HomeMy WebLinkAboutAlternative Service Concepts, LLC - 6/24/19ASC
Alterriat ve Service Concepts, LLC
CLAIMS SERVICE CONTRACT
THIS AGREEMENT is made and entered into with an effective date of July 1,
2019, between ALTERNATIVE SERVICE CONCEPTS, LLC, formed in Delaware, with
principal offices at 2501 McGavock Pike, Suite 802, P.O. Box 305148 Nashville,
Tennessee 37214-1213, hereinafter referred to as "ASC", and CITY OF WATERLOO,
IOWA with principal offices in Waterloo, Iowa, hereinafter referred to as "Client".
WITNESS:
WHEREAS, "ASC" is in the claims service business; and
WHEREAS, "Client" desires to contract with "ASC" as its claims service company
to service the Workers' Compensation claims of "Client's" arising out of their facilities
located in Waterloo, Iowa.
NOW, THEREFORE, "ASC" and "Client" contract as follows:
"ASC" AGREES:
1. (a) To review all claims and/or losses reported during the term of this Contract
which involve Workers' Compensation claims against "Client".
(b) To investigate, adjust, settle or resist all such losses and/or claims within the
agreed discretionary settlement authority limit of Ten Thousand Dollars
($10,000).
(c) To investigate, adjust, settle or resist all such losses and/or claims in excess of
the agreed discretionary settlement authority limit only with specific prior
approval of "Client"
(d) To use legal counsel selected by "Client" whenever legal assistance is required.
(e) To report excess claims to "Client's" excess carrier only if "Client" fulfills its
obligations under "Client Agrees" Section, 4c.
2. To furnish all claim forms necessary for proper claims administration.
3. To establish claim and/or loss files for each reported claim and/or loss. Such files
shall be the exclusive property of "Client". Such files are available for review by
"Client" at any reasonable time, with notice.
4. To maintain adequate Automobile Liability, Errors and Omissions, Fidelity Bond,
General Liability, and Workers' Compensation insurance coverage.
5. To indemnify, defend and hold harmless "Client" with respect to any claims asserted
as a result of any errors, omissions, torts, intentional torts or other negligence on the
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part of "ASC" and/or its employees, unless the complained of actions of "ASC" were
taken at the specific direction of "Client".
"CLIENT" AGREES:
1. To make funds available that "ASC" may draw from at any time and from time to
time for claim and/or loss payments and for associated allocated expense within the
discretionary settlement authority limit of Ten Thousand Dollars ($10,000) and for
claim and/or loss payments in excess of the discretionary settlement authority limit of
Ten Thousand Dollars ($10,000) with the prior approval of "Client".
2. To pay "ASC" fees in accordance with the Fee Schedule attached to this Contract.
3. To pay "ASC" within thirty (30) days of the effective date of all invoices. All past due
invoices are subject to an interest penalty of one and one-half percent (1 1/2%) per
month. In the event "ASC" brings any action or proceeding to recover any part or all
of an outstanding indebtedness, "ASC" shall be entitled to recover as additional
damages any reasonable attorney fees not to exceed twenty percent (20%) of the
outstanding indebtedness.
4. (a) To pay all Allocated Loss Expenses in addition to the claim service fee to be
paid to "ASC" as prescribed in this Contract.
(b) "Allocated Loss Expenses" shall include but not be limited to attorneys' fees;
experts' fees (i.e. engineering, physicians, chemists, etc.); fees for independent
medical examinations; witnesses' fees; witnesses' travel expenses; court
reporters' fees; transcript fees; the cost of obtaining public records; commercial
photographers' fees; automobile appraisal or property appraisal fees; medical
cost containment services, such as utilization review, provider bill audit,
preadmission authorization, hospital bill audit, and medical case management;
all outside expense items; extraordinary travel expenses incurred by "ASC" at
the request of "Client"; and any other similar fees, cost or expenses associated
with the investigation, negotiation, settlement or defense of any claim
hereunder or as required for the collection of subrogation on behalf of "Client".
(c) To provide "ASC" with complete copies of all excess policies which apply to the
claims reported during the Contract period.
5. To relinquish authority to "ASC" in all matters relating to claims service within the
agreed discretionary settlement authority limit of Ten Thousand Dollars ($10,000).
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6. (a) In the event, "ASC", acting at the specific direction of "Client", becomes liable to
any third party, "Client" agrees to indemnify, defend and hold "ASC" and/or its
employees harmless.
(b) If "ASC" or any of its employees are named as defendant in any action (i)
where the plaintiff's cause of action involves a claim hereunder and (ii) where
there are not allegations of errors, omissions, torts, intentional torts or other
negligence on the part of "ASC", "Client" will assume the defense of the action
on behalf of "ASC" and/or its employees and indemnify and hold "ASC" and/or
its employees harmless from any judgment rendered as a result of such action.
"ASC" AND "CLIENT" MUTUALLY AGREE AS FOLLOWS:
1. (a) The term of this Contract is continuous from its effective date for one (1) year.
This Contract may be terminated by either "ASC" or "Client" with or without
cause by providing sixty (60) days' prior written notice by certified mail.
(b) In the event that this Contract terminates or expires for any reason "Client" shall
have the option:
(i) to have "ASC" handle open files which have been reported for an
additional fee based on our prevailing annual rate per file, or
(ii) to have "ASC" return the files to the client.
2. This Contract covers Claim Service for "Client" in the United States of America.
3. Gross receipts tax or assessments in those states or jurisdictions where levied shall
be in addition to the service fee.
4. In the event any one or more of the provisions of this Contract shall be determined to
be invalid or unenforceable by any court or other appropriate authority, the
remainder of this Contract shall continue in full force and effect, as if said invalid and
unenforceable portion had not been included in this Contract.
5. This Contract shall be construed and interpreted in accordance with the laws of the
state of Iowa.
6. This Contract represents the entire understanding of "ASC" and "Client" and
supersedes all prior oral and written communications between "ASC" and "Client" as
to the subject matter. Neither this Contract nor any provisions of it may be
amended, modified or waived except in writing signed by a duly authorized
representative of "ASC" and "Client".
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7. The failure or delay of either "ASC" or "Client" to take action with respect to any
failure of the other party to observe or perform any of the terms or provisions of this
Contract, or with respect to any default hereunder by such other party, shall not be
construed as a waiver or operate as a waiver of any rights or remedies of either
"ASC" or "Client" or operate to deprive either "ASC" or "Client" of its right to institute
and maintain any action or proceeding which it may deem necessary to protect,
assert or enforce any such rights or remedies.
8. To not employ a person who has been employed by the other party at any time
during the term of this Contract, unless the person to be employed shall not have
been employed by the other party during the immediately preceding six (6) months
or unless the hiring party shall have the other party's prior written consent. This
provision shall survive the termination of this Contract for a period of one (1) year.
9. During the term of this Contract, "ASC" will store closed files for a period of three (3)
years from the date of closure, the date of the last payment of benefits, or the
retention requirements of "Client's" carrier. The storage cost is included in the
administrative fees. After the three (3) year period, files will either be returned to
"Client" or destroyed if permitted by Statute.
10. This Contract is binding on any and all successors to the parties and assignable, in
whole or any part, only with the written consent of the non -assigning party.
11. "ASC" will query and transmit information under MMSEA requirements to CMS.
IN WITNESS WHEREOF, "ASC" and "Client" have caused this Contract to be
executed by the person authorized to act in their respective names.
ALTERNATIVE SERVICE CONCEP L sC
WITNESS: /7 (J-? Jgpl-,76
WITNESS:
BY:
TITLE:
DATE:
,46110 )1
CITY OF WATERLOO, IOWA
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BY:
TITLE:
DATE: /1(11 /,
(.44/4
07528
ASC
Alternative Service Concepts, LI C
Alternative Service Concepts, LLC
City of Waterloo, Iowa
July 1, 2019 through June 30, 2020
One -Year Claims Handling
Service
Number Of
Claimants
Per -Claimant
Fee
Total Fee
Workers' Compensation Claims
Indemnity
13
$623
$ 8,099
Medical Only
39
$168
$ 6,552
Run In Claims (D/L prior to 7/1/06)
TBD
$400
Incident Reports'
TBD
$40 Per Report
---
Total Minimum Claims Fee
$14,651
On -Line Access (One User)
No Charge
Additional Users
$60/User/Month
MMSEA-Annual Transmission Fees
(includes query & submissions)
$ 2,100
Systems Fee
$ 2,500
Account Administration Fee
$ 3,750
Total Minimum Fees
$23,001
Claims will be handled for one year from the date the loss is reported to "ASC" with
no additional per -claim fees. Any claim remaining open after 12 months will be subject
to an annual maintenance fee of $415 plus systems fees and administration fees. Fees
are based on claims volume provided. At the conclusion of the contract, any claims that
exceed the claim count stated above will be invoiced at the quoted per -claim rate.
The account administration fee includes:
• Account Setup
• New Claim Setup
• Client Meetings
• Excess Reporting
• State Reporting
• Storage fees
Recorded in claims system only. Must be specified as "Incident" at time of reporting.
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Medical Cost Management
Medical Bill Review/PPO Usage 30% of Savings
Subrogation Pursuit and Recovery
15% of Recovery
Allocated Expenses
Allocated expenses will be charged to the claim file and include fees for:
• Legal services
• State -mandated EDI
• Court reporters
• Professional photographs
• Official documents and transcripts
• Experts' / rehabilitation services
• Architects, contractors, engineers, chemists
• Police, fire, coroner, weather reports
• Accident reconstruction
• Subrogation collection cost payable to third party
• Extraordinary travel at client's request
• Medical records
• IMEs, MRIs, etc.
• Managed care
• Medical bill review
• Index Bureau reporting
• Outside investigation
• Surveillance
• Any other expense requiring client approval
Claims Handling at Contract Conclusion
At the conclusion of the contract, the following options are available for continued
handling of open claims:
• Annual per -claimant fee at ASC's prevailing rates
• Claims returned to client
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Workers' Compensation Definitions (for billing purposes on per claim fee
contracts)
Medical Only Claims - Work-related claims that require medical treatment only and do
not exceed $2,500 in total payments.
Indemnity Claims - Work-related claims that involve disability benefits or medical only
claims that require payment of medical and other expenses in excess of $2,500.
ALTERNATIVE SERVICE CONCE S, LC
WITNESS: /601 c 2 BY:
TITLE:
DATE:
CITY OF WATERLOO, IOWA
BY:
TITLE:
DATE:
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