation Program. ASC is
proposing no increase in their fees for the contract period of October 1, 2014 to
September 30, 2015.
The requested action is for the City Council to pass a motion approving the renewal
rates for our workers compensation claims administration effective October 1, 2014
through September 30, 2015. I will send you the Administrative Services Agreement as
soon as it is available.
RP:Imh
Alternative Service Concepts
Loyalty * * • Exp-orcAe
City of Dubuque, Iowa
October 1, 2014 -October 1, 2015
Two -Year Claims Handlin
Per-Ciaittlalit Estin.tated
Fee
To Fee
kersCompensation
Medical Only 7
Indemnity 22
*tigation fee TBD
Run -In Claims
ncident Reports
Catastrophic Claims2
TBD
TBD
TBD
TBD
$450
$50
$ 40
ime & Expense
Estimated Minimum Claims Fee
8,350
MSEA- AnnualTransmission
Fees(includes query & submissions)
Account Administration Fee
inimum & Deposit Claims Fee
$2,100
2,500
25,590
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
Notes
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.
Recorded in claims system only. Must he specified us "Incident" at time of reporting,.
2 Any event resulting in 10 or more claimants and/or property losses over $50,000 will he treated as a catastrophe.
Alternative Service Concepts
Loyiiity neuy• * t-wpf.4-1Ifr,(?.
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
• 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
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
Carrier Data Transmission
State -Mandated EDI
Computer Compatible Checks & Electronic Transfers
Data Conversion From Prior Administrator
On -Line Access (One
Additional Users
Reports Produced by Client........................................
Reports Produced by
Systems Training •••••••••••••••••••••••••••14111•1/••••••••••••••••••
Customized Programming ••••••••••••••••••••••••••••••••••••••••••
Actuarial Data Requests
Travel Over 100
Outside Investigation
Medical Cost Management4
Fee Scheduling
PPOUsage................................................................
$2500PerRelease
Per Release
.......................$3 Per Report/Bill
At Cost
.......................At Cost
.......................No Charge
Per User Per
.......................No Charge
.......................$50 Per Copy
T&E ($85 Per Hour)
.......................T&E ($/Hour)
........................$50 Per Hour
T&E ($85 Per Hour)
T&E ($85 Per Hour)
........,....28% of Savings
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 • Professional photographs
• Medical records • Experts' / rehabilitation services
3.1s required or requested. Most .services are optional.
Pricing fiff additional managed care services is available upon request.
IS Alternative Service Concepts
•
Poi Loyalty • Inteprity * * Expertise
• Index Bureau reporting
• Architects, contractors
• Police, fire, coroner, weather reports
• Surveillance
• Extraordinary travel at client's request
• Independent medical examinations,
MR1s, etc.
• Accident reconstruction
• Engineers, chemists
• Expert witness statements
• Official documents and transcripts
• Court reporters
• Managed care
Workers' Compensation Definitions
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.
All claims, regardless of type, will be investigated, evaluated, and adjudicated in
accordance with state statutory requirements and corporate guidelines.
Masterpiece on the Mississippi
TO: Michael C. Van Milligen, City Manager
FROM: Randy Peck, Personnel Manager
SUBJECT: Acceptance of Worker's Compensation Claims Administrative Services
Agreement
2007 • 2012 • 2013
DATE: October 27, 2014
On October 16, 2014, 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, 2014. On October 6, 2014, the City Council approved the renewal rates for
Worker's Compensation Claims Services effective October 1, 2014 through September
30, 2015. ASC is proposing no increase in their fees for the contract period of October
1, 2014 to September 30, 2015.
The Agreement has been reviewed by City Attorney Barry Lindahl and he found the
terms to be acceptable. I request that the City Council pass a motion approving the
Agreement and authorizing you to sign the Agreement.
RP:Imh
ASC
Alternative Service Concepts, LLC
CLAIMS SERVICE CONTRACT
THIS AGREEMENT is made and entered into with an effective date of October 1,
2014 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/1014 Page1 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 Toss 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/1014 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/1014 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.
WITNESS:
ALTERNATIVE SERVICE CONCEPTS, LLC
BY:
e.:! 1/4/-14/eel-I
TITLE:
DATE: /i' /'y`,%%.4,
CITY OF DUBUQUE, IOWA
WITNESS: _t,e-
" 6'r;sL. L. Giczso...
BY:
Mich. el C. Van Milligen
TITLE:
City Manager
DATE: /Ci
}
Dubuque/1014 Page 4 07269
ASC
Alternative Service Concepts, LLC
Alternative Service Concepts, LLC
City of Dubuque, Iowa
October 1, 2014 -October 1, 2015
Two -Year Claims Handling
Service
Estimated Number
Of Claimants
Per -Claimant
Fee
Estimated
Total Fee
Workers' Compensation
Medical Only
7
$170
$ 1,190
Indemnity
22
$780
$17,160
Litigation fee
TBD
$300 + base fee
Run -In Claims
Indemnity
TBD
$450
---
Medical Only
TBD
$50
---
Incident Reports'
TBD
$ 40
---
Catastrophic Claims2
TBD
Time & Expense
--
Estimated Minimum Claims Fee
$18,350
MMSEA- AnnualTransmission
Fees(includes query & submissions)
$ 2,100
Account Administration Fee
$ 3,000
Systems Fee
$ 2,500
Minimum & Deposit Claims Fee
$25,950
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
Notes
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
' Recorded in claims system only. Must be specified as "Incident" at time of reporting.
Any event resulting in 10 or more claimants and/or property losses over $50,000 will be treated as a catastrophe.
Dubuque/1014 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
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 Management4
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 1'/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 • Professional photographs
• Medical records • Experts' / rehabilitation services
• Index Bureau reporting • Accident reconstruction
• Architects, contractors • Engineers, chemists
• Police, fire, coroner, weather reports • Expert witness statements
• Surveillance • Official documents and transcripts
• Extraordinary travel at client's request • Court reporters
• Independent medical examinations, • Managed care
MRIs, etc.
-3 As required or requested. Most services are optional.
4 Pricing for additional managed care services is available upon request.
Dubuque/1014 Page 6
07269
ASG
Alternative Service Concerts, LLC
Workers' Compensation Definitions
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 Toss 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.
All claims, regardless of type, will be investigated, evaluated, and adjudicated in
accordance with state statutory requirements and corporate guidelines.
WITNESS:
WITNESS:
ALTERNATIVE SERVICE CONCEPTS, LLC
BY:
TITLE: 1/'/ r ,
DATE: /0/ /
CITY OF DUBUQUE, IOWA
—i'�`cs►> L. Cal e,,Soos,
BY:
Michael.C. Van Milligen
TITLE:
City ManagerL�
DATE: 'it /1
Dubuque/1014 Page 7 07269
City of Dubuque Insurance Requirements for Professional Services
1.
Insurance Schedule C
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. Providers 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. Each certificate shall include a
statement under Description of Operations as to why issued. Eg: Project # or Lease of premises
at or construction of
2. All policies of insurance required hereunder shall be with a carrier authorized to do business in Iowa and
all carriers 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 contracting department of the City of Dubuque.
4. Failure to provide minimum coverage 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. Subcontractors and sub subcontractor performing work or service shall provide a Certificate of Insurance
in accord with Exhibit I.
6. All required endorsements to various policies shall be attached to Certificate of insurance.
7. Whenever a specific I50 form is listed, an equivalent form may be substituted subject to the provider
identifying and listing in writing all deviations and exclusions that differ from the ISO form.
8. Provider shall be required to carry the minimum coverage/limits, or greater if required by law or other
legal agreement, in Exhibit I.
9. Whenever an ISO form is referenced the current edition of the form must be used.
Page 1 of 3 Schedule C, Professional Services October 2013.Doc
City of Dubuque Insurance Requirements for Professional Services
Insurance Schedule C (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
a) Coverage shall be written on an occurrence, not claims made, form. All deviations from the
standard ISO commercial general liability form CG 0001, or Business owners form BP 0002,
shall be clearly identified.
b) 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.
c) Include endorsement indicating that coverage is primary and non-contributory.
d) Include endorsement to preserve Governmental Immunity. (Sample attached).
e) Include an endorsement that deletes any fellow employee exclusion.
f) 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.
B) AUTOMOBILE LIABILITY $1,000,000 (Combined Single Limit)
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 an endorsement providing a waiver of subrogation to the City of Dubuque.
Coverage B limits shall be greater if required by Umbrella Carrier.
D) UMBRELLA LIABILITY $1,000,000
Umbrella liability coverage must be at least following form with the underlying policies included
herein.
E) PROFESSIONAL LIABILITY $
Page 2 of 3 Schedule C, Professional Services October 2013.Doc
City of Dubuque Insurance Requirements for Professional Services
Preservation of Governmental Immunities Endorsement
1. Nonwaiver of Governmental Immunity. The insurance carrier 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 Coverage. The insurance carrier 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.
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 insurance carrier.
4. Non -Denial of Coverage. The insurance carrier shall not deny coverage under this policy and the
insurance carrier 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 Change in Policy. The above preservation of governmental immunities shall not otherwise
change or after the coverage available under the policy.
SPECIMEN
Page 3 of 3 Schedule C, Professional Services October 2013.Doc