2000-24121 RESO
RESOLUTION NO. 2000-24121
A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF
THE CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE
ADMINISTRATION TO ISSUE A REQUEST FOR PROPOSALS
(RFP) FOR CLAIM ADMINISTRATION SERVICES FOR THE
CITY OF MIAMI BEACH SELF-INSURED WORKERS'
COMPENSATION PROGRAM.
WHEREAS, the City is approved by the Florida Department of Labor and Employment
SecuritylDivision of Workers' Compensation to self-insure for Workers' Compensation; and
WHEREAS, the Division of Workers' Compensation requires that claims administration be
provided by a State Certified Workers' Compensation Administrator; and
WHEREAS, on January 10, 1996, the Mayor and City Commission authorized the Administration
to execute an Agreement with Johns Eastern Co., as the State Certified Workers' Compensation
Administrator, to provide the claims administration for the Self-Insured Workers Compensation Program
for three years,with renewal options for two additional one-year periods; and
WHEREAS, the Administration has continued the Agreement with Johns Eastern Co. through
option years one and two for a total service agreement period of five years, which expires on January 31,
2001; and
WHEREAS, the issuance of an RFP for the aforestated services would allow the City to move
. forward with the selection of a State Certified Workers' Compensation Administrator as required by the
Division of Workers' Compensation.
NOW, THEREFORE, BE IT DULY RESOLVED BY THE MAYOR AND THE CITY
COMMISSION OF THE CITY OF MIAMI BEACH, FLORIDA, that the Mayor and City Commission
hereby authorize the Administration to issue a Request for Proposals (RFP) for Claim Administration
Services for the City of Miami Beach Self-Insured Workers' Compensation Program.
PASSED AND ADOPTED this 18th day of October
,2000.
11
Mayor
ATTEST:
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City Clerk
APPROVED AS 10
FORM & LANGUAGE
& FOREXECUnON
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CITY OF MIAMI BEACH
CITY HALL 1700 CONVENTION CENTER DRIVE MIAMI BEACH. FLORIDA 33139
http:\\ci.miami-beach.fl.us
COMMISSION MEMORANDUM NO.
I,Co-OO
TO:
Mayor Neisen O. Kasdin and
Members of the City Commission
DATE: October 18, 2000
FROM:
Jorge M. Gonzalez
City Manager
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SUBJECT: A RESOLUTION OF THE MAYOR AND CITY COMMISSION OF THE
CITY OF MIAMI BEACH, FLORIDA, AUTHORIZING THE
ADMINISTRATION TO ISSUE A REQUEST FOR PROPOSALS (RFP) FOR
CLAIM ADMINISTRATION SERVICES FOR THE CITY OF MIAMI
BEACH SELF-INSURED WORKERS' COMPENSATION PROGRAM.
ADMINISTRATION RECOMMENDATION:
Adopt the Resolution.
ANALYSIS:
The City is approved by the Florida Department of Labor and Employment Security/Division of
Workers' Compensation to self-insure for Workers' Compensation. The Division of Workers'
Compensation requires that the claims administration be provided by a State Certified Workers'
Compensation Claims Administrator.
On January 10, 1996, the Mayor and City Commission authorized the Administration to execute an
Agreement with Johns Eastern Co. as the State Certified Workers' Compensation Claims
Administrator. The Agreement period was for three years with renewal options for two additional
one-year periods. The Administration has continued the Agreement through option years one and
two for a total service agreement period of five years. The current Agreement expires on January
31,2001. The issuance of an RFP will allow the City to move forward with the selection of a State
Certified Workers' Compensation Claims Administrator.
The City Administration recommends that the City Commission authorize the Administration to
issue a Request for Proposals for Claims Administration Services for the City of Miami Beach Self-
Insured Workers' Compensation Program.
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Attachme&s'
f:\RlSK\SAI.L\Clifl\Workcomp eso,rfp
AGENDA ITEM ~~f!
DATE IO-IS-DO
SECTION II -SCOPE OF SERVICES
A. WORKERS' COMPENSATION CLAIMS ADJUSTING AND INVESTIGATION
SERVICES:
Upon receipt of all workers' compensation claims, the claims administrator shall perform the
following:
I. The claim manager or supervisor will review all notices of injury received from the City prior
to the assignment to an adjuster approved by the City.
2. Accept or deny all reported claims for employees' injuries on behalf of the City in accordanoe
with the applicable Workers' Compensation Law. The decision to controvert a claim must
first be discussed with and approved by the City.
3. To conduct the required investigations as deemed necessary as it relates to workers'
compensation including scene investigations and personal claimant contact on aU lost time
or light dutv cases. Contact with claimants is to be made within 24 hours of the
administrator's receipt of the claim.
4. Subject to the prior approval of, and at the expense of the City, employ outside professionals
such as surveillance, rehabilitation, experts and attorneys to assist in the investigation and
adjustment of claims. Payment will be made by the administrator from the loss fund as an
aUocated expense.
5. Review aU medical biUs and other services for which a claim is being made for
reasonableness and conformity to appropriate medical and surgical fee schedules and
network discounts.
6. Coordinate the medical treatment of all claims by setting appointments and authorizing
necessary physician referrals and treatments.
7. Every 14 days provide written notification indicating all employees that are not working in
a fuU duty unrestricted capacity.
8. Every 90 days, submit a full sununary report to the City on all claims of the following lypes:
- any claim in which an employee is not working full duty
- total incurred value exceeding $50,000
- potentiaUy controverted cases
- claims in which settlement (washout) is recommended
RFP No: 145-99/00
Date: October 20, 2000
12
9. The administrator must have approval for all settlements. For settlements for more than
$10,000, the administrator will submit a full captioned report to the City summarizing all
issues and evaluating exposures along with a settlement recommendation for City
approval. .
10. Prepare and maintain files necessary for legal defense of claims and/or other litigation (such
as actions for subrogation) or other proceedings.
II. Pay in a timely fashion all claims and expenses from the loss fund account established by the
City, which will be maintained by the administrator. Fees, interest and civil penalties
required due to late payments or adjuster mishandling are to be paid by the administrator
unless caused by late reporting from the City.
12. Pursue all possibilities of subrogation, liens and recovery from the Special Disability Fund.
13. The City will approve and assign the attorneys that provide the defense of claims. The
administrator is to provide the defense attorney a complete copy of the file in question at the
time an assignment is made. The administrator will provide a monthly report to the City
regarding new legal assignments.
14. The administrator will attend workers' compensation hearings and mediation as requested
by the City.
15. Provide all required managed care services as required by Florida Statute 440. with
nurses/medical case managers employed by the administrator and located in the local claims
office. Provide your fees for these services separately, as these fees will be paid as allocated
expenses.
B. STAFFING AND PERSONNEL:
It is the City's claims management philosophy that the proper and most cost-effective method
to handle claims and thereby reduce and control the City's self-insured loss payments is to
ensure the administrator hires and retains the appropriately qualified professionals to handle
our claims. Additionally, the adequate number of adjusters and a manageable caseload
enables qualified adjusters to perform the required services. The City therefore requires that
the proposer agree to staffing, qualifications and caseload criteria established by the City.
The City reserves the right to the final prior approval of the hiring and/or assignment of the
claims manager, supervisors and adjusters that are to handle the City's claims.
The required maximum open case loads for adjusters are to be as follows (claims manager
should not handle files):
workers' compensation (lost time) - 100
workers' compensation (medical only) - 500
RFP No: 145-99/00
Date: October 20, 2000
13
The administrator agrees to add staff as necessary to maintain these maximum pending
caseload levels. Explain how the office or unit will be staffed and explain the level of
supervision that will be provided. Claims personnel must be employees of the administrator.
The use of independent adjusters, subcontractors or temporary adjusters is not acceptable
without prior approval of the City. Adjuster trainees are not acceptable for handling of the
City's claims. Additionally, resumes of all claims professionals specifically assigned to this
account are to be submitted with this proposal. All claims professionals must possess a
current Florida Workers, Compensation adjuster's license.
C. ADMINISTRATION SERVICES:
The administrator will additionally perform the following related services:
1) State required filings
2) Loss fund management
3) Computer generated loss runs and other management reports as required
D. ST ATE REQUIRED FILINGS:
1. The administrator will prepare and file, on behalf of the City, with the appropriate state
agency, all applications required for the City's continued qualification as a self-insurer.
2. Prepare, maintain, and file all records and reports as may be required by legal authorities
(state or federal).
3. Prepare, maintain and file statistical information required by workers' compensation rating
bureaus, including all data required for the promulgation of the City's experience
modification and state assessments. (BSI-17)
4. Prepare and file any other reports as required by the City and the state relating to claims
experience, payments, etc.
E. LOSS FUND MANAGEMENTI
I. The Imprest Account will be maintained at the City's commercial banking institution. The
account will be classified as part of the analysis group of City accounts. The City will pay
all service fees that are normal and customary in this account. All interest earned or service
credits generated will accrue to the benefit of the City.
2. The claims administrator is required to follow Florida law concerning public deposits.
Failure to comply with Florida law is sufficient cause forthe City to terminate the contractual
agreement with the claims administrator.
RFP No: 145-99/00
Date: October 20, 2000
14
3. All claims, expense and legal payments will be made by the claims administrator on checks
drawn on an account set up by the administrator and funded monthly by the City. It is
understood that all funds in this account are City funds and are to be returned to the City
upon request or at termination of this contract.
4. The administrator is responsible for the monthly reconciliation of this account and will
provide bank statements to the City monthly, along with a request for a deposit from the Cily
to maintain the monthly balance in the loss fund, as determined by the City.
5. The monthly reconciliation statement submitted by the administrator to the City will include
the following:
- balance at inception of statement period
- total disbursements which cleared, by date and claimant/payee
- balance at close of statement period
- amount of deposit required
6. A list of all checks is to be submitted monthly.
F. COMPUTER LOSS INFORMATION:
All charges related to these services are to be included in the annual claims administration
fee. Any costs associated with programming changes that are necessary to create a report
required by the City are the responsibility of the administrator. Advise what reports can be
provided beyond those requested by the City and whether there is an additional charge for
these optional reports. Indicate any fees to be charged for the creation of any special reports
requested by the City, as necessary. All reports currently provided to the City are required
from the successfully selected administrator.
All claims data is the property of the City and any data and media will be provided to the
City upon request or upon termination of this agreement. All computer notes will be printed
out and placed in the files prior to file transfer to a successive administrator.
The selected administrator, at their expense, will ensure all claim and payment data is
included in their loss runs by 06/01/01. Historical data from our current administrator's
database cannot be purged. Claims data for all open and closed claims must be transferred.
Loss runs are to be provided on a quarterly basis (2 copies), sorted separately by policy year,
and department/location. Loss runs should list each claim separately. Specific summary
reports also must be provided. The following reports are required:
I. Claims list - lists all claims alphabetically
2. Check register
3. Annual summary reports
4. Location report
RFP No: 145-99/00
Date: October 20, 2000
15
5. Large loss or severity report
6. Loss prevention report to include accident frequency and severity
7. Litigation report
8. Legal payments report
9. SAF 200 (OSHA log)
Workers' compensation claims involving no payment or no medical treatment are reported
by the City for inclusion in the data base as reporting purpose only (RPO) or first aid or no
pay cases and should be identified in the system that way.
The administrator must provide the City the ability to dial-in via modem to the system for
file review, e-mail or other purposes at no additional cost to the City. An 800 or other toll-
free number is necessary for on-line connections and faxes if the call is outside Miami-Dade
County. The administrator will also provide an 800 or toll-free telephone line for calls from
within Miami Dade County.
G. CLAIMS HISTORY
The information provided as to current pending claims data is provided by our current
administrator and is accurate to the best of the City's knowledge. The proposer has the
right to contact the present administrator to review current files if desired and it is the
responsibility of the proposer to confirm the pending claim counts in order to determine
any takeover fees. Please see attached for a claim experience.
RFP No: 145-99/00
Date: October 20, 2000
16
SECTION IV -EV ALVA TION/SELECTION PROCESS: CRITERIA FOR EV ALVA TION
The procedure for proposal evaluation and selection is as follows:
I. Request for Proposals issued.
2. Receipt of proposals.
3. Opening and listing of all proposals received.
4. An Evaluation Committee, appointed by the City Manager, shall meet to evaluate each
proposal in accordance with the requirements of this RFP. If further information is
desired, proposers may be requested to make additional written submissions or oral
presentations to the Evaluation Committee.
5. The Evaluation Committee shall recommend to the City Manager the proposal or proposals
acceptance of which the Evaluation Committee deems to be in the best interest of the City.
The Evaluation Committee shall base its recommendations on the following factors:
1. The proposer's responsiveness to the RFP.
2. The proposer's qualifications and experience in providing administration
services.
3. The qualifications and experience of the proposer's personnel that will be
assigned to the account.
4. The proposer's experience and knowledge of municipal
administration/operations.
5. Cost ofservices provided (fee).
6. Demonstration of successful prior performance in providing these services to
government agencies.
7. Proposer's references. Submit a list of current clients. Also submit a list of
clients which discontinued using your service in the past two (2) years.
6. After considering the recommendation(s) of the Evaluation Committee, the City Manager
shall recommend to the City Commission the proposal or proposals acceptance of which the
City Manager deems to be in the best interest of the City.
7. The City Commission shall consider the City Manager's recommendation(s) in light of the
recommendation(s) and evaluation of the Evaluation Committee and, if appropriate, approve
the City Manager's recommendation(s). The City Commission may reject City Manager's
recommendation(s) and select another proposal or proposals. In any case, City Commission
shall select the proposal or proposals acceptance of which the City Commission deems to be
in the best interest of the City. The City Commission may also reject all proposals.
RFP No: 145-99100
Date: October 20, 2000
18
8. Negotiations between the selected proposer and the City Manager take place to arrive at a
contract. If the City Commission has so directed, the City Manager may proceed to negotiae
a contract with a proposer other than the top-ranked proposer if the negotiations with the
top-ranked proposer fail to produce a mutually acceptable contract within a reasonable period
of time.
9. A proposed contract or contracts are presented to the City Commission for approval,
modification and approval, or rejection.
10. If and when a contract or contracts acceptable to the respective parties is approved by the
City Commission, the Mayor and City Clerk sign the contract(s) after the selected
proposer(s) has (or have) done so.
Imoortant Note:
By submitting a proposal, all proposers shall be deemed to understand and agree that no
property interest or legal right of any kind shall be created at any point during the aforesaid
evaluation/selection process until and unless a contract has been agreed to and signed by both
parties.
RFP No: 145-99/00
Date: October 20, 2000
19