Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
Resolution - 2006-R0458 - Agreement - Hammerman & Gainer Inc.- Insurance Claim Investigation And Payment - 09_28_2006
Resolution No. 2006-RO458 September 28, 2006 Item No. 5.15 RESOLUTION BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK: 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 281h day of September, 2006. DAVID A. MILLER, NAYOk ATTEST: Reb ca Garza, City Secretary APPROVED AS TO CONTENT: Leisa Hutcheson, Risk Manager APPROVED AS TO FORM: ssisidni Lary ,vitorncy as/ cityattllohniResolntions, Hammerman & Gamer September 19, 2006 Resolution No. 2006-RO458 September 28, 2006 Item No. 5.15 CLAIM SERVICE AGREEMENT THIS AGREEMENT is made as of this day of ,i1fiy1/ 2006, 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 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, 2006 and ending September 30, 2007. 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 06-056-MA, and Service Company's response attached hereto and made a part hereof Claim pricing proposal I in Exhibit A. 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") shalI 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 2 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 and VI 3 below. If Client assumes the control and handling of any Claim under Article VI 2 and VI 3 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 time 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 a primary additional insured on 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 3 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 S1,000,000 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 pursuant to Section 406.002 of the Texas Labor Code and shall maintain Employers Liability Insurance in the amount of S500,000. 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 S100,000 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 waive the fees paid or payable by Client and 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, 4 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" and 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. ARTT(-'T.F TV 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. 1. 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. 5 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. W. 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 21 directors, officers, attorneys, employees, agents or other representatives, (ii) Service Company being named in litigation as the insurer of record, (Ili) 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 I. This Agreement covers the period as stated in Article 1. 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 7 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. 2. 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 Article VI 3 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. 9 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. ARTTCLF. VTT GOVERNING LAW This Agreement shall be governed by, and its provisions construed in accordance with, the laws of the State of Texas. Any disputes will be handled in Lubbock, Lubbock County, 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. AR TIC..T .F. 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 1112 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 parry 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 Attn: Larry D. Oney, President If to Client CITY OF LUBBOCK P. O. Box 2000 Lubbock, TX 79457 Attn: Leisa Hutcheson, Risk Manager ff 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 COUNTERPAR 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 28th day of September , 2006. CITY OF LUBBOCK HAMMERMAN AND GAINER, INC. h DAVID A OILLER, MAY6R ` BRA ORD WEBB, CHIEF OPERATING OFFICER ATTEST. f1 Rebecca Garza, City Secretary F1 APPROVED AS TO CONTENT: Leisa Hutcheson, Risk Manager APPROVED AS TO FORM: Knight, Asgifstant City Attorney HG Contract-Final.06 12 Resolution No. 2006-RO458 September 28, 2006 Item No. 5.15 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 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 pre -approved by the City Secretary of the City of Lubbock. 1'3 Resolution No. 2006-RO458 September 28, 2006 Item No. 5.15 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 14 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. (b) 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. 1'5 "E�IBIT A" Resolution No. 2006-RO458 RFP #06-056-MA, Liability Claims Services SUBMIT TO: , o CITY OF LUBBOCK a 1 Purchasing & Contract Management CITY OF LUBBOCK, TEXAS % 1625 13`b Street, Rm 204 Lubbock, Tx REQUEST FOR PROPOSAL 79401-3830 AN EQUAL OPPORTUN 1 TY #Q 6-056-MA CONTACT PERSON: Marta Alvarez EMPLOYER TEL: 806.775.2167 FAX: 806.775.2164 http://purchasing.ci.lubbock,tx.us TITLE: Liability Claims Services SUBMITTAL DEADLINE: August 24, 2006, 3:00 p.m. CST PRE PROPOSAL DATE, TIME AND LOCATION: August 08, Any proposals received after the time and dale listed 2006 at 10:00 A.M. in the Municipal Building, 1625 13t° above.. regardless of the mode of delivery, shall be Street Purchasing C204 Lubbock,Texas. returned unopened. RESPONDENT NAME: OF 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 AND WAIVE ANY INFORMALITY IN THE COMPETITIVE PROPOSAL PROCESS. FURTHER, TELEPHONE NO: THE CITY RESERVES THE RIGHT TO ENTER INTO ANY CONTRACT DEEMED TO BE IN THE BEST INTEREST OF THE CITY. FAX NO: IT IS THE INTENT AND PURPOSE OF THE CITY OF LUBBOCK THAT THIS REQUEST PERMITS COMPETITIVE PROPOSALS. IT IS THE OFFEROR'S E-MAIL: RESPONSIBILITY TO ADVISE THE CITY OF LUBBOCK PURCHASING MANAGER IF ANY LANGUAGE, REQUIREMENTS, ETC., OR ANY COMBINATIONS THEREOF, INADVERTENTLY RESTRICTS OR LIMITS FEDERAL TAX ID NO. OR SOCIAL SECURITY NO. 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 THAN FIVE (5) BUSINESS DAYS PRIOR TO THE ABOVE SUBMITTAL DEADLINE. THE OFFEROR HEREBY ACKNOWLEDGES RECEIPT OF AND AGREES ITS PROPOSAL IS BASED ON ANY ADDENDA POSTED ON I7.FPDEPOT.COM 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 firm? 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. Authorized Signature Title Print/Type Name Date THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR RESPONSE. 06-056RFP.doc RFP #06-056-MA. Liability Claims Services Liability Claims Services CITY OF LUBBOCK, TEXAS RFP #06-056-MA 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: 1. INSTRUCTIONS TO OFFERORS 1 PROPOSAL DELIVERY, TIME & DATE 1.1 The City of Lubbock will receive written and sealed competitive proposals for Liability Claims Services until 3:00 p.m. p.m. CST, August 24, 2006, if date/time stamped on or beiire 3:00 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 sealed envelope or container plainly labeled in the lower left-hand corner: "RFP #06-056- MA, Liability Claims Services " 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: Marta Alvarez, Purchasing Manager City of Lubbock 1625 13th Street, Room 204 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 will 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 bidders with the requirements, answering questions, and issuing addenda as needed for the clarification of the Invitation to Bid (ITB) documents, fro -bid meeting will be held at 10:00 A.M. August 8. 2006 in the Municipal Building, 1625 13« Street, Purchasing CR204, Lubbock. Texas. All persons attending the conference will be asked to identify themselves and the prospective bidder they represent. 06-056RFP.doc 2 RFP #06-056-MA, Liability Claims Services 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. 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 PurchasingAmanager 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. 3.2 ALL REQUESTS FOR ADDITIONAL INFORMATION OR CLARIFICATION CONCERNING THIS REQUEST FOR PROPOSAL (RFP) MUST BE SUBMITTED IN WRITING NO LATER THAN FIVE (5) BUSINESS DAYS PRIOR TO THE PROPOSAL CLOSING DATE AND ADDRESSED TO. Marta Alvarez, Purchasing Manager City of Lubbock 1625 I P Street Lubbock, Texas 79401 Fax: (806) 775-2164 Email: [name]@mylubbock.us RFPDepot: http://www.PFPdenot.com 4 ADDENDA & MODIFICATIONS 4.1 Any changes, additions, or clarifications to the RFP are made by ADDENDA information available over the Internet at http://www.RFPdepot.com. We strongly suggest that you check for any addenda a minimum of forty-eight hours in advance of the response deadline. BUSINESSES WITHOUT INTERNET ACCESS may use computers available at most public libraries. 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 addenda issued by the Purchasing Department. Such addenda issued by the Purchasing Department will be available over the Internet at httn://www,RFPdoot.com 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 The City does not assume responsibility for the receipt of any addendum sent to offerors. 5 EXAMINATION OF DOCUMENTS AND REQUIREMENTS 06-056RFP.doc 3 RFP #W-056-MA, Liability Claims Services 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 shall 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 6.1 OFFEROR'S MUST SUBMIT THE ORIGINAL AND FOUR COPIES OF THE SEALED PROPOSAL TO THE PURCHASING DEPARTMENT PRIOR TO RESPONSE DUE DATEITIME. FAILURE TO SUBMIT THE ADDITIONAL COPIES MAY RESULT IN THE PROPOSAL BEING DECLARED UNRESPONSIVE. The original must be clearly marked "ORIGINAL" and the copies must be clearly marked "COPY". 6.2 All proposals, responses, inquiries, or correspondence relating to or in7eference 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 All costs related to the preparation and submission of a proposal shall be paid by the proposer. 8 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 will 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 will 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 will 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 06-056RFP,doc 4 RFP #06-056-MA, liability Claims Services Section 552.110 of the Government Code and Section 252.049 of the Local Government Code, then such information will be made available to the requester. 8.4 Marking your entire proposal CONFIDENTIAL/PROPRIETARY is not in conformance with the Texas Open Records Act. 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 (DBE's) 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 DELETED 11 CONFLICT OF INTEREST 11.1 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. 11.2 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. 12 ANTI -LOBBYING PROVISION 12.1 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. 12.2 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. 13 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. 14 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 06-056RFP.doe 5 RFP #06-056-MA, Liability Claims Services meeting firm specifications for the lowest price. As such, the lowest price proposed will not guarantee an award recommendation. Sealed 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 will 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 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. 15 EVALUATION PROCESS 15.1 All proposals will be evaluated by an evaluation committee and may include senior management representatives, a financial officer, and/or an independent consultant. 15.2 Respondents to this RFP may be required to submit additional information that the City may deem necessary to further evaluate the offeror's qualifications. 15.3 The committee will evaluate and numerically score each proposal in accordance with the evaluation criteria included in the Request for Proposal. 15.4 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. 16 SELECTION 16.1 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. 16.2 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. 17 EQUAL EMPLOYMENT OPPORTUNITY Offeror agrees that it will not discriminate in hiring„ promotion, treatment, or other terns 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. 18 NONAPPROPRIATION All 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 ofthe then -current fiscal year or when the appropriation made for the then -current year for the goods or services covered by 0"56RFP.dac 6 RFP #06-056-MA, Liability Claims Services this contract is spent, whichever event occurs first. If at any time funds are not appropriated for the continuance of this contract, cancellation shall 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 shall not be obligated under this contract beyond the date of termination. 19 PROTEST 19.1 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. 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 Manager. All staff recommendations will be made available for public review prior to consideration by the City Council as allowed by law. 19.2 FAILURE TO PROTEST WITHIN THE TIME ALLOTTED SHALL CONSTITUTE A WAIVER OF ANY PROTEST. The City oT Lubbock is aware of the time and effort you expend in preparing and submitting proposals to the City. Please let us know of any requirement causing you difficulty in responding to our Request for Proposal. We want to facilitate your participation so that all responsible firms can compete for the City's business. Awards should be made approximately two to six weeks after the opening date. If you have any questions, please contact the City of Lubbock Purchasing Manager at (806) 775-2165. 06-056RFP.doc 7 RFP WS-056-MA. Liability Claims Services H. GENERAL REQUIREMENTS 1 INTENT a) The City of Lubbock (hereinafter called "City") is seeking proposals from interested firms and individuals, (hereinafter called "Offeror") to provide Liability Claims Services — Annual Pricing. b) Offerors 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 shall 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 shall administer, process and aggressively investigate all General, Automobile, and Other ( Police, Employment and Public Entity) 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 you with the following list of issues that we feel should assist you when preparing your overall presentation. Estimated Number of Annual Claims • Automobile Claims 50 • General and Other Liability Claims 325 Loss information provided is based upon anticipated volume of claims. The City of Lubbock will 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. Assistance/Problem Resolution • To have one key contact person with a solid claims background that coordinates activities between your internal department (e.g., sales, administration, claims and accounting) and The City of Lubbock Risk Management Department. • To have one key contact person with at least five years experience to resolve claim related programs/issues on Liability claims. Claims Management 06-058RFP.doc 8 RFP #06-056-MA, Liability Claims Services • To have a designated claims supervisor for Liability claims. • To have a designated claims adjuster in the Lubbock, Texas office for Liability claims. • To allow the City of Lubbock Risk Manager and/or their designated representative the opportunity of physically reviewing the claim files on an as needed basis or conduct telephone reviews directly with the claim representative. • To have an active and aggressive file supervision program for Liability claims. • To have timely access to competent technical and legal knowledge. • In an effort to select the claims service provider best equipped to minimize the City of Lubbock's cost of loss and expense, the City of Lubbock has developed minimum standards expected of the service company. These standards, combined with the field instruction procedures, shall serve as the basis for an annual performance review of the service provided. Performance service reviews may be done on an as needed basis other than annually. • To have proven large account experience. • Utilize its own staff to keep contractor's use at a minimum. • Exhibit internal/external fraud control measures. • Conduct its own routine internal field audits. Internal Audits 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 will have location codes verified and changed if the investigation warrants. • All claims will be appropriately coded for General Liability, Police Liability, Employment Liability and Other liability and shall distinguish between bodily injury and personal injury. • The City of Lubbock will be copied on all denial letters. • No claim settlement shall be made without prior approval of City of Lubbock. • 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 City of Lubbock that will provide the Offeror with a copy of all correspondence. • Verbal approval for settlement can be secured for cases less than S 10,000. However, the claim representative should be prepared to discuss the merits of the claim. • $10,000 or more settlement value, the service company shall provide a written request to the City of Lubbock Risk Manager prior to settlement negotiations commencing. The report shall include the following- (1) Claimant's name (phone number) Social security number (2) Accident location 06-056RFP.doc 9 RFP #06.056-MA, Liability Claims Services (3) Location code (4) Date of loss (5) Claim adjuster Supervisor's name (phone number) (b) Details of the case (7) Results of your investigation (8) Theory of liability Application of the law (9) Nature of the claimant's allegations (10) Possible exposure (11) Recommendations for future handling (12) Reserves and paid amounts by category (13) Settlement recommendations • The City of Lubbock will require that the successful vendor be able to obtain claim or expense checks that do not exceed $10,000, within 24 business hours. Defense Counsel The City of Lubbock retains the right to select legal counsel to represent its interest and will be assigned by the City Attorney's office of the City of Lubbock. Subcontracts Although the City of Lubbock does not envision subcontracting of services, all subcontracting arrangements must be approved by the City of Lubbock Risk Manager and as they reserve the right to approve such arrangements. Should it become necessary to enter into a subcontract, a written request for approval shall be submitted to the City of Lubbock Risk Manager providing the following information: ► Purpose of subcontract services ► Benefits to the City of Lubbock ► Costs/expenses associated with the service ► Reason Service Company cannot provide the service ► Background information on the subcontract service provider ► Copy of the contract The service company shall be responsible for the subcontracting service company in its entirety, as if they were their own company. All terms, conditions, specifications and requirements shall apply to the subcontracting service company. 06-056RFP.doc 10 RFP #06-056-MA, Liability Claims Services Third -Party Litigation The servicing company shall not join any third -party in any suit on behalf of the City of 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 loth day of each month via Compact Disc and in a format compatible with Microsoft Excel. • Reports shall be provided until all claims assigned under the contract are closed. 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 claim. • The City of Lubbock must be notified within 24 hours of recognition of any claim 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 Risk 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 City of Lubbock without prior consent of the City of Lubbock Risk Manager. Structured Settlements The City of Lubbock requests consideration for utilization of structured settlements of serious injury cases or in any case where it may be deemed cost effective. Settlements on Minors The City of Lubbock requires that all settlements on minors be concluded by friendly suit. Assigximent for counsel shall be made by the City Attorney's office of the City of Lubbock. SRecial Handling Instructions Prior to any individual claim activity, a review of the procedural guidelines set by the City of Lubbock and the servicing company is required. Claim Investigation 06-056RFP.doc 11 RFP #06-056-MA, Liability Claims Services • 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 to be contacted within 24-hours of receipt of notice. • Contact all available witness within 48-hours of receipt of notice. • Obtain statements from the claimant and/or witnesses in the following cases. Serious Injuries (Amputations, disfigurement, quadriplegic, paraplegic, etc.) Fatalities Assault and Battery Pre-existing medical or claim condition Suspected Fraud Requested by the City of Lubbock Risk Manager • Maintain a current activity log (manual or automated) outlining current status for each claim. • An action plan shall be provided on each claim for future handling. • Conduct activity checks as necessary with City of Lubbock Risk Manager concurrence. • Schedule independent medical examination (IME) and secure necessary medical 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 Attorney's office shall manage all cases in litigation; however, Risk Management shall be informed of any requests made by the City Attorney's office. • 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 operational 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 $250,000 or greater. Pricing/Runoff Include a listing of those allocated charges not included in your nricin. These forms must be used to submit your pricing options and they may be copied. A detailed written explanation of your offer can be provided to support your position or plan. 06-056RFP.doc 12 sb RFP #06-056-K4A, Liabilit Claims Services TYPE OF CLAIM PRICING Option I Option II Option III Option IV Automobile Liability General Liability Other Liability (Police, Employment, Public Officials) Option I — Flat Fixed Fee for Life of the Claire Option II — Fee for Two Year Claim Service Option III — Flat Fixed Fee for Contract Period Option N — Other Pricing Structure You Care to Submit 4 EVALUATION CRITERIA All proposals will 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 well qualified personnel, ability to provide a technical and comprehensive investigation process, ability to satisfy authority levels, ability to respond within 30 minutes in the event of an emergency, ability to provide local adjuster 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 ability to accommodate appropriate funding transfers for payment of claims. Cost 25% Includes consideration of options quoted including all allocated expenses. 5 CONTRACT The City of Lubbock shall not consider this service contract claim proposal complete unless the service company's planned contract specific to the City of Lubbock, Texas is attached as part of the proposal with proposed terms, conditions and pricing. The service company shall be properly licensed to do business in the state of Texas. 06-056RFP.doc 13 RFP #06-056-MA, Liability Claims Services The City of Lubbock will retain the right of approval regarding the assignment of personnel to service their account. The City of Lubbock prefers an annual contract renewable for two (2) additional terms. However, the service company must agree that services may be terminated without cause upon sixty (60) days written notice. In the event of termination, the service company may be required to provide the necessary best effort to transfer records and cumulative loss data to a superseding service company for the City of Lubbock. The service company shall be responsible and held accountable and responsible for any all erroneous payments and overpayments caused by the service company, its employees and subcontractors. The service company shall notify the City of Lubbock of any imminent or pending court actions at the earliest opportunity. The service company shall be responsible and held accountable for any and all payments to third -parties and legal expenses resulting from errors and omissions of the service company, its employees and subcontractors related to the claim handling process for Automobile, General and Other liability claims. The service company shall defend, hold harmless and indemnify the City of Lubbock for any acts, error or omissions of their firm, employees, associates, or subcontractors arising out of the services provided. Insurance protection carried by the servicing company for services rendered shall be primary to policies that may be carried by the City of Lubbock. Any and all materials/documents gathered or produced are the sole property of the City of Lubbock and shall be retained or destroyed in accordance with their instructions. Allocated expenses DO NOT include office operating expenses, telephones, and expenses for salaried employees of the service company or the subcontractor. 6 PENALTIES Specific standards have been established to effectively and efficiently manage City of Lubbock claims. It is of paramount 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 for a failure to follow established procedures and guidelines. 06-056RFP.doc 14 RFP #06-056-MA, Liability Claims Services • 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. 7. INSUP.ANCE REQUIREMENT The servicing provider must provide the following insurance prior to contract execution in the limits indicated. 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. Upon award of the Contract to the successful proposer, the Consultant shall submit a Certificate of insurance naming the City as a primary additional insured on the General Liability Insurance and Auto Liability Insurance policies. All policies shall be endorsed to include a waiver of subrogation in favor of the City. • General Liability Insurance with a minimum of $1,000,000 CSL in the aggregate and per occurrence. • Professional Errors and Omissions with a minimum limit of $1,000,000 CSL in the aggregate and per occurrence. Auto Liability with a minimum limit of $500,000 CSL in the aggregate and per occurrence. • The firm shall elect to obtain Workers' Compensation Insurance pursuant to Section 406.002 of the Texas Labor Code and shall maintain Employers Liability Insurance in the amount of $500,000. The service company shall defend, hold harmless and indemnify the City of Lubbock for any acts, error or omissions of their firm, employees, associates, or subcontractors arising out of the services provided. Insurance protection carried by the servicing company for services rendered shall be primary to policies that may be carried by the City of Lubbock. 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 your 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: 06-056RFP.doc 15 RFP #06-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal YES NO % COMMENTS 1. CLAIM -CANDLING COMPANY QUALI IMATIONS A. Does your company carry Professional Liability Insurance in the aggregate amount of $2,000,000 that would apply to this activity? If so, please provide a current certificate of insurance. B. Does your company have, or have they had in the past five years, any E&O claims filed against them? If so, how many? C. Are you a member of the Claim Index Bureau Reporting System? OM56RFP.doc 16 RFP #06-0564AA, Liability Claims -Services D. Does your company have a Formal Quality Control program in place? Explain. E. Does your company have an Automated Claim Reporting System? If so, can the client have access? Is there a charge for client access? If so, how much? F. Does your company have a 24-hour emergency number with an adjuster that can respond in 30 minutes or less? G. Can Loss Runs be provided monthly on a CD, or sent electronically, in a format compatible to Microsoft Excel? Is there are additional cost for this? 06-056RFP.doc 17 RFP #06-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal YES NO % COMMENTS 2. STAFFING AND TRAININC A. Does your company have an in-house or ongoing training program for claims personnel? Explain. B. What is your average case load per adjuster per line of business? Please indicate the mix of claims that your adjusters handle. For example, does your Liability adjuster handle a mix of cases that would include both minor and serious claims? • General and Other Liability • Automobile Liability 06-056RFP.doc 18 RFP #06-056-MA. Liabilitv Glaims.Sarviees C. Does your company have caseload guidelines? if so, what are they by line of business? • General and Other Liability • Automobile Liability Are they adhered to? D. What is your average turnover rate for supervisors? E. What is your average turnover rate for adjusters? F. What is your average turnover rate companywide? G. Can we designate key adjusters to handle our losses? H. Can we designate key supervisors to handle our losses? O"56RFP.doc RFP #06-0%-MA, Uability Claims Services Answer the following questions, and submit with your proposal • coordinate activities? Is there an addition fee? If so, how much? B. Shall the contact person have the: • Authority to implement changes requested by the City of Lubbock Risk Management? • Authority to meet with City of Lubbock Risk Management quarterly to discuss outstanding problems and issues? • Is there a charge for these activities? If so, how much? 06-056RFP.doc 20 RFP #06-0564AA, Liability Claims Services Answer the following questions, and submit with your proposal YES NO % COMMENTS 4,r= s b,i o S A. Are you willing to quote a fee for? Option I Option II Option III Option IV B. Specifically, what are considered allocated expense? Please list. 06-056RFP.doc 21 RFP #06-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal PIES _ : NOD eln G�MIIN'�S 5. CLAIM MANAGEMENT A. Does your company have written claim handling standards for: • General and Other Liability • Automobile Liability if so, please forward a copy. • Are recorded statements taken? • What is the maximum diary allowed? • Are action plans developed and followed on files? 06-056RFP.doe 22 RFP #06-0564AA, Liability ClaimSServices Answer the following questions, and submit with your proposal YES NO % COMMENTS - 6.. CLAti�C. A. Are claims handled by telephone or field adjuster? B. Is there additional costs for field adjusters? C. Shall all claimants and the City of Lubbock Risk Management contacts be made within 24-hours from the date notice received? D. Does your company have written claim handling standards that include: • When recorded statements taken? • What is the maximum allowable diary? • Action plans being developed and followed on files? 06-056RFP,Clm 23 RFP #06-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal X +;S Nos. 1% COMMENTS 7. RESERVING A. What is your reserving philosophy? B. Who is responsible for establishing reserves? C. How soon are initial reserves set? D. Is a reserve analysis contained in every file? Please provide a sample. E. How often arc reserves reviewed? 06-OMRFP.aoc 24 RFP N06OM-MA, Uabiliity Claims Services Answer the following questions, and submit with your proposal YES NO % COMMENTS & REFQRT1NG A. Are captioned reports completed on files? If so, • at what level? • how often? • provide sample B. Are captioned reports sent to client? If so, how often? Is there a fee? If so, how much? C. Are clients notified timely and in writing of hearings and trails? D. Shall the City of Lubbock Risk Manager be kept apprised of all claims as they deem necessary? E. Are files actively supervised? If so: • how often? • what reserve level? F. Are files supervised by both branch and regional personnel? 06-056RFP.doc 25 RFP #006-06&MA, Liability Claims Services Answer the following questions, and submit with your proposal YES NO % 00h9l1VIENTS 9. CLAISIWFILE REVIEWS A. Does your company allow claim file reviews? If so, is there an additional cost? What is the cost? B. Does your company allow physical audits of claim files? 06-056RFP.doc 26 RFP #06-0564AA, Uabillty Claims Services Answer the following questions, and submit with your proposal YES NO % COMMENTS 10, STRUCTURED SIE T YLEMENTS ^_ A. Does your company utilize structured settlements? B. Have you established guidelines when considering this approach to settlement? If so, please provide a copy of these guidelines. C. Are there separate costs associated with this service? If so, please provide your pricing structure 06-056RFP.doc 27 RFP #06.056-MA, Liability Claims Services 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 FORMMUST BE RETURNED WITH YOUR PROPOSAL Government/Company Name: Address: Contact Person and Title: Phone: REFERENCE ONE Fax: Contract Period: Scope of Work: REFERENCE TWO Government/Company Name: Address: Contact Person and Title: Phone: Fax: Contract Period: Government/Company Name: Address: Contact Person and Title: Scope of Work: REFERENCE THREE Phone: Fax: Contract Period: Scope of Work: 06-056RFP.doc 28 RFP #06-056-MA, Liability Claims Services EXHIBIT A CLAIMS REPORTING REQUIREMENTS An individual authorized to bind the COMPANY must sign off on the following requirements. ("You" in the text below refers to the Insured; "We" refers to the Insurer.) You must give us prompt notice of any accident which may result in a claim or suit seeking an amount for loss in excess of your "bodily injury by accident" retention. The notice must be no later than 30 calendar days from the date you are notified of such accident. The notice should include: a. How, when and where the accident took place; b. The names and addresses of any injured persons and witnesses; and c. Complete details of the injury or death. Authorized Signature # 1 a,b & c 2. You must furnish us with: a. A monthly report which provides the following information (by claim year) for each claim or suit which was outstanding, opened, revised or closed during the previous month: the identify of the claimants or injured parties; the dates, places, description and cause of injuries; the amounts of reserves for such claim or suit; claims expenses (both paid and outstanding) and payments of claims; judgments or settlements. This report must be furnished not later than the 10th day after the end of each month. b. Written notification of each claim or suit which has, or should have or is likely to have, without regard to liability, a reserve equal to or exceeding fifty percent (50%) of your retention. Written notice must be provided as soon as possible, but no later than fifteen (15) calendar days from the date you have sufficient knowledge of facts surrounding such claim or suit which could put you on notice that such reserve or payment is indicated. Complete files on such claim or suit must be given to us within thirty (30) calendar days from the date we request such files. 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); 06-056RFRdoc 29 RFP #0"56-MA, Liability Claims Services (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 & d 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 actin 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 & d S PROPOSAL FORMAT a) Proposals should provide a straightforward, concise description of the Offeror's capabilities to satisfy the requirements of the RFP. Emphasis should be on completeness, clarity of content, and conveyance of the information requested by the City. b) The original copy of the proposal should be bound in a single volume where practical. All documentation submitted with the proposal should be bound in that single volume. c) If the proposal includes any comment over and above the specific information requested in the RFP, it is to be included as a separate appendix to the proposal. d) The original copy of the proposal must be organized into the following response item sections and submitted in an indexed binder. i) Cover letter addressed to the Honorable Mayor and City Council that states the Offeror understands the services to be provided. Include any additional information believed necessary that is not requested elsewhere in the RFP. 0"56RFP.doc 30 RFP #06-056-MA, Liability Claims Services ii) A description of the methodology to be used to complete the project to include, but not be limited to, how recommendations will be formulated and commitment of adequate appropriate resources to the project. iii) Offeror's specific expertise in areas pertinent to the project to include a listing and brief description of similar projects completed (with the dates of completion) or in progress and a list of references by name, address, and telephone number for each project listed. This list of projects in progress shall include the phase of work that each project is currently in (i.e. design, bid, construction), and the estimated completion date. iv) A brochure (if applicable) of past work, with emphasis on comparable projects. v) List of principal(s) of the Offeror and amount of time that principal(s) will be involved in the project. vi) List of other professionals to be used, if applicable, with a record of experience in projects of this nature. Identification of principal(s) and percentage of time the principal(s) will be involved in the project. vii) The organizational structure of the employees who will be assigned to this project along with resumes of those individuals. If a joint venture is expected, then provide the organizational structure of the sub -contractor and resumes of those persons who will be involved in the project. viii) The Offeror must assure the City that he/she will to the best of his/her knowledge, information and belief, be cognizant of, comply with, and enforce, where applicable and to the extent required, all applicable federal or state statutes and local ordinances including, but not limited to the Davis -Bacon Federal minimum wage requirements. ix) Describe the Offeror's methodology for handling errors and omissions. x) Disclosure of any obligations posing a potential conflict of interest, including service on City boards and/or commissions and any current contracts with the City of Lubbock. This would apply to the Offeror as well as consultants subcontracted by the Offeror. xi) Offerors are strongly encouraged to explore and implement methods for the utilization of local resources, and to outline how they would address outreach issues in their proposal. It is also the desire of the City that the City of Lubbock program serve, as much as practicable, to stimulate growth in all sectors of the local business community. Describe how your firm would facilitate this process, and provide any relevant information about similar efforts on previous projects. xii) Any material which the proponent wishes to submit and which is not specifically requested in the above categories. 06-056RFP.doe 31 RFP #06-056-MA, Liability Claims Services CITY OF LUBBOCK INSURANCE REQUIREMENT AFFIDAVIT To Be Completed by Bidder And Attached to Bid Submittal 1, the undersigned Bidder, certify that the insurance requirements contained in this bid document have been reviewed by me with the below identified Insurance Agent/Broker. If I am awarded this contract by the City of Lubbock, I will be able to, within ten (10) days after being notified of such award by the City of Lubbock, furnish a valid insurance certificate to the City meeting all of the requirements defined in this bid/proposal. Contractor (Signature) Contractor (Print) CONTRACTOR'S NAME: (Print or Typel CONTRACTOR'S ADDRESS: Name of Agent/Broker: Address of Agent/Broker: City/State/Zip: Agent/Broker Telephone Number: { Date: I NOTE TO CONTRACTOR I If the time requirement specified above is not met, the City has the right to reject this bid/proposal and award the contract to another contractor. If you have any questions concerning these requirements, please contact the Purchasing Manaaer for the Citv of Lubbock at (806) 775-2165. 06-056RFP.doc 32 RFP #06-056-MA, Liability Claims Services SUSPENSION AND DEBARMENT CERTIFICATION Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non -Federal entities from contracting with or making sub -awards under covered transactions to parties that are suspended or debarred or whose principals are suspended or debarred. Covered transactions include procurement contracts for goods or services equal to or in excess of $25,000 and all non -procurement transactions (e.g., sub -awards to sub -recipients). Contractors receiving individual awards of $25,000 or more and all sub -recipients must certify that their organization and its principals are not suspended or debarred by a Federal agency. Before an award of $25,000 or more can be made to your firm, you must certify that your organization and its principals are not suspended or debarred by a Federal agency. I, the undersigned agent for the firm named below, certify that neither this firm nor its principals are suspended or debarred by a Federal agency. COMPANY NAME: Signature of Company Official: Date Signed: Printed name of company official signing above: 06-056RFP.doe 33 "IMIBIT All HAMMERMAN & GAINER, INC. Resolution No. 2006—RO458 Fdl, Claims Administrators • Consultants • Investigators • Adjusters Proposal for Liability Claims Services RFP-06-056-MA The City of Lubbock Proposal Due: August 24, 2006 at 3:00 P.M. Marta Alvarez Purchasing Manager City of Lubbock 1625 13`h Street, Room 204 Lubbock, Texas 79401 806-775-2167 Mike Kessler Vice President Hammerman & Gainer, Inc. 800 West Airport Freeway Ste. 301 Irving, Texas 75062 972-554-9400 A Risk Technology Insi7lute Company Office Locations Califomia - Banning Texas - Austin, Dallas/Fort Worth (Irving), El Paso, Houston, Lubbock, San Antonio Louisiana - Lafayette, Now Orleans (Laplace), Shreveport TABLE OF CONTENTS 1. LETTER OF REPRESENTATIVES AND CERTIFICATIONS .................1-1 2. EXECUTIVE SUMMARY .................................... ..... .......... ............2 1 Hammerman & Gainer, Inc. is the Best Financial Choice 3.OVERVIEW OF HAMMERMAN & GAINER, INC.................................3-1 Hammerman & Gainer, Inc. Introduction Hammerman & Gainer, Inc. Research Sources Hammerman & Gainer, Inc. Publications Hammerman & Gainer, Inc. Continuing Education Seminars Hammerman & Gainer, Inc. Disadvantaged Business Enterprise Hammerman & Gainer, Inc. Conclusion 4. LIABILITY CLAIMS ADMINISTRATION .............. .............4-1 Hammerman & Gainer, Inc. Service Office Hammerman & Gainer, Inc. Adjusting Personnel Hammerman & Gainer, Inc. Liability Accident Investigation Hammerman & Gainer, Inc. Appraisals Hammerman & Gainer, Inc. Reserving Practices Hammerman & Gainer, Inc. Index Bureau and DMV Reporting Hammerman & Gainer, Inc. Diary. System Hammerman & Gainer, Inc. Subrogation/Third Party Involvement Hammerman & Gainer, Inc. Electronic Data Interchange Hammerman & Gainer, Inc. Financial Administration Hammerman & Gainer, Inc. Quality Control Hammerman & Gainer, Inc. 24-Hour Capability Hammerman & Gainer, Inc. Lubbock Office Staff Proposed for Lubbock 5. RISK MANAGEMENT INFORMATION SYSTEMS AND REPORTS ........ 5-1 i The Allegro Integrated Risk Management Information System . WinFrame/Metaframe 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 . City of Lubbock Personnel Access to our System Ad Hoc Reporting Capabilities System Security Archiving of Closed Claim Files • Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24.2006 Extraction of Data to be Loaded into Allegro Additional Comments on Allegro 6. REQUIRED FORMS AND QUESTIONNAIRE.....................................6-1 Questionnaire Vendor References Exhibit A Insurance Requirement Affidavit Suspension. and Debarment Certification 7. PRICING OPTIONS........................................................................7-1 8. ATTACHMENTS.........................................................................8-1 A. Hammerman & Gainer, Inc. - TPA Specific Information B Hammerman & Gainer, Inc. - Liability Claim Management Standards of Performance C. Hammerman & Gainer, Inc. - Certificate of Insurance D. Hammerman & Gainer, Inc. - Texas TPA License E. Hammerman & Gainer, Inc. - M/WBE Certification F. Hammerman & Gainer, Inc. - Financials G. Hammerman & Gainer, Inc. - References H. Hammerman & Gainer, Inc. - Reference Letters I. Hammerman & Gainer, Inc. - Sample RMIS Reports from Allegro Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 raHAMMERMAN & GAINER, INC. Claims Administrators - Consultants - Investigators • Adjusters Wells Fargo Tower Telephone: 972-554-9400 800 West Airport Freeway Suite 301 Facsimile: 972-554-8100 Irving, Texas 75062 August 24, 2006 Marta Alvarez Purchasing Manager City of Lubbock 1625 131h Street, Room 204 Lubbock, Texas 79401 806-775-2167 Re Proposal for Liability Claims Services RFP-06-056-MA Dear Ms. Alvarez, Thank you for the opportunity to submit this proposal. Hammerman & Gainer, Inc. does hereby declare that they have read and understand the Request for Proposal for Liability Claims Services for the City of Lubbock. 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. 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. A Hammerman & Gainer, International Group Company Office Locations California — Redlands • Texas — Austin, Dallas/Fort Worth, El Paso, Lubbock. San Antonio Louisiana —Alexandria, New Orleans, Shreveport HAMMERMAN & GAINER, INC. Page 2 — August 24, 2006 We are very excited about the opportunity to work with the City of Lubbock. Our management team is focused on providing the best service to our customers in part by employing the best adjusters. Simply stated, our goal is to maintain "Triple A" service to Lubbock. We pride ourselves on our accessibility, our accountability and our accuracy. Our internal associates have embraced this philosophy as their responsibility to all of our external customers. 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 during the term of the agreement. The undersigned is the designated contact representative for Hammerman and Gainer, Inc. and is authorized to accept the terms and conditions proposed herein. We acknowledge any addendum to this RFP. This Proposal is valid for a period of 90 days. Hammerman and Gainer, Inc. 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. Respectfully submitted, ew X,-,elof Mike Kessler Vice President Marketing and Sales A Hammerman & Gainer, International Group Company Office Locations Texas — Austin, Dallas/Fort Worth (Irving), El Paso, Lubbock, San Antonio Louisiana —Alexandria, New Orleans (LaPlace), Shreveport PA0:4=1411j9hM-1i1i[►TLT:�A Hammerman & Gainer provides a comprehensive claims management program that goes beyond traditional claims adjusting services. By teaming experienced claims adjustment staff with the City of Lubbock's risk management personnel, we will provide the City with a superior claims management program deigned 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. All services are discussed in the sections that follow.. Section 3 will provide a brief overview of Hammerman & Gainer, Inc. Section 4 discusses our liability claims administration program, the qualifications of our staff and provides brief staff resumes. Section 5 provides information regarding our Risk Management Information System, Allegro. Section 6 provides our response to your questions and required forms. Section 7 is a detailed discussion of our pricing. Section 8 includes additional attachments and certifications 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. Our focus is illustrated by the following: • 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 material 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 City officials on-line access to more pertinent data on each claim. 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. Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24.2006 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 these systems may be found in Section S of our proposal response. Hammerman & Gainer, Inc. appreciates the opportunity to offer the City of Lubbock a superior program for the management of automobile and general liability claims. Section 4 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 others. Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 3. OVERVIEW OF HAMMERMAN & GAINER, INC. Introduction This is a proposal by Hammerman & Gainer, Inc. for liability claims administration. This section will discuss the corporate structure and background of our company. Hammerman & Gainer, Inc. is a claims management company providing property and casualty claims administration services nationwide. Hammerman & Gainer has a long history in Texas and employs a staff that is extremely knowledgeable in automobile and general liability claims. With this expertise, Hammerman & Gainer has produced seminars for the past 35 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 1973 guaranteed stability and continuity. 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 77 years ago, the firm has grown to five offices in Texas, three in Louisiana, and one in Banning, California. We serve as claim managers, consultants, investigators and adjusters for our clients across the state of Texas, Louisiana and California. 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. 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-insured's before the Division of Workers' Compensation), 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: Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 Workers' Compensation Training and Qualifications. Hammerman & Gainer, Inc. has expertly represented numerous entities, insurance carriers, self-insured's, and political subdivisions before the Division of Workers' Compensation (and before the Industrial Accident Board) since 1929. In each of our branch offices, we have highly trained workers' compensation specialists, many of whom represent clients at all levels of hearings before the DWC. In addition to our adjusters who are trained to handle Benefit Review Conferences and Contested Case Hearings, we have one adjuster on staff who is also an attorney 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 DWC Appeals Panel Decisions. When our adjusters have questions about the law or a recent DWC Appeals Panel decision, they have to look no further than Hammerman & Gainer's quarterly "S" Memo which contains commentary on Appeals Panel decisions, and updates in the law. Our adjusters and customers"may also consult with one of our on staff attorneys 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 "S" Memo, a sample of which is enclosed with this proposal. This report provides our clients with a summary of all current appeals panel cases. 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 also for Continuing Legal Education credit by the State Bar of Texas, the State Bar College and the Texas Board of Legal Specialization. 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. Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 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 this. 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, Inc. Proposal for the City of Lubbock August 24. 2006 4. LIABILITY CLAIMS ADMINISTRATION Hammerman & Gainer, Inc. Service Office Hammerman & Gainer will continue to 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 your 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 a synopsis of typical Hammerman & Gainer personnel, job descriptions and duties in our Claims Administration program. • H and G Risk Services Manager: We have a Risk Services Division headed by a highly experienced claim 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. • host Time Adjuster: Our Lost time adjusters are experienced in investigation and administration of Iiability 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. Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24.2006 • 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 recommendations through the Claims Supervisor for upgrade to indemnity or questionable case status as i 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, 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 and assistance to the claims r 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. • 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. Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 1 1 1 1 1 Liability Accident Investigation Whether we receive a telephone call, a notice by fax or an e-mail Ioss 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 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 she 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 r 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 and expense on liability claims. Venue, appraisals of defense and plaintiff counsel, expert witnesses or actual accident witnesses, etc. are also viewed on appropriate claims. . Subrogation or contribution are also considered as appropriate and are noted 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. 9 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 liability claims as well as for determining prior claims history of the • Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 r r r client employees. We also have on-line access to the Department of Motor Vehicles (DMV) for determination of vehicle ownership. Diary System r The Hammerman & Gainer Claims Information Management System (CIMS) and our r 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 r add a review date for the supervisor. Diary dates, which are due, or past due appear on r the user's screen each time they log in. The system allows for each diary posting through r a function, which automatically posts a diary at, set intervals (7, 60, 90 days, etc.) or r dates can be entered manually. A CIaims Analysis Deporting Screen will allow the supervisor to print or display a list of all claims that are due or overdue for diary check r and review. r . 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 r initial 60-80 days of the life of the claim. Our supervisors may review these claims as r many as seven or eight times in that initial time period to ensure all investigation is r complete, benefits have been paid timely and accurately or that disputes have been filed r timely. Our claims supervisors are experienced and well informed regarding the importance of appropriate and proper diary reviews. With strict time flames and the extensive reporting requirements, a properly run diary is essential for compliance with the law, timely delivery of benefits, and proper claims handling. r r Subrogation/Third Party InvolvementlLitigation Management r In order to fully administer our Claims Management program, we understand that pursuit r of subrogation is a very important component. From the initial receipt of all claims, the r handling adjuster and supervisor review for potential third party responsibility and will r 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, r 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, r proper certified subrogation notice letters are mailed to the potential third party, telephone contact and confirmation made, information regarding possible third party r insurance will be secured and additional notices will be transmitted to the appropriate r third party insurance carrier. In serious cases, claimants may seek legal representation on his or her liability claim r and/or third party loss. As carrier or self -insured entities may be entitled to first dollar reimbursement, documentation of the extent of the liability claim will be documented and r submitted to appropriate parties. In many cases, it may not be necessary for counsel to be r r Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24.2006 r r 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 r 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. Electronic Data Interchange Hammerman & Gainer is 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. Financial Administration Hammerman & Gainer currently works with the City of Lubbock established banking arrangements suitable to the City. If another option is needed, Hammerman & Gainer, Inc. will be pleased to work with the banking institution of your choice. Quality Control Our Home Office provides claims support, quality control and direction, continuing 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, our promise to provide prompt efficient investigation, supervision, benefit delivery, claims management, loss control, as well as subrogation and litigation management services. Hammerman & Gainer has access to and can make recommendations for independent audi.-ing 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. Proposal for the City of "Lubbock August 24. 2006 Hammerman & Gainer, Inc. Lubbock Office Staff Oversight of the transition process from the current TPA will be by Bradford Webb, Chief Operating Office, Mike Kessler, Vice President, Nancy Stoll, our Lubbock area Branch Manager, John Guillot, Chief Technology Officer of Risk Management Information Systems, and Julie Blackburn, Liability Claims Adjuster. The following personnel are currently employed in our Lubbock office and handle the City of Lubbock liability claims. Our current claims adjusting and TPA professionals are supported by highly trained professional clerical and claim assistant staff. Brad Webb, Chief Operating Officer, provides oversight and supervision for the operations of Hammerman & Gainer and will therefore be actively involved in the success of your program. Mr. Webb has over 30 years experience in claims and has an exempt all lines adjuster license. His former experience includes supervision and management as a branch, area and regional claims manager for Adjustco, Inc.; National Claims Manager of Lloyd's U.S., President of Texas Claims & Consulting Services, Inc., and AVP/Claims Manager for Swiss Re. He joined our team in March 2006. Mike Kessler, Vice President, is responsible for the sales and marketing efforts of our Texas, Louisiana and California offices. He works directly with our employees and our clients to provide assistance to their service needs. His 20 years of experience in marketing, sales and insurance is now directed to increase the services that are offered by Hammerman & Gainer, Inc. and to increase the number of new clients by explaining our excellent services and competitive pricing. Mike joined our company in January of 2006. Nancy Stoll, Hammerman and Gainer, Inc.'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 DWC hearing representation. Ms. Stoll is a multi -line licensed adjuster and has worked for H&G since 1986. John Guillot, our Chief Technology Officer is responsible for all computer hardware and software components. In addition, he is responsible for the computer operations for twelve branch offices with an excess of 100 work stations, four file servers, networks, WANs, ISDN lines, dedicated lines, ISP's, fax machines, print servers, cabling and internet. His duties include purchasing, assembling, programming, developing, maintaining equipment, overseeing all network development/operations, setting up all software, and employee/customer training. Julie Blackburn, Hammerman and Gainer, Inc.'s Lubbock area liability adjuster, is responsible far liability claims, litigation and mediation. Ms. Blackburn worked for Progressive Insurance Company for 15 years, specializing in liability claims and litigation. Ms. Blackburn joined our company in 2003. Hammerman & Gainer, Inc. Proposal for the City of Lubbock A " -n t IA 1)M4 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 claims handling system will allow Hammerman & Gainer staff to input information on injured workers and 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 City of Lubbock may access Allegro through the Internet. The Allegro system is used for: • First Notice Information • 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 • Conversions • 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, Inc. Proposal for the City of Lubbock August 24. 2006 WinFrame/Metaframe Hammerman and Gainer, Inc. provide easy access to their centralized system through a program called WinFrame/Metaframe. Its single -point control permits us to plug hundreds of users into corporate applications simply from a single machine. Application installations, updates and additions need be made only once - on the server - and then are instantly available to all users anywhere. WinFrame/Metaframe also includes an extensive set of administrative utilities for user configuration, troubleshooting, real-time monitoring and system reports that assist our RMIS department in its efforts to service our accounts. WinFrame/Metaframe permits us simply to link up virtually any client with vital applications. There is no need to change client hardware, adjust client system configurations or add special emulation software. WinFrame/Metaframe can be used over Intranet or Internet to access corporate applications from anywhere in the world, simply and easily. Integration of the Allegro, our Fisk Management Information System For The City of Lubbock's account, the Allegro System will serve as the primary data repository. All Hammerman and Gainer, Inc. and City's designated staff can upload all information initially entered in our medical management partner's database, if requested, to Allegro where the complete information on the claim can be viewed. For example, • First notice data collected by adjusters or telephonic case managers, as the case might be, will be uploaded to the relevant screens. • Case management, peer review and pre -authorization notes, if so requested, can be uploaded to remarks pages. • Medical bills can be entered and audited in our medical management partner's database then uploaded to the Allegro for production of checks and claims accounting functions. All Hammerman and Gainer, Inc. staff will have access to the Allegro system and will have E-mail communications with all partners in this project. 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 Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 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. Transaction 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, the City's 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 integration Microsoft Word, Outlook and Excel. Users can easily create, update and manage templates for letters, spreadsheets and other 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. r • Hammerman & Gainer, Inc. Proposal for the City of Lubbock Auaust 24. 2006 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. We will be pleased to provide The City of Lubbock with sample reports upon request. Ease of Integration 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,. 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. 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. Hammerman & Gainer, Inc. Proposal for the City of Lubbock Anpq9st 24. 2006 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 and Gainer, Inc.'s RMIS Director, John Guillot, is highly experienced in hardware and software issues and is responsible for maintaining our system in proper working order. Mr. Guillot is located in our New Orleans Service office. Client Access to our Syste 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, Inc. Proposal for the City of Lubbock Aueust 24. 2006 • 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 passwords. 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 Ioaded 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's claim data, a sample download of the City'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". AlI 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. Location Reporting, Department Reporting, Line of Business, Cause of Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 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. 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 EDT 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 clients into a partnership in the management of their claims. We are confident you will be pleased with the Allegro system. Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 RFP #06-056-MA, Liability Claims Services SUBMIT TO: i s T n CITY OF LUBBOCK "' Purchasing & Contract Management CITY OF LUBBOCK, TEXAS 1625 13" Street, Rm 204 REQUEST FOR PROPOSAL Lubbock, Tx 79401-3830 AN EQUAL #06-056-MA CONTACT PERSON: OPPORTUNITY Marta Alvarez EMPLOYER TEL: 806.775.2167 FAX: 806.775.2164 http://purchasing.ci.lubboclr-tx.us TITLE: Liability Claims Services SUBMITTAL DEADLINE: August 24, 2006, 3:00 p.m. CST PRE PROPOSAL DATE, TIME AND LOCATION: August 08, Arry proposals received after the time and state 2006 at 10:00 A.M. in the Municipal Building, 162513`s' Street, listed above, regardless of the mode of delivery, Purchasing C204 , Lubbock, Texas. shall be returned unopened RESPONDENT NAME: Hammerman & Gainer, Inc. IF RETURNING AS A"NO RESPONSE", PLEASE STATE REASON. MAILING ADDRESS: 800 West Airport Freeway Suite 301 CITY - STATE - ZIP: THE CITY OF LUBBOCK RESERVES THE RIGHT TO ACCEPT OR Irving, Texas 75062 REJECT ANY AND ALL PROPOSALS IN WHOLE OR IN PART AND WAIVE ANY INFORMALITY IN THE COMPETITIVE PROPOSAL TELEPHONE NO: 972-554-9400 PROCESS. FURTHER, THE CITY RESERVES THE RIGHT TO ENTER INTO ANY CONTRACT DEEMED TO BE IN THE BEST INTEREST OF FAX NO: 972-554-8100 THE CITY, IT IS THE INTENT AND PURPOSE OF THE CITY OF LUBBOCK THAT E-MAIL: mikekohng.com ling. coin THIS REQUEST PERMITS COMPETITIVE PROPOSALS. IT 1S THE OFFEROR'S RESPONSIBILITY TO ADVISE THE CITY OF LUBBOCK FEDERAL. TAX ID NO. OR SOCIAL SECURITY PURCHASING MANAGER IF ANY LANGUAGE, REQUIREMENTS, ETC_, NO. 74-1780638 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 PURCHASING MANAGER NO LATER THAN FIVE (5) BUSINESS DAYS PRIOR TO THE ABOVE SUBMITTAL DEADLINE. THE OFFEROR HEREBY ACKNOWLEDGES RECEIPT OF AND AGREES ITS PROPOSAL IS BASED ON ANY ADDENDA POSTED ON RFPDEPOT.COM 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 firm? YES X NO IN COMPLIANCE WITH THIS SOLICITATION, THE UNDERSIGNED OFFEROR HAVING EXAMINED THE REQUEST FOR PROPOSAL, AND BEING FAMILIAR WITH THE CONDITIONS TO BE MET, HWEBY 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 fimuL 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 connmodity(s) or service (s) purchased or acquired by the City of Lubbock_ At the City's discretion, such assignment shall be made and became effective at the City nders payment to the vendor. 'spy Vice President Authorized'Signature Title Mike Kessler Print/Type Name August 18, 2006 Date THIS FORM MUST BE COMPLETED AND RETURNED WITH YOUR RESPONSE. 06-056P P.doc wiwwfwwwwwwilww!!!•wiwlwwwww rwwwwwwlwiqpwwwwwm RFP #06-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal 1. CLAIN1-HA NDLING COS-411. ANV QUALIFICATIONS A. Does your company carry Professional Liability Insurance Hammerman & Gainer, Inc. has a $5, 000, 000. 00 Professional Liability aggregate. We have included a in the aggregate amount of. $2,000,000 that would apply to x copy of our Certificate of Insurance in the Attachments this activity? If so, please provide a current certificate of section of our Proposal, as requested. insurance. B. Does your company have, or have they had in the past five years, any E&O claims filed against them? if so, how X marry? C. Are you a member of the Claim Index Bureau Reporting x System? M056RFP.doc 17 RFP #06-056-MA. Liability Claims Services • D. Does your company Have a Formal Quality Control x We respectfully refer you to the Attachments section of our Proposal. program in place? Explain. E. Does your company have an Automated Claim Reporting x our claim reporting system is called Allegro. Our client System? If so, can the client have access? Is there a may have access to this system. There is no additional charge for client access. charge for client access? If so, how much? F. Does your company have a 24-hour emergency number x Yes, our adjusters phone number has already been shared shared with the City of Lubbock and we do respond in with an adjuster that can respond in 30 minutes or less? 30 minutes or less. Our loss runs are provided on a monthly basis. G. Can Loss Runs be provided monthly on a CD, or sent x These are generally exported from Allegro to an excel fi] electronically, in a format compatible to Microsoft Excel? which is then electronically transmitted in an email attachment. Is there an additional cost for this? There is -no charge for this service. 0"56RFP.doc 18 B e, • RFP #06-05&MA. Llabi(ity Malms Services Answer the following questions, and submit with your proposal YES I NO I % 2. STAFFING A'�D TRMNLN"G A. Does your company have an in-house or ongoing training x program for claims personnel? Explain. B. What is your average case load per adjuster per line of business? Please indicate the mix of claims that your adjusters handle. For example, does your Liability adjuster handle a mix of cases that would include both minor and serious claims? • General and Other Liability • Automobile Liability 06-056RFP.doo 19 COMMENTS Hammerman & Gainer, Inc has conducted training seminars £or customers and personnel for 34 years. our automobile liability and general liability adjusters average a case load of 150-175 files. Claims involving serious injury, complex liability or coverage issues are assigned to our senior adjusters. 0 ww•!•ww••www•••t!w••wwwwwi•••••!wwwwwwwwwwwm RFP tMA-0rP-LAA 1 iahiliW rl.i— q—i— • C. Does your company have caseload guidelines? If so, what our adjusters are required to handle 150-175 files as indicated above. Case loads are monitored by our are they by line of business? supervisors to insure adherence to client requirements. • General and Other Liability • Automobile Liability Are they adhered to? D. What is your average turnover rate for supervisors? 0 We have not had any turnover in our Lubbock office in 17 years. We have not had any turnover in our lubbock office in E. What is your average turnover rate for adjusters? ° 17 years. F. What is your average turnover rate companywide? 13 % G. Can we designate key adjusters to handle our losses? x H. Can we designate key supervisors to handle our losses? x 06-056RFP.cioc 20 w•!•••lwlww!!!w•wrwtwwwlwwwww•slwwwwwwww ■ wwm RFP #96-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal 3. CONTACT PrRS(1NNEL A. Shall your company provide a key person to: • assist in claim problem resolution? • coordinate activities? Is there an addition fee? If so, how much? B. Shall the contact person have the: • Authority to implement changes requested by the City of Lubbock Risk Management? • Authority to meet with City of Lubbock Risk Management quarterly to discuss outstanding problems and issues? • Is there a charge for these activities? If so, how much? YM I NO [% x x x x 06-056RFP.dx 21 COMWNI TS. Claim problem resolution and the coordination of activities will be handled by the designated claim supervisor and our Chief Operating officer, Bradford Webb. There is no additional charge for this service. w••!••wwwww wwwwwwwwwwwwww•wwwwwwwwwwwwwwwwm RFP #06-056-MA, Uabliity Claims Services Answer the following questions, and submit with your proposal YES -I NO I % I CONINIENT 4. BILLING AND COST A. Are you willing to quote a fee for? Option I X Option II X Option III x Option IV x B. Specifically, what are considered allocated expense? Please list. 06-056RFP.doc 22 We respectfully refer you to our definition of "Allocated Expense" detailed in the Pricing section of our Proposal. Answer the following questions, and submit with your proposal . Cf.A.] N1 MANAGLMETAT A. Does your company have written claim handling standards for. • General and Other Liability • Automobile Liability If so, please forward a copy. • Are recorded statements taken? • What is the maximum diary allowed? • Are action plans developed and followed on files? VJP8 I NO I % I COMMENTS X X X X 06-058RFP.dx 23 RFP #O64)56-MA, Liabitily Claims Services our system allows for virtually unlimited (64,000) diary entries on each of our claim file_ wwwwwwwwwwww••••w!•wwwwwwwwwiwwfwwwwwww•wwmI RFP #06-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal 6. C1_,r'1IM FTATl ill TNG A. — Are claims handled by telephone or field adjuster? B. Is there additional costs for field adjusters? C. Shall all claimants and the City of Lubbock Risk x Management contacts be made within 24-hours from the date notice received? D. Does your company have written claim handling standards that include: I x • When recorded statements taken? I x • What is the maximum allowable diary? • Action plans being developed and followed on files? x 06.056RFP.doc 24 COMMENTS Both. Claims are handled at the direction of the client either Ly telephone or in the field. Field investigations are conducted with client approval at $66.00 per hour. Our system allows for unlimited amount of diary. Automatic diaries are set at 7,60, and 90 days. w•ww•ww•!w!wwwwww!ww!!!•wlwrwwwwwwwwwwwwwwwv RFP #W-056-MA, LlabilEty Claims Services Answer the following questions, and submit with your proposal 7. RESERVING A. What is your reserving philosophy? B. Who is responsible for establishing reserves? C. How soon are initial reserves set? D. Is a reserve analysis contained in every file? Please provide a sample. E. How often are reserves reviewed? ITS I NO I % I CO-MMEiITS Hammerman & Gainer, Inc. believes in.reserving a claim for its ultimate cost/exposure. The adjuster is responsible for setting reserves, up to the amount of their individual authority, and with the concurrence of the client. Initial reserves are set within 24 to 48 hours upon receipt of a claim. X Reserve analysis are indeed contained in every file. They are captured in the file note -screens in narrative format. AL/GL reserve worksheets can be composed upon request. Reserves are reviewed every 60-90 days each time the s claim is handled, and with each new development. P6-055RFP.doc 25 RFP #06#64SA, LlablUty Clai ns 5srvicas 'Answer the following questions, and submit with your proposal 1 5 NO % CO1 MFNTS S. REPORTING A. Are captioned reports completed On files? If so, x Captioned reports are completed on files as required • at what level? by the client. The level and frequency are determined based upon individual client needs. There is no charge • how often? for this service. • provide sample B. Are captioned reports sent to client? if so, how often? Is please refer to 8 of our Proposal. there a fee? If so, how much? x C. Are clients notified tiimely and in writing of hearings and trails? x D. Shall the City of Lubbock Risk Manager be kept apprised of all claims as they deem necessary? x up front direction is provided by the Supervisor at the E. Aare Ales actively supervised? If so: • how often? x time of initial assignment and at 60-90 day intervals throughout the life of the claim file. • what reserve level? F. Are files supervised by both branch and regional personnel? x D"56RFP.doc 26 weewwwwwwwwwww•wwwwwwwwww wwwwwwwwwwwwwwwwwm RFP #06-056-MA, Liability Claims Services Answer the following questions, and submit with your proposal NO % COMMENTS 9. CLAIS rfIFILE REVIEWS A. Does your company allow claim file reviews? If so, is there an additional cost? What is the cost? 11 x a There is no additional charge for this service, B. Does your company allow physical audits of claim files? x W-056RFP.doc 27 w••••!•!w!w#ww#!w!!!!!!•ww!!•lwwwwwwwwwwswwV RFP #06-05&MA, Uabi lly Claims Services Answer the following questions, and submit with your proposal VE5 f N 0 16o 1 COMMENTS-.. 10. STRUC'l'U ED SF'X"Z'LENW. T - A. Does your company utilize structured settlements? I X I I I Structured settlements are recommended to the client B. Have you established guidelines when considering this approach to settlement? If so, please provide a copy of these guidelines. C. Are there separate costs associated with this service? If so, please provide your pricing structure 06-056RFP.dm 28 and approved by the client on those cases involving high dollar exposure. Guidelines are established based on the individual needs of the client. Hammerman & Gainer, Inc. utilizes services provided by independent structured settlement companies. Fees for this service are usually contained within the cost of the annuity. RFP tMA, Liability Claims Services VENDOR REFERENCES Please list three (3) references of current customers who can verify the duality 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 �. ;a:�_,� � '�bti&ri. *, �"�-+: - s,�4 tii �-�,° , �',r - �...� w � a i+a ✓ .tv- � x ,. a . �.<,:r...ii� a�4:-'-- 1"LwnM Government/Company _ Address: P.O. Box 31109 Shreveport, Louisiana 71130-1109 Contact Person and Title: Tom Cody, Risk Manager Phone: 318-673-5548 )Fw 318-673-5546 Contract Period: 5 Years Scope of Work: Liability Claims Administration Government/Company Name: Webb county Address: 1110 Washington Street Suite 204 Laredo, Texas 78040 Contact Person and Title: Cynthia Maras, Risk Manager Phone: 956-523-4143 Fw Workers' Compeneation,Auto, Contract Period: 5 Years Scope Of Work: GL Claims Administration `a'����� � �yi;' . ; Ian '�,s�� �g•� `%�, 3� �r � � � �� �'� x � . �si���w%i :�r'.�.� �`r..:� .,—�'N . ��z... x?^ A�: Govemment/Company Name: Texas Property and Casualty Insurance Guarantee Association. Address: 9120 Burnet Road Austin, Texas 78758 Contact Person and Title: Marvin Kelly, Executive Director Phone: 800-856-0298 Fax: Workers' Compensation Contract Period: 4 Years Scope of Work: Claims Administration 08-056UP.doc 29 RFP #0-05CrMA, Liability Claims Services EXHIBIT A CLAIMS REPORTING REQUIREMENTS An individual authorized to bind the COMPANY must sign off on the following requirements. ("You" in the text below refers to the Insured; "We" refers to the Insurer.) 1. You must give us prompt notice of any accident which may result in a claim or suit seeking an amount for loss in excess of your "bodily injury by accidenf 'retention. The notice must be no later than 30 calendar days from the date you are notified of such accident. The notice should include: a. How, when and where the accident took place; b. The names and addresses of any injured persons and witnesses; and c. Complete details of the injury or death. Authorized Signature #1a,b & c 2. You must fimiish us with: a. A monthly report which provides the following information (by claim year) for each claim or suit which was outstanding, opened, revised or closed during the previous month: the identify of the claimants or injured parties; the dates, places, description and cause of injuries; the amounts of reserves for such claim or suit; claims expenses (both paid and outstanding) and payments of claims; judgments or settlements, This report must be furnished not later than the I e day after the end of each month. b. Written notification of each claim or suit which has, or should have or is likely to have, without regard to liability, a reserve equal to or exceeding fifty percent (50%) of your retention. Written notice must be provided as soon as possible, but no later than fifteen (15) calendar days from the date you have sufficient knowledge of facts surrounding such claim or suit which could put you on notice that such reserve or payment is indicated. Complete files on such claim or suit must be given to us within thirty (30) calendar days from the date we request such files. 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) Bums — involving over 10% of body with third degree or 30% with second degree; (6) Multiple fractures — involving more than one member or nonunion of any part of the may; (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); 00"56RFP,doc 30 RFP #06-056-MA, Liability Claims Services (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, nape, 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 & d 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 actin involving a sum in excess of your retention; b. Authorize us to obtain► records and other information; c. Assist us, the City Attomey or others to famish us with information we may request to evaluate the "accident''; and d. Attempt to settle the claim or "suit" within your retention. 101A� Authorized Signature Item #3 a, b, c & d 8 PROPOSAL FORMAT a) Proposals should provide a straightforward, concise description of the Offeror's capabilities to satisfy the requirements of the RFP. Emphasis should be on completeness, clarity of content, and conveyance of the information requested by the City. b) The original copy of the proposal should be bound in a single volume where practical. All documentation submitted with the proposal should be bound in that single volume. c) If the proposal includes any comment over and above the specific information requested in the RFP, it is to be included as a separate appendix to the proposal. d) The original copy of the proposal must be organized into the following response item sections and submitted in an indexed binder. i} Cover letter addressed to the Honorable Mayor and City Council that states the Offeror understands the services to be provided. Include any additional information believed necessary that is not requested elsewhere in the RFP. 06-13ssRIFP.eoc 31 RFP #06-056-MA, Liability Claims Services ii) A description of the methodology to be used to complete the project to include, but not be limited to, how recommendations will be formulated and commitment of adequate appropriate resources to the project. iii) Offeror's specific expertise in areas pertinent to the project to include a listing and brief description of similar projects completed (with the dates of completion) or in progress and a list of references by name, address, and telephone number for each project listed. This list of projects in progress shall include the phase of work that each project is currently in (i.e. design, bid, construction), and the estimated completion date. iv) A brochure (if applicable) of past work, with emphasis on comparable projects. v) List of principal(s) of the Offeror and amount of time that principal(s) will be involved in the project. vi) List of other professionals to be used, if applicable, with a record of experience in projects of this nature. Identification of principal(s) and percentage of time the principal(s) will be involved in the project. vii) The organizational structure of the employees who will be assigned to this project along with resumes of those individuals. If a joint venture is expected, then provide the organizational structure of the sub -contractor and resumes of those persons who will be involved in the project. vii i) The Offeror must assure the City that he/she will to the best of his/her knowledge, information and belief, be cognizant of, comply with, and enforce, where applicable and to the extent required, all applicable federal or state statutes and local ordinances including, but not limited to the Davis - Bacon Federal minimum wage requirements. ix) Describe the Offeror's methodology for handling errors and omissions. x) Disclosure of any obligations posing a potential conflict of interest, including service on City boards and/or commissions and any current contracts with the City of Lubbock. This would apply to the Offeror as well as consultants subcontracted by the Offeror. xu) Offerors are strongly encouraged to explore and implement methods for the utilization of local resources, and to outline how they would address outreach issues in their proposal. It is also the desire of the City that the City of Lubbock program serve, as much as practicable, to stimulate growth in all sectors of the local business community. Describe how your firm would facilitate this process, and provide any relevant information about similar efforts on previous projects. xn) Any material which the proponent wishes 'to submit and which is not specifically requested in the above categories. OS-056RFP.doc 32 RFP #06-056-MA, Liabillty Claims Services CM OF LUBBOCK INSURANCE REQUIREMENT AFFIDAVIT To Be Completed by Bidder And Attached to Bid Submittal 1, the undersigned Bidder, certify that the insurance requirements contained in this bid document have been reviewed by me with the below identified Insurance Agent/Broker. If I am awarded this contract by the City of Lubbock, I will be able to, within ten (10) days after being notified of such award by the City of Lubbock, furnish a valid insurance certificate to the City meeting all of the requirements defined in this bid/proposal. xo�"& A�5 Mike Kessler, Contractor! Contractor (Print) CONTRACTOR'S NAME: Hammermaas r- Gainer, Inc. (Print or Type) vice President CONTRACTOR'S ADDRESS: 800 west Airport Freeway Suite 301 Irving, Texas 75062 Name of AgentBroker: ICT'.insurance Address of Agent/Broker: PO Box 12710 City/State/Zip: New > feria, LA 70562-2710 Agent/Broker Telephone Number: { Date. 8/18/06 337 ) 365-5426 NOTE TO CONTRACTOR If the time requirement specified above is not met, the City has the right to reject this bid/proposal and award the contract to another contractor. If you have any questions concerning these requirements, please contact the Purchasing Manager for the City of Lubbock at (806) 775-2165. 06-056RFP.doc 33 RFP #06-056-MA, Liability Claims Services SUSPENSION AND DEBARMENT CERTIFICATION Federal Law (A-102 Common Rule and OMB Circular A-110) prohibits non Federal entities from contracting with or making sub -awards under covered transactions to parties that are suspended or debarred or whose principals are suspended or debarred. Covered transactions include procurement contracts for goods or services equal to or in excess of $25,000 and all non -procurement transactions (e.g., sub -awards to sub -recipients). Contractors receiving individual awards of $25,000 or more and all sub -recipients must certify that their organization and its principals are not suspended or debarred by a Federal agency. Before an award of $25,000 or more can be made to your firm, you must certify that your organization and its principals are not suspended or debarred by a Federal agency. I, the undersigned agent for the fmn named below, certify that neither this firm nor its principals are suspended or debarred by a Federal agency. COMPANY NAME: ?:ammerman & Gainer, Inc. Signature of Company Official: 1111A 1e551&-:e � P Y Date Signed: 8/18/06 Printed name of company official signing above: Mike Kessler 06-056RFP.doc 34 6. REQUIRED FORMS AND QUESTIONNAIRE The following pages included those forms required by the City of Lubbock including the required questionnaire. Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 7. PRICING OPTIONS Hammerman & Gainer, Inc. offers to provide claims administration to the City of Lubbock on the following fee basis. Option I — Fiat Fixed Fee for Life of the Claim Automobile Liability - $520.00 per suffix lifetime flat rate General Liability - $520.00 per suffix lifetime flat rate Other Liability - $2184.00 per suffix lifetime flat rate Option II — Fee for Two Year Claim Service Automobile Liability - $270.00 per suffix for two years General Liability - $270.00 per suffix for two years Other Liability - $1136.00per suffix lifetime flat rate for two years Option III — Flat Fixed Fee for Contract Period See Option IV Option IV — Other Pricing Structure Automobile Liability — $307.00 for one AL PD $515.00 for two suffixes $307.00 for suffixes three -- ten Time and Expense @ $66.00 per hour for 10+ suffixes General Liability — $515.00 for two suffixes $307.00 for suffixes three — ten Time and Expense @ $66.00 per hour for 10+ suffixes Other Liability — $2184.00 per suffix Claims Administration Fee - $1500.00 per year Date Conversion Fee - $5000.00 One Time Fee (not applicable) Allegro - $350.00 per seat per year Hammerman & Gainer, Inc. Proposal for the City of Lubbock e— —f 1n 'MOA Indexing - $7.00 per item Automobile Appraisal Fee Schedule Auto Appraisals: Up to 1 % ton light duty truck $92.00 Total Loss w/CCC Form $99.00 Total Loss w/Evaluation $109.00 Drive-in $68.00 Motorcycles, Boats, RVs, Heavy Equipment T&E Secure Salvage Bids (3) $20.00 • Above schedule should 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 ME Additional Expenses: T&E Property and Casualty $66.00 per hour outside work Photos $3.00 each Cassettes $2.00 each Mileage $0.55 Special Activity - $66.00 per hour for vehicles over one ton and specialty vehicles Hammerman & Gainer, Inc. Proposal for the City of Lubbock A-m,cr'n )nnr Property Fee Schedule Property: Gross Loss Range Full Adjustment Agreed Price Appraisal $0 - $500 $110.00 $103.00 $501 - $1,000 $162.00 $151.00 $1,001 - $2000 $201.00 $196.00 $2,001 - $3,500 $290.00 $244.00 $3,500 - $5,000 $332.00 $296.00 $5.001 - $7,500 $395.00 $338.00 $7,501 - $10,000 $456.00 $394.00 $10,001 -up T&E T&E Damage to interior will require biling 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 miles, additional photos when necessary, long distance phone/fax charges, express mail charges and out of pocket expense (such as ton, parking and official report charges,which are bined 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 adjusted at ME as a separate claim. Hammerman & Gainer, Inc. Proposal for the City of Lubbock e,,m-t')n ')nn4 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 pubic 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. 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 & G4iner, Inc. Proposal for the City of Lubbock e,,. —t -)n 1nn4 8. ATTACHMENTS A. Hammerman & Gainer, Inc. - TPA Specific Information B Hammerman & Gainer, Inc. - Liability Claim Management Standards of Performance C. Hammerman & Gainer, Inc. - Certificate of Insurance D. Hammerman & Gainer, Inc. - Texas TPA License E. Hammerman & Gainer, Inc. - M/WBE Certification F. Hammerman & Gainer, Inc. — Financials G. Hammerman & Gainer, Inc. - References H. Hammerman & Gainer, Inc. - Reference Letters I. Hammerman & Gainer, Inc. - Sample RMIS Reports from Allegro Hammerman & Gainer, Inc. Proposal for the City of Lubbock AllEllst 24- 2006 This is a proposal by Hammerman & Gainer, Inc. for liability claims administration. We include the following information. • Location of our office. Hammerman & Gainer, Inc. 3307 82°d Street Suite G Lubbock, Texas 79453 806-796-0122 • Hours staffed and holidays observed. Office hours are from 8:00 AM until 5:00 PM. Claim service is provided 24 hours per day. Hammerman & Gainer, Inc. observes the following holidays: New Years Day, Memorial Day, Fourth of July, Labor Day, Thanksgiving Day, Christmas Day. • Number of attorneys on staff. Hammerman & Gainer, Inc. has one (1) attorney on staff, who is also a licensed adjuster. • Number of liability claims adjusters. Hammerman & Gainer's Lubbock Branch Office has two (2) liability adjusters. Names of principal owners, partners or officers. Larry D. Oney, Chief Executive Officer, and President Bradford Webb, Chief Operating Officer Mike Kessler, Vice President of Marketing John Guillot, Chief Information officer • Who is primarily responsible for the management and supervision of the City of Lubbock's account? Ms. Nancy Stoll, our Lubbock Branch Manager will be the primary person responsible for the management and supervision of the City's account. She has over 20 years as an adjuster, supervisor, and manager. • What is the average and maximum number of files claims adjusters and/or examining personnel must handle at the office assigned to handle the District's claims? Liability 150 claims • Will designated claims personnel be involved in on -site investigations and other outside claims adjusting functions? Please provide details. Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 Yes Each adjuster who is assigned to the District's account will be selected because of their experience level, and will be capable of conducting on -site investigations and other outside claims adjusting functions. The adjusters will be responsible for handling each file to conclusion. • How frequently does our diary system allow claim supervisory personnel to review open claim files? Supervisory review of claim files is conducted at day 7, day 60, and day 90 for the initial life of the claim. Thereafter, normal diary dates are set at additional 90-day intervals. Factors such as injury severity and client instructions obviously can change diary dates. Our RNUS, Allegro sets an automatic diary for each supervisor at the time frames outlined above. Allegro will also allow our supervisors to set pre- determined diary dates based on individual claim activity. • Do you have a formal program for managing lawsuits and litigation expenses? Yes We respectfully refer you to the Attachments section of our proposal response to review a copy our recommended Litigation Management strategy. We will be pleased to follow any strategy already employed the City of Lubbock. • Do you use a formal claims procedure and performance manual and if so, describe. Yes We respectfully refer you to the Attachments section of our proposal to review a copy of our Liability Claim Management Standards of Performance, as well as our Care and Claim Workflow requirements. • Indicate the types of allocated claims expenses which are not included in your per claim cost, We respectfully refer you to Section 7 of our proposal response to review our list of these expenses. • Indicate whether the per -claim cost includes recovery of subrogation losses. Yes, the per -claim cost includes the recovery of subrogation losses. • Claim Payment Funding Procedure Hammerman & Gainer will be pleased to comply with the City's Claim Payment Funding Procedure. • Include a list of local and Texas public entity references. We respectfully refer you to the Attachments section of our proposal to review a list of our references. Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 Hammerman & Gainer, Inc. Liability Review Standards A. Coverage 1. Proper policy used - Applicable to insured and loss description 2. Coverage Analysis conducted - Coverage analysis (persons, perils, property, loss location, hazards, accidental, time) 3. Identify Governmental Immunity, proceed accordingly 4. Primary/excess identified - Documented in note screens 5. Coverage denial procedure followed — Proper letter, manager approved 6. Excess letter sent — When applicable B. Investigation 1. 24 hour contacts — from time of assignment 2. Statement insured — Contact, interview and recorded statement when necessary 3. Statement claimant -- Contact interview and recorded statement when necessary 4. Statement witness — Contact, interview and recorded statement when necessary 5. Photos — Vehicles, real property, scene photos, injury evaluation when necessary 6. Police report — when available 7. Vehicle damages investigated 4- Inspection and photos 8. Parked vehicle loss - ISO search by VIN and claimant name 9. Report prepared — within 10 days of receipt of claim C. Liability Assessment 1. Comparative negligence (if applicable) — Describe comparative rule, apply to facts of claim 2. Decision documented — Note screen law of venue and describe applicability to investigation 3. Joint-tortfeasor recognized — Identify other parties at fault and actions to include in settlement process 4. Timeliness of decision — Assess at conclusion of investigation, revisit if changes occur D. Claims Process/Settlement 1. DOI reg compliance — According to loss state regulations or guidelines 2. Timely response to demands — within 10 days of completed liability and damage assessment PD, 30 days BI 3. Adherence to limits of liability under statutory guidelines 4. Settlement within authority — Authority 5. Evaluation documented — Thorough description of settlement evaluation (liability and damages) 6. lrst call settlement — When opportunity presented (complete note screen documentation) 7. Negotiations documented — Note screen documentation of demands, offers, settlement (one or multiple notes) 8. Authority obtained — According to procedure guidelines Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 E. Damages/Property L Betterment/depreciation/LKQ — Estimate review for items described 2. Proof of Loss/ownership — Verification of ownership vehicles and real property 3. Loss of use controlled — Actual repair days or cash settlement based on estimate labor hours 4. Proper salvage docs. received — Ownership certificate, power of attorney, transfer of ownership certificate S. IA inspection within 48 hours — From IA assignment (unless delayed by claimant) 6. Salvage addressed and accounted for — Documented in note screens or owner retained. 7. ACV established — Documented in note screen 8. Business interruption controlled — calculated per expected repair time and noted for any delays F. Damages/Bodily Injury 1. Medical verified — Medical report and bills in file -- Reviewed when applicable 2. Loss of wage verified — Confirmed with employer and supported by medical report 3. Medical authorization requested — Upon notice of injury (including represented claimants through attorney) 4. Wage authorization requested — Upon notice of wage loss (including represented claimants through attorney) S. Evaluation in file — Documented in notes screens with clear and complete assessment 6. Adherence to limits of liability under statutory guidelines 7. Negotiations documented — Note screen documentation of demands, offers, settlement (one or multiple notes) 8. 1rst call settlement — When appropriate and documented in note screen 9. Timely response to demands — Within 30 days of final medical or demand package 10. Settlement within authority — Authority G. Reserving 1. All claimants/coverage reserved — Explained in notes screen (yes, no, reason) 2. Changes made timely — According to all reserve guidelines 3. Dangling reserves eliminated (closed files) — All exposures at $0 reserve at closing of file and claims coded closed in Allegro H. File Documentation 1. Diary maintenance —Allegro on diary and up to date within 10 days 2. Has supervisor review instructions been followed? — Complete and documented in note screen 3. Subrogation realized — Explained in note screen 4. Initial report to TAPS — Within ten days of assignment Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 5. Plan of action — Upon receipt of assignment. Note screen description of steps needed for resolution 6. POA follow up — Note screen documentation of action steps completions and supervisor direction completion 7. File indexed — On cases with suffix at $10,000 + 8. Organized file — physical file orderliness 9. Clear and precise documentation — Do the note screens tell the story of the claim? (Clear, concise, complete) 10. Re-assignment/new POA — Note screen file review summary and note new POA I. Litigation Management 1. As per client instructions I Unit Supervisor Evaluation 1. File on diary — Allegro diary and up to date within 15 days 2. Supervisor direction — On all diary dates with note screen review and direction 3. Timely reviews — Minimum standards — PD 15 to 30 days, BI 45 to 60 days, Litigation 30 to 90 days Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 ACORQ CERTIFICATE OF LIABILITY INSURANCE OP 3D DATE(MiAf 5 HAt�1B-3 08 15 5/05D5 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE ICT Insurance HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR P O Box 12710 1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. New Iberia LA 70562-2710 Phone:337-365-5426 Fax:337-367-2420 INSURED Hammerman and Gainer Inc 110 Belle Terre Blvd SE 201 La Place LA 70068-3358 COVERAGES INSURERS AFFORDING COVERAGE NAIC # INSURER A Transcontinental Ina Co 20486 INSURERS: Continental Casualty Co 20443 INSURERC: Houston Casualty Conpany 42374 ]"SURER D: Continantal Insurance Ca-pany 35289 INSURER E THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POUCYNUMBER D/lTPOLE MMlDWYY POLICY EXPIRATION DATE MMIDOrYY LIMITS GENERAL IJABILTTY EACH OCCURRENCE $1 , 000 , 000 PREMISES (Eaocarwcai S 100,000 A X COMMERCLALGENERAL LIABILITY CLAIMS MADE ® OCCUR TCP2011605945 07/28/05 07/28/06 MEo ow (Any one person) S 5, 000 PERSONAL A ADV INJURY S1,000,000 GENERAL AGGREGATE s2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMPOOPAGG $1 000 000 POLICY JECOi LOC ETR Ban. 1 1 000 1 000 B AUTOMOBILE X LIAB1LfTY ANYAUTO C2011605976 07/29/05 07/28/06 COMBINED (Ea ncctdSINGLEiIMIT oddent) $1,000,000 BODILY INJURY (Per person) _ ALL OWNED AUTOS SCHEDULED AUTOS X BODILY INJURY (Per accident) $ HIRED AUTOS NO"WNED AUTOS X PROPERTY DAMAGE (Per acclderd) S GARAGE LIABILITY AUTO ONLY • EA ACCIDENT S OTHF-R THAN EA ACC AUTO ONLY: AGG $ ANY AUTO 3 EXCESSIUMBRELLA LIAII,ILTTY EACH OCCURRENCE $5 , 000 000 B X OCCUR F-1CLAiMsMADE C2011605962 07/28/05 07/28/06 AGGREGATE S5,000,000 s 3 HDEDUCTIBLE 3 X RETENTION $10 , 0 Q 0 B WORKERS COMPENSATION AND EMPLOYERS UABILITY ANY PROPRIETORIPARTNERIEXECUTIVE OFFICER'MEMBEREXCLUDEW WC211605959 07/28/05 07/28/06 X I TORY LIMITS = ER E.L. EACH ACCIDENT $ 1000000 E,L.DISEASE - EA EMPLOYEEI s 1000000 Wss describe under CIALPROVISiONSbelow E.L. DISEASE - POLICY LIMIT 31000000 OTHER D Crime 169909299 09/01/05 09/01/06 Blkt Lunt 1,000,000 C Professional 11705147117 - CLIUM MADE 08/01/05 08/01/06 Limits 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS *Professional Coverage is Claims Made Policy CERTIFICATE HOLDER CANCELLATION V FOR INFORMATION ONLY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE 133UING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO 30 SHALL IMPOSE NO OBUGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001I08) © ACORD CORPORATION 1988 Texas Department of Insurance CERTIFICATE NO. 13850 COMPANY NO. 30-095998 CERTIFICATE OF AUTHORITY THIS IS TO CERTIFY THAT HAMMERMAN & GAINER, INC. AUSTIN, TEXAS has complied with the laws of the State of Texas applicable thereto and is hereby authorized to transact the business of within the State of Texas. This Certificate of Authority shall be in full force and effect until it is revoked, canceled, or suspended according to law. IN TESTIMONY WHEREOF witness my hand and seal of office at Austin, Texas, this 11 th day of May, A.D. 2005 JOSS MONTEMAYOR COMMISSIONER OF INSURANCE BY � , MATT Y DEPUTY COMONER LICENSING DIVISION No Text 2005 FINANCIALS Balance Sheet Assets Cash $1,236,744 Accounts receivable, net 1,831,302 Work in process 62,386 Prepaid income taxes 10,000 Other current assets 184,240 Loans to shareholders 0 Total current assets $3,324,672 Other investments $80,895 Building & other depreciable assets, net 213,247 Intangible assets (amortizable) 537,124 Other assets Total assets $4,155,938 Liabilities and equity Accounts payable and accrued expenses $1,365,361 Mortgages, notes, bonds payable in less than one year 377,291 Deferred revenue 16,827 Other current liabilities 168,340 Total current liabilities $1,927,819 Mortgages notes, bonds payable in more than one year $1,001,443 Other liabilities 9,771 Total liabilities $2,939,033 Capital stock - common $1 Preferred stock 2,941,998 Additional paid -in capital Retained earnings (1,725,093) Less treasury stock Total equity $1,216,905 Total liabilities and equity $41155,938 Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 Income Statement Income Gross receipts or sales $7,955,705 Less returns and allowances (120,521) Net sales 7„835,184 Interest income 291 Loss on sales of assets (3,999) Total income $7,831,476 Expense Compensation and benefits $5,727,112 Travel expense 122,463 Occupancy and office expense 665,891 Administrative expense 596,407 Interest expense 93,798 Depreciation and amortization 110,518 Total expense $7,316,189 Income before taxes 515,287 Federal & state taxes 178,800 Net income $336,487 Hammerman & Gainer, Inc. Proposal for the City of Lubbock August 24. 2006 0 &M mAkAmAkAhmAmAka am &am Reference List Following is a list of accounts and contact persons for whom we have provided full property and casualty claims administration, EDI and DWC representation services, and some for whom we handle claims adjusting/administration or DWC representation only. We also refer you to the list of entities that we currently represent before the DWC in Austin and around the State, including insurance carriers, governmental entities, certified self -insurers and risk pools. Webb County 1110 Washington Street, Suite 204 Amarillo, Texas 78040 Cynthia Mares, Risk Manager 956-523-4143 1400 Employees We provide workers' compensation and liability claims administration. This contract began. October 1, 2005 and runs through September 30, 2008. Dallas ISD 3700 Ross Avenue, Sox 91 Dallas, Texas 75224 Cheryl Johnson, Director 214-932-5279 Over 20,000 Employees We provide workers' compensation claims administration. This contract started September 1, 2002 and runs through August 31, 2005. Mesquite ISD 405 East Davis Street Mesquite, Texas 75149 James E. Huckaby, Risk Manager 972-882-7333 5000 Employees We provide workers' compensation claims administration. This contract began September 1, 2004 and runs through August 31, 2007. R. E. Thomason General Hospital 4815 Alameda Avenue El Paso, Texas 79905 Lettie Lopez, Workers' Compensation Administrator 915-521-7884 1200 Employees Hammerman & Gainer, Inc. Proposal for the City of Lubbock AuLyust 24. 2006 We are in the second year of a three-year contract. We provide workers' compensation claims administration services. 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 D WC representation for 5 years. Lubbock County 916 Main Street, Room 1206 Lubbock, Texas 79408 Mandy Mantooth, Director of Human Resources 806-775-1690 950 Employees We are in the second year of a one-year contract with two optional renewal years. We provide workers' compensation claims administration services. AIG WorldSource 8144 Walnut Hill Lane, Suite 1600 Dallas, Texas 75231 Vicki Dickerson, Claim Manager SW Regional Claim Department 214-932-2203 Patty Schibler, CIaim 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. San Antonio Water Systems Hammerman & Gainer, Inc. Proposal for the City of Lubbock Aueust 24. 2006 P.O.. Box 2449 San Antonio, Texas 78298-2449 Randy Son, Claims Supervisor 210-704-7932 1500 Employees We have been DWC 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 7 years. Crowley ISD P.O. Box 699 Crowley, Texas 76036-0688 Jean Drennan 817-297-5800 1541 Employees We have been DWC rep. since November 1,1999. Hammerman & Gainer, Inc. Proposal for the City of Lubbock Au¢ust 24. 2006 We66 County RiSkManagement June 19, 2006 To Whom It May Concern: It is my understanding that Hammerman & Gainer, Inc. is submitting a bid to administer your worker's compensation claims. Webb County self -insured our worker's compensation fund and contracted administration with Hammerman & Gainer, Inc. in October 01, 2005. We have worked with Robyn Tydelski and staff and have been very pleased with the level of service we are receiving. In addition to their professional claims- administrative services, their customer relations are above and beyond any that I have experienced. Their loyalty to the account is more than you would expect under any circumstance. We have quarterly meetings to revivov all open claims. We have never experienced this level of expertise or service with our worker's compensation claims. Due to Hammerman & Gainers' attention to detail, we hope to be saving hundreds of thousands of dollars in claims costs. It is with highest regard that I recommend Hammerman & Gainer, Inc. as your workers' compensation administrator. You will see the same cost savings and personal attention that we have enjoyed this year. If you should have any questions or comments, don't hesitate to call me. Cynthia Mares, Webb�Eounty Risk Manager ' Eon S'ttee'c, Suite 2a4 • �-atedo,'� ®xas � a0ao p 1110Wahtr�g523-'14,3 hone �g56� 4• �956) 523_5012tax i 1 i r i i i OF November 18, 2004 Workers' Compensation RFP Committee . Commissioners' Court Midland County, Texas Dear Members of the Court and RFP Committee: . It is my understanding that Hammerman & Gainer, Inc. is submitting a bid to administer your workers' compensation claims. Lubbock County self -insured our worker's compensation fund and contracted administration with Hammerman & Gainer, Inc. in January, 2004. We have worked with Robyn Tydelski in Irving and Nancy Stoll in i Lubbock and have been very pleased with the level of service we are receiving. We are renewing for an additional year on January 1, 2005. Nancy Stoll is our local claims manager and is a joy to work with. She returns our calls promptly, personally investigates claims, interviews claimants and reviews findings with us. We have quarterly meetings to review all open claims and Nancy pursues r subrogation when other parties might share liability. We have never experienced this level of expertise or service with our workers' compensation claims. Due to . Hammerman & Gainers' attention to detail, we are saving hundreds of thousands of dollars in claims costs. . It is with highest regard that I recommend Hammerman & Gainer, Inc. as your workers' . compensation administrator. You will see the same cost savings and personal attention that we have enjoyed this year. r . Sincerely, Mandy Mantooth . Director of Human Resources Lubbock County r r r r Dalln School District March 15, 2004 An Furt d Executive vice President Hammerman b Gainer, Inc. 110 Bak Terra Blvd., Ste 201 LaPlace, LA 70068 Deer Jinn, I went 10 congrakilift Hammerman r!< Gainer and In particular .your staff in playkrg s large part to help the Dafts hxWendent SdxW DIM,- redrxre our workers' oompernsdon costs by ¢2„021,878 for dw first 6Knonth period of sdroal year 2003-04 compared to the name period of 2002-03. Spodfioery our TIES are down by 62, IBBS by 8 and SIBS by 11 aver that same period. We expect a savngs in our workers' cornpauratlon program for to flat Wm In 11 yeerst Please no graph attached. Thank you for pravk*v us with audit WaUBed and quality adjusters who taus bow A part of the DISD'h mW. We k3ok fKxwsrd to a kxv and prodnK:h-a mWb=sd r List vM put money beck Into the schools and with the kids where 8 belongs. Ch" Johnson Executive Di *cloy of Risk MenaparnsM Dares Independent Sdrooi District CPJ LUM MONS. eta . OftW,.rsqKOfEMknf AMRAwaw •LbA% Tear Ma-s01 + TdyArAar Nn) J"-J7M - RE-CP41 11"n- A U6 0 5 ?M5 July 26'.2005 HOME Tu MOM It--uVq:C-OnCM: ThO:,CApYf Nexandft hes had ft:pjwsute- of wqrldng: wfth MorTem Risk *es Management -Ser, inc- and 113 pamnt:eompany, Hammern-wn &. Gainer lhteffiathnal sintd M J. o ,I aidmiNs p —p 00 �Ov, pi q -4, tr ji y !A. They yloeo Ajrn p and medical bill rep servic - fDr the City -". ng this peded4 They have . w sumep.#Uly managed our" workers' ppmpemoon, program -apd. liability claim exposures. t, need ov rEreduction .esuft, the has, expetW a, 50% e & in the costs of m-- anaging its program. I vmWcf hi4hly recommend ihis 6rm: as they have demonsiratecl a high d6gres of ph)f6ssioriafismapt :ail finjoA, lhfty,hive 'OrdVbO very good customer oner service. to bur staff and to tho,pubd by addm$�Ing;cur -needs. Considering we are -a; pudic eNity whosa:objectives..Bretoc6nstarft serve the COMun *Oil, WO are proud to be hi 'rt6o III --th Ha - pa rpupw . . mah. & GWher 1ht.etn;itional Mmer and Mor-TeMrRjSk Management, . Service, Inc. KGS/ss jStA*j^w-4 Sincerely., I<Wvin Sanders Cfty Attorney QtV AMWOry, Tel: (00449-SMS eVX-(V$)-449-*5019 ALLEGRO RISK MANAGEMENT INFORMATION REPORTS ➢ New Claim ➢ Closed Claim ➢ Open Claim ➢ Claim Cost Detail ➢ Claim Activity -Y - ➢ claim Composite ➢ Claim Summary by Year ➢- Loss Analysis ➢ Payment Composite Claim Status ➢ Claims Overview ➢ Cost Management ➢ Provider Cost Management Summary Cost Management Overview ➢ Check Register @Global, Inc. proprietary and confidential information Selection Criteria: As -or -Deter ilJira001 Workers' Compensatlon 001 From: NIA 001To: NIA t ew Claim Report . Created From: 111f2001 Created To: V31f2001 In Order. Claim SubType Employer ABC Employer Company Printed: 7/20/2001 Page: Client: ABC Client Company Claim Numbar Claimant Name Clalm SubType p.O,L opened 1,1101s 9-1... rm [PA h I^ILnla em.r... it, TPA t,.puma a-1.0 Reserves Payments Recoveries tncurre+ Client: 'ABC Client Comparly Employer: ABC. Employer Company and All Subdivisions Claim SubType Indemnity 01300190536 tndemnity 1123101 W0.101 2 5 0 7 Cause of Injury: Slraln or Injury by Lifting Madlcaf. ;0.00 $0.00 30.D0 $0.0 Nature of injury: Strain indemnity: 30'w. $0.00 $0.00 ;0.a Body Pan: Trunk; Low Back Area (Inc; Lumbar and Lumbo-Sacrat Expense: 10.00 30.06 $0.00 ;0,0 Occupellon; Door Assembly _ Rehab: Woo ;0 00 10.00 ;0 0 Total: $0,00 $0,00 $0.00 30'a 01000180073 indemnity 1110101 weld) 0 6 3 .9 Cause of injury: Slraln or Injury by Reaching Madlcal: $500.00 $0.00 $0.00 4603.0 Nature of Injury: Strain Indamnily; $0.00 ;0.00 ;0.00 $n.D Body Part: Upper Exlremhles: Finger(s) Expense: $0.00 30A0 40,00 ;0.0 Occupation: Mgr15ly1ist Rehab: $0.00 SO 00 $0.00 10.0 Total: $500.00. ;0.00 $0.00 5500,0 O10Q0180070 Indemnity 1111101 if19f01 1 4 3 6 Cause of injury: Fall. Slip nr Trip, NOC Medical: $500.00 10.00 $0.00 $500.0 Nature of Injury: Slraln . .. 16damnily: 10,O0 10.00 ;b.00 , ;0,0 Body Para: Trunk; Low Back Area (inc; Lumber and Lumbo-Saeral Expense: $0.00 $0.00 10.00 ;0.0 Occupation: Localdr Rehab: $0.00 $0.00 10.00 ;o 0 Total: ;500 00 1#0.00 $0.00 4500.0 01000179555 indemnity I15101 119101 3 0R 1 4 Causa of Injury: Struck or injured by Motor Vehicle Medical: 17,000.00 30.00 $0.00 s7,000,0 Nature of injury: Strain Indamnlly: 32,000.00 $0.00 10.00 $2,000.0 Body Pad: Mulltple Body Paris Expense: 30.00 $0.00 30.110 10.0 Occupalion: Locator Raheb: $0,00 $0.00 ;0 ❑0 ;0 0 Total: ;9,000.00 $0.00 $0.00 ss Ot7fl.0 O1t]D0179945 Indemnity 113101 U17101 8 7 1 14 Cause of Injury: Strain or Injury by, NOC Medical: $2,750.00 ;0.00 30.00 32.750.0 Nature or Injury: Strain Indamnily: $1,066.38 10.00 $0.00 31,p66.3 Body Pad; lower Extremities: Knee Expense: $0,00 110.00 10,00 sD.a Ocrupailon: SRM Rehab- $0.00 $0.00 10.00 3❑ 0 Total: 13,818.38 30.00 $0.00 $3,816.3 01000179570 Indemnity 114101 119/01 0 4 i 5 Cause of Injury: Struck or Injured, NOC Medical: 350b.o0 10.0D $0.00 $500.D Nature of lnjury: Slraln Indamnlly: koo $0.00 S0.00 $0.0 '0ody Pan: Upper Extremilies; Hand Expense: $0,00 $0.00 $0.00 $0.0 Occupation: Manager Rehab: 30 00 ;0 D0 10 00 40.0 Total: 3500.00 $0,00 $0.00 $500.0 r • & • • • (MGlobal, i= proprietary and confMarillal Information. - . ` r r r • Selection Criteria: A"t-Dole: W112 as Workers` Compensation (301From: 001To: Closed Claim Report Ctored From: 111=01 Closed To: U3112001 Employer ABC Eniployar Company Prinied: 712012001 Page: Caeni: ABC Client Company peva ooen Lm Claim Number Clslmenl Hsme 2LIS Swaiteg II&L $nun mum ffild tKMFeeaa Qw " bumbi Arsaids' tom' B11bT*W by Client~ ABC Client Company tge S1311i0 rMI142." 36.00 $206.210.1 Indamnay: 30.00 S172.352.911 30.00 $172.359.9 Claims; 67 Avg Days open Lsg, From Dol: 143 Expense: $0.00 $30,286.35 . SI.00 330 295.3 Avg Days open Log. From opened: 134 Retlate SO I0 SD 0I SO OO SILO Taial: $127.e0 $409.767.00 $0.00 $406,915.4 S !� @ �W Selection Criteria,, . As -of -Date: 6130f2061 DOI From:-1/107001 Dot To: en0/2001 _ Workers' Compensation Crested From: NIA Created To: N/A - Loss Analysis Report Selected Tap 10 By: Claim count Claim Status: All Claims Employer. ABC Employer Company Printed: 7/20/20111 Page: Client: ABC Client Company Client: Employer: ABC Employer Company and All Subdivisions Medical Only YL_W Indemnity • * 0i Total . CaLis a of In Ivy C_iaims Paid lnctjrrcd JgW Cause of inlury - CI# rn■ Bd Incurred Total Cava■ of inluN clalml Paid Incurred Fall or Slip Injury From ' 27 $24,264.38 332,917.13 %15 Foil of Slip "M From 7 i81,638.52 $84,055.66 %26 Fell at Slip injury From 34 386.102.90 1116,973.49 1 Fail, Slip or Trip. NOC 27 513,640.16 $27,502.17 %15 Olhar-Miscaltansous, NOC 5 14 442.24 35,e73.22 %19 Fall, Slip or Trip, NOC 30 $27,129,26 $63,107.46 1 Strain at Injury by, HOC 17 39,145.21 $11,837M %10 Slrsin or frijin by, NOC 5 $20,844-59 325.209.115 . %19 Slrah or Injury by, NOC 22 329,969,80 337.046.24 1 Struck or Intend. HOC 18 $8,157-44 59.305.54 %9 F4 Slip at Tdp. HOC 3 11113,21119.112 $3SA05.31 %11 01hr-Mlscs1lanaoua, NOC 18 $7.230.89 511,321;46 ❑ih■r-M ocallen■ou■, NOC 15 42.790.66 45,548.24 %T 3wdt or Wad by Foil 2 $4.230-90 ' 327.'436.99 %7 Struck or lrllurad. HOC 16 $8,157.44 59,306.84 ' B1rsin or Infiay by L161ng Q. 16,643.99 37,987.26 %S 1 $0.00 30.00 '64 Strain or I" by LI81ng 10 38,543.92 $7,057.26 ' Cut, Punckned, Seeped,, 6 31,426.92 31,920.62 %5 Fag or Slip Ir3kay From 1 115,599.11 118,9711.02 %4 •Slrudkor injured by Fall 10 $2,596.02 335,027.07 ' Smock or bljkxsd by Fall 8 35.488.30 $7,500.06 %5 Fag or SOP 1r1(kult From 1 $23.09 125,91XIA0 %4 Cut, Punctured, Scraped, 8 it;126.52 s1,926.62 ' Birch or it" by Pushing, 5 s1,501.86 $2,643.79 %3 Rubbed or Abraded By, Rep 1 $5.080.19 11111,725.411 %4 Slratrt or Iryury by pushing 5 41,501.86 $2,643.79 ' 6lrein or k4kay by Holding 4 $077.58 51,566-62 %2 Strain or Iryury by LAIng 1 30.00 80.00 %4 Rubbed or Abraded By, Rep 4 $5,689.01 $12,502.01 ' All Other Causes 41 312,113.39 320.271.93 %23 All Other Causes 0 $0.00 10,00 %0 An Other Causes 45 s28,125.01 165,955.15 1 Taint: 175 $88,325.58 s129,220.99 %100 To.ah 27 3125,34B,21 $234,576.BZ %1t10 Total: 202 3211,873.79 3363,797.48 'A Madlcal Only hQj Indemnity yam{ Total Nature of Inlufy Claims P Incurrsd 79laJ tltltirs of InlurY 4111[pl! a jgij ' N■! a ( lulu �[� Q ill . Sclli101 1?.!!Si 1[1fuf>3d Slnln 129 $70.040.54 $102,983.82 %74 $&rein Is 497,f>a5.37 $108,452,64 %/7 strain `147 $187,085.91 $271.416.26 1 Contusion Is 33,271.40 16,449.45 %td Fracture 3 $8,143.22 $39,259.89 %11 Contuslcn 19 0,762.08 312,827.30 ' Lacarsdon 5 $1.534.75 32,534.75 %3 All other kytalas. NOC 2 $315.74 1507.61 %1 Alt other Injwins, NOC 5 Se69.22 S11e1.29 ' Pundur■ 4 _ $1107.69 31.107.69 %2 1 40.00 30.00 %4 Laceration 5 11.534.75 52,534.75 ' Sprain 4 ' $988,63 31,118.63 %2 A8.0Ihr Cuknrdalive U* I i15,509.11 118,971.07 %4 Pundkae 4 s107,69 $1.107.69 ° All ether Injuries, NOC 3 $353.49 $353.41 %2 Contusion I $3,490.80 58,377.85 %4 Sprain 4 498e.83 s1,485.53 ' Burn 3 3900.17 s1,670.01 %2 Mental strass 1 1794.02 31,007.81 %4 3 11,045.02 $1.045.02 ' Foreign Body 3. $656.04 41,199.04 %2 All Other Nature% 0 30.04 $0.00 %0. Burn 3 S901317 .31.870.02 ' 2 31,04S.02 11,045.02 %1 ForelgnBody 3 $658.04 51,158.04 ' AllOkherOrrupallonal 1 5223.81 5511.47 %I Fracture 3 35,143.22 $39.259.59 ' All01hirNdurse 3 -175 $7,205.79 39,754.21 *A2 Ali OtherHuurse 6 $23,822.56 130.252.59 " Total: $88;325M $120,220.89 %100 Tula[: 27 - 8125,348.21 8234,576,82. %100 Total; 202 3211.573.79 $3113.797.48 % Medical Only 'Ya( Indemnity YLuj Total Body a >dtems ■)? jl cu ■ ots Body PortClalml Ell (cn urred Toat body Aa Claims 1' aid Inc _1[fed Multiple Body Paris 41 331,588.91 339,584.88 %27 Lower Extremities: (Gies B 345,952.74 _ 117111.116212 %22 Multiple Body Psrts 51 353,678.20 580,309.17 1 Trunk; Low Back Area (Me 17 s14,217.84 323,005.33 %10 Mulliple Body Paris 4 $22,069.29 $40.744,42 rb15 Trunk; Low Back Armstinc 19 314,217.84 324,iCIB.33 ' Upper Ex&remRfas; Hand 13 $3,889.49 55,632.59 %7 MuWpls Body Parts; Body 3 $1,109.78 31,515.62 %I I lower Exlrsmltiss; Man 14 $53,347.37 192,140.63 ' Upper Exlremilles; Should 10 35,539.13 $6,226.93 %6 Upper ExImmillu; Should 3 113,788.89 156,42L21 %i f Upper Ektramiltes; Hand 13 $3,889.49 36,632.59 ° Lower Extremities; Ankle 9 $1.617.53 33,476.09 %S LowerExlromlliss; AnWe 2 i1e,489.96 419.843.33 %7 UpperExlremAlu; should 13• 319,326.02 452,049.14 Upper Exiismillss; Finger 9 $919.46 33,919.46 %5 Trunk; Low Beck Ares (Inc • 2 50.00 3500.00 %7 lower Extremities; Ankh 11 $18.2157.51 323,319.42 ' Lower Exlremfll■.; Kn.. 6 37,394.63 i W,4T7.71 %5 Upper kramhles: Lower 2 0,332.41 $4.157.60 %7 Upper Extremities, Finger . 9 $919.46 33.919.40 Upper Extremities; Thumb 7 52.860.94 $3,860.94 %4 1 ' su.00 $0.00 %4 Upper Exlrsmilfes. Lower 6 $5,517.82 $7.700.79 ' Upper Extremities; Met 7 32,363AS $3,201.54 %4 Hand; Note 1 $3,490.68 $13,377.95 144 Upper Extremities, Thumb 6 34,690.96 37,613.65 ' Upper ExlromBles; Lower 5 $2,185.34 33,543.19 %3 Trunk; Upper BackAre■ (Th 1 i 1.657.10 $3.629.67 %4 Upper Exlrom&itas; Wdst 7 12,363.95 $3,201.54 ' M Other Ports 42 313;550:35 321.711.20 %24 AB Other Pads 2 517,429,20 42I,723.13 %7 AN Other Parts 49 535.437.17 $52,205.36 To Lai: 175 586,325-51 5129.220.65 %100 Total: 27 9126,348-21 1234,576.62 %100 Total; 202 -5711.673.79 $163,797.46'A ' 1� l� M ja WAIh ✓_ _ Ah t' AN Ah a' ` •, f♦ 2h A• Salectlon Critarta: As -of -Dale; 3/3112001 ' DOI From: NIA D01 To: NIA Created From: NIA Created To:' NiA Aclivily From: 311/2001 Activity To: 3131r2001 Claim SubType: All SubTypes I:mptoyar. ABC Employer Company Client: ABC Client Company Claim SubTyDe: Indemnity Claim Status: open Clalmr. 6 Js al Payment CaleOory # Payments 1 Payments Total 8-42-124 Relmbursemenl - 1 $572.73 %1 Ambulance ;• 1 $475.00 %1Anesthesia yq 1 $334.50 'A1 BIII ReviewlNelwark Access 76 $1,641.15 %3 Durably Medical Equipment 2 $1,574.61 %3 Emergency Care 1 $83.78 ■%0 Medical Cure 73 $10,017.21 1A17 Mileage Reimbursement 1 $266.77 %0 PhysicalTharepy 33 $3,545.81 %6 PPO-Scheduled Paymenli 3 $2,177AD %4 PPn-Working-Unit i $9211.81 %2 Prescriptlon Medlcallon 8 $407.41 %1 Psychiatric Care 2 $227.73 %0 Radiology (MRi Only) 2 $1,100.00 •A2 Radiology(X-ray, CT Scan) i $46A2 %0 RN Case Management 7 $2,509.46 9L5 Settlement -Full rL Final 1 $1500.00 %4 Supplins/Physical Accessories 13 s1,611.49 %3 Surgery 2 $5,834.21 %10 5urgeryAssistant 1 $79.57 %0 TPD 11 $4,981.9i %5 Transporladon 1 $23.20 %0 Travel RelmbursemenItAdvance 1 3158.70 a40 TTD 9 $5.580,69 %9 Total: Workers' Compensation Payment Composite Report Sort by: Payment Category Name. Calculate °% of Tolat by: 1 Payments Printed: 7/23/2U01 Page: Claim Status: Closed Claims; 5 ft e( Payment Caleaor-y A Payments $ Payments jgtal Anesthesia 1 $287.60 %0 Bill Adview/NelworkAecess 54 31.057.16 %2 ❑Isllguremsni 1 1200.00 %D Durable Medical Equipment 1 $28 t.60 %1 Impairment Evaluation 3 $405:00 %1 Medical Cara 49 $5,599.26 %10 Medical RamrdslCopy Charges 2 $37,40 140 Mileage Relmburseinani 1 $47.88 'A0 Physical Therapy 23 $7,635.39 %7 PPD-Schadulad Payments 4 $2,604AB %5 PPO-Warking Unit 17 $21;120.45 %39 Prescription Madleallon 39 $10,333.10 %19 Psychlaldc Care 13890.56 %2 Radloiogy(X-ray, CT Scan) 2 $122.12 %a SupplieslPhyslcal Accessories 9 31,149.32 %2 Surgery 2 $2,456.59 %5 TPO 5 $710.08 %1 Transportellon 3 $12340 %0 Travel RetmbursamenitAdvance 1 $70.80 'AD TT❑ 4 12.163.42 s%4 251 159,457.68 %100 Total: 122 %53 678.07 %100 Claim Status: Total Payment CalaRury 8-42-124 Reimbursement Ambulance Anesthesia BIII ReylewfNetworkAccess D29flguremanl Durable Medical Equipment Emergency Care Impairment Evaluation Medical Care Medical RecordslCopy Charges Mileage Reimbursement Physical Therapy PPD-Schaduted Payments PPD-Warking Unit Prescription Medlcalton Psychiatric Care Radiology (MRI Only) Radiology (X-ray, CT Scan) RN Case Management Settlerhanl-Full 8 Final Supplies/Physical Accessories Surgery Sugery Assistant TPD ,r.. ,, Transportation Travel ReimbursamenuAdvance TTO Total: Claims: 11 . 4 Payments 1 i 2 130 1 3 1 3 t22 2 3 56 7 i6 45 3 2 3 7 473 $ Payments $572.73 $47 5.00 $602.10 $2,698.31 $200.00 $1,856.41 363.76 $4D5.00 115,6 t 6, 47 337.40 $313.85 $7,381.22 $4,7911.26 s22,042,25 $10,740.51 11,IJ8.29 st,lon.00 $168.04 42,805.46 115,000.00 $2,76a 1fl $8.690.80 $79.V $5,672.57 $146.80 $237.50 '$ 7,744.11 $113,333;75 .���►sa_aa..M��amsrra��r�►aaaaa�a�aaa��avaaa�l�►•a Selection Criteria: 001 From: NIA 001 To: NIA Created From: NIA Created To: NIA Workers' Compensation Notes Frcm: lJ1A Notes To: NIA Claim status Report Last Name; Claimant First Name: John Case No: NIA Client No; • NIA printed; 819/2001 Page: Employer. ABC Employer Company Client ABC Client Compainy client: ABC Client Company Employer: ABC Employer and All Subdivisions �_ __ .,,�gi w'-�':r�"�• 'C'Z` -'�•y°�'.-�:=,°,u ; i t''�%.� � ?'SX?i>'T;c»rY;;. 'y �4T= �c i� �' ���':��F^.:ir`t�-.�L, .�7t`r. v4: �f_ .'�i �-_t' Reserv�N"ista ,Seo;tcanti"'�`L. '�,. .� ,ate f4 r 3 �;??':'"i`_3 ._,. �•-�4..°x•„t ,3�' r.,�_,�.,. j�'r.:�;fij5�,'a,�h�a , ._ .:�'r��..e..:t�.,..�s.�'.'�:-��`��-•L�fs.nls:�ira���l;;"ai5�s�,.3"1�'trkJrn �.:-....raA:c:�3;r �:.'�Si�-n'�z.,,•' '�`':'`J.. �;*�7�,�,�::_`i..:k�::i,c.�r f--• Old Incurred New Incurred Date Reason Reserve Category: Expenses History for Reserve Category:Expenses------------------- ------------------------------------------------ $0.00 538.47 51=01 Bill Review/Network Access ao.00 530.75 5122101 Bill Review/Network Access $0.00 36.45 STZ01 Bill Review/Network Access .0100 30.89 5410101 Blll Review/Network Access $0,00 32.39 Sr30101 Bill ReviewlNetwork Access 50,00 51.64 611&01 Bill Review/Network Access $0.00 315.47 6/15MI Bill Review/Network Access $0.00 $1.41 6/15/01 Bill ReviewlNetwork Access $0.00 45.02 ti122/01 Bill Review/Netvork Access S0.00 $1.54 &28101 Bill RevievdNetwork Access , 50.00 S37.10 715101 Bill Review/Netwcft Access ' S0.00 • =90.39 7/5/01 Bill ReviewlNetwork Access $0.00 S7,23 7111101 Bill ReviewlNetwork Access .50.00 $5.43 711&a1 Bill Review/Network Access $0.00 $1.41 7116MI Bid ReviewlNetwork Access 30.00 515.43 7119101 Bill Review/Network Access 30.00 56.05 7r2=1 Bill Review/Network ACCESS Co:hTnral by Rae. "p r`.a}ngnrs• FXpACf-5. it ruy+ i_-- Reserve Category: Indemnity History for Payment Category: Disfigurement S0,00 $800.00 4124/01 Reviewed S Revised by Adjuster History for Payment Category: TTD $0,00 3593.61 4124101 Initial Reserve History for Reserve Category: Indemnity '-------------------------------------------------------- - --------- $0.00 4593.81 4124MI Initial Reserve $593.81 51,393,81 4424/01 Reviewed d. Revised by Adjuster SubTotal by Reserve Category:. Indemnity s1,393.81 Reserve Category: Medical History for Reserve Category: Medical----------------------------------------------------------------------- 50.00. 33,500.170 4124101 Initial Reserve SubTotal by Reserve Category: Medical $3,500.00 Total by Claim: $4,899.36 Selection Criteria: 001 From: NA 001 To: NIA Created From: WA Created To: NA Workers' Compensation Notes From: NIA Notes To: NIA Claim Status Report L341 Name: Claimant First Name: John Case No: NIA Client NO: NIA Printed: SS'2001 Page: Employer. ABC Employer Comparry Client, A13C Client Company Client, ABC Client Company Employer ABC Employer Company and All Subdivisions late Time User 10 Note Text T127101 10:09 MARY 7f27101 LOTCP to Occupational Health, spoke to Dave. He stated that daim2rd saw Dr. Doe an 7125. Work status: wntinue full duty. He is to rehim to -see or. Smith on =i al 1:45. Dave thought Mat claimant wig be reicased trom care at that time. 7=1 10:15 MARY 7r310I FOR Dr. Smith Cifica Notes dated 61 and 6AW I. 6r1 Assessment 1) status post Injury with sJgnificant wound with infection, improved 2) nark out mm"sous wpxy. Plant 1) remain an modified duty 2) continue with healing as outlined by the Wound Care clinic. 3) MR? of his knee. 618 Assessment status post ir!Lwy with persistent knee pain. Plan: 1) refer back to Dr. Jones for evaluation. 2) remain an modified duty with no emergency response given the persistence al his sympiorns, 3) reevaluate After the above. 7r=1 FOR Or. Jones Office Note dated 6fl Z1011. X-rays: reviewed the MR1 which was totally normal. Impression medial hamstring lendinitis. Plan: Celebrox 200mg a day for 10 to 12 days; continue of his limited duty for that peraid at time; see Or.. Smith next weak: ww moist heal an this. He was released to full duty. Next appointment is 7125101 at 9: 45. 6113)01 10:55 MARY 6113101 FOR MRl Report of the RL knee dated &7101. Impression: no evidence of cruciate or callatecal ligament irqury. Menisci are intact. Marrow signal Is normal will% W evidence of "aAw Cartilage injury. No fracture of subjuxation appreciated. Patellae tetinaculs 6-dact. Extc-soir mechanism intact. 61II/01 111116 MARY 611=1 LOTCC to daimanL He stated that his leg is doing better. He said that the abcesa has completely closed and the Laceration has heeled in the middle but he has two open ends. He said that he does oat have to do daily w6urd care and just his bandaides over the open areas, He stated that he cardinues to have knee pain and has a knot along the side of his knee. He noted that herecently had a MR1 of the knee and will sec Dr. Smith an 6/12 to disn,ss the findings. He said that he saw Or : Jones an &B and Or. Jones could not see anything wrong with the knee on FAR]. He slated that he will nest w Dr. Doe Vie .ail week in June. He said Mait Dr. Smith in keeping him on light duty for the present. Sr29J01 14:58 JOHN Filing G A today for closed rM. sr2sto 09M, MARY 512SM1 FOR Dr. Smith office Note dalcd I0113MIl. Ncizd !:=1 =dc Izz2 -c=Wce. Ha =::Nas '.,a larva parallel abrasibm over the anterior tibial area tout he is "rig much llemr. Plan: see him an a as needed basis, have Or. Doe tallow him. W21101 1613.4 JOHN Sn 1101 CORR iinooductory lieflem to Claim" and to Dr. Smith at Occupational Health- wisfol 14:59 MARY Sit SK11 LOTCC to ciakmv* Inn to =4 CM. SIUM11 LOTCO to Robin at OccupaSorsal Cenw. LM to calt C&L SM71011 15DG JOHN Per Dave, go ahead and issue a suppi Ck for the addl days off and mail. Address conm CL Will a1suirie that the olhLr check will'show up. 5/17101 %1:39 JOHN PC !tarn drvtr$ wife, stalling she had not yet reed her TTO ct, advised was issued 5110 & mailed. She does not believe that R could take that She called Dave who promptly caged nw Explalrad was waiting for time ~, which was faxed an 511 ... We issued ck on 5110 for one day. Not sure why the delay, but it was maged, Howe ver. in reviewing the limesheeL it appears that the cirrit nerd to ;Perk on 44MMI. TheMons, tachnic2dly, the clmt should have been paid horn 420 thins 424MI. AL&o, wig. r Ln '" Pay' on check to 5" it it has cleared. ALsa, E-Mail Dave the address to verity if it is correct. Spoke to Carol cequesiled she complain a SROA, as the time sheet r"i W be Clear. win show LJPW as 417 as CLents days of are SUn Main. & Tuesk But was working overtime on Sunday. Owe an addl $2S4.49. 5115/o1 CM: 12 MARY Voice msg taken Ws am for Linda from JOHN from Robin at Ocoupabonall Health requesting 'a,AhocLuation for an addill" 12 visits for wound care. Apparently drrd has wound infection. Will check file and call her hack a SSSZ00-121Z. New case to MCM for Linda. Talked with JOHN, completed aKAh yesterday for 10 visits. Will let Unda know of new the on Thursday, 5110f01 12-.13 JOHN TIC from City, stating cint has not gotten his rhecX Reviewed notes arid XYZ was waiting for time card to verify 11t. 041MUMd wr-V01 At City and figuring out brne card, drM last 10 hrs p" the 3-day w.p., whilch is paid by City under wage continuadwL Told Carat I would issue the ifir wks of TTt3 lodey and walAd have XYZ file the GA next week. Tic from . HOSPITAL bo auth to appi flit 5114. ahacked notes mrid auth'd that PLL appt for XYZ Q25MI 111:12 JOHN No SROA yet reed by C4. Will hold off Issuing ck. awaiting verification of Lost Time from City. Selection Criteria: Month: July Year. 2001 Workers' Compensation Payment Category: Expenses, Indemnity, Medical- Claims Overview Deport Employer, ABC Employer Company Client: ABC Client Company Printed: B/10/ = Page: TPA: NIA ` SubTatal by Employa►: ABC Smployer Company and All Subdivisions Averag Cateaory Claim sub7vae 1 Pmt cateaery February M.11-ch Aprilmay June July 3101 Opening Inventory Indemnity 115 119 118 114 116 103 1 i Medical Only 56 93 '95 89 122 iO3 9: Sub. 173 W 213 203 238 205 20' New Clalms Indemnity 6 1.1 4 6 3 2 1 Medidal Only '56 • 56 40 72 33 18 41 Sub: 84 67 44 78 36 20 51 Closed Claims Indemnity 6 14 8 5 19 13 1 Medical only 25 56 46 40 52 25 4' Sub: 31 70 54 45 _ 71 38 5- Ending Inventory Indemnity i 17 116 114 115 100 92 10! Medical Only 89 93 89 121 103 96 9! Sub: 206 209 203 236 203 188 201 Closure Ratios Indemnity %75.0 %127.3 %200,0 %83.3 %633.3 %650.0 %294.1 Medical Only. %44.6 %100.0 %115.0 %55.6 %157.6 %138,9 %101.! Sub: °/s48.4 %104.5 %122.7 %57.7 0/6197.2 %190,0 DA120.- Avg Days / Closed Claim Indemnity 295.0 436.9 356.4 261.8 423.7 766.3 432.1 Medical Only' 68.8 57.4 67.2 73.9 a 79.5 67A 69.1 Sub: 363.8 546.3 423.6 335.7 503.2 833.4 5011 Avg Cost 1 Closed Medical Claim Expenses $10 $12 $10 $10 $10 $20 $ f Medical $475. $402 $469 $387 $406 ' $548 $441 Sub: $494 $414 $479 $397 $415 $567 $46• Avg Cost / Closed Indemnity Claim Expanses $292 $2,994 $72 $576 $525 $518 $82l Indemnity $2,492 $21.258 S3,413 S7,679 $1;490 $3,100 $6,60' Medical $7,032 $14,82i $4,381 $6,079 $6,336 $5,279 $7,32- Sub: $9,818 S39,073 $7,667 $14,533 $8,351 $6,906 $14,751 In-Pertad Payments Expenses $7,2211 $13,378 . $20,362 $8,223 $8,347 $12,997 $11,7.51 Indemnity $51,172 $103,739 $65.613 $54,858 $91.417 $56,099 $70.451 Medical $74,456. $142,337 $146,554 $87,794 $77.589 $78,415 $101,19' Sub: $132,656. $259.454 $232,528 $150,675 $177.354 $147,511 $183,391 Month -End Reserves Indemnity $1,922,666 $1,702,027 $1.649,354 $1.621,711 $1.532,843 $1,484,899 i1,652,28: Medicat Only $73,731 $76.351 $80.235 $91.368 $74,542 $87,992 $80,70: Sub: $1,998,597 $1,778,378. $1,729.589 $1,713,079 $1,607,385 $1,572,892 $1,732,9a- aiA r;a���►aaaa+�►aAkaahaaia�►aaal►aaaaaaaehal•aaaaa Selection Criteria: Date Received: NIA NIA Oats Processed: 1/1/2001 1/31/2001 Employer: ABC Employer Company Ghent: ABC Cllenl Comparly Workers' Compensation Cost Management Report Printed: 7/20/2001 Page: Client: ABC Client Company Amount Billed FS Allowance PPO Savings Amount Paid Cast M ml Fees q: Net Savin Emptoyer: ABC Employer Company and All SuhdIvIslons Activity; In -Network Activity Provider; XZY PHYSICAL_ THERAPY 00000168414 DOS From: 1211/00 Indemnity DOS Thru: 00544921 $50.00 $50.00 $4.33 $38/01 00000174839 12/1106 Dale Recelved: 12/14/00 Date Processed: 118101 $2rou Turn Around Time: $g g: DOS From: 11/29100 Indemnity D05 Thru: 00544848 11I29144 $164.00 date Received: $14.24 $9:02 $81.22 $4.51 2! 00000175029 Medical Only 00544875 12/14/00 Date Processed: 118/01 Turn Around Time: $78.2 2l DOS From: 9119100 DOS Thru: 9/1w6o $0.00 Date Received: $D 00 12/14100 $2 56 Dale Processed: $23.04 $1.28 -$24.3: 00000175560 DOS From: 12/4/00 Medical Only OD546113 $195.75 $i31.99 $11.54 118101 Turn Around Time: 2! 000401755fi0 DOS Thru: 12/4100 Dale Received: 12/19/00 Date Processed: $103.86 1/11141 $5.77 DOS From: 12/12/00 Medical Only DOS Thru: 00549087 - $280.50 $166.98 $16.69 $150.29 Turn Around Time: 2: 00000177411 Medical Only 12/15/00 0454379fi Data Received: 1/5101 Dale Processed: 1123101 $8.35 Turn Around Time: $121.81 11 DOS From: 11/28/00 DOS Thru: 11I30lDO $390.00 Received: $211/08 $23,14 $208,3] $11.57 00000177411 Medical D4546095 Date 12/111D0 ❑ale Processed: 1/4/01 Turn Around Time: $170 1, 2' D05 From: 12/5100 DOS Thru: 1.2/7/00 $406.00 bate Received: $119/00 12If91D0 $23.6d $212.74 $11.82 $181.41 000001774ii Medical Only 00547i74 $214,04 Dale Processed: 1111/01 Turn Around Time: 2: DOS From: 12/121DD DOS Thru: 12/12/00 Date Received: $135.84 12/28/00 $12.52 Dale Processed: $112,69 $6.26 395.0" 00000177411 DOS From: 12/20/00 Medical Only 00549832 � $391.00 $228.48 $211:56 1l16ID1 • Turn Around Tfine: i1 DOS Thru: 12/21/00 Dale Received: i/8/01 Date Processed: $194.12 $10.78 $186.11 00000177549 Indemnity 04549054 $933.60 1125101 Turn Around Time: 1 • DOS From: 1211/00 DOS Thru: 12/21l44 Dale Received: $578.i6 ` 1/5/01 $54,99 $495.09 $27.50 $41 i.I 00000177655 Medical Only 00543794 $346.00 Date Processed: 41231p1 Turn Around Time: it DOS From: 11/27/00 DOS Thru: 11/29/00 Date Received: $204 48 12/11/00 $2044 Dale Processed: $184.04 $10.22 $151.7• 00000177655 Medical Only � 00546084 $374.5D 114/01 Turn Around Time: 21 DOS From: 12/4100 DOS Thru:' 12/6100 Dale Received: $236.18 12/19/00 $21.89 Oats Processed: $197.13 00000177655 DOS From: Medical Only 00547167 $378.Q0 $225.28 1112,7 Turn Around Turn Around Time: 2: 12/11/00 DOS Thru: 12/13/00 Dale Recelved: 12/28/04 $22 52 Date Processed: $202,76 $11.26 $163.91 04000477655 DOS Medical Only 00549831 $189.04 $i12.64 1/16101 Turn Around Time: 11. From: 12/15/00 .DOS Thru: 12/i 5100 Oale Received: 118/D1 $11.26 Date Processed: $iD1.3a $5.63 00000177791 DOS From: 11/21/00 Medical Only 00546061 $572.00 $33.3p 1/25/01 Turn Around Time: i 00000177791 DOS Thru: 11/3p10D Data Received: 2116/00$354.24 t2119/p0 Date Processed: $299,68 1111I01 $16.65 $255.6' DOS From: 12/8/00 Medical Only D0547165 $166.00 $1D9.84 $10.44 Turn Around Time: 2: 00000178102 DOS Thru: 1218/00 Dale Received: 12/28/00 Dale Processed: $91.25 11/1fi/01 $5.07 $69.6t DOS From: 11/30/00 Medical Only DOS Thru: 00547160 12f7/00 $587.40 $369.14 $36.15 $325.40 Turn Around TIME: it OOODOi78i02 Medical Only 005d9$19 Date Received: 12128/00 Date Processed: � 1/16101 $18.08 Turn Around Time: $24J.5: D05 From: 12/19104' DOS Thru: 12/21/00 $361.00 Date Received: $193.28 $19.32 $173,96 $9.66 11 00000178227 Medico! Only 00547144 $1,047,00 118/01 Dale Processed: 1/25/01 Turn Around Time: $177.31 1' DOS From: 12/1100 DOS Thru: 12/13/00 Date Received: $592.3fi- 12/28/00 $58.74 $528.81 $29.37 $488.B: Dale Procass ■ �0 & ift- 1a lift �e�alallYM ALOM9M th ri � Ak r♦ Ah �aAL a 11♦-� �1Al >♦ +♦ n11�W'TI� �!� i Selection Crfleda: f Workers' Compensation Date Racaived: N/A - N!A Provlder, Cost Management Summary Report Data Procassed: 1/112001 - 113 1 /2001 Employer: ABC Employer Company Pdnled: 712312001 pegs: 1 Client: ABC Client Company Amount Billed f5 Aftowance EPO sfvfn91 Amount Pald Coat I,1aml Feei tiiel seyln(tr Cllem: ABC Client Company Employer: ABC Employer Company and All Subdivisions Activity: In -Network Activity Provider; HEALTH, i�C. $424.96 $424.99 S74.00 $390.96 $17.00 S17,00 Bills: 3 %1.00.00 %8,00 %92.00 %50.00 %4.00 Average TAT. 23.57 Provider. CENTER CORP $236.02 $236.01 $0.00 $254.24 SO.00 -Sie.22 Bills: 3 %100.00 %0.00 %107,72 °b0.00 -%7.72 Average TAT: 20.00 Provider: CLINIC SVC $7.501.56 $1.318.25 $186.84 $1,12225 $58.61 V,320.70 Bills: 7 %52.70 %14.17 %44.86 %4.25 `%+52.80 Averega TAT: 25.29 Provider; THERAPY ASSOCIATES $993,25 $762.05 $117.71 $617.66 $50.8a $318.71 Bills: ti %76.72 %15.45 %62.19 %15.68 %31.89 Average TAT: 22.00 Provider: REHABILITATION. PC $87.89 $57.89 $3.52 $84.37 $1.76 $1.75 Bills; 1 96100.00 %4.01 %95.99 %50.00 %2.00 Average TAT: 20.00 SubTaist by Activily: In-Nelwork Activity $4,243.58 $2.829,17 $342.07 $2r469.48 S136,25 $1,637.95 Bills: 20 %66.67 %12.09 %58.19 °87.68 %38.60 Average TAT: 23.00 Activity: Out -of -Network Activity Provider: MARY PROVIDER, M.D. $770.03 $247.38 SO. DO :1..., 5247.38 $0.00 $22.62 Billy: 1 %91,62 %0.00, %91.82 %0,00 %8.38 Avategs TAT: 28.00 Provider: MEDICAL CENTER $0.00 S6.00 $0.00 $0.00 S0.00 $0.00 Bills: 1 %0.00 %0,00 %6,00 %0.00 %0.00 Averaga TAT,.... 20.00 SubTolai by Ac4lvtiy: OW -at -Newyork AcIIvIIy $270.007 $247.38 $0,00 $247.38 S0.00 $22.62 Bins: 2 %91.62 96o:tw %91.62. Average TAT: 24.00 SubTotal by Employer: ABC Employer Company and All Subdivlslons In-Hetwofk Activity: Bills: 20 54,243.68 $2,829.17 $342.07 S2,469.48 $136.25 $1.637.95 %66.67 %12,09 %58„ 19 %7.66 %38.60 Aver aga TAT: 23A Oul•ot-liatwofk Activity: Bills: 2 $270.00 S247,38 50,00 $247.38 SO.00 522.62 %91.62 %O,DO %91.62 %0.00 9L8,38 Average TAT: 24.00 TOTALS: Bills: 22 $4,513.68 $3,076.55 $342.07 $2,716.86 5136.25 SI,660_57 %t 1.12 %60,19 %7.58 %36,79 Average TAT: 23.09 �.. A&ALM aa►�ra�tltLALMMA&MAhM �,•�ii�aiiai�+risi�■ a Check Register Report Selected by: Bank Name - N/A Check Status: All Printed: 08/10/2001 Account- NIA 5uhaccount- N/A Oate Range: From 01/01/2000 . , To 08110/2001 Carrier - N/A Client - N/A Employer - NIA TPA N/A Order by: Check No Check Status: Paid Payee Name TPA Claimant Name Client Check Dt Issue Dt Bank Name Vold/Stop lit Carrier Check Number Payee ID Claim No. Employer Claim Number . Service From Dt & To Dt Account subaccount Reserve Type Pmt Code - Amount Test Testor Test TPA Testor Test ABC Clleat Company ' 07/16/2001 07116/2001 Test Bank ABC Cutler 999-99-2272 01000000010 Clerical 07/16/2001 07/16/2001 Medical Medlcal Cue tlew Perron Test TPA Person L New ABC Client Cnmpiny 07/30/2001 07/30/2001 ABC Oink _ ABC Carrier 999.94-8688 olooDOODD20 Food Prep TEST 07/3012001 07130/2001 Medical Medical 125 Sub Totals for Check Status - Paid Sub Totals by subaccount: Sub Totals by Carrier: Carriez- ASC Carrier Sub Totals: n Subaccount: Checks Amount NIA 2 24.25 Checks Amount 2 24.25 _ Checks Amount 2 24.25 Grand Totals: Checks Amount 2 24.25 i r As ar.rr.rrra.rdb aararrrrrr