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HomeMy WebLinkAboutAlternative Service Concepts, LLC - Claims Service Contract - 7.10.2006 7,4ASC oma Alternative Service Concepts, LLC CLAIMS SERVICE CONTRACT THIS AGREEMENT is made and entered into with an effective date of July 1, 2006 between ALTERNATIVE SERVICE CONCEPTS, LLC, a Delaware Corporation, with principal offices at 1101 Kermit Drive, Suite 800, P.O. Box 305148, Nashville, Tennessee 37230-5148, 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 as stated below. (c) To investigate, adjust, settle or resist all such losses and/or claims as are 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. 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 General Liability, Automobile Liability, Workers' Compensation, Fidelity Bond, and Errors and Omissions 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 ContractName/MMYY Page 1 Acct# ASC Alternative Service Concepts, LLC the 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 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. 4. (a) To pay all Allocated Loss Expense in addition to the claim service fee to be paid to "ASC" as prescribed in this Contract. (b) "Allocated Loss Expense" shall include but not be limited to attorneys' fees; commercial photographers' fees; experts' fees (i.e. engineering, physicians, chemists, etc.); fees for independent medical examinations; witnesses' travel expense; extraordinary travel expense incurred by "ASC" at the request of "Client"; court reporters' fees; transcript fees; the cost of obtaining public records; witnesses' fees; medical cost containment services, such as utilization review, preadmission authorization, hospital bill audit, provider bill audit, and medical case management; automobile appraisal or property appraisal fees; all outside expense items; and any other similar fee, cost or expense associated with the investigation, negotiation, settlement, or defense of any claim hereunder or as required for the collection of subrogation on behalf of "Client." ASC agrees to use specific vendors of these items if and when directed by Client and to apply and reasonable cost control measures as directed by client. 5. To relinquish authority to "ASC" in all matters relating to claims service within the agreed discretionary settlement authority limit of $ 2,500 Dollars. 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 ContractName/MMYY Page 2 Acct# ASC Alternative Service Concepts, LLC 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. "ASG" AND "CLIENT" MUTUALLY AGREE AS FOLLOWS: 1. The term of this Contract is continuous from its effective date for one (1) year and shall automatically renew for a like period thereafter unless and until terminated by either party pursuant to this paragraph. 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. 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." 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 ContraactName/MMYY Page 3 Acct# ASC Alternative Service Concepts, LLL: 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, at its expense, closed files for a Period of three (3) years from the date of closure or the date of the last compensation, whichever is latest. After this period, files will either be returned to "Client" or stored by "ASC" at "Client's" option and expense. If stored by "ASC," "Client" will be charged a one-time inventory fee and monthly storage fees at "ASC's" outside vendor's then prevailing rates. 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. 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 CONCEPTS, LLC WITNESS- BY: TITLE: CEO DATE: /� City of Waterloo, Iowa WITNESS: BY: TITLE: "Ti ►^-, }�t�r e•, IMa,rdr DATE: '7 Jo—OG ContractName/MMYY Page 4 Acct# One-Year Claims Handling Service Number Of Claimants Per-Claimant Fee Total Fee Workers' Compensation Claims Indemnity 5 $525 $ 2,625 Medical Only 36 $ 95 $ 3,420 Incident Reports' TBD $35 Per Report --- Total Claims Fee $ 6,045 Data Conversion from Prior Administrator At Cost On-Line Access(One User) No Charge Additional Users $60/User/Month Account Administration Fee $ 2,500 Total Fee $ 8,545 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$240 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 Medical Cost Management Medical Bill Review/PPO Usage........................................................................................................22%of Savings Medical Case Management.................................................................................................................$75 Per Hour Subrogation Pursuit and Recovery 15%of Recovery Banking Should the client wish for ASC to manage the claims payment account, an additional fee will apply. 1 Recorded in claims system only. Must be specified as "Incident"at time of reporting. 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 Workers' Compensation Claims Definitions 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.