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HomeMy WebLinkAbout2009-267 SG JOHNS EASTERN COMPANY, INC. Chirp Adjusters and Third Party Adnikiistriwrs SERVICE CONTRACT FOR MULTIPLE LINES CLAIMS HANDLING THIS SERVICE CONTRACT FOR AUTOMOBILE LIABILITY, GENERAL LIABILITY, PROPERTY, AND WORKERS ' COMPENSATION CLAIMS HANDLING is made and entered into this 9th day of September, 2009 , but is effective for all purposes as of the 1 st day of October, 2009 , by and between the INDIAN RIVER COUNTY BOARD OF COUNTY COMMISSIONERS (referred to as the " CLIENT " ) , and JOHNS EASTERN COMPANY, INC . (referred to as the " Service Agent" ) . WITNESSETH : WHEREAS , the Client has undertaken to self- insure its Automobile Liability , General Liability , Property and Workers' Compensation liability in accordance with the Florida Workers' Compensation Law and other applicable Florida statutes and regulations ; and WHEREAS , the Service Agent is engaged in the supervision and administration of programs for self- insured employers ; WHEREAS, the Client desires to engage the Service Agent for, and the Service Agent desires to assist the Client in , automobile liability , general liability, property and workers' compensation claims handling ; NOW , THEREFORE , for and in consideration of the premises and of the mutual obligations , performance of services , and payment of compensation set forth herein , the parties agree as follows : 1 . Enuagement. The Client hereby engages the Service Agent to supervise and administer the Self- Insured Workers' Compensation Program of the Client in accordance with the Workers' Compensation Law as adopted and amended by the State of Florida (the " Law " ) and the applicable rules and regulations as promulgated by the applicable agencies of the State of Florida relating to the Law (the " Rules " ), all in accordance with the Service Agent' s proposal dated February 4 , 2009 , a copy of which is attached hereto and incorporated herein by this reference (the " Proposal ") . 2 . Term . Subject to termination pursuant to Paragraph 9 , the term of this Agreement shall begin as of October 1 , 2009 and shall terminate on September 30, 2014 ; provided , however, that this Agreement shall renew automatically for two additional one-year terms unless otherwise terminated . 3 . Fund for Payment of Claims . The Client has the sole obligation and responsibility for funding the payment of claims made by its employees under the Law and Rules . The Service Agent assumes no duty to fund any such claims at any time and shall have no obligation to advance funds for any such payment . The Client agrees to maintain all necessary funds for payment of claims in accordance with the Law and Rules and to inform the Service Agent of all relevant details with respect to any such accounts in order for the Service Agent to perform its duties under this Agreement . The Client shall add to or increase the amount in any such accounts as needed , and , in any event , within five ( 5 ) business days from the Service Agent's notice to the Client to such effect . 4 . Allocated Claims Expenses . " Allocated Claims Expenses " shall be defined as expenses arising in connection with the settlement of claims, which shall be defined as expenses directly allocated to a particular claim to be discharged from the accounts funded by the Client specified in Paragraph 3 , including, but not limited to : a . Attorneys ' and legal assistants' fees for claim and any lawsuits , before and at trial , on appeal , or otherwise ; b . Court and other litigation and settlement expenses , including, without limitation : ( i ) Medical examinations to determine extent of liability ; ( ii ) Expert medical and other testimony ; ( iii ) Laboratory , X - ray and other diagnostic tests ; ( iv) Autopsy , surgical reviews , and other pathology services ; (v ) Physician and related fees and expenses in reading, interpreting, or performing any of the foregoing tests or services ; ( vi ) Stenographer, process server, and other related trial preparation , trial , settlement, and court costs ; (vii ) Witnesses fees and expenses before and at trial , deposition , settlement discussions , or otherwise ; and c . Fees and expenses for surveillance, private investigators , or otherwise , d . Fees for the indexing of injured employees , e . Fees for any work done outside the office , including , but not limited to , field investigations necessary to determine compensability , liability , Special Disability Trust Fund or subrogation recoverability , claimant control , attendance at mediations , hearings and depositions , attendance at management meetings , attendance at medical consultations or hearings , appraisals , medical management, case management and cost containment, recorded statements , f Fees for any field investigation will be $ 105 . 00 per hour, $ 0 . 55 a mile and $ 1 . 00 per color photograph , and administrative expenses . We will bill at these rates all activities involving handling, controlling, or settling a client ' s liability on a claim , g . Fees for over- night or special mail service for various documents , h . Fees for examining and reducing hospital and medical bills as appropriate , i . Photocopying and/or CD- ROM copies and review of relevant documentation . j . Fees for Pre - Certification of Hospital Admissions , On - Site Case Management, Peer Review , Medical Care Audits , and Hospital Bill Audits . k . Medical Management - Telephonic case management would be provided on all cases at a rate of: • $ 525 . 00 per lost time exposure • $ 125 . 00 per medical only exposure I . Provider Bill Review/Cost Containment Services - Fees for these services are : • $ 5 . 95 per bill • 30 % of all savings over and above Fee Schedule reductions • 35 % out- of- network and hospital audits M , Medicare Set- Aside ( MSA ) services to include ; recommendation for MSA submission , MSA cost projection , MSA submission , liability MSA services , comprehensive drug utilization review , lien search , conditional lien dispute, projection update . 5 . Compensation for the Service Agent. For performing its services under this Agreement, the Service Agent shall be entitled to the following compensation : a. Fees for workers ' compensation exposures whose dates of loss fall between October 1 , 2009 and September 30 , 2010 will be a minimum and deposit of $ 625350 . 00 . This fee contemplates handling 150 workers ' compensation exposures . If the number of exposures exceeds 150 , then the fees will be increased proportionately . All years are subject to audit . b . Fees for non - workers ' compensation exposures whose dates of loss fall between October 1 , 2009 and September 30 , 2010 will be a minimum and deposit of $ 13 , 400 . 00 . This fee contemplates handling 22 non- workers ' compensation exposures . If the number of exposures exceeds 22 , then the fees will be increased proportionately . All years are subject to audit. C , Fees for workers ' compensation exposures whose dates of loss fall between October 1 , 2010 and September 30 , 20 ; 1 will be a minimum and deposit of $ 62 , 350 . 00 . This fee contemplates handling 150 workers ' compensation exposures . If the number of exposures exceeds 150 , then the fees will be increased proportionately . All years are subject to audit. d . Fees for non - workers ' compensation exposures whose dates of loss fall between October 1 , 2010 and September 30, 2011 will be a minimum and deposit of $ 13 ,400 . 00 . This fee contemplates handling 22 non- workers ' compensation exposures . If the number of exposures exceeds 22 , then the fees will be increased proportionately . All years are subject to audit. e . Fees for the 3rd , 4th , and 5th years are guaranteed not to exceed 6% over the previous year ' s fee . f. Information Services - Optional programs available . If selected by Indian River County , Johns Eastern Company will bill accordingly . • Online NO1 ( Pre - fill ) $ 1 , 000 . 00 (per year) • Ad Hoc Report Library No charge • Ad Hoc Query Studio $ 1 , 000 . 00 Setup Fee (one-time charge ) $250 . 00 per login and password ( per year) g . Handling of property claims during a catastrophe will be billed based upon the attached catastrophe schedule ; or the schedule in effect at the time of the catastrophe . Fees for fieldwork for first party property claims will be billed per the attached Property Rate Schedule . 6 . Continuing Handling of Claims After Termination of Contract or Legally Imposed Mandates . Upon termination of this Agreement as set forth in paragraph 8 , the Service Agent agrees to continue handling all claims that have been made and reported to it prior to such date of termination for thirty (30 ) days unless the parties have agreed otherwise in writing . Upon repeal of any service mandated by the workers ' compensation law and/or other applicable statutes and/or regulations , the Service Agent agrees to continue handling all claims under the repealed service that have been reported to it prior to the date of such repeal for thirty ( 30) days unless the parties have agreed otherwise in writing . Upon exiting , client data will be provided to the new TPA either by a series of attachments to one or more email messages containing zip files which can be password -, protected or via CD ROMS . The claim files may exist as paper files and will be shipped as such . If the claim files are stored as images in a document retrieval system , they will be provided via CD ROM or the most current means of providing data . The cost for this will be no greater than $ 3 , 500 . 00 . The Client will be billed for any additional programming to help in data transfer . 7 . Excess Reporting Obligation . Unless otherwise specified in this Agreement, Service Agent agrees that reporting claims to excess insurance carrier is the Service Agent ' s responsibility . It is the responsibility of the Client to provide accurate coverage information regarding any insurance policies insuring claims covered by this Agreement . The information for all claim years that the Service Agent is handling will be made available to the Service Agent within 90 days of contract inception . New insurance information on renewal years will be made within 90 days of renewal date . Excess information will include name and claims reporting address and phone number of all carriers , policy number, effective dates, limits of liability , deductibles , specific retentions and loss funds . Actual policies will be provided . This information is required for each claim year that the Service Agent is handling for the Client. If this information is not made available as outlined in this paragraph , Service Agent will not be responsible for any penalties , interest, or reductions in excess recoveries because of late reporting . 8 . Disputes Subject to Arbitration . Any dispute or claim arising out of or relating to this Agreement or any breach thereof shall be resolved by submission of such dispute or claim to an arbitration panel composed as follows : The Client and the Service Agent shall each select one member of the panel and the two selected members shall select a third member . The parties agree to follow the rules of the American Arbitration Association . 9 . Termination . This Agreement may be terminated by either the Client or the Service Agent by giving prior written notice of ninety (90 ) days . In the event of such termination , compensation paid or payable to Service Agent under Paragraph 5 shall be prorated as appropriate . Notwithstanding anything in this Paragraph 9 to the contrary , the insolvency or tiling for relief from creditors of any party pursuant to the United States Bankruptcy Code or the material breach of a material provision of this Agreement by any party shall permit the other party to cancel this Agreement immediately upon written notice . 10 . Covenants of the Service Agent and the Client. Each of the Service Agent and the Client agrees to use its normal and ordinary professional care and diligence in the performance of its duties under this Agreement and will use its best efforts to comply at all times with the Law and the Rules . 11 . Miscellaneous . a. Each party represents and warrants that it has full power and authority to enter into this Agreement . b . All notices , requests , demands and other communications which are required or may be given under this Agreement shall be in writing and shall be deemed to have been duly given when received if personally delivered ; when transmitted if transmitted by telecopy , electronic telephone line facsimile transmission , or other similar electronic or digital transmission method ; the day after it is sent, if sent by recognized expedited delivery service ; and five ( 5 ) days after it is sent, if mailed , certified or registered mail , return receipt requested , postage prepaid . In each case, notice shall be sent to : If to the Client : Indian River County BOCC 180027 1h Street Vero Beach , FL 32960 If to the Service Agent : Johns Eastern Company , Inc . Post Office Box 110259 Lakewood Ranch , FL 34211 - 0004 or to such other address as either party may have specified in writing to the other using the procedures specified above in this paragraph . c . ( i ) This Agreement shall be construed pursuant to and governed by the substantive laws of the State Of Florida ( and any provision of Florida law shall not apply if the law of a state or jurisdiction other than Florida would otherwise apply ) . ( ii ) The headings of the various paragraphs in this Agreement are inserted for the convenience of the parties and shall not affect the meaning , construction , or interpretation of this Agreement . ( iii ) Any provision of this Agreement which is determined by a court of competent jurisdiction to be prohibited, unenforceable or not authorized in any jurisdiction shall , as to such jurisdiction , be ineffective to the extent of such prohibition , unenforceability or non - authorization without invalidating the remaining provisions hereof or affecting the validity , enforceability or legality of such provision in any other jurisdiction . In any such case , such determination shall not affect any other provision of this Agreement , and the remaining provisions of this Agreement shall remain in full force and effect . If any provision or term of this Agreement is susceptible to two or more constructions or interpretations , one or more of which would render the provision or term void or unenforceable , the parties agree that a construction or interpretation which renders the term or provision valid shall be favored . d . This Agreement constitutes the entire Agreement, and supersedes all prior agreements and understandings , oral and written among the parties to this Agreement with respect to the subject matter hereof. e . (i ) If, within ten ( 10 ) days after demand to comply with the obligations of one of the parties to this Agreement served in writing on the other, compliance or reasonable assurance of compliance is not forthcoming , and the other party takes steps to enforce rights under this Agreement pursuant to paragraph 8 or otherwise , the prevailing party in any action shall be entitled to recover all reasonable costs and expenses ( including reasonable attorneys' and legal assistants ' fees before and at trial , on appeal , or otherwise . ) ( ii ) If any monies shall be due either of the parties to this Agreement hereunder and shall not be paid within forty- five ( 45 ) days from the due date of such payment , interest shall accrue on such unpaid amount at the rate of 1 % per month in accordance with the Florida Prompt Payment Act - F . S . 218 . 70 -79 . f. This Agreement shall be binding upon and inure to the benefit of the successors in in and assigns of the parties . g. The parties to this Agreement will execute and deliver, or cause to be executed and delivered, such additional or further documents , agreements , or instruments and shall cooperate with one another in all respects for the purpose of carrying out the transactions contemplated by this Agreement . h . This Agreement may be executed in any number of counterparts , each of which shall be considered an original , but all of which together shall constitute one and the same instrument and shall become effective when each of the parties has executed at least one of the counterparts even if all the parties have not executed the same counterpart . IN WITNESS WHEREOF , the parties have executed this Agreement effective for all purposes as of October 1 , 2009 . WITNESSES : INDIAN RIVER COUNTY BOYM ze, OF COUNTY COMMISSIONERS zo 5 y ort s ey avel s , al man act Darcy Vas las WITNESSES : JOHN$ EASTERN COMPANY, INC . Z1 I 4Bevly Adk s , AIM , AIC Ex ecutive Vice President PROPERTY FEE SCHEDULE FULL REPAIR COST FULL ADJUSTMENT $ 0 . 01 $ 500 .00 $ 225 . 00 $ 500001 11000 . 00 $ 256 . 00 $ 1 , 000 . 01 21500 . 00 $ 379 . 00 $ 21500 . 01 51000 . 00 $ 465 . 00 $ 5 , 000 . 01 7 , 500 .00 $ 559 . 00 � � $ 7 , 500 . 01 - 10, 000 . 00 $669 . 00 $ 10 , 000 . 01 15 , 000 . 00 $ 825 . 00 $ 15 , 000 . 01 201000 .00 $ 980 . 00 $ 20, 000 . 01 30 , 000. 00 4 . 5 % of Less $ 995 minimum $ 30 , 000 . 01 40 , 000 . 00 3 . 5 of Loss - $ 1 , 350 minimum $ 40 , 000 . 01 55 ,000 . 00 3 . 0% of Loss - $ 1 , 400 minimum $ 55 , 000 .01 70 , 000 . 00 2 . 5 `Xo of Loss - $ 1 , 650 minimum y $ 70 , 000 . 01 90 , 000 . 00 2 . 0`Xo of Loss - $ 1 , 750 minimum $ 90 ,000 . 01 110 , 000 . 00 2 . O% of Loss - $ 1 , 800 minimum $ 110 , 000 . 01 1500000. 00 2 . 0`X0 of Loss - $ 2 , 200 minimum $ 150 , 000.01 ABOVE 2 . 0% of Loss - $ 3 , 000 minimum 1 . Above fees include local telephone , file creation , copying, and secretarial support. 2 . Full Repair Cost - Agreed cost to repair or replace before applying depreciation , deductible , or other clauses limiting coverage. 3 . In addition to the schedule , the tollowing charges will he made: a . All miles driven at $0 . 55 per mile . b . Photos - $ 2 . 00 each C , Outside fees , reports , telephone , and other direct expense, at cost. I Drive time charged (prorated when possible) when loss is more than 20 miles from our office . 4 . These schedules do not apply to catastrophes . 5 . All assignments handled by General Adjuster will be billed at the full adjustment rate . 6 . Subrogation efforts charged on an hourly basis . JOHNS EASTERN COMPANY, INC. �J Pwx) ACCURACY CATASTROPHE FEE SCHEDULE FULL REPAIR COST SERVICE FEE $ 0 . 01 $ 21500 . 00 $ 387 . 00 2 , 500 . 01 51000 . 00 485 . 00 51000001 71500 . 00 572 . 00 7 , 500 . 01 10 , 000 . 00 681 . 00 10 , 000 . 01 15 , 000 . 00 864 . 00 155000 . 01 201000 . 00 11012 . 00 20 , 000 . 01 25 , 000 . 00 4 . 5 % of Loss - $ 1 , 025 minimum 25 , 000 . 01 35 , 000 . 00 4% of Loss - $ 1 , 200 minimum 355000 . 01 50 , 000 . 00 3 . 5 `Yo of Loss - $ 1 , 400 minimum 50 , 000 . 01 100 , 000 . 00 3 `% of Loss - $ 1 , 750 minimum Over 100 , 000 . 00 2`% of Loss - $ 3 , 000 minimum 1 . Full Repair Cost - Agreed cost to repair or replace before applying depreciation , deductible , or other clauses limiting co verahe . 2 . In addition to the schedule , the following charges will be made : a . All miles driven at $ 0 . 55 per mile . h . Photos - $ 2 . 00 each c . Outside fees , reports , telephone, and other direct expense , at cost . d . Administrative/Set up fee $ 50 . 00 e . Drive time charged and mileage (both prorated when possible) when loss is more than 20 miles from our base of operation . JOHNS EASTERN COMPANY, INC. w,� accueacv