HomeMy WebLinkAboutResolution - 2003-R0363 - Claim Service Agreement - Hammerman & Gainer, Inc. - 09/04/2003 (3)Resolution No. 2003-80363
September 4, 2003
Item No. 26A
RESOLUTION
IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK, TEXAS:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock a Claim Service
Agreement with Hammerman & Gainer, Inc. for services with respect to the
investigation and payment of insurance claims, which Agreement is attached hereto and
incorporated herein as part of this Resolution.
Passed by the City Council this 4th day of September 2003.
MARC—W%0UGAL, MAYOR
ATTEST:
Reb ca Garza, City Secretary
APPROVED AS TO CO
Human Resources
(APPROVED AS TO FORM:
Knight,
CD/ccdocs/Hammerman. agmt.2003. Res
August 25, 2003
Resolution No. 2003—RO363
September 4, 2003
Item No. 26A
CLAIM SERVICE AGREEMENT
THIS AGREEMENT is made as of this 4th day of September , 2003, between
Hammerman & Gainer, Inc., a corporation of the State of Texas ("Service Company") and the City of
Lubbock, Texas ("Client").
WITNESSETH:
WHEREAS, Service Company is engaged in the business of providing certain services with
respect to the investigation and payment of casualty insurance claims; and
WHEREAS, Client desires to retain Service Company for the provision of its services for Client's
claims for its self -insured Municipal liability exposures and whereas, Client hereby designates Service
Company as its agent to provide support services as set forth in this agreement and whereas, Service
Company is willing to provide such services, on the terms and conditions set forth below;
NOW THEREFORE, in consideration of the premises hereof, the mutual promises and
agreements contained herein, and the payments to be made to Service Company for services rendered to
Client hereunder, the parties hereto, intending to be legally bound, hereby agree as follows:
ARTICLE I
TERM
Service Company agrees to provide all services set forth herein to Client in connection with its self -
insured claims Exposures for a one year period occurring during the period commencing October 1, 2003
and ending September 30, 2004. This contract may be renewed for two additional one-year terms upon
written mutual agreement of the parties.
ARTICLE II
PRICE
See Exhibit A Client's Request for Proposal 113-03/DC, Addendum #1 and Request for Corrections to
Deficient Proposals and Service Company's responses, attached hereto and made a part hereof. Claims
handling by subcontractors shall be included in the prices quoted unless the service is listed in Article IV 1.
below.
ARTICLE III
SERVICE COMPANY
Service Company agrees as follows:
1. To provide Client with those services as set forth in Paragraph 2 below (the "Basic Services")
with respect to any claim referred to Service Company that is made under any Exposures which involves an
actual or alleged loss occurring during the term of this Agreement for the monetary considerations set forth
in Article II, except that Allocated Loss Adjustment Expense, as defined in Article IV below, will be paid
by Client in addition to the monetary considerations set forth in Article II.
2. To consider that the Basic Services to be rendered with respect to any claims described in this
Article III, Paragraph 1 above ("Claims") shall be the following:
A. To establish a file with respect to each Claim.
B. To investigate all Claims and to recommend the amount of loss reserve to be established
with respect to each such Claim.
C. To provide each Claim file with a written chronology of all actions taken with respect to
the underlying Claim.
D. To furnish all claim forms necessary for proper claims administration.
E. To adjust, settle or resist all Claims within the discretionary settlement authority limit of
Service Company as agreed upon by Service Company and Client, in writing, from time
to time (the "Authority Limit").
F. To adjust, settle or resist all Claims in excess of the Authority Limit with the express
prior approval of Client.
G. To supervise all litigation or other proceedings involving any Claim and, where
permitted, to attend any judicial or administrative hearing involving any Claim.
H. To retain and then destroy files for each Claim in accordance with the File Retention and
Destruction Policy set forth in Exhibit B, attached hereto and made a part hereof.
I. To furnish to Client and/or its designees on a monthly basis, a "Loss Run" and a "Loss
Fund Activity Report." The term "Loss Run" means a computer generated listing of
Claims that have been posted to Service Company's Claims Information Management
System. The term "Loss Fund Activity Report" means a computer generated listing of
accounting activity in the Loss Fund Account, as defined in Paragraph 8 below, during
the preceding month that has been posted to Service Company's Claims Information
Management System. These computer generated listings will be provided to Client and/or
its designees in a format compatible with Microsoft Excel Service Company reserves the
right to amend or alter the substance and form of the listings to be provided to Client
and/or its designees with prior consent of Client hereunder if Service Company hereafter
amends or alters the substance or form of such listings for its customers generally.
J. To make all reasonable attempts to abide by the standards set forth in II 3. Scope of
Services of Exhibit A.
3. To Client's right to assume the control and handling of any Claim at any time, and Service
Company agrees to deliver promptly any Claim file to Client which it may request. There will be no off -set
or deduction from any of the fees or charges paid or payable by Client to Service Company under Article V
below unless the Client is assuming the control and handling of any Claim under Article VI 2. below. If
Client assumes the control and handling of any Claim under Article VI 2. below, there may be an offset or
deduction from any of the fees or charges paid or payable by Client to Service Company. In the event
Client requires Service Company to return all open and/or closed Claim files, Client may desire to retrieve
the Claim files with resources provided by Client at no cost to Client or may require Service Company to
deliver files. In the event Client requires Service Company to deliver Claim files, Service Company will
bill the costs and expenses incurred by Service Company along with documentation showing such costs and
Client will pay Service Company within thirty (30) days. The parties agree that at all times prior to and
after the cancellation of this Agreement all Claim files are owned by and are the property of Client. Claim
files are subject to review by Client and its employees and authorized agents during Service Company's
regular business hours, with reasonable prior notice.
4. To exercise reasonable efforts to manage the services provided hereunder in such a way and
in such manner as to ensure that every adjuster, claims investigator, appraiser and/or employee used by
Service Company or subcontracted by Service Company will adjust and/or investigate every alleged Claim
or matter covered by this Agreement in accordance with this Agreement and that failure to do so may result
in an offset or deduction from any of the fees or charges paid or payable to Service Company.
5. To provide to Client, prior to the inception of the contract, Certificates of Insurance for
Service Company and any subcontractor for the types and in the limits listed below. All insurance shall be
written with a company licensed to do business in the State of Texas and shall have a Best Rating of "A" or
better. All policies shall be endorsed with a waiver of subrogation in favor of the City of Lubbock. The
City of Lubbock shall be named as an additional insured on the Automobile Liability and the General
Liability Insurance policies.
A. General Liability Insurance. The Service Company shall maintain, for the life of the
Agreement, General Liability Insurance with a minimum limit of $1,000,000 CSL in the
aggregate and per occurrence.
B. Professional Liability Insurance. The Service Company shall maintain, for the life of
the Agreement, Professional Liability Insurance with a minimum limit of $2,000,000
CSL in the aggregate and per occurrence.
C. Automobile Liability Insurance. The Service Company shall maintain, for the life of
the Agreement, with a minimum limit of $1,000,000 CSL in the aggregate and per
occurrence.
D. Workers' Compensation Insurance. The Service Company shall elect to obtain, for the
life of the Agreement, Workers' Compensation Insurance pursualnt to Section 406.002
of the Texas Labor Code and shall maintain Employers Liability Insurance in the
amount of $500,000.
E. Fidelity and Surety Insurance. The Service Company shall maintain, for the life of the
Agreement, Fidelity and Surety Insurance with a minimum limit of $100,000 per
employee.
6. To indemnify, defend and hold Client and Client's directors, officers, attorneys, employees,
agents and other representatives, wholly harmless from and against any and all
damage, loss, costs and expenses whatsoever (including, without limitation, attorneys'
fees and litigation expenses) incurred by Client or by any of Client's directors,
officers, attorneys, employees, agents or other representatives, by reason of any
negligent, grossly negligent or willful act or omission of Service Company or of
Service Company's directors, officers, attorneys, employees, agents or other
representatives, taken or omitted to be taken pursuant to this Agreement; provided,
however, that Service Company shall have no obligation to indemnify anyone
pursuant hereto with respect to (i) any act or omission of Service Company or any of
Service Company's directors, officers, attorneys, employees, agents or other
representatives taken or omitted to be taken at the direction of Client or any of Client's
directors, officers, attorneys, employees, agents or other representatives, (ii) Service
Company being named in litigation as the insurer of record, (iii) Service Company or
Service Company's directors', officers', attorneys', employees', agents' or other
representatives' failure to settle a Claim that could have been settled within Service
Company's Authority Limit (so long as such failure to settle does not result from a
negligent, grossly negligent or willful act, error or omission by Service Company or
by any of Service Company's directors, officers, attorneys, employees, agents or other
representatives), or (iv) Service Company or Service Company's directors', officers',
attorneys', employees', agents' or other representatives' failure to pay any Claim or
approved Allocated Loss Adjustment Expense on a timely basis due to Client's or
Client's directors', officers', attorneys' employees', agents' or other representatives'
failure to comply with Article V, Paragraphs 5 and 6 hereunder. In the event Client or
any of its directors, officers, attorneys, employees, agents or other representatives, is
named as a defendant in any legal action or proceeding in which a Claim indemnified
hereunder is asserted, Service Company will assume, at Service Company's expense,
the defense of such action on behalf of Client and its directors, officers, attorneys,
employees, agents and other representatives, as the case may be. Service Company
has sole discretion to select the attorneys who will defend any such action, provided,
however, that Service Company shall exercise such discretion reasonably. This
indemnity shall survive termination of this Agreement.
7. To exercise reasonable care in the selection of any Service Company, Adjusting Company,
Adjuster, Claims Investigator or Appraiser it subcontracts its responsibilities hereunder, to ascertain that
such subcontractors hold proper licenses for the work to be performed, and to warrant that it and its
Adjusters, Claims Investigators and Appraisers hold proper licenses for the work to be performed and are
resident in those states requiring residency, and in which it renders services hereunder.
8. To issue its checks from its bank account (the "Loss Fund Account") to be funded by Client
as set forth in Exhibit C, attached hereto and made a part hereof, for the payment by Service Company of
Claims and Allocated Loss Adjustment Expense associated with Claims for which Service Company is
providing Claims Adjusting Services hereunder, and for deposit of recovery amounts, including, without
limitation, subrogation, salvage and adjustment reimbursements from Claim and/or Allocated Loss
Adjustment Expense amounts previously paid from such Loss Fund Account ("Recoveries").
9. To report directly to Client and Client's excess municipal liability carrier "Carrier" any claim
as required in the "Claims Reporting Requirements" of Exhibit A. Any Claims handling directed by
Client's Carrier will be billed to Carrier at a rate agreed to between Service Company and Carrier. Service
Company will continue to handle Claims once Client's self-insurance retention has been exceeded, unless
Client has tendered its self-insurance retention to the Carrier.
ARTICLE IV
ALLOCATED LOSS ADJUSTMENT EXPENSE
1. The term "Allocated Loss Adjustment Expense" shall mean such of the following items of
expense incurred by Service Company and approved by Client in connection with its provision of the Basic
Services:
A. Medical examinations of claimants, including the reasonable and necessary transportation
expenses of claimants.
B. Reports from attending or examining physicians.
C. Attorneys' fees and disbursements.
D. Court reporter services and transcripts.
E. Stenographic services and transcripts.
F. Witness attendance fees or travel expenses.
G. Court costs.
H. Appeal bonds.
I. Printing costs related to trials and appeals.
J. Testimony, opinions, appraisals, reports, surveys and analyses of professionals and
experts.
K. Automobile and Property appraisals.
L. Trial and hearing attendance fees.
M. Reports from government agencies or branches not provided by Client
N. Credit bureau reports.
O. Private investigators.
P. Long distance telephone or fax charges.
Q. DMV or Index System submittal or retrieval costs.
R. Photographs and/or commercial photographers' fees.
S. Any fees or expenses related to the outside investigation or handling of a claim whether
by Service Company personnel or one of its subcontractors.
T. Any similar service related to the investigation and defense of a particular Claim, or the
protection of and collection of the subrogation rights of Client.
ARTICLE V
CLIENT
Client agrees as follows:
1. To pay to Service Company the fees prescribed in Article II. If Client fails to pay Service
Company the fees prescribed in Article II and/or in accordance with the time frames set forth therein,
Service Company will notify Client and if Client does not cure such failure within ten (10) days of such
notice, Service Company may terminate this Agreement immediately, notwithstanding the ninety (90) days
prior written notice set forth in Article VI. In the event of such immediate Agreement termination, the
termination option as set forth in Article VI, Paragraph 1. B. shall apply.
2. To pay to Service Company at its then prevailing hourly rate and expense method of billing
for all claims and/or losses previously handled or attempted to be handled by any person, firm or
corporation or Client before being assigned to Service Company.
3. To pay all approved Allocated Loss Adjustment Expense, as defined in Article IV, in addition
to the Claim service fee to be paid to Service Company as prescribed in Article II. Client may offset or
deduct the Claim service fee to be paid to Service Company if Service Company fails to meet standards set
out in Article III 2.
4. To indemnify, defend and hold Service Company and Service Company's directors, officers,
attorneys, employees, agents and other representatives wholly harmless, to the extent allowed by law, from
and against any and all damage, loss, costs and expenses whatsoever (including, without limitation,
attorneys' fees and litigation expenses) incurred by Service Company or by any of Service Company's
directors, officers, attorneys, employees, agents or other representatives, by reason of any negligent, grossly
negligent or willful act or omission of Client or of Client's directors, officers, attorneys, employees, agents
or other representatives, taken or omitted to be taken pursuant to this Agreement, including, without
limitation, any such damage, loss, cost or expense incurred by reason of (i) any act or omission of Service
Company or of any of Service Company's directors, officers, attorneys, employees, agents or other
representatives taken or omitted to be taken at the direction of Client or any of Client's directors, officers,
attorneys, employees, agents or other representatives, (ii) Service Company being named in litigation as the
insurer of record, (iii) Service Company or Service Company's directors', officers', attorneys', employees',
agents' or other representatives' failure to settle a claim that could have been settled within Service
Company's Authority Limit (so long as such failure to settle does not result from 'a negligent, grossly
negligent, or willful act, error or omission by Service Company or by any of Service Company's directors,
officers, attorneys, employees, agents or other representatives), or (iv) Service Company or Service
Company's directors', officers', attorneys', employees', agents' or other representatives' failure to pay any
Claim or Allocated Loss Adjustment Expense on a timely basis due to Client or Client's directors', officers',
attorneys', employees', agents' or other representatives' failure to comply with Article V, Paragraphs 5 and 6
hereunder. In the event Service Company or any of its directors, officers, attorneys, employees, agents or
other representatives, is named as a defendant in, or is otherwise obligated to defend, any action asserting
any Claim indemnified hereunder, Client will assume, at Client's expense, the defense of such actions on
behalf of Service Company and its directors, officers, attorneys, employees, agents or other representatives,
as the case may be, Client has sole discretion to select the attorneys who will defend any such action,
provided, however, that Client shall exercise such discretion reasonably. The obligations in this section
are intended to be within the limits of liability found in the Texas Tort Claims Act. This clause shall
survive termination of the Contract.
5. To provide sufficient funds to the Loss Fund Account to enable Service Company at all times to
pay Claims and Allocated Loss Adjustment Expenses in accordance with the terms and conditions of this
Agreement, including the terms and conditions contained in Exhibit C, attached hereto and made a part
hereof.
6. To authorize and hereby does authorize Service Company to withdraw from the Loss Fund
Account such funds as may be necessary to enable Service Company to pay Claims, provided such
payments do not exceed $10,000. Service Company also may withdraw from the Loss Fund Account such
funds as may be necessary to enable Service Company to pay all approved Allocated Loss Adjustment
Expenses. Service Company may withdraw funds from the Loss Fund Account to pay Claims in excess
$10,000 only with the express authorization of Client. Service Company is also authorized and directed to
deposit Recoveries into the Loss Fund Account.
ARTICLE VI
TERMINATION
1. This Agreement covers the period as stated in Article I. Any continuation or renewal of this
Agreement shall be the subject of further negotiation between Client and Service Company. If this
Agreement is terminated without cause or not renewed, Client shall exercise one of the following options.
A. Client may require Service Company to conclude the handling of all Claims occurring
during the term of this Agreement whether reported before or after the term of this
Agreement subject, however, to the terms, conditions and limitations of this Agreement.
B. Client may require Service Company to return all open and/or closed Claim files,
provided such return of open and/or closed Claim files shall not result in any expense or
reduction in per claimant fees for all flat rate claims referred to Service Company prior to
the effective date of termination, or time and expense fees incurred on time and expense
Claims prior to the effective date of termination. Client may desire to retrieve the Claim
files with resources provided by Client at no cost to Client. Client may require Service
Company to deliver Claim files. If Service Company delivers Claim files, the costs and
expenses incurred by Service Company in returning such files will be billed, with
documentation showing such costs, to Client by Service Company. Such billing will be
paid by Client to Service Company within thirty (30) days of billing.
This Agreement covers the period as stated in Article I. Any continuation or renewal of this
Agreement shall be the subject of further negotiation between Client and Service Company.
If this Agreement is terminated with cause for failure to make all reasonable attempts to abide
by the service standards set forth in Article III 2. hereto or provisions of Article VI 4. below,
Client shall exercise the following option.
A. Client shall require Service Company to provide on demand all open and/or closed Claim
files, which may result in the offset or deduction from any of the fees or charges paid or
payable to Service Company on Claim files open and unresolved. Client may decide to
retrieve the Claim files with resources provided by Client at no cost to Client. Client may
require Service Company to deliver Claim Files. If Service Company delivers Claim files,
the costs and expenses incurred by Service Company in returning such files will be billed,
with documentation showing such costs, to Client by Service Company. Such billing will be
paid by Client to Service Company within thirty (30) days of billing.
3. This Agreement may be terminated by either Client or Service Company with or without
cause and for any reason whatsoever upon Ninety (90) days prior written notice.
4. Notwithstanding the provisions of Paragraphs 1,2 and 3 of this Article VI, this Agreement
may be terminated immediately by Service Company or Client if the other party (i) is
rendered or becomes insolvent, (ii) is unable to pay debts as they come due, (iii) is
adjudicated a bankrupt, or files, or becomes subject to a petition of any insolvency, creditors
or bankruptcy law, (iv) has a receiver, liquidator or trustee of substantially all its assets
appointed by a court of competent jurisdiction or (v) fails to maintain an office located in
Lubbock, Texas.
5. This Agreement may be terminated by either Client or Service Company without cause upon
ninety (90) days written notice. Upon such termination or non -renewal Client and Service
Company shall exercise the option found in Article VI 1.
In the event of such immediate Agreement termination by Service Company, the termination option
as set forth in Paragraph 1. B. of this Article VI shall apply. In the event of immediate Agreement
termination by Client, Client shall have the right to exercise its options upon termination as set forth in
Paragraph 2. B. of this Article VI.
ARTICLE VII
GOVERNING LAW
This Agreement shall be governed by, and its provisions construed in accordance with, the laws of
the State of Texas.
ARTICLE VIII
INVALID PROVISIONS
In the event any provision of this Agreement shall be held to be invalid, unenforceable or in conflict
with applicable law, then the validity of the other provisions of this Agreement shall not be deemed to be
adversely affected but shall remain in full force and effect.
ARTICLE IX
EXCLUSIVITY
This is an exclusive Agreement between Service Company and Client to the extent Service
Company shall be assigned and provide services under this Agreement for all Claims and/or losses
occurring under Exposures, except as may be otherwise provided herein.
This agreement may only be set -aside on an individual Claim basis in the event of a conflict of
interest. Should such conflict occur, Service Company will find a qualified sub -contractor to provide the
Basic Services outlined in Article III 2. hereto at a cost not to exceed that Stated in Article II hereto.
ARTICLE X
AMENDMENT AND WAIVER
No amendment or waiver of any provision of this Agreement, and no consent to any departure
herefrom, shall be effective or binding unless and until set forth in a writing signed by each party, and then
any such waiver or consent shall be effective only in the specific instance and for the specific purpose for
which it is given. No notice or any other communication given by one party hereto to the other party shall
be construed to constitute approval or ratification by the other party of any matter contained or referred to
in such notice, unless the same be consented to by the other party in writing.
ARTICLE XI
ENTIRE AGREEMENT
This Agreement, together with the exhibits attached hereto, constitutes the entire agreement
between the parties relating to the subject matter hereof, and there exist no other written or oral
understandings, agreements or assurances with respect to such matters except as are set forth herein. Unless
expressly stated, this Agreement confers no rights on any person or business entity that is not a party
hereto.
ARTICLE XII
NOTICES
All notices, requests and other communications from either party to the other regarding disputes of
this Agreement shall be in writing and delivered either personally or by certified mail, return receipt
requested. Any such notice, request or other communication shall be deemed to have been given on the date
of personal delivery or, if mailed, on the date of mailing. All communications shall be addressed as
follows:
If to Service Company:
HAMMERMAN & GAINER, INC.
1101 West Airline Highway, Suite C
LaPlace, LA 70068
Attu: Larry D. Oney, President
If to Client
CITY OF LUBBOCK
P. O. Box 2000
Lubbock, TX 79457
Attn: Leisa Hutcheson, Risk Manager
ARTICLE XIII
ASSIGNMENT
Neither party may assign its rights or obligations under this Agreement without the prior written
consent of the other party.
ARTICLE XIV
BINDING EFFECT
This Agreement shall be binding upon and inure to the benefit of each party hereto and their
respective permitted successors and permitted assigns.
ARTICLE XV
COUNTERPARTS
This Agreement may be executed in one or more counterparts, each of which shall be considered an
original, and all of which shall constitute one and the same instrument.
IN WITNESS WHEREOF, the parties hereto have executed this contract and agreement on the
4th day of September , 2003.
CITY OF LUBBOCK
ATTEST:
HAMMERMAN AND GAINER, INC
MAYOR LARRY . CONEY, PRESIDENT
Reb)Ccca�G�arza, City Secretary
APPROVED AS TO CONTENT:
VY\
Scott Snider, Director of Human Resources
APPROVED AS TO FORM:
e
Jo ig t, Ass ity ttorney
EXHIBIT "A" Resolution No. 2003-BO363
RFP i113-03/DC, LiebiliyCiallms Services -Annual Pricing.
SUBMIT TO:
CITY OF LUBBOCK
ft
CITYOF LUBBOCK, TEXASPURCHASING
DEPARTMENT
rr
162513TM STREET, RM L04
LUBBOCK, TX79401-3830
AN EQUAL
OPPORTUNITY
REQUEST FOR PROPOSAL
#113-03/DC
CONTACT PERSON:
Diana Caudillo
EMPLOYER
TEL: 806.775.2167
FAX: 806.775.2164
http://purchasing.cl.tubbGck.tx.us
TITLE:
SUBMITTAL DEADLINE:
Liability Claims Services - Annual Pricing
August 5, 2003, =2:00 pm CST
PRE PROPOSAL DATE, TIME AND LOCATION:
Arty proposals receiv Wter the time and dote listed
above, regardless of &— mode of delivery, shall be
returned unopened.
RESPONDENT NAME:
IF RETURNING AS A "NO RESPONSE`, PLEASE STATE REASON.
MAILING ADDRESS:
CITY - STATE - ZIP:
THE CITY OF LUBBOCK RESERVES THE RIGHT TO ACCEPT OR REJECT ANY
AND ALL PROPOSALS IN WHOLE OR IN PART ANC WAIVE ANY INFORMALITY IN
THE COMPETITIVE PROPOSAL PROCESS. RET"ER, THE CITY RESERVES THE
RIGHT TO ENTER INTO ANY CONTRAQ DEEMED TO BE IN THE BEST
TELEPHONE NO:
INTEREST OF THE Cm.
IT IS THE INTENT AND PURPOSE OF THE CI-TY OF LUBBOCK THAT THIS
FAX NO:
•
REQUEST PERMITS COMPETITIVE PROPOSAL. IT 5 THE OFFEROR'S
RESPONSIBILITY TO ADVISE THE CITY OF LUOCK PURCHASING MANAGER IF
ANY LANGUAGE, REQUIREMENTS, ETC., OR ANW COMBINATHNS THEREOF,
E-MAIL:
INADVERTENTLY RESTRICTS OR LUMTS THE REQUIREMENTS STATED IN THIS
RFP TO A SINGLE SOURCE. SUCH NnRCAT"ION MUST BE SUBMITTED IN
WRITING AND MUST BE RECEIVED BY THE PURCHASING MANAGER NO LATER
FEDERAL TAX ID NO. OR SOCIAL SECURITY NO.
THAN FIVE (5) BUSINESS DAYS PRIOR TO TIEAEBOVE SUBMlTIAL DEADLINE.
THE OFFEROR HEREBY ACKNOWLEDGES RECEIPT OF AND AGREES ITS PROPOSAL IS BASED ON THE F=OLLOWING ADDENDA:
#1 #2 #3 #4 Ifs (Please Initial)
The City of Lubbock Charter states that no officer or employee of the City can benefit from any contract, job, work or service for the municipality or
be interested in the sale to the City of any supplies, equipment, material or articles purchased. Will any officer or emp'toyee of the City, or member
of their immediate family, benefit from the award of this proposal to the above firmT YES NO
IN COMPLIANCE WITH THIS SOLICITATION, THE UNDERSIGNED OFFEROR HAVING EXAMINED THE REQUEST F-OR PROPOSAL, AND BEING
FAMILIAR WITH THE CONDITIONS TO BE MET, HEREBY SUBMITS THE FOLLOWING. AN INDIVIDUAL AUtHMZED TO BIND THE COMPANY
MUST SIGN THE FOLLOWING SECTION. FAILURE TO EXECUTE THIS PORTION MAY RESULT IN PROPOSAL RUCTImN.
By my signature I certify that this offer is made without prior understanding, agreement, or connection v-4th any corporation, firm,
business entity, or person submitting an offer for the same materials, supplies, equipment, or servke(s), anal is in all respects fair and
without collusion or fraud. I further agree that if the offer is accepted, the offeror will convey, sell, assign _ , or transfer to the City of
Lubbock all right, title, and interest in and to all causes of action it may now or hereafter acquire under the Awnti-trust laws of the United
States and the State of Texas for price firing relating to the particular commodity(s) or service (s) purdased3 or acquired by the City of
Lubbock. At the City's discretion, such assignment shall be made and become effective at the time the City tenders final payment to the
vendor.
Authorized Signature
Print/Type Name
Title
Date
THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR RESPONSE.
113-03/DCRFPSVC.doc
RFP #113-03/DC, HabilityClaims Services —Annual Pricing
Liability Claims Services - Annual Pricing
CITY OF LUBBOCK, TEXAS
RFP #113-03/DC
The City of Lubbock appreciates your time and effort in preparing your proposal. All offerors should
familiarize themselves with the following INSTRUCTIONS TO OFFERORS and GENERAL REQUIREMENTS:
I. INSTRUCTIONS TO OFFERORS
PROPOSAL DELIVERY, TIME 8 DATE
1.1 The City of Lubbock wilt receive written and seated competitive proposals for Liability
Claims Services - Annual Pricing until 2:00 p.m. CST, August 5, 2003, if date/time
stamped on or before 2:00 p.m. at the office listed below. Any proposal received after
the date and hour specified will be rejected and returned unopened to the offeror.
Each proposal and supporting documentation must be in a seated envelope or container
plainly labeled in the lower left-hand corner: "RFP #113-03/DC, Liability Claims
Services - Annual Pricing" and the closing date and time. Offerors must also include
their company name and address on the outside of the envelope or container.
Proposals must be addressed to:
Victor Kilman, Purchasing Manager
City of Lubbock
1625 13th Street, Room L-04
Lubbock, Texas 79401
1.2 Offerors are responsible for making certain proposals and proposed contracts are
delivered to the Purchasing Department. Mailing of a proposal does not ensure that the
proposal will be delivered on time or delivered at all. If offeror does not hand deliver
proposal, we suggest that he/she use some sort of delivery service that provides a
receipt. The City of Lubbock assumes no responsibility for errant delivery of proposals,
including those relegated to a courier agent who fails to deliver in accordance with the
time and receiving point specified.
1.3 Proposals will be accepted in person, by United States Mail, by United Parcel Service, or
by private courier service. No proposals wilt be accepted by oral communication,
telephone, electronic mail, telegraphic transmission, or telefacsimile transmission. THE
CITY WILL NOT ACCEPT FAX PROPOSALS.
1.4 Proposals may be withdrawn prior to the above scheduled time set for closing.
Alteration made before RFP closing must be initiated by offeror guaranteeing
authenticity.
1.5 The City of Lubbock reserves the right to postpone the date and time for accepting
proposals through an addendum.
2 PRE -PROPOSAL MEETING
2.1 For the purpose of familiarizing offerors with the requirements, answering questions,
and issuing addenda as needed for the clarification of the Request for Proposal (RFP)
documents, a are -proposal meeting will be held at 10:00 a.m., July 17, 2003, in
Municipal Buildine, 1625 13u' Street, Committee Room 103, Lubbock, Texas. Alt persons
attending the conference wilt be asked to identify themselves and the prospective
offeror they represent.
2.2 it is the offeror's responsibility to attend the pre -proposal meeting though the meeting
is not mandatory. The City will not be responsible for providing information discussed
at the pre -proposal meeting to offerors who do not attend the pre -proposal meeting.
11"3/DCRFPSVC.doc 3
RFP #113-03JDC, Liability Claims Services —Annual Pricing
2.3 The City of Lubbock does not discriminate against person with disabilities. City of
Lubbock pre -proposal meetings are available to all persons regardless of disability. If
you would like information made available in a more accessible format or if you desire
assistance, please contact the City of Lubbock ADA Coordinator, 1625 13th Street,
(806)775-2018 at least forty-eight (48) hours in advance of the conference.
3 CLARIFICATION OF REQUIREMENTS
3.1 it is the intent and purpose of the City of Lubbock that this request permits competitive
proposals. It is the offeror's responsibility to advise the City of Lubbock Purchasing
Manager if, any language, requirements, etc., or any combinations thereof,
inadvertently restricts or limits the requirements stated in this RFP to a single source.
Such notification must be submitted in writing and must be received by the City of
Lubbock Purchasing Office no later than five (5) business days prior to the proposal
closing date. A review of such notifications will be made.
Diana Caudillo, Buyer
City of Lubbock
1625 13" Street
Lubbock, Texas 79401
Fax: (806) 775-2164
Email: dcaudillo@mail.ci.lubbock.tx.us
4 ADDENDA it MODIFICATIONS
4.1 Any changes, additions, or clarifications to the RFP are made by amendments
(addenda).
4.2 Any offeror in doubt as to the true meaning of any part of the RFP or other documents
may request an interpretation thereof from the Purchasing Department. At the request
of the offeror, or in the event the Purchasing Department deems the interpretation to
be substantive, the interpretation will be made by written addendum issued by the
Purchasing Department. Such addendum issued by the Purchasing Department will be
sent to all offerors receiving the original Request for Proposal (RFP) and will become
part of the proposal package having the same binding effect as provisions of the
original RFP. No verbal explanations or interpretations will be binding. In order to
have a request for interpretation considered, the request must be submitted in writing
and must be received by the City of Lubbock Purchasing Department no later than five
(5) days prior to the proposal closing date.
4.3 All addenda, amendments, and interpretations of this solicitation shall be in writing.
Any amendment or interpretation that is not in writing shall not legally bind the City of
Lubbock. Only information supplied by the City in writing or in this RFP should be used
in preparing proposal responses. All contacts that an offeror may have had before or
after receipt of this RFP with any individuals, employees, or representatives of the City
and any information that may have been read in any news media or seen or heard in
any communication facility regarding this RFP should be disregarded in preparing
responses.
4.4 The City does not assume responsibility for the receipt of any addendum sent to
offerors.
113-MCRFPSVC.doc 4
RFP #113-03tDC, Liability Claims Services —Annual Pricing
5 EXAMINATION OF DOCUMENTS AND REQUIREMENTS
5.1 Each offeror shall carefully examine all RFP documents and thoroughly familiarize itself
with all requirements prior to submitting a proposal to ensure that the proposal meets
the intent of this RFP.
5.2 Before submitting a proposal, each offeror shalt be responsible for making all
investigations and examinations that are necessary to ascertain conditions and
requirements affecting the requirements of this RFP. Failure to make such
investigations and examinations shall not relieve the offeror from obligation to comply,
in every detail, with all provisions and requirements of the Request for Proposal.
6 PROPOSAL COPIES fro°l`
6.1 OFFEROR'S MUST SUBMIT THE ORIGINAL AND TkRE`E COPIES OF THE SEALED PROPOSAL
TO THE PURCHASING DEPARTMENT PRIOR TO RESPONSE DUE DATE/TIME. FAILURE TO
SUBMIT THE ADDITIONAL COPIES MAY RESULT IN THE PROPOSAL BEING DECLARED
UNRESPONSIVE TO SPECIFICATION AND MAY NOT BE FURTHER EVALUATED.
6.2 Att proposals, responses, inquiries, or correspondence relating to or in reference to this
RFP, and all electronic media, reports, charts, and other documentation submitted by
offerors shall become the property of the City of Lubbock when received.
7 PROPOSAL PREPARATION COSTS
7.1 Issuance of this RFP does not commit the City of Lubbock, in any way, to pay any costs
incurred in the preparation and submission of a proposal.
7.2 The issuance of this RFP does not obligate the. City of Lubbock to enter into contract for
any services or equipment.
7.3 Ali costs related to the preparation and submission of a proposal shall be paid by the
proposer.
TRADE SECRETS, CONFIDENTIAL INFORMATION AND THE TEXAS PUBLIC INFORMATION ACT
8.1 if you consider any portion of your proposal to be privileged or confidential by statute
or judicial decision, including trade secrets and commercial or financial information,
clearly identify those portions.
8.2 Proposals wilt be opened in a manner that avoids disclosure of the contents to
competing offerors and keeps the proposals secret during negotiations. All proposals
are open for public inspection after the contract is awarded, but trade secrets and
confidential information in the proposals are not open for inspection.
8.3 The City of Lubbock wilt honor your notations of trade secrets and confidential
information and decline to release such information initially, but please note that the
final determination of whether a particular portion of your proposal is in fact a trade
secret or commercial or financial information that may be withheld from public
inspection wilt be made by the Texas Attorney General or a court of competent
jurisdiction. In the event a public information request is received for a portion of your
proposal that you have marked as being confidential information, you will be notified of
such request and you will be required to justify your legal position in writing to the
Texas Attorney General pursuant to Section 552.305 of the Government Code. In the
event that it is determined by opinion or order of the Texas Attorney General or a court
of competent jurisdiction that such information is in fact not privileged and
confidential under Section 552.110 of the Government Code and Section 252.049 of the
Local Government Code, then such information wilt be made available to the requester.
8.4 Marking your entire proposal CONFIDENTIAL/PROPRIETARY is not in conformance with
the Texas Open Records Act.
113-MCRFPSVC.doc 5
RFP #113.03/DC. Liability Claims Servioes—Annual Pricing
9 DISADVANTAGED BUSINESS ENTERPRISE (DBE) REQUIREMENTS
9.1 The City of Lubbock hereby notifies all offerors that in regard to any contract entered
into pursuant• to this RFP, Disadvantaged Business Enterprises (DBEs) will be afforded
equal opportunities to submit proposals and will not be discriminated against on the
grounds of race, color, sex, disability, or national origin in consideration of an award.
9.2 A DBE is defined as a small business concern which is at least 51% owned and controlled
by one or more socially and economically disadvantaged individuals, or in the case of
any publicly owned business, at least 51% of the stock of which is owned by one ore
more socially and economically disadvantaged individuals. Socially and economically
disadvantaged include Women, Black Americans, Hispanic Americans, Native Americans,
Asian -Pacific Americans, and Asian -Indian Americans.
10 CONFLICT OF INTEREST
10.1 The Offeror shall not offer or accept gifts or anything of value nor enter into any
business arrangement with any employee, official or agent of the City of Lubbock.
10.2 By signing their proposal, the offeror certifies and represents to the City the offeror has
not offered, conferred or agreed to confer any pecuniary benefit or other thing of value
for the receipt of special treatment, advantage, information, recipient's decision,
opinion, recommendation, vote or any other exercise of discretion concerning this RFP.
11 ANTI -LOBBYING PROVISION
11.1 DURING THE PERIOD BETWEEN PROPOSAL SUBMISSION DATE AND THE CONTRACT
AWARD, PROPOSERS, INCLUDING THEIR AGENTS AND REPRESENTATIVES, SHALL NOT
DIRECTLY DISCUSS OR PROMOTE THEIR PROPOSAL WITH ANY MEMBER OF THE LUBBOCK
CITY COUNCIL OR CITY STAFF EXCEPT IN THE COURSE OF CITY -SPONSORED INQUIRIES,
BRIEFINGS, INTERVIEWS, OR PRESENTATIONS, UNLESS REQUESTED BY THE CITY.
11.2 This provision is not meant to preclude offerors from discussing other matters with City
Council members or City staff. This policy is intended to create a level playing field for
all potential offerors, assure that contract decisions are made in public, and to protect
the integrity of the RFP process. Violation of this provision may result in rejection of
the offeror's proposal.
12 AUTHORIZATION TO BIND SUBMITTER OF PROPOSAL
Proposals must show vendor name and address of offeror. The original proposal must be
manually signed by an officer of the company having the authority to bind the submitter to its
provisions. Person signing proposal must show title or AUTHORITY TO BIND THEIR FIRM IN A
CONTRACT. Failure to manually sign proposal will disqualify it.
13 ABOUT THIS DOCUMENT
This document is a Request for Proposal. It differs from an Invitation to Bid in that the City of
Lubbock is seeking a solution, as described in the following General Requirements section, not
a bid/quotation meeting firm specifications for the lowest price. As such, the lowest price
proposed will not guarantee an award recommendation. Seated proposals will be evaluated
based upon criteria formulated around the most important features of a product or service, of
which quality, testing, references, availability or capability, may be overriding factors, and
price may not be determinative in the issuance of a contract or award. The proposal evaluation
criteria should be viewed as standards that measure how well an offeror's approach meets the
desired requirements and needs of the City of Lubbock. Those criteria that will be used and
considered in evaluation for award are set forth in this document. The City witl thoroughly
review all proposals received. The City will also utilize its best judgment when determining
whether to schedule a pre -proposal conference (before proposals are accepted), or meetings
with offerors (after receipt of all proposals). A Purchase Order/Contract will be awarded to a
113.03/DCRFPSVC.doc 6
RFP #113-030C. Liability Claims Services — Annual Pricing
qualified offeror submitting the best proposal. The City reserves the right to select, and
subsequently recommend for an award, the proposed service which best meets its required
needs, quality levels, and budget constraints.
14 EVALUATION PROCESS
14.1 All proposals will be evaluated by an evaluation committee and may include senior
management representatives, a financial officer, and/or an independent consultant.
14.2 Respondents to this RFP may be required to submit additional information that the City
may deem necessary to further evaluate the offeror's qualifications.
14.3 The committee will evaluate and numerically score each proposal in accordance with
the evaluation criteria included in the Request for Proposal.
14.4 The committee will arrive at a short list of the top respondents and these short-listed
respondents may be scheduled for a structured oral presentation and interview. Such
presentations will be at no cost to the City of Lubbock. At the end of the oral
presentation and interview, the evaluation of the short-listed respondents will be
completed. The oral interview may be recorded and/or videotaped.
15 SELECTION
15.1 Selection shall be based on the responsible offeror whose proposal is determined to be
the most advantageous to the City of Lubbock considering the relative importance of
evaluation factors included in this RFP.
15.2 NO INDIVIDUAL OF ANY USING DEPARTMENT HAS THE AUTHORITY TO LEGALLY AND/OR
FINANCIALLY COMMIT THE CITY TO ANY CONTRACT, AGREEMENT OR PURCHASE ORDER
FOR GOODS OR SERVICES, UNLESS SPECIFICALLY SANCTIONED BY THE REQUIREMENTS OF
THIS REQUEST FOR PROPOSAL.
16 EQUAL EMPLOYMENT OPPORTUNITY
Offeror agrees that it will not discriminate in hiring, promotion, treatment, or other terms and
conditions of employment based on race, sex, national origin, age, disability, or in any way
violative of Title VII of 1964 Civil Rights Act and amendments, except as permitted by said
laws.
17 NONAPPROPRIATION
Alt funds for payment by the City under this contract are subject to the availability of an annual
appropriation for this purpose by the City. In the event of non -appropriation of funds by the
City Council of the City of Lubbock for the goods or services provided under the contract, the
City will terminate the contract, without termination charge or other liability, on the last day
of the then -current fiscal year or when the appropriation made for the then -current year for
the goods or services covered by this contract is spent, whichever event occurs first. if at any
time funds are not appropriated for the continuance of this contract, cancellation shalt be
accepted by the Seller on thirty (30) days prior written notice, but failure to give such notice
shall be of no effect and the City shalt not be obligated under this contract beyond the date of
termination.
18 PROTEST
18.1 All protests regarding the RFP process must be submitted in writing to the City
Purchasing Manager within five (5) business days following the opening of proposals.
This includes all protests relating to advertising of notices, deadlines, proposal opening,
and all other related procedures under the Local Government Code, as well as any
protest relating to alleged improprieties with the RFP process.
113-03/1)CRFPSVC.doc
RFP #113-031DC, Liability Claims Services — Annual Pricing
This limitation does not include protests relating to staff recommendations as to award
of contract. Protests relating to staff recommendations may be directed to the City
Council by contacting the Executive Assistant to the City Council.
All staff recommendations will be made available for public review prior to
consideration by the City Council as allowed by law.
18.2 FAILURE TO PROTEST WITHIN THE TIME ALLOTTED SHALL CONSTITUTE AWAIVER OF
ANY PROTEST.
113.03/DCRFPSVC.doc 8
RFP #113-03/DC, Liability Claims SeMms —Annual Pricing
THIS PAGE INTENTIONALLY LEFT BLANK
113-03JDCRFPSVC.doc
RFP#113.03/DC,Llabl4Clainna Services -Annual Pricing
It. GENERAL REQUIREMENTS
1 INTENT
a) The City of Lubbock. (hereinafter called "City") is seeking proposals from interested firms
and individuals, (hereinafter called "Proposer") to provide Liability Claims Services - Annual
Pricing.
b) Proposers are invited to submit demonstrated competence and qualifications of their firm
for providing these services.
c) The information contained within this document is intended to provide interested firms
with the requirements and criteria that will be used to make the selection.
2 PROJECT DESCRIPTION
The City of Lubbock, Texas is looking to establish a relationship with a quality claims handling
company who is technically proficient, automated, flexible and effective with competitive pricing.
In evaluating your proposal for claims services, emphasis shalt be placed on your ability and
commitment to conduct a timely and comprehensive investigation prior to acceptance of any
liability claim as compensable. The service company shalt administer, process and aggressively
investigate all General, Other and Automobile Liability claims filed against the City of Lubbock.
The City of Lubbock is aware of the impact claims -handling can have on their bottom line, however,
in no way does this financial responsibility reduce their concern for their citizens in third -party
liabilities. Integrity is the cornerstone of The City of Lubbock reputation and foundation for a
proactive risk management program.
3 SCOPE OF SERVICES
To help you understand the needs of The City of Lubbock we are providing yo u with the following
list of issues that we feet should assist you when preparing your overall presentation.
Estimated Number of Annual Claims
• Automobile Claims 52
• General and Other Liability Claims 250
Loss information provided is based upon anticipated volume of claims. The City of Lubbock vvill
NOT be responsible for any error or omission in volume of claims presented and makes no guarantee
as to future volume of claims to be submitted to the successful Offeror.
113-03/DCRFPSVC.doc 10
RFP #113-03/DC, UetftClmirns Senwim-Annual Pricing
Internal Aud i is
Internal audit results/reports shall be provided to the City of Lubbock .at the time of their
issuance.
The following are specific standards required by the City of Lubbock. They must be included
specifically within the written proposal and must be part of the service contract,
Automobile and General Liability
• All claims Witt have location codes verified and changed if the investigation warrants.
• All claims wilt be appropriately coded for General Liability, Police Lability, Employment
Liability and Other liability and shall distinguish between bodily injury and personal injury.
• The City of Lubbock will be copied on atl denial letters.
• No claim settlement shalt be made without prior approval of City of Lubbo=k.
• The City of Lubbock will be provided with a copy of all letters of representation.
• Litigated Claims - shall be managed by the City Attorney's office of the {ity of Lubbock that
will provide the Offeror with a copy of all correspondence.
• Verbal approval for settlement can be secured for cases less than $5,000. However, the claim
representative should be prepared to discuss the merits of the claim.
• $5,000 or more settlement value, the service company shall provide a wri-itten request to the
City of Lubbock Risk Manager prior to settlement negotiations commencing. The report shalt
include the following:
(�) Claimant's Name (Phone Number)
Social Security Number
(2) Accident Location
(3) Location Code
(4) Date of Loss
(5) Claim Adjuster
Supervisor's Name (Phone Number)
113-03MCRFPSVC.doc 12
RFP #113.03/DC. LiabilkClaaims Services —Annual Pricing
Third -Party Litigation
The servicing company shall not join any third -party in any suit on behalf of the CityroF Lubbock or seek
contribution from any third -party on behalf of the City of Lubbock without prior consultation and approval of
the City of Lubbock.
Loss Reports
• Required to provide by the 10"' day of each month via Compact Disc and irs a format compatible
with Microsoft Excel.
• Reports shall be provided until all claims assigned under the contract are dosed.
Third -Party Administration Standards — General Liability, Other Liability and
Automobile Liability
Timeliness
The Offeror shall have a 24-hour emergency number with ability to respond within 30 minutes of a call
from the City of Lubbock.
The claimant shall be contacted by telephone within 24-hours of receipt of the da 3m.
• The City of Lubbock must be notified within 24 hours of recognition of any claii m that may create a
problem as to large loss potential or public relations.
• Basic investigation shall be completed within thirty (30) days of claim assignment_
New claims shall be entered into the automated loss system within 24-horus
• Maintain a minimum thirty (30) day contact schedule with the City of Lubbock Rid-, Manager.
The service company shall contact all witnesses within 48-hours from the date of claim notice.
• The service company shall not take any statements for employees of the Cityof Lubbock without prior
consent of the City of Lubbock Risk Manager.
113-03/DCRFPSVC.doc 14
RFP #113-03/DC, Liability Clasims Services -Annual Pricing
• Schedule independent medical examination (IME) and secure necessary med®cal reports timely to
evaluate exposure. Authority from City of Lubbock Risk Manager is required prior to an IME
assignment. Telephone authority shall suffice.
• The City Attorneys office shall manage all cases in litigation; however, Risk Wanagement shall be
informed of any requests made by the City Attorneys office.
Is All injury claims shall be reported to the Central Index Bureau, and re -indexed every six (6) months for
the life of the claim.
• No claim shall be denied without approval from the City of Lubbock Risk Manager-.
• Certificates of Insurance and contracts should be obtained through the City of Lubbock Purchasing
Department or affected operational department.
Lease documents shall be obtained from the affected City of Lubbock operationalF department.
Claim Status Reports
Automobile General and Other Liability
• Updates on specific claims must be available on demand and in a timely manner.
• Formal reports shall be submitted to the City of Lubbock Risk Manager and the excess liability carrier
when the potential liability is determined to be $125,000 or greater.
11 "30CRFPSVC.doc 16
RFP#113-03/DC,LWAyClairnsSOMM-Annual Pridng
PRICING/RU NOFF
Include a listi n4 of those allocated charges not included in your Dricino.
These forms must be used to submit your pricing options and they maybe copied.
A detailed written explanation of your offer can be provided to support your position or plan.
TYPE OF CLAIM
PRICING
Option I
Option II
Option II I
Option IV
Automobile Liability
General Liability
Other Liability (Police,
Employment, Public Officials)
11"3MCRMSVC.doc 17
RFP #113-031DC, Uabirdy Claims Services- Annual Pricing
4 EVALUATION CRITERIA
All proposals wilt be evaluated by a team to include but not be limited to City of Lubbock members,
legal counsel, and independent consultant(s). The following criteria will be used to judge and rank
submittals:
Service
30%
Includes ability to provide qualified personnel, ability to provide a technical ars d comprehensive
investigation process, ability to satisfy authority levels, ability to respond withi n 30 minutes in the
event of an emergency and references
Management Information
30 %
Includes ability to provide loss reports in desired manner, access to claims management system
and flexibility of providing special reports.
Financial Capacity
15%
Includes ability to provide insurance certificates as required and abilityto accommodate
appropriate funding transfers for payment of claims.
Cost 25 %
Includes consideration of options quoted including all allocated expenses.
113-03JDCRFPSVC.doc 18
RFP #113-03/DC, Uabj14 Claims Sen m-Annual Pricing
6 PENALTIES
Specific standards have been established to effectively and efficiently manage City of Lubbock claims. It
is of tantamount importance the service company complies with these standards. Audits will be
conducted at the discretion of the City of Lubbock on a random basis of both open and closed claims to
determine the level of compliance with these standards. Failure to meet these standards shall result in
termination of the service contract at the discretion of the City of Lubbock.
• The service company shall be held accountable, responsible and liable for the following: caused by
the service company, its employees and/or subcontractors through errors and omissions.
► All legal costs associated with defense of any and all fines, penalties and costs, imposed by the
Federal, States or local agency wherein the service company fails to perform to the standards set
forth in the Acts.
► Any and all erroneous payments or overpayments including but not limited to legal fees, expenses
and costs.
► All third -party and legal fees/expenses or a failure to follow established procedures and
guidelines.
• Should the service company fail to follow claim handling procedures agreed to in this contract, the
service company shall be held liable for any overpayments or legal fees resulting from this failure to
perform and shall waive the claim handling charge associated with this claim.
• Should there not be an overpayment or additional legal fees that resulted from the service company's
failure to follow claim -handling procedures, the service company shall waive its claim handling charge
for failure to follow procedures.
113-03/DCRFPSVC.doc 20
RFP #113-03/DC, Liability Claims Services -Annual Pricing
Instructions to Answering the Questions
• Answer all questions on the forms provided)`All other information can be provid ed using your format,
however, it must be clearly represented that this is you response.
• Answer all questions and comments when required to do so.
• Please type your answers in the space provided on the chart; sign, date and return the original to us.
Your written proposal shall be in your own format and shall be a separate document from this question
and answer chart:
11343/DCRFPSVC.doc 22
rAHAMMERMAN & GAINER, INC.
Claims Administrators - Consultants - Investigators - Adjusters
800 West Airport Freeway, Suite 620, Irving, Texas 75062 www.hng.com
Telephone: 972-554-9400
Facsimile: 972-554-8100
Proposal to Provide
Liability Claims Services - Annual Pricing
Third Party Administration
RFP Number: 113-03/DC
The City of Lubbock
Proposal Due: August 5, 2003 at 2:00 P. M.
Mr. Victor Kilman
Purchasing Manager
The City of Lubbock
162513th Street
Lubbock, Texas 79401
Robyn C. Tydelski
Sr. Marketing Representative
Hammerman & Gainer, Inc.
800 W. Airport Freeway, Ste 314
Irving, TX 75062
972-554-9400
A Risk Technology Institute Company
Office Locations
Texas - Austin, Dallas/Fort Worth (Irving), El Paso, Houston, Lubbock, San Antonio
Louisiana - Lafayette, New Orleans (LaPlace), Shreveport
TABLE OF CONTENTS
1. REPRESENTATIONS AND CERTIFICATIONS.................................................................1-1
2. EXECUTIVE SUMMARY................................................................................2-1
Hammerman & Gainer is the best financial choice
3.OVERVIEW OF HAMMERMAN & GAINER, INC..................................................3-1
Introduction
Workers' Compensation Training and Qualifications
Hammerman & Gainer's Research Sources
Hammerman & Gainer Publications
Hammerman & Gainer Continuing Education Seminars
Disadvantaged Business Enterprise
Conclusion
4. CLAIMSDMINISTRATION.................................................................................................4-1
Hammerman & Gainer's Service Office
Hammerman & Gainer Adjusting Personnel
Workers Compensation Accident Investigation
Liability Accident Investigation
Appraisals
Reserving Practices
Index Bureau and DMV Reporting
Diary System
Subrogation/Third Party Involvement/Litigation Management
TWCC Representation and Dispute Resolution
Electronic Data Interchange
Financial Administration
Quality Control
24-Hour Capability
H&G Lubbock Office Staff Proposed for the City of Lubbock
5. RISK MANAGEMENT INFORMATION SYSTEMS AND REPORTS..............................5-1
The Allegro Integrated Risk Management Information System
Desktop Views and Navigational Flexibility Transaction Tracking
Global Intake and Access Characteristic Screens
Microsoft Office Integration
Open Data Set Access for Ease and Autonomy in Generating Customized Reports
Ease of Integration with Other Systems
Management of Information Systems
Maintaining the Allegro System
Client Access to our System
Ad Hoc Reporting Capabilities
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
System Security
Archiving of Closed Claim Files
Extraction of Data to be Loaded into Allegro
Additional Comments on Allegro
Conclusion
6. REQUIRED FORMS AND QUESTIONNAIRE...........................................................6-1
Liability Claims Services - Annual Pricing
One -Minute Customer Survey
Reference List
Questionnaire
7. PRICING OPTIONS...................................................................................................................7-1
8. ATTACHMENTS.............................................................................................8-1
A. ' Hammerman & Gainer, Inc.
History
Management Team
Branch Office Locations
Answers to FAQ's
Affiliated Organizations
B. Staff Resumes
C. Certificate of Insurance
D. M/WBE Certification
E. Hammerman & Gainer, Inc. - Standards of Performance
F. Hammerman & Gainer, Inc. - Sample Reports and Forms
G. Hammerman & Gainer, Inc. - Reference List
H. Hammerman & Gainer, Inc. - Recommended Transition Plan
I. Hammerman & Gainer, Inc. - Sample RMIS Report from Allegro
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
raHAMMERMAN & GAINER, INC.
Claims Administrators - Consultants • Investigators - Adjusters
Wells Fargo Tower
800 West Airport Freeway, Suite 620
Irving, TX 75062
August 5, 2003
Mr. Victor Kilman
Purchasing Manager
City of Lubbock
1625 13t' Street, Room L-04
Lubbock, Texas 79401
Re RFP Number: 113-03/DC
Liability Claims Services — Annual Pricing
Mr. Kihnan,
Thank you for the opportunity to submit this proposal.
Telephone: 972/554-9400
Facsimile: 972/55418100
www.hng.com
Hammerman & Gainer, Inc. does hereby declare that they have read and understand the Request for
Proposal Number 113-03/DC for Liability Claims Services. Hammerman & Gainer, Inc. is submitting a
proposal with full knowledge of the requirements, and does hereby agree to furnish all services in full
accordance with the requirements outlined therein.
Hammerman & Gainer, Inc. affirms this proposal has been arrived at independently and is submitted
without collusion to obtain information or gain any favoritism that would in any way limit competition or
give unfair advantage over other proposers.
Hammerman & Gainer, Inc. offers this proposal with the understanding of the local conditions under
which work is to be performed, and acknowledges receipt of all addenda and amendments contained
within this Request for Proposal.
Hammerman & Gainer, Inc. certifies that we do not and will not engage in employment practices which
have the effect of discriminating against employers or prospective employees because of race, color,
religion, national origin, sex, age, handicap, political belief or affiliation.
Hammerman & Gainer, Inc. does not take exception to any aspect of this proposal.
A Risk Technology Institute Company
Texas Office Locations
Austin, Dallas (Irving), El Paso, Houston, Lubbock, San Antonio
HAMMERMAN Ili GAINER, INC.
Page 2 — August 5, 2003
The undersigned hereby declares that they have the authority to represent Hammerman & Gainer, Inc. in
submitting this proposal, and is authorized to contractually bind the Proposer responding to this Request
for Proposal. The undersigned declares this Proposal to be our official offer to undertake this project at
the prices quoted in this document, and declares that this Proposal represents the services offered by
Hammerman & Gainer, Inc.
Respectfully submitted,
JQsp �-----•
Robyn C. Tydelski
Sr. Marketing Representative
2. EXECUTIVE SUMMARY
Hammerman & Gainer will provide a comprehensive claims management program that goes beyond
traditional claims adjusting services. By teaming experienced claims adjustment staff with the City's
risk management personnel, we will provide the City of Lubbock with a superior claims management
program designed to reduce overall claims cost. Hammerman & Gainer, Inc. brings a complete range
of experienced claim professionals together with the goal of providing the City of Lubbock with
unmatched expertise in claims management and medical cost containment.
Hammerman & Gainer offers two workers' compensation claim management programs available, and
a complete managed care program in a partnership with qualified medical management partners. If at
any time you wish to learn more about these programs, please let us know. In reviewing your request
for proposal, it appears that you are looking form liability claims management services. A detailed
discussion of our liability services may be found in Sections 2 and 3 of our proposal response.
All service Vare discussed in the sections that follow. Section 3 will provide a brief overview of
Hammerman & Gainer, Inc. Section 4 discusses our workers' compensation and liability claims
administration program, and the qualifications of our staff. Section 5 provides information regarding
our Risk Management Information Systems, Allegro. Section 6 provides our response to your
questions and required forms. Section 7 is a detailed discussion of our pricing, and Section 8 provides
additional attachments as requested by the City of Lubbock or offered by Hammerman & Gainer, Inc.
in support of our proposal response.
Hammerman & Gainer is the best financial choice. Hammerman & Gainer, Inc. will provide workers
prompt and effective claim handling methods to produce equitable outcomes and improved- cost
savings. Cost savings will come from:
♦ Prompt professional claims handling by experienced liability adjusters.
♦ Immediate investigation of automobile and general liability claims by experienced adjusters to
document accident details, determine liability factors and identify subrogation opportunities in
a coordinated effort with Legal staff employed by the City of Lubbock.
♦ Appropriate use of physician review of medical treatment and impairment ratings to identify
"building" of medical specials and prevent overpayment of indemnification.
♦ Appropriate use of IME's to determine nature and extent of bodily injury and to evaluate claim
exposure.
♦ Improved coordination with the City of Lubbock's risk management staff through an integrated
data system that provides the City of Lubbock's officials on-line access to more pertinent data
on each claim.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Hammerman & Gainer, Inc. has carefully reviewed and understands the Scope of Work for Liability
Claims Services described in this RFP. We are agreeable to the terms and requirements found therein.
We also understand and agree to the insurance requirements as well.
We are pleased to offer the use of our Risk Management Information System, Allegro. Allegro is a
state -of -the -art -Windows based claims operating system. A complete discussion of this system may be
found in Section 5 of our proposal response.
Hammerman & Gainer, Inc. offers the City of Lubbock a superior program for the management and
handling of automobile and general liability claims.
Section 3 will review in detail the background of our firm. It will also introduce you to the programs
and activities that set our firm apart from all the others.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
3. OVERVIEW OF HAMMERMAN & GAINER, INC.
Introduction
This is a proposal by Hammerman & Gainer, Inc. liability claims administration. This section will
discuss the corporate structure and background of Hammerman & Gainer, Inc.
Hammerman & Gainer is a subsidiary of Risk Technology Institute, L.L.C., (RTI) a risk services and
claim management holding company providing property and casualty claims administration services
nationwide. Through its operating entities, Hammerman & Gainer, Inc. and Integra Management
Group, Inc., RTI provides risk management and insurance consulting services, Third Party
Administration and claims adjusting- for all lines of casualty/property business, claims auditing,
medical management and cost containment services and in Texas representation before the Texas
Workers' Compensation Commission for over 300 clients, including insurance carriers, political
subdivisions, independent school districts, cities, counties, risk pools, hospital districts, and certified
self -insurer
Hammerman & Gainer has enjoyed a long history in Texas and employs a staff that is extremely
knowledgeable in Texas Workers' Compensation Claims, automobile and general liability claims. One
fact that sets Hammerman & Gainer apart from its competition is the expertise the company has in the
legal aspects of Texas Workers' Compensation claims. The Director of Workers' Compensation
Services, Don York, is an attorney, as are four other staff members. All five are licensed adjusters as
well. This in-house legal expertise provides for more professional and defensible claims handling.
With this expertise, Hammerman & Gainer has produced seminars for the past 34 years on automobile,
general liability, property, professional liability, and workers' compensation and provides updates on
new and proposed legislation to Hammerman & Gainer clients.
Hammerman & Gainer was founded January 1, 1929, by Edna Hammerman and John Gainer, Sr.,
opening in Austin, Texas to handle claims before the Industrial Accident Board. Incorporation in 1971
guaranteed stability and continuity. On August 1, 1999, Risk Technology Institute, L.L.C. acquired
100% ownership of Hammerman & Gainer. The current management team of Hammerman & Gainer
is an extension of the original organization and is dedicated to enhancing the tradition of excellence
and integrity that were the trademarks of Edna Hammerman and John Gainer. A brief biographical
resume of our management team is included as an attachment to this proposal.
Since we began over 74 years ago, the firm has grown to nine offices in Texas, three in Louisiana, and
one in Albuquerque, New Mexico. We serve as claim managers, consultants, investigators and
adjusters for our clients across the state of Texas, Louisiana and New Mexico. All offices are staffed
with experienced personnel to provide full investigation and claims administration services. Most of
our adjusters and supervisors are "specialists" in that their activity is confined to claims/losses in a
given category or line of coverage. Our claims adjusters are "field trained" as they have been since our
first day in business, and we perform field investigations on losses that require this expertise. -
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Our attorneys, adjusters, investigators and clerical assistants are under the supervision of individuals
recognized within the industry for their leadership and technical ability. With the diversity of
experience of our technical staff, our expertise lies in many areas: workers' compensation (including
statewide representation of insurance companies and self -insureds before the Texas Workers'
Compensation Commission), commercial/private auto, long haul truck, products and malpractice,
commercial/personal property, general liability, fidelity, surety, crime losses and claims under the
Texas Tort Claims Act. Such losses are received from more than five hundred insurance companies in
the United States and foreign countries, as well as self -insured, public and commercial accounts, re-
insurers, excess and surplus lines carriers, agents and general agents.
Beyond claims administration, Hammerman & Gainer provides a number of other services to clients.
These include:
Workers' Compensation Training and Qualifications. Hammerman & Gainer, Inc. has
expertly represented numerous entities, insurance carriers, self -insureds, and political subdivisions
before the Texas Workers' Compensation Commission (and before the Industrial Accident Board)
since 1929. In each of our branch offices, we have highly trained workers' compensation specialists,
many of who represent clients at all levels of hearings before the TWCC. In addition to our adjusters
who are trained to handle Benefit Review Conferences and Contested Case Hearings, we have five
adjusters on staff who are also attorneys licensed by the State Bar of Texas.
Hammerman & Gainer's Research Sources Hammerman & Gainer also has an in-house library
of legal research resources no other TPA in Texas has, such as on-line access to the Texas Workers'
Compensation Act, Rules, and indexed TWCC Appeals Panel Decisions. When our adjusters have
questions concerning the law or a recent TWCC Appeals Panel decision, they have to look no further
than Hammerman & Gainer's manual which contains almost 130 pages of commentary on Appeals
Panel 'decisions, or to their computer containing the Act and Rules and all Appeals Panel Decisions, or
to an attorney in a nearby office.
We are also on-line with Westlaw; therefore, we have immediate access to all Texas Statutes and
cases. Additionally, we have Internet access to the Legislature, the Secretary of State (Texas Register)
and other State agencies whereby we can keep up with the latest developments in the regulatory
environment.
Hammerman & Gainer Publications Hammerman & Gainer is the author of a quarterly
newsletter, The H and G Report, a sample of which is enclosed with this proposal. Additionally, we
publish the Texas Workers' Compensation Act and Rules on an annual basis with appeals panel
summaries and all statutes and rules changes that occur in the previous twelve months. Hammerman
& Gainer also provides our clients a case law summary for all lines of claims.
Hammerman & Gainer Continuing Education Seminars. Our firm has also conducted annual
continuing education seminars for clients and staff for 34 years, which requires us to "stay on our toes"
from the standpoint of developments in the law. Such seminars are approved not only for adjusters and
agents licensing credits, but are also approved for Continuing Legal Education credit by the State Bar
of Texas, the State Bar College and the Texas Board of Legal Specialization.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
We believe these services set us apart from our competitors. No other claims administration firm
provides these in-house services for the growth and education of their staff, and certainly none are able
to offer these services to their clients.
Disadvantaged Business Enterprise
Hammerman & Gainer, Inc. is a member in good standing with the North Central Texas Regional
Certification Agency as a Disadvantaged Business Enterprise. A copy of our certificate is enclosed as
an Attachment to this proposal response.
Conclusion
Hammerman & Gainer offers the City of Lubbock experienced workers' compensation injury claim
management. Hammerman & Gainer staff will oversee each and every injury from the date of first
notice of loss with a goal of proactive adjusting and medical management to avoid or shorten lost time
from work. Hammerman & Gainer employs staff with the knowledge and expertise to accomplish
these goals. Qur staff has worked for years in the workers' compensation market. Our staff is ready to
assist in field investigation on any serious claim and will work promptly and professionally to
minimize the any loss sustained under this contract. Our highly trained staff will work to reduce the
overall costs of claims for the City of Lubbock.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
4. CLAIMS ADMINISTRATION
Hammerman & Gainer, Inc. Service Office
Hammerman & Gainer will provide liability claims administration services for this account from our
Lubbock, Texas branch office. We have operated a claims office in Lubbock continuously since 1970,
and we hire only the most qualified staff. This section will address the adjusting functions
Hammerman & Gainer will provide for claims administration.
H & G Adjusting Personnel
Hammerman & Gainer, Inc. will provide a comprehensive approach to claims administration, and this
begins with staffing. All clients have different requirements and needs; however, our experience
shows that in order for claims to be properly investigated and managed, the following types of
personnel are required. Some accounts may need one adjuster while others may need six, but the
following is & synopsis of typical Hammerman & Gainer personnel, job descriptions and duties in our
Claims Admiiistration program.
• H and G Risk Services Manager: In addition to our Home Office and TWCC Service Office in
Austin, we have a Risk Services Division headed by a highly experienced claims professional. Our
Risk Services Manager offers oversight and monitoring of the day-to-day operation of all claims
management accounts statewide, while our claim supervisor is responsible for everyday
management and supervision of the claim files.
• Claims Supervisor: Our claims supervisors are responsible for assigning claims, establishing and
continually analyzing reserves, providing direction on all claim investigations and review of all
files and reports, running our computerized and manual diary systems, and hands-on supervision
and direction of all employees involved in the claims administration process.
• Lost Time Adjuster: Our Lost time adjusters are experienced in investigation and administration
of workers compensation claims in accordance with the statute and rules. Our lost time adjusters
will investigate claims in the field or by telephone as appropriate, documenting third party
involvement and subrogation potential. They dispute or initiate benefits, compute and pay
compensation according to the statute and rules, review medical billings and initiate the ,audit
process, working very closely with our medical management partners and clients in all aspects of
medical management and cost containment. Our adjusters prepare file status reports, input adjuster
file notes into the system, prepare files for hearings under the dispute resolution process, and on
occasion may attend BRCs on behalf of our clients.
• Medical Only Adjuster: Our medical only adjusters, perform three point contact investigation on
all cases by contacting the appropriate employer personnel, employee and physician, and will
review and work with claims assistant staff to timely transmit all medical bills to audit. - Our
medical only adjusters are trained to monitor claims for medical, compensability and dispute
issues. As appropriate, this individual may take a claimant or witness statement and will make
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
recommendations through the Claims Supervisor for upgrade to indemnity or questionable case
status as appropriate.
• Claims Assistant: Our claims assistants perform an extremely important role in our claims
administration process. They provide daily assistance to the adjusters in the transmission of bills to
audit, preparation of client reports, preparation of reserve sheets and required TWCC forms,
issuance of indemnity and medical drafts, opening and closing of claim files, input of claims and
statistical data into H&G's Allegro Risk Management Information System, submitting claims to the
Index System, preparation and mailing of contact letters to injured workers and physicians and
assistance to the claims supervisor in any support capacity required on our accounts.
Liability Claims Adjuster: Our liability adjusters are trained in field investigation, accident scene
investigation, photography and diagramming, securing statements of witnesses and all parties for
subrogation purposes. In addition to training and expertise in the Texas Tort Claims Act, our
adjusters are trained in handling matters under a reservation of rights, taking of proper proofs of
loss and common law or indemnifying releases, settlement negotiation and handling matters in
litigation.,.
f 11
Management Information System Operator: Our MIS operator is also a very important member
of our claims administration accounts process. The MIS operator is responsible for transferring
data from the current claim administrator's claim system to Hammerman & Gainer's CIMS or
Allegro Risk Management Information System. He also assists in training of client staff, purchase
and installation of computer hardware and software, maintaining and upgrading this equipment as
appropriate, works with client staff and the Hammerman & Gainer claims unit on any ad hoc
reports they desire as well as all appropriate functions in the preparation and printing of loss runs,
check payment registers and filing of 1099 forms.
Our MIS operator is directly responsible for integrating medical bill audit, dispute, payment, pre -
certification and any additional medical management documentation, including nurses file notes, if
requested, from our medical management partner's system to the CIMS or Allegro RMIS for read-
only and report formatting and printing access by client staff. Our MIS operator is experienced in a
variety of database programming, software and hardware applications and installation, as well as
network training. Our MIS operator has the ability to create reports using report creators,
knowledge of Microsoft Word, Microsoft Excel and Microsoft Access, and will handle help desk
support and answer questions regarding hardware and software related issues.
Workers' Compensation Accident Investigation
Whether we receive first notice by telephone or by receipt of a TWCC 1, the Employers First Notice of
Injury form, the loss is immediately referred to the claims supervisor who will make an assignment of
the loss to the appropriate medical only or lost time adjuster. Contact with all parties is made
immediately in most instances but our goal is to provide contact on. all claims within 24 hours of
receipt of notice of the claim. Our indemnity adjusters are field trained and will investigate losses
appropriately, according to their severity, question of compensability, frequency of injury, history of
prior claims, and potential of third party involvement and subrogation. The claims supervisor closely
Hammerman & Gamer Proposal to the City of Lubbock
August 5, 2003
monitors all investigative activity and in conjunction with our cost containment partner will be
responsible for making the ultimate decisions on all issues. Depending on the desires of our clients,
before official disputes of compensability or other issues is filed, we will discuss with designated client
representatives.
Liability Accident Investigation
Whether we receive a telephone call, a notice by fax or an e-mail loss report, we begin our
investigation immediately. Upon receipt of a loss notice, our claims supervisor reviews each claim for
coverage consideration and assigns the loss to a liability adjuster. Prompt 24 hour contact is made with
all parties. Decisions regarding the scope and the type of investigation are made in conjunction with
staff from the City. Our investigations include the securing of fact statements from appropriate parties
and witnesses, the investigation of the accident scene, photographed and scoped as appropriate, the
securing of medical authorizations and wage loss information, the inspection of property damage and
the appraisal of damage. Settlements or denials of losses are appropriately made dependent on the
results of coverage determination and decisions on liability and damages.
Appraisals ,' -11,
Hammerman & Gainer, Inc. has experienced and highly trained automobile and property appraisers on
staff and under contract. We employ the use of Mitchell Manual products and Simsol software for
damages to personal or commercial property. Appraisals are routinely completed within 24 — 36 hours
of assignment and in most cases, we are able to secure agreed prices from repair or contracting
facilities as the situation warrants.
Reserving Practices
Hammerman & Gainer understands that proper file reserving is extremely important for many reasons.
Under -reserving can give a distorted picture of the profitability of lines of business in insurance. It can
cause reinsurance or excess insurance problems. Evaluation of the ultimate cost of a claim or a lawsuit
is based on an adjuster and their supervisor's knowledge, experience, and integrity, and we believe that
there is actually an art to the reserving process.
We attempt to provide an honest and realistic appraisal of the ultimate value of a claim in a particular
jurisdiction. We use detailed forms to make our initial reserve assessment and any subsequent reserve
changes, and these are well documented in our claim file. We view the issues of coverage, liability,
comparative responsibility on appropriate cases, our experience with the Texas Tort Claims Act, the
Texas Workers' Compensation Statutes, extent of injury and expected or determined impairment, age
of the claimant, sex, dependency, lost wages, economic status, as well as property damages and
medical expense on liability claims, for instance. Venue, appraisals of defense and plaintiff counsel,
expert witnesses or actual accident witnesses, etc. are also viewed on appropriate claims. Workers'
Compensation reserves are reviewed somewhat differently, but we always keep in mind the limitations
of benefit rates, potential or actual impairment, cost of medical care, defense of claim, and any
allocated expenses that may affect the ultimate cost of the loss such as attorneys fees, private
investigations, etc. Subrogation or contribution are also considered as appropriate and are noted
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
properly in the file and in our reserve. We also work very closely with your preferred cost
containment experts to discuss any issues related to medical care that may affect indemnity or medical
reserves.
Index Bureau and DMV Reporting
Hammerman & Gainer is a member of the ISO, and are on-line with their system for the reporting of
new WC injury claims as well as for determining prior claims history of the client employees. We also
have on-line access to the Department of Motor Vehicles (DMV) for determination of vehicle
ownership.
Diary System
The Hammerman & Gainer Claims Information Management System (CIMS) and our Allegro RMIS
have an automated diary system that is used by the supervisor and handling adjuster. Each time a new
claim is established, the system prompts the user to add a review date for the supervisor.Diary dates,
which are date, Qr past due appear on the users screen each time they log in. The system allows for
each diary �osting through a function, which automatically posts a diary at, set intervals (7, 60, 90
days, etc.) or dates can be entered manually. A Claims Analysis Reporting Screen will allow the
supervisor to print or display a list of all claims that are due or overdue for diary check and review,
In workers' compensation claims, we also use a "Drop Draft Diary System". When a file is set up, the
supervisor manually inserts important review dates on this sheet for the initial 60-80 days of the life of
the claim. Our supervisors may review these claims as many as seven or eight times in that initial time
period to ensure all investigation is complete, benefits have been paid timely and accurately or that
disputes have been filed timely.
Our claims supervisors are experienced and well informed regarding the importance of appropriate and
proper diary reviews. With strict time frames and the extensive reporting requirements of the TWCC,
a properly run diary is essential for compliance with the law, timely delivery of benefits, and proper
claims handling.
Subrogation/Third Party Involvement/Litigation Management
In order to fully administer our Claims Management program, we understand that pursuit of
subrogation is a very important component. From the initial receipt of all claims, the handling adjuster
and supervisor review for potential third party responsibility and will investigate and monitor the claim
accordingly. Prompt identification of potential third parties is critical. During the course of
investigation, which may involve securing of employee, witness and third parties statements, contact
with investigating police officers, fire marshals, etc., subrogation potential will be identified.
Authorization to pursue subrogation is normally sought from our client, and as soon as authorization is
received, proper certified subrogation notice letters are mailed to the potential third party, telephone
contact and confirmation made, information regarding possible third party insurance will be secured
and additional notices will be transmitted to the appropriate third party insurance carrier.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
In serious cases, claimants may seek legal representation on his or her workers' compensation claim
and/or third party loss. As carrier or self -insured entities may be entitled to first dollar reimbursement,
documentation of the extent of the WC claim (indemnity and medical costs) will be documented and
submitted to appropriate parties. In many cases, it may not be necessary for counsel to be retained to
protect our client's interests; however, on claims that warrant involvement of counsel, Hammerman &
Gainer will make a recommendation of appropriate retention of counsel and will refer to the defense
attorney authorized by the client. Our firm is actively involved in the investigation, documentation,
pursuit and recovery of subrogation funds on behalf of our clients.
Our supervisors are knowledgeable in the management of losses through the court system as well. Part
of their function is coordination, direction, supervision and monitoring of defense counsel on behalf of
our clients if requested. Not only do we offer monitoring of activity, planning and budgeting, selection
and authorization of personnel and numbers of legal counsel authorized to handle a litigated claim, we
also offer monitoring of defense costs.
TWCC Representation and Dispute Resolution
Hammermar& & Gainer has represented clients before the TWCC (formerly the Texas Industrial
Accident Board) since 1929. We have highly trained hearing representatives in every branch office
and five adjusters who are also licensed as attorneys by the State Bar of Texas who handle dispute
resolution statewide. We represent numerous insurance carriers, self -insureds and political entities
before the TWCC in Austin and can handle every facet of the worker's compensation process before
the TWCC, from providing mail handling between the client and the TWCC, to handling the spinal
surgery process, securing certified records, to assisting clients in the compliance audit process,
handling old and new law hearings including pre -hearing conferences, benefit review conferences,
formal hearings, contested case hearings, personal appearances before the TWCC, appeals panel
matters and medical disputes before the State Office of Administrative Hearings. Brief resumes of our
TWCC Service Office dispute resolution representatives are enclosed in Section 3 of this proposal
response.
Having employees who specialize in handling dispute resolution before the TWCC and who are
working in a cooperative effort with our claim administration program is a distinct advantage for our
claims administration professionals and our clients. Our adjusters and claim supervisors have instant
free access to their knowledge and expertise, not to mention all appeals panel decisions, case law
developments, etc. This is an enhancement to our claims administration program of which we are very
proud and which we believe that no other claims administration company can offer without employing
expensive outside representation.
Electronic Data Interchange
Hammerman & Gainer is authorized by the TWCC to provide electronic data interchange of required
file documents on behalf of our clients and we perform this function on behalf of numerous entities in
Texas.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Financial Administration
Hammerman & Gainer will work with the City of Lubbock to establish banking arrangements suitable
to the City of Lubbock. It is our preference that the City of Lubbock, with the assistance of our firm,
establishes a payment account for their workers' compensation program. We currently have an
extremely successful and service oriented arrangement with Hibernia Bank in Texas. With sufficient
balance in the account, usually a minimum balance in the area of two or three months estimated losses,
there have been no charges assessed to our clients whatsoever, with the exception of the cost of check
stock. The Account Manager will meet with the City of Lubbock staff to decide the banking
arrangements for the account. These will be incorporated into the contract between Hammerman &
Gainer and the City of Lubbock. The City of Lubbock will be responsible for the cost of all banking
charges and check stock, etc. If the City of Lubbock already has established banking arrangements, we
will be happy to work with the banking institution of your choice.
Quality Control
Our Homeffice and Risk Services Office in Austin provide claims support, quality control and
direction, c tinuing education of our employees, and all files reflect evidence of supervisory review
and control in every facet of our claims administration process. We are flexible in our procedures in
order to fit the varied needs of our clients, but we will not compromise on our commitment to quality
of work product, adherence to the TWCC statute and rules, our promise to provide prompt efficient
investigation, supervision, benefit delivery, claims management, loss control, TWCC representation
and dispute resolution, as well as subrogation and litigation management services. RTI and
Hammerman & Gainer have access to and can make recommendations for independent auditing
personnel who will be interested in discussing an audit of claim files in your behalf.
24-Hour Capability
We have 24-hour claims service availability 365 days per year. Any claim that occurs after normal
business hours can be reported to our Answering Service who immediately contacts the on -duty
adjuster. All calls are answered within minutes, and scene investigations and handling is undertaken
immediately if appropriate.
Hammerman & Gainer, Inc. Lubbock Office Staff Proposed for the City of Lubbock
Oversight of the transition process from the current TPA will be by Robyn Tydelski, Sr. Marketing
Representative and Account Manager, Nancy Stoll, our Lubbock area Branch Manager, and Patrick
Wysocki, Chief Technology Officer of Risk Management Information Systems.
The following personnel are currently employed in our Lubbock office facility. It is apparent however,
that we may hire additional claims and claim assistant staff in order to properly manage, supervise and
adjust the City's workers' compensation claims. Any adjusting staff dedicated to the City's claims
administration account will be experienced and well -versed in the investigation and handling of claims
under the Texas Workers' Compensation Act and rules, including recent law changes. Our current
claims adjusting and TPA professionals are supported by highly trained professional clerical and claim
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
assistant staff.
Nancy Stoll, Hammerman & Gainer's Lubbock Branch and West Texas Regional Manager, will
provide oversight and supervision of all day to day claims handling activity for the City account. Ms.
Stoll has over 30 years of experience in automobile, general liability and workers' compensation
claims handling, supervision, file auditing, and TWCC hearing representation. Ms. Stoll is a multi -line
licensed adjuster and has worked for H&G in the West Texas area since 1986.
Robyn C. Tydelski is a multi -line licensed adjuster with over 20 years experience in the handling of
workers' compensation, general liability, product liability, automobile liability and medical
malpractice claims investigation and handling. Ms. Tydelski has experience in claims supervision,
team leadership and file auditing. She has also served as senior claims examiner and dedicated
national account representative for Texas, Oklahoma, Colorado, New Mexico, Kansas and Arkansas.
Currently, Ms. Tydelski is active in account management, sales and marketing for Hammerman &
Gainer for a multi -state region.
Patrick Wysocki is responsible for all computer hardware and software components and operations of
thirteen office branches with an excess of 100 workstations, four file servers, networks, WANs, ISDN
lines, dedicated lines, ISP's, fax machines, print servers, cabling and internet. Duties include
purchasing, assembling, programming, developing, maintaining equipment, overseeing all network
development/operations, setting up of all software and employee training.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
5. RISK MANAGEMENT INFORMATION SYSTEMS AND REPORTS
The Allegro Integrated Risk Management Information System
Hammerman & Gainer, Inc. is pleased to offer to our clients an extremely progressive and effective
windows -based risk management information system, Allegro. The Allegro approach is the alternate
claims handling system that Hammerman & Gainer staff will offer to use to input information on
injured workers and to keep this information current. It will be the central repository for all
information on the claims. The system operates in real time mode and automatically feeds the
accounting system and other financial records. Users are empowered to record or access information
quickly and perform key activities efficiently.
The Allegro system is used for:
• Farst„Notice Information (TWCC-1)
• Patient Information
• Provider and PPO information
• Client Information
• Accident Information
• Claims Data
• Reserves — Categories, Sub -Categories, Pay Codes
• Patient Medical Status
• Return -to -Work Status
• Adjuster and Nurse Notes
• Controverts
• Litigation
• Communicate Decisions
• Generate Payments and Issue Checks
• Bill Clients
• Create Meaningful Reports.
Allegro offers numerous features that are unique to the industry and match up well with the industry's
trendsetters. These include:
• Desktop Views and Navigational Flexibility
• Transaction Tracking
• Global Intake and Access Characteristic Screens
• Microsoft Office Integration
• Open Data Set Access for Ease and Autonomy in Generating Customized Reports
• Ease of Integration with Other Systems
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Desktop Views and Navigational Flexibility
Allegro was created in such a fashion as to allow the user to create views that are organized as grids on
the system desktop. From the desktop, the user can summon any screens pertaining to the chosen data
on the grid. For example, the user can create a view of all "diary items with a due date of today", all
"open claims with reserves in excess of a certain dollar amount", all "cases with a particular projected
return to work date" and yet another of all "litigated claims by client and attorney". Supervisors may
want to select a view of "all claims with no activity in the last thirty days." From these views, the user
can select a row from the grid, right click, and invoke a screen to review or change any data related to
that claim. This includes such things as medical authorizations, claim notes and activities, reserves,
payments, and return to work status, to name a few. This exceptional feature of Allegro empowers
users to organize their workflow on the screen. With less innovative systems, users in similar
situations must call up the data entry screen, refer to documents on their desk, search for a case, and
make changes. With the "case desktop" feature, users can sequentially go through their view related to
any of a variety of entities (i.e. claims, payments, checks, reports) invoke screens, review data, and
move to the next case or other entity on their grid.
TransactioA Tracking
Allegro provides organizations with the power to track data changes, and the "reason" the data was
changed. Each time data changes, the system not only records each change, it also tracks information
on the who, why and when of any changed data element. For example, each time a reserve or
projected return to work date is modified, the system tracks the name of the user making the change,
the old value, the new value and the reason for modification. This information facilities accountability
and also provides an audit trail that can be used as backup in any potential claim -related legal
proceeding and adds an entirely new dimension to creating reports.
Global Intake and Access Characteristic Screens
Often the requirements for data intake differ from data retrieval. This need has largely been unmet by
any system in the insurance industry. Allegro is the first system in the industry to acknowledge and
address this need by allowing users to enter data in one format, while retrieving and viewing it another.
For example, standardized forms such as First Notice of Injury, medical bills and other state and
government forms are a common means for transmitting information from one entity to another in the
insurance industry. Utilizing the flexibility of Allegro, data entry clerks or anyone else entering initial
case or claim data can enter the date in the same order as these forms, or perhaps, follow an interview
process to which they are accustomed. Claims representatives, case managers, City of Lubbock staff
or other users can then retrieve the same data in a different format. By taking advantage of this
innovative feature, information becomes readily available to all stakeholders in a format that is
meaningful to each stake -holder's responsibilities and job functions.
Microsoft Office Integration
Additionally, Allegro harnesses the power of Microsoft Office integrating Microsoft Word, Outlook
and Excel. Users can easily create, update and manage templates for letters, spreadsheets and other
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
documents. Whether its e-mailing authorizations to providers, accessing reserve worksheets in Excel,
or requesting more information via a letter automatically generated in Word, Allegro provides
unprecedented power and flexibility.
Open Data Set Access for Ease and Autonomy in Generating Customized Reports
Any data captured by the system can be used for creating reports. The system works well with any of
the commercially available report writers. Clients can then develop reports most applicable to their
individual needs. In addition, we are pleased to advise that a large variety of standard reports are
available with the Allegro system.
We would like to emphasize our strong willingness to create/alter reports to replicate your existing
reporting formats. Having programmers on staff ultimately provides unprecedented flexibility to meet
the desires of our clients. Please view the many sample reports available through the Allegro system in
Section 9 - Attachments.
Ease of Ingration with Other Systems
Allegro makes exchanging or fully integrating with a care management system and medical bill review
system faster and simpler. This helps tackle one of the biggest integration problems in the industry:
"making sure claim management activities are communicated to the care management and medical bill
review processes and vice versa so they are accounted for during reviews".
Management of Information Systems
Internet E-mail. Hammerman & Gainer offers electronic communications via Internet E-mail.
We currently use Microsoft Outlook Express E-mail system. This allows easy and direct
communications between our clients and Hammerman & Gainer employees; management,
accounting, MIS staff and our adjusters. Reports can be digitally sent via the E-mail system on
a moment's notice. Status reports are only a few keystrokes away.
Disaster Recovery Plan. In the event that disaster strikes, Hammerman & Gainer is able to
work off -site to continue giving the best service to our clients.
EDI (Electronic Data Interchange). We have been in production with the electronic
transmissions of EDI data to the Texas Workers' Compensation Commission for more than two
years and will continue to provide this service to our workers' compensation clients as its use
expands.
Backup System. State of the art software and hardware protect the integrity of our data.
Daily, weekly, monthly, and yearly backups are made automatically. Weekly, monthly, and
yearly backups are stored in an off -site location.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Security. Only certain qualified personnel are granted access to our client's databases, with
log -on IDs and passwords. Our computer room has limited accessibility and is closely
monitored. Secured transmissions of data assure confidentiality.
System Compatibility. We have experience in being able to extract and export data from and
to several types of computer systems, languages, and databases. Data transformation from one
system to another is a common task.
Maintaining the Allegro System
The software system is updated every quarter, with downloads that are invisible to users. Allegro has
various "back-up" hard drives, so if one fails, another will immediately activate. Hammerman &
Gainer's RMIS Director, Patrick Wysocki, is highly experienced in hardware and software issues and
is responsible for maintaining our system in proper working order. Mr. Wysocki is located in our
Austin Service office.
Client Acc � s to our System 11
Designated client personnel may have access via the Internet/Winframe to view and print reports as
outlined earlier in this response. The views and reports cover a wide array of information that can be
easily and selectively retrieved. The Claim Status Report provides detailed financial data as well as
adjuster progress notes. These reports can be viewed and printed directly from the user's PC. No
software or hardware requirements exist, other than access to the Internet.
Ad hoc Reporting Capabilities
Allegro provides Internet access to ad hoc reports. Report templates are available with a variety of
filter and sort options. The following reports are available over the Internet. Samples of Allegro
reports are enclosed as an attachment to this proposal response.
• New Claim - Provides loss run activity for all claims created within a specified time frame;
grouped and sorted by location
• Closed Claim -Provides loss run activity for all claims closed within a specified time frame,
grouped and sorted by location
• Open Claim - Provides loss run activity for all open claims, grouped and sorted by location
• Claim Cost Detail - Provides detailed financial information for each claim grouped and sorted
by location
• Claim Composite - Provides reserve and payment summaries for each type of claim (i.e.
Indemnity, Medical Only) per location, per accident year, for open, closed and all claims.
• Claim Summary by Year - Provides financial summaries by year and type of loss
• Loss Analysis - Provides frequency and costs of claims for each loss type broken down by,
"Cause of Injury", "Nature of Injury" and 'Body Part"
• Payment Composite - Provides total payments broken down by payment categories
• Claim Status - Complete claim detail that includes, incurred, payments, reserves, payment
register, progress notes and claim summary
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
• Claims Overview Report - Quality Assurance report that addresses closing ratios, inventory
control, average cost per claim, and average days open, grouped and sorted by location
• Cost Management Report - Provides detailed fee schedule and PPO savings, grouped and
sorted by provider
• Provider Cost Management Summary- Provides summary of fee schedule and PPO savings,
grouped and sorted by provider
• Cost Management Overview - Provides medical bill processing activity and cost saving ratios
grouped and sorted by location
• Check Register - Provides detail of checks issued within specified date range
Programming time to produce additional custom reports is solely dependent on the programming time
involved. The cost associated with additional customized report programming is $95.00 per hour.
System Security
Only certain qualified and authorized personnel are granted access to our client's databases, with log -
on IDs and prswords. Our computer room has limited accessibility and is closely monitored. Secured
transmission of data assures confidentiality.
Archiving of Closed Claim Files
The Allegro system can easily store the claims information and data in their information system.
Program, and data, information, adjuster/nurse file notes can be retrieved on closed files as well as
open claim files very easily.
Extraction of Data to be Loaded into Allegro
We can take an exported file and extract information for our system. We will not require the data to be
in a particular format, but we will require a record layout scheme for the City of Lubbock's claim data,
a sample download of the City of Lubbock's claim data, and an "as -of -dated" loss runs so we can
match the converted data to the legacy data.
Allegro is a transaction database. Almost all activities in Allegro are date and time "stamped". All
Allegro reports have an "as of date" feature, and almost all reportable data in Allegro is "as of date"
sensitive. We have provided sample copies of Allegro reports that can be easily generated over the
Internet using Allegro 's Internet Extender Advanced Hosting Package
Additional Comments on Allegro
The Allegro system is extremely flexible and can provide any type of report required, as long as the
data element is captured within the individual claim file. Location structure hierarchy has virtually
unlimited levels, providing global to drill -down reporting to meet any RMIS need. Member Reporting,
Department Reporting, Line of Business, Cause of Loss by line, and Deductibles are all common data
elements that can be reported individually or in a consolidated format. Ad hoc design is simple and
flexible, and most can be done directly off of the claim desktop, within seconds.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Aggregate excess experience and excess billing reimbursement tracking would require a bit more
detailed configuration, using either Crystal Reporting or Excel. However, in either format, reports can
be designed and made available for on -going client use. Electronic data transmission is facilitated by
our open data set, which will integrate with most platforms. Allegro has yet to meet any obstacles in
its abilities to electronically interface with other entities. It can provide EDI of first reports as well as
financial transactions. Its open flexibility facilitates data conversion processes with minimal errors.
Conclusion
Hammerman & Gainer offers the City of Lubbock a proactive claims administration and cost
management system providing all services needed for a successful program. Hammerman & Gainer
will employ the right level of expertise to the claim to assure positive outcomes. We can integrate our
system(s) in a way that allows us to provide truly comprehensive and coordinated claims management
services. This communication also extends to our clients, allowing them immediate access to all
information regarding the status and handling of a claim. The integration is another way in which we
bring our cliepts; into a partnership in the management of their claims. We are confident you will be
pleased wit Ithe Allegro system.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
6. REQUIRED FORMS AND QUESTIONNAIRE
The following pages included those forms required by the City of Lubbock including the required
questionnaire.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
RFP #113-03/DC, Liability Claims Services —Annual Pricing
SUBMIT TO:
CITY OF LUBBOCK
CITY OF LUBBOCK,TEXAS
PURCHASING DEPARTMENT
ift
1625 13TH STREET, RM L04
LUBBOCK, TX 79401-3830
AN EQUAL
OPPORTUNITY
REQUEST FOR PROPOSAL
#113-03/DC
CONTACT PERSON:
Diana Caudillo
EMPLOYER
TEL: 806.775.2167
FAX: 806.775.2164
http://purchasing.cf.tubbock.tx.us
TITLE:
SUBMITTAL DEADLINE:
Liability Claims Services - Annual Pricing
August 5, 2003, 2:00 pm CST
PRE PROPOSAL DATE, TIME AND LOCATION:
Any proposals received after the time and date listed
July 17, 03 @ 10:OOAM, Lubbock,
TX
above, regardless of the mode of delivery, shall be
returned unopened.
RESPONDENT NAME:
IF RETURNING AS A "NO RESPONSE", PLEASE STATE REASON.
MAILING ADDRESS:
800 W. Airport Frwy, Ste 620
CITY - STATE - ZIP:
THE CITY OF LUBBOCK RESERVES THE RIGHT TO ACCEPT OR REJECT ANY
Irving, Texas 75062
AND ALL PROPOSALS IN WHOLE OR IN PART AND WAIVE ANY INFORMALITY IN
THE COMPETITIVE PROPOSAL PROCESS. FURTHER, THE CITY RESERVES THE
TELEPHONE NO:
RIGHT TO ENTER INTO ANY CONTRACT DEEMED TO BE IN THE BEST
(9 7 2) 5 5 4— 9 4 0 0
INTEREST OF THE CITY.
IT IS THE INTENT AND PURPOSE OF THE CITY OF LUBBOCK THAT THIS
FAX NO:
9 7 2) 5 5 4 81 0 0
REQUEST PERMITS COMPETITIVE PROPOSALS. IT IS THE OFFEROR'S
-
RESPONSIBILITY TO ADVISE THE CITY OF LUBBOCK PURCHASING MANAGER IF
ANY LANGUAGE, REQUIREMENTS, ETC., OR ANY COMBINATIONS THEREOF,
E-MAIL:
ROB`�NT HNG COM
INADVERTENTLY RESTRICTS OR LIMITS THE REQUIREMENTS STATED IN THIS
RFP TO A SINGLE SOURCE. SUCH NOTIFICATION MUST BE SUBMITTED IN
WRITING AND MUST BE RECEIVED BY THE PURCHASING MANAGER NO LATER
FEDERAL TAX ID NO. OR SOCIAL SECURITY NO.
174-1780638
THAN FIVE (5) BUSINESS DAYS PRIOR TO THE ABOVE SUBMITTAL DEADLINE.
THE OFFEROR HEREBY ACKNOWLEDGES RECEIPT OF AND AGREES ITS PROPOSAL IS BASED ON THE FOLLOWING ADDENDA:
#1P-L #2 #3 #4 #5 (Please Initial)
The City of Lubbock Charter states that no officer or employee of the City can benefit from any contract, job, work or service for the municipality or
be interested in the sale to the City of any supplies, equipment, material or articles purchased. Will any officer or employee of the City, or member
of their immediate family, benefit from the award of this proposal to the above firmT YES NO
IN COMPLIANCE WITH THIS SOLICITATION, THE UNDERSIGNED OFFEROR HAVING EXAMINED THE REQUEST FOR PROPOSAL, AND BEING
FAMILIAR WITH THE CONDITIONS TO BE MET, HEREBY SUBMITS THE FOLLOWING. AN INDIVIDUAL AUTHORIZED TO BIND THE COMPANY
MUST SIGN THE FOLLOWING SECTION. FAILURE TO EXECUTE THIS PORTION MAY RESULT IN PROPOSAL REJECTION.
By my signature I certify that this offer is made without prior understanding, agreement, or connection with any corporation, firm,
business entity, or person submitting an offer for the same materials, supplies, equipment, or service(s), and is in all respects fair and
without collusion or fraud. I further agree that if the offer is accepted, the offeror will convey, sell, assign, or transfer to the City of
Lubbock all right, title, and interest in and to all causes of action it may now or hereafter acquire under the Anti-trust laws of the United
States and the State of Texas for price fixing relating to the particular commodity(s) or service (s) purchased or acquired by the City of
Lubbock. At the City's discretion, such assignment shall be made and become effective at the time the City tenders final payment to the
vendor.
�la-----y SR. Marketing Rep.
Authdrized Signbture , Title
Robyn C. Tydelski 8/5/03
Print/Type Name Date
THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR RESPONSE.
113.03/DCRFPSVC.doc 1
Please return this questionnaire to Victor Kilman, Purchasing Manager, 1625 13th Street, Room
L04, Lubbock, Texas 79401 or Fax to (806) 775-2164. THANK YOU!
Visit our website at http://Purchasinst.ci.lubbock.tx.us for bid opportunities and bid tabulations.
l \purchase\forms\OneMinuteVendorSurvey.dac
t
RFP #113-03/DC, liability Claims Services — Annual Pricing
VENDOR REFERENCES
Please list three (3) references of current customers who can verify the quality of service your company
provides. The City prefers customers of similar size and scope of work to this RFP. THIS FORM MUST
BE RETURNED WITH YOUR PROPOSAL
REFERENCE ONE
Government/Company Name: Dallas Independent School District
Address: 3700 Ross Avenue, Box 91, Dallas, TX 75224
Contact Person and Title: Cheryl Johnson, Director
Phone: (21 4) 932-5279 Fax: (21 4) 932-5288
Contract Period: 5 years Scope of Work:Workers' Compensation
Claim Administration
REFERENCE TWO
Government/Company Name: City of Dallas
Address: 1500 Marilla, Dallas, Texas 75201
Contact Person and Title: Jeffrey Adams, Claim Manager
Phone: (2 1 414) 6 7 0- 4 2 2 4 Fax:
Contract Period: 5 years Scope of Work: Auto, GL Claims
Administration
REFERENCE THREE
Government/Company Name: Texas Property Casualty Insurance Guarantee Assoc.
Address: 9120 Burnet Rd. Austin, Texas 78758
Contact Person and Title: Marvin Kelly, Executive Director
Phone: (800) 856-0298 Fax:
Contract Period: 4 years Scope of Work: Workers' Compensation
Claims Administration
113-03/DCRFPSVC.doc 35
RFP M 13-030C, Liability Claims Services —Annual Pricing
Answer the following questions, and submit with your proposal
YES
".NO
%,
COMMENTS
1 i= CLAIM=HANDLING COMPANY
QUALIFICATIONS.
-
A. Does your company carry Professional Liability Insurance in
the aggregate amount of $2,000,000 that would apply to this
Hammerman & Gainer, Inc. has a $ 5, 000, 000
activity?
Professional Liability aggregate. We
.X
have included a copy of our Certificate
If so, please provide a current certificate of insurance.
of Insurance in the Attachments section of
our proposal, as requested.
C. Are you a member of the Claim Index Bureau Reporting
System?
X
D. Does your company have a Formal Quality Control program
X
We respectfully refer you to the
in place? Explain.
Attachments s. 3ction of our proposal.
E. Does your company have an Automated Claim Reporting
Our clients may have access to this
System? If so, can the client have access? Is there a
X
system. There is no additional charge for
charge for client access? If so, how much?
for client access.
F. Does your company have a 24-hour emergency number with
an adjuster that can respond in 30 minutes or less?
X
G. Can Loss Runs be provided monthly on a CD in a format
compatible to Microsoft Excel? Is there an additional cost for
There is no additional charge for this
X
service.
this?
113-03,'DCRFPSVC.doc 24
RFP #113-031DC, Liability Claims Services —Annual Pricing
Answetthe following questions, and submit with your proposal
YES,
NO
%
COMMENTS
2. STAFFING AND TRAINING
A. Does your company have an in-house or ongoing training
Hammerman & Gainer has conducted
program for claims personnel? Explain.
x
trainin S min for customers and
B. What is your average case load per adjuster per line of
Our automobile liability and general
business? Please indicate the mix of claims that our
Y
liabilityadjustersaverage a case load
adjusters handle. For example, does your Liability adjuster
of 1 50-175 files. Claims involving
serious injury, complex liability or
handle a mix of cases that would include both minor and
coverage issues are assigned to our
serious claims?
Senior adjusters.
• General and Other Liability
• Automobile Liability
C. Does your company have caseload guidelines? If so, what
Our adjusters are required to handle
are they by line of business?
150-175 files as indicated above.
• General and Other Liability
Caseloads are monitored by our
supervisors to insure adherence to
• Automobile Liability
client requirements.
Are they adhered to?
D. What is your average turnover rate for supervisors?
we have not had any turnover in our
E. What is your average turnover rate for adjusters?
Lubbock office in 17 years.
113.031DCRFPSVC.doc 25
RFP g113-03/DC. Liability Claims Servkes—Annual Pdcbg
Answer the following questions, and submit with your proposal
7<
-
-
F. What is your average turnover rate company wide?
1 3 %
G. Can we designate key adjusters to handle our losses?
R
H. Can we designate key supervisors to handle our losses?
X
113-03/DCRFPSVC.doc 26
RFP #113-03/13C, LIalAlityClaims Services —Annual Pricing
Answer the following questions, and submit with your proposal
to
3 CONTACT PERSQNNEC.777777
COMMENTS
A. Shall your company provide a key person to:
Claim problem resolution and the
coordination of activities will be handle
• assist in claim problem resolution?
X
by the designated claim supervisor and
your Account Manager Robyn Tydelski .
There is no additional charge for this
• coordinate activities?
service.
Is there an addition fee? If so, how much?
C. Shall the contact person have the:
• Authority to implement changes requested by the City of
Lubbock Risk Management?
X
• Authority to meet with City of Lubbock Risk Management
quarterly to discuss outstanding problems and issues?
X
• Is there a charge for these activities? If so, how much?
g
113-03/DCRFPSVC.doc 27
RFP #113.031DC, Liability Claims Services —Annual Pricing
Answer the following questions, and submit with your proposal
4-0
GMMENT,S t "
_
A. Are you willing to quote a fee for?
Option I
X
Option II
X
Option III
X
Option IV
X
We respectfully refer you to our
B. Specifically, what are considered allocated expense? Please
definition of allocated expense contained
in the Pricing section of our proposal.
list.
113-03IDCRFPSVC.doc 28
RFP Hi 13-MC, Liability Claims Services — Annual Pricing
Answer the following questions, and submit with your proposal
CQMMENFS
-
5' Ct,AIMI tyjANAGE�VtENT _• � _<
::
i
A. Does your company have written claim handling standards
for:
• General and Other Liability
X
• Automobile Liability
X
If so, please forward a copy.
• Are recorded statements taken?
X
Our system allows unlimited diary on our
• What is the maximum diary allowed?
claim files.
• Are action plans developed and followed on files?
X
Yi3-03/DCRFPSVC.dm 29
RFP #t 13.03/DC, Liability Claims Services —Annual Pricing
Answer the following questions, and submit with your proposal
YES' .
NO
"/•
COMMENTS '
CLAIM HANDLING :.
A. Are claims handled by telephone or field adjuster?
Both. Claims are handled at the
direction of the client either by
telephone or in the field.
B. Is there additional costs for field adjusters?
Field investigations are conducted with
client approval at $63.00 per hour.
C. Shall all claimants and the City of Lubbock Risk
Management contacts be made within 24-hours from the
date notice received?
X
D. Does your company have written claim handling standards
X
that include:
• When recorded statements taken?
X
• What is the maximum allowable diary?
Our system allows for unlimited amount of
diary. Automatic diaries are set at 7,
• Action plans being developed and followed on files?
X
60 and 90 days.
113-03/DCRFPSVC.doc 30
RFP #113-03/DC, Liability Claims Services —Annual Pddng
Answer the following questions, and submit with your proposal
YES"
.NO
<cy-
% -
COMMENTS
7: > .:RESERVING . _.:.
Hammerman & Gainer, Inc. beli6vas.in
A. What is your reserving philosophy?
reserving a claim for its ultimate
cost/exposure.
The adjuster is responsible for setting
B. Who is responsible for establishing reserves?
reserves, up to the amount of their
individual authority, and with the
concurrence of the client.
Initial reserves are set within 24 to
C. How soon are initial reserves set?
48 hours of receipt of a claim.
Reserve analysis are contained in every
D. Is a reserve analysis contained in every file?
file. They are captured in the file
notescreens in narrative format. AL/GL
reserve worksheets can be composed upon
request.
Please provide a sample.
Reserves are reviewed every 60 -90 days
E. How often are reserves reviewed?
each time the claim is handled, and
with each new development.
113.03/DCRFPSVC.doc 31
RFP #113-03113C, Liability Claims Services —Annual Pricing
Answer the following questions, and submit with your proposal
YES`
` NO
%
COMMENTS
8., _..REPORTING
A. Are captioned reports completed on files? If so,
X
Captioned reports are completed on files
• at what level?
as required by the client. The level and
frequency are determined based on
' how often?
individual client needs. There is no
• provide sample
charge for this service.
B. Are captioned reports sent to client? if so, how often? Is
there a fee? If so, how much?
X
Please refer to 8A.
C. Are clients notified timely and in writing of hearings and
trails?
g
D. Shall the City of Lubbock Risk Manager be kept apprised of
all claims as they deem necessary?
X
E. Are files actively supervised? If so:
Up front direction is provided by the
• how often?
X
Supervisor_ at the time of initial
assignment and at 60-90 day intervals
• what reserve level?
throughout the life of the claim file.
F. Are files supervised by both branch and regional personnel?
X
113-030CRFPSVC.doe 32
RFP #113-03I13C. LWAty Maw Services —Annual Prldng
Answer the following questions, and submit with your proposal
4
A. Does your company allow claim file reviews? If so, is there
an additional cost? What is the cost?
X
There is no additional charge for this
service.
B. Does your company allow physical audits of claim files?
x
113-03/DCRFPsvc.doc 33
RFPrN13-MDC,L WkClaimsSWVkes—AnnualPddw
Answer the following questions, and submit with your proposal
-01b-
YEG¢II�INO
1`6'- 'xST UCTUi2EQ SETTM NIEN S ; •
r
Structured settlements are recommended
A. Does your company utilize structured settlements?
X
to the client and approved by the client
on those cases involving high dollar
exposure.
Guidelines are established based on the
B. Have you established guidelines when considering this
individual needs of the client.
approach to settlement? If so, please provide a copy of
these guidelines.
Hammerman & Gainer utilizes services
C. Are there separate costs associated with this service? If so,
provided by independent structured
settlement companies. Fees for this
please provide your pricing structure
service are usually contained within the
cost of the annuity.
113-MCRFPsvc.doc 34
7. PRICING OPTIONS
Hammerman & Gainer, Inc. offers to provide claims administration to The City of Lubbock on the
following fee basis.
Option I — Flat Fixed Fee for Life of the Claim
Automobile Liability - $ 500 per suffix lifetime flat rate
General Liability - $ 500 per suffix lifetime flat rate
Other Liability - $2100 per suffix lifetime flat rate
Option U — Fee for Two Year Claim Service
Automobile,iability - $ 250 per suffix for two years
General Liability - $ 250 per suffix for two years
Other Liability - $1050 per suffix for two years
Option III — Flat Fixed Fee for Contract Period
See Option IV
Option IV — Other Pricing Structure
Automobile Liability —
$295 for one AL PD
$495 for two suffixes
$295 for suffixes three — ten
Time & Expense @ $63.00 per hour for 10+ suffixes
General Liability
$495 for two suffixes
$295 for suffixes three — ten
Time & Expense @ $63.00 per hour for 10+ suffixes
Other Liability
$2100 per suffix
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Claims Administration Fee - $1500 per year
Date Conversion Fee - $5000 One Time Fee
Allegro - $350 per seat per year
Indexing - $7.00 per item
Automobile Appraisal Fee Schedule
Auto Appraisals:
Up to 1 'h ton light duty truck
$ 88.00
Total Loss w/CCC form
$ 95.00
Total Loss w/Evaluation
$105.00
Drive-in 0,
$ 65.00
Motorcycles, Boats, RVs, Heavy Equipment
T&E
Secure Salvage Bids (3)
$ 20.00
• Above schedule shall include two photographs local phone calls, 25 road miles, office/clerical
expense local phone/fax and routine supplements
• Additional expenses include drive time and mileage outside of 25 miles additional photos when
necessary, long; distance phone/fax charges express mail charges and out of pocket expense (such
as tolls parking and official report charges which are billed at actual cost).
• Salvage disposal and litigation testimony is billed at T&E.
Additional Expenses:
T&E Property and Casualty
$63.00 per hour outside work
Photos
$3.00 each
Cassettes
$2.00 each
Mileage
$0.50
Special Activity - $63.00 per hour for vehicles over one ton and specialty vehicles
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Allocated Loss Adjustment Expenses
We feel it appropriate to provide our definition of Allocated Claims Expenses, so that there will be no
confusion in this regard.
For the purposes of this proposal response, allocated expenses are those costs that are generally not
included in our pricing for claims administration and is paid directly through the loss fund or billed
back to the City. These shall include all items such as attorney fees, commercial photographer. fees,
expert fees (i.e. engineers, physicians, chemists), fees for independent medical examinations,
rehabilitation fees, witness fees and travel expenses. They also include court reporter fees, transcript
fees, cost of obtaining public records, reports from attending or examining physicians, stenographic
services and transcripts, court costs, appeal bonds, printing costs related to trials and appeals,
testimony, opinions, surveys, and analyses of professionals and experts, trial and hearing attendance
fees, reports from government agencies or branches, credit bureaus, private investigators, and medical
or vocational rehabilitation. Additional TWCC related costs include record checks, orders of prior
employee accident -related files, banking costs for providing claimants with direct deposit or electronic
funds transfeare also considered an allocated expenses. This list is not intended to be exhaustive of
all other potential fees that should be allocated against the claim file. Allocated expenses are charged
against the claim file and are generally not a part of the direct costs or part of the claims administration
fees as outlined in this proposal response.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
8. ATTACHMENTS
A. Hammerman & Gainer, Inc.
History
Management Team
Branch Office Locations
Answers to. FAQs
Affiliated Organizations
B. Staff Resumes
C. Hammerman & Gainer, Inc. - Certificate of Insurance
D. Han4hefrnan & Gainer, Inc. — M/WBE Certification
E. Hammerman & Gainer, Inc. - Standards of Performance
F. Hammerman & Gainer, Inc. - Sample Reports and Forms
G. Hammerman & Gainer, Inc. — Reference List
H. Hammerman & Gainer, Inc. — Recommended Transition Plan
I. Hammerman & Gainer, Inc. — Sample RMIS Report from Allegro
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
HAMMERMAN & GAINER, INC.
1 Claims Administrators - Consultants - Investigators - Adjusters
800 West Airport Freeway, Suite 620
Telephone: 972-554-6400
Facsimile: 972-554-8100
Irving, Texas 75062
HAMMERMAN & GAINER, INC.
Hammerman & Gainer was founded January 1, 1929, by Edna Hammerman and John
Gainer, Sr., opening in Austin, Texas to handle claims before the Industrial Accident
Board. Edna Hammerman was a pioneer, one of the early women claim managers, a
talented arld successful businesswoman, equestrian and aviatrix, who not only won the
heart, bute admiration of the industry. John W. Gainer, a West Texas native who
knew the meaning of hard work, became a leader both in Texas and nationally within
the adjusting fraternity. An attorney, John Gainer was an acknowledged authority on
workers' compensation. Edna Hammerman passed away in 1970 after many years of
service to the insurance industry. John W. Gainer, Sr. remained active in the firm until
the time of his death in May 1981.
Incorporation in 1971 guaranteed stability and continuity. On August 1, 1999, Risk
Technology Institute, L.L.C. acquired 100% ownership of Hammerman & Gainer, Inc.
Mr. Larry D. Oney, Chairman of the Board and CEO is located in our LaPlace,
Louisiana office. This acquisition positions Hammerman & Gainer as one of the largest
minority -owned third party claims administrators (P&C) in the United States. The
current management team is an extension of the original organization and is dedicated
to enhancing the tradition of excellence and integrity that were the trademarks of Edna
Hammerman and John Gainer.
Since our early beginning over 74 years ago, the firm has grown to eleven offices in
Texas, Louisiana, and New Mexico. We serve across the States of Texas, Louisiana,
and New Mexico as claim managers, consultants, investigators and adjusters for our
clients. With the diversity of experience held by technical staff, our expertise lies in
many areas: workers' compensation (including statewide representation before the
Texas Workers' Compensation Commission), commercial/private auto, long haul truck,
products and malpractice, commercial/personal property, general liability, fidelity,
surety and crime losses. Such losses are received from over five hundred entities,
including insurance companies in the United States and foreign countries, self -insured
commercial accounts and governmental entities, re -insurers, excess and surplus lines
carriers, agents and general agents.
A Risk Technology Institute Company
Office Locations
Texas - Austin, Dallas/R. Worth (Irving), El Paso, Houston, Lubbock, San Antonio
Louisiana - Lafayette, New Orleans (LaPlace), Shreveport
Hammerman & Gainer, Inc.
Page 2
Our adjusters, attorneys, investigators and clerical assistants are under the supervision
of individuals who are highly recognized within the industry for their leadership and
technical ability.
Our firm maintains twelve well -established branch offices in addition to our home office
in Austin. All offices are staffed with experienced personnel to provide full investigation
and handling_ services in the generalized coverage areas of workers' compensation,
automobile/general liability, and property. Most of our adjusters and supervisors are
"specialists" in that their activity is confined to claims/losses in a given category or line
of coverage. Our adjusters are highly trained in field investigation, as they have been
since our first day in business. Attached is a list of our offices.
Beyond claims administration, Hammerman & Gainer provides a number of other
services to clients. These include:
• Workers' Compensation Training & Qualification
• Research Sources
• Annual Continuing Education Seminars
Hammerman & Gainer is more than adequately insured for Automobile and General
Liability (including Personal Injury), and Professional Liability. Certificates of Coverage
are provided to clients upon request. A list of client references, as well as credit or
other information will be provided if desired.
Call Robyn Tydelski at 1-800-929-9525 for additional information.
HAMMERMAN & GAINER, INC.
1 Claims Administrators - Consultants - Investigators - Adjusters
MANAGEMENT TEAM
LARRY D. ONEY - Chairman of the Board, CEO and President. With H&G since August 1999.
Over 22 years experience in Property, Casualty, Workers' Compensation, Jones Act, USL&H, Litigation
Management and Claims/Risk Management. Nicholls State, B.A. Also President/CEO of Integra
Management Group. Previously held executive claims management positions with three insurance
carriers, RislVlanager for City of New Orleans, and Associate Executor Director and Claims Executive of
Louisiana Insurance Guaranty Association.
JIM FURFARI - Executive Vice President, Chief Operating Officer. With H&G since February 2002.
Over 23 years experience in Property and Casualty Claims holding positions of Adjuster, Supervisor,
Examiner, Claim Manager, National Account Coordinator, Assistant Vice President, Regional Vice
President of Operations, Vice President of Claims, National Account Executive, Senior Vice President
and Managing Director of Corporate Operations. Corporate responsibilities include firm -wide
management of H&G Operations and Marketing Divisions. B.Sc. degree in Education from Bridgewater
State College.
DON YORK - Senior Hearing Representative of Workers' Compensation Services. Mr. York is a
licensed adjuster and attorney. Over 17 years of law practice before the Texas Workers' Compensation
Commission. Baylor University School of Law JD and Baylor University B.A. Business Administration.
Member: Austin Claims Association, Texas Claims Association, Texas Independent Insurance Adjusters
Association, and State Bar of Texas.
NANCY STOLL - Branch Manager, Lubbock, Texas. Over 30 years experience handling
automobile, general liability and workers' compensation claims, supervision, auditing and TWCC
representation. Ms. Stoll is a multi -line licensed adjuster. Attended La Salle University. Member West
Texas Claims Association, Texas Independent Insurance Adjusters Association, and Insurance Women
of Lubbock.
A Risk Technology Institute Company
Office Locations
Texas - Austin, Dallas (Irving), El Paso, Houston, Lubbock, San Antonio
Louisiana - Lafayette, New Orleans, (LaPlace), Shreveport
HAMMERMAN & GAINER, INC.
HOME OFFICE
Sz
TWCC SERVICE CENTER
823 Congress Avenue, Suite 300 (78701)
P. O. Box 1090
Austin, Texas 78767-1090
Phone (512) 494-9198
Fax (512) 494-0991
Contact: Tim McGillicuddy
or Patrick Wysocki, MIS Director
www.hng.com
DALLAS, TX
800 West Airport Freeway, Suite 314
Irving, Texas 75062
Phone (972) 554-9400
Fax (972) 554-8100
Contact: Mary Parra
EL PASO, TX
7500 Viscount Blvd., Suite 156
El Paso, Texas 79925
Phone (915) 779-5784
Fax (915) 778-1451
Contact: Carol Parker
HOUSTON, TX
Centre One
9800 Centre Parkway, Ste. 110
Houston, Texas 77036
Phone (713) 272-8404
Fax (713) 272-8605
Contact: Norma West -Green
LUBBOCK, TX
3307 82nd St., Suite 1-A (79423)
P. O. Box 53814
Lubbock, Texas 79453
Phone (806) 796-0234
Fax (806) 796-0122
Contact: Nancy Stoll
SAN ANTONIO, TX
5825 Callaghan Rd., Suite 206 (78228)
P. O. Box 40249
San Antonio, Texas 78229
Phone (210) 680-3682
Fax (210) 680-6565
Contact: Bruce Williamson
ANSWERS TO QUESTIONS FREQUENTLY ASKED ABOUT HAMMERMAN & GAINER
Q: WHAT MAKES H&G DIFFERENT FROM OTHER CLAIM ORGANIZATIONS
A: A lot of things. Some firms may be our equal in certain areas but few reach our stature in:
a. Specialization:
1. Except for the activity of our El Paso Office in the Republic of Mexico, our firm
devotes the majority of its energy and study to Texas, Louisiana and New Mexico
claim problems. We give priority to the study of Texas, Louisiana and New
Mexico Policy Forms, statutory and case law, regulatory action and rules, and
other unique Texas, Louisiana and New Mexico challenges; however, we also
monitor insurance law and legislative activity across the country, will be
expanding our branch service locations into other states in the coming months.
We also can provide a network of insurance professionals to handle and
supervise regional as well as national accounts for our clients.
2. . Our field adjusters and supervisors are often specialized by "line of coverage and
,type of claim" which allows them to develop a level of expertise in their specialty
to a greater degree than all -lines personnel.
b. Supervision: Every assignment receives the full attention of an experienced
supervisor who directs and guides every function of the handling adjuster, and the
supervisor maintains final responsibility for the work product.
c. Dedication to Quality: A trademark of H&G is quality control. In addition to our
thorough supervision and diary systems which keep the file supervisor continuously in
control of every claim, our firm conducts regular file audits - both scheduled and
unscheduled - by teams from our Home Office.
d. Longevity and Dependability: Over 7 decades of continuous, reliable claims service
- a fact which speaks for itself.
e. Philosophy of Claim Handling: Our firm believes in handling claims with people -
not with numbers. Our adjusters are field -trained, and we are committed to face-to-
face contact and communication on all files that require this activity.
Insured Protection: Our firm is bonded and more than adequately insured for
automobile and general liability exposures (including personal injury), and
professional liability. Certificates of insurance coverage are furnished to clients upon
request.
g. Continuing Education: In addition to providing our clients with continuing education
in the form of specialized schools and seminars, approved for continuing education
credits for adjusters, agents and Texas attorneys, our firm conducts a continuing
program of education on an in-house basis.
Q: WHAT TYPE OF LOSS RUN DATA DOES H&G PROVIDE?
A: We use an internally developed data base loss run program which encompasses Auto,
General Liability and Workers' Compensation, including claims for self -insureds and non -
subscribers. Access to our system is available to clients through the Internet or through
direct modem connection. Clients may run reports, review adjuster activity and conduct
on-line file reviews.
Each report is modeled to suit the needs of our clients. We have found that a particular
client may not require the same data or data structure as another. So, we are as flexible
as possible to ensure the client receives the reports necessary for their particular
operation.
Q: DOES H&G TRIAL WORK?
A: No. Although we have a number of adjusters on staff who are also Texas licensed
attorneys, we do not practice law or handle litigation.
Q: ARE ALL H&G SERVICES ON A TIME AND EXPENSE BASIS?
A: No. We utilize some fixed fee charges and fee schedules designed to fit the needs of
individual accounts. We are also willing to discuss arrangements, such as gain sharing,
which align the interests of H&G and its clients.
Q: DOES H&G PROVIDE SERVICE BEFORE STATE AGENCIES OTHER THAN THE
TEXAS WORKERS' COMPENSATION COMMISSION?
A: Yes. We are able to provide some services before the Texas, Louisian, and New Mexico
Departments of Insurance, Texas Department of Public Safety (including Safety
Responsibility Division), Texas Railroad Commission, Secretary of State et al.
Q: WHEN H&G RECEIVES AN ASSIGNMENT, WHAT IS THE INTERNAL SYSTEM FOR
MONITORING THE CLAIM, AND WHEN SHOULD WE EXPECT REPORTS?
A: A supervisor immediately reviews the file, decides on the course of action, frequently
makes the initial contacts and selects the most appropriate adjuster, who receives the file
with instructions. An initial report with suggested reserves is transmitted within 24 hours.
A full report is sent within 10-14 days. Subsequent diary and report dates are selected
based on the needs of the particular file and the requirements of the client. Status reports
with no value are avoided. Urgent communications are submitted by overnight mail, fax,
Email or phone.
Q: WHAT ARE YOUR CLAIMS MANAGEMENT CAPABILITIES?
A: H&G has an established Claims Management Division in conjunction with its Home Office
and Branch Office operations in Austin. This division handles automobile, general liability,
property losses and workers' compensation claims on an individual basis, as well as
claims for clients who require professional investigations, supervision, and management of
claims on a National or Statewide basis. In addition to insurance carrier clients, our
Claims Management Division manages losses for self -insured entities, political
subdivisions, and non -subscribers to workers' compensation. We have computer
capability to provide detailed loss runs and other important statistical/loss control data for
our clients. This division also provides consultation services for employers who are non -
subscribers with special problems, as well as for employers who have questions
concerning the requirements and procedures for becoming a non -subscriber.
Q: DOES H&G BID FOR CLAIM WORK BY CONTRACT?
A: Yes. We will bid on a contract to manage or to investigate and handle claims/losses. We
will not bid merely to process claims.
Q: ARE ALL YOUR HEARING REPRESENTATIVES LICENSED ATTORNEYS?
A: No. We do have adjusters on staff who are also licensed attorneys who are available to
handle all levels of hearings before the TWCC. However, under both the "new" and the
"old" law, licensed adjusters are permitted to represent insurance carriers and self -insured
entities at all levels of hearings before the TWCC, and we utilize a number of adjusters
who are highly trained and qualified to represent our clients at such hearings.
Q: WHAT SERVICES ARE RENDERED FOR THE "MAIL HANDLING RETAINER"
CHARGED TO TWCC CLIENTS?
A: All carriers licensed to write workers' compensation insurance in the State of Texas, as
well as self -insured employers, are required by statute and Commission rule to appoint an
Austin TWCC representative. That representative's function is to receive communications
from thf Austin (Central) office of the Commission and to expedite any handling required.
In effect, the Austin representative is `on call" should any problem arise that needs
immediate attention. This retainer also covers the handling of numerous small items with
the Austin TWCC which do not require enough activity to justify an individual invoice. It
does not cover matters which require creation of a file or diary, such as TWCC
Compliance Division activities or a Spinal Surgery Log. The mail handling retainer should
be distinguished from other retainer programs which we arrange for clients who request a
much broader range of activities.
Q: HOW MANY CLIENTS DOES H&G REPRESENT BEFORE THE TWCC?
A: We are the appointed TWCC representative for approximately 500 insurance carriers,
carrier groups, risk pools, and self -insured entities.
Q: DOES H&G PROVIDE OTHER SPECIALIZED SERVICES?
A: Yes, and we are pleased to mention:
a. Bilingual capability (English/Spanish) in most of our locations.
b. Consultation and expert testimony in litigation involving issues of "bad faith" and other
insurance claims related issues.
c. Representation by members of our Management Team at mediation - ADR
Conferences.
d. Educational Seminars hosted annually (sometimes more often) for the benefit of H&G
clients and others in our profession, plus quarterly publication of The H&G Report,
our update of judicial, legislative, and regulatory developments.
e. Pre -Trial investigations.
f. Direct computer access with the Texas Department of Transportation for immediate
reports containing motor vehicle ownership and lien holder information.
g. Texas Workers' Compensation "Hot Line" - 1-800-448-COMP to our TWCC Service
Center.
h. Publish TWCC Act and Rules manual, including commentary on appellate decisions.
i. Litigation management by team of specialized senior personnel.
j. Auditing of claims for self -insured or insurance carrier clients for proper reserve,
quality and completeness of investigation/subrogation, or for compliance and practice
purposes.
k. Provide automobile and property appraisal services in all offices.
I. Catastrophe office services in the event of a severe weather -related disaster. We
have designed a catastrophe claims management computer program for efficient
handling of catastrophe situations.
Q: WHAT IS THE MEANING OF "FULL SERVICE" AVAILABILITY ON WC, AUTO,
GENERAL LIABILITY, OR PROPERTY ACCOUNTS?
A: Our firm is staffed and experienced to handle all phases of WC claims, from the simplest
medical only through litigation management. In between, we provide field investigations
and handling of indemnity claims, out -sourced medical auditing and medical management,
representation at all levels of TWCC Hearings, and customized claims information data
and reports.
With our medical management partners, we offer either a full managed care program for
worker compensation claims or a more traditional approach, whichever best suits the
needs of our clients.
We also provide a full range of services for claims administration of auto, general liability,
law enforcement, public official liability, and property claims for insurance carriers, self -
insured entities and political subdivisions.
HAMMERMAN & GAINER, INC.
1 Claims Administrators - Consultants - Investigators - Adjusters
The Firm and certain individual personnel are affiliated with the following
organizations:
Texas Independent Insurance Adjusters Association
(Charter Member)
Texas Claims Association (Charter Member)
Texas Self -Insurance Association
State Bar of Texas
Texas Public Risk Management Association
Austin Claims Association
Dallas Claims Association
El Paso Claims Association
Houston Claims Association
Lubbock Claims Association
Rio Grande Valley Claims Association
San Antonio Claims Association
A Risk Technology Institute Company
Office Locations
Texas - Austin, Dallas/Ft. Worth (Irving), El Paso, Harlingen, Houston, Lubbock, San Antonio
Louisiana — Lafayette, LaPlace (New Orleans), Shreveport
New Mexico - Albuquerque
NANCY Y. STOLL
BRANCH MANAGER, LUBBOCK
Experience
1986 - Present
1978 - 1985
1969 - 1978
Education
Technical Training
Hammerman & Gainer, Inc. Served as the Abilene, Texas Branch
Manager from January, 1986 through December 1990. Opened the
Hammerman & Gainer Lubbock, Texas Branch Office in January
1991. Have worked as an Outside Independent field adjuster. Benefit
Review Conference representative for client insurance carriers in
Abilene, San Angelo, Lubbock, Amarillo, Midland/Odessa Texas
Workers' Compensation field offices. Works as an adjuster in the
investigation, evaluation, negotiation of all lines of clams.
Gulf Insurance Group, Abilene, Texas. Senior Claims Representative
(office closed)
Gulf Insurance Group, Lubbock, Texas. Staff Adjuster (office closed)
La Salle University - Law for Claims Representatives, 1982
Insurance Institute of America - Certificate of General Insurance, 1973
Licensed by the Texas Department of Insurance as a Type 01 (All
Lines) Adjuster
Professional Associations
South Plains Claims Association, President, 1994
Claims Person of the Year, 1994
West Texas Claims Association, Abilene, President 1985
Federation of Insurance Women of Texas
The Insurance Women of Abilene, President from 1988 - 1990
Insurance Women of Lubbock, President 1978
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
RESUME
Robyn C. Tydelski
SR. MARKETING REPRESENATIVE
Experience
April, 2002 to present Hammerman & Gainer, Inc., Irving, Texas — Account Executive in
Marketing Division. Senior Staff Adjuster with over twenty years
experience in multi -line claims of automobile, general liability,
workers' compensation, products and professional liability.
August 2000 to April, 2002 Colonial Casualty Insurance Company, Dallas, Texas — Senior
Workers' Compensation Examiner
May, 1999 to July 31, 2000 Travelers Insurance, Dallas, Texas — Senior Workers' Compensation
National Accounts Claim Examiner; performed on -site file reviews
with clients and brokers.
March, 1998 - March, 1999 Cigna Integrated Care, Irving, Texas — Benefits Services Team Leader,
supervising benefit and care specialists handling workers'
compensation and disability claims.
July, 1995 to July, 1997 Gates McDonald, Dallas, Texas — Senior Claims Examiner for eight
national accounts.
July, 1993 - January, 1995 TIC United Corporation, Dallas, Texas — Claim Manager responsible
for TPA supervision of automobile, trucking and general liability
claims. Conducted on -site investigation of all trucking accidents
involving fatalities.
Education
Technical Training
Graduate of Smithtown High School East
Attended Albany State University of New York
Licensed by Texas Department of Insurance as Automobile, General
Liability and Workers' Compensation Adjuster
Professional Associations
Texas Independent Insurance Adjusters Association
Dallas Claims Association
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
RESUME
PATRICK WYSOCKI
CHIEF TECHNOLOGY OFFICER
Experience
February 1998 - Present Hammerman & Gainer, Inc., Austin, Texas. Responsible for all
computer hardware and software components and operations of
thirteen office branches with an excess of 100 workstations, four file
servers, networks, WANs, ISDN lines, dedicated lines, ISP's, fax
machines, print servers, cabling and internet. Duties include
purchasing, assembling, programming, developing, maintaining
equipment, overseeing all network development/operations, setting up
of all software and employee training.
April 1990 - February 1998 State of Texas Public Utility Commission & Youth Commission,
Austin, Texas. Responsibilities included backups, restores and batch
jobs on a Vax mainframe system. In June, 1992 moved into the
system support specialist role in a Novel and Windows environment
supporting 100+ users. In August, 1994 promoted to Network
Manager and worked in that capacity until February, 1996 when I
became a database administrator for the agency wide human resource
system.
Education
September 1990 - May 1993 Austin Community College - Associates Degree in Computer science
Technical Training
Novell 3.12 and 4.1 training
MS Access 2.0 training
Foxpro training
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TEAM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH
POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L
TYPE OF INSURANCE
POLICY NUMBER
DATE
DA MUM
LIMITS
EACH OCCURRENCE
31,000,000
A,
GENERAL LIABILITY
g COMMERCIAL GENERAL LIABILITY
D OCCUR
C2011605945
07/28/02
07/28/03
FIRE DAMAGE WYOns*G)
$50,000
MED EXP V" aft POMM)
$5 , 0 0 0
PERSONAL & ADV INJURY
$1,000,000
CLAMS MADE
XNCLXM IULM 9004"nft
AND ADDL INSURED
GENERAL AGGREGATE
$2, 0 0 0, O O 0
PRODUCTS - COMPIOP AGG
$1, 0 0 0 , 0 0 0
GENL AGGREGATE LIMIT APPLIES PER
8 POLIcY ERCT LoxBen.
11000,000
C
AUTOMOSLE
L1ABIUTY
ANY AUTO
C2011605976
07/28/02
07/28/03
COMBINED SINGLE LIMIT
(F--dd-O
S1,000,000
ALL OWNED AUTOS
BODILY INJURY
(Par
$
$
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
alcLoote IgLrvx s0/a06a12011
AND ADDL INSURED
BODILY
stt INJURY
$
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PROPERTY DAMAGE
(Pat acddeM)
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AUTO ONLY - EA ACCIDENT
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EA ACC
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ANY AUTO
THAN
AUTO ONLY: AGG
$
B
EXCESS UABN.ITY
% OCCUR CLARNsMADE
2011605962
07/28/02
07/28/03
EACH OCCURRENCE
$5, 0 0 0, 00 0
AGGREGATE
.$5, 000, 000
s
DEDUCTIBLE
X RETENTION $10 , 0 0 0
AT
D
�(M COMP£NSATTON AND
EMPLDYEWLUmLITY
NC211605959
Dim at= toxvaa/Aar mL
07/28/02
07/28/03
E TORY LIMITS ER
E.L. EACH ACCIDENT
$1000000
E.L. o18EASE - EA EMPLOYE
$ 10 0 0 0 0 0
EL DISEASE - POUCY LIMIT
S 10 0 0 0 0 0
B
B
OTHER
Crime
Professional
R=jwAL 08 169665833
SPL0005806
09/01/02
08/01/02
09/01/03
08/01/03
Blkt Lmt 11000,000
Limit 51000,000
DESCRIPTION OF OPERATIONS&OCATIONSNEtMCLEEIE)CCLUSWW ADDED BY ENDORSEM E NTrA ECIAL PROhSbMS
*Professional Coverage is Claims Xade Policy
%,rK 1 It R.A 1 C nULUCrt In >,+na n�nL wwunct+; wwi�+nc,. a.�. �+• -- -- -
SAMPLE - SHOULD ANY OF THE ABOVE DESCRIBED POUCAES SE CANCELLED BEFORE THE EXPIRA
DATE THEREOF, THE WSUMG INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN
NOTICE TO THE CEfT IF1CATF HOLDER NAMED To THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBLIGATION oR LumuTY OF ANY IGND UPON THE INSURER, ITS AGENTS OR
For Information Only REPRESENTATIVES. /
NCTRCA
4*10
D/M/WBE CERTIFICATION
Hammerman & Gainer, Inc.
has filed with the Agency the appropriate Affidavit and is hereby certified as a
Disadvantaged Business Enterprise
providing service(s) in the following areas:
524291;
Claims Adjusting;
This Certification is valid beginning October 2002 and supersedes any registration or listing
previously issued. This certification must be updated annually by submission of a Annual Update Affidavit. At any
time there is a change in ownership or control of the firm, notification must be made immediately to the North
Central Texas Regional Certification Agency.
Certificate expiration October 2003 ._
Issued date October 2002 C 6cation Administrator
CERTIFICATION NO. BMDB12379N0902
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Liability Review Standards & Measurement
Audit Field
A. Coverage(4)
1. Proper policy used
2. Coverage Analysis conducted
3. Primary/excess identified
4. Coverage denial procedure followed
5. Excess letter sent
B. Investlgatlon(6)
1.24 hr. contact lessee/cimt.
2. Statement insured
3. Statement claimant
4. Statement witness
5. Photos
6. Police report
7. U-Haul damages investigated
8. Equipment on -hold if appropriate
9. U.S.T. considered
10. Parked Vehicle loss
11. Fatal/Serious Rept prepared or updated
C. Liability Assessment(4)
1. Comparative Negligence (if applicable)
2. Decision documented
3. Joint-tortfeasor recognized
4. Timeliness of decision
D. Claims Process/Settlement(6)
I. DOI Reg compliance
2. Timely response to demands
3. Settlement within authority
4. Evaluation documented
5. 1st call settlement
6. Negotiations documented.
7. AID notification sent
Explanation 4*0
Applicable to insured & loss description
Coverage Analysis (persons, perils,property, loss location, hazards,accidental,time)
Documented in notepad
Proper letter, manager approval
When applicable
From time of assignment
Contact, interview and recorded statement when necessary
Contact, interview and recorded statement when necessary
Contact, interview and recorded statement when necessary
Vehicles, real property, scene photos, injury evaluation when necessary
When available
Inspection and photos of truck, EDR research when applicable
Claim number opened, notepad documentation of EOH, reason and location of equipment
Does it meet the low impact soft tissue criteria
ISO search by VIN and Claimant name
To be completed within 1st notification of injury/damage within 5 days
Describe comparative rule, apply to facts of claim
Notepad law of venue and describe applicability to investigation
Identify other parties at fault and actions to include in settlement process
Assess at conclusion of investigation, revisit if changes occur
According to loss state regulations or guidelines
Within 10 days of completed liability and damage assessment PD, 30 days BI
Authority
Thorough description of settlement evaluation (liability & damages)
When opportunity presented (complete notepad documentation)
Notepad documentation of demands, offers, settlement (one or multiple notes)
On all AID claims, including quick claim settlements
8. Authority obtained
9. TIS closing letter sent
E. Damages/Property(7)
1. Betterment/depreciation/LKQ
2. Proof of Loss/ ownership
3. Loss of use controlled
4. Proper salvage docs. received
5. IA inspection w/in 48 hours
6. ACE utilized/Eauto utilized
7. Salvage addressed/accounted for
1. ACV Established (CCU)
3. Business Interruption Controlled (CCU)
D. Damages/ Bodily Injury(9)
1. Medical verified
2. Loss of wage verified
3. Med. authorization requested
4. Wage authorization requested
5. Evaluation in file
6. Negotiations documented.
7. 1 st call settlement offer
8. Timely response to demands
9. Settlement within authority
F. Reserving(3)
1. All claimants/coverage reserved
2. Changes made timely
3. Dangling reserves eliminated (closed files)
G. File Documentation(10)
1. Diary maintenance
2. Has supervisor review
instructions been followed
3. Subrogation realized
4. IA authorization and control
5. PILR report
6. Plan of action
7. POA follow up
8. Organized imaged file/AS400
9. Clear & precise documentation
According to procedure guidelines
Required on all physical damage and casualty/lit files
Estimate review for items described
Verification of ownership vehicles and rUiproperty
Actual repair days or cash settlement based on estimate labor hours
Ownership certificate, power of attorney, Transfer of ownership certificate
From I/A assignment date (unless delayed by claimant)
$500 - $5000 in lieu of inspection and subrogation demands/driveable autos only
Documented in notepad or owner retained (cargo & vehicles)
Documented in file per scope
Calculated per expected repair time and noted for any delays
Medical report and bills in file - Reviewed when applicable
Confirmed with employer and supported by medical report
Upon notice of injury (including represented claimants through attorney)
Upon notice of wage loss (including represented claimants through attorney)
Documented in notepad with clear and complete assessment
Notepad documentation of demands, offers, settlement (one or multiple notes)
When appropriate and documented in notepad
Within 30 days of final medical or demand package
Supervisor authority or individual authority
All claimants have open exposures
According to reserve guidelines
All exposures at $0 reserve at closing of file and claims coded closed in Allegro
Allegro on diary and up to date within 10 days
Complete and documented in notepad
Explained in notepad (yes, no, reason)
Supervisor approved (unless waived by AVP) and task assignment
On all property claims > $500
Upon receipt of assignment. Notepad description of steps needed for resolution
Notepad documentation of action steps completions and supervisor direction completion
Document types in specified folders/physical file orderliness(no duplicate docs.)
Does the notepad tell the story of the claim? (Clear, concise, complete)
10. Re-assignment/new POA
11. RCA completed
12. Deductible Recovery Process applied
H. SIU(2)
1. WINS researched
2. SIU guidelines considered
I. Litigation Management(7)
See Litigation standards sheet
I. Unit Supervisor Eval.(3)
1. File on diary
2. Supervisor direction
3. Timely reviews
SIU Audit Fields
A. Investigation(12)
1. 24 hour response to referral
2. Statement - Insured
3. Statement - claimant
4. Statement of witness/dealer/center rep.
5. Photos
6. Police report
7. U-Haul damages investigated
8. Equipment on -hold if appropriate
9. Medical verified
10. Wages verified
11. Receipts verified
12. Communication with adjuster
B. Documentation(11)
1. Diary maintenance
2. Has supervisor review
instructions been followed
3. Plan of action
4. Adequate file documentation
5. Plan of action follow up
6. Timely reporting
7. Internal report -15 day
Notepad file review summary and note new POA
30 days Fast Track/AID, 90 days casualty/litigation and documented in notepad
File has met criteria, letters sent and logged in H drive
Documented in notepad as completed ft _
Notepad documentation of consideration of SIU flags
�1
Allegro diary and up to date within 15 days
On all diary dates notepad review and direction
Minimum standards - PD 15-30 days, BI 45-60 days, Lit 30-90
Notepad documentation of receipt of referral
Can be done by SIU, adjuster or IA. Notepad documentation
Can be done by SIU, adjuster or IA. Notepad documentation
If applicable - same standards as above
Photos of % vehicles and damages
Notepad documentation of request for police report
Notepad documentation
Notepad documentation if applicable
Copies of bills in file Authorization if possible
Authorization from claimant should be signed
Verification of any documents provided to support loss - notepad documentation of same
Notepad documentation of conversations
Any method is acceptable - constant progress in file is adequate documentation
Notepad docmentation or written evidence in SIU file
Notepad documentation
Notepad documentation or outlined in SIU report
Notepad, Allegro or Activity log !in SIU file
Should be evident in file documentation
As outlined in SIU manual
SIU First Report required 15 days post referral
8. Intermediate report - 30 day
SIU Intermediate Report every 30 days unless otherwise noted
9. Final report
Should be completed when investigation is complete
10. Recommendations
Should be included in Final Report
11. Timely response to correspondence
example - IA reports should be summarized to adjuster when received
C. SIU
1. Timely research
Background checks shold be done on receipt of referral
2. Timely follow up
Any information discovered in background`search should be researched
3. Contact
with/or
index info
sheets all
applicable
carriers
Other carriers with simimal losses should be contacted for information
4. Submission to NICB/DOI timely
Based on the requirement of the State involved
5. Direction and control of investigations
IA's should be given specific direction - folow up to ensure compliance by IA's
6. File organization
Should be neat and easy to review
7. SIU involved in litigation process
Notepad documentation of discussions with counsel and SIU input
HAMMERMAN & GAINER, INC.
CLAIM MANAGEMENT STANDARDS OF PERFORMANCE
COVERAGE CONFIRMATION (Within 24 Hours of Receipt of Assignment)
❑ Within 24 hours of receipt of assignment, the Adjuster is to confirm coverage per client instructions.
❑ Any question of coverage is to be immediately discussed with the Claim Manager.
❑ Claim Manager will advise client of the coverage issue within 24 hours of receipt of assignment via telephone,
confirming discussion by fax, e-mail, or in writing.
❑ Any declination of coverage will be approved, authorized, and confirmed by fax,
e-mail, or in writing by the client, prior to the issuance of any denial of coverage letter.
CONTACT (Within 24 Hours of Receipt of Assignment)
❑ Three or four point contact via telephone will be made within 24 hours of receipt of assignment.
INVESTIGATION (Within 24-48 Hours of Receipt of Assignment)
❑ Within 24 hours of receipt of assignment, the Adjuster will begin the claim investigation addressing compensability,
exposure, and potential subrogation.
❑ Within 24 hours of receipt of assignment, the need for outside investigation will be determined and tasks assigned
accordingly. The assignment of outside investigation will be approved by the Claim Manager and by the client if per
the client instructions.
❑ Within 48 hours of receipt of assignment, the Adjuster will initiate action to obtain records and send the necessary
forms, based on the information obtained during the three-point contact.
MANAGED CARE
❑ Within 24 hours of receipt of assignment, all medical only and lost time cases that fit the Telephonic and On -site
Referral Criteria as outlined in the client instructions are immediately sent to the Nurse Case Manager for review.
❑ If the medical condition warrants further case management activity, the nurse will contact the injured worker to:
❑ Explain the Telephonic Case Manager's role.
MANAGED CARE - Continued
❑ Assess the injured worker's symptoms, level of understanding of their medical condition and the prescribed medical
treatment.
❑ Assess the injured worker's compliance with treatment recommendations.
❑ Assess the injured worker's satisfaction with the medical treatment and physician.
❑ Assess the injured worker's return -to -work mentality.
❑ Any claim that deviates from established referral criteria would be referred to client for consideration of assignment for
on -site case management.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
❑ Should a claim exceed ninety (90) days post -injury with ongoing lost time, without an immediate projected return to
work date, the claim should be referred to client for review of possible referral for on -site case management.
❑ Any claim that deviates from established referral criteria would be referred to client for consideration of assignment for
on -site case management. The following are assigned for immediate case management:
❑ Low Back Sprain/Strain
❑ Knee Injuries
❑ Groin Injuries
❑ Carpal Tunnel Syndrome
❑ Head Trauma (closed or open), Non Catastrophic
❑ Fractures
❑ Multiple Trauma
❑ Serious Burns
❑ Complex Lacerations
❑ Crush Injuries
❑ Motor vehicle accident (work related)
❑ Employees over age 60
❑ Chiropractic care
❑ Employees vitlfother known medical problems
❑ Employees with multiple WC injuries
❑ Stress related conditions
❑ New employees
❑ Within 24 hours of receipt of assignment, injuries involving the following will be immediately referred for on -site case
management.
❑ Spinal cord injuries
❑ Brain injuries
❑ Second degree (30%) and third degree (101/o) burns
❑ Amputation
❑ Impairment — vision or hearing by 50% or more
❑ Nerve damage
❑ Cardiac failure
❑ Environmental claims
❑ Severe internal injuries
❑ Multiple factors including occupational disease cases
RESERVING
❑ Initial Medical Only reserves are established within 24-48 hours of receipt of assignment.
❑ Initial Lost Time reserves are established within 10-14 days of receipt of assignment.
❑ Reserves are reviewed minimally every 60-90 days, however, case progress, activity, and additional information
obtained during and throughout the investigation will dictate the necessity for a reserve review.
LITIGATION MANAGEMENT
❑ Within 24 hours
❑ The Adjuster will notify the Claim Manager of a Summons & Complaint and/or any other litigation notification.
❑ The Adjuster will notify appropriate client company personnel per client instructions, and request authorization to
assign file to approved defense counsel for filing of timely answer.
❑ Within 48 hours
❑ The Adjuster is required to assess the case for ultimate case exposure, identifying next steps, options, and an action
plan.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
SUBROGATION
❑ Immediately upon receipt of the assignment, the Claim Manager/Supervisor will review the first report of loss for
potential subrogation.
❑ If subrogation potential exists, the file will be stamped "Subrogation" and a Statute of Limitations date will be clearly
posted on the front of the file jacket.
❑ Within 24-48 hours, the Adjuster will identify potential third parties, evaluate the probability of recovery, and place all
third parties on notice of clients' lien interest.
❑ The Adjuster will contact the designated client contact person per client instructions, advise of subro potential, and
request authorization for on -site investigation.
❑ The Adjuster will report results of initial subrogation investigation to client within 30 days of file creation, and send a
status report every 90 days thereafter.
REPORTING
❑ An acknowledgement of receipt of assignment if required, will be sent in accordance with client instructions.
❑ Per the State Worker's Compensation Board/Commission, and/or Department of Industry and Labor, all required
filings will be made in accordance with jurisdictional requirements and time frames.
❑ Within 10-14 days, a first formal captioned report is to be completed on all lost time claims with reserves of $25,000
and greater. Any and all client instructions to the contrary supercede internal Hammerman & Gainer Inc Claim
Managemeft P'rformance Standards.
❑ Unless client instructions dictate to the contrary, or because developments in the file warrant earlier reporting, all
subsequent report updates are due to file at intervals of 60 days.
❑ Regardless of reserves, the following catastrophic losses must be reported to the client. Any specific client instructions
to the contrary supercede internal Hammerman & Gainer Inc. Claim Management Performance Standards
❑ Fatalities
❑ Spinal cord injuries resulting in paraplegia or quadriplegia
❑ Brain Damage affecting mentality, including, but not limited to, such conditions as permanent disorientation, behavior
disorder, personality change, seizure, motor deficit, aphasia hemiplegia or unconsciousness
❑ Third Degree Bums covering at least 10% of the body or Second Degree Burns covering at least 30% of the body
❑ Amputations
❑ Impairment of vision or hearing by 50% or more
❑ Nerve Damage causing paralysis or loss of sensation in arm, hand or leg
❑ Massive Internal Injuries affecting a body organ or organs
❑ Multiple fractures involving more than one member, malunion or significant shortening of the limbs
❑ Fracture of both heel bones
❑ Occupational Disease such as asbestosis, black lung disease and long-term chemical exposure
❑ Back injury claims requiring surgery or with a disability of one year or more
❑ Any disability of more than one year
❑ Permanent Total Disability
❑ Cardiac Failure
❑ Paralytic Stroke
❑ Sexual Assault and Molestation
❑ Any controversy as to coverage, state law, reserving, settlements or an allegation of bad faith made to the adjustment
company
SUPERVISION
❑ Immediately upon receipt of a first report of loss, the Claim Manager/Supervisor reviews the first report and client
instructions to outline a plan of action for timely and thorough investigation by the Adjuster.
The Claim Manager/Supervisor's initial review focuses on the following claim management issues.
❑ Special Client Instructions (Within 24 Hours of Receipt of First Report)
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
The Claim Manager/Supervisor reviews the Special Client Instructions to make sure all unique client instructions are
clearly understood and followed.
❑ Coverage Confirmation (Within 24 Hours of Receipt of First Report)
The Adjuster in accordance with Client Instructions confirms coverage.
❑ Contact (Within 48 Hours of Receipt of First Report)
❑ Determine Compensability (Within 72 Hours of Receipt of First Report)
❑ Evaluate Claim and Establish Initial Reserves (Within 72 Hours of Receipt of First Report)
❑ Calculation of Average Weekly Wage (Within 72 Hours of Receipt of First Report)
❑ Request and obtain needed wage statements to calculate AWW and indemnity benefits. File is documented to reflect
how AWW was calculated.
❑ Subrogation Addressed (Within 72 Hours of Receipt of First Report)
❑ Initial Supervisory File Review (Within 14 days of Receipt of First Report)
❑ On -going Thirty Day Supervisory File Review Until Closed
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
raHAMMERMAN & GAINER, INC.
Claims Administrators - Consultants - Investigators - Adjusters
P.O. Box 53814, Lubbock, Texas 79453
Telephone: 806/796-0234
Facsimile: 806/796-0122
Fire & Marine
13810 FNB Parkway
Anywhere, NE 68154-5202
Attention: John Smith
Our file number,
Insured:
Claimant:
Date of accident:
Claim number:
Dear Mr. Smith,
3307 82nd Street, Suite 1-A (79423)
www.hng.com
August 4, 2003
L-3397
Someone's Trucking
Andrew Bugle, Charles Hunt and Wayne Claim
7-21-03
321196
This will confirm receipt of the assignment faxed to us on 7-28-03 and confirm our phone
conversation this morning regarding the handling. This will serve as our initial report on the
information we have to date.
INSURED:
The insured is Someone's Trucking, Inc. with main offices at 4507 16th St., Lubbock, TX and a
satellite office in Andrews, TX with phone 915-524-4405. We have discussed this claim with
the owner, Mike Policyholder and secretary, Sherry Jones.
The insured driver was Bill Jones who works out of the Andrews, TX office. Mr. Jones has a
home phone of (915) 555-5555 and cell phone (915) 222-2222. Mr. Jones left for a 3-week
vacation shortly after this accident occurred and will not return to Texas until the middle of
August.
We contacted Mr. Jones on his cell phone this morning to determine his location so that you
can arrange for an adjuster to meet with him in person for the Trucking Questionnaire and
interview. On this date Mr. Jones is in Tennessee, but will be leaving there tomorrow to travel
to a very small town called Rural Retreat in Virginia. This is between Marion and Wytheville in
the southwest portion of Virginia. He will be at his niece's house but can be reached on his cell
phone. Mr. Jones expects to leave there sometime Friday, August 1st and travel to
Washington, North Carolina. According to Mr. Jones this is about 40 miles from Greenville, NC.
He stated that the best time to reach him would be on Monday, August 4th in Washington, NC
on his cell phone to arrange for an appointment to meet in person.
A Risk Technology Institute Company
Office Locations
Texas - Abilene, Austin, Corpus Christi, Dallas (Irving), El Paso, Harlingen, Houston, Lubbock, Odessa, San Antonio
Louisiana - Baton Rouge, Lafayette, New Orleans (LaPlace)
Hammerman & Gainer, Inc.
Page 2
Someone's Trucking
INSURED VEHICLE:
We confirmed with Mike Policyholder that Mr. Jones was driving a 1985 Mack tractor #02130
owned by Someone's Trucking, Inc. He was pulling a 1987 Fruehauf trailer #16008 also owned
by Someone's Trucking, Inc. The tractor is in use out of the Andrews, TX location. It was not
damaged from this accident.
The trailer did receive damage from the accident and is currently at Tom's Welding, 319 W.
Maryland, Hobbs, New Mexico. The shop phone number is 505-393-5305. The insured has
authorized repairs as soon as parts are received. Mr. Policyholder believes repairs will start by
tomorrow, July 30t'. The insured needs to get repairs done ASAP and get the trailer back in
use.
It is our understanding that you will reassign the inspection and appraisal of the insured
vehicles to someone in the Hobbs, NM area. Our appraiser is in Lubbock, approximately 110
miles one way from Hobbs. If you need our appraiser to go please let us know ASAP.
FACTS OF THE ACCIDENT:
This accident occurred about 9:30 AM on Monday, July 213', 2003 on Highway 62/180 5 miles
West of Hobbs, NM. Highway 62 is a 4 lane divided highway with a grass median and posted
speed limit of 65 mph. It runs east and west and is level and straight. The weather was dry
and clear.
From what we know, a small SUV driven by a lady (name unknown) was eastbound on the
highway and went off the roadway on the right, overcorrected to her left losing control of the
vehicle. The vehicle overturned in the median and ended up upside down in the center of the
westbound lanes of traffic. There were 2 small children in the vehicle.
Charles Hunt was westbound on the highway, saw the accident with the SUV and stopped his
2003 Chevrolet pickup on the roadway to prevent the oncoming vehicles from hitting the
overturned car. We understand Mr. Hunt was assisting the woman driver and the children out
of the vehicle.
The next vehicle to come along was Wayne Claim driving a 1997 Ford pickup pulling a 27 ft.
1990 Coachman travel trailer. He was traveling West in the outside lane and came to a stop on
the side of the roadway to assist. Mr. Claim got out of his pickup to meet a man walking
towards him on a cell phone (could have been Mr. Hunt). Mrs. Claim remained in the pickup.
Then a 2000 Lincoln driven by Andrew Bugle came upon the accident scene and stopped
behind Mr. Claim. Mr. and Mrs. Bugle remained in their vehicle stopped in the right hand lane
also westbound.
cAwindows\temp\3397.rpc.doc
Hammerman & Gainer, Inc.
Page 3
Someone's Trucking
Shortly afterward, our insured driver came upon the scene and attempted to come to stop his
tractor -trailer. The brakes locked down and the trailer was skidding sideways toward the
vehicles stopped on the side of the roadway. The right front of our insured's trailer struck the
rear of the Bugle vehicle. The impact pushed the Bugle vehicle forward causing it to strike the
left door of the Claim pickup. The travel trailer was not damaged.
As this was occurring, the insured continued on west and also struck the rear of the pickup
belonging to Mr. Hunt. It is our understanding that the Hunt vehicle was unoccupied when
struck.
ACCIDENT REPORT:
The New Mqcico State Police investigated this accident. It is our understanding that the County
sheriff and ire department were also at the scene.
We have contacted the New Mexico State Police to obtain an accident report but it is not yet
available. The officer we spoke with told us to check back late tomorrow and he would fax it to
us if ready. The accident # is 10120032 for Lea County, NM.
WITNESSES:
At this point the only names we know are those individuals involved in the accident.
CLAIMANTS:
1. HUNT VEHICLE:
This vehicle was driven by Charles Hunt, 411 West Avenue B, Lovington, NM, phone 505-396-
0515. We have phoned Mr. Hunt several times but there is no answer. We will continue our
efforts to reach him and obtain his recorded statement by phone. From the information we
have now, Mr. Hunt was not in his vehicle and there were no passengers.
2. CLAIM VEHICLE:
Dyl Wayne Claim and his wife, Billye Francis Claim reside at 306 Minyard, Sudan, TX 79371
with home phone 806-227-2122. Mr. Claim is a retired farmer, age 71 and his wife is a
housewife. The Claims were traveling to Ruidoso, NM for a week's vacation in their trailer.
After the accident, Mr. Claim leased another pickup in Hobbs and continued on to Ruidoso with
the travel trailer.
Wayne Claim was not in his vehicle and is claiming no injury. He stated that he ran away to
avoid being struck. Mrs. Claim was seated in the right passenger side of the pickup. She
received bruises to both arms and her hip but has not sought any medical treatment since the
accident and does not expect to, unless she worsens.
cAwindows\temp\3397.rpc.doc
Hammerman & Gainer, Inc.
Page 4
Someone's Trucking
We obtained a recorded statement from Wayne Claim on this date, 7-29-03, and will forward
the summary with a few days.
3. BUGLE VEHICLE:
Andrew Bugle and wife Bell Bugle live at 1008 N. Pecan, Hobbs, NM 88240. Their home phone
is 505-111-1111. Mr. Bugle is age 82 and is a retired chiropractor. Bell Bugle is age 80. Mr.
Bugle was in the driver's seat and his wife in the right front passenger side. Their vehicle was
stopped.
We obtained a recorded statement from Andrew Bugle by phone on this date and will forward
the summa to you as soon as possible.
Mr. Bugle stated that he was hurting and sore in his mid back area but to date has not sought
medical treatment.
Bell Bugle was checked at the scene by the paramedics but refused to go in the ambulance.
She stated that she has a very sore neck and that it is swollen, mainly on the left side and some
pain in the mid back area also. On 7-22-03 she went to her family doctor, Dr. Sambiah
Kenkanala in Hobbs, NM, phone 505-392-7537. The doctor ordered xrays of her neck and she
has been told they are negative for any fracture. She is giving it some time and if she does not
get better will return for follow up care. Her medical expenses to date are around $250.00.
PROPERTY DAMAGE:
1. HUNT - We have little information other than this was a 2003 Chevrolet pickup. It was y
taken to a wrecking yard near the airport in Hobbs. However, Sherry (with the insured) told
us that it has been moved by the owner.
When we have additional information we will let you know where this vehicle is presently
located.
2. CLAIM - 1997 Ford F150 Ford super cab, white over red in color. This vehicle is located at
John's Wrecker near the Hobbs airport, phone # 505-393-8585. The vehicle has
been drawing storage since the date of the accident. Mr. Claim reports damage to the left
door area and also to the right front tire. The impact pushed the pickup sideways causing the
tire to come off of the rim.
In addition to the vehicle damage, Mr. Claim has expenses for the lease of a pickup to pull his
trailer.on to Ruidoso. He was not sure of the cost of the lease vehicle as he got it from an
individual in Hobbs. He leased the pickup on 7-22-03 and returned it on 7-28-03. He is
needing another vehicle to get around.
cAwindows\temp\3397.rpc.doc
Hammerman & Gainer, Inc.
Page 5
Someone's Trucking
Mr. Claim is insured by Southern Farm Bureau, Littlefield, TX, phone 806-000-0000. Their
adjuster is Domea Favor. We have left a message for Mr. Favor.
3. BUGLE - The Bugle vehicle is a 2000 Lincoln Towncar, dark blue in color. This vehicle
was towed to Don Rogers Wrecker and then moved to Massey Body and Repair, 409 W.
Marland St., Hobbs, NM, phone 505-393-6768. This vehicle has damage to the front and rear.
The Bugle vehicle is insured by Progressive Insurance and their adjuster is Pop Tart in Hobbs,
phone 505-333-3333. We spoke with Mr. Tart and he has provided us with a copy of his
preliminary estimate of damage. Visible damage at this time is $11,586. This is not a final
estimate as they anticipate additional damage after teardown. The adjuster was also kind
enough to email us the photos. We are forwarding them to you by email also for your viewing.
Again, it is (cur understanding that you will re -assign these vehicle inspections and appraisals to
an adjuster in the Hobbs area. Please let us know if you need our appraiser from Lubbock.
We would be glad to inspect all 3 claimant vehicles and the insured vehicle in one day to
reduce mileage and travel time expenses.
ADDITIONAL INVESTIGATION AND ACTIVITY:
We will contact Mr. Hunt and obtain his recorded statement and obtain the NM police accident
report. When we have this information we will email or call you with the vehicle location.
If you have any questions please do not hesitate to email me at nancyst .hn%com or call at
806-796-0234. We are here to help in any way we can. Further reports will follow.
Thank you for this assignment.
Sincerely,
HAMMERMAN & GAINER
Nancy J. Stoll, Branch Manager
Enc.: Estimate & photos - Bugle vehicle (from Progressive)
cAwindows\temp\3397.rpc.doc
Reference List
Following is a list of accounts and contact persons for whom we have provided full claims
administration, EDI and TWCC representation services, and some for whom we handle claims
adjusting/administration or TWCC representation only. We also refer you to the list of entities that we
currently represent before the TWCC in Austin and around the State, including insurance carriers,
governmental entities, certified self -insurers and risk pools.
University Health System
(Bexar County Hospital District)
4502 Medical Drive
San Antonio, Texas 78229-4493
Lupe Gomez, Human Resources
210-358-2370
4000 Emplo eef
We have handled for over three years and are currently in first year of second contract period as
TPA and TWCC rep. Contract runs through December 2005.
Dallas ISD
3700 Ross Avenue, Box 91
Dallas, Texas 75224
Cheryl Johnson, Director
214-932-5279
Over 20,000 Employees
This contract started September 1, 2002 and runs through August 31, 2005.
City of Dallas
1500 Marilla
Dallas, TX 75201
Jeffrey Adams
214-670-4224
10,000 Employees
We are on third year of 3-year contract with two possible one-year extensions. (This is a Texas
Tort Claims Act administration account)
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Texas Property Casualty Insurance Guarantee Association
9120 Burnet Road
Austin, Texas 78758
Marvin Kelley, Executive Director
800-856-0298
Number of employees unknown
We have provided claims administration services and TWCC representation for 4 years.
Fairfield Insurance Company
C/O Midlands Claims Administrators
P.O. Box 268996
Oklahoma City, Oklahoma 73126
Aven Brinlee
866-264-2805
Number of employees unknown.
We have been providing TWCC representation for five months.
AIG WorldSource
8144 Walnut Hill Lane, Suite 1600
Dallas, Texas 75231 -
Vicki Dickerson, Claim Manager SW Regional Claim Department
214-932-2203
Patty Schibler, Claim Examiner
415-836-2698
We have been providing hearing representation for 2 years.
Liberty Mutual Insurance Company
13201 N. W. Freeway, Suite 100
Houston, Texas 77240
Kirby Sims, Claims Manager
800-526-1547
Number of employees unknown
We have handled claims investigations and hearings statewide for over 20 years.
The City of College Station
1101 Texas Avenue
College Station, Texas 77842
W. D. Cody, Risk Manager
979-764-3572
500 Employees
979-764-3572
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
We have been providing claim administration services and hearing representation for 1 year.
Texas Association of Counties
1204 San Antonio
Austin, Texas 78701
Larry Cowles, Claim Manager
512-478-8753
75,000 Employees
We have provided hearing representation for over 15 years statewide.
Managed Comp
14275 Midway Road, Suite 330
Addison, Texas 77001
Diane Weems
800-626-671
We provided hearing representation for 2 years.
San Antonio Water Systems
P.O. Box 2449
San Antonio, Texas 78298-2449
Randy Son, Claims Supervisor
210-704-7932
1500 Employees
We have been TWCC rep. since December 1989
City of Snyder
P. O. Box 1341
Snyder, TX 79550-1341
Jeanne Johnson
915-573-9361
83 Employees
We have handled this account for over 6 years.
Crowley ISD
P.O. Box 699
Crowley, Texas 76036-0688
Jean Drennan
817-297-5800
1541 Employees
We have been TWCC rep. since November 1, 1999.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
Fort Worth Independent School District
100 N. University Drive
Ft. Worth, Texas 76107
Karen Porterfield
817-871-2000
10,467 Employees
We have been TWCC rep. on this account since February 1, 1994.
Dodson Insurance Group
9201 State Line Road
Kansas City, MO 64114
John Demos, Area Claim Manager
816-361-9600
We have handled WC claims and have been TWCC rep for over 30 years.
Ysleta Independent School District
9600 Sims
El Paso, Texas 79925
Rosie Bilsbarrow
915- 434-0471
6000 Employees
We have been Austin TWCC rep. for over 10 years.
VIA Metropolitan Transit
P.O. Box 12489
San Antonio, Texas 78212
Andrew Morales
210-362-2000
1774 Employees
We have been TWCC rep. since 1984.
City of Carrollton
1945 E. Jackson
Carrollton, Texas 75006
Kim Webb
972-466-3000
1000 Employees
We have been TWCC rep. since 1992.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
TRANSITION PLAN
For the purposes of this section, Hammerman & Gainer, Inc. will assume that the City of Lubbock will
award a contract for this solicitation by September 1, 2003 and that services under the contract will
begin on October 1, 2003. Changes to these dates will affect this plan accordingly. It is extremely
important that the transition from the City of Lubbock's existing vendor occurs smoothly to avoid any
interruption of payments to injured workers or medical providers. Therefore we assume that transition
efforts will begin immediately after we sign the contract, and have allowed for transition expenses in
our pricing.
Hammerman & Gainer Lubbock office adjusters and supervisors and our medical cost containment
partners, will begin work on the account by September 1, 2003. Besides injury management team
members, our senior operations managers and our medical bill review (if applicable) and Risk
Management Information Systems staff will be working on the transition throughout September, 2003.
Transition work is necessary in the following areas.
F 7
Written Transition Plan
As soon as possible after we sign the contract, we will request a meeting with the City of Lubbock and
the current vendor for a general discussion of all transition issues. If the third party administrator is
using a subcontractor for medical cost management services, the subcontractor should also attend.
Based on this meeting, we will prepare a written transition plan defining milestones, target dates and
responsible parties. We will distribute this document to all meeting participants for their comments
and corrections. Once approved by the City of Lubbock's representative, we will carry out our
responsibilities under the plan and provide a weekly status report to all parties. The following topics
will all be covered in greater detail in the Transition Plan.
Transfer of Electronic Claims Data
Hammerman & Gainer, Inc. information systems managers will meet with their counterparts with the
City and with the existing vendor to learn what claims data is available in electronic form and to decide
the best way to transfer this data to Hammerman & Gainer, Inc. We will establish a schedule for
transferring data prior to October 1, 2003, with one or more updates after October 1 as the existing
vendor completes its activities.
Transfer of Medical Bill Review Data
We will need to obtain a data tape from the firm currently performing medical bill review for all
medical bills reviewed showing actual amounts paid. This firm can accept the data in any reasonable
format if formatting is documented and definitions are provided for all internal codes. The format used
for submission of data to TWCC would be our preference.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
The City of Lubbock must decide who is responsible for handling appeals and requests for
reconsideration on bills initially reviewed by the current vendor. We recommend that the current
vendor process all requests for reconsideration received on or before September 30, 2003 and that the
new vendor process all such requests received on or after October 1, 2003.
Transfer of Paper Claims Files
The Account Manager will meet with the City of Lubbock and the current vendor as soon as possible
but not later than two weeks prior to the effective date of the contract to learn the location, volume and
organization of paper files on open claims. We will provide the current vendor with a "Top Sheet File
Status" form for them to complete. This form outlines the current claim status, identifies any disputed
issues, current reserves, brief discussion of medical issues, etc. This simple form helps greatly in the
review of transferred claim files. We will agree on the physical transfer of files from the current
vendor at close of business the day before the effective date of the contract. We will also arrange to
obtain closed files in the possession of the City of Lubbock should they have to be reopened.
Definition of -City Active Provider Network
We will work with the City of Lubbock to identify medical providers that will form the active provider
network for the City's employees. The medical cost containment company will also use their
knowledge of the local medical community to begin development of a prospective list of providers.
Banking Arrangements
The Account Manager will meet with the City of Lubbock staff to decide the banking arrangements for
the account. These will be incorporated into the contract between Hammerman & Gainer and the City
of Lubbock. Hammerman & Gainer or the City of Lubbock will open the necessary accounts prior to
the effective date of the contract.
Computer and Communications Equipment
We will provide the City of Lubbock staff with access to Allegro. We will conduct training of City
staff who plan to use Allegro and will also train them on the use of Hammerman & Gainer e-mail, how
to access claims data, file notes, reserve and payment data, and how to print reports. These steps
should be completed prior to October 1.
Review of Reserves and Claim Closure Plans
During the first 30 days of the contract we will review all open claims, analyze the options available to
close each case as appropriate and make reserve adjustments. We will prepare a formal report to the
City of Lubbock on these claims and brief designated City staff.
Hammerman & Gainer Proposal to the City of Lubbock
August 5, 2003
City of Lubbock
PURCHASING DEPARTMENT
ROOM L04, MUNICIPAL BUILDING
1625 137H STREET
LUBBOCK, TEXAS 79401
PH: (806)775-2167 FAX: (806)775-2164
http://purchasing.d.lubbock.tx.us
RFP #113-03/DC, Addendum #1
ADDENDUM # 1
RFP #113-03/ DC
Liability Claims Services - Annual Pricing
MAILED TO VENDOR: July 21, 2003
CLOSE DATE: August 5, 2003 @ 2:00 p.m. CST
The following items take precedence over specifications for the above named Invitation to Bid (ITB).
Where any item called for in the ITB documents is supplemented here, the original requirements, not
affected by this addendum, shall remain in effect.
1. QUESTION:
Is the TPA required to have an office located in Lubbock?
ANSWER:
No, there does not have to be an office in Lubbock, Texas
2. QUESTION:
Is it mandatory for claims to be adjusted/handled in Lubbock?
ANSWER:
Yes, it is requirement that claims be handled in Lubbock to provide optimal service to our citizens.
3. QUESTION:
Can you breakdown the number of AL/GL claims by PD (property damage), BI (bodily injury), and
other?
ANSWER:
Here are the numbers of BI vs PD for the last two full claims years and half of the current claim
year:
GL
YE '01 18 BI 293 PD
YE '02 9 BI 299 PD
YE '03 (As of 3/31 /03) 5 BI 88 PD
Auto
YE '01 11 BI 20 PD
YE '02 13 BI 16 PD
YE'03 (As of 3/31/03) 6 BI 18 PD
113-03/DCAddend 1.doc
RFP #113-03/DC, Addendum #1
Other PI claims (includes Police Liability, Employment Liability, Breach of Contract, Inverse
Condemnation, etc)
YE '01 38
YE '02 43
YE'03 (As of 3/31/03) 8
4. QUESTION:
Are the service current administered in-house or with an existing TPA?
ANSWER:
Claims are currently being handled under contract with a TPA. That contract will expire 9/30/03.
5. QUESTION•
Can we receive the RPF in Word Format by electronic mail?
ANSWER:
Yes, if you wish to receive the RFP in Word Format, please email your request.
6. PROPOSAL COPIES
Offeror's must submit one(1) original and four (4) copies, of the seated proposal to the
purchasing department prior to response due date/time.
7. QUESTION•
Can we submit the RFP by electronic email?
ANSWER:
NO, proposals will be accepted in person, by United States Mail, by United Parcel Service, or by
private courier service. No proposals wilt be accepted by oral communication, telephone,
electronic mail, telegraphic transmission, or telefacsimile transmission. THE CITY WILL NOT
ACCEPT FAX PROPOSALS.
8. INSTRUCTIONS TO ANSWERING QUESTIONS, see attached.
9. EXHIBIT A, see attached.
10. QUESTION.
On page 19 of the contract, can we change that requirement to a cross indemnification clause?
ANSWER:
Yes, I have asked the legal office to assist me with new wording and will get that to you in the next
few days.
113-03/DCAddend 1.doc
RFP #113-03/DC, Addendum #1
11. QUESTION:
Does the City require access to RIMS or a similar system?
ANSWER:
The city would like access if the cost is reasonable, however, it is not a requirement. There would
be a need for three (3) users.
12. QUESTION:
Who is the current TPA?
ANSWER:
Crawford and Company.
13. ADDITIONAL REQUIREMENT:
The City of Lubbock will require that the successful vendor be able to obtain claim or expense
checks that do not exceed $10,000.00 within 24 business hours.
All requests for additional information; or clarification must be submitted in writing and directed to
Diana Caudillo, Buyer, City of Lubbock, P.O. Box 2000, Lubbock, Texas 79457
Questions may be faxed to (806)775-2164 or Email to dcaudillo@mail.ci.lubbock.tx.us
THANK YOU,
CITY OF LUBBOCK
Diana Caudillo
Buyer
It is the intent and purpose of the City of Lubbock that this request permits competitive bids. It shall be the
bidder's responsibility to advise the City of Lubbock Purchasing Manager if anv language, requirements, etc., or
any combinations thereof, inadvertently restricts or limits the requirements stated in this ITB to a sinele source.
Such notification must be submitted in writing and must be received by the Purchasing Manager no later than five
(5) business days prior to the bid close date. A review of such notifications will be made.
113-03/D CAddend 1.doc
RFP #113-03/DC, Addendum #1
Instructions to Answering the Questions
• All questions on the forms provided, including "EXHIBIT A" must be answered and
submitted with your proposal.
All other information can be provided using your format, however, it must be
clearly represented that this is you response.
• Answer all questions and comments when required to do so.
• Please type your answers in the space provided on the chart; sign, date and return
the original to us.
Your written proposal shall be in your own format and shall be a separate
document from this question and answer chart:
113-03/DCAddend 1.doc
RFP #113-03/DC, Addendum #1
c. Written notification of each claim or suit which involves serious injury. This notice
must be provided as soon as possible, no later than then (10) business days from the
date you have knowledge of such claim or suit. Serious injuries include, but are not
limited to:
(1) Cord Injury - paraplegia, quadriplegia;
(2) Amputations - requiring a prosthesis;
(3) Brian damage affecting mentality or central nervous system - such as
permanent disorientation, behavior disorder, personality change, seizures,
motor deficit, inability to speak (Aphasia), hemiplegia or unconsciousness
(Comatose);
(4) Blindness;
(5) Burns - involving over 10% of body with third degree or 30% with second
degree;
(6) Multiple fractures - involving more than one member or non -union of any part
of the body;
(7) Fracture of both heel bones (Fractured or Bilateral OS Calcis);
(8) Nerve damage causing paralysis and loss of sensation in arm and hand (Brachial
Plexus Nerve Damage);
(9) Massive internal injuries affecting body organs;
(10) Injury to nerve at base of spinal canal (Cauda Equina) or any other back injury
resulting in incontinence of bowel or bladder;
(11) Fatalities;
(12) Any claim or suit not specified above that presents an unusual exposure to the
coverage. Examples include: sexual molestation, AIDS, rape, class actions and
bad faith allegations; or
(13) Any other serious injury which may involve our liability.
d. Individual written loss reports of all serious injuries must be given to us within thirty
(30) calendar days from the date you have knowledge of any claim or suit which
involves serious injuries. This report must contain the facts surrounding the claim or
suit, a description of injuries, suggested reserves, recommendations for future claims
handling.
Authorized Signature #2a,b,c Et d
113-03/DCAddend 1.doc
RFP #113-03/DC, Addendum #1
3. You must:
a. Immediately send us copies or any demands, notice, summonses or legal papers
received in connection with the claim or "suit" or action involving a sum in excess of
your retention;
b. Authorize us to obtain records and other information;
c. Assist us, the City Attorney or others to furnish us with information we may request to
evaluate the "accident"; and
d. Attempt to settle the claim or "suit" within your retention.
Authorized Signature Item #3 a,b,c Et d
113-03/DCAdd end 1.doc
cA
Department of
Human Resources
P. O. Box 2000—162513u' Street
Lubbock, Texas 79457
(806) 775-2311 — Fax: (806) 775-3316
August 13, 2003
Ms. Robyn C. Tydelski
Hammerman and Gainer, Inc
300 W. Airport Frwy, Ste 620
Irving, TX 75062
TRANSMITTED VIA EMAIL TO: ROBINT(-),HNG.COM
SUBJECT: City of Lubbock Liability Claims Services — Annual Pricing
Dear Ms. Tydelski:
Thank you for your proposal dated July 30, 2003, for a City of Lubbock Liability Claims Services
— Annual Pricing. Your proposal has been undergoing review by the City of Lubbock Selection
Committee. In order to proceed with our review: however, the following clarifications or
corrections of technical deficiency will be required:
1. Section 3, Pricing/Runoff. In your response you indicate that Time and Expense charges
will only apply to 11 or more suffixes on quote IV. Please verify that this is correct.
2. Section 3, Pricing/Runoff. In your response you indicate that field adjusting would be
charged at $63.00/hour. Does Hammerman and Gainer utilize a standardized time
charged by task? If yes, please provide.
3. Section 3, Pricing/Runoff. What is the Claims administration fee of $1500/year for?
4. Section 3, Pricing/Runoff. What is the one time data conversion fee of $5,000 for?
5. Section 3, Pricing/Runoff. In your response, you indicate on page 24 of the questionnaire
that there is no additional fee for client access to your claims management system,
however, in Section 7 of your proposal, you indicate that there is a $350/seat annual
charge. Which is correct?
6. Section 3, Pricing/Runoff. When a file reaches Time and Expense, are clerical charges
the same $63.00 hourly fee, or are they charged differently?
7. Section 3, Pricing/Runoff. On option II, at the end of the two year time, how would be
conversion fee be priced?
8. Section 3, Scope of Services. In your response, you indicate that Hammerman and
Gainer, Inc. may have to hire additional staff. Please provide the qualifications that you
would consider suitable for an adjuster to work the City account and advise if those are
the qualifications that you would utilize for hiring.
Hammerman and Gainer, Inc. must submit clarifications or corrections of technical deficiencies
in accordance with the information provided in this letter within 5 calendar days of the date of
receipt of this notification. If the due date falls on a Saturday, Sunday or City of Lubbock
holiday, the correction must be received by the City on the next day that is not a Saturday,
Sunday or City of Lubbock holiday. If the deficiency is not corrected within the time period, the
City will reject Hammerman and Gainer, Inc.'s proposal as incomplete and it will not be
considered.
This letter constitutes our notification that specified additional information is needed in order to
fully assess your plan. The review period has been stopped by this request and will resume as
soon as a substantive response to all of the enclosed questions is received. I would be happy to
answer any questions you may have in regard to this letter and to assist your staff in formulating a
response.
Please send electronically, as well as in hard copy to Leisa Hutcheson, selection committee
chairperson for the City of Lubbock Liability Claims Services — Annual Pricing proposal, with a
copy to Victor Kilman, Purchasing Manager. My Internet address is
lutcheson@mail.ci.lubbock.tx.us . My mailing address is:
Risk Management Department
P. O. Box 2000
Lubbock, TX 79457
Mr. Kilman's Internet address is vkilman@mail.ci.lubbock.tx.us . His mailing address is:
Purchasing Department
P. O. Box 2000
Lubbock, TX 79457
We appreciate the efforts of your staff. If you have questions or concerns regarding the matters
raised in this letter, your staff may contact me at (806) 775-2277. I will provide or arrange for
any technical assistance that you may require in preparing your response. Your cooperation is
greatly appreciated.
Sincerely,
cj�- C� r -
Leisa Hutcheson
Risk Management Coordinator
Cc: Victor Kilman
FAHAMMERMAN & GAINER, INC.
Claims Administrators • Consultants • Investigators • Adjusters
800 W. Airport Freeway, Suite 620
Telephone: 972-554-9400
Facsimile: 972-554-8100
August 21, 2003
Ms. Leisa Hutcheson
Risk Management Coordinator
Department of Human Resources
City of Lubbock
P. O. Box 2000
Lubbock, Texas 79457
Irving, Texas 75062
www.hng.com
Re City of Lubbock Liability Claims Services — Annual Pricing
Dear Ms. Hutchinson,
Thank you for your interest in our proposal and the services offered by Hammerman &
Gainer, Inc. We are pleased to offer the following letter of clarification.
Question #1
Correct. Time and expense will be charged on any liability claim involving more than ten
suffixes.
Question #2
Hammerman & Gainer, Inc. does not utilize a standardized time for individual tasks.
Field investigations are billed based on actual time spent traveling and investigating
claims outside of the office.
Question #3
Our claim administration fee at $1500 per year covers the cost of travel and meeting
time by our management and marketing team with the City of Lubbock for the purpose
account implementation in addition to discussing the City's claims or a ny other aspect
of the services being provided. RSPIFIVED
A Risk Technology Institute Company 2003
Office Locations HUMM RESOURCES
ES URS
Texas -Austin, Dallas (Irving), El Paso, Houston, Lubbock, San Antonio V GEVG
Louisiana - Baton Rouge, Lafayette, New Orleans (LaPlace)
Hammerman & Gainer, Inc.
Page 2
Question #4
Our data conversion fee at $5000 covers the cost of downloading the City's historical
data into our risk management information system, Allegro. As you know, this data is
used in the claim handling process.
Question #5
Thank you for bringing this to our attention. There is a $350 per seat, per year charge
for access to our risk information management system, Allegro.
Question #6
Clerical charges are billed at a rate of $45.00 per hour.
Question #7
No additional conversion fee would be associated with the renewal of our contract at
the end of two years. The data conversion fee is a one-time charge.
Question #8
Hammerman & Gainer, Inc. looks for an average of five years of liability claims handling
experience. Our adjusters must have and maintain a current Texas license.
Additionally, we require our adjusters to participate in ongoing continuing education for
the purpose of staying informed with respect to new law developments, etc.
Hammerman & Gainer, Inc. looks for people that enjoy successful service delivery and
customer relations. We look for individuals who are flexible, and will work within the
parameters required by our customers. Adjusters interviewed for this position will be
asked to share their success stories as examples of their expertise and level of
commitment.
Hammerman & Gainer, Inc. will be pleased to consider any current staff handling the
City's claims for hire, at the recommendation of the City.
Pie-1%1 ry
AUG 2 5 2003
HUMAN RE UUHCEw
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Hammerman &Gainer, Inc.
Page 3
Question #9
As requested, please see our property appraisal fees as follows:
Property Fee Schedule
Pro erg
Gross Loss Range Full Adjustment
*Wnd/Hail Only
Agreed Price Appraisal
$0 - $500
125.00
105.00
99.00
$501 - $1,000
185:00
155.00
145.00
$1,001 - $2,000
245.00
199.00
189.00
$2,001 - $3,500
305.00
279.00
235.00
$3,501 - $5,000
375.00
319.00
285.00
$5,001 - $7,500
450.00
379.00
325.00
$7,501 - $10,000
525.00
439.00
379.00
$10,001 — Up
T&E
T&E
T&E
Damage to interior will require billing at other perils rate.
• Above schedule shall include two photographs. local phone calls, 25 road miles
office/clerical expense, local phone/fax and routine supplements.
• Additional expenses include drive time and mileage outside of 25 mil es, additional
photos when necessary, long distance phone/fax charges, express mail charges
and out of pocket expense (such as tolls, parking and official report charges which
are billed at actual cost).
• Salvage disposal and litigation testimony is billed at T&E.
• Burglary and theft losses will be adjusted at T&E.
• T&E interim billing at 60 days.
• Business interruption and stock inventory losses will be adiusted at T-&Eas a
separate claim.
AUG 2 5 2003
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Hams Herman & Gainer, Inc.
Page 4
Additional Expenses:
T&E Property and Casualty
$63.00 per hour (incl. Office/Clerical)
Photos
$3.00 each
Cassettes
$2.00 each
Mileage
$0.50
Ms. Hutcheson, I hope that this information is of help to you in your decision making
process. We will be pleased to answer any additional questions you may have. We look
forward to the opportunity to be of service to the City of Lubbock.
Very truly yours,
Robyn C. Tydelski
Sr. Marketing Representative
Copy Victor Kilman
Purchasing Department
City of Lubbock
P. O. Box 2000
Lubbock, Texas 79457
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AUG 2 5 Z003
UtAM RESOutiGE�
HAMMERMAN & GAINER, INC.
rPJj
Claims Administrators • Consultants • Investigators • Adjusters
i
Wells Fargo Tower
800 West Airport Freeway, Suite 620
Irving, TX 75062
August 26, 2003
Ms. Leisa Hutcheson
Risk Management Coordinator
Department of Human Resources
City of Lubbock
P. O. Box 2000
Lubbock, Texas 79457
Telephone: 972/554/9400
Facsimile: 972/554/8100
www.hng.com
Re City of Lubbock Liability Claims Services — Annual Pricing
Dear Ms. Hutcheson,
Thank you for choosing Hammerman & Gainer, Inc. as the City's liability third party administrator. We
are very excited to have been selected, and we look forward to a long, successful partnership.
Pursuant to our conversation of August 25, 2003, Hammerman & Gainer, Inc. will be pleased to provide
the City with Liability Claims Services beyond the first two years of service for an additional two years of
service at an escalation rate of 4% of the originally quoted pricing. For clarification purposes, your
automobile and general liability claims would be charged at $260 per suffix for an additional two years,
and other liability claims would be charged at $1092.00 per suffix for an additional two years.
Please let me know if you have any questions in this regard. We look forward to working with you.
Very truly yours,
Robyn C. Tydelski
Sr. Marketing Representative
A Risk Technology Institute Company
Texas Office Locations
Texas - Austin, Dallas (Irving), El Paso, Houston, Lubbock, San Antonio
Louisiana - New Orleans (La Place)
HAMMERMAN & GAINER, INC.
Page 2 - August 26, 2003
Copy Larry D. Oney
President, Chief Executive Officer
Hammerman & Gainer, Inc.
Jim Furfari
Vice President, Chief Operations Officer
Hammerman & Gainer, Inc.
1:\safety\rfp's\tpa\02-03\hg2yrrunoffagree.doc
Exhibit B
To Claims Service Agreement
with
City of Lubbock
File Retention and Destruction Policy
The City of Lubbock, or its appointed agent, is subject to the Public Information Act of the State of Texas.
The following is the Retention period on file with the State of Texas:
Schedule GR, Records Common to All Local Governments:
1000-20 (a) Accident Reports
Liability Investigative File 5 Years
(B) Reports of accidents to minors
Liability Investigative File 5 Years, or 2 years after
Minor reaches age 18,
Whichever is later
It is a requirement of the State of Texas that any records destroyed be listed on an approved form and
approved by the City Secretary of the City of Lubbock.
Exhibit C
To Claims Service Agreement
With
City of Lubbock
Loss Fund Account
(1) On or before the effective date of this Agreement, Client will provide an initial imprest deposit to
Service Company in the amount equivalent to five (5) banking days of average anticipated claim and/or
loss and associated allocated expense payments or ten thousand dollars ($10,000), whichever is greater, to
be maintained by Service Company as a loss fund deposit, hereinafter referred to as "Deposit", for payment
of claims and/or losses and associated allocated expense from Service Company's "Loss Fund Account".
(2) Reimbursement to the "Loss Fund Account" will be made by a daily direct debit executed by Service
Company's bank against Client's designated bank account for deposit into Loss Fund Account at Service
Company's bank. Service Company computing the average claim and/or loss and associated allocated
expense payments made daily for Client will determine the amount of the daily direct debit. Each day the
same average amount will be deposited into Service Company's Loss Fund Account via direct debit drawn
against Client's designated bank account. Client shall monitor the daily direct debits and specifically
reserves the right to refuse any direct deposit that exceeds amounts as defined herein. At the end of each
month, beginning with the end of the first month from the effective date of this Agreement, Service
Company will compare the total deposits to Loss Fund Account, including all direct debits resulting from
the average daily budgeted amount and any amount as and specified in (4) below, made during the month
to Service Company's Loss Fund Account to the actual claim payment account detailed in the Monthly
Loss Fund Activity and Loss Run Reports and an adjustment direct debit will be made, so the monthly
deposits are equal to the totals shown on such Loss Fund Activity and Loss Run Reports which reflect
payments based on checks issued.
(3) Service Company will conduct a quarterly analysis of the adequacy of the Deposit in Service
Company's Loss Fund Account based upon the most current three (3) months of Loss Fund Account
activity. If the analysis determines that the current average Loss Fund Account activity exceeds the then
existing Deposit, then Service Company will authorize its bank to initiate an adjustment direct debit in the
amount necessary to bring the Deposit to the level stipulated in (1) above. Service Company will adjust the
average daily direct debit to the revised average daily Loss Fund Account activity in accordance with (2)
above.
(4) Service Company will notify Client, via facsimile, whenever any single claim and/or loss payment or
associated allocated expense payment is to be made for ten thousand dollars ($10,000) or more, and these
amounts will be included in the direct debit along with the daily budget amount upon approval of Client.
Service Company will not consider such amounts in arriving at the daily budgeted direct debits and will not
consider such amounts in computing the necessary Deposit required of Client as set forth in (3) above.
(5) An appropriate letter, hereinafter referred to as the "letter of Authority", will be provided, within fifteen
(15) days from the effective date of this contract, to Service Company's bank authorizing the Service
Company's bank to initiate the necessary daily direct debits against Client's designated bank account for
deposit to the Loss Fund Account at Service Company's bank. In addition, Client will furnish Service
Company with such account documentation with respect to the Loss Fund Account that may be required by
Service Company's bank and the Service Company respectively.
(6) Service Company may draw and authorize checks, drafts, and other items on the Loss Fund Account
only if Service Company determines that it has sufficient funds in the Loss Fund Account to cover such
checks, drafts, and other items.
(7) Service Company will issue checks from the Loss Fund Account for amounts in excess of Client's per
occurrence self-insurance retention unless Client specifically instructs Service Company to the contrary so
long as the Loss Fund Account balance is adequate to accommodate such amounts such amounts or
necessary additional deposits are made by Client to the Loss Fund Account to adequately accommodate
such amounts or necessary additional deposits are made by Client to the Loss Fund Account in payment of
any amount in excess of Client's specific per occurrence self-insurance retention, as identified by Client to
Service Company until such time as Client transfers fund for the full amount of such payment into the Loss
Fund Account. Service Company assumes and has no responsibility or obligation to recover from any of
Client's excess insurer(s) any amounts represented by checks issued from the Loss Fund Account.
No Text