RESOLUTION 92-20498 •
RESOLUTION NO. 92-20498
A RESOLUTION OF THE CITY COMMISSION OF THE CITY OF MIAMI
BEACH, FLORIDA, AUTHORIZING PAYMENT OF $137,031 TO HUMANA
HEALTH CARE PLANS FOR REIMBURSEMENT OF COSTS INCURRED IN AN
INJURY FOUND TO BE COMPENSABLE.
WHEREAS, the City of Miami Beach, Florida, is self-insured on workers'
compensation claims up to an excess insurance level of $250,000 per claim, and;
WHEREAS, the City has expended $112,969 on an injury which was found to be
compensable pursuant to the Order of the Judge of Compensation Claims, and;
WHEREAS, Humana Health Care Plans has, in their contract with the City, a
right of reimbursement and subrogation, and;
WHEREAS, Humana Health Care Plans has expended $195,000 in cost associated
with this injury,
NOW, THEREFORE BE IT RESOLVED BY THE CITY COMMISSION OF THE CITY OF MIAMI
BEACH THAT the City of Miami Beach through its Self Insurance Fund be authorized
to pay $137,031 to Humana Health Care Plans and refer the balance to the City's
excess insurance provider.
PASSED and ADOPTED this 22nd day of April , 1992.
MAYOR
ATTEST BY:
1111111 4111"
CITY CLERK
CITY ATTORNEY
'
1 t. i
CITY OF MIAMI BEACH (7/ 1
CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH FLORIDA 33139
OFFICE OF THE CITY MANAGER TELEPHONE: (305) 673-7010
• FAX: (305) 673-7782
COMMISSION MEMORANDUM NO. 123-9Z •iria) ise4
DATE: April 22 , 1992
TO: Mayor Seymour Gelber and
Members of the City Commission
FROM: Roger M. Carlton
( ! (
City Manager er
AUTHORIZING PAYMENT OF $137, 031 TO HUMANA HEALTH CARE
SUBJECT: . PLANS
One of the employees of the City was involved in an accident which
aggravated a pre-existing condition which resulted in multiple
surgical procedures and an ultimate disability. The City denied
Workers ' Compensation as the surgery was related .to the pre-
existing condition and not to the accident. The case went to Court
and the Judge of Compensation Claims ruled that the accident was
compensable.
As the City had denied Workers ' Compensation coverage, the City' s
health care provider, Humana, covered the employee for costs
incurred as a result of the accident. In their contract with the
City, Humana has the right of recovery and subrogation in the event
that costs they have incurred are found to be compensable.
The City, through its Self Insurance Fund, self insures the first
$250, 000 per claim on Workers ' Compensation. Over that limit there
is an excess insurance policy. As the City has already paid out
$112 , 969 in fees and costs on this matter and Humana has submitted
a claim totaling $195, 000 for medical, this will be the first
instance where a claim reaches our self insured retention. We seek
authorization to pay the balance of our retention, $137 , 031, and
will refer the balance to the excess insurance provider.
To the credit of Mr. Larry Feingold, City Attorney, a theory was
forwarded to you which appears to be a cost saving to the City.
After lengthy discussions concerning this issue, whether we
negotiate this amount or not, the cap of $250, 000 must be reached
before the excess insurance provider will cover the subsequent
cost. Therefore, whether the City pays Humana or direct medical
bills, • it will pay no less than or no more than the $250, 000.
ADMINISTRATION RECOMMENDATION:
The Administration recommends that the City Commission approve the
attached Resolution authorizing the payment of $137 , 031 to Humana
Health Care Plans.
•
RMC: CBT: jh
Attachments
•
147
AGENDA
ITEM
DATE ���
ORIGINAL
RESOLUTION NO. 92-20498
Authorizing payment of $137,031 to Humana
Health Care Plans for reimbursement of
costs incurred in an injury found to be
compensable.