HomeMy WebLinkAboutAlternative Service concepts, LLC- 06.18.2007 AS
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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
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 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 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;
experts' fees (i.e. engineering, physicians, chemists, etc.); fees for independent
medical examinations; witnesses' fees; witnesses' travel expense; 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 expense incurred by "ASC" at
the request of "Client"; 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".
(c) To provide "ASC" with complete copies of all excess policies which apply to the
claims reported during the Contract period.
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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).
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.
(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.
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ASC
Alternative Service Concep,
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
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.
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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: /3t= I c5 BY:
TITLE: CEO
DATE: 6--44 7
CITY OF WATERLOO, IOWA
WITNES : C' B :
TITLE: N\ay r
DATE: ( - l $-U 7
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ASC
Alternative Service Concepts, 1_, rY
Alternative Service Concepts, LLC
City of Waterloo, Iowa
July 1, 2007 to June 30, 2008
One-Year Claims Handling
New Claims
Service Number Of Per-Claimant
Claimants Fee Total Fee
Workers' Compensation Claims
Indemnity 5 $525 $ 2,625
Medical Only 80 $100 $ 8,000
Run In Claims (D/L prior to 7/1/06) TBD $350
Incident Reports' TBD $35 Per Report
Total Minimum Claims Fee $ 10,625
Data Conversion
At Cost
On-Line Access (One User) No Charge
Additional Users $60/User/Month
Account Administration Fee $ 2,500
Minimum & Deposit Fee $ 13,125
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$260 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
1 Recorded in claims system only.Must be specified as "Incident"at time of reporting.
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ASC
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Medical Cost Management2
Fee Scheduling 22% of Savings
PPO Usage and Other Non-Fee Schedule Savings 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.
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:
2 Pricing for additional managed care services is available upon request.
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• 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.
ALTERNATIVE SERVICE CONCEPTS, LLC
WITNESS: /3a ) ( i(e F BY: , e,-/Zek,,,,,401
TITLE: CEO
DATE:
CITY OF WATERLOO, IOWA
WITNES : ( BY: /
A/4_
TITLE: Y)--)cz yor
DATE: 6' -- / 8-67
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