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HomeMy WebLinkAbout2003-326 �0 I c7 SERVICE AGREEMENT December THIS AGREEMENT is entered into this2nd day of N&ditbtr, 2003 , by and between Brown & Brown Inc. , a Florida corporation doing business as Preferred Governmental Claim Solutions, hereinafter referred to as " PGCS " , and Indian River County BCC hereinafter referred to as " IRC " . I. RECITALS A. IRC wishes to retain the services of PGCS to provide claims Management services for it' s Workers' Compensation, General Liability and Automobile Liability claims and desires to have PGCS provide specific services in connection with such claims program. B . PGCS is willing to provide such services on the terms and conditions hereinafter stated. II. TERM This Agreement shall be effective for a period of One ( 1 ) year from October 1 , 2003 through September 30, 2004 and shall remain in full force and effect except as amended or terminated as hereinafter provided. l III, CANCELLATION Either Party shall have the right to terminate the Agreement by giving to the other Party written notice of such termination at least thirty (30) days in advance. IRC failure to pay or object to the PGCS service fee as provided in Item IV, Section B of this Agreement within the time limit allowed by the Florida Prompt Payment Act, 218 . 70 F . S . shall be construed as a breach of the Agreement and, in such event, PGCS shall have the right to terminate the Agreement by giving IRC ten ( 10) days' written notice of its intention to terminate. Upon termination of this Agreement, neither Party shall have any further responsibility or obligation hereunder except as provided in Item IV, Section D of this Agreement. IV. AGREEMENT A. Services to be Performed by PGCS . PGCS agrees to perform the following services : 1 . With regard to CLAIMS ADMINISTRATION, PGCS shall : a. Review all claim and loss reports submitted by IRC to PGCS during the term of this Agreement and process each submitted claim or loss report in accordance with administrative notification requirements . s ' b . Conduct a good faith investigation of each reported claim or loss under subparagraph " a" above (hereinafter referred to as a " qualified claim or loss ") to the extent deemed necessary by PGCS in the performance of its obligations hereunder. C, Maintain a file for each qualified claim or loss, which shall be available for review by IRC at any reasonable time. d. Adjust, settle or resist all qualifying claims or losses arising there from within the stated discretionary settlement authority limit and, with specific prior approval of IRC , adjust, settle or resist all other qualifying claims and losses resulting there from in excess of the discretionary settlement authority limit. e. Perform reasonable and necessary administrative and clerical work in connection with each qualified claim or loss, including the preparation of correspondence, reports, vouchers, compromises, releases, agreements and any other documents to finalize a claim. f. Recommend claim reserves and provide a continuous review and updating of these to reflect changes . g. PGCS will assist IRC in arranging a loss and expense payment account as set out in Section B , Paragraph 2 . h. Notify Beth Jordan, IRC Risk Management representative or if unavailable, the assigned Risk Management representative or excess insurers, as determined by IRC, of all qualified claims or losses with respect to which potential losses may exceed the excess retention and, if requested, provide such Parties with necessary information on the current status of those claims or losses . i . Coordinate investigations on litigated claims with attorneys approved by IRC and with adjusters and attorneys of the excess insurance carrier as required. This includes the negotiation of settlements and preparation of subrogation and contribution actions . It is expressly understood by the Parties to this Agreement that all legal costs and loss payments will be charged to the IRC Loss Fund. j . All sizable and unusual claims will be reviewed by PGCS staff at no additional cost to IRC . k. PGCS will furnish to IRC a standard set of loss and information reports showing detail and summary loss information no later than 30 working days following the close of the month. 1 . Additional optional information, analysis reports and services can be provided on a time and expense basis, as mutually agreed upon by PGCS and IRC . M, Provide narrative or analytical reports of major or litigated claims, if requested by IRC . S n. Provide claim forms and other forms believed by PGCS to be appropriate for the efficient administration of the IRC program. o . Investigate and pursue all subrogation possibilities on behalf of IRC in all states permitting subrogation. Funds received from all subrogation collections shall be considered property of IRC . p . Provide all qualified personnel necessary to promptly and effectively perform the services agreed to herein. 2 . With regard to WORKERS ' COMPENSATION and MEDICAL CONTROL, PGCS shall : a. Arrange for independent medical or other experts to the extent deemed necessary by PGCS in connection with processing any qualified claim or loss . b . Pay medical and death benefits, temporary and permanent disability compensation and other losses and expenses but only if in the judgment of PGCS , such payment would be prudent for IRC and IRC is legally obligated to pay said benefits and the anticipated amount thereof does not exceed the stated settlement authority or, in any case, IRC specifically approves or directs such action. C, Assist in the IRC selection of a panel of physicians or other providers of health care to initially treat employees and a panel of medical specialists to provide long-term or specialty care. d . Consult with IRC in order to develop ways of using any medical facility more effectively. e. Monitor the treatment programs recommended for employees by physicians, specialists and other health care providers by reviewing all medical reports so prepared and by maintaining such contact with these providers as may be appropriate in the judgment of PGCS . 7 f. As IRC directs, assist in interpreting medical reports to consider the circumstances under which an injured employee who desires to do so could return to work in the shortest period of time. g. Assist IRC in arranging for rehabilitation or retraining of employees in appropriate cases ; charges for these programs shall be considered allocated expense and charged to the IRC claim file. 3 . With regard to PROGRAM DEVELOPMENT, PGCS shall , to the extent appropriate : a. Consult with key personnel of IRC on the establishment and coordination of necessary procedures and practices to meet any applicable state requirements and the needs of IRC . b . Participate in the orientation of IRC personnel who are directly or indirectly involved in the processing of qualified claims or losses . C, Review the development of the IRC program periodically with representatives of IRC in order to identify problems and recommend corrective action. B . Obligations of Indian River County BCC 1 . IRC shall pay PGCS for services rendered herein the service fees as stated in Attachment "A" of this contract. 2 . IRC shall at all times provide funds adequate for the payment of qualified claims or losses and of allocated loss expenses . For this purpose, allocated loss expenses shall mean all reasonable and necessary costs, charges or expenses of third parties incurred by PGCS , its agents or its employees, which are properly chargeable to a qualified claim or loss including reasonable and necessary court costs, fees and expenses of attorneys, independent investigators, experts and witnesses, and fees for obtaining diagrams, reports, documents and photographs . a. IRC will establish procedures to make timely payments of loss and expense vouchers submitted by PGCS during the course of their claims management program . It is understood that voucher programs may result in late or untimely payments . IRC will not hold PGCS responsible for any fines or penalties incurred as a result of IRC utilizing a voucher program . 3 . It is expressly understood that PGCS shall not be required to advance its own funds to pay losses, allocated loss expenses or banking charges hereunder, or to perform any services hereunder if IRC fails to provide adequate funds as herein set forth C . Discretionary Disbursement Authori . Limit. The limit on any discretionary payment by PGCS for a qualified claim or loss, or for allocated loss expenses, as the case may be, shall be Five Thousand Dollars ($ 5 , 000 . 00) initially. This amount may be changed at any time by IRC upon written notice to PGCS . It is agreed that PGCS shall have full authority and control in all matters pertaining to the payment, processing, investigation and administration of qualified claims or losses within the limit established by this paragraph. Failure of PGCS to settle a qualified claim or loss within such limit, however, shall not subject PGCS to liability to any party in the event of an adverse judgment entered by any court or the settlement of such claim or loss for an amount in excess of such limit. ( O D . Terms of Agreement and Cancellation. 1 . In the event of cancellation of this Agreement, PGCS will ship all files to the location designated by IRC at IRC ' s expense, unless otherwise agreed upon by both parties . a. PGCS will treat as confidential all data furnished by IRC or generated as a result of the processing services performed under this Agreement and any other information so designated in writing by IRC, and PGCS will abide by all state and federal laws, rules and regulations regarding all types of confidentiality and privilege. b . PGCS reserves the right to gather and utilize, as it sees fit statistical information from the data base; provided, however, that IRC name and proprietary and/or confidential data are adequately protected and not disclosed. c. PGCS recognizes that certain information within its care and control may be subject to disclosure pursuant to Chapter 119, F . S . , PGCS agrees to abide by Chapter 119 F . S . If E . Practice of Law. It is understood and agreed that PGCS will not perform, and IRC will not request performance of, any services which may constitute the unauthorized practice of law. Indemnification : PGCS agrees to indemnify and hold IRC harmless from any and all costs , claim demands, liabilities and damages (including attorney fees) arising out of or caused by : 1 ) Any breach of this agreement terms ; or 2) The negligence or misconduct of PGCS , its employees, authorized representatives, or any adjuster in processing, investigating and / or paying claims or; 3 ) The fraudulent conduct or embezzlement or any other defalcation or negligence attributable to PGCS , its officers, employees, authorized representatives or any adjuster or; 4) The failure of PGCS to comply with the claims paying standards imposed by the state of Florida 440 statutes . PGCS agrees to pay all fines, penalties, or other assessments imposed against IRC by an Governmental entity for any misconduct or negligence of PROS , its employees or representatives which was not authorized or caused by IRC or caused by PGCS in fulfilling its obligations under this contract. To the extent allowed by law, IRC agrees to indemnify PGCS against all claims, demands, proceedings, actions, damages, costs and expenses to which PGCS maybe subjected as a consequence of acting at the direction of IRC . IZ To the extent allowed by law, IRC agrees to indemnify and hold PGCS harmless from any and all costs, claims, demands , liabilities and damages (including attorney fees) arising out of or caused by any breach of this agreement terms by the IRC or the negligence or misconduct of IRC , its employees , authorized representatives , in processing, investigating and/or paying claims . G. Notices . Any notice required to be given under this Agreement shall be sent by certified mail to the following in the case of PGCS : Mr. Kevin Cothron Preferred Governmental Claim Solutions P . O . Box 958456 Lake Mary, FL 32795 - 8456 and to the following in the case of Indian River County BCC Beth Jordan, Risk Manager Indian River County BCC 1840 25r'' Street Vero Beach, Florida 32960-3365 H . Successors . This Agreement shall be binding upon and shall inure to the benefits of all assigns, transferees and successors in the interest of any kind of the Parties hereto . I . Entire Agreement and Modification or Amendment. This Agreement represents the entire and exclusive statement of the agreement of the Parties and, except as otherwise provided in Item IV, Section C, may be modified or amended only by a written statement signed by both Parties . Such modification or amendment shall be attached to , and shall thereupon become a part of this Agreement. J. Headings . Headings herein are for convenience of reference only and shall not be considered in any interpretation of this Agreement. K. Independent Contractor. It is understood and agreed that PGCS is engaged to perform services under this Agreement as an independent contractor and not as an agent of IRC . The Parties hereto agreed that neither Party has any relationship with, or contractual liability to, the other with respect to the subject matter of this Agreement, other than as set forth herein. f t IN WITNESS WHEREOF , the Parties hereto have caused this Agreement to be executed on the day and date first above written. Preferred Governmental Cla' olutions By : Ka n Cothron Title : Vice President Indian River County BCC By : a Kenneth R . Macht Title : Chairman BCC Approved : December 2 , 2003 j4S Jeffrey K . Barton ,"Cierlk;� Jai E � E . Ct'IANlaI.E COUNTY ADMINISTRATOR r im Co ApproveC Date in.l C � /- 2 t get jl J3 Dept Risk Mgr , 1 9! 03 l � ATTACHMENT " A " ONE YEAR GUARANTEED RATE WORKERS ' COMPENSATION Medical Only and Lost Time Claims Administration MO - $ 140. 00 LT - $575. 00 All pricing is for life of contract only. Above pricing is on a per claim basis . All services are invoiced on a monthly basis. All subrogation is handled at no additional charge. Medical Bill fee scheduling is performed for $ 1 . 30 per line Excess reporting , monthly loss reports , quarterly large loss reports , check processing , check register reports and BSIA 7's are provided for a monthly administration fee of $ 1 , 250. 00. 1099's are processed for a fee of $5 . 00 per form . Field adjusters for workers' compensation claims are available on an as needed basis for $250. 00 per assignment. This fee is inclusive of mileage and photographs . Remote computer access is available to the employer. PGCS currently utilizes Progressive Data Solution ( PDS ) software . Remote access requires purchase of a yearly license and a monthly user access fee. PGCS receives no monetary rebates, commissions and / or other incentives form the use, recommendation or assignment of any outside service including but not limited to; managed care, surveillance, attomey's, transportation company' s, rehabilitation and medical facilities. } ONE YEAR GUARANTEED RATE t , Claim Service Program General Liability 1 't Year Bodily Injury $400 . 00 Personal Injury $325 , 00 Property Damage $400, 00 E & O $550. 00 Automobile Liabilitv Bodily Injury $575 , 00 Property Damage $425 . 00 Property Claims : $400. 00 All pricing above is on a per claim basis. All pricing and services are for the life of the contract. There is no additional charge for the handling of subrogation . All invoicing for above services is performed on a monthly basis . Above listed full service fees cover mileage and two (2 ) photographs . All pricing for automobile claims does not include automobile appraisals In the event of a Hurricane or other natural disaster, PGCS has a Catastrophe team that will be dispatched to handle the claims . Catastrophe services are time and expense at $48. 00 per hour. ' PGCS Preferred Governmental Claim Solutions REBATE As you may be aware, some Third Party Claim Administrators (TPA) offer a low per claim fee for administration services in order to secure your business . The TPA ' s income is then derived from rebates / commissions they receive from the outside vendors they assign various services to . The result of this practice is the outside vendors charge a higher price for their services in order to compensate the Third Party Claims Administrator. These higher prices are passed on as an allocated expense to the individual claims . The Employer thereby incurs a substantially higher per claim cost as a consequence of this practice . In addition, there is always the question if the TPA is using a particular outside vendor because of the high quality of work product or because that vendor provides the highest commission / rebates back to the TPA. PGCS receives no monetary rebates , commissions and / or other incentives from the use, recommendation or assignment of any outside / allocated service including but not limited to ; managed care, surveillance, attorney ' s, transportation company ' s, rehabilitation and medical providers. P. O. Box 958456 Lake Mary, FL 32795- 8456 Phone : (321 ) 832- 1400 Facsimile : (321 ) 832 - 1448