CA Review JRT
Meeting Date: April 14, 2026
To: Mayor and City Council
From: Geoff Patnoe, City Manager
Staff Contact: Kierstyn Yaross, Senior Human Resources Officer [email protected], 760-814-4288
Sarah Reiswig, Risk Manager
[email protected], 442-200-4718
Subject: Agreement with Athens Administrators for Workers’ Compensation Third Party Administration Services
Districts: All
Rec
ommended Action
Adopt a resolution authorizing the City Manager to execute an agreement with Athens Insurance Services, Inc. DBA Athens Administrators for workers’ compensation third-party administration services.
Executive Summary
The city partners with a workers’ compensation administration company to manage and administer its workers’ compensation claims and to provide employees with the medical treatment they need to recover and return to work as quickly as possible.
The city’s current agreement with AdminSure Inc. expires May 31, 2026. To continue these services, the city requested proposals from qualified administrators to manage and administer its workers’ compensation claims.
Staff reviewed the proposals the city received and are now recommending the City Council authorize the City Manager, or designee, to execute an agreement with Athens Insurance Services, Inc., doing business as Athens Administrators, for workers’ compensation third-party administration services.
The term of the proposed agreement with Athens Administrators is for five years. The annual fee for the first year is $501,926, with a 3.65% increase for each of the subsequent years. The total fee for the five-year term shall not exceed $2,696,803.
The City Council’s approval is required under Carlsbad Municipal Code Section 3.28.060 because the agreement will cost the city more than $250,000 per year.
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This type of third-party administrator:
• Investigates and manages claims in accordance with the regulations adopted by state’s Division of Workers’ Compensation
• Coordinates medical treatment, interfaces with employees who have experienced a work-related injury or illness
• Provides compliance and financial reporting services
• Coordinates claim settlements
• Performs other related functions, such as cost containment, utilization and medical bill review, and payment of benefits to employees.
The city received nine proposals for this work. The proposals were evaluated based on the quality of the proposals, cost, experience, staff qualifications and level of services available.
Staff also conducted interviews with the five companies that had the highest rated proposals.
Athens Administrators proposed services to the city consisting of five claims adjusters and management staff with specialized California professional licenses and certifications and other staff assigned as needed, including registered nurses, state certified bill reviewers and contracted physicians. The services also include maintaining records in specialized databases and allowing city staff in the Human Resources Department to access these records to monitor claim resolution and review data analytics for the purposes of injury prevention and cost management.
Athens Administrators was the highest rated vendor, provided competitive pricing and had excellent references. The proposed agreement, including the scope of services, is included as Attachment A of Exhibit 1.
Fiscal Analysis
The proposed agreement contains an annual fee of $501,926 for the first year of administrative services and a 3.65% increase for each of the subsequent years. Sufficient funds for this expense have been included in the fiscal year 2025-26 and 2026-27 budgets and future fiscal year impacts will be reflected during the annual budget process.
Next Steps
With the City Council’s approval, staff will complete all administrative actions necessary to implement the agreement with Athens Administrators.
Environmental Evaluation
The proposed action is not a “project” as defined by California Environmental Quality Act, or CEQA, Section 21065 and CEQA Guidelines Section 15378(a) and does not require environmental review under CEQA Guidelines Section 15060(c)(2) because the action is limited to the execution of a service agreement to workers’ compensation third-party administration services. The action has no potential to cause either a direct physical change in the environment or a reasonably foreseeable indirect physical change in the environment.
E
xhibit
1. City Council resolution
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RESOLUTION NO. 2026-070 .
A
RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD,
CALIFORNIA, AUTHORIZING THE CITY MANAGER TO EXECUTE AN
AGREEMENT WITH ATHENS INSURANCE SERVICES, INC. DBA ATHENS ADMINISTRATORS FOR WORKERS’ COMPENSATION THIRD -PARTY
ADMINISTRATION SERVICES
W
HEREAS, the City of Carlsbad provides workers’ compensation benefits to its employees in accordance with the laws of the State of California; and WHEREAS, effective administration of workers’ compensation claims is necessary to ensure timely delivery of benefits to injured employees, compliance with statutory requirements, and prudent management of public funds; and
WHEREAS, the c ity desires to engage the services of a qualified Third -Party Administrator (“TPA”) to provide professional claims administration, cost containment, reporting, and related services; and
WHEREAS, staff solicited requests for proposals and received nine proposals from qualified firms; and
WHEREAS, staff reviewed the submittals and negotiated an agreement with Athens Insurance Services, Inc., doing business as Athens Administrators, which staff recommends executing; and WHEREAS, under Carlsbad Municipal Code Section 3.28.060(D)(5) relating to the procurement of professional services and services, City Council approval is required because the first year of the agreement will cost more than $250,000 for that agreement year; and WHEREAS, the budget for the first year of the agreement is available in the fiscal year 2025-26 and 2026-27 Budgets; and
WHEREAS, the funding for the agreement’s future years will be considered on an annual basis in the Human Resources Department’s annual budget requests.
NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California, as follows:
1. That the above recitations are true and correct.
2. That the action is not a “project” as defined by California Environmental Quality Act, or CEQA, Section 21065 and CEQA Guidelines Section 15378(a) and does not require environmental review under CEQA Guidelines Section 15060(c)(2) because the action is April 14, 2026
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Docusign Envelope ID: 1B980319-BD84-45EA-964E-31699322BDA4 limited to the execution of a service agreement to workers’ compensation third -party administration services. The action has no potential to cause either a direct physical change in the environment or a reasonably foreseeable indirect physical change in th e environment.
3. That the agreement with Athens Insurance Services, Inc., dba Athens Administrators (Attachment A) is approved and the City Manager or designee is authorized to e xecute all required procurement documents on behalf of the City.
4. That
the services under the agreement shall not exceed $2,696,803 for the term of the agreement.
PASSED, APPROVED AND ADOPTED at a Regula r M eeting of the City Council of the City of Carlsbad on the 14th day of April, 2026, by the following vote, to wit:
AYES: Blackburn, Bhat-Patel, Acosta, Burkholder, Shin.
NAYS: None.
ABSTAIN: None.
ABSENT: None.
_______
_______________________________
KEITH BLACKBURN, Mayor
__________________
____________________
SHERRY FREISINGER, City Clerk
(SEAL)
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AGREEMENT FOR THIRD PARTY ADMINISTRATION FOR WORKERS’ COMPENSATION CLAIMS
ADMINISTRATION SERVICES
ATHENS ADMINISTRATORS, INC.
THIS AGREEMENT (“Agreement”) is made and entered into as of the ______________ day of _________________________, 20___, by and between the City of Carlsbad, California, a municipal corporation ("City") and Athens Insurance Services Inc., dba Athens Administrators, Inc., a corporation, ("Contractor").
RECITALS
A. City requires the professional services of a consultant that is experienced in third-party administration of workers’ compensation claims.
B. Contractor has the necessary experience in providing professional services and advice related to the administration of workers’ compensation claims.
C. Contractor has submitted a proposal to City and has affirmed its willingness and ability to perform such work.
NOW, THEREFORE, in consideration of these recitals and the mutual covenants contained in this Agreement, City and Contractor agree as follows:
1. SCOPE OF WORK
City retains Contractor to perform, and Contractor agrees to render, those services ("Services") that are defined in attached Exhibit "A," which is incorporated by this reference in accordance with this Agreement’s terms and conditions.
2. STANDARD OF PERFORMANCE
While performing the Services, Contractor will exercise the reasonable professional care and skill customarily exercised by reputable members of Contractor's profession practicing in the Metropolitan Southern California area, and will use reasonable diligence and best judgment while exercising its professional skill and expertise.
3. TERM
The term of this Agreement will be effective for a period of five (5) year(s) from the date first above written.
4. TIME IS OF THE ESSENCE
Time is of the essence for each and every provision of this Agreement.
5. COMPENSATION
The total fee payable for the Services to be performed during the initial Agreement term shall not exceed five hundred and one thousand, nine hundred and twenty-six dollars ($501,926) per agreement year. The total fee payable for the Services to be performed shall increase by three point six five percent (3.65%) per agreement year in years two through five. The total fee for the five-year term shall not exceed $2,696,803. No other compensation for the Services will be allowed except for items covered by subsequent amendments to this Agreement. Payment terms are Net 30 unless otherwise provided in Exhibit “A” or agreed to in writing by the parties.
Attachment A
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Incremental payments, if applicable, should be made as outlined in attached Exhibit "A."
6. STATUS OF CONTRACTOR
Contractor will perform the Services in Contractor's own way as an independent contractor and in pursuit of Contractor's independent calling, and not as an employee of City. Contractor will be under the control of City only as to the result to be accomplished, but will consult with City as necessary. The persons used by Contractor to provide services under this Agreement will not be considered employees of City for any purposes.
The payment made to Contractor pursuant to this Agreement will be the full and complete compensation to which Contractor is entitled. City will not make any federal or state tax withholdings on behalf of Contractor or its agents, employees or subcontractors. City will not be required to pay any workers' compensation insurance or unemployment contributions on behalf of Contractor or its employees or subcontractors. Contractor agrees to indemnify City within thirty (30) days for any tax, retirement contribution, social security, overtime payment, unemployment payment or workers' compensation payment which City may be required to make on behalf of Contractor or any agent, employee, or subcontractor of Contractor for work done under this Agreement. At City’s election, City may deduct the indemnification amount from any balance owing to Contractor.
7. SUBCONTRACTING
Contractor will not subcontract any portion of the Services without prior written approval of City. If Contractor subcontracts any of the Services, Contractor will be fully responsible to City for the acts and omissions of Contractor's subcontractor and of the persons either directly or indirectly employed by the subcontractor, as Contractor is for the acts and omissions of persons directly employed by Contractor.
Nothing contained in this Agreement will create any contractual relationship between any subcontractor of Contractor and City. Contractor will be responsible for payment of subcontractors. Contractor will bind every subcontractor and every subcontractor of a subcontractor by the terms of this Agreement applicable to Contractor's work unless specifically noted to the contrary in the subcontract and approved in writing by City.
8. OTHER CONTRACTORS
City reserves the right to employ other Contractors in connection with the Services.
9. INDEMNIFICATION
Contractor agrees to defend (with counsel approved by City), indemnify, and hold harmless the City and its officers, elected and appointed officials, employees and volunteers from and against all claims, damages, losses and expenses including attorneys fees arising out of the performance of the work described in this Agreement caused by any negligence, recklessness, or willful misconduct of Contractor, any subcontractor, anyone directly or indirectly employed by any of them or anyone for whose acts any of them may be liable. Athens will not be responsible for any penalties, damages, etc. that are the sole responsibility of the City’s actions.
If Contractor’s obligation to defend, indemnify, and/or hold harmless arises out of Contractor’s performance as a “design professional” (as that term is defined under California Civil Code Section 2782.8), then, and only to the extent required by California Civil Code Section 2782.8, which is fully incorporated in this Agreement, Contractor’s indemnification obligation shall be limited to claims that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of Contractor, and, upon Contractor obtaining a final adjudication by a court of competent jurisdiction. Contractor’s liability April 14, 2026
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for such claim, including the cost to defend, shall not exceed Contractor’s proportionate percentage of fault.
The parties expressly agree that any payment, attorneys fee, costs or expense City incurs or makes to or on behalf of an injured employee under City’s self-administered workers’ compensation program is included as a loss, expense or cost for the purposes of this section, and that this section will survive the expiration or early termination of this Agreement.
10. INSURANCE
Contractor will obtain and maintain for the duration of the Agreement and any and all amendments, insurance against claims for injuries to persons or damage to property which may arise out of or in connection with performance of the services by Contractor or Contractor’s agents, representatives, employees or subcontractors. The insurance will be obtained from an insurance carrier admitted and authorized to do business in the State of California. The insurance carrier is required to have a current Best's Key Rating of not less than "A-:VII"; OR with a surplus line insurer on the State of California’s List of Approved Surplus Line Insurers (LASLI) with a rating in the latest Best’s Key Rating Guide of at least “A:X”; OR an alien non-admitted insurer listed by the National Association of Insurance Commissioners (NAIC) latest quarterly listings report.
10.1 Coverages and Limits. Contractor will maintain the types of coverages and minimum limits indicated below, unless Risk Manager or City Manager approves a lower amount. These minimum amounts of coverage will not constitute any limitations or cap on Contractor's indemnification obligations under this Agreement. City, its officers, agents and employees make no representation that the limits of the insurance specified to be carried by Contractor pursuant to this Agreement are adequate to protect Contractor. If Contractor believes that any required insurance coverage is inadequate, Contractor will obtain such additional insurance coverage, as Contractor deems adequate, at Contractor's sole expense.
The full limits available to the named insured shall also be available and applicable to City as an additional insured.
10.1.1 Commercial General Liability (CGL) Insurance. Insurance written on an “occurrence” basis, including personal and advertising injury, with limits no less than $2,000,000 per occurrence. If a general aggregate limit applies, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit.
10.1.2 Automobile Liability. (if the use of an automobile is involved for Contractor's work for City). $2,000,000 combined single-limit per accident for bodily injury and property damage.
10.1.3 Workers' Compensation and Employer's Liability. Workers' Compensation limits as required by the California Labor Code. Workers' Compensation will not be required if Contractor has no employees and provides, to City's satisfaction, a declaration stating this.
10.1.4 Professional Liability. Errors and omissions liability appropriate to Contractor’s profession with limits of not less than $1,000,000 per claim. Coverage must be maintained for a period of five years following the date of completion of the work.
10.2 Additional Provisions. Contractor will ensure that the policies of insurance required under this Agreement contain, or are endorsed to contain, the following provisions:
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10.2.1 City will be named as an additional insured on Commercial General Liability which shall provide primary coverage to City.
10.2.2 Contractor will obtain occurrence coverage, excluding Professional Liability, which will be written as claims-made coverage.
10.2.3 If Contractor maintains higher limits than the minimums shown above, City requires and will be entitled to coverage for the higher limits maintained by Contractor. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage will be available to City.
10.2.4 This insurance will be in force during the life of the Agreement and any extensions of it and will not be canceled without thirty (30) days prior written notice to City sent by certified mail pursuant to the Notice provisions of this Agreement.
10.3 Providing Certificates of Insurance and Endorsements. Prior to City's execution of this Agreement, Contractor will furnish certificates of insurance and endorsements to City.
10.4 Failure to Maintain Coverage. If Contractor fails to maintain any of these insurance coverages, then City will have the option to declare Contractor in breach, or may purchase replacement insurance or pay the premiums that are due on existing policies in order to maintain the required coverages. Contractor is responsible for any payments made by City to obtain or maintain insurance and City may collect these payments from Contractor or deduct the amount paid from any sums due Contractor under this Agreement.
10.5 Submission of Insurance Policies. City reserves the right to require, at any time, complete and certified copies of any or all required insurance policies and endorsements.
11. BUSINESS LICENSE
Contractor will obtain and maintain a City of Carlsbad Business License for the term of the Agreement, as may be amended from time-to-time.
12. ACCOUNTING RECORDS
Contractor will maintain complete and accurate records with respect to costs incurred under this Agreement. All records will be clearly identifiable. Contractor will allow a representative of City during normal business hours to examine, audit, and make transcripts or copies of records and any other documents created pursuant to this Agreement. Contractor will allow inspection of all work, data, documents, proceedings, and activities related to the Agreement for a period of one (1) year from the date of final payment under this Agreement.
13. OWNERSHIP OF DOCUMENTS
All work product produced by Contractor or its agents, employees, and subcontractors pursuant to this Agreement is the property of City. In the event this Agreement is terminated, all work product produced by Contractor or its agents, employees and subcontractors pursuant to this Agreement will be delivered at once to City. Contractor will have the right to make one (1) copy of the work product for Contractor’s records.
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14. COPYRIGHTS
Contractor agrees that all copyrights that arise from the services will be vested in City and Contractor relinquishes all claims to the copyrights in favor of City.
15. NOTICES
The name of the persons who are authorized to give written notice or to receive written notice on behalf of City and on behalf of Contractor under this Agreement are:
For City: For Contractor:
Name Sarah Reiswig Name James Jenkins
Title Risk Manager Title President
Dept Human Resources Address 2552 Stanwell Drive
CITY OF CARLSBAD CONCORD, CA 94520
Address 1635 Faraday Avenue Phone 925.826.1100
Carlsbad, CA 92008 Email [email protected]
Phone 442-200-4718
Each party will notify the other immediately of any changes of address that would require any notice or delivery to be directed to another address.
16. CONFLICT OF INTEREST
Contractor shall file a Conflict of Interest Statement with the City Clerk in accordance with the requirements of the City of Carlsbad Conflict of Interest Code. Contractor shall report investments or interests as required in the City of Carlsbad Conflict of Interest Code.
Yes No
If yes, list the contact information below for all individuals required to file:
Name Email Phone Number
17. GENERAL COMPLIANCE WITH LAWS
Contractor will keep fully informed of federal, state and local laws and ordinances and regulations which in any manner affect those employed by Contractor, or in any way affect the performance of the Services by Contractor. Contractor will at all times observe and comply with these laws, ordinances, and regulations and will be responsible for the compliance of Contractor's services with all applicable laws, ordinances and regulations.
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Contractor will be aware of the requirements of the Immigration Reform and Control Act of 1986 and will comply with those requirements, including, but not limited to, verifying the eligibility for employment of all agents, employees, subcontractors and consultants whose services are required by this Agreement.
18. SEVERABILITY
If any term or portion of this Agreement is held to be invalid, illegal, or otherwise unenforceable by a court of competent jurisdiction, the remaining provisions of this Agreement shall continue in full force and effect.
19. CALIFORNIA AIR RESOURCES BOARD (CARB) ADVANCED CLEAN FLEETS REGULATIONS Contractor’s vehicles with a gross vehicle weight rating greater than 8,500 lbs. and light-duty package delivery vehicles operated in California may be subject to the California Air Resources Board (CARB) Advanced Clean Fleets regulations. Such vehicles may therefore be subject to requirements to reduce emissions of air pollutants. For more information, please visit the CARB Advanced Clean Fleets webpage at https://ww2.arb.ca.gov/our-work/programs/advanced-clean-fleets.
20. DISCRIMINATION, HARASSMENT, AND RETALIATION PROHIBITED Contractor will comply with all applicable local, state and federal laws and regulations prohibiting discrimination, harassment, and retaliation.
21. DISPUTE RESOLUTION
In the event of a dispute arising out of or relating to this Agreement, the parties shall first attempt in good faith to resolve the matter through informal discussions between designated representatives of each party.
If the dispute cannot be resolved at the staff level, the matter shall be escalated to senior representatives of both parties, including the City Manager or designee, for further good faith resolution.
If the dispute remains unresolved after such escalation, the parties agree to participate in non-binding mediation with a mutually agreed-upon neutral mediator prior to initiating litigation. Each party shall be responsible for and shall pay one-half (50%) of all costs and fees associated with the mediation, including but not limited to mediator fees and administrative expenses.
If mediation is unsuccessful, either party may pursue any remedies available at law.
22. TERMINATION
In the event of Contractor's failure to prosecute, deliver, or perform the Services, City may terminate this Agreement for nonperformance by notifying Contractor by certified mail of the termination. If City decides to abandon or indefinitely postpone the work or services contemplated by this Agreement, City may terminate this Agreement upon written notice to Contractor. Upon notification of termination, Contractor has five (5) business days to deliver any documents owned by City and all work in progress to City address contained in this Agreement. City will make a determination of fact based upon the work product delivered to City and of the percentage of work that Contractor has performed which is usable and of worth to City in having the Agreement completed. Based upon that finding City will determine the final payment of the Agreement.
City may terminate this Agreement by tendering sixty (60) days written notice to Contractor. Contractor may terminate this Agreement by tendering sixty (60) days written notice to City. In the event of termination of this Agreement by either party and upon request of City, Contractor will assemble the work April 14, 2026
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product and put it in order for proper filing and closing and deliver it to City. Contractor will be paid for work performed to the termination date; however, the total will not exceed the lump sum fee payable under this Agreement. City will make the final determination as to the portions of tasks completed and the compensation to be made.
23. COVENANTS AGAINST CONTINGENT FEES
Contractor warrants that Contractor has not employed or retained any company or person, other than a bona fide employee working for Contractor, to solicit or secure this Agreement, and that Contractor has not paid or agreed to pay any company or person, other than a bona fide employee, any fee, commission, percentage, brokerage fee, gift, or any other consideration contingent upon, or resulting from, the award or making of this Agreement. For breach or violation of this warranty, City will have the right to annul this Agreement without liability, or, in its discretion, to deduct from the Agreement price or consideration, or otherwise recover, the full amount of the fee, commission, percentage, brokerage fees, gift, or contingent fee.
24. CLAIMS AND LAWSUITS
By signing this Agreement, Contractor agrees that any Agreement claim submitted to City must be asserted as part of the Agreement process as set forth in this Agreement and not in anticipation of litigation or in conjunction with litigation. Contractor acknowledges that if a false claim is submitted to City, it may be considered fraud and Contractor may be subject to criminal prosecution. Contractor acknowledges that California Government Code Sections 12650 et seq., the False Claims Act applies to this Agreement and, provides for civil penalties where a person knowingly submits a false claim to a public entity. These provisions include false claims made with deliberate ignorance of the false information or in reckless disregard of the truth or falsity of information. If City seeks to recover penalties pursuant to the False Claims Act, it is entitled to recover its litigation costs, including attorneys fees. Contractor acknowledges that the filing of a false claim may subject Contractor to an administrative debarment proceeding as the result of which Contractor may be prevented to act as a Contractor on any public work or improvement for a period of up to five (5) years. Contractor acknowledges debarment by another jurisdiction is grounds for City to terminate this Agreement.
25. JURISDICTION AND VENUE
This Agreement shall be interpreted in accordance with the laws of the State of California without regard to, or application of, choice of law rules or principles. Any action at law or in equity brought by either of the parties for the purpose of enforcing a right or rights provided for by this Agreement will be tried in a court of competent jurisdiction in the County of San Diego, State of California, and the parties waive all provisions of law providing for a change of venue in these proceedings to any other county.
26. SUCCESSORS AND ASSIGNS
It is mutually understood and agreed that this Agreement will be binding upon City and Contractor and their respective successors. Neither this Agreement nor any part of it nor any monies due or to become due under it may be assigned by Contractor without the prior consent of City, which shall not be unreasonably withheld.
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27. THIRD PARTY RIGHTS
Nothing in this Agreement should be construed to give any rights or benefits to any party other than City and Contractor.
28. ENTIRE AGREEMENT
This Agreement, together with any other written document referred to or contemplated by it, along with the purchase order for this Agreement and its provisions, embody the entire Agreement and understanding between the parties relating to the subject matter of it. In case of conflict, the terms of the Agreement supersede the purchase order. Neither this Agreement nor any of its provisions may be amended, modified, waived or discharged except in a writing signed by both parties. This Agreement may be executed in counterparts.
29. AUTHORITY
The individuals executing this Agreement and the instruments referenced in it on behalf of Contractor each represent and warrant that they have the legal power, right and actual authority to bind Contractor to the terms and conditions of this Agreement.
Executed by Contractor this___________ day of _______________________, 2026.
CITY OF CARLSBAD, a municipal corporation
of the State of California
CONTRACTOR
Athens Administrators a -Type Corporation
By:
By:
(sign here) Geoff Patnoe, City Manager
ATTEST:
By: SHERRY FREISINGER, City Clerk
(sign here) By:
Deputy / Assistant City Clerk
(print name/title)
If required by City, proper notarial acknowledgment of execution by contractor must be attached. If a corporation, Agreement must be signed by one corporate officer from each of the following two groups.
Group A Group B
Chairman, Secretary,
President, or Assistant Secretary,
James Jenkins/President
8th April
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Vice-President CFO or Assistant Treasurer
Otherwise, the corporation must attach a resolution certified by the secretary or assistant secretary under corporate seal empowering the officer(s) signing to bind the corporation.
APPROVED AS TO FORM:
CINDIE K. McMAHON, City Attorney
BY: _____________________________
Sr. Assistant City Attorney
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EXHIBIT A
SCOPE OF SERVICES AND FEE
Contractor shall provide usual and customary claims administration services that shall include, at minimum, the following:
a) Review all claims and loss reports filed against the City of Carlsbad, and adhere to Best Practices for claim handling.
b) Thoroughly investigate all claims made against City of Carlsbad through appropriate claim procedures as necessitated by the severity of the injury and ensures correct payment of medical and time loss claims.
c) Provide cost containment services, including medical fee reductions and a preferred provider network, provide quarterly report of cost containment services.
d) Integrate the current Medical Provider Network into the claims management process.
e) Prepare claim files for submission to a defense attorney.
f) Attend trials, mediations and /or settlement conferences as appropriate.
g) Develop and maintain an investigative file on each claim in accordance with an approved format by the City of Carlsbad. Files are to be readily available for the City of Carlsbad to review and shall be well documented and up-to-date.
h) Notify excess insurance carriers of claims and or occurrences at predetermined levels required by Excess insurers within 30 days of recognition. Provide information and status of claims as requested by the excess insurance carrier. Obtain reimbursements from Excess carrier and maintain accurate refund records on the claim file.
i) Develop and maintain a claims database to be used in the administration of the claims and to generate reports to the City of Carlsbad.
j) Provide the City of Carlsbad with a monthly report of account for individual claims and aggregate loss experience analysis. This report shall show the status of each open claim and experience year-to-date of all claims.
k) Have the capability of providing data necessary to prepare financial and statistical reports on losses or claims.
l) Within 24 hours contact employees and/or injured parties regarding the status of their claim.
Return calls or inquiries from employees and/or injured parties within 24 hours of receipt of inquiry.
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m) Provide assistance as necessary to the City of Carlsbad staff for proper procedural handling of claims.
n) Identify and investigate all subrogation possibilities for potential recovery including investigation, evaluation and negotiation of subrogation cases. Maintain financial records of all recoveries on the claim file.
o) Attend quarterly meetings with the City of Carlsbad staff.
p) Prepare administrative reports required by the State of California. Monitor the compliance of the City’s employer reporting requirements and record keeping requirements and advise of any deficiencies in the City of Carlsbad overall self-insured compliance matters.
q) Prepare and/or assist City staff with all appropriate responses to audits and inquiries of all regulatory agencies.
r) Provide 24/7 online electronic access to the City of Carlsbad’s claims, including payments, claim notes, status and messaging capabilities and ad-hoc report capability.
s) Provide sufficient data producing capability to provide the reporting requirements outlined in the RFP as well as sufficient records and electronic data retention and back-up and business recovery plan.
t) Provide Bi-Annual program review of claim activity, claim frequency, total incurred, and payment analysis.
u) Prepare data to provide to actuary upon request.
v) Maintain and keep all records directly related to the City of Carlsbad’s accounts.
w) Provide all usual and customary managed care services (example: medical bill review, utilization review, case management and physician review) per the price proposal, which is attached here and incorporated by reference as Attachment 1, and in compliance with State regulations and fee schedules.
Additional Requirements:
The Contractor shall, upon reasonable notice and at a reasonable time during normal business hours, allow authorized City Human Resources personnel the privilege, of inspecting, examining and/or auditing, any/all records which are directly related to the City's accounts. All inspection, examination and/or auditing shall be conducted at the Contractor's locations where records shall normally be kept.
All expenses related to such inspection, examination and/or auditing will be the responsibility of the city.
All reports, documentation, and material developed or acquired by the Contractor as a direct requirement specified herein shall become the property of the City of Carlsbad. The Contractor shall agree and understand that all discussions with the Contractor and all information gained by the April 14, 2026
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Docusign Envelope ID: 1B980319-BD84-45EA-964E-31699322BDA4 City Attorney Approved Version 10/23/2025
Contractor as a result of the Contractor's performance under the contract, shall be confidential and that no reports, documentation, or material prepared as required by the contract shall be released to the public without the prior written consent of the City of Carlsbad.
Upon expiration, termination, or cancellation of the contract, the Contractor shall assist the City to insure an orderly transfer of responsibility and/or continuity of those services required under the terms of the contract to an organization designated by the City, if requested in writing. The Contractor shall provide and/or perform any or all of the following responsibilities:
The Contractor shall deliver, FOB destination, prepaid, all records, documentation, reports, data, recommendations, master, or printing elements, etc., which were required to be produced under the terms of the contract to the City and/or to the City's designee within seven (7) calendar days after receipt of the written request. Any and all records which are on electronic media must be delivered in a format which is compatible with the system(s) currently in use by the City of Carlsbad.
The Contractor shall agree to continue providing any part or all of the services in accordance with the terms and conditions of the contract for a period not to exceed thirty (30) calendar days after the expiration, termination or cancellation date of the contract for a price not to exceed those prices set forth in the contract.
The Contractor shall have, at a minimum, the following qualifications:
1. A claims administration office located in Southern California.
2. The Contractor's firm and staff should have five years of experience in handling claims for self-insured public entities.
3. Sufficient staff to conduct field investigations, prompt reporting, prompt adjudication of medical and time loss payments and the appropriate level of supervisory personnel to assure compliance with the content of the proposal. The City shall be notified within 24 hours of professional staff turnover and resumes for replacements shall be provided to the City prior to selection.
4. The Contractor's third-party administrator services shall be provided in compliance with all applicable federal, state and local laws, requirements and/or ordinances relating to such services.
ATTACHMENT 1 – ATHENS PRICING PROPOSAL DATED 3/27/26
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Docusign Envelope ID: 1B980319-BD84-45EA-964E-31699322BDA4 Andrea Contreras
Sales Director
[email protected]
925-826-1286
Corporate Headquarters
Athens Administrators
2552 Stanwell Dr. | Concord, CA 94520
CITY OF CARLSBAD
Pricing Proposal
April 14, 2026
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Docusign Envelope ID: 1B980319-BD84-45EA-964E-31699322BDA4
PROPOSED STAFFING MODEL
Supervisor
Senior Claim Examiner
Future Medical Claim Examiner
Assistant Claim Examiner
Annual Stewardship Report Included
Electronic Delivery of Monthly Loss Runs Included
Claim Reporting (web, fax, telephonic) Included
Designated or Dedicated Bi-lingual Staff (Spanish) Included On-Line Claim System + Dashboard Access (Up to 5 Users) Included Banking - includes management of (1) bank account with monthly escrow replenishment. Each additional account will be charged at $600 per month. Included
Data Management Included
Account Management Included
4) Claim Volume: In the event that new annual claim volume exceeds the assumptions noted above than each claim above the stated number will be charged at the per claim fees noted within the terms of this proposal.
ADDITIONAL SERVICES
Annual Administration Fee - Includes the noted services below: $7,500 3) Full Claims Admin. Pricing contemplates the takeover of the following open historical claims. Please note that 25 claims were marked as "Indemnity/Future Medical" on your loss runs. We counted these claims as "Future Medical" versus "Active Indmnity" Indemnity 127
Future Medical 216
Medical Only 16
Info. Only/Report Only 10
1 Fully Dedicated 1 Fully Dedicated
PRICING NOTES
1) Pricing contemplates Athens providing both claim administration and managed care services. 2) Full Claims Admin. Pricing contemplates annual new claim volume of: Indemnity 99 Medical Only 65
1 Designated 1 Designated
1 Fully Dedicated +
1 Designated
1 Fully Dedicated +
1 Designated
1 Designated 1 Designated
STAFFING
Program Year 3 6/1/2028 5/31/2029 $628,325 $531,178
Program Year 4 6/1/2029 5/31/2030 $651,259 $550,566
Program Year 5 6/1/2030 5/31/2031 $675,030 $570,661
Program Year 2 6/1/2027 5/31/2028 $606,199 $512,472
CITY OF CARLSBAD
Unbundled Option Fully Bundled Option
FLAT ANNUAL FEE Start Date End Date TOTAL TOTAL
Program Year 1 6/1/2026 5/31/2027 $584,852 $494,426
3/27/2026
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Docusign Envelope ID: 1B980319-BD84-45EA-964E-31699322BDA4 Year 4 Year 5
Medical Fee Schedule Reduction (OMFS)
Year 4 Year 5
$176 $187
$340 $355
$57 $63
Year 4 Year 5
$150 $155
$155 $160
$160 $165
Year 4 Year 5
$355 $365
$305 $320
Bilingual Examiner Surcharge (Pro rata Charge will be based on caseload of 135)
CITY OF CARLSBAD
MEDICAL BILL REVIEW Year 1 Year 2 Year 3
$10.25 Per Bill(Includes: Medical, Pharmacy and Supplies) $8.75 $9.05 $9.40 $9.80 Per Bill
PPO Network & Specialty Bill Negotiations
Percentage applied below fee schedule reduction 24% 24% 24% 24% 24% of Savings Hospital In an Out Patient Fee Schedule Reductions $600 $622 $645 $668 $693
UTILIZATION REVIEW, CASE MANAGEMENT AND PHYSICIAN REVIEW Year 1 Year 2 Year 3
Duplicate Bills (No Charge to Review) $0.00 $0.00 $0.00 $0.00 $0.00 Concurrent, Prospective and Retrospective Review $155 $160 $167 Flat Fee UR appeals: Peer to Peer $300 $310 $325 Per Hour
Authorization Only $45 $48 $52 Flat Fee
Case Management Year 1 Year 2 Year 3
Catastrophic Case Mgmt. (Per Hour + Travel & Mileage) $145 $150 $155 Telephonic Nurse Case Management (Per Hour) $135 $140 $145 Field Case Management (Per Hour + Travel & Mileage) $140 $145 $150 Records Review $260 $275 $290 Per Hour
Peer Review Year 1 Year 2 Year 3
Physician Peer Review $325 $335 $345 Flat Fee
Jarvis Claim Communication System Included
New Loss Text Messaging to Injured Workers Included
CMS Reporting (Verisk) Included
Pharmacy Benefits Management (PBM) Included
Claim Reporting Included
Predictive Modeling Included
Subrogation Recovery - 15% of Gross Recovery
Medical Provider Network (Anthem) $6.00 Per Bill
IT Special Projects (i.e., Custom report creation, API feeds & special conversions) $180 Per Hour $8,000 Per Exam.
Nurse Triage - Optional Service $180 Per Claim
Pharmacy Drug Review $125 Per Hour
Central Index Bureau & First and Subsequent Report of Incident Reporting $27 Per 3/27/2026
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Docusign Envelope ID: 1B980319-BD84-45EA-964E-31699322BDA4 3)
= =
=
4)
5)
6)
7)
Sub rosa investigations Index bureau filings
Official documents and transcripts Chemist
Pre-and post-judgment interest paid Claim intake fees
Architects, Contractors and Engineers Outside investigations Police, fire, coroner, weather, or other such Subrogation recovery fees Property damage appraisals Property damage appraisals
Medical records Court reports
Experts' rehabilitation costs Accident reconstruction
Fees for service of process Collection cost payable to third parties Extraordinary cost for witness statements Extraordinary travel made at client's request b) Carrier report package by e-mail or website
Claim Reporting inclused the following:
a) Telephonic 800# b) Web Reporting
Custom Report Creation: Access to Athens' complete report library is standard and included in fees. In the event client requires report customization there will be a charge of $180 per hour to create required reports.
Legal fees Managed care expenses
Professional photographs Medical examinations
b) Settlement authority set at $10,000 d) Scheduled meetings/claim reviews Data Management includes the following:
a) Monthly claim reporting by e-mail or website
Indemnity (Covid Related) 500$
Account Administration includes the following:
a) Detailed status reports c) Banking Administration
Indemnity 1,000$ Medical Only 165$
CITY OF CARLSBAD
1) Athens Administrators will invoice company for all basic fees on a monthly basis and such invoice shall be paid by company upon receipt of invoice.
2)
Claims will be handled for the life of the contract (unless specifically noted as life of cliam) with no additional per claim fees.
If you should decide to non-renew with Athens Administrators, the existing open files can be handled in one of two ways. a) Athens Administrators could continue to handle open files at our prevailing rates per year per open file. b) Athens Administrators would return the files to the client at the clients expense Claim Volume Protection Clause: In the flat annual fee scenario if annual new claim inventory increases in any year beyond the noted annual inventory assumption in our pricing proposal then each claim beyond that number will be billed at the 3/27/2026
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Docusign Envelope ID: 1B980319-BD84-45EA-964E-31699322BDA4