HomeMy WebLinkAboutAgenda Report - December 17, 2008 E-09AGENDA ITEM EOF9
CITY OF LODI
COUNCIL COMMUNICATION
TM
AGENDA TITLE: Adopt Resolution Authorizing the City Managerto extend an Agreement for
Workers Compensation Claims Adjusting and Administration Services with Gregory
B. Bragg & Associates, Inc. ($106,500 Year One, $111,300 Year Two, and
$116,500 Year Three)
MEETING DATE:
PREPARED BY:
December 17,2008
Risk Manager
RECOMMENDED ACTION: Adopt resolution authorizing the City Manager to extend an
agreement for Workers Compensation claims adjusting and
administration services with Gregory B. Bragg & Associates, Inc.
($106,500 Year One, $111,300 Year Two, and $116,500 Year
Three).
BACKGROUND INFORMATION: The City of Lodi is nearing the end of a three-year agreement with
Gregory B. Bragg & Associates, Inc. for Workers Compensation
Third Party Administrative (TPA) services. The selection and
subsequent authorization by Council followed consideration of 12
proposals submitted in response to a Requestfor Proposal (RFP) distributed by staff in 2005.
A primary focus for a TPA is to provide stabilization of reserves, ensuring a predictability of costs and the
elimination of excessive loss development factors. Data from Bragg (Exhibit A) shows that our increases
have been minimal. In addition, since assuming administration of the City's workers compensation
claims, G. Bragg & Associates has processed 3,796 medical bills totaling over $1.9 million. Diligent
review and negotiation of those bills resulted in a savings of over $1.1 million.
FISCAL IMPACT: Claims administration services - $334,300 over three years.
Additional fees such as bill review, utilization review, and
investigations are billed based on factors detailed in the contract.
FUNDING AVAILABLE: Funds are available in the Workers Compensation 310202.7323
uuc�
ttocover expenditures for G. Bragg & Associates services.
ans, Budget Ma ger
L
4a et Hamilton
k Manager
APPROVED: ---,
Blair King, ' nager
AGREEMENT FOR WORKERS' COMPENSATION CLAIMS
ADJUSTING AND ADMINISTRATION SERVICES
AMENDMENT
THIS AMENDMENT to the agreement entered into on December I, 2005 by and
between the City of Lodi, a political subdivision of the State of California (hereinafter
"Client") and Gregory B. Bragg & Associates, Inc., a California corporation (hereinafter
"Claims Administrator") is amended effective on December I, 2008 as follows:
2. Scope of Services
(e) All services which Claims Administrator provides to Client pursuant to this
AGREEMENT shall conform to the standards of quality as outlined in LAWCX's
current "Performance Standards for Claims Administrators" and the Claims
Administrator's "Workers' Compensation Claims Administration Guidelines"
4. Compensation
A. Claims Management Rates: Annual Flat Rate
The annual rate for managing all workers' compensation claims from December
I, 2008 to November 30, 2009 is $106,500. The annual rate for managing all
workers' compensation claims from December I, 2009 to November 30, 2010 is
$1 11,300. The annual rate for managing all workers' coinpensation claims from
December I, 2010 to November 30, 2011 is $ I 16,500.
B. Annual Client Services Fee: $2,000
This includes the following services: computer input of all open claims, monthly
computer loss information and quarterly and annual reports, trust account
(excluding checks and bank charges), and management attendance at claim
review meetings. This fee includes 2 online access licenses. Additional licenses
may he purchased upon request.
C. Bill Review Fees
Bill review/PPO access services may be provided at $9.50 per bill reviewed and
20% of PPO savings for PPO access.
D. Other Services
Other services may he done after authorization of Client at the following time and
expense rates. These rates may he negotiated on an annual basis:
1. Investigation Services $ 72.5 0 per hour
2. Risk Control Services $1 10.00 per hour
3. Hearing/Lien Representative $ 85.00 per hour
3. Mileage IRS reimbursable tate
4. index Reports at actual cost
5. Other Expenses at actual cost
12. Notice
Any notice required to be given under this Agreement shall be given by personal
delivery or registered or certified mail or overnight carrier at the addresses
specified below or at such other addresses as may be specified in writing by the
parties hereto:
To the Claims Administrator
by mail:
To the Claims Administrator by
personal or overnight carrier:
To the Client:
Gregory B. Bragg & Associates, Inc.
P.O. Box 2216
Granite Bay, CA 95746
Gregory B. Bragg & Associates, Inc
I Sierra Gate Plaza, Suite 250-B
Roseville, CA 95678
Blair King
City Manager, City of Lodi
221 West Pine Street
Lodi, CA 95240
With a copy to: Janet Hamilton
Management Analyst, City of Lodi
221 West Pine Street
Lodi, CA 95240
Notice shall he deemed given three (3) business days after the date of mailing, or
if personally delivered or delivered by overnight carrier, when received. A
party's address for notice may be changed by giving notice to the other party in
the manner set Forth above and indicating the new address for notice.
CITY OF LODI, a municipal corporation:
BLAIR KING
City Manager
Gregory B. Bragg & Associates, Inc.:
RANDALL C. SMITH
President
ATTEST:
RANDI JOHL
City Clerk
APPROVED AS TO FORM:
D. STEPHEN SCHWABAUER
City Attorney
PERFORMANCE STANDARDS
"For Use as an Exhibit to TPA Agreement"
t, Caseload
Each examiner shall have a caseload not to exceed one hundred and fifty (150) open indemnity claims, which
includes future medical claims. Each claims assistant shall have a caseload not to exceed two hundred (200)
open claims. The supervisor shall not have a caseload but may handle specific issues.
The TPA shall provide a computer generated monthly caseload report to the ENTITY's Administrator for all
examiners handling the ENTITY's claims. The report shall include all clients and claims each examiner is
handling and shall be provided to ENTITY's Administrator electronically within ten (10) business days of
closure of the previous month.
2. Claim File Set Up
Upon receipt of the Employer's Report of Occupational Injury or Illness or Application for Adjudication of
Claim, the TPA will prepare an individual claim tile within one (1) business day for each claim. Preparation of
the claim file shall include entering each new claim into the computer system and establishing appropriate
initial reserves based on the information obtained at the time of claim set up. A copy of the worksheet
establishing the initial reserves shall be maintained in the applicable claim file. The file shall be available to the
ENTITY, including its members, their representatives, claims auditors, and agents, for inspection and contain
all medical and factual information on each reported claim.
3. Coverage
The TPA shall verify coverage was provided to the member by the ENTITY on the date of injury or illness in
accordance with member program dates and governing documents. If applicable, the TPA shall exercise due
diligence in joining applicable co-defendants. All activity to verify coverage and join co-defendants shall be
clearly documented in the computer notepad.
4. Index Bureau
The TPA shall subscribe to the Index Bureau. Costs to subscribe to the Index Bureau shall be included in the
pricing structure. The examiner shall request a report from the Index Bureau on all new indemnity claims.
Subsequent requests should be made every six (6) to twelve (12) months thereafter on all active indemnity
claims.
5. Emnlover Contact
The TPA shall request the Employer's Report of Occupational Injury or Illness form within one (1) business
day when or if notification of any injury or illness by any source is received first.
If the DWC Form 1 has not been received by the TPA within two (2) business days after receiving the
Employer's Report of Occupational Injury or Illness, the examiner will contact the member to ensure the DWC
Form I was given to the employee within one (1) business day of knowledge of the injury. If a DWC Form I
had not been given to the injured employee, the TPA shall immediately send the DWC Form 1 directly to the
employee.
The TPA shall contact the member within two (2) business days of receipt of notice of a claim by any source to
conduct an initial and meaningful investigation. Such contact with the member shall be clearly documented in
the computer notepad.
When a claim reaches or exceeds $100,000 in total incurred value, the TPA shall report to the member every
ninety (90) calendar days regarding the status of the claim. A copy of the claim status report will be provided
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 2 of 11
to the ENTITY's Workers' Compensation Program Manager. Such report shall include a current status of the
claim, the examiner's plan of action for the future handling of the claim, and the current paid to date and total
incurred amounts listed by indemnity, vocational rehabilitation, medical, and expense categories.
The examiner will provide on-site file reviews if requested by a member of the ENTITY. Other periodic on-
site file reviews will be scheduled based upon the needs of the members.
Return phone calls to members shall be made within one (1) business day
6. Employee Contact
In all non -litigated, lost time cases, where the employee has not returned to work, telephone or personal contact
will be established with the injured employee within two (2) business day of receipt of notice of claim. Such
contact will continue as often as necessary, but at least monthly. Such contact with the employee shall be
clearly documented in the computer notepad.
Return phone calls to employees will be accomplished within one (1) business day.
All correspondence from employees will be responded to within five (5) business days of receipt
7. Compensability
The compensability determination (accept claim, deny claim, or delay acceptance pending the results of
additional investigation) and the reasons for such determination will be made and clearly documented in the file
within three (3) business days of the receipt of the notification of the loss. Delay of benefit notices shall be
mailed in compliance with the Division of Industrial Relations' guidelines. Copies of benefit notices will be
maintained in the applicable claim file. The TPA shall notify the member of delay or denial of any claim.
In no case shall a final compensability decision be extended beyond ninety (90) calendar days from the
member's knowledge of the claim.
8. Investigations
The TPA shall promptly initiate investigation of issues identified as material to potential litigation. The
member shall be alerted to the need for an outside investigation as soon as possible and the examiner shall
appoint an investigator who is acceptable to the member. The member shall be kept informed on the scope and
results of all investigations. All activities shall be clearly documented in the computer notepad.
9. Reserves
Reserves shall he established based on the facts of the claim and the ultimate probable cost of each claim. All
reserve categories shall be reviewed on a regular basis but not less than at least every ninety (90) calendar days.
Such reviews shall be clearly documented in the computer notepad. Any changes to reserves shall include an
explanation for the change. A copy ofreserve worksheet will be maintained in the applicable claim file.
10. Pavments
The ENTITY has established a zero -balance account, which shall at all times contain sufficient funds to enable
the TPA to make timely payments of claims, allocated loss expenses, and other amounts The TPA is authorized
to make on behalf of the ENTITY. To comply with the positive pay requirements, the TPA shall electronically
submit the information required by the ENTITY's financial institution on a daily, weekly, or monthly basis.
The submissions will be at no additional cost to the ENTITY.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 3 of 11
11. Provision of Benefits
The TPA shall provide all compensation and medical benefits in a timely manner and in compliance with the
statutory requirements of the California Labor Code. The TPA shall compute and pay temporary disability
benefits to injured employees based upon earnings information and authorized disability periods. The TPA shall
review, compute, and pay all informal ratings, death benefits, Findings and Awards, life pensions, or
Compromise and Release settlements. However, all such benefits shall be paid from the ENTITY's established
zero -balance account that will be linked to the ENTITY's "positive pay" account.
12. Initial Indemnitv Pavment
The initial indemnity payment or voucher will be issued and mailed to the injured employee together with a
properly completed DWC benefit notices within fourteen (14) calendar days of the first day of disability.
Copies ofbenefit notices will be maintained in the applicable claim file.
Late payments must include the self-imposed 10% penalty in accordance with Labor Code Section 4650
13, Subsequent Indemnitv Pavments
All indemnity payments or vouchers subsequent to the first payment will be verified, except for obvious long-
term disability, and issued in compliance with Labor Code Section 4651.
Late payments must include the self-imposed 10% penalty in accordance with Labor Code Section 4650.
Copies of benefit notices issued with subsequent benefits will be maintained in the applicable claim file
14. Medical Administration
The TPA, absent a Medical Provider Network (MPN), shall select a panel of general practitioners, specialists,
hospitals, and emergency treatment facilities to which injured employees should be referred and regularly
review and update the panel.
The physician's office will be contacted within five (5) calendar days of notice of all new claims to conduct an
initial investigation as to the medical aspects of the claim and discuss the member's return -to -work goals. Such
contact will continue as needed during the continuation of temporary disability to assure that treatment is
related to a compensable claim and clearly documented in the computer notepad.
The TPA shall maintain contact with treating physicians to ensure employees receive proper medical treatment
and are returned to full or modified employment at the earliest possible date.
The TPA shall maintain direct contact with medical providers to ensure their reports are received in a timely
manner.
The TPA shall arrange medical evaluations when needed, reasonable, and/or requested in compliance with the
current California Labor Code.
The TPA shall ensure that medical bills are reduced to the Official Medical Fee Schedule (DMFS) and
recommended rates established by the Administrative Director of Workers' Compensation. The use of a
service contractor is acceptable provided approval is first obtained from the ENTITY's Administrator. The
ENTITY shall pay for the use and benefits of the services provided; however, fees charged by the service
contractor shall have been approved by the ENTITY's Workers' Compensation Program Manager prior to the
provision of and payment for services. The ENTITY's Workers' Compensation Program Manager will approve
the service contractor's fees on a monthly basis prior to payment by TPA to the service provider. Such fees
will be charged to the applicable claim file and will be paid from the medical categoty.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 4 of L 1
The TPA shall provide, at the ENT[TY's expense, utilization review and/or professional managed care services
on an as -needed basis to injured employees, provided the ENTITY and/or the member's approval is obtained
prior to the provision of such service. The use of a service contractor to provide this service is acceptable
provided the ENTITY's approval is first obtained. Such fees will be charged to the applicable claim file and
will be paid from the medical category.
15. Medical Pam
Medical bills will be reviewed for correctness, approved for payment, and paid within time limits established by
Labor Code Section 4603.2. If all or part of the bill is being disputed, the TPA will notify the medical
provider, on the appropriate form letter, within time limits established by Labor Code Section 4603.2.
Complete medical management services will he provided to the employer.
16. Transportation Expense
Transportation reimbursement will he mailed within five (5) calendar days of the receipt of the claim for
reimbursement. Advance travel expense payments will he mailed to the injured employee at least ten (10)
calendar days prior to the anticipated date of travel.
17. Retum-to-Work
The TPA shall provide assistance to the ENTITY and its members in establishing a modified work program that
is appropriate for injured employees while recovering and prior to their return to regular duties.
The TPA shall consult with the member at least once a month in those cases where the injury residuals might
involve work restrictions.
18. Permanent Disability
The TPA shall provide information and assistance to injured employees in completing the necessary forms to
obtain a permanent disability rating.
The TPA shall determine the nature and extent of permanent disability and arrange for an informal disability
rating whenever possible to avoid Workers' Compensation Appeals Board (WCAB) litigation. The TPA shall
take advantage of any potential apportionment potential to prior claims, disabilities, and impairments. The TPA
shall also advise the member of potential credits and penalties to permanent disability benefits should the
member accommodate permanent/alternative work for at least twelve (12) months.
All permanent disability benefit notices shall be sent to the employee as required by the California Labor Code
Copies of benefit notices will be maintained in the applicable claim file.
19. Vocational Rehabilitation
In accordance with all applicable California laws in place at the date of injury, the TPA shall:
A. Determine the Qualified Injured Worker/Non-Qualified Injured Worker status;
B. Advise the injured worker of his/her right to rehabilitation benefits;
C. Provide appropriate vocational rehabilitation benefits;
D. Control rehabilitation costs;
E. Attempt to secure the prompt conclusion of vocational rehabilitation benefits; and
F. Provide notification to the ENTITY's members should work restrictions require permanent or modified
alternative accommodations.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 5 of I 1
20. Diary Review
All claim files shall be reviewed at least every forty-five (45) calendar days for active claims and at least every
six (6) months for claims that have settled but are open for the employee's future medical care. The examiner
shall distinguish the regular diary review from routine file documentation in the computer notepad. A plan of
action will be included and separately labeled in the file notes during a diary review. The plan of action shall
include, but not limited to, the employee's current work status, medical status, review ofreserves, and future
activity to move the claim towards resolution.
The supervisor shall monitor the diary reviews by printing a "No Activity" report each month to identify any
files that have fallen off the diary system.
21. Plan of Action
Each claim file shall contain the examiner's plan of action for the future handling of that claim. The plan of
action on new claims will be clearly documented in the computer notepad within fourteen (14) calendar days of
initial claim set up. Such plan of action shall be clearly stated including the reasoning for the plan. The plan of
action will be updated at least every forty-five (45) calendar days and clearly identified in the computer
notepad.
22. Claim Supervision
The TPA shall provide supervisory staff that will regularly review the work product of the examiners. The
supervisor shall review at least ten percent (10%) of each examiner's caseload each month to ensure each
examiner is following the performance standards outlined in this AGREEMENT. In addition, the supervisor
shall conduct a regular quarterly review of all open indemnity claims with reserves in excess of $100,000 and
all problem or complex claims. Such reviews shall be labeled as "Supervisor Review" and clearly documented
in the computer notepad.
23. Status Reports
Claim status reports requested by members, in addition to the regular ninety (90) day status reports, shall be
provided by the TPA to the respective member within ten (10) business days. Verbal status reports requested
by members shall he provided by the TPA to the respective member within two (2) business days. Other than
standard monthly loss runs referenced in Section 38 of this EXHIBIT, computer generated loss data reports
requested by members shall he provided within twenty (20) business days.
24. Claim Reconciliation
All claim files shall be reconciled to ensure all indemnity payments have been made correctly. The
reconciliation should verify that payments were made in the correct amount and from the correct claim file.
The physical file should he verified with the computer information. All open claim files shall be reconciled at
the time of a request for settlement authorization and at the time of submission for closure. Proof of the
reconciliation should remain in the claim file and clearly documented in computer notepad.
25. Settlements
The TPA shall obtain the member's authorization on all settlements. The TPA or defense counsel shall forward
settlement proposals to the member in a format approved by the ENTITY's Workers' Compensation Program
Manager. All requests for settlement authority shall be clear and concise and include a written claim analysis,
estimate of permanent disability, and the defense counsel's comments and recommendations. If the settlement
exceeds an amount established by the ENTITY's governing body, the written settlement proposal shall also be
directed to the ENTITY's Workers' Compensation Program Manager to provide authority in addition to the
member's authority.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 6 of 11
26. Award Payment
Payments on Awards, computations, or Compromise and Release agreements will be issued within ten (10)
business days or sooner if necessary to ensure payment within ten (10) calendar days of the WCAB approval
date, following receipt of the appropriate document.
27. Future Medical Claims
Claims that remain open to monitor future medical care shall remain open for two (2) years from the last
payment of benefit. Reviews shall be documented in the claim notes to include settlement information, future
medical care outline, last date and type of treatment, name of excess carrier, excess carrier reporting level, and
excess carrier reporting history. Reserves for future medical treatment will he reviewed every six (6) months
and adjusted for use over a three (3) year average and the injured employee's life expectancy based on the latest
version of the U.S. Life Table. The reason(s) and calculation(s) for the adjustment(s) shall be clearly
documented in the computer notepad.
28. Subro ag tion
In all cases where a third party is responsible for the injury to the employee, the TPA will send a letter to the
member indicating they will pursue subrogation unless instructed otherwise by the member. When subrogation
is to be pursued, the third party shall he contacted within ten (10) business days with notification of the
member's right to subrogation and the recovery of certain claim expenses. If the third party is a governmental
entity, a claim shall be filed with the governing entity within six (6) months of the injury or notice of injury.
Such contact will he documented in the claims administrator's computer notepad.
Periodic contact shall be made with the responsible third party and/or insurer to provide notification of the
amount of the estimated recovery to which the member will be entitled. Such contact will be documented in the
claims administrator's computer notepad.
If the injured worker brings a civil action against the party responsible for the injury, the TPA shall consult with
the Workers' Compensation Program Manager about the value of the subrogation claim and other
considerations. If subrogation rights are waived, TPA shall obtain written authority from the ENTITY's
Workers' Compensation Program Manager. Upon the member's authorization, subrogation counsel shall he
assigned to file a Lien or a Complaint in Intervention in the civil action.
Whenever practical, the TPA should take advantage of any settlement in a civil action by attempting to settle
the workers' compensation claim by means of a Third Party Compromise and Release. If such attempt does not
succeed, then every effort should he made through the WCAB to offset claim expenses through a credit against
the proceeds from the employee's civil action.
29. Litigated Cases
TPA shall promptly initiate investigation of issues identified as material to potential litigation. The member
shall be alerted to the need for an outside investigation as soon as possible and the examiner shall appoint an
investigator who is acceptable to the member. Such referrals will be documented in the claims administrator's
computer notepad. The member shall be kept informed on the scope and results of all investigations.
When defense counsel is not necessary, the TPA shall work closely with the applicant's attorney in informal
disposition of litigated cases. All assignments to outside counsel will be done with the member's authorization
and consent. Such referrals will be documented in the claims administrator's computer notepad. The TPA
shall prepare clear and concise litigation referrals to outside counsel outlining the issues of the claim and duties
that will be handled by defense counsel, In conjunction with the member, the TPA shall monitor the outside
counsel's progress. The TPA shall audit all defense counsel's bills before payment is authorized.
All preparation for a trial shall involve the member so that all material evidence and witnesses are utilized to
obtain a favorable result for the defense.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 7 of I I
The manager, supervisor, or the examiner shall attend WCAB hearings, rehabilitation hearings, meetings with
defense counsel, and meetings with member's staff, departments, and employee groups as necessary and as
requested to do so.
30. Fraudulent Claims
Any claim believed to be fraudulent shall be referred to TPA's in-house special investigation unit for further
investigation and potential referral to the District Attorney. If TPA does not have an in-house special
investigation unit, the claim will be referred to an investigator, with the member's prior approval, to conduct
further investigation.
31. Excess Insurance
Cases that have the potential to exceed the ENTITY's self-insured retention shall he reported in accordance
with the reporting criteria established by the excess insurance policies. All cases that meet the established
reporting criteria are to be reported within five (5) business days of the day on which it is known the criterion is
met. A copy of the submission to the excess carrier shall be forwarded to the ENTITY's Workers'
Compensation Program Manager until such time the TPA is instructed otherwise.
32. Penalties
Late payment of all benefits must include the self-imposed penalty in accordance with California law. The TPA
will provide the ENTITY a quarterly listing of any administrative penalties paid the quarters ending March 31,
June 30, September 30, and December 31, which were the responsibility of the TPA, and a check from the TPA
payable to ENTITY for reimbursement. The check and report shall be submitted to ENTITY by the 20'h of the
following month after the quarter ends.
33. Case Closure
The supervisor must review all medical only claims open beyond ninety (90) calendar days from the date of
entry by the TPA for potential closure or conversion to indemnity claim status. Claims with $3,000 or more
paid -to -date on any claim open beyond one hundred eighty (180) calendar days from date of entry shall be
converted to indemnity status and a reasonable, precautionary indemnity reserve placed on the claim.
All indemnity cases, where permanent disability is not an issue, will be closed within sixty (60) calendar days
of the final financial transaction or final correspondence to the injured worker as required by law. All
indemnity claims where permanent disability is an issue, will remain open for two (2) years from the last
payment of benefit and then closed within sixty (60) calendar days of that date.
34. Forms
The TPA shall provide all forms necessary for the processing of benefits or claims information including the
Employer's Report of Occupational Injury or Illness, DWC Form 1, medical service orders, return -to -work
slips, lost time information reports, vouchers, checks, and other related forms. The cost of providing these
forms shall be included within the contract price set forth in this AGREEMENT.
35. Claims Renortin
The TPA shall, at its expense, provide two (2) weeks prior to any governing meeting of the ENTITY, a written
summary report showing the number of claims reported during the prior month, separated by category (i.e.
indemnity or medical only), the number of claims closed during the prior month, separated by category, and any
medical cost savings. This report shall show a comparison of the same information for the same month for the
prior year.
The TPA shall maintain all loss information as required by the Workers' Compensation Insurance Rating
Bureau.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 8 of I 1
The TPA shall assist in the preparation of all reports that are now, or will be required by the State of California
or other government agencies with respect to self-insurance programs. The TPA will also assist in the
preparation of all reports or databases required by the California Institute for Public Risk Analysis (CIPRA) or
other statistical database organizations as requested by the ENTITY.
36. Record Retention
All claim files shall be maintained in accordance with statutory time requirements and the ENTITY's Record
Retention Policy. The members shall be notified prior to any destruction of files to determine if the member
wishes to retain the claim file.
31. Computer Access
The TPA shall provide online access at no additional charge to the ENTITY's Administrator. Such data shall
be in a format accessible from the ENTITY's Administrator's computers and will permit the ENTITY's
Administrator to print copies of the data on its printers. The TPA shall provide training for use of the computer
system for the ENTITY's Administrator. If the ENTITY's Administrator, under the TPA's guidance, is not
able to maintain online interface with data maintained by the TPA, the TPA may he required to provide a copy
of all data processed during the previous month to the ENTITY's Administrator's office on a disk by the tenth
(10`h) calendar day following month end.
38. Loss Runs
The TPA shall, at its expense, by the tenth (10`h) calendar day of the following month, unless otherwise
specified below:
A. Provide the following information monthly to the members, as it pertains to their respective claims,
electronically, on diskette, or in written format:
i. A listing of all open claims showing the employee's name, claim number, date of injury, paid amount,
future liability, total incurred, and any amounts recovered;
ii. OSHA 300 and 300A logs or a listing of all information needed for the ENTITY's members to
complete the OSHA 300 and 300A logs. The logs or report shall include claims where temporary
disability benefits were paid during the applicable month showing the paid -to -date amounts, from and
through dates of temporary disability benefits paid, claim number, and date of injury; and
iii. A summary listing by fiscal year showing paid to date amounts, future liability or reserve amounts,
total incurred amounts, number of open claims, number of closed claims, and average cost per claim.
B. Provide the following information monthly to the ENTITY's Administrator electronically in Excel format;
All open and closed claims run by fiscal year and then alphabetically by member, to include the
employee's name, claim number, date of injury, occupation, text description of the injury, number of
days temporary disability benefits were paid, paid amount with 4850 benefits separated by type, paid
amount without 4850 benefits separated by type, future liability or reserves separated by type, total
incurred with 4850 benefits separated by type, total incurred without 4850 benefits sorted by type, any
amounts recovered for subrogation or excess insurance, free form text description of the claim and
descriptions of cause, site, and nature;
ii. A summary listing run alphabetically by member and then by program year showing paid to date
amounts, future liability or reserve amounts, total incurred amounts, number of open claims, number
of closed claims, and average cost per claim;
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 9 of 11
iii. A summary listing run by program year showing paid -to -date amounts, future liability or reserve
amounts, total incurred amounts, number of open claims, number of closed claims, and average cost
per claim;
iv. A check register, excluding vouchers, in check number order, including any voids, refunds, and
recoveries received with a page showing the total payments for the month by fiscal year;
v. A check register, including all activity, in check number order, including any voids, refunds, and
recoveries received with a page showing the total payments for the month to be run by member and
then fiscal year;
vi. A voucher register run by fiscal year and then by member; and
vii. A "No Activity" report listing the claims that have had no activity during the previous six (6) months.
The report components should include no reserve changes, no payments, no recoveries, no refunds,
and/or no computer notepad activity.
C. Provide the following quarterly reports, in addition to the regular monthly reports, to the ENTITY's
Administrator electronically in Excel format:
►• A listing of subrogation claims showing the employee's name, claim number, date of injury, paid
amount with 4850 benefits, paid amount without 4850 benefits, future liability, total incurred with
4850 benefits, total incurred without 4850 benefits, and any excess or subrogation recoveries; and
u. A listing of any administrative penalties paid during the quarter that were the responsibility of the
TPA.
D. Provide a report to the ENTITY's Administrator annually in written format as of June 30, in addition to the
regular monthly and quarterly reports, a year-end report. The report shall include all open and closed
claims run by fiscal year and then alphabetically by member, to include the employees' name, claim
number, date of injury, occupation, text description of the injury, number of days temporary disability
benefits were paid, paid amount with 4850 benefits separated by type, paid amount without 4850 benefits
separated by type, future liability or reserves separated by type, total incurred with 4850 benefits separated
by type, total incurred without 4850 benefits sorted by type, and any amounts recovered for subrogation or
excess insurance; and
E. Provide other special reports required of the ENTITY or its Administrator including, but not limited to,
loss trend reports, claim abstract reports, reports required by actuaries, excess insurance carriers, etc,,
provided that such reports do not require data elements that have not previously been collected by the TPA
on behalf of the ENTITY. If new programming is required in order to provide such reports, the TPA shall
pay at its own expense for new or special programming costs.
Any corrections to the loss runs shall be made within twenty (20) calendar days of the request for correction.
39. Availability of Personnel
The TPA shall maintain at all times, one (I) or more of the examiners assigned to the ENTITY's claims, or in
their absence, the supervisor or management above the supervisory level, to be available by telephone for
emergencies through a 24-hour emergency telephone number. The TPA shall provide a toll free telephone
number at no additional charge to the ENTITY.
The TPA shall ensure at least one (1) or more of the examiners assigned to the ENTITY's claims are on-site
and available to the ENTITY every business day throughout the term of this AGREEMENT.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page 10 of 1 I
40. Member Servi
The TPA shall provide special on-site training services annually to the members' staff to ensure that the
members' staff that process workers' compensation claims are effectively carrying out the procedures required
for a successful program. A copy of the ENTITY's Workers' Compensation Claims Procedures Manual should
be readily available for review by the members' staffor representative
The TPA shall require its examiners or other TPA personnel, as necessary, to attend the ENTITY's regularly
scheduled Board of Directors meetings to report on the general state of the program since the last meeting, and
on any particular cases of interest to the Board. The TPA may require the supervisor or other TPA personnel, as
necessary, to attend the ENTITY's Executive Committee meetings to report on the general state of the program
since the last meeting and on any particular cases of interest to the Executive Committee.
The TPA shall consult annually with the ENTITY on the establishment and coordination of necessaty
procedures and practices to meet the needs of the ENTITY with respect to the administration and processing of
claims.
The TPA shall require one of the examiners or supervisoty staff to meet with each member's personnel, at the
member's location, at least once annually to review program procedures regarding workers' compensation
reporting requirements and other program matters that require the timely participation of the members'
personnel.
The TPA shall require an examiner to be available and readily respond to a member's request for assistance
with problem cases, including on-site visits to the member.
The TPA shall provide the ENTITY with information regarding statutes, proposed changes to statutes, and
changes to the rules and regulations affecting the ENTITY and its responsibility as a legally uninsured workers'
compensation authority.
The TPA shall develop and recommend policies and procedures in areas as required by the ENTITY
41. Emnlovee Services
As required, the TPA will develop, for review by the ENTITY, materials which will provide information and
guidance to the members' employees regarding workers' compensation and the self-insurance program.
As required, the TPA will meet with and assist injured employees in resolving problems that arise from injury
or illness claims,
42. Examiner Trainine and Certification
The claims examiner handling the member's claims shall receive training at least once per year, be certified by
the State of California, and have a minimum of at least two (2) years or workers' compensation claims
experience at the examiners level.
The TPA shall annually certify to the ENTITY that each claims examiner handling the members' claims is in
compliance with all legal and regulatory licensing and continuing educational requirements as presently or in
the future shall be promulgated and required by the State of California. Such certification for the prior year
shall he in the form of a letter to be received no later than August I of each year.
SAMPLE
ENTITY and TPA Agreement for Workers' Compensation Claims Service Page I 1 of 11
43. Rieht to Auditor Review
The ENTITY or its designated representative is authorized to visit the TPA's processing and/or storage
premises, for purpose of performing a claims audit or review, and have access to all data, including paper
documents, microfilm, microfiche, and magnetically stored data which relate to payments or non -payments
made by the ENTITY. Any assistance or service provided in response to a claims audit described above will be
rendered at no additional cost to the ENTITY.
44. Conflict of Interest
The TPA shall avoid all conflicts of interest or appearance of conflicts of interest in performance of this
AGREEMENT. If, during any given year, the TPA receives compensation from any party for services included
in this AGREEMENT, such as hill review services, managed care, or investigations, the TPA shall disclose
total compensation received in prior year. Such disclosure shall be in the form of a letter and shall he received
by ENTITY no later than April I of each year.
SAMPLE
Gregory B. Bragg & Associates, Inc.
Claims and Risk Management Services
P.O. Box 619058
Roseville, CA 95661-9058
TELE (916)783-0100
FAX: (916)783-0334
December 9,2008
Ms Janet Hamilton, Management Analyst
City of Lodi
PO Box 3006
Lodi, CA 95241-1910
RE: Workers Compensation Performance
Dear Ms Hamilton:
On behalf of Gregory B. Bragg & Associates, Inc., we are pleased to provide the City of
Lodi (City) with an overview of our claims administration performance beginning July 1,
2006.
Fiscal
Year
As
6/30/2006
of. As of:
6/30/2008
01-02
$937,693.00
$1,008,800.00
02-03
$526,972.00
$598,429.00
03-04
$821,932.00
$727,562.00
04-05
$316,345.00
$267,543.00
05-06
$703,159.00
$287,059.00
Since accepting the responsibilities for handling the City's claims, we have processed
over 3,796 medical bills that have resulted in a net savings/reduction of 59%. Currently
we are working on providing the City with a managed medical cost containment program
that will cost less than the current program and yield a greater savings. The program will
also allow the City to be more selective in their choice of medical facilities.
Attached is a summary page of the City's most recent claims audit. While we would have
preferred a score of 100%, the 92% score we received verifies our competency.
Finally we are attaching a listing of California City's, three year, average loss Fates.
Please note that the City of Lodi's rate is in the lowest 25%. Most of those cities with
lower rates than the City of Lodi, are those cities that do not offer Police and Fire
services.
In summary, we are pleased that in our partnering with the City and its staff, we have
changed the City's upward spiral of worker's compensation cost to a more. stable and
predictable result. We look forward to continuing our relationship with the City to
achieve an even more favorable outcome.
Thank you for allowing our Firm to be of service to the City.
Sincerely,
Tom McCampbell, CPCU, ARM -P, AIC
Vice President Claims
Gregory B. Bragg & Associates, Inc.
Bragg & Associates
P.O. Box 619058
Roseville, CA 95661-9058
Client Performance
From Dare: 12/01105 To Date: 11/30,108
Client
LODI -City of€-odi
0 Billed
B.R.
%BR
PPO
% PPO
PPO
% PPO Total
BR
PPO
Bill(s) Charges
Savings
Savings
Hits
Hits
Savings
Savings Savings
Fees
Fees
3.796 51,949.436.38
S1,144307.37
59%
2487
66%
S60-120.34
7% S1,204,427.71
S36.062.00
S12,054.74
2187
66%
$60,120.34
7 % $1,204427.71
536,062.00
512,054-74
Grand Totals: 3.796 S€,949,43618
$1,141,30737
59%
Total
Total Net
Cross %
Net %
Fees
Savings
Savings
Savings
545,116.74
S 1,156310.97
62%
591.
59%
548,116.74
$1,156,314).97
62%
Copyright Q' 2000-2008 ComplQ Corp. All rights reserved. 121812008 11:44):30AM Page 1 of 1
3mpSTATS Pagel U3
com pSTATS
Workers Compensation Benchmarking Database
Home 3 -Year Stats 1 -Year Stats Trends Benchmark Reports Triangles F.A.Q. Contact
Loss Rate per $100 of Payroll
Nan ]PAs a City
7/04 through 6/07
ttn://www.cinra.com/dir/Comt)arativeResult.cfin 12/8/2008
Name
Pa oil
Incurred
1.m�r..kq
1
Corte Madera, Town of
14,895,554
45,294
0.30,
2
Vernon, City of
74,769,104
290,265
0.39'
3
Livermore, City of
117,330,602
493,049
0.42
4
Yorba Linda, City of
22,132,045
112,300
0.51'
5
Morgan Hill, City of
47,281,050
249,688
0.53
6
Pacifica, City of
47,612,049
275,056
0.58
7
Lemon Grove, City of
12,244,821
75,912
0.62
8
Thousand Oaks, City of
89,813,766
559,023
0.62
9
Encinitas, City of
49,977,912
377,168
0.75:
10
Benicia, City of
51,625,606
390,792
0.76;
11
Roseville, City of
236,592,945
1,839,908
0.78'
12
San Clemente, City of
37,842,829
299,414
0.79
13
Los Gatos, Town of
44,814,741
384,900
0.86
14
South Lake Tahoe, City of
38,294,143
351,388
0.92
15
Santee, City of
29,874,458
280,838
0.94
16
Napa, City of
97,303,585
1,058,138
1.09
17
Campbell, City of
49,364,351
578,165
1.17
18
Costa Mesa, City of
148,180,540
1,769,052
1.19,
19
Redwood City, City of
157,949,315
1,916,576
1.21
20
Gardena, City of
63,302,685
771,515
1.22'
21
Watsonville, City of
69,564,933
862.617
1.24
22
Los Alamitos, City of
16,223,014
201,268
1.24
23
South San Francisco, City of
115,516,042
1,498,072
1.30
24
Orange, City of
158,986,974
2,083,681
1.31
25
Westminster, City of
67,824,980
890,513
1.31
26
San Diego, City of
2,080,693,291
28,055,430
1.35'
27
City of Solana Beach
13,616,310
186,606
1.37;
28
Los Angeles, City of
7,643,103,808
106,178,314
1.39
29
Covina, City of
40,888,836
573,215
1.40
30
Carson, City of
80,331,205
1,128,215
1.40
31
Mountain View, City of
159,517,415
2,263,518
1.42
32
Lodl, City of
88,833,769
1,264,527
1.42
33
Placentia, City of
31,268,285
472,202
1.51
34
Tustin, City of
63,244,390
957,868
1.51
35
Calton, city of
73,422,803
1,127,811
154
36
Anaheim, City of
560,294,296
8,649,421
1 54
37
Vacaville, City of
138,375,495
2,193,413
159
38
San Bruno, City cf
62,344,091
995,157
160
39
Moreno Valley, City of
66,344,827
1,067,701
161
40
Fontana. city of
114,644,445
1,868,230
1.63
ttn://www.cinra.com/dir/Comt)arativeResult.cfin 12/8/2008
compSTATS
Page 2 of 3
41
Santa Barbara, City of
220,816,499
3,600,396
1153-
42
Carmel, City of
14,681,434
246,415
1.68
43
Newark, City of
72,553,463
1,224,001
1.69
44
Petaluma, City of
77,408,040
1,328,147
1.72
45
Laguna Beach, City of
61,131,926
1,079,043
1.77
46
Santa Rosa, City of
267,040,128
4,782,957
1.79
47
Corona, City of
199,001,718
3,621,478
1.82
48
Chino, City of
85,799,186
1,565,819
1.82
49
Cupertino, City of
35,193,493
656,217
1.86
50
Long Beach, City of
897,874,182
16,916,022
1.88
51
Huntington Beach, City of
276,995,629
5,256,743
1.90
52
Sunnyvale, City of
243,826,117
4,630,714
1.90
53
Rialto, City of
95,690,686
1,838,513
1.92
54
Oceanside, City of
187,295,577
3,603,053
1.92
55
Burbank, City of
314,826,106
6,085,967
1.93
56
Pacific Grove, City of
29,628,514
575,114
1.94
57
San Buenaventura, City of
143,785,975
2,843,786
1.98
58
Carlsbad, City of
140,805,611
2,795,126
1.99
59
Riverside, City of
411,048,473
8,174,176
1.99
60
Fullerton, City of
137,228,074
2,770,498
2.02
61
Daly City, Clty of
145,205,279
2,967,098
2.04
62
Fountain Valley, City of
58,183,814
1,202,721
2.07
63
San Leandio, City of
90,096,196
1,882,942
2.09
64
Hawthorne, City of
85,635,195
1,801,645
2.10
65
Escondido, City of
163,327,893
3,470,544
2.12
66
Imperial Beach, City of
15,804,546
341,164
2.16
67
Los Altos, City of
25,864,817
561,862
2.17
68
Redding, City of
163,899,297
3,568,978
2.18
69
South Gate, City of
64,740,687
1,413,402
2.18
70
Compton, City of
57,431,694
1,254,233
2.18
71
Alameda, City of
181,891,491
3,981,166
2.19
72
Palo Alto, City of
259,247,161
5,757,753
2.22
73
Newport Beach, City of
212,482,157
4,787,206
2.25
74
Monterey, City of
88,985,354
2,006,015
2.25
75
Irvine, City of
173,181,587
3,975,390
2.30
76
West Covina, City of
98,244,436
2,263,321
2.30
77
Suisun, City of
15,673,946
363,274
2.32
78
San Mateo, City of
157,055,233
3,658,430
2.33
79
Chula Vista, City of
269,733,707
6,339,675
2.35
80
Sacramento, City of
807,204,896
18,982,866
2.35
81
Pomona, city of
150,046,944
3,571,053
2.38
82
San Rafael, City of
98,559,246
2,358,734
2.39
83
Merced, City of
87,404,509
2,093,501
2.40
84
Oxnard, City of
249,282,271
6,266,340
2.51
85
Glendale, City of
399,022,765
10,042,814
2.52
86
Berkeley, City of
326,893,985
8,257,301
2.53
87
Turlock, City of
57,986,952
1,469,852
2.53
88
Bakersfield, City of
241,868,346
6,180,583
2.56
89
Gilroy, City of
71,584,539
1,836,320
2.57
90
Coronado, City of
48,839,422
1,253,300
2.57
91
Montclair, City of
44,157,292
1,135,672
2.57
htti)://www.civra.coni/dir/Com»arativeResult.cfm 12/8/2008
compSTATS
rage J or 3
Egywlyc�Ylsdfcity of
'99:9?`,U?i
�;W:991
94
Santa Ana, City of
417,556,367
11,085,423
2.65
95
EI Centro, City of
53,509,992
1,433,830
2.68
96
Def Mar, City of
12,956,982
351,706
2.71
97
Hayward, City of
212,530,722
5,846,488
2.75
98
Torrance, City of
340,223,343
9,399,230
2.76
99
Fairfield, City of
136,328,971
3,788,709
2.78
100
Santa Cruz, City of
124,433,501
3,490,050
2.80
101
vista, city of
59,920,566
1,706,796
2.85
102
Fremont, City of
259,809,101
7,411,038
2.85
103
Walnut Creek, City of
85,280,851
2,461,361
2.89
104
La Mesa, City of
46,210,235
1,338,382
2.90
105
National City, City of
61,779,050
1,828,673
2.96
106
Pasadena, City of
434,255,076
12,897,146
2.97
107
City of Santa Marla
91,909,607
2,747,761
2.99
108
Brea, City of
87,865,234
2,644.628
3.01
109
Salinas, City of
121,904,992
3,723,133
3.05
110
Garden Grove, City of
146,651,348
4,502,599
3.07
III
Santa Monica, City of
426,046,479
13,259,170
3.11
112
Lompoc, City of
57,720,545
1,807,238
3.13
113
Milpitas, City of
133,131,372
4.254.574
3.20
114
Fresno, City of
627,860,003
20,598,800
3.28
115
Millbrae, City of
27,966,225
930,464
3.33
116
Modesto, City of
235,337,519
7,850,534
3.34
117
Cypress, City of
35,566,119
1,192,636
3.35
118
Sim# Valley, City of
123,867,785
4,171,045
3.37
119
San Marino, City of
18,983,210
641,357
3.38
120
Redlands, City of
107,871,272
3,780,747
3.50
121
Clovis, city of
102,015,643
3,680,966
3.61
122
Ontario, City of
190,320,384
7,057,631
3.71
123
Burlingame, City of
71,117,052
2,695,095
3.79
124
Santa Clara, City of
291,971,171
11,086,985
3.80
125
Oakland, City of
903,748,907
36,851,024
4.08
126
Concord, City of
117,032,141
4,796,153
4.10
127
Stockton, City of
348,644,502
14,528,918
4.17
128
Richmond, City of
180,657,171
7,628,084
4,22
129
San Bernardino, City of
265,744,340
12,180,228
4.58
130
San lose, City of
1,386,775,813
65,146,068
4.70
131
Vallejo, City of
173,992,224
8,346,642
4.80
132
Montebello, City of
89,645,467
4,396,058
4.90
133
San Gabriel, City of
40,266,728
2,131,325
5.29
134
Palm Sorings, City of
83,205,719
6,124,249
7.36
Home_ 3,Year { 1,Vear I Tren¢s (Benchmark (Triangles i F:A.Q: i Contact I
Copyright O 2008 CIPRA. All Rights Reserved.
Original design lay growldesign
lttFr+•��xtnvxty ni�ro r•nmlrlsrl('nmr�arnfitraiJneitl4 nFeY. 11/R/1)AAQ
I
I
R EFFECTIVENESS OF PROGRAM
We feel that the effectiveness of the workers' compensation claims
administration program, as now handled by Bragg, is excellent.
AS is customary at Bragg, the files are very well organized into various
sections, including correspondence, medical reports, rehabilitation,
excess reports, as well as payments. There are standard Monthly Status
Reports in all of the files, which are provided to the clients on a regular
basis.
Service Level
Alpha Grade
Percentage
Excellent
A
90-100%
Very Good
B
so- 89%
Good
C
70- 79%
Fair
D
60- 69%
Poor (Unacceptable)
F
Less than 60%
Factors
Maximum
Score
Bragg
Score
1. Quality of claims staff, particularly the
Claims Examiner & Supervisor
25%
22%
2 Excess claims recognition & reporting
10%
8%
3. Cost containment; both medical & legal
10%
10%
4. Reserving
10%
8%
5. Subrogation
10%
10%
6. Employee, employer & physician contact
10%
10%
7. File organization
5%
5%
8. Investigations
5%
5%
9 Rehabilitation recognition & cost control
5%
5%
10. File posting & claim communication
5%
5%
11. Computer data availability and accuracy
5%
5%
TOTAL
100%
92%
2
RESOLUTION NO. 2008-244
A RESOLUTION OF THE LODI CITY COUNCIL
AUTHORIZING THE CITY MANAGER TO EXTEND AN
AGREEMENT FOR WORKERS COMPENSATION
ADMINISTRATION WITH GREGORY B. BRAGG
AND ASSOCIATES
NOW, THEREFORE, BE IT RESOLVED that the Lodi City Council does hereby
authorize and direct the City Manager to extend an Agreement for Workers
Compensation claims adjusting and administration services with Gregory B. Bragg &
Associates, Inc. beginning December 1, 2008, in an amount not to exceed as follows:
$106,500 (year one)
$111,300 (year two)
$116,500 (year three)
BE IT FURTHER RESOLVED that the City Manager is hereby authorized to
execute the contract on behalf of the City of Lodi.
Dated: December 17, 2008
I hereby certify that Resolution No. 2008-244 was passed and adopted by the
City Council of the City of Lodi in a regular meeting held December 17, 2008, by the
following vote:
AYES: COUNCIL MEMBERS — Hitchcock, Johnson, Katzakian, Mounce,
and Mayor Hansen
NOES: COUNCIL MEMBERS — None
ABSENT: COUNCIL MEMBERS — None
ABSTAIN: COUNCIL MEMBERS— None
LJO
City Clerk
2008-244