Our utilization review program provides prospective, concurrent and retrospective reviews to determine appropriateness of care, frequency and care setting. AMC’s experienced staff of utilization review specialist and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting.
AMC offers a team of Registered Nurses who are contracted through RehabWest but are monitored and supervised by AMC. These qualified, licensed professionals have experience in treatment planning, medical and specialty case management with a focus on return-to-work. Their professional case management staff has an average of 8.5 years of experience in managing California Workers’ Compensation injuries. Additionally, AMC provides our clients with bilingual case management nurses throughout California that include Field & Telephonic services. At the request of the client, AMC offers dedicated, on-site nurses.
All UR and NCM personnel work on the same internet-based software allowing for real-time updates and easy accessibility.
The benefits of having the UR unit connected to the examiners include:
• Communication – Seamless communication
• Information – Robust reporting of your managed care results • Control - Ability to customize your approach to utilization review. • Speed - Expedited timelines in accordance with the guidelines and regulations of SB863
• Efficiency – Integrated referral process leads to quicker service delivery & lower claim costs.
• Relationships – Creating a better connection.
#8..
- 463 -
5 | Page
• Medical bill review services
Our bill review service operations are not run in the traditional manner where either service is done in-house by leasing software or service bureau. We employ a unique hybrid model that we feel maximizes savings, increases turn-around time and provides our clients with the best possible outcomes.
Currently, AMC, Inc.’s employees total (14) fourteen. All of our staff is experienced in workers’ compensation bill review rules and regulations. Continuing education is constantly being provided and our new hires go through an extensive training program.
Athens Managed Care, Inc. has a partnership with Accuro Solutions to provide medical bill review, state reporting and PPO networks. All of these services are overseen by Athens Managed Care. This unit is tasked with monitoring the work product, interfacing with our clients and guaranteeing that our program standards are adhered to.
Our software is utilized nationally throughout a wide variety of organizations. The flexibility of this software allows for unique customization to meet the needs of our clients. We believe that the seamless integration between the claims team and the bill review analyst is invaluable creating an overall ease to the process. The claims team can easily access the resources they need to get things completed in an efficient, expedited manner.
Athens Administrators will ensure that medical bills are reduced to the Official Medical Fee Schedule rates established by the Administrative Director of Workers' Compensation. Athens Administrators has flexibility and options when it comes to choosing your PPO Networks for Bill Review purposes. We utilize multiple PPO networks, such as Blue Cross and First Health. Our bill review software is state-of-theart software that is updated on a regular basis to reflect current fee schedules and PPO networks. The medical bill review software system is used to detect a broad range of questionable billing practices, excessive and duplicate charges, over-utilization, and unnecessary services.
Our qualified trained staff reviews each bill and medical report to determine appropriateness of treatment and to ensure provider compliance with fee schedule ground rules.
Our Cost Containment Program incorporates multiple strategies to control costs, as follows:
• Before costs are incurred: through pre-authorization of inpatient and outpatient treatment plans, according to guidelines and channeling to network providers whenever possible.
• During the life of the claim: by channeling specialty care to network providers, when possible, within the confines of the workers’ compensation statute, early identification of red flags, and through concurrent review of treatment plans against #8..
- 464 -
6 | Page
medical necessity and appropriateness guidelines and length of stay/treatment criteria.
• Retrospectively: through comprehensive fee schedule audit procedures and application of workers’ compensation network discounts (when applicable).
Athens Administrators utilizes the claims software SIMS and we currently have an EDI established for bill review data exchange. Athens Managed Care (AMC) can accept paper or electronic provider bills. All bills are sent to our main mailroom for preparation and scanning. Once they are scanned the bills are routed to the owning examiner. The examiner then determines if the bill is payable and routes it to Athens Managed Care. A file is created daily and uploaded for processing nightly. All paper bills are converted to an electronic format and OCR is used when processing.
The City will be provided quarterly and monthly bill savings reports in your desired format. Also, Generate Explanations of Reductions (EOR) containing all required information will be produced for every provider bill that is processed.
Any bill that is not considered your standard medical i.e. physical therapy, chiropractic bill is given special handling and is routed to a more experienced analyst for processing.
Special handling bills are listed below:
• Surgery bills
• In/Out patient hospital bills
• Med-legal
• High level office visits
• By report codes or unlisted CPT codes
• OMFS exempt facilities/services
• Hearing aides
• Air Ambulance
• Critical acute care facilities
Turn-around times are as follows:
• Standard bills: 2-3 business days
• Hospital bills: 5-7 business days
• Negotiations: 3-5 business days
• Complex surgery bills: 5-7 business days
• Med-legal bills: 3-5 business days
5. Describe your firm’s mission and goals as related to corporate growth, customer service, quality assurance/quality control management and affirmative action standards.
Corporate Mission/Vision/Growth
MISSION STATEMENT: The Mission of the Athens brand is to provide discerning organizations with comprehensive, leading-edge claims administration solutions through delivery of highly personal service, thoughtful strategy and superior quantitative and #8..
- 465 -
7 | Page
qualitative results.
VISION STATEMENT: The Vision of the Athens brand is to become a model for a highly effective, industry leading claims administration organization that is valued and admired for both the results it delivers to customers and the positive impact it has on employees, the industry and the community.
Alignment with our mission and vision statement is reviewed annually at our management strategic planning session.
Athens Administrators corporate growth goals are to continue to grow organically.
Athens has never acquired another entity to grow nor is that a part of our strategic mission.
Customer Service
A cornerstone of our customer service philosophy is client communication. Athens Administrators takes a proactive approach on every claim to establish and maintain open and positive lines of communication. We will assist injured City employees through the entire workers’ compensation process, respond to their questions and concerns and provide timely appropriate benefits in accordance with regulations. Every new claim reported is entered into our claims management system within 24 hours and will be triaged by the assigned City claim supervisor to identify all key technical issues, nature and scope of the injury and provide instructions to the senior examiners. Contact is made with the injured employee, the City risk manager and medical provider within 24 hours.
We continue to communicate with the injured employee on a regular basis and bi-weekly while off work. Examiners will conduct regular follow-up throughout the life of the claim file, which includes providing information, guidance and assistance regarding permanent disability ratings, Qualified Medical Exams and the settlement process.
Contact is made verbally and followed up in writing to appropriately document the activity in claim file.
We also recommend regular telephonic follow-up with the injured worker(s) as long as the employee remains on temporary total disability. It is important to maintain open and positive lines of communication with the employees, to provide assistance, respond to their questions, and to avoid unnecessary litigation and/or change of physicians. Athens will return phone calls to injured City employees within one (1) working day. All correspondence from employees will be responded to within five (5) days of receipt.
Athens Administrators will develop customized Special Account Instructions for the City. These standards will outline the customized approach to claims administration, which will include specific procedures for claims management and communication with the City and all parties associated with the workers’ compensation process.
Orientation meetings are conducted with new clients to introduce our staff and provide all parties with the opportunity to become acquainted.
Athens Administrators will attend all in-person claims meetings as requested. With the City’s key staff and department heads, this will include quarterly claim reviews, #8..
- 466 -
8 | Page
administrative hearings, Board Meetings and site visits when necessary. The claims selection criteria for the review process will be discussed with the City in advance. Our focus will be to review claims in which we can have the greatest impact on the overall claims cost and successful resolution. We are flexible in claim review criteria, meeting destinations and in providing a conference call “schedule” for multiple locations, so that all parties can participate in the claim review process.
At Athens Administrators, we proactively work with our client partners to ensure complete satisfaction with the services we provide. If an issue should arise, our client’s first point of contact would be the account manager and claims supervisor assigned to oversee their account. It is important to note that our clients have direct access to our entire management team, either in person, telephonically and through electronic communication. We are always available to hear concerns and will work collaboratively to develop solutions if they should arise.
We continually review and assess our customer service to our clients for improvement.
Part of our approach includes surveys to our clients on our performance. As we are graded on how we perform, we work with our clients to improve on their expectations where needed. We encourage open and honest feedback at every step of our partnership.
Quality Control
Athens has a dedicated Quality Control specialist. The primary responsibility of this position is to ensure that the processes and procedures of the Claims Department meet the overall quality expectations and are in compliance with state and federal regulations and customer requirements. This position involves analyzing and reviewing insurance claims for accuracy by performing routine and focused audits of all aspects of the claims process, including coverage, documentation, coding, payments, reserves, claim denials, and claim closure. Individual findings and recommendations will be provided as feedback to the claims staff. Both detailed and summary results will be provided and reviewed with the EVP Workers’ Compensation.
Our approach to the management of our clients’ claims and programs centers on quality, service and results. We are committed to a constant focus on these key elements of our total claims management approach.
Our knowledgeable, dedicated operations management team provides strong leadership and objectives. There are (4) levels of supervision and accountability: President, oversees the entire claims operations, EVP Workers’ Compensation manages the claims technical processes and overall claims results and claims operations, and Division Manager monitors supervisory compliance with best practice performance standards, client specific special account instructions, legal and regulatory compliance. The designated Division Manager and supervisor will monitor the City’s Workers’ Compensation claims in accordance with our Supervisory Audit Procedures.
Athens internal audit team reviews claims to assure legal and regulatory compliance, as well as conformity to best practices and client-specific performance standards. Athens has various types of internal audit procedures that are performed at all levels of the claims management program on an on-going basis. Athens Administrators provides strong #8..
- 467 -
9 | Page
supervisory oversight. We do not allow our supervisors and managers to carry caseloads as they are focused on providing continuous oversight of the claims and programs. In addition to the Diary Management System, the supervisor subsequently reviews claims at regularly timed intervals (not less than every 90 days) or when specific events occur such as surgery or litigation, when the claim meets reserving or payment thresholds, and in the course of continuous random audits. The supervisor reviews delayed claims every 30 days until a decision is rendered. Higher value claims or claims with complex issues are also reviewed by the Division Manager.
Affirmative Action Standards
Athens Administrators is an Equal Opportunity Employer and strives to foster a culture of nondiscriminatory behavior. The Company follows established policies and procedures to ensure that individuals are treated in a fair and consistent manner throughout their relationship with the Company. This mission extends internally through recruitment and employment processes and externally through partnerships with vendors, suppliers and clients. On an annual basis Athens Administrators submits an EEO-1 survey to ensure compliance with the U.S. Equal Employment Opportunity Commission.
6. Describe the number and types of clients your firm currently provides TPA services to, both corporately and locally. Please list all public agency clients with 1,000 or more employees and the number of years served. Provide contact name and phone number for each.
Athens Administrators currently has hundreds of public agency and private employer clients. Currently, our client ratio is 60% public agency and 40% private employer. As mentioned in our cover letter, our public agency clients consist of Cities, Counties, Hundreds of Fire Protection Districts, Transportation Districts, Housing Authorities, Utility Districts, Water Districts and County Hospitals.
While we do have public agency clients of varying sizes, we do have those with over 1,000 employees. These include:
7. Provide information regarding any contracts which have been terminated within the past thirty-six (36) months with an explanation of the termination. Provide contact name and phone number for each.
Client Name Years Served Client Contact Phone Number
Fire Agency Self-Insurance System (FASIS) 16 Howard Wood (707) 447-2252 Bay Area Rapid Transit (BART) 15 Jesse Alcantara (510) 464-6250 City of Stockton 3 Timothy Claiborne (209) 937-8618
County of Marin 2 Karen Shelar (415) 473-6445
County of Imperial 6 Rodolfo Aguayo (760) 482-4488
Solano County 6 Melissa Tharp (707) 784-6186
San Francisco USD 7 Ken Neu (415) 241-6309
East Bay Municipal Water District 13 Vladimir Besarabov (510) 287-0177 East Bay Regional Parks District 9 Sean Donnelly (510) 544-2171 San Diego County Office of Education 7 Felicia Amenta (858) 571-7221 #8..
- 468 -
10 | Page
8. Provide a history of CSAC-EIA audit results for the past five (5) years, if applicable, including an explanation of any negative findings.
2017: No PRISM audits conducted
2018: 84% score
2019 79% score
2020 85% score
2021 88% score
9. Provide a history of State audit results for the past five (5) years including an explanation for any penalties that may have been assessed.
Athens Administrators has always passed our DWC audits at the PAR level with no penalties assessed.
Below are the State audits conducted over the past five (5) years:
*1.68032 is a passing score with lower being better and a higher performing organization
2020 Athens/Concord – 0.81277
2018 Athens/San Diego – 0.37697
2017 Athens/Orange – 0.89923
Utilization Review State audit (with 100% being highest achievable):
2021 – 100%
2020 – 98.9%
We have passed the PAR audit every time since we were founded in 1976.
No penalties ever assessed.
10. Submit a detailed implementation plan, including the expected timeline for each of the following:
a) Staff recruitment and training.
b) Data conversion of the City’s existing electronic claim files. c) Transfer of existing hard copy files from current TPA. d) Distribution of all required notifications (vendors, claimants, WCAB, etc.). e) Providing printed forms.
f) Training and coordination of IT systems and operational procedures with City staff Please see Transition Plan Tracking & Timeline and Onboarding Checklist Attachments Client Name: Crestwood Behavioral Health Inc
Contact Person: Troy Gupton , Director of Workers Compensation and Risk Management Telephone: (916) 206-2448
Reason: The program moved to a fully insured, guaranteed cost one with State Fund. #8..
- 469 -
11 | Page
We understand that transitioning to another TPA can be a stressful and confusing event. We have developed a process that ensures a smooth transition of all data and uninterrupted services to your employees.
Athens Administrators has extensive experience in the takeover and transitioning of large programs from other employers, third party administrators and carriers. Athens adheres to estimated industry guidelines for transfer of claims administration. We normally recommend 60 days for a smooth transition of existing claim files. Upon notification of award of contract, an implementation meeting will be scheduled immediately with the City to discuss our customized formal transition plan and detailed timeline. Our formal transition plan includes a step-by-step schedule of instructions for the transition of all claims and financial data. Our schedule minimizes the delays and issues that are often associated with the movement of an existing workers’ compensation program.
The formal transition plan addresses the following critical areas: staffing, program orientation and current law education for City staff, data conversion, physical file transfer, data scanning, benefit payments, pending UR authorizations, notification distribution, forms and banking program procedures. This plan has emerged from years of hands-on practical experience in facilitating takeovers and transitions of programs. Our plan minimizes the risks, delays and issues that are often associated with the movement of an existing workers’ compensation program.
The transition plan includes four primary phases; the Implementation, the Organization and Assimilation of Files, Staffing, Hiring and Training, and Orientation and Notification of Internal and External Customers. Our sample transition plan details each of these steps. If awarded, Athens will work with the City to create their own customized transition plan to address all unique needs.
The conversion process also allows the ideal opportunity for the City to review and make changes to your current claim coding and location structures.
Implementation Phase
Upon notification of award of contract, an implementation meeting will be scheduled immediately with all key City personnel to develop a customized formal transition plan and detailed timeline.
We will identify specific claims handling instructions and interface specifications that meet the goals of the City.
Organization & Assimilation of Files
Athens takes a proactive approach to ensure seamless transition by securing agreed upon action plans (i.e. identifying priority claims, hearing dates, delays, ongoing payments, utilization review, etc.). We use a task force approach, triaging all incoming claims by senior technical staff, identifying all key facts, issues and develop a proactive action plan to move the claim towards closure. Reserves are reviewed and allocated for probable ultimate cost and through this formal process, we are usually able to achieve immediate cost reductions and file closures.
In accordance with generally accepted guidelines and state regulations, we would request lists of benefit payments and due dates, delayed claims and their due dates, on-going Utilization Reviews and their due dates, trial dates and future diaries. We will review all open claim files and once #8..
- 470 -
12 | Page
completed, we will have all prior financial and claim detail data previously captured. We will add to this data our new diary dates, manual payments, trial, dates and begin entering new activity.
Staffing Plan for Recruiting, Hiring and Training
Our responsive staffing model and plan will ensure effective recruiting, hiring and training of all key claims personnel. Athens is committed to continuously interviewing claims professionals at all levels on an ongoing basis.
This proactive approach identifies qualified talent and ensures we always have resources available for additional staffing. Our hiring process includes a face-to-face interview with two claims managers or supervisors, a written claims test, and background and reference checks. We are usually able to connect with interviewees through the efforts of our human resources department.
We have an internal recruiter who will assist us in finding excellent candidates. Our overall salary and benefit compensation is in line with market conditions and we also have a variety of internal incentive programs.
Athens requires all staff to attend and complete training sessions regarding legislative, legal and regulatory changes in the workers’ compensation industry. We conduct training on a regular basis in the areas of subrogation, fraud, medical management and other key training areas within our Best Practices Performance Standards. Individual training programs and goals are formulated on an annual basis and reviewed with the examiner during quarterly performance evaluations. Our supervisors provide constant coaching and counseling to our technical staff for ongoing claims handling development and future internal promotions.
Orientation & Notification of Internal & External Customers Orientation meetings are conducted with new clients to introduce our staff and provide all parties with the opportunity to become acquainted. These orientation meetings also provide the opportunity to develop special claims handling requirements and procedures unique to each and every client. Upon notification of award of contract, we will meet immediately with key personnel to discuss and identify specific claims handling instructions, transition plan, and interface specifications that meet the goals of the City.
Our formal transition plan ensures prompt written notification (2 weeks prior to effective date) to all injured employees with open claims, frequently utilized vendor partners and other applicable parties informing them Athens Administrators will be the new TPA.
Athens will provide required and agreed upon claim reporting information and electronic forms including:
• Employers Report of Work Injury or Illness (5020)
• Employee’s Claim Form (DWC1)
• Work Injury posters and notices
• Instructions for reporting claims
#8..
- 471 -
13 | Page
Customer Training
Athens Administrators will continuously inform each client of changes or proposed changes in statues, rules and regulations and case law affecting the workers’ compensation program. We offer employer training programs covering a variety of subjects including: “Workers’ Comp 101”, legislative changes, return-to-work programs, system training, fraud, and how workers’ compensation creates ADA and FEHA risks. Our knowledgeable licensed staff will be available as needed. We also provide full training on our claims management system.
Please see Transition Plan Tracking & Timeline and Onboarding Checklist Attachments B. About Your Firm’s Management Information System(s)
1. Describe the type of data processing hardware and software proposed for this contract.
Discuss your firm’s experience in using the system, whether the system is owned and operated in-house or through an agreement with another provider, the general capabilities of this system, compatibility with other existing systems for continuity of data and transferring of historical data, and any projected upgrades or changes during the term of this contract.
Athens maintains a state-of-the-art in-house RMIS system supported by our internal IT team. Our claims management system is a state-of-the-art, cloud-based software package and available 24/7/365. It is a uniquely flexible system that includes a complete document management system that is embedded in the claims system. The system is customizable and supports client-specific data fields, hierarchical location structures and unique business rules.
Our RMIS system provides convenience and access to real-time and “point in time” financials for generating customized Ad Hoc reports, multiple program reports for data downloads and monthly loss reports which can be exported into other applications such as .pdf or excel. These reports can be provided at any interval as set forth by the City through our customized reporting schedule. Both standard and specialized reports are available to be generated.
The City would have real-time access to our claims management system 24/7/365. New claims can be entered remotely and all data including notes and financials can be viewed.
Self-serve reports are also available via the web. In addition to claims information, all investigative films, reports and statements are available and are included in the electronic file as additional attachments.
City staff will have the ability to create their own reports as well as having Athens IT staff support and develop them as requested.
#8..
- 472 -
14 | Page
Access to the system can be configured with different authority levels as described by the City, with all of the security controls overseen and implemented by our Claims Operation team. All historical data can be archived in the system if the City so desires, with data being backed up on a daily basis.
Our claims management system incorporates a full spectrum of data elements including relevant dates, claims detail, temporary modified duty, temporary partial disability, financial information, narrative notes, litigation fields, subrogation information, lien information, lost time information, Medicare, and state reporting information. The list of data fields is proprietary and cannot be included. In addition to the standard fields included in the claims system, Athens has added many custom codes and fields. We can add any additional fields that may be required. Any field that is captured in the system can be reported on.
At Athens Administrators, we are continuously focused on how we can make the claims process as seamless as possible for our clients and their injured workers. Keeping this focus, we have added another service option and it is our new Athens app. With different login procedures, the Athens App allows risk management professionals and injured workers to access appropriate and real time information on their claims 24 hours a day, 7 days a week.
Once you have access to our Athens Administrators Claims Portal, you download the Athens App and you will be able to see specific claim information through the Athens App as well. Through the Risk Managers portal, you will be able to search losses based on:
• Claim Number
• Injured Workers Name
• Date of Loss
• Open/Closed Status
• Date of Injury
Once you select a claim, you will have access to see:
• Date of Injury
• Nature of Injury
• Claim Number
• Accepted/Denial Date
• Open/Closed Status
• Litigation Status
• Examiner Contact Information
Athens has an in-house IT team which will provide the technical support. #8..
- 473 -
15 | Page
2. List and describe the management information reports generated by your firm’s data processing system. Identify those reports which are standard and included in the service fee. Identify those reports which are optional and the cost for generating these reports.
Include in each description the interval at which the reports are generated. Provide a onepage example of each of 5 reports listed and explain how each will assist the City of Modesto in managing its program.
Our web based RMIS system provides convenience and access to real-time and “point in time” financials for generating customized Ad Hoc reports, multiple program reports for data downloads and monthly loss reports which can be exported into other applications.
These reports can be provided at any interval as set forth by the City through our customized reporting schedule.
Our system offers on-line real time access to our client’s claims information, including examiner notes and financial information. Athens’ claims management system can accommodate unlimited levels of location coding and customizable codes and descriptions.
Through the use of custom code sets, we are able to extract accurate, detailed, and relevant data that satisfies the needs of each client. We have a web-based entry of 5020’s (Employers' First Report of Industrial Injury or Illness), Self-Insurers Annual Report generation, 1099 reporting to the IRS, OSHA reports, and electronic interface with the Index Bureau and WCIS. Athens’ claims management system can produce all required regulatory reports and data exports and we are state EDI compliant.
There are hundreds of data elements tracked in our system but at a minimum there are 48 that form the basis of available bordereau reports. The Systema SIMS claims management system has extensive capability to customize reports and additional data fields may be added at a client’s request to allow for increased reporting. Reportable bordereau fields include but are not limited to:
• Program and Locations
• Program Year
• Policy Number
• Jurisdiction
• Policy From and Through Dates
• Broker
• Claim Number
• Claimant Name
• Status
• Days Open
• Claim Type
• Insured Reported Date
• Accepted Date
• Loss Date
• Received Date
• Entry Date
• Closed Date
• Reopened Date
#8..
- 474 -
16 | Page
• Delayed Date
• Denied Date
• Body Part
• Nature of Injury
• Agent
• Cause of Injury
• Class Code
• Occupation
• Examiner
• Life Pension
• PD Rating
• Litigated
• Future Medical
• Age At Injury
• Death Date
• Hire Date
• Termination Date
• Stip Amount
• C&R Amount
• Lost Days
• Restricted Days
• Indemnity Paid, Reserves, & Incurred
• Medical Paid, Reserves, & Incurred
• Expense Paid, Reserves, & Incurred
• Total Paid, Reserves, & Incurred
• Recoveries
• Net Incurred
• Loss Description
Athens has a full suite of reports to produce data on both the claims administration, managed care and bill reviews services we provide. Our RMIS system provides convenience and access to real-time and “point in time” financials for generating customized Ad Hoc reports, multiple program reports for data downloads and monthly loss reports which can be exported into other applications such as .pdf or excel. These reports can be provided at any interval as set forth by the City through our customized reporting schedule. Both standard and specialized reports are available to be generated.
Below is a partial representation of the client reports available:
Report Title Report Description
Bordereau Detailed excel loss run
Claim Cost Summary List of claims with paid amounts during specified period.
Claim Log Report Database Standard Claim Log - No Financials Claimant Type Changes List of claims in period with loss type changes Claimants With Multiple Claims Lists claimants with multiple claims Claims Activity Report Database Lists claims with activity during the period and checks off the type of activity
Claims Summary By Fiscal Year Summary report of claims in each year by loss type #8..
- 475 -
17 | Page
Claims Summary By Year With Groupings Claim Summary by Year can be run for all locations at a selected lower level
Claims with Defense or Applicant Attorney Assigned Lists claims that had an attorney assigned in the period Closed Claims List of closed claims in a date range
Cumulative Trauma Claim Log 1004 List claims by Program with Cumulative Trauma custom field Days Without Injury Report Database Lists each location with the date of the last injury and the number of days elapsed
Delayed Claims List of delayed claims in a date range
Denied Claims List of denied claims in a date range
Detail Loss Run Report Database Loss run with detailed claim information Excel Loss Run Basic Excel claim listing
Excess Bordereau A shortened version of the Bordereau; includes Excess Report Date & Excess Decontrolled Date.
Financial Reconciliation By Bank Accounting - Check Register that lists payments by bank.
Financial Reconciliation By Program Report Database Basic Check Register Financial Reconciliation By Program With Summary Check register that lists payments by program (not by bank).
Incurred Change With Subtotal Lists claim with selected amount of incurred change in the period.
Incurred Changes Lists claims with selected amount of incurred change in the month.
Incurred Loss Triangle Incurred loss development report that shows trending over multiple years.
Medical Cost Containment Details Cost Containment costs paid in chosen period.
Mod Duty and TD Day Summary Summary by program of all claims with loss days and Mod Duty days entered.
More than 60 days TTD Lists claims with TTD paid in the last 30 days; having more than 60 days of TTD. Includes last payment date.
New Claims Report Shows new claims entered in the time period OSHA_Form300_Org Select Designed to mimic the federal OSHA form.
OSHA_Form300a Designed to mimic the federal OSHA form.
Outstanding Checks Report Database Lists checks that have not been marked as Cleared with the bank.
Paid Loss Triangle Paid loss development report; shows trending over multiple years; supports multiple program selection provides LOB breakouts
Payment Type Totals Report Database List of total paid, average and number of payments for each pay type.
Reinsurance List of claims above the Notice Amount or SIR for Excess reporting requirements
Reopened Claims Returns Reopened Claims for specified date range, across all Programs WC Management Summary Report Database Claims summary by location level When developing adhoc reports on your account, there is an option for capturing data at a certain valuation date on most reports. Listed below is a sampling of the more common reports utilized by clients:
• Claims Log
• Payment Type Totals
• Transaction Register (can be done nightly as requested above) • Claims Summary by Year
• Loss Triangle – Paid Loss
• Management Summary
• Claims Activity – Claims Cost Detail, Claims Cost Summary Indemnity Claims, Claims over $25,000
#8..
- 476 -
18 | Page
• Frequency Analysis – Loss Agency, Body Part, Loss Cause, Day of Week, Job Code, Loss Age, Loss Nature
• OSHA 300 AND 300A
• Claims Summary by Year report
• Claims Cost Detail report
• Financial Reconciliation report
In addition to these reports, Athens provides its clients with very comprehensive annual reports, which provide both a global and a detailed analysis of all claim, risk management (including safety), and financial program evaluations. This is done in colored graphic/chart form for easy reading by management and includes our analysis of any deficiencies in the program and very specific recommendations for program improvement. The reports are department/cost-center specific and, as requested by our clients, more frequent specialfocus reports can be done if the need arises.
City Risk Management staff will have the ability to create their own reports as well as having Athens IT staff support and develop them as requested. There is no additional cost for our reports.
The Athens claim management system is a pure browser-based on-line system with in the cloud access and can be accessed on or off-site with a web-based connection. City would have real-time access to our claims management system. New claims can be entered remotely and all data including notes and financials can be viewed. And self-serve reports are also available via the web. In addition to claims information, all investigative films, reports and statements are available and are included in the electronic file as additional attachments.
The City can choose at what interval reports are generated but our typical clients have us set up a monthly run of their report package which would be automatically generated and forwarded to the City.
Please see sample reports
3. Describe the unique features of the management information reports provided by your firm which are not typically provided by other TPAs.
Unique features of our reports include:
• Dedicated account claim portal
• The ability to drill down to the smallest detail level (Ie. Age, body part, time of day, day of week, etc.)
• Available on-demand via secure log-in
• Reports query includes hundreds of data elements and have the ability to add additional ones as requested.
#8..
- 477 -
19 | Page
• Integrated with Claims, Financial and Safety dashboards • Our claims administration system has the ability to import almost any type of electronic media including video clips, audio and photos. The following extensions are files that our RMIS can currently export, accept and upload. New extensions can be added as required.
• .doc • .pdf • .wmv • .docx • .txt • .tif • .zip • .html • .xls • .jpeg • .wav. • .xlsx • .wma • .mp3 • .jpeg • .txt • .ppt • .ppsx • .pptm • .pptx All captured media can be link to a specific incident or claim file.
4. Discuss the methods used by your firm to segregate and track OSHA-recordable injuries, first aid injuries, medical-only injuries, time loss injuries, denials, aggravations and any other claim type designations.
All claims are assigned a claim type that is used in reporting and tracking. The claim type is updated as required when case facts change. OSHA reports detail the claim type on the reports, and are typically created excluding first aid, information only, and denied files.
5. Describe how your system differentiates Workers’ Compensation injuries and days lost from OSHA-recordable injuries and days lost. Provide an example of the OSHA 300 Log report provided by your firm. Discuss how this report is generated and reconciled against Workers’ Compensation data.
Our claims system (SIMS) includes an OSHA module that allows us to flag an injury if it is or in not recordable. If the claim is flagged as not-recordable, it will not show up on the OSHA report. Our OSHA reports are generated annually, on an ad-hoc basis, or at the interval requested by the client. The report can be run for the organization as a whole, or by location.
Please see Sample OSHA 300 Log report
6. Describe you firm’s ability to provide the City of Modesto with a minimum of 3 MIS user connections on existing personal computers allowing for full database access and standard/ad hoc report writing/generating.
Our system, SIMS Claims™ is a pure browser-based on-line system. As such, we can provide access to the minimum (3) three City users who can connect into the system utilizing existing personal computers. Full, real time database access is available along with report writing/generating.
Athens' claims management system includes web-based access that clients can utilize to enter new claims, review existing claims, and generate reports. Each user ID is assigned to an access group that restricts that login’s access to only that client’s data. New claims can be entered by the client via the website. Claims entered using the web are assigned a pending status until they are reviewed and determined before the coding is completed #8..
- 478 -
20 | Page
in the claims management system.
Web clients can view their claims and run reports using the client report module.
7. Discuss the MIS technical support services provided by your firm. Include the location of MIS staff and how many clients are serviced from that location.
Athens Administrators has an in-house IT Department. They offer external, support services to all our client partners. This includes technical support for our SIMS claims system including report generation and troubleshooting services. Our IT staff is located in our Concord, CA corporate office and service all our clients from this location.
C. Claims Administration Services
1. Discuss the allocation of personnel your firm will use to staff a dedicated claims unit to adjust City of Modesto’s claims. Describe the title, function and minimum ongoing training/experience requirements for each position.
Athens’ infrastructure has been meticulously planned over our forty-year history. Our management and staffing model is one of our biggest strengths as an organization. It has been designed to guarantee consistent levels of quality control. Our proposed staffing model for the City of Modesto will be located in Concord, CA and provides a significant advantage to Athens in the daily management of our processes, procedures and outcomes for the City. Additionally, every account receives regular attention from the highest levels of management in our company including the President, EVP, Claims and Division Managers.
As the City would be assigned a fully dedicated examiner team, we would immediately begin identifying the claim supervisor and examiners upon notification of contract award.
It is our philosophy at Athens Administrators that we do not transfer or disrupt current employer/adjuster relationships for new incoming programs. Maintaining staff stability for our programs has helped us achieve a client retention over 98% for the past five years. We would encourage and invite the City to be involved in the final selection of their claims administration team. Note: Athens would agree to hire those examiners recommended by the City which on your current program. (The suggested candidates would need to go through Athens Human Resources vetting and our hiring practices.) POSITION (Examiner Staff Will Be Fully Dedicated Only To City of Modesto STAFFING Unit Supervisor 1 Fully Designated
Senior Claim Examiner 2 Fully Dedicated
Assistant Claim Examiner 1 Fully Dedicated
*Once we identify staff, we also invite the City to participate in the selection and interview process. #8..
- 479 -
21 | Page
City of Modesto Proposed Staffing
James Jenkins,
President
Douglas Gibb, EVP,
Workers
Compensation
Jeanette Mason,
Claims Director
Russ Quinn, Division
Claims Director
TBD, Claims Unit
Supervisor
TBD, Dedicated
Senior Claims
Examiner
TBD, Dedicated
Senior Claims
Examiner
TBD, Dedicated
Assistant Claim
Examiner
Leann Farlander, AVP,
Cost Containment,
Athens Managed Care
Emily Hart, Director,
Claim Operations
#8..
- 480 -
22 | Page
Staff Position Descriptions
Athens Administrators requires the following minimal qualifications for each of the identified positions:
Unit Supervisor – Minimum 9 years’ experience as a manager with Self-Insured State Certification and Public Agency account experience.
Senior Claim Examiner – Minimum 7 years workers’ compensation claims handling experience, public agency experience, Self-Insured State Certification, and/or IEA certification equivalent.
Future Medical Claim Examiner – Minimum 3 years future medical claims handling experience, public entity experience.
Assistant Claim Examiner – Minimum 3 years assistant claims examiner duties, public entity experience and IEA technical training preferred.
The qualifications and roles of the hired positions include:
Claims Supervisor
Upon award of the contract, Athens Administrators will commit to providing a qualified Supervisor for your program.
The Claims Supervisor, at no time, will ever carry a caseload, which will allow them to be fully dedicated to supervising and overseeing your program. They will provide a more detailed technical oversight to your workers’ compensation program and also ensure that the requirements in your Scope of Services are either met or exceeded. The supervisor will also participate in internal claim audits and reviews.
The Supervisor will provide daily oversight of the program and works directly with the examiners and assistants.
Senior Claims Examiners
Upon award of the contract, Athens Administrators will commit to providing qualified Senior Claims Examiners. The qualified candidates will have a minimum of seven (7) years’ experience in adjusting and will be certified to administer self-insured workers’ compensation programs including public agency experience.
While the duties of the senior claims examiner are many and varied, their essential function #8..
- 481 -
23 | Page
is to provide proactive claims management of the individual claims they handle and to promote the overall success of the claims program. This equates to delivering at all times quality service, communications, and results for the employers and their injured workers.
In order to achieve the senior examiners must be experienced, with manageable caseloads and have adequate clerical and administrative support provided to them in order that they may fulfill their roles. All of our technical staff is state certified to administer self-insured workers’ compensation claims.
Future Medical Examiners
This person plays a vital, but focused role to adjust workers’ compensation future medical claims. They ensure timely processing of claims and payment of benefits, managing and directing medical treatment, and negotiating settlements. It’s a more focused and specialized effort.
Assistant Claim Examiners
The assistant examiners also have many and varied duties. Their essential role is to provide full administrative support to their senior examiners and handle the medical only claims.
This supporting role allows the senior examiners to be proactive case managers and not get bogged down in clerical/administrative tasks. Our assistant examiners are technical claims people who have completed or are in the process of completing all of their Insurance Educational Association courses in workers’ compensation and, in many instances, who have passed the Self-Insurance Plans Administrators Exam.
Our supervisory staff are responsible for our staff as follows:
Divisional Claim Manager: On average has two to three claim supervisor direct reports.
Claim Supervisor: On average has three to five senior claim examiner and up to three assistant claim examiner direct reports.
Our current staff has the following average experience:
Claim Supervisor: 20 Years’ industry experience; 7 Years with Athens Senior Claim Examiner: 12 Years’ industry experience; 5 Years with Athens Future Medical Examiner: 10 Years’ industry experience; 9 Years with Athens Assistant Claim Examiner: 7 Years’ industry experience; 5 Years with Athens Examiner Staff Training
Athens recognizes that the only way to ensure compliance with workers’ compensation laws, regulations and statutes is to maintain a high level of continuing education and #8..
- 482 -
24 | Page
training in order to keep up with legislative, legal, and regulatory changes in our industry.
We empower our staff by providing ongoing continuing education. We conduct training on a regular basis (typically once a month) in the areas of subrogation, fraud, medical management and other key training areas within our Best Practices Performance Standards.
Athens Administrators also annually certifies that each claims examiner handling workers’ compensation or liability claims is in compliance with all legal and regulatory licensing and continuing educational requirements. Where required by law or regulation, Athens will provide copies of all such certifications at least annually to our clients.
Athens examiners are well versed and trained in those special areas of workers’ compensation that relate to public employees, safety officers, PERS and other public employee retirement programs. We work closely with our clients to develop carefully coordinated benefit delivery systems so that all benefits can be properly paid to the employees. All of our supervisors and technical staff are state certified to administer selfinsured workers’ compensation claims. Our technical staff is focused on identifying key issues that have a large financial impact on the overall claim. Such exposures are subrogation, fraud, apportionment, litigation management, and investigation of questionable claims. The examiners proactively utilize all available internal and external resources to address and resolve these issues to reduce the bottom line costs.
Prior to any team member being assigned to your account, we encourage a meeting with each proposed examiner to ensure that they will be the right fit for you and your risk management team.
Athens evaluates candidates’ industry expertise, education and technical qualifications as well as traits and characteristics that align with the Company culture. We have high standards and expectations and candidates must meet all of the job qualifications and requirements to be considered. We will not settle for less even if it takes longer to fill a position. Our interview process is extremely thorough. We prepare specific questions for every position and we press for specifics throughout the interview. We ask behavioral interview questions to get beyond surface level responses. We look for contrary evidence throughout the interview. We retain a database of candidates that have interviewed in the past and contact them if they were strong contenders. All final candidates undergo additional screenings which include background checks, thorough reference checks, skill assessments and management behavioral assessments. The entire recruitment process is reviewed for each candidate to help make a final determination.
2. Please indicate which of the personnel you plan to use to staff this claims unit have attained certification to administer self-insured claims (SIP Certification) and when all staff members will be certified.
All claim management and examiner personnel we plan to utilize on the City’s program will be SIP certified at contract inception.
3. Discuss your firm’s standard ratio for case closures as related to new claims.
Explain how you utilize closure performance comparisons and the frequency that these #8..
- 483 -
25 | Page
comparisons are calculated. Explain other criteria used to determine the appropriateness of closing claims.
The expectation for Athens’ examiners is at least a 100% closing ratio which is closing the same number of claims as received on average. However, our goal is to achieve a 105% – 110% closing ratio. We provide examiners month end closing statistics each month to see how they are trending. Management also compiles this data to share during year end performance reviews for a 12-month (1-year) average for the claim closures. We also provide our employees a quarterly incentive program that allows them to earn up to one free day off based on their closure and penalty occurrences. Examiners are expected to obtain a 125% closing ratio. They are required to obtain 21 closures for the quarter in order to be eligible for the incentive of 3.75 bonus hours of PTO.
Athens shares the data/expectations and results for closures on a monthly, quarterly (with incentives) and annual basis with our clients.
4. Please submit your firm’s Claims and Litigation Management Guidelines.
Please see our Claims and Litigation Management Best Practices
5. Explain how the claims adjuster will coordinate legal activities with counsel once a claim is assigned to defense counsel.
While we have clients who mandate referral to defense counsel upon receipt of Notices of Representation and Applications for Adjudication, we do not believe that files should automatically be referred to defense attorneys. We have highly trained and experienced claims experts, and they should be able to handle matters of litigation outside the need for depositions or WCAB appearances. Even when files are referred to defense attorneys, we continue to direct the claim, and we never defer to defense counsel on matters that can be handled by the claims examiner, which would include the subpoena of records, setting medical or medical-legal appointments, and lodging objections to the treating physicians.
We recognize that there are some cases that are better referred to defense counsel in order to achieve maximum results. These cases generally involve serious complex claims, very questionable claims where significant discovery, including depositions, are required or where there is a great likelihood that the case will go to trial. Referral to a defense attorney will only occur with approval of the City.
Athens Administrators sends a litigation plan and budget request on all legal referrals. The adjuster will aggressively follow up for both of these items from defense counsel. Upon receipt, a detailed review of both the plan and budget will be completed and documented in claim notes by the adjuster. This review will focus on the proposed legal analysis, legal recommendations, timelines/expected duration of litigation as well as the estimated costs. If we are in agreement with the legal recommendations, action plan and costs, we will continue to work with our attorney and monitor the monthly expenditures to ensure that approved is in line with what #8..
- 484 -
26 | Page
is actually being incurred. Should there be a discrepancy identified in the initial review/cost analysis by our adjuster, Athens Administrators will contact defense attorney to discuss and ensure complete agreement is reached between all parties with full documentation in claim notes.
Athens Administrators values the relationships with all partners and believes that any successful relationship is based on clear and concise expectations for both parties well prior to commencing work together. These entry level discussions should focus on claims handling philosophies, expectations of representation of the City and Athens, as well as agreed upon hourly rates for the service.
Additionally, Defense attorneys who bill at the traditional fee for service method must agree to work within specific guidelines similar to those outlined below. These guidelines were developed as part of our litigation cost control program in an effort to maintain control over the legal billing process. All legal expenses and bills must be itemized and are reviewed prior to payment.
Hourly rates to be broken down in to 1/10ths
Itemized by date of activity
Identify all billing entities
When there are multiple files, no duplication of charges All billings should reflect actual time spent
No minimum billing rates
Prorate all multiple appearances between employers
Itemize all expense items
Mileage will be reimbursed at the current IRS rate
Incoming faxes will not be billed
Outgoing faxes will be paid on an itemized long distance phone rate
Postage will be paid as an actual itemized cost
Only bill for long distance phone calls at itemized long-distance rate
No bill for local phone calls
No bills for inquiries
6. Discuss your interaction with clients in reporting on account management or claims related issues. How frequently do you expect supervisors and/or adjusters to initiate contact with City of Modesto? What is your protocol regarding returning telephone and/or E-Mail messages?
As part of our proposed staffing plan for the City’s program, the Division Manager assigned will also be designated as your account manager. They would be responsible for maintaining high customer satisfaction, being a primary point of contact for the roll out and delivery of services, ensuring issues are dealt with in an efficient manner and understanding when to escalate internally to appropriate members of the management team.
Athens Administrators takes a proactive approach on every claim to establish #8..
- 485 -
27 | Page
and maintain open and positive lines of communication with the injured employees. We will assist your injured employees through the entire workers’ compensation process, respond to their questions and concerns and provide timely appropriate benefits in accordance with regulations. Every new claim reported is entered into our claims management system within 24 hours and will be triaged by the supervisor to identify all key technical issues, nature and scope of the injury and provide instructions to the senior examiner. Contact is made with the injured employee, the designated City contact and medical provider within 24 hours. We continue to communicate with the injured employee on a regular basis and bi-weekly while off work.
The supervisor and adjusters dedicated to the City’s account will have daily contact with the City as they manage your claims process. As regards to our telephone/email communications, our requirement is to respond with 24 hours of receipt.
7. Identify the firm’s criteria for designating a claim as a first aid, medical only or indemnity case.
First Aid - defined as any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care. This one-time treatment, and follow-up visit for the purpose of observation, is considered first aid even though provided by a physician or registered professional personnel.
Medical Only - Any alleged work-related injury or illness for which medical treatment is sought, the claimant is not hospitalized, temporary disability does not exceed the waiting period as defined by the Workers' Compensation Laws of California, and no other Indemnity benefits are claimed.
Indemnity Case - Any alleged work-related claim for which any of the following is claimed:
(1) Temporary Disability
(2) Permanent Disability
(3) Vocational Rehabilitation
(4) Life Pension
(5) Death
8. Explain your firm’s current policies regarding the assignment of claims to each claims supervisor, claims examiner and claims assistant. Include a description of the number and types of claims assigned to each position.
Supervisors
Our supervisors do not carry a caseload, enabling them to provide technical oversight of the individual claims and of the employers’ workers’ compensation program, ensuring quality, service, results as well as compliance with regulatory and client-specific program #8..
- 486 -
28 | Page
performance standards. Every new claim reported is entered into our claims management system within 24 hours and will be triaged by the assigned claim supervisor to identify all key technical issues, nature and scope of the injury and provide instructions to the senior examiners. Our supervisors review claims at regularly timed intervals (not less than every 90 days) or when specific events occur such as surgery or litigation, when the claim meets reserving or payment thresholds, and in the course of continuous random audits. The supervisor reviews delayed claims every 30 days until a decision is rendered. Higher value claims or claims with complex issues are also reviewed by the Division Manager.
Claims (Senior) Examiner
While the duties of the senior claim examiner are many and varied, their essential function is to provide proactive claims management of the individual indemnity claims they handle and to promote the overall success of the claims program. In order to achieve the senior examiners must be experienced, with manageable caseloads not exceeding 140 open indemnity claims, and have adequate clerical and administrative support provided to them in order that they may fulfill their roles.
Assistant Claim Examiner
In our staffing models, we utilize claims assistants on all our programs. Each assistant has a 1 to 1.2 claims examiner ratio. Their essential role is to provide full administrative support to their senior examiners and handle the medical only claims. This supporting role allows the senior examiners to be proactive case managers and not get bogged down in clerical/administrative tasks. The assistant examiners will be technical claims people who have completed or are in the process of completing all of their Insurance Educational Association courses in workers’ compensation and, in many instances, who have passed the Self-Insurance Plans Administrators Exam. They are our next generation of senior claims examiners through our in-house training program. Assistant Claims Examiners handle an average of 30 medical only claims. Additionally, they could also handle First Aid or Info Only claims.
9. Describe the criteria for re-indexing existing claims.
Claims are automatically indexed at 6-month intervals but this can be customized per the City’s request and incorporated into the Special Claims Handling Instructions.
10. Describe the firm’s policies and practices in establishing and maintaining reserves for indemnity, medical care, expenses and future medical benefits.
Our claim reserves reflect the probable ultimate cost of the claim. Reserve estimates are not determined by formulas, but, rather, are based on current information in the file including medical reports, current and anticipated medical treatment and periods of disability, disputed or litigated issues and additional areas of investigation. Initial reserves are posted to the file once the initial investigation is complete and anticipated reserves have been determined. This will be completed no later than 14 days from receipt of the claim. Reserve estimates are not determined by formulas, but, rather, are based on current information in the file including medical reports, current and anticipated medical #8..
- 487 -
29 | Page
treatment, and periods of disability, disputed or litigated issues, and additional areas of investigation. Medical reserves are based on current information in the file and anticipated future medical treatment. After a claim has been settled with a future medical award, future medical reserves are calculated based on a three-year average and the injured worker’s life expectancy. The claim supervisor must approve any reserve change over $20,000. Management must approve all reserves over $100,000. Reserves are reviewed no less frequently than every 90 days and an explanation of any changes is entered into the claim notepads. Additionally, we notify the City of any reserve changes that exceed a specified amount set by you.
11. Describe the firm’s policies and procedures to ensure timely review and appropriate payment of benefits and bills.
Our policy is to submit bills for review and payment within 30 calendar days of receipt. We are able to generate reports to identify unprocessed documents by aging, which allows us to identify specific bills that have not been routed for review and payment within that timeframe. These reports are run daily and distributed to all levels of management for review.
Regarding timely benefit payments, our claims staff are expected to review mail and address any and all benefits within the statutory timeframes. We are able to generate reports to identify unprocessed documents by aging, which allows us to identify specific types of medical reports and settlement documents that have not been reviewed and addressed. These reports are run daily and distributed to all levels of management for review.
In addition, new claims are placed on a 14-day diary to address any benefits that might be due. Injured workers who are due long term temporary or permanent disability benefits are tracked by both a manual and a computerized diary to ensure they do not fall off payment cycle. Manual tracking books are reconciled with a daily indemnity payment dashboard to further ensure all payments were successfully processed.
12. Describe how the firm will assist and facilitate Return-to-Work activity at the earliest possible opportunity.
Return to Work/Transitional Work Program
Athens’ claims examiners manage every claim to ensure that the modified work is addressed in an expedient manner and that the disability is reasonable based on the nature and extent of the injury and to ensure that the 24 Cap for chiropractic, occupational and physical therapy visits is appropriately applied.
Our software allows us to monitor and track these services. Our Diary Management System tracks key dates to ensure timely actions on decisions/referrals. Claims are monitored on a weekly diary for ongoing temporary disability to address modified work and every 30 days for all other indemnity claims for medical status update.
Athens immediately notifies a client once a physician advises that an employee is released to return to work to mitigate the overall indemnity costs and potential ADA #8..
- 488 -
30 | Page
and FEHA exposures.
Athens Administrators has been working with its clients for many years in developing, implementing, and coordinating Return to Work programs, which includes working with in-house liaisons for coordination of the program. We have found our customers achieve results if caseloads remain low and the examiner to assistant ratio is sufficient.
With similar accounts the coordination of return to work is managed by our highly trained assistants. We would also commit to a formal on-going RTW Training Program for City.
Additionally, senior claims examiners and their assistants are responsible for all return-to-work efforts on their claims. Our claims team is most knowledgeable about each claim and its unique issues. Return to work efforts are not segmented from the claim, but rather are handled directly by the claims team in the course of managing the entire claim. Work statuses are obtained on a regular basis and communicated back to the client. Medical reports are reviewed and our team ensures that the treating doctor understands the clients modified work programs. Custom forms can be also be utilized. We will meet with City’s key staff and develop a step-by-step program to support your return to modified work program.
We also recommend regular telephonic follow-up with the injured worker(s) as long as the employee remains on temporary total disability. It is important to maintain open and positive lines of communication with the employees, to provide assistance, respond to their questions, and to avoid unnecessary litigation and/or change of physicians. Athens will return phone calls to injured District employees within one (1) working day.
Transitional Work Program
Many of our clients have implemented Transitional Work Programs and have asked us to provide data or information to help facilitate these types of programs. We understand that these types of programs provide a system of returning employees back to work quickly and safely after an injury. By immediately identifying any temporary work restrictions given to the injured worker by the treating physician, the Athens Administrators examiner, in conjunction with the Return-to-Work Coordinator, is able to help get the injured worker back to transitional work, which we anticipate will also help the employee recover faster and allow them to return to their regular work assignments.
Our emphasis on close collaboration between Athens Administrators and the designated City contact, we believe, will create positive results for your workers’ compensation program, and help minimize lost workdays.
13. Describe how the firm communicates temporary and permanent work restrictions in a timely manner.
For our clients who offer temporary modified duty, our practice is to proactively reach out to the treating physician’s office before the scheduled medical appointment, provide them a detailed job analysis whenever possible, and to let them #8..
- 489 -
31 | Page
know our client has a robust return to work program. With that in mind, we ask the physician to let us know what the employee’s capabilities are, rather than presuming the employee should be temporarily totally disabled. We find physicians are more likely to entertain modified duty as an option if we approach them before, rather than after a medical appointment.
In most cases, preferences concerning how and when work restrictions are communicated to the employer are discussed at the time our clients are on-boarded and these preferences are outlined in the customized claims handling instructions for each of our clients. The examiner or assistant examiner maintains a diary to follow up on the employee’s work status following each scheduled medical appointment, and then either calls or sends an e-mail to the client to determine whether or not modified duty is available.
Preferences concerning how permanent work restrictions are communicated also vary by client and are discussed during the onboarding process and documented in the customized claims handling instructions. Once the employee is deemed at MMI with permanent work restrictions, the examiner promptly communicates the work restrictions to the client so they can commence the interactive process. The examiner then sets a diary to ensure the offer of modified or alternate work is timely sent.
Some of our clients prefer to send the offer of modified or alternate work directly to their employees, while others prefer us to complete the form. These preferences are outlined in the client’s customized claims handling instructions.
The claims supervisor uses the document aging reports to identify PR4’s and medical legal reports and ensure the examiner has timely reviewed them and that permanent work restrictions are timely addressed.
14. Discuss your firm’s policy on payments of fines and penalties resulting from errors internal to your firm. Describe how your firm accounts for such payments and provide the total dollar amount of fines and penalties paid to State or Federal regulators in each of the preceding five fiscal years.
Athens Administrators specially codes any penalty that is a result of an Athens’ error. Each quarter we run a report of those payment codes and reimburse our clients those funds. Once claims determines the penalty, they forward a check request to our accounting department to issue payment. We either mail the check to the client or deposit it into their trust account, based on their instructions. We take full responsibility for our errors and make it right with our clients.
Regarding fines and penalties paid to State or Federal regulators, we have passed the PAR audit every time since we were founded in 1976 and in the preceding five years, no penalties have been assessed.
D. Summary
1. Describe in detail your firm’s data processing and staff experience with converting claim and financial records date from former TPAs to your proposed system. Provide the #8..
- 490 -
32 | Page
client’s company name, type of system converted from, contact name and phone number.
Our claims and IT staff have successfully completed numerous data (claims and financial) conversions from our client’s former TPAs.
Below are recent clients that have had their claim information successfully converted from other TPA’s to Athens Administrators. All the conversions were completed within the required timeframes.
Client Name System or
TPA
Converted
From
Client Contact Phone Number
Alameda-Contra Costa
Transit District
York/Sedgwick Kelley R. Easter-Grant (510) 891-4810
Eskaton Properties York/Sedgwick Ken Fisher (916) 334-0810 County of Marin Tri-Star Karen Shelar (415) 473-6445
2. Describe your firm’s plan for provision of each of the following service elements. Include documentation of your firm’s philosophy, protocol and readiness to provide the following services:
• Utilization Review
• Preferred Provider Organization Network*
• Bill Review Services
*Include the number of members in the PPO to be used and the number of specialties represented. In addition, provide the PPO member’s contract provision language which specifies the percentage below the California Official Medical Fee Schedule to which the PPO member has agreed.
Utilization Review
The DWC has completed an audit of Athens UR services in 2021. With a best possible score of 100%, we are proud to state that Athens utilization review services passed with a final, perfect score of 100%.
Athens Managed Care’s (AMC) utilization review program has been setup in accordance with the policies and regulations implemented by the State of California. Our Utilization Review plan was developed with our management team, medical director, and panel of physicians to ensure all processes are most effective for claims handling as well as employee health. We do have a standard protocol for examiner treatment approval guidelines to decrease the number of unnecessary requests going through the full UR process. These protocols can be reviewed at the client’s directive and discussed with our medical director should changes be requested. Treatments that fall outside the examiner approval guidelines are recommended for full UR review. #8..
- 491 -
33 | Page
Our utilization review program provides prospective, concurrent and retrospective reviews to determine appropriateness of care, frequency and care setting. AMC’s experienced staff of utilization review specialist and peer review physicians utilize medical treatment protocols and expert systems technology to determine the medical appropriateness of care as well as frequency, duration and setting.
Utilization Review is performed when appropriate. The examiner manages the Nurse Case Manager and schedules QME and medical legal evaluations. All medical bills are submitted for Bill Review.
Cases that would benefit from medical case management. Some cases require an on-site nurse for field case or limited task assignments. It is recommended the following cases be considered for these types of assignments:
• Lost time of 21 days or more
• Back surgery/fusion or second back injury
• Rotator cuff tear, ACL tear, meniscus tear
• Treater delaying RTW or P&S report
• Slow healing fractures
• Diseases or disorders (RSD, Chronic Pain Syndrome)
• Multiple medical providers, frequent changes in providers • Prolonged light duty with no progression to regular duty • History of multiple work injuries
• Continued missed appointments
• Chronic illness
• Accepted psychiatric issues
• Catastrophic Injuries: Burns, head injuries, spinal cord injuries • No progress noted 6 weeks post-surgery
• Complicated family dynamics
• Hospitalization
• Major multiple fractures, cardiac
• Amputations
Activities to expect from a Case Manager: Upon referral of a case management assignment, the Case Manager follows these timelines:
• Referral Source Contact: Within in (1) day of case assignment, verify and or obtain missing information.
• Attorney Contact (if represented): Within one (1) day of case assignment • Injured worker/Physician/Employer Contact: Within one (1) day of case assignment or attorney authorization
• Initial Interview: Meet as soon as possible with the injured worker, and if possible, attend the next medical appointment or visit hospital or physician office. • Initial Report: Within the first seven (7) days of case assignment Athens Managed Care has its own utilization review nurses providing first level review.
We also contract with an outside vendor for overflow coverage for nurse services. This vendor, Shearwater Health, is a URAC accredited organization. All nurse reviewers are #8..
- 492 -
34 | Page
licensed within the United States. Additionally, we contract with an outside vendor for all physician reviewers. Claims Eval is a URAC accredited organization and provides physician reviewers throughout the United States to ensure appropriate coverage based on state requirements.
All services provided by outside vendors is monitored. This is done through auditing and QA calibrations between Athens Managed Care and the service vendor. Calibrations are done on a bi-weekly basis as well as weekly operations calls.
Preferred Provider Organization Network
Athens Administrators offers the Anthem network to our clients. We feel this is the best option due to the breadth and size of Anthem as well as the steep discounts available through Anthem.
Anthem provides access to a comprehensive network of physicians and hospitals that meet access standards in over 98% of all California zip codes giving the City employees access and choice in California statewide. Anthem’s client base represents over 40% of the workers’ compensation market and the network is utilized by over 300 MPNs. The network has consistently delivered best in class savings below the California official medical fee schedule for workers’ compensation for more than 20 years.
Anthem’s network consists of over 71,135 provider locations in California including direct contracts with 294 general acute care hospitals, 494 ambulatory surgery centers, and 867 Frontline or urgent care clinics. Their comprehensive network also includes skilled nursing and rehabilitation facilities, home health care and Durable Medical Equipment providers, radiology and imaging services, laboratory and other ancillary providers.
Anthem can provide the City substantial unit cost savings below OMFS for medical services rendered by participating providers and facilities based on the confidential Anthem contract rates. PPO Savings is defined as the least amount of the difference between: (a) PPO’s contract rates with Participating Providers and the applicable State’s Workers’ Compensation Fee Schedule; or (b) the Participating Provider’s customary charge and PPO’s contracted rate where no State Workers’ Compensation Fee Schedule applies; or (c) the billed charge by the Participating Providers and PPO’s contract rates with such Providers.
Anthem Workers’ Compensation average book of business yielded 80.12% PPO penetration with some clients yielding as high as 96.8% penetration with pro-active channeling mechanisms.
Anthem’s Network Composition:
Frontline Occupational Clinics 867
Ambulatory Surgery Centers 495
General Acute/Specialty Hospitals 294
Other Health Facilities: 2,399
#8..
- 493 -
35 | Page
Skilled Nursing Facilities, Chemical Dependency (IP/OP), Mental Health (IP/OP), Residential Treatment Center,
Transitional Living, X-ray/Diagnostic Imaging, MRI
Ancillary Providers: 6,762
Home Health, Home Infusion, DME
Labs, X-ray/MRI, Ambulance (Air & Ground),
Hearing Aid Dispensers, Orthotics & Prosthetics
Primary Treating Physicians 9,215
Other Physicians and Health Professionals 51,103
Total 71,135
Bill Review Services
Athens Administrators has in-house bill review service capabilities. Our bill review software is state-of-the-art Windows based software that is updated on a regular basis to reflect current fee schedules and PPO networks. The medical bill review software system is used to detect a broad range of questionable billing practices, excessive and duplicate charges, over-utilization, and unnecessary services. Our qualified trained staff reviews each bill to determine appropriateness of treatment and to ensure provider compliance with fee schedule ground rules.
Athens Managed Care offers an innovative medical bill review program with an average savings per bill of 71%. We offer a complete medical savings solution for all of your innetwork and out-of-network medical bills, including PPO management, medical bill repricing, line-item review, expert fee negotiations, professional review, automated adjudication and electronic reimbursement. Each feature focuses on increasing processing efficiencies and maximizing savings opportunities.
Athens Managed Care specializes in reducing the cost of all medical bills through a combination of robust rules-based technology, clinical expertise, expert review and PPO networks. Athens Managed Care is able to identify unbundled services, re-bundling opportunities, reasonable and customary review, fee schedule analysis, pharmacy review and PPO management.
Our Cost Containment Program incorporates multiple strategies to control costs, as follows:
Before costs are incurred: through pre-authorization of inpatient and outpatient treatment plans, according to guidelines and channeling to network providers whenever possible.
During the life of the claim: by channeling specialty care to network providers, when possible, within the confines of the workers’ compensation statute, early identification of red flags, and through concurrent review of treatment plans against medical necessity and appropriateness guidelines and length of stay/treatment criteria. Retrospectively: through comprehensive fee schedule audit procedures and application of workers’ compensation network discounts (when applicable). #8..
- 494 -
36 | Page
3. List and describe the features that distinguish your firm from other third-party administrators.
The key to successful TPA services is the people who work the claims and that interact with injured workers on a daily basis. Athens’ core business model is to take care of our people and to create an environment that attracts and retains the very best. We have been recognized as a Best Place to Work in the San Francisco Bay area, Orange County and San Diego. More specifically, for the past 16 years, Athens Administrators has been ranked as one of the best places to work in the San Francisco Bay area. What does this mean for you? It allows us to retain the most professional and hardworking team in our industry, as well as being able to attract new talent that wants to work for a dynamic organization. In 2020, our proposed Concord, CA office proposed to administer the District’s account, received its a ranking of being voted as the 4th best place to work in Bay Area for mid-sized corporations across all industries and the highest of any midsize TPA or related risk management/insurance company!
Our staff is stable and happy and they take great care of our clients. Through Glassdoor.com (an independent internet-based employer ranking website) we are able to see that Athens Administrators clearly outranks our competitors in employee satisfaction. Below are the independent rankings of Athens Administrators:
There are a number of reasons why we believe the City should choose Athens Administrators for their risk management program.
PHILOSOPHY
Athens Administrators’ philosophy is to build strong, long-term partnerships and provide the highest level of claims administration services for our clients. Our focus is to always be excellent in everything we do. We believe in:
Partnership – We support our clients’ objectives and philosophies by setting goals and regularly communicating with the objective of never surprising our clients. We measure our #8..
- 495 -
37 | Page
performance and frequently report back. We are always accountable for our actions. People – The people at Athens drive results for our clients. We attract the highest caliber staff and equip them with all of the necessary resources to succeed. Technology – We continually invest in systems to provide reliable data, which enables all stakeholders to make powerful decisions.
Service –The key to our success is a sense of urgency to constantly deliver exceptional service to our clients through professionalism, communication and quality. Problem Solving – We always ask questions and take the next logical steps. We don’t stop at barriers, we keep moving ahead until we can provide a solution. Maximum Cost Savings – We achieve maximum cost savings by focusing on return to work, reducing litigation, curtailing medical costs and expediting claim closure.
Core Values:
At every level within our organization, core values support our vision and the shape of our company. We ultimately believe that our loyalty to adhering to these core values assist us in providing exceptional service to our employees, our clients and their injured workers. Below are the core Values for Athens Administrators.
#8..
- 496 -
38 | Page
Beyond our specific public municipality and agency related experience there are a number of additional critical components as to why we believe we are the best claims administration option for the City. The following is a high-level outline of our key strengths that differentiate us from the other third-party administrators in the marketplace today and reflects the overall benefits we can bring to the City of Modesto’s program:
Transparent Flexible Approach to Claims Administration
• No hidden fees or revenue sharing agreements in place • Promotes an open, honest environment for our clients
• Our clients have the ability to hand pick their vendor of choice Company-wide Claims Closing Incentive Program in Place
• Clients enjoy outstanding closing ratios
• Claims are closed faster while ensuring compliance with all state rules/regulations/statutes
• Further supports our total alignment of interests with our customers RMIS Solutions
• AthenScan - Paperless claim files which provide better response time, enhanced communication and better facilitate the decision-making process • Athens Focus - Risk Management dashboard, provides drill down data, refreshed four times per day, including interactive location claim mapping
• Client Direct Specific Portal
• Data Integration Solution
• Secure Data - Successfully implemented and tested Business continuity Catastrophe Plan Quality
Experience/Stability
• Exclusive California focus and expertise
• 45 years of workers’ compensation claims administration public agency experience • Mandatory ongoing continuing education - effective claim resolutions, increased cost containment utilization, use of workers’ compensation laws, regulations and statutes • Fully Licensed/Designated Technical Staff - delivering prompt, timely & correct benefits • Management Structure
Consistent Superior Audit Results
• DWC Audit Results - Athens Administrators consistently passes the Workers’ Compensation PAR audit.
Client Specific Customization of Programs
• We develop and maintain special account instructions for all our customers based on their requirements and specifications for desired results.
Excellent References
Internal Athens Operations
Training/Education
• Mandatory regularly scheduled on-site staff training – procedural, legislative and regulatory
#8..
- 497 -
39 | Page
• On-site workers compensation training to AC Transit
High Employee Retention Rate (Low Turnover)
• Results in long term consistent claims administration • Enhanced communication and client program knowledge/understanding • Satisfied, motivated employees who work hard for our customers We specialize in the management of California Workers’ Compensation claims, we are focused to identify, address and manage all areas of your workers’ compensation program and we believe we bring a unique skill set and different perspective to make your program succeed. #8..
- 498 -
JENKINS, JAMES
R.
President
CATELANI
HOWARD, JANE
Chief Financial
Officer
HART, EMILY
Director of Claim
Operations and
Compliance
BAKER,
BARBARA
Auditor - Property
and Casualty
HUERTA,
VICTORIA
Workers
Compensation
Claims Auditor
MASYADA,
SUSAN
Corporate Trainer
MILLER, ERIC
Data Quality
Analyst
POPEJOY, GINA
Compliance
Specialist
PARK, NICOLE
Implementation
Specialist
DUARTE, LIBBY
Corporate
Services
Supervisor
BRADFORD,
DAYNA
Corporate
Services Lead
CARDENAS,
CHRISTY
Corporate Service
Assistant
HART, BRIAN
Claim Service
Assistant
HUNTER,
CONNOR
Corporate
Services
Receptionist
NICHOLS,
LACEY
Corporate
Services Assistant
PAIN, ELSA
Administrative
Services Lead
PANTAGES,
CHRISTINA
Claim Service
Assistant
STEVENS, JADE
Corporate
Services Lead
WHITE,
CAMERON
Receptionist
WINFIELD, LISA
Accounting
Manager
GALDOS,
ENRIQUE
Senior Payroll
Specialist
CHAMBERLIN,
PAMELA
Accounting
Specialist II
HAMILTON,
SHEALAMAR
Lead Accounting
Specialist
LOGAN,
RODEMERE R
Accounting
Specialist III
REYES, SONIA
Accounting
Specialist I
TORNO,
ADRIANA
Accounting
Supervisor
QUINONES,
GRACE
Accounting
Specialist III
TIERRA,
JOSELINA
Accounting
Specialist II
ALWAY, LISA
Accounting
Specialist II
LOCKETT, SOFIA
Accounting
Specialist II
MCCARTHY,
MADELIENE
Accounting
Specialist I
BARNWELL,
DON
Information
Technology
Director
BRENNER,
LANDON
Software
Developer
DEGAETANO II,
ARTHUR
Database
Developer II
FONG, RANDALL
Sr. Database
Developer
SAECHAO,
DENNIS
Associate
Infrasructure
Engineer
MCGRATH,
JOHN
Sr. Database
Developer
GIBB, DOUGLAS
Executive Vice
President,
Workers
Compensation
MASON,
JEANETTE
Claims Director
SIMPSON, JULIE
Division Claims
Manager
JOHNSON,
TAFFY
Claims Supervisor
ANDERSON,
KAREN
Future Medical
Claims Examiner
AUTAJAY,
KIMBERLY
Senior Claims
Examiner
GARNER,
CORINA
Senior Claims
Examiner
KING, LINDA
Lead Assistant
Claims Examiner
LACSAMANA,
VINCENT
Assistant Claims
Examiner
MARTINEZ,
MEAGAN
Senior Claims
Examiner
ORDONIO,
DANIEL
Senior Claims
Examiner
RICAFRANCA,
BROOKE
Future Medical
Claims Examiner
RODRIGUEZ,
PAUL
Assistant Claims
Examiner
PETERSEN,
PHALBA
Assistant Claims
Examiner
STENGEL,
JERILYN
Claims Supervisor
BERGUM,
CHRISTINE
Assistant Claims
Examiner
BURROW,
CARLA
Future Medical
Claims Examiner
CROSS,
RANDALL
Assistant Claims
Examiner
ESCLAMADO,
ANDREA
Assistant Claims
Examiner
GIBBS,
VANESSA
Assistant Claims
Examiner
KERKHOFF,
KRISTIN
Senior Claims
Examiner
MONTGOMERY,
MARLA
Future Medical
Claims Examiner
NAVAT, ELENO
Senior Claims
Examiner
PEEK, CURTIS
Senior Claims
Examiner
SCHAEFER,
MARY
Senior Claims
Examiner
STUCK,
VIRGINIA
Assistant Claims
Examiner
WONG,
MATTHEW
Claims Examiner I
VALDERRAMA,
CYNTHIA
Quality Assurance
Lead
VOHRA, VISHAL
Division Claims
Manager
BARRIENTEZ,
VICTOR
Claims Supervisor
BUHRE, ROBERT
Claims Examiner I
HUGHES,
CHRISTOPHER
Claims Examiner I
HURTADO,
ROXANNE
Assistant Claims
Examiner
JAY, LISA
Future Medical
Claims Examiner
RUBIN, JEFFREY
Senior Claims
Examiner
THOMPSON,
NANCY
Senior Claims
Examiner
GUERRERO,
ANDREW
Senior Claims
Examiner
HASSNAOUI,
CHLOE
Assistant Claims
Examiner
SHEPHERD,
JACK
Assistant Claims
Examiner
WALKER, HOLT
Claims Supervisor
AMELING,
STEPHANIE
Senior Claims
Examiner
CHAPIN,
TIMOTHY
Senior Claims
Examiner
CLEVENGER,
DANIELLE
Assistant Claims
Examiner
GILBERT,
GRIFFIN
Senior Claims
Examiner
HYLAND,
AUGUSTINA
Senior Claims
Examiner
MELARA,
JESSICA
Assistant Claims
Examiner
RODRIGUEZ,
MARIA
Assistant Claims
Examiner
TIDWELL,
ELISHA
Assistant Claims
Examiner
WEATHERBY,
STEPHANIE
Assistant Claims
Examiner
MARTINEZ,
ZACHARY
Senior Claims
Examiner
CHERRY,
SHARON
Senior Claims
Examiner
PLEITES, MARIO
Senior Claims
Examiner
QUINN,
RUSSELL
Division Claims
Manager
COLLADO, RYAN
Claims Supervisor
FREDRICKSON,
BARBARA
Senior Claims
Examiner
NATIVIDAD,
JEANNIE
Future Medical
Claims Examiner
QUINTERO,
MYCHELL
Assistant Claims
Examiner
ROBERTS,
KAREN LYNN
Senior Claims
Examiner
SANCHEZ, TINA
Senior Claims
Examiner
TAYLOR, KELLY
Assistant Claims
Examiner
THOMAS,
MARIAN
Future Medical
Claims Examiner
CARRION,
JAVIER
Senior Claims
Examiner
DARSEY,
BRENDEN
Assistant Claims
Examiner
FIERROS,
GLORIANNA
Claims Examiner I
JONES-BISHOP,
LAKISHA
Claims Supervisor
BECKLER, JOHN
Senior Claims
Examiner
DUCUMMON,
ALYSSE
Assistant Claims
Examiner
HAYNES,
CHRISTINA
Assistant Claims
Examiner
JENSEN, ANN
Senior Claims
Examiner
JIMENEZ,
STEPHANNIE
Assistant Claims
Examiner
OSHEA, KAREN
Senior Claims
Examiner
PALOMO,
KRISTINA
Future Medical
Claims Examiner
QUIAMCO,
EDWINA
Future Medical
Claims Examiner
SMITH,
ERNESTINE
Senior Claims
Examiner
SOTO, LANETTE
Claims Examiner I
CERDA, OLGA
Claims Supervisor
ALVAREZ, ALMA
Senior Claims
Examiner
BARNES,
DENISE
Senior Claims
Examiner
EATON JR.,
SCOTTIE
Assistant Claims
Examiner
HEREDIA,
SHANNON
Senior Claims
Examiner
HIRAKAWA,
AMBER
Assistant Claims
Examiner
NICHOLS,
MARIETTE
Senior Claims
Examiner
WATSON,
VENESSA
Senior Claims
Examiner
TRAN, NGA
Claims Supervisor
BARTON,
ASHLEY
Assistant Claims
Examiner
WILSON,
CHRISTINA
Senior Claims
Examiner
WHITE, SUNNY
Division Claims
Manager
LANCASTER,
CASSIE
Claims Supervisor
CANCIO, MA.
THERESE
Claims Examiner I
CHRISTENA,
CRAIG
Senior Claims
Examiner
COLLADO,
ASHLEY
Assistant Claims
Examiner
DE LA PENA,
ELVIRA
Assistant Claims
Examiner
MANUZON,
RHODORA
Senior Claims
Examiner
GASTELLO,
ROSANA
Senior Claims
Examiner
SIMPSON,
BRIANA
Assistant Claims
Examiner
SOTO,
PRISCILLA
Assistant Claims
Examiner
MOREHEAD,
ANDREW
Claims Supervisor
AIELLO, MINDY
Senior Claims
Examiner
CARROLL,
LORAYNE W
Lead Senior
Claims Examiner
COOPER,
ALODIE
Assistant Claims
Examiner
GRAM-REEFER,
AILEEN
Senior Claims
Examiner
JUAN, KATLYN
Assistant Claims
Examiner
LEE, DOROTHEA
Return To Work
Coord EBMUD
MORENO,
KIMBERLY
Future Medical
Claims Examiner
RENINGER,
HEIDI
Senior Claims
Examiner
SEBASTIANI,
STELLA
Lead Senior
Claims Examiner
VANDERFORD,
JENNIFER
Claims Supervisor
ALVARADO,
ERIKA
Senior Claims
Examiner
ANTOINE-FORT,
LEASHA
Assistant Claims
Examiner
GRUBB,
RAQUEL
Senior Claims
Examiner
KENNEDY,
LUCILLE
Lead Senior
Claims Examiner
SOMERA, RHEA
Assistant Claims
Examiner
THOMAS,
SUZANNIE
Future Medical
Claims Examiner
TROXLER,
THOMAS
Senior Claims
Examiner
DERUBEIS,
KATRINA
Claims Supervisor
EASTWOOD,
CINDY
Claims Examiner
II
MCQUADE,
MICHAEL
Assistant Claims
Examiner
PRUNEAU,
STEPHANIE
Senior Claims
Examiner
SILVERSTEIN,
JON
Future Medical
Claims Examiner
SNELL, JENIFER
Senior Claims
Examiner
SUSEE, DENISE
Claims Examiner I
TIDWELL,
CHARLENE
SHANEE
Assistant Claims
Examiner
GEORGE,
ELIZABETH
Division Claims
Manager
BERGUM, BETH
ANN
Lead Senior
Claims Examiner
BORJA,
ROWENA
Assistant Claims
Examiner
CAMPOS
VASQUEZ, EVA
Assistant Claims
Examiner
COURSE,
CHRISTINE
Senior Claims
Examiner
DELFIN, MONICA
Senior Claims
Examiner
HURTADO,
TIFFANY
Assistant Claims
Examiner
MELARA, JERRY
Senior Claims
Examiner
SLUGA, KELLEN
Senior Claims
Examiner
THONGDY,
DALAVANH
Assistant Claims
Examiner
TIDWELL,
CANDICE
Assistant Claims
Examiner
LANDA,
MICHAEL
Executive Vice
President,
Business
Development
CICHURSKI,
KEVIN
Sales Director
ROBRECHT,
HANNAH
Marketing
Specialist
MCCLAIN,
JANET
Executive Vice
President, Human
Resources
GIACOLETTO,
TERYN
Executive
Assistant
INDABURU,
SAMANTHA
Human Resources
Generalist
QUALLS,
CANDICE
Corporate
Recruiter
SOLIS,
JENNIFER
Human Resources
Business Partner
VANVLIET,
TAMARA
Human Resources
Business Partner
PAULAUSKAS,
SIMONA
Human Resources
Coordinator
Concord Organizational Chart
#8..
- 499 -
JENKINS, JAMES
R.
President
GIBB, DOUGLAS
Executive Vice
President,
Workers
Compensation
MASON,
JEANETTE
Claims Director
SIMPSON, JULIE
Division Claims
Manager
JOHNSON,
TAFFY
Claims Supervisor
ANDERSON,
KAREN
Future Medical
Claims Examiner
AUTAJAY,
KIMBERLY
Senior Claims
Examiner
GARNER,
CORINA
Senior Claims
Examiner
KING, LINDA
Lead Assistant
Claims Examiner
LACSAMANA,
VINCENT
Assistant Claims
Examiner
MARTINEZ,
MEAGAN
Senior Claims
Examiner
ORDONIO,
DANIEL
Senior Claims
Examiner
RICAFRANCA,
BROOKE
Future Medical
Claims Examiner
RODRIGUEZ,
PAUL
Assistant Claims
Examiner
PETERSEN,
PHALBA
Assistant Claims
Examiner
STENGEL,
JERILYN
Claims Supervisor
BERGUM,
CHRISTINE
Assistant Claims
Examiner
BURROW,
CARLA
Future Medical
Claims Examiner
CROSS,
RANDALL
Assistant Claims
Examiner
ESCLAMADO,
ANDREA
Assistant Claims
Examiner
GIBBS,
VANESSA
Assistant Claims
Examiner
KERKHOFF,
KRISTIN
Senior Claims
Examiner
MONTGOMERY,
MARLA
Future Medical
Claims Examiner
NAVAT, ELENO
Senior Claims
Examiner
PEEK, CURTIS
Senior Claims
Examiner
SCHAEFER,
MARY
Senior Claims
Examiner
STUCK,
VIRGINIA
Assistant Claims
Examiner
WONG,
MATTHEW
Claims Examiner I
VALDERRAMA,
CYNTHIA
Quality Assurance
Lead
VOHRA, VISHAL
Division Claims
Manager
BARRIENTEZ,
VICTOR
Claims Supervisor
BUHRE, ROBERT
Claims Examiner I
HUGHES,
CHRISTOPHER
Claims Examiner I
HURTADO,
ROXANNE
Assistant Claims
Examiner
JAY, LISA
Future Medical
Claims Examiner
RUBIN, JEFFREY
Senior Claims
Examiner
THOMPSON,
NANCY
Senior Claims
Examiner
GUERRERO,
ANDREW
Senior Claims
Examiner
HASSNAOUI,
CHLOE
Assistant Claims
Examiner
SHEPHERD,
JACK
Assistant Claims
Examiner
WALKER, HOLT
Claims Supervisor
AMELING,
STEPHANIE
Senior Claims
Examiner
CHAPIN,
TIMOTHY
Senior Claims
Examiner
CLEVENGER,
DANIELLE
Assistant Claims
Examiner
GILBERT,
GRIFFIN
Senior Claims
Examiner
HYLAND,
AUGUSTINA
Senior Claims
Examiner
MELARA,
JESSICA
Assistant Claims
Examiner
RODRIGUEZ,
MARIA
Assistant Claims
Examiner
TIDWELL,
ELISHA
Assistant Claims
Examiner
WEATHERBY,
STEPHANIE
Assistant Claims
Examiner
MARTINEZ,
ZACHARY
Senior Claims
Examiner
CHERRY,
SHARON
Senior Claims
Examiner
PLEITES, MARIO
Senior Claims
Examiner
QUINN,
RUSSELL
Division Claims
Manager
COLLADO, RYAN
Claims Supervisor
FREDRICKSON,
BARBARA
Senior Claims
Examiner
NATIVIDAD,
JEANNIE
Future Medical
Claims Examiner
QUINTERO,
MYCHELL
Assistant Claims
Examiner
ROBERTS,
KAREN LYNN
Senior Claims
Examiner
SANCHEZ, TINA
Senior Claims
Examiner
TAYLOR, KELLY
Assistant Claims
Examiner
THOMAS,
MARIAN
Future Medical
Claims Examiner
CARRION,
JAVIER
Senior Claims
Examiner
DARSEY,
BRENDEN
Assistant Claims
Examiner
FIERROS,
GLORIANNA
Claims Examiner I
JONES-BISHOP,
LAKISHA
Claims Supervisor
BECKLER, JOHN
Senior Claims
Examiner
DUCUMMON,
ALYSSE
Assistant Claims
Examiner
HAYNES,
CHRISTINA
Assistant Claims
Examiner
JENSEN, ANN
Senior Claims
Examiner
JIMENEZ,
STEPHANNIE
Assistant Claims
Examiner
OSHEA, KAREN
Senior Claims
Examiner
PALOMO,
KRISTINA
Future Medical
Claims Examiner
QUIAMCO,
EDWINA
Future Medical
Claims Examiner
SMITH,
ERNESTINE
Senior Claims
Examiner
SOTO, LANETTE
Claims Examiner I
CERDA, OLGA
Claims Supervisor
ALVAREZ, ALMA
Senior Claims
Examiner
BARNES,
DENISE
Senior Claims
Examiner
EATON JR.,
SCOTTIE
Assistant Claims
Examiner
HEREDIA,
SHANNON
Senior Claims
Examiner
HIRAKAWA,
AMBER
Assistant Claims
Examiner
NICHOLS,
MARIETTE
Senior Claims
Examiner
WATSON,
VENESSA
Senior Claims
Examiner
TRAN, NGA
Claims Supervisor
BARTON,
ASHLEY
Assistant Claims
Examiner
WILSON,
CHRISTINA
Senior Claims
Examiner
WHITE, SUNNY
Division Claims
Manager
LANCASTER,
CASSIE
Claims Supervisor
CANCIO, MA.
THERESE
Claims Examiner I
CHRISTENA,
CRAIG
Senior Claims
Examiner
COLLADO,
ASHLEY
Assistant Claims
Examiner
DE LA PENA,
ELVIRA
Assistant Claims
Examiner
MANUZON,
RHODORA
Senior Claims
Examiner
GASTELLO,
ROSANA
Senior Claims
Examiner
SIMPSON,
BRIANA
Assistant Claims
Examiner
SOTO,
PRISCILLA
Assistant Claims
Examiner
MOREHEAD,
ANDREW
Claims Supervisor
AIELLO, MINDY
Senior Claims
Examiner
CARROLL,
LORAYNE W
Lead Senior
Claims Examiner
COOPER,
ALODIE
Assistant Claims
Examiner
GRAM-REEFER,
AILEEN
Senior Claims
Examiner
JUAN, KATLYN
Assistant Claims
Examiner
LEE, DOROTHEA
Return To Work
Coord EBMUD
MORENO,
KIMBERLY
Future Medical
Claims Examiner
RENINGER,
HEIDI
Senior Claims
Examiner
SEBASTIANI,
STELLA
Lead Senior
Claims Examiner
VANDERFORD,
JENNIFER
Claims Supervisor
ALVARADO,
ERIKA
Senior Claims
Examiner
ANTOINE-FORT,
LEASHA
Assistant Claims
Examiner
GRUBB,
RAQUEL
Senior Claims
Examiner
KENNEDY,
LUCILLE
Lead Senior
Claims Examiner
SOMERA, RHEA
Assistant Claims
Examiner
THOMAS,
SUZANNIE
Future Medical
Claims Examiner
TROXLER,
THOMAS
Senior Claims
Examiner
DERUBEIS,
KATRINA
Claims Supervisor
EASTWOOD,
CINDY
Claims Examiner
II
MCQUADE,
MICHAEL
Assistant Claims
Examiner
PRUNEAU,
STEPHANIE
Senior Claims
Examiner
SILVERSTEIN,
JON
Future Medical
Claims Examiner
SNELL, JENIFER
Senior Claims
Examiner
SUSEE, DENISE
Claims Examiner I
TIDWELL,
CHARLENE
SHANEE
Assistant Claims
Examiner
GEORGE,
ELIZABETH
Division Claims
Manager
TIDWELL,
CANDICE
Assistant Claims
Examiner
BERGUM, BETH
ANN
Lead Senior
Claims Examiner
BORJA,
ROWENA
Assistant Claims
Examiner
CAMPOS
VASQUEZ, EVA
Assistant Claims
Examiner
COURSE,
CHRISTINE
Senior Claims
Examiner
DELFIN, MONICA
Senior Claims
Examiner
HURTADO,
TIFFANY
Assistant Claims
Examiner
MELARA, JERRY
Senior Claims
Examiner
SLUGA, KELLEN
Senior Claims
Examiner
THONGDY,
DALAVANH
Assistant Claims
Examiner
Concord Workers' Compensation Department
#8..
- 500 -
Kevin Cichurski Director of Sales 925-826-1103
Nicole Park Implementation Specialist 925-826-1050
Doug Gibb EVP, Workers' Compensation 925-826-1283
Jeanette Mason Division Claims Manager 925-826-1160
Leann Farlander AVP, Cost Cointainment 949-296-3961
Janet McClain HR Director 925-826-1288
Emily Kephart Claims Operations Manager 925-826-1112
Libby Duarte Mail Room Supervisior 925-826-1295
Jane Catelani CFO 925-826-1281
Don Barwell Director of IT 925-826-1232
Who Task Description Accountability Due Date Comments
City of Modesto Notify exiting TPA
Athens Contact Client to confirm exiting TPA has been notified.
Athens Contact current TPA to begin transfer discussion Athens Provide exiting TPA with suggested transfer guidelines.
Athens and ICS Agree upon tenative transfer dates
Athens Notify COO, DM, OS
Athens Notify Administrative Services Supervisor w/ contact Athens Obtain IT contact from exiting TPA
Who Task Description Accountability Due Date Comments
Athens Provide IT Director with IT Contact
Athens Notify programmer of conversion project
Athens Notify Self Insurance Plans of change
Athens Request claims data layout, tables and test data from current TPA Claims Data
[email protected]
[email protected]
[email protected]
Notifications
Claims Data Conversion
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
PEOPLE, POWERED.
Proposed Implementation Plan Tracking - City of Modesto Athens Transition Team
[email protected]
[email protected]
#8..
ICS Provide Athens with initial claims data layout, tables and test data Athens Provide claims data layout, tables and test data to programmer Athens Review job codes and location codes with client for possible updates or changes Athens Complete table mapping
Athens Load converted test claims data into test site
Athens Review converted test data for completeness and accuracy Athens Reconcile test data
ICS Send final data
Athens Convert final data and load into test site
Athens Review final data for completeness and accuracy
Athens Reconcile final data
Athens Load final data into live site
Electronic Documents
Athens Request E-Documents layout and test data from current TPA ICS Forward E-Documents layout and test data
Athens Provide E-Documents layout and test data to programmer Athens Complete table mapping
Athens Load converted documents into test site
Athens Review converted documents
Who Task Description Accountability Due Date Comments
Athens Load final documents into live site
Athens Program rules tables
Data Interface
Athens Request Data Specs from partners and stakeholders Athens Complete Programing
Athens Test data integration points
Athens Document interface
Athens Load into live production
Athens Contact client to determine funding account
City of Modesto & Athens Determine who owns bank account Athens Notify Athens CFO of client contact
Athens Complete signature cards
Banking Arrangements
#8..
Athens Determine if data will be sent to bank for Positive Pay Athens Notify programers of new bank for Positive Pay Programming Athens Review reporting requirements with Client
City of Modesto & Athens Determine funding amount
City of Modesto & Athens Fund account
Athens Establish Weekly Meetings
City of Modesto & Athens Develop special claim handling requirements City of Modesto & Athens Discuss and approve vendor panels City of Modesto & Athens Approve UR and NCM guidelines
City of Modesto & Athens Discuss RTW Program and other special procedures City of Modesto & Athens Review and schedule monthly report package City of Modesto & Athens Review new claim intake process Who Task Description Accountability Due Date Comments
City of Modesto & Athens Review MPN with Client
Athens Request any changes from MPN
City of Modesto Send out MPN notification
Athens Provide claim reporting kits
Athens Request user ID's and passwords for client
Athens Provide documentation and training for web claims access City of Modesto & Athens Discuss Training and Orientation City of Modesto & Athens Discuss Site Visits
City of Modesto & Athens Register Medicare Reporting
Athens and ICS Confirm file transfer date
Sedgwick Provide estimated number of boxes
Sedgwick Provide location of boxes for pickup
Sedgwick Confirm number of boxes for pickup
Sedgwick Notify claimant and parties of transfer
Sedgwick Confirm that exiting TPA will pay benefits 2 weeks in advance Athens and ICS Agree upon final cut off date for claim activity Athens Pick up boxes
Athens Deliver boxes to Athens
Athens Inventory boxes of open and closed files
City of Modesto & Athens Identify high exposure or high needs files Claim Files
Client Program
#8..
Athens Begin claims processing manually
Athens Send welcome notices to injured workers
Athens Notify vendors (clinics, attorneys, managed care) Athens Determine claim inventory
City of Modesto & Athens Discuss and approve staffing model and organization structure Who Task Description Accountability Due Date Comments
Athens Interview new and/or existing staff
Athens Present team to client
Athens Hire staff (as necessary)
Staffing
#8..
Client Onboarding - General Information
Program Name Claims Handling Office
Program Contact Account Manager
Program ID Division Manager
Program Period Supervisor
Effective Date Current TPA / Contact
Line of Business Takeover Open Claims
Jurisdiction(s) Total Takeover Claims
Policy Number (if
applicable)
Anticipated Annual
Indemnity Claim Volume
Policy Type Anticipated Annual MO
Claim Volume
Tax ID MPN on account?
Address MPN #/Effective Date
Bill review vendor MPN Name
AMC for NCM? AMC for UR?
Fiscal or Calendar
Year
Paperless status
PBM on Account? Number of physical file
boxes
Broker/Consultant Prior TPA’s transition
coordinator
Excess Carrier Prior TPA’s IT contact
Claims Transfer
Assigned to Notes Completed
Agree to cut-off date for claims
administration
Agree to medical bill review cut-off
date
Agree to advance compensation
timeline
Request hot box
Send notification to claimants
Send notification to
providers/other parties
Provide prior TPA with posttransfer contact
#8..
- 505 -
Physical File Transfer
Assigned to Notes Completed
Determine backscan details
Schedule pickup of physical files
Program Setup
Assigned to Notes Completed
Establish Organization
Create Codeset ID
Create UI Group Criteria
Establish custom fields
Set up ISO schedule
Add reserve types
Set up Dashboard accounts
Data Transfer
Assigned to Notes Completed
Obtain test data
Agree on due date for final data
transfer
Obtain loss runs
Obtain Medical Bill Review history
Obtain PBM History
Banking
Assigned to Notes Completed
Clarify if Client or Athens will own
bank account
Bill Review fees – determine if
checks or vouchers
Establish bank account
Set up positive pay
Set up Bottomline
Print test check(s)
Reporting
Assigned to Notes Completed
Obtain sample reports
Schedule report distribution
Add RRE to Insurer Table
Create custom reports (if needed)
#8..
- 506 -
Other Details
Assigned to Notes Completed
Complete account instructions
Complete OSIP notification
Obtain 3 year annual report history
Obtain current Profile Report
Update Trading Partner Profile
Set up claim numbering protocol
Obtain Profile Report and update
RRE
Send out MPN letter
Obtain PBM information for Rx
cards
Set up Bill Review in StrataCare
Preferred method of claim
reporting
Schedule claim reporting training
Schedule SIMS training
List of RMIS SIMS users:
Name E-mail address Special Instructions (e.g. no
notes/reports)
List of Claim Compass users:
Name E-mail address Location
#8..
- 507 -
Meeting Information:
Meeting Date Follow-up Items
Athens Transition Team
Kevin Cichurski Director of Sales 925-826-1103 [email protected] Doug Gibb EVP, Workers’ Compensation 925.826.1283 [email protected] Janet McClain EVP, Human Resources 925-826-1288 [email protected] Leann Farlander AVP, Cost Containment 949.296.3961 [email protected] Emily Kephart Claims Operations Manager 925-826-1112 [email protected] Nicole Park Implementation Specialist 925-826-1050 [email protected] Jane Catelani CFO 925-826-1281 [email protected] Lisa Winfield Accounting Manager 925-826-1175 [email protected] Don Barnwell Director of IT 925-826-1232 [email protected] Jeanette Mason Claim Director 925-826-1160 [email protected] Libby Duarte Mail Room Supervisor 925-826-1295 [email protected] #8..
- 508 -
Athens Claim Team
#8..
- 509 -
From 1/1/2015 To 12/31/2019 As Of 12/31/2019
Claim Type Open Closed Total Litg. Paid Incurred Paid Reserve Incurred Recoveries Net Incurred 12/31/2015
First Aid 0 6 6 0 $1,066.28 $1,066.28 $1,066.28 $0.00 $1,066.28 $0.00 $1,066.28 Indemnity 11 76 87 29 $3,099,981.95 $3,737,781.72 $3,099,981.95 $637,799.77 $3,737,781.72 $0.00 $3,737,781.72 Info Only 0 49 49 0 $40.00 $40.00 $40.00 $0.00 $40.00 $0.00 $40.00 Medical Only 1 38 39 0 $23,520.60 $24,602.41 $23,520.60 $1,081.81 $24,602.41 $0.00 $24,602.41 Total: 12 169 181 29 $3,124,608.83 $3,763,490.41 $3,124,608.83 $638,881.58 $3,763,490.41 $0.00 $3,763,490.41 12/31/2016
First Aid 0 5 5 0 $1,371.21 $1,371.21 $1,371.21 $0.00 $1,371.21 $0.00 $1,371.21 Indemnity 17 84 101 28 $2,228,597.94 $2,753,090.16 $2,228,597.94 $524,492.22 $2,753,090.16 ($90,806.11) $2,662,284.05 Info Only 0 50 50 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Medical Only 1 45 46 1 $26,797.23 $36,779.23 $26,797.23 $9,982.00 $36,779.23 $0.00 $36,779.23 Total: 18 184 202 29 $2,256,766.38 $2,791,240.60 $2,256,766.38 $534,474.22 $2,791,240.60 ($90,806.11) $2,700,434.49 12/31/2017
First Aid 0 8 8 0 $2,226.02 $2,226.02 $2,226.02 $0.00 $2,226.02 $0.00 $2,226.02 Indemnity 19 65 84 23 $2,198,792.36 $3,282,484.48 $2,198,792.36 $1,083,692.12 $3,282,484.48 $0.00 $3,282,484.48 Info Only 0 51 51 0 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 Medical Only 1 29 30 2 $17,124.03 $26,906.03 $17,124.03 $9,782.00 $26,906.03 ($300.00) $26,606.03 Total: 20 153 173 25 $2,218,142.41 $3,311,616.53 $2,218,142.41 $1,093,474.12 $3,311,616.53 ($300.00) $3,311,316.53 12/31/2018
First Aid 0 10 10 0 $3,620.36 $3,620.36 $3,620.36 $0.00 $3,620.36 $0.00 $3,620.36 Indemnity 25 64 89 22 $1,985,527.20 $3,209,341.54 $1,985,527.20 $1,223,814.34 $3,209,341.54 ($9,067.58) $3,200,273.96 Info Only 0 52 52 0 $559.07 $559.07 $559.07 $0.00 $559.07 $0.00 $559.07 Medical Only 1 45 46 1 $73,328.12 $83,409.02 $73,328.12 $10,080.90 $83,409.02 $0.00 $83,409.02 Total: 26 171 197 23 $2,063,034.75 $3,296,929.99 $2,063,034.75 $1,233,895.24 $3,296,929.99 ($9,067.58) $3,287,862.41 12/31/2019
First Aid 0 7 7 0 $1,633.83 $1,633.83 $1,633.83 $0.00 $1,633.83 $0.00 $1,633.83 Indemnity 33 43 76 23 $794,031.50 $1,385,572.89 $794,031.50 $591,541.39 $1,385,572.89 $0.00 $1,385,572.89 Info Only 6 48 54 0 $600.45 $600.45 $600.45 $0.00 $600.45 $0.00 $600.45 Rpt # O080
Report Run: 9/10/2020 6:26:01 AM
1 of 3
Claim Summary By Year - Program Name
Claim Loss Dates From 1/1/2015 Through 12/31/2019
Activity Dates From 1/1/2015 Through 12/31/2019
Period Ending 12/31
As Of 12/31/2019
#8..
- 510 -
From 1/1/2015 To 12/31/2019 As Of 12/31/2019
Claim Type Open Closed Total Litg. Paid Incurred Paid Reserve Incurred Recoveries Net Incurred 12/31/2019
Medical Only 5 28 33 1 $24,337.23 $29,969.14 $24,337.23 $5,631.91 $29,969.14 $0.00 $29,969.14 Total: 44 126 170 24 $820,603.01 $1,417,776.31 $820,603.01 $597,173.30 $1,417,776.31 $0.00 $1,417,776.31 Open Closed Total C Litg. Paid In Period Incurred In
Period
Paid Reserves Incurred Recoveries Net Incurred
Grand Total 120 803 923 130 $10,483,155.38 $14,581,053.84 $10,483,155.38 $4,097,898.46 $14,581,053.84 ($100,173.69) $14,480,880.15 Medical Only 9 185 194 5 $165,107.21 $201,665.83 $165,107.21 $36,558.62 $201,665.83 ($300.00) $201,365.83 Indemnity 105 332 437 125 $10,306,930.95 $14,368,270.79 $10,306,930.95 $4,061,339.84 $14,368,270.79 ($99,873.69) $14,268,397.10 Pending 0 0 0 0 $0.00 $0.00
Information Only 0 0 0 0 $0.00 $0.00
Unassigned 0 0 0 0 $0.00 $0.00
First Aid 0 36 36 0 $9,917.70 $9,917.70 $9,917.70 $0.00 $9,917.70 $0.00 $9,917.70 Rpt # O080
Report Run: 9/10/2020 6:26:01 AM
2 of 3
Claim Summary By Year - Program Name
Claim Loss Dates From 1/1/2015 Through 12/31/2019
Activity Dates From 1/1/2015 Through 12/31/2019
Period Ending 12/31
As Of 12/31/2019
#8..
- 511 -
Program Name Period: 12/1/2019 To 12/31/2019
Claim No. Claimant Stat. Type Loss Date Knowl St Leg Paid Incurred Paid Reserves Incurred C Info Onl 12/3/2019 12/4/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Medical 12/5/2019 12/5/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 C Medical 12/6/2019 12/6/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Medical 12/6/2019 12/6/2019 CA N $0.00 $1,150.00 $0.00 $1,150.00 $1,150.00 O Temporar 12/11/2019 12/11/2019 CA N $833.52 $4,156.00 $833.52 $3,322.48 $4,156.00 O Info Onl 12/17/2019 12/17/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/15/2019 12/15/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/31/2019 12/31/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/31/2019 12/31/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/27/2019 12/27/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 O Info Onl 12/6/2019 12/6/2019 CA N $0.00 $0.00 $0.00 $0.00 $0.00 Totals For: Program Name
Ending Open: 9 Period 12/1/2019 - 12/31/2019 Financials As Of 12/31/2019 Ending Closed: 2 Paid Incurred Paid Reserves Incurred
Total: 11 $833.52 $5,306.00 $833.52 $4,472.48 $5,306.00 Recoveries: $0.00 Net Incurred: $5,306.00
Report Total:
Ending Open: 9 Period 12/1/2019 - 12/31/2019 Financials As Of 12/31/2019 Ending Closed: 2 Paid Incurred Paid Reserves Incurred
Total: 11 $833.52 $5,306.00 $833.52 $4,472.48 $5,306.00 Recoveries: $0.00 Net Incurred: $5,306.00
Report run: 9/10/2020 6:25:15 AM
Report Id:
1 of 1
Examiners: All
Status: Open
ClaimType: All
Incurred Range: ($1,000,000,000,000.00) - $1,000,000,000,000.00 Legal Activity: Both
Claims Cost Summary
As Of: 12/31/2019
Activity Period 12/1/2019 - 12/31/2019
Loss Dates between 12/1/2019 - 12/31/2019 #8..
- 512 -
, INC.
Claimant Name
Description
Stat
Litg
Loss Age
Juris
Loss Date
Knowledge
Nature Of Injury
Body Part
Claim Type
Life Medical
Claim No. Close
d
55 12/3/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/4/2019 Shoulder N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Muscle Strain Left Shoulder
Claim No. Open 62 12/5/2019 Strain Medical Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/5/2019 Head N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Hit the right side of temple. Bruising around the area.
Claim No. Open 37 12/6/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/6/2019 Multiple Body Parts N Paid Paid Reserve Incurred Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 right heel and right knee
Claim No. Open 58 12/6/2019 Strain Medical Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/6/2019 Rib(s) N Paid Paid Reserve Incurred
Medical $0.00 $0.00 $750.00 $750.00
Other $0.00 $0.00 $400.00 $400.00
Examiner: jthongdy Claim Total: $0.00 $0.00 $1,150.00 $1,150.00 hurt right ribs, have not received results from x rays
Claim No. Close
d
36 12/6/2019 Puncture Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/6/2019 Hand, Right N Paid Paid Reserve Incurred Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Hand, Right middle and ring finger puncture
1 of 4
Detail Loss Run
Program Name
Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #8..
- 513 -
, INC.
Claimant Name
Description
Stat
Litg
Loss Age
Juris
Loss Date
Knowledge
Nature Of Injury
Body Part
Claim Type
Life Medical
Claim No. Open 33 12/11/2019 Strain Temporary
Disability
Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/11/2019 Leg - Right N Paid Paid Reserve Incurred Medical $0.00 $0.00 $1,500.00 $1,500.00
Temporary Disability $815.52 $815.52 $1,340.48 $2,156.00 Other $18.00 $18.00 $482.00 $500.00
Examiner: mdelfin Claim Total: $833.52 $833.52 $3,322.48 $4,156.00 Right side of right lower leg, near the inner portion behind the kneecap.
Claim No. Open 62 12/15/2019 Contusion Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/15/2019 Arm - Right N Paid Paid Reserve Incurred Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Ladder slipped from load beams and landed on him right arm.
Claim No. Open 52 12/17/2019 Contusion Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/17/2019 Head N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Head Contusion
Claim No. Open 36 12/27/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/27/2019 Back N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 Employee was bringing refrigerator down from liftgate of trailer when it began to fall. Employee strained his back while trying to keep refrigerator from falling.
Claim No. Open 29 12/31/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/31/2019 Back N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 upper back between shoulder blades; light throbbing and muscle spasms. 2 of 4
Detail Loss Run
Program Name
Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #8..
- 514 -
, INC.
Claimant Name
Description
Stat
Litg
Loss Age
Juris
Loss Date
Knowledge
Nature Of Injury
Body Part
Claim Type
Life Medical
Claim No. Open 48 12/31/2019 Strain Info Only Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 N CA 12/31/2019 Back N Paid Paid Reserve Incurred
Examiner: jthongdy Claim Total: $0.00 $0.00 $0.00 $0.00 possible strained middle of back
89561 Ending Open: 9
Ending Closed: 2
Total: 11
Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 Paid Paid Reserve Incurred
Medical $0.00 $0.00 $2,250.00 $2,250.00
Temporary Disabilty $815.52 $815.52 $1,340.48 $2,156.00 Other $18.00 $18.00 $882.00 $900.00
Total: $833.52 $833.52 $4,472.48 $5,306.00
Net Incurred: $5,306.00
Ending Open: 9
Ending Closed: 2
Total: 11
Grand Totals: Activity Paid 12/1/2019--12/31/2019 Totals Through 12/31/2019 Paid Paid Reserve Incurred
Medical $0.00 $0.00 $2,250.00 $2,250.00
Indemnity $0.00 $0.00 $0.00 $0.00
4850 $0.00 $0.00 $0.00 $0.00
Death $0.00 $0.00 $0.00 $0.00
Permanent Disability $0.00 $0.00 $0.00 $0.00
3 of 4
Detail Loss Run
Program Name
Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #8..
- 515 -
Temporary Disabilty $815.52 $815.52 $1,340.48 $2,156.00 Rehab / Voucher $0.00 $0.00 $0.00 $0.00
Other $18.00 $18.00 $882.00 $900.00
Legal $0.00 $0.00 $0.00 $0.00
Investigation $0.00 $0.00 $0.00 $0.00
Recovery $0.00 $0.00 $0.00
Total: $833.52 $833.52 $4,472.48 $5,306.00
Net Incurred: $5,306.00
4 of 4
Report # 0070
4 of 4
Report Run: 9/10/2020 6:24:39 AM
Detail Loss Run
, INC.
Loss Date Between 12/1/2019 and 12/31/2019 Financials As Of 12/31/2019 #8..
- 516 -
Check # Date Level 2 Level 3 Claim # Loss Date Claimant From Through Amount 12/3/2019 6/5/2019 06/05/2019 06/05/2019 $0.00
12/3/2019 7/16/2019 07/19/2019 07/19/2019 $0.00
12/3/2019 5/17/2019 05/24/2019 05/24/2019 $0.00
12/4/2019 10/3/2019 10/17/2019 10/18/2019 $0.00
12/4/2019 7/7/2014 04/05/2018 04/05/2018 $0.00
12/4/2019 3/5/2019 08/05/2019 08/05/2019 $0.00
12/5/2019 4/30/2018 07/23/2018 07/23/2018 $0.00
12/5/2019 4/30/2018 07/26/2018 07/26/2018 $0.00
12/5/2019 6/14/2018 11/17/2018 11/17/2018 $0.00
12/5/2019 6/8/2019 07/17/2019 07/19/2019 $0.00
12/6/2019 7/15/2019 07/15/2019 07/15/2019 $0.00
12/6/2019 6/11/2019 09/20/2019 09/20/2019 $0.00
12/6/2019 8/21/2017 04/18/2018 04/18/2018 $0.00
12/6/2019 7/25/2018 07/16/2019 07/16/2019 $0.00
12/6/2019 7/26/2019 09/16/2019 09/16/2019 $0.00
12/9/2019 6/8/2019 07/17/2019 07/19/2019 $0.00
12/10/2019 8/9/2013 06/13/2017 06/13/2017 $0.00
12/10/2019 10/3/2019 10/17/2019 10/18/2019 $0.00
12/10/2019 3/4/2019 09/17/2019 09/19/2019 $0.00
12/10/2019 3/4/2019 09/24/2019 09/27/2019 $0.00
12/10/2019 4/4/2019 04/10/2019 04/10/2019 $0.00
12/10/2019 9/13/2018 02/01/2019 02/07/2019 $0.00
12/13/2019 5/31/2012 11/04/2019 11/04/2019 $353.00
12/12/2019 8/3/1984 04/12/2019 04/12/2019 $0.00
12/17/2019 9/12/2017 09/18/2017 09/18/2017 $0.00
12/17/2019 7/13/2018 11/27/2018 11/27/2018 $0.00
12/17/2019 12/16/1999 09/03/2019 09/03/2019 $0.00
12/18/2019 7/26/2019 09/16/2019 09/16/2019 $0.00
12/18/2019 3/5/2019 04/15/2019 04/30/2019 $0.00
12/18/2019 3/5/2019 05/03/2019 05/07/2019 $0.00
12/18/2019 3/5/2019 05/09/2019 05/14/2019 $0.00
Pay Type Payee Name Method
Attending Physician Occupational Health
Centers of California, A
Paper
Transaction
Financial Reconciliation Ledger
Transactions between 12/1/2019 and 12/31/2019
Program Name
Surgeon COAST SURGERY
CENTER
Paper
Transaction Medical Copy Gemini Duplication, Inc Paper
Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Attending Physician Kenneth R. Sabbag, M.D. Paper Transaction
Attending Physician HealthFirst Medical Group Paper
Transaction Radiology Group Central Valley Imaging
Medical Associates Inc
Paper
Transaction
Medical Copy Gemini Duplication, Inc Paper
Transaction Attending Physician Ronald B. Perelman, MD Paper Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Attending Physician Occupational Health
Centers of California, A
Paper
Transaction
Medical Copy Gemini Duplication, Inc Paper
Transaction Surgeon US Healthworks Medical
Group PC
Paper
Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Pathology/Lab Cranford L Scott, MD Inc Paper Transaction
Physical Therapy Southern California
Permanente Medical
Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
DME Progressive Medical LLC
DBA Optum
Paper
Transaction Attending Physician Banning Med Services, A Med Corp
Paper
Transaction
DME CareWorks Paper
Transaction Utilization Review Athens Managed Care NonPrintable Physical Therapy Align Networks, Inc. Paper
Transaction Anesthesiolgst Souther California
Permanente Medical
Paper
Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
Physical Therapy Align Networks, Inc. Paper
Transaction Physical Therapy Align Networks, Inc. Paper Transaction
Physical Therapy MedRisk Inc. Paper
Transaction Attending Physician Alex Zand, M.D. A
Professional Corp.
Paper
Transaction
Pay methods included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:28:47 AM
1 of 1
#8..
- 517 -
Financial Reconciliation Ledger
Transactions between 12/1/2019 and 12/31/2019
104279 12/31/2019 9/25/2019 11/11/2019 11/11/2019 $82.06 104280 12/31/2019 8/24/2018 12/10/2019 12/10/2019 $166.56 104281 12/31/2019 4/15/2019 07/01/2019 07/01/2019 $875.82 104282 12/31/2019 10/10/2019 11/22/2019 11/22/2019 $134.84 104283 12/31/2019 1/25/2019 12/30/2019 12/30/2019 $98.00 104283 12/31/2019 7/27/2018 12/30/2019 12/30/2019 $98.00 104283 12/31/2019 12/16/1999 12/30/2019 12/30/2019 $98.00 104284 12/31/2019 9/30/2019 10/08/2019 10/08/2019 $130.96 104285 12/31/2019 10/30/2019 10/31/2019 10/31/2019 $7.50 104285 12/31/2019 9/30/2019 10/08/2019 10/08/2019 $7.50 104285 12/31/2019 9/30/2019 10/08/2019 10/08/2019 $3.20 104285 12/31/2019 10/30/2019 11/12/2019 11/12/2019 $7.50 15499 12/20/2019 7/15/2004 07/15/2004 07/27/2004 ($32.57) 93848 12/16/2019 3/1/2016 02/20/2018 02/20/2018 ($10.00) 95567 12/16/2019 3/1/2016 06/12/2018 06/12/2018 ($10.00) 937 $221,300.47
937 $221,300.47
Attending Physician Southern California
Permanente Medical
Check
Surgeon Patrick O'Maley MD Check
Radiology Group Radiology Medical Group
Of Santa Cruz, Inc.
Check
Physical Therapy Align Networks, Inc. Check
Bill Review Athens Insurance
Services, Inc.
Check
Utilization Review Athens Managed Care,
Inc.
Check
Utilization Review Athens Managed Care,
Inc.
Check
Physical Therapy MedRisk Inc. Check
Utilization Review Athens Managed Care,
Inc.
Check
Medical/Legal
Travel
McShane, Cheryl Void
Medical/Legal
Travel
McShane, Cheryl Void
Bill Review Athens Insurance
Services, Inc.
Check
Attending Physician U S HEALTHWORKS
MEDICAL GRP
Refund
Bill Review Athens Insurance
Services, Inc.
Check
Bill Review Athens Insurance
Services, Inc.
Check
Reversals 2 ($20.00)
Total 937 $221,300.47
Payments 933 $221,360.78
Refunds 2 ($40.31)
Total For ABF FREIGHT SYSTEM, INC. Count: Total
Grand Total Count: Total
Payments Amount
Pay methods included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:28:47 AM
1 of 1
#8..
- 518 -
, INC. % Of
Body Part Desc Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc. 90 Multiple Body Parts 9 27 409 0 15 $56,265.77 $212,644.81 $2,083.92 $14,534.15 $156,379.04 15.429 6.145 13.273 90 Respiratory System 0 1 0 0 0 $516.98 $516.98 $516.98 $516.98 $0.00 0.571 0.056 0.032 66 No Physical Injury 0 1 0 0 0 $209.98 $209.98 $209.98 $209.98 $0.00 0.571 0.023 0.013 61 Abdomen 0 4 171 0 43 $30,549.36 $30,549.36 $7,637.34 $24,512.40 $0.00 2.286 3.336 1.907 61 Groin 1 3 229 0 76 $55,562.49 $64,111.75 $18,520.83 $53,950.10 $8,549.26 1.714 6.068 4.002 57 Toe(s) 0 3 91 0 30 $12,086.91 $12,086.91 $4,028.97 $5,115.58 $0.00 1.714 1.320 0.754 56 Foot, Left 1 5 272 0 54 $17,193.49 $35,735.89 $3,438.70 $9,193.20 $18,542.40 2.857 1.878 2.231 56 Foot, Right 0 3 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 1.714 0.000 0.000 55 Ankle 0 2 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 1.143 0.000 0.000 55 Ankle, Left 1 4 219 0 55 $22,055.34 $48,750.38 $5,513.84 $18,951.20 $26,695.04 2.286 2.409 3.043 54 Calf Right 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 54 Leg 0 4 27 0 7 $3,856.29 $3,856.29 $964.07 $3,704.17 $0.00 2.286 0.421 0.241 54 Leg - Right 2 4 302 0 76 $49,073.78 $74,253.83 $12,268.45 $46,914.69 $25,180.05 2.286 5.359 4.635 53 Knee, Left 0 2 103 0 52 $16,410.53 $16,410.53 $8,205.27 $16,410.53 $0.00 1.143 1.792 1.024 53 Knee, Right 4 6 720 0 120 $35,094.07 $65,409.96 $5,849.01 $21,569.95 $30,315.89 3.429 3.833 4.083 51 Hip 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 51 Hip, Left 0 1 8 0 8 $2,868.59 $2,868.59 $2,868.59 $2,868.59 $0.00 0.571 0.313 0.179 51 Hip, Right 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 49 Heart 1 1 0 0 0 $18.00 $13,000.00 $18.00 $18.00 $12,982.00 0.571 0.002 0.811 44 Rib(s) 1 2 56 0 28 $2,814.66 $3,964.66 $1,407.33 $2,814.66 $1,150.00 1.143 0.307 0.247 42 Lower back area (inc. Lum 0 9 118 0 13 $19,964.18 $19,964.18 $2,218.24 $9,002.09 $0.00 5.143 2.180 1.246 42 Lower Back Area: Lumbar/S 1 4 614 0 154 $58,181.50 $68,500.66 $14,545.38 $53,090.12 $10,319.16 2.286 6.354 4.276 37 Thumb, Left 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 36 Finger(s) 2 4 217 0 54 $33,381.65 $67,484.59 $8,345.41 $22,756.02 $34,102.94 2.286 3.646 4.212 36 Finger(s) - Left 0 2 14 0 7 $1,615.54 $1,615.54 $807.77 $1,615.54 $0.00 1.143 0.176 0.101 36 Finger(s) - Right 1 1 57 0 57 $6,946.00 $15,848.40 $6,946.00 $6,946.00 $8,902.40 0.571 0.759 0.989 35 Hand, Left 0 1 0 0 0 $283.44 $283.44 $283.44 $283.44 $0.00 0.571 0.031 0.018 35 Hand, Right 1 3 133 0 44 $5,531.59 $28,311.79 $1,843.86 $2,939.80 $22,780.20 1.714 0.604 1.767 34 Wrist 0 1 208 0 208 $30,407.11 $30,407.11 $30,407.11 $30,407.11 $0.00 0.571 3.321 1.898 34 Wrist, Right 0 1 0 0 0 $6,852.58 $6,852.58 $6,852.58 $6,852.58 $0.00 0.571 0.748 0.428 31 Shoulder 8 14 1,843 0 132 $202,692.24 $386,836.66 $14,478.02 $80,189.54 $184,144.42 8.000 22.136 24.145 31 Arm 0 1 70 0 70 $10,974.81 $10,974.81 $10,974.81 $10,974.81 $0.00 0.571 1.199 0.685 31 Arm - Left 1 5 229 0 46 $74,071.13 $111,874.46 $14,814.23 $52,825.64 $37,803.33 2.857 8.089 6.983 31 Arm - Right 1 3 4 0 1 $1,513.49 $1,513.49 $504.50 $1,300.84 $0.00 1.714 0.165 0.094 31 Shoulder,Clavicle & Scapu 2 5 314 0 63 $52,690.48 $74,575.90 $10,538.10 $33,858.63 $21,885.42 2.857 5.754 4.655 31 Upper Arm 0 1 6 0 6 $302.13 $302.13 $302.13 $302.13 $0.00 0.571 0.033 0.019 30 Back 6 15 592 0 39 $54,133.84 $104,254.26 $3,608.92 $22,192.34 $50,120.42 8.571 5.912 6.507 30 Multiple Upper Extremitie 1 1 0 0 0 $4,786.72 $15,000.00 $4,786.72 $4,786.72 $10,213.28 0.571 0.523 0.936 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - BodyPart Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:22 AM
#8..
- 519 -
Program Name % Of
Body Part Desc Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc. 20 Multiple Neck Injury 1 1 0 0 0 $18.00 $6,500.00 $18.00 $18.00 $6,482.00 0.571 0.002 0.406 20 Neck 1 2 115 0 58 $26,693.74 $46,626.24 $13,346.87 $26,370.88 $19,932.50 1.143 2.915 2.910 19 Facial Bones 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 19 Forehead 0 1 0 0 0 $292.57 $292.57 $292.57 $292.57 $0.00 0.571 0.032 0.018 18 Face 0 2 0 0 0 $392.00 $392.00 $196.00 $392.00 $0.00 1.143 0.043 0.024 18 Lips 0 1 0 0 0 $628.79 $628.79 $628.79 $628.79 $0.00 0.571 0.069 0.039 17 Mouth 0 1 0 0 0 $366.82 $366.82 $366.82 $366.82 $0.00 0.571 0.040 0.023 14 Eye(s) 0 3 0 0 0 $716.13 $716.13 $238.71 $381.79 $0.00 1.714 0.078 0.045 14 Eye, Right 0 1 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 0.571 0.000 0.000 13 Ear(s) 0 2 0 0 0 $0.00 $0.00 $0.00 $0.00 $0.00 1.143 0.000 0.000 10 Head 2 12 41 0 3 $17,642.55 $17,642.55 $1,470.21 $10,361.77 $0.00 6.857 1.927 1.101 Program Name 48 175 7,182 0 41 $915,655.27 $1,602,135.02 $5,232.32 $80,189.54 $686,479.75 100.000 100.000 100.000 Report Total 48 175 7,182 0 41.04 $915,655.27 $1,602,135.02 $5,232.32 $80,189.54 $686,479.75 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - BodyPart Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:22 AM
#8..
- 520 -
Program Name % Of
Injury Cause Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc.
Walking 0 2 103 0 51.5 $16,836.74 $16,836.74 $8,418.37 $16,410.53 $0.00 1.14 1.84 1.05 Vehicle; motor vehicle NOC 0 3 48 0 16.0 $7,817.43 $7,817.43 $2,605.81 $5,087.00 $0.00 1.71 0.85 0.49 Vehicle Accident 1 2 14 0 7.0 $8,982.66 $21,331.66 $4,491.33 $8,696.98 $12,349.00 1.14 0.98 1.33 Unknown 1 1 0 0 0.0 $18.00 $13,000.00 $18.00 $18.00 $12,982.00 0.57 0.00 0.81 Twisting 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Tripped/Fall 0 1 0 0 0.0 $64.90 $64.90 $64.90 $64.90 $0.00 0.57 0.01 0.00 Tripped 1 3 426 0 142.0 $16,803.19 $37,227.34 $5,601.06 $10,361.77 $20,424.15 1.71 1.84 2.32 Struck: Object
Lifted/Handled
0 2 0 0 0.0 $322.86 $322.86 $161.43 $322.86 $0.00 1.14 0.04 0.02 Struck: Obj Handled By
Others
0 2 32 0 16.0 $4,232.50 $4,232.50 $2,116.25 $4,198.69 $0.00 1.14 0.46 0.26 Struck By-Object Being
Lifted or Handled
2 15 324 0 21.6 $55,868.10 $81,634.35 $3,724.54 $33,858.63 $25,766.25 8.57 6.10 5.10 Struck By/Moving Object 0 2 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 1.14 0.00 0.00 Struck by Object 1 3 12 0 4.0 $5,673.22 $10,694.79 $1,891.07 $5,673.22 $5,021.57 1.71 0.62 0.67 Struck by fellow worker 1 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Struck By Falling/Flying
Object
4 6 373 0 62.2 $16,670.69 $61,315.77 $2,778.45 $9,193.20 $44,645.08 3.43 1.82 3.83 Struck By Fall'G/Flying
Object
1 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Struck against 1 2 0 0 0.0 $485.18 $1,606.35 $242.59 $356.35 $1,121.17 1.14 0.05 0.10 Striking Against - Stationary
Object
0 1 0 0 0.0 $2,342.04 $2,342.04 $2,342.04 $2,342.04 $0.00 0.57 0.26 0.15 Strike; object being lifted or
handled
0 1 104 0 104.0 $24,512.40 $24,512.40 $24,512.40 $24,512.40 $0.00 0.57 2.68 1.53 Strike/Step On Sharp Object 0 2 0 0 0.0 $292.57 $292.57 $146.29 $292.57 $0.00 1.14 0.03 0.02 Strain; strain or injury by,
NOC
1 5 180 0 36.0 $3,183.20 $4,264.48 $636.64 $1,299.43 $1,081.28 2.86 0.35 0.27 Strain; pushing or pulling 4 12 619 0 51.6 $51,609.13 $163,149.64 $4,300.76 $12,668.13 $111,540.51 6.86 5.64 10.18 Strain; lifting 1 7 513 0 73.3 $71,344.40 $128,919.16 $10,192.06 $58,914.83 $57,574.76 4.00 7.79 8.05 Strain Or Injury By Lifting 0 7 71 0 10.1 $12,193.82 $12,193.82 $1,741.97 $9,002.09 $0.00 4.00 1.33 0.76 Strain Or Injury By Jumping 0 1 0 0 0.0 $800.66 $800.66 $800.66 $800.66 $0.00 0.57 0.09 0.05 Strain - Body Motion 2 9 349 0 38.8 $66,973.09 $75,522.35 $7,441.45 $53,950.10 $8,549.26 5.14 7.31 4.71 Strain 0 1 40 0 40.0 $4,804.81 $4,804.81 $4,804.81 $4,804.81 $0.00 0.57 0.52 0.30 Stepped on Object/Sharp
Object
0 1 0 0 0.0 $815.34 $815.34 $815.34 $815.34 $0.00 0.57 0.09 0.05 Stepped On Object 3 3 196 0 65.3 $23,115.54 $62,896.24 $7,705.18 $18,951.20 $39,780.70 1.71 2.52 3.93 Sprain 1 2 480 0 240.0 $22,255.53 $37,666.34 $11,127.77 $21,569.95 $15,410.81 1.14 2.43 2.35 Slip/Fall on stairs 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Slip, Trip, or Fall - Stairs 0 1 0 0 0.0 $3,463.22 $3,463.22 $3,463.22 $3,463.22 $0.00 0.57 0.38 0.22 Slip From Liquid/Grease Spill 0 2 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 1.14 0.00 0.00 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - Loss Cause Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:30 AM
#8..
- 521 -
Program Name % Of
Injury Cause Open Total Lost Rest Avg Days Paid Incurred Avg Paid Max Paid Reserves Claims Paid Inc.
Slip And No Fall 1 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Slip And Fall 0 3 216 0 72.0 $33,275.70 $33,275.70 $11,091.90 $30,407.11 $0.00 1.71 3.63 2.08 Repetitive Motion 2 4 65 0 16.3 $19,612.61 $44,889.41 $4,903.15 $7,815.53 $25,276.80 2.29 2.14 2.80 Pushing 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Pulling/Pushing Injury 2 2 188 0 94.0 $22,210.34 $54,624.64 $11,105.17 $22,192.34 $32,414.30 1.14 2.43 3.41 Pulling 3 6 844 0 140.7 $132,313.97 $222,260.15 $22,052.33 $80,189.54 $89,946.18 3.43 14.45 13.87 Misc; other - miscellaneous,
NOC
0 2 0 0 0.0 $209.98 $209.98 $104.99 $209.98 $0.00 1.14 0.02 0.01 Misc; cumulative (NOC) 1 1 0 0 0.0 $14,534.15 $27,000.00 $14,534.15 $14,534.15 $12,465.85 0.57 1.59 1.69 Misc Step On 1 1 285 0 285.0 $46,914.69 $68,772.26 $46,914.69 $46,914.69 $21,857.57 0.57 5.12 4.29 Lifting 1 6 308 0 51.3 $24,429.11 $31,799.09 $4,071.52 $10,974.81 $7,369.98 3.43 2.67 1.98 Lift/Bend/Twist 1 2 574 0 287.0 $53,555.86 $63,875.02 $26,777.93 $53,090.12 $10,319.16 1.14 5.85 3.99 Injured by; object being
lifted/handled
1 2 67 0 33.5 $11,839.78 $11,839.78 $5,919.89 $11,839.78 $0.00 1.14 1.29 0.74 Foreign body in eye 0 3 0 0 0.0 $334.34 $334.34 $111.45 $334.34 $0.00 1.71 0.04 0.02 Foreign Body 0 1 0 0 0.0 $381.79 $381.79 $381.79 $381.79 $0.00 0.57 0.04 0.02 Fall; on same level 0 2 0 0 0.0 $425.70 $425.70 $212.85 $425.70 $0.00 1.14 0.05 0.03 Fall/Slip From Different Level 0 1 0 0 0.0 $3,840.00 $3,840.00 $3,840.00 $3,840.00 $0.00 0.57 0.42 0.24 Fall, slip or trip, NOC 3 6 0 0 0.0 $2,289.03 $20,582.73 $381.51 $1,836.30 $18,293.70 3.43 0.25 1.28 Fall Different Level 0 1 14 0 14.0 $1,934.81 $1,934.81 $1,934.81 $1,934.81 $0.00 0.57 0.21 0.12 Exposure - Noise 0 1 0 0 0.0 $0.00 $0.00 $0.00 $0.00 $0.00 0.57 0.00 0.00 Exposure - Gases, Fumes,
or Vapors - NOC
0 1 0 0 0.0 $516.98 $516.98 $516.98 $516.98 $0.00 0.57 0.06 0.03 Cut; object being lifted or
handled
0 3 8 0 2.7 $1,648.42 $1,648.42 $549.47 $1,281.60 $0.00 1.71 0.18 0.10 Cut/Puncture/Scrape - Obj
being Handled
0 2 0 0 0.0 $283.44 $283.44 $141.72 $283.44 $0.00 1.14 0.03 0.02 Cut,Puncture,Scrape - NOC 1 4 96 0 24.0 $9,423.76 $15,678.15 $2,355.94 $5,210.63 $6,254.39 2.29 1.03 0.98 Cut 0 1 14 0 14.0 $1,615.54 $1,615.54 $1,615.54 $1,615.54 $0.00 0.57 0.18 0.10 Cumulative (All Others) 3 3 0 0 0.0 $4,822.72 $36,000.00 $1,607.57 $4,786.72 $31,177.28 1.71 0.53 2.25 Collision With A Fixed Object 1 1 339 0 339.0 $22,017.92 $31,224.04 $22,017.92 $22,017.92 $9,206.12 0.57 2.40 1.95 Caught; in, under, between,
NOC
1 2 132 0 66.0 $22,756.02 $50,604.57 $11,378.01 $22,756.02 $27,848.55 1.14 2.49 3.16 Caught in or Between - NOC 0 2 21 0 10.5 $3,188.09 $3,188.09 $1,594.05 $2,591.79 $0.00 1.14 0.35 0.20 Caught Between 1 2 111 0 55.5 $56,959.04 $94,762.37 $28,479.52 $52,825.64 $37,803.33 1.14 6.22 5.91 Bending 0 1 16 0 16.0 $2,029.24 $2,029.24 $2,029.24 $2,029.24 $0.00 0.57 0.22 0.13 Animal or Insect Bite 0 4 0 0 0.0 $811.02 $811.02 $202.76 $300.16 $0.00 2.29 0.09 0.05 As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - Loss Cause Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:30 AM
#8..
- 522 -
Program Name 48 175 7,182 0 41.0 $915,655.27
$1,602,135.0
2 $5,232.32 $80,189.54 $686,479.75 100.00 100.00 100.00 Report Total 48 175 7,182 0 41.0 $915,655.27
$1,602,135.0
2 $5,232.32 $80,189.54 $686,479.75
As of: 12/31/2019
Program Name
Entered Date Between 1/1/2019 and 12/31/2019 Frequency Analysis - Loss Cause Reporting Level: Program
Status: Open,Closed,Reopened 9/10/2020 6:32:30 AM
#8..
- 523 -
Payment Type Totals By Program
Category Payments Amount
Program Name
Expense
Investigation
Investigation 23 $37,717.99
Police Report 1 $10.00
Sub-Rosa Invest 1 $1,600.00
Total For Investigation Count: 25 $39,327.99
Legal
Court Reporter Fees 27 $18,205.48
Defense Legal 632 $407,434.85
Deposition Fee 23 $27,440.88
Hearing Representative (Def) 3 $1,515.00
Independent Rating 3 $2,275.00
Legal Copy 1 $990.99
Misc Legal 1 $1,350.00
Subro Legal (Def.) 12 $8,162.30
Total For Legal Count: 702 $467,374.50
Other
Bill Review 4,363 $229,671.99
Copy Expense 207 $26,113.13
IMR Fees 59 $22,383.00
Index - Initial 170 $3,060.00
Medicare Set-Aside Vendor Fees 4 $4,850.00
MSA Vendor Fees 5 $1,212.50
Other 3 $530.96
Travel 7 $198.76
Utilization Review 471 $67,137.00
Total For Other Count: 5,289 $355,157.34
Total For Expense Count: 6,016 $861,859.83
Indemnity
Permanent Disability
Applicant Attorney Fee 21 $56,107.35
C&R Claimant Counsel 9 $67,468.35
Comp & Release 8 $165,151.69
Life Pension 52 $7,321.26
Misc Lien 1 $5,000.00
PD Penalty - On Late 1 $18.91
PD Penalty - Other TPA 19 $1,587.80
Perm.Disability 27 $22,536.63
Perm.Partial Disab. 82 $63,781.42
Stipulated Award 168 $221,313.54
Finding & Award 6 $0.00
Total For Permanent Disability Count: 394 $610,286.95
Rehabilitation\Voucher
Rehab Vendor 1 $9,893.00
SJDB Voucher 3 $7,100.00
Total For Rehabilitation\Voucher Count: 4 $16,993.00
Transactions between 1/1/2019 and 12/31/2019
Totals
Jurisdictions included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:31:34 AM
1 of 2
#8..
- 524 -
Payment Type Totals By Program
Transactions between 1/1/2019 and 12/31/2019
Temporary Disability
EDD Reimbursement 9 $56,908.15
Misc. TD/Wage Loss 2 $1,984.68
TD Adjustment 7 $1,031.56
TD Attorney Fees 1 $311.18
TD Child Support 50 $14,440.80
TD Late: 1st - Athens 1 $161.13
TD Late: 1st - Employer 1 $4.45
Temporary Disability 531 $853,642.69
Temporary Partial Disability 308 $268,653.54
Wage Loss 31 $23,825.68
Total For Temporary Disability Count: 941 $1,220,963.86 Total For Indemnity Count: 1,339 $1,848,243.81
Medical
Medical
Anesthesiolgst 25 $5,456.26
Assistant Surgeon 3 $542.33
Attending Physician 1,358 $171,679.89
Atty Fees: Applicant 1 $7,500.00
Audiology 4 $977.68
Chiropractor 58 $7,225.09
DME 43 $31,025.73
Drugs 235 $16,218.49
Hospital Outpatient 44 $90,823.21
Lien Order -Disputed 2 $3,104.20
Med Reimbursement Claimant 7 $754.67
Medical C&R 5 $228,399.29
Medical Copy 71 $8,268.05
Medical Interpreter 8 $1,088.11
Medical Lien 10 $28,410.00
Medical Supplies 17 $4,182.96
Medical Travel 82 $19,482.86
Medical/Legal Travel 24 $869.45
Medical/Travel Other 1 $18.10
Medicare Trust 1 $87,141.39
ML 101 4 $2,917.69
ML 102 12 $4,375.00
ML 103 7 $5,994.13
ML 106 18 $14,625.00
MSA Fees 7 $4,660.50
Nurse Case Management 24 $15,568.66
Nursing Care 6 $1,575.00
Pain Management Clinic 5 $1,025.57
Physical Therapy 878 $101,537.14
Psychiatric Treatment 43 $4,622.65
QME/Panel 1 $937.50
Radiology Group 166 $22,728.65
Surgeon 80 $91,189.65
Voucher Attending Physician 1 $163.22
Jurisdictions included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:31:34 AM
1 of 2
#8..
- 525 -
Payment Type Totals By Program
Transactions between 1/1/2019 and 12/31/2019
Acupuncture 80 $10,382.49
Ambulance/Transportation 5 $907.80
Medical Legal 6 $1,250.00
Missed Appointment 4 $0.00
ML 104 18 $55,525.92
Pathology/Lab 65 $2,923.09
Total For Medical Count: 3,429 $1,056,077.42
Total For Medical Count: 3,429 $1,056,077.42
Recovery
Recovery
Rec: 3rd Party Subro MED 3 ($161,660.65)
Rec: Excess 4 ($21,489.26)
Total For Recovery Count: 7 ($183,149.91)
Total For Recovery Count: 7 ($183,149.91)
Total For ABF FREIGHT SYSTEM, INC. Count: 10,791 $3,583,031.15 Total 10,791 $3,583,031.15
Jurisdictions included on report: All
Pay types included on report: All
Report run: 9/10/2020 6:31:34 AM
1 of 2
#8..
- 526 -
Activity Period: 1/1/1900 and 12/31/2025
Loss Dates: 1/1/1900 and 12/31/2025
Program Name
Claim Count Claim Type Totals Activity Period: 1/1/1900 and 12/31/2025 Totals on Loss Dates through 12/31/2025 as of 9/10/2020 Open Total Lit FA MO IN Info Paid Incurred Paid Reserves Incurred Avg Claim (excl First Aid) Program Name - Freight System, Inc.
195 5747 961 104 2219 2951 473 $87,677,197.50 $96,944,101.84 $87,677,197.50 $9,266,904.34 $96,944,101.84 $17,176.13 Recoveries ($6,540,129.31) Net Incurred $90,403,972.53
Program Name - Logistics Company
2 124 27 0 58 66 0 $3,613,763.38 $3,810,237.98 $3,613,763.38 $196,474.60 $3,810,237.98 $30,727.73 Recoveries ($1,247,380.24) Net Incurred $2,562,857.74
Program Name. - Trucking Company
1 738 129 16 335 387 0 $16,692,377.45 $16,728,777.94 $16,692,377.45 $36,400.49 $16,728,777.94 $23,170.05 Recoveries ($1,581,302.36) Net Incurred $15,147,475.58
198 6609 1117 120 2612 3404 473 $107,983,338.33 $117,483,117.76 $107,983,338.33 $9,499,779.43 $117,483,117.76 $18,102.00 Recoveries ($9,368,811.91) Net Incurred $108,114,305.85 Grand Total
Open Total Lit FA MO IN Info Paid Incurred Paid Reserves Incurred Avg Claim 198 6609 1117 120 2612 3404 473 $107,983,338.33 $117,483,117.76 $107,983,338.33 $9,499,779.43 $117,483,117.76 $18,102.00 Recoveries ($9,368,811.91) Net Incurred $108,114,305.85 1 of 1
Report run: 9/10/2020 6:28:14 AM
Workers' Compensation Management Summary #8..
- 527 -
#8..
- 528 -
Sample Bordereau with Date Details
Valued As Of Date Program Level2 Level 3 Level 4 Claim Number Claimant Name Status Days Open Claim Type Loss Date Body Part 8/31/2020 Program Name Level2 Level 3 Closed 6663 Major PD 5/23/2002 Lower Back Area: Lumbar/Sacral 8/31/2020 Program Name Level2 Level 3 Closed 1587 Minor PD 4/21/2016 Foot 8/31/2020 Program Name Level2 Level 3 Closed 125 Temporary Disability 4/16/2020 Lower back area (inc. Lumb./Lumb.-Sac.) 8/31/2020 Program Name Level2 Level 3 Closed 61 Temporary Disability 6/24/2020 Multiple Body Parts 8/31/2020 Program Name Level2 Level 3 Closed 61 Temporary Disability 6/23/2020 Ankle, Left 8/31/2020 Program Name Level2 Level 3 Closed 29 Temporary Disability 6/26/2020 No Physical Injury 8/31/2020 Program Name Level2 Level 3 Closed 48 Temporary Disability 6/25/2020 Toe(s) 8/31/2020 Program Name Level2 Level 3 Closed 25 First Aid 11/24/2019 Hand 8/31/2020 Program Name Level2 Level 3 Closed 27 Temporary Disability 7/24/2020 Lower back area (inc. Lumb./Lumb.-Sac.) 8/31/2020 Program Name Level2 Level 3 Closed 17 Info Only 8/10/2020 Lower back area (inc. Lumb./Lumb.-Sac.) 8/31/2020 Program Name Level2 Level 3 Closed 10 Info Only 8/17/2020 Leg - Right 8/31/2020 Program Name Level2 Level 3 Closed 1 Info Only 8/17/2020 Back 8/31/2020 Program Name Level2 Level 3 Closed 5 Info Only 8/21/2020 Foot, Right 13 #8..
- 529 -
Nature Agent Cause Occupation Examiner Lost Days Indemnity Paid Indemnity Reserves Indemnity Incurred Strain metal items: plates/rods/scrap Pulling/Pushing Injury Not Assigned mdelfin 707 $93,075.69 $0.00 $93,075.69 Contusion fork lift Struck: Obj Handled By Others City Driver mdelfin 325 $76,708.39 $0.00 $76,708.39 Strain Platform/Pallet Strain; pushing or pulling City Driver mdelfin 54 $6,728.48 $0.00 $6,728.48 Strain hand truck Tripped/Fall Dock Worker mdelfin 36 $3,835.95 $0.00 $3,835.95 Strain Bodily Motion Strain; strain or injury by, NOC City Driver mdelfin 24 $3,026.06 $0.00 $3,026.06 Exposure infections/disease/agents Pandemic City Driver mdelfin $0.00 $0.00 $0.00 Laceration hand truck Caught in or Between - Objects Handled City Driver mdelfin 3 $376.83 $0.00 $376.83 Puncture Metal/Wood/Plastic Proc Equip Caught in or Between - NOC Dock Worker jthongdy $0.00 $0.00 $0.00 Strain Bodily Motion Loading/Unloading City Driver mdelfin $0.00 $0.00 $0.00 Strain fork lift Strain; lifting Dock Worker jthongdy $0.00 $0.00 $0.00 Strain Steps Strain; pushing or pulling City Driver jthongdy $0.00 $0.00 $0.00 Strain Platform/Pallet Loading/Unloading City Driver jthongdy $0.00 $0.00 $0.00 Strain ramp Strain - Body Motion Dock Worker jthongdy $0.00 $0.00 $0.00 #8..
- 530 -
Medical Paid Medical Reserve Medical Incurred Expense Paid Expense Reserves Expense Incurred Total Paid Total Reserves Total Incurred Recoveries Net Incurred $38,861.73 $0.00 $38,861.73 $29,152.48 $0.00 $29,152.48 $161,089.90 $0.00 $161,089.90 $0.00 $161,089.90 $24,672.85 $0.00 $24,672.85 $54,667.29 $0.00 $54,667.29 $156,048.53 $0.00 $156,048.53 $0.00 $156,048.53 $2,554.33 $0.00 $2,554.33 $356.30 $0.00 $356.30 $9,639.11 $0.00 $9,639.11 $0.00 $9,639.11 $1,265.20 $0.00 $1,265.20 $116.72 $0.00 $116.72 $5,217.87 $0.00 $5,217.87 $0.00 $5,217.87 $1,823.05 $0.00 $1,823.05 $178.65 $0.00 $178.65 $5,027.76 $0.00 $5,027.76 $0.00 $5,027.76 $0.00 $0.00 $0.00 $18.00 $0.00 $18.00 $18.00 $0.00 $18.00 $0.00 $18.00 $547.57 $0.00 $547.57 $56.26 $0.00 $56.26 $980.66 $0.00 $980.66 $0.00 $980.66 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $475.71 $0.00 $475.71 $38.33 $0.00 $38.33 $514.04 $0.00 $514.04 $0.00 $514.04 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00 #8..
- 531 -
(A) (B) (C) (D)
(M)
(G) (H) (I) (J) (K) (L) (1) (2) (4) (5)
20011812 Sergio Ochoa Dock Worker 08/10 0 0
20011814 Arturo Dominguez City Driver 08/10 14 0
20012004 Edward Silvius City Driver 08/14 14 0
20012005 Silvestre Vazquez
Nava City Driver 08/17 6 0
20012070 Nab Hayfron City Driver 08/17 0 0
20012122 Alexander
Ustyuzhin City Driver 08/17 0 0
20012456 Russell Lopez Mechanic 08/17 0 0
20012162 Thomas Torres City Driver 08/19 0 0
20012211 Samuel Krieger Dock Worker 08/21 0 0
20012349 Paul Kautz City Driver 08/24 0 0
20012366 Jose Cervantes City Driver 08/25 0 0
20012455 Batoy Diogenes City Driver 08/26 0 0
20012500 Michael Pallares Yard Worker 08/28 0 0
20012577 Jesus Iniguez City Driver 08/31 0 0
0 3 0 11 34 0 14 0 0 0 Injury Skin disorder Poisoning Hearing loss (1) (2) (4) (5) Respiratory condition
All other
illnesses
(3) (6)
ABF FREIGHT
SYSTEM, INC. Contusion - Finger(s) - Right - Bodily Motion Group Totals 0 0
ABF FREIGHT
SYSTEM, INC. Strain - Lower back area (inc. Lumb./Lumb.-Sac.) - Bodily Motion ABF FREIGHT
SYSTEM, INC. Strain - Multiple Body Parts - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Elbow - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Contusion - Hand, Left - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Multiple Body Parts - ground
ABF FREIGHT
SYSTEM, INC. Strain - Foot, Right - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Back - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Sprain - Shoulder,Clavicle & Scapula, Right - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Abdomen incl. groin - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Leg - Right - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Heel - Bodily Motion
ABF FREIGHT
SYSTEM, INC. Strain - Shoulder - Bodily Motion
(6)
ABF FREIGHT
SYSTEM, INC. Strain - Lower back area (inc. Lumb./Lumb.-Sac.) - fork lift
Job transfer
or restriction
Other recordable cases
Injury
(3)
Case no. Employee's name Job title
(e.g., Welder)
Date of injury
or onset of
illness
(e.g.,
month/day)
Where the event
occurred
(e.g., Loading dock
north end)
(E) (F) Using these four categories, check ONLY the
most serious result for each case:
Enter the number of
days the injured or ill
worker was:
Check the "Injury" column or
choose one type of illness: Describe injury or illness, parts of body affected, and object/substance that directly injured or made person ill (e.g., Second degree burns on right forearm from
acetylene torch)
Death Days away
from work
Remained at work
Job transfer
or restriction
On job
transfer or
restriction
Skin disorderRespiratoryconditionPoisoningHearing lossAll otherillnesses You must record information about every work-related death and about every work-related injury or illness that involves loss of consciousness, restricted work activity or job transfer, days away from work, or medical treatment beyond first aid. You must also record significant work-related injuries and illnesses that are diagnosed by a physician or licensed health care professional. You must also record work-related injuries and illnesses that meet any of the specific recording criteria listed in CCR Title 8 Section 14300.8 through 14300.12. Feel free to use two lines for a single case if you need to. You must complete an Injury and Illness Incident Report (Cal/OSHA Form 301) or equivalent form for each injury or illness recorded on this form. If you’re not sure whether a case is recordable, call your local Cal/OSHA office for help.
Establishment name
City State
Identify the person Describe the case Classify the case Cal/OSHA Form 300 (Rev. 7/2007) Appendix A
Attention: This form contains information relating to employee health and must be used in a manner that protects the
confidentiality of employees to the extent possible while the information is being used for occupational safety and health purposes.
Year 2020
Log of Work-Related Injuries and Illnesses Department of Industrial Relations Division of Occupational Safety and Health
#8..
- 532 -
OSHA's Form 300A (Rev. 01/2004)
Summary of Work-Related Injuries and Illnesses
Year 2020
U.S. Department of Labor
Occupational Safety and Health Administration
Form approved OMB no. 1218-0176
All establishments covered by Part 1904 must complete this Summary page, even if no work-related injuries or illnesses occurred during the year. Remember to review the Log to verify that the entries are complete and accurate before completing this summary.
Using the Log, count the individual entries you made for each category. Then write the totals below, making sure you¶ve added the entries from every page of the Log. If you had no cases, write 0.
Employees, former employees, and their representatives have the right to review the OSHA Form 300 in its entirety. They also have limited access to the OSHA Form 301 or its equivalent. See 29 CFR Part 1904.35, in OSHA¶s recordkeeping rule, for further details on the access provisions for these forms.
Number of Cases
Total Number of
Deaths
Total number of
cases with days
away from work
Total number of
cases with job
transfer or
restriction
Total number of
other recordable
cases
(G) (H) (I) (J)
0 3 0 11
Number of Days
(K)
34 Total number of days away
from work
Total number of days of job
transfer or restriction
0 (L)
Injury and Illness Types
Total number of...
(M)
(1) Injuries
(2) Skin disorders
(3) Respiratory conditions
(4) Poisonings
(5) Hearing loss
(6) All other illnesses
0 0
0 14
0 0
Public reporting burden for this collection of information is estimated to average 58 minutes per response, including time to review the instructions, search and gather the data needed, and complete and review the collection of information. Persons are not required to respond to the collection of information unless it displays a currently valid OMB control number. If you have any comments about these estimates or any other aspects of this data collection, contact: US Department of Labor, OSHA Office of Statistical Analysis, Room N-3644, 200 Constitution Avenue, NW,Washington, DC 20210. Do not send the completed forms to this office.
Establishment name
City State ZIP
Industry description (e.g., Manufacture of motor truck trailers) Standard Industrial Classification (SIC), if known (e.g., 3715 ) Employment Information (If you don't have these
figures, see the Worksheet on the back of this page to estimate.) Annual average number of employees
Total hours worked by all employees last year
Sign here
Knowingly falsifying this document may result in a fine.
I certify that I have examined this document and that to the best of my knowledge the entries are true, accurate, and complete.
Company executive
Date
Title
Phone
ABF FREIGHT SYSTEM, INC.
Establishment information
dept name ABF FREIGHT SYSTEM, INC.
Street
3801 Old Greenwood Road
Fort Smith AR 72917
Post this Summary page from February 1 to April 30 of the year following the year covered by the form. #8..
- 533 -
#8..
- 534 -
#8..
- 535 -
Stewardship Report
2017‐2018 Fiscal Year
As of 5/31/2018
#8..
- 536 -
As of 5/31/2018
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
Claims Entered
672 646
696
745
700
656 686
837
707 719
192 182
227
177 185 183 156 183 173 189
352 334 339
413
371 371 383
486
391 381
128 130 130 155 144 102
147 168 143 149
0 100
200
300
400
500
600
700
800
900
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Claims Entered ‐ 10 Year History
All MO Indemnity Info Only
55%
9% 8%
5% 3% 2%
8%
3% 2% 1% 0% 2%
0%
10%
20%
30%
40%
50%
60%
0 500
1000
1500
2000
2500
3000
3500
4000
% of Total
# of Claims
Claim Reporting Lag Time ‐ 10 Year History
Lag Days % of Total
#8..
- 537 -
As of 5/31/2018
Cause of Injury # of Delays % of Delayed Claims
Misc. Strain 174 18.0%
Cumulative, Repetitive 135 14.0%
Slip, Trip, Fall 72 7.5%
Pushing, Pulling 69 7.2%
Holding, Lifting, Carrying 62 6.4%
Other than Phy Cause of Injury 58 6.0%
Mental Stress 42 4.4%
Strike, Step on 34 3.5%
Misc. Absorption, Ingestion 32 3.3%
Other 93 9.6%
Occupation # of Delays % of Delayed Claims
Occupation 1 205 21.3%
Occupation 2 160 16.6%
Occupation 366 6.8%
Occupation 457 5.9%
Occupation 557 5.9%
Occupation 649 5.1%
Occupation 747 4.9%
Occupation 820 2.1%
Occupation 919 2.0%
Occupation 10 12 1.2%
Delayed Claims by Occupation ‐ Top 10
Delayed Claims by Cause of Injury ‐ Top 10
Delayed/Denied Claims ‐ Ten Year History
All
All
• Enter Description Here
• Enter Description Here
• Enter Description Here
84 85
71 122
111
84 59
96 120
132
56 76 70
114
87 103
93 119 117 112
0 20
40 60
80 100
120
140
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Delayed Denied
#8..
- 538 -
As of 5/31/2018
Year # Closed (%) of Total Total Incurred (%) of Incurred Avg. Incurred < 1 Year 594 79.8% $ 1,369,054 10.4% $ 2,305 1 Year 21 2.8% $ 698,061 5.3% $ 33,241 2 Years 22 3.0% $ 422,262 3.2% $ 19,194 3 ‐ 4 Years 41 5.5% $ 3,817,231 29.0% $ 93,103 5 ‐ 7 Years 27 3.6% $ 2,730,542 20.8% $ 101,131 8 ‐ 10 Years 13 1.7% $ 1,350,325 10.3% $ 103,871 11 ‐ 15 Years 16 2.2% $ 1,739,827 13.2% $ 108,739 16 ‐ 20 Years 4 0.5% $ 338,943 2.6% $ 84,736 > 20 Years 6 0.8% $ 680,510 5.2% $ 113,418 Claims Closed in 2017‐18 Year
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
2.4 0.2
0.0 0.5
1.0 1.5
2.0 2.5
3.0 Indemnity Medical Only
Average Claim Age at Time of Closure (Years)
425
144
Closures by Claim Type
Indemnity Medical Only
$30,603
$903
$‐
$5,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
Indemnity Medical Only
Average Incurred Value at Time of Closure
#8..
- 539 -
As of 5/31/2018
• Enter Description Here
• Enter Description Here
• Enter Description Here
Closed Claims
• Enter Description Here
• Enter Description Here
• Enter Description Here
672 646 696 745 700 656 686 837 707 719 661 629 678 719 660 616 619 727 606 537 98% 97% 97% 97% 94% 94% 90% 87% 86%
75%
0%
20%
40%
60%
80%
100%
120%
0 200
400
600
800
1000
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Closed Claims by Year
All Claim Types
10 Year History
Entered Closed (%) of Claims Closed
352 334 339 413 371 371 383 486 391 381 341 317 321 387 331 331 317 376 295 231 97% 95% 95% 94% 89% 89% 83% 77% 75%
61%
0%
20%
40%
60%
80%
100%
120%
0 100
200
300
400
500
600
2008‐09 2009‐10 2010‐11 2011‐12 2012‐13 2013‐14 2014‐15 2015‐16 2016‐17 2017‐18 Closed Claims by Year
Indemnity Claims
10 Year History
Entered Closed (%) of Claims Closed
#8..
- 540 -
As of 5/31/2018
Frequency Analysis
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
21.3% 18.9%
9.0% 8.0% 6.5% 5.8% 5.5%
2.4% 2.4% 2.1%
25.7%
10.1% 10.5%
6.2% 6.1% 7.4%
4.8% 6.6%
1.0% 0.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
Frequency Analysis by Occupation ‐ Top 10
% of Claims % Costs
0.1%
5.7%
20.6%
31.9% 30.4%
10.7%
0.0% 0.7% 0.0%
2.6%
15.4%
32.6%
36.7%
12.0%
0.6% 0.0%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
30.0%
35.0%
40.0%
0‐19 20‐29 30‐39 40‐49 50‐59 60‐69 70‐79 80 +
Frequency Analysis by Age
% of Claims % of Cost
#8..
- 541 -
As of 5/31/2018
• Enter Description Here
• Enter Description Here
• Enter Description Here
Frequency Analysis
• Enter Description Here
• Enter Description Here
• Enter Description Here
12.5%
10.5% 10.1%
7.6% 6.9% 5.8%
3.9% 3.5%
7.5% 7.3%
18.1%
10.4%
13.1%
4.3%
2.1%
11.9%
3.4%
5.9%
4.5%
9.3%
0.0%
2.0%
4.0%
6.0%
8.0%
10.0%
12.0%
14.0%
16.0%
18.0%
20.0% Frequency Analysis by Cause ‐ Top 10
% of Claims % Costs
47.2%
14.8%
6.2% 2.5% 1.9% 1.6% 1.4% 1.1%
10.5% 6.3%
64.6%
12.1%
3.0% 0.9% 0.1% 0.1% 1.4% 0.3%
6.2%
1.0%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
70.0%
Frequency Analysis by Nature ‐ Top 10
% of Claims % Costs
#8..
- 542 -
As of 5/31/2018
Frequency Analysis
• Enter Description Here
• Enter Description Here
• Enter Description Here
22.3%
16.4%
11.4% 10.4%
7.1%
3.6% 2.9% 2.6%
9.6%
7.5%
18.5%
20.6%
12.0% 10.8%
14.7%
1.6% 1.5% 0.6%
3.1%
13.8%
0.0%
5.0%
10.0%
15.0%
20.0%
25.0%
Frequency Analysis by Body Part ‐ Top 10
% of Claims % Costs
#8..
- 543 -
As of 5/31/2018
Location 2017‐18 2016‐17 Dollar Variance (%) Variance
Location 1 $ 8,966,649 $ 9,223,143 $ (256,494) ‐3% Location 2 $ 2,769,859 $ 2,284,811 $ 485,048 21% Location 3 $ 78,724 $ 124,603 $ (45,879) ‐37% Location 4 $ 224,715 $ 238,867 $ (14,152) ‐6% Location 5 $ 103,464 $ 73,901 $ 29,563 40% Location 6 $ 3,351 $ 4,837 $ (1,485) ‐31% Location 7 $ 7,854 $ 246 $ 7,608 3096% Location 8 $ 67,968 $ 93,828 $ (25,860) ‐28% Location 95 $ 0 $ 601 $ (551) ‐92% Location 10 $ 60,033 $ 41,459 $ 18,574 45% Total $ 12,282,667 $ 12,086,294 $ 196,373 2% Payout Comparison by Location
$0
$1,000,000
$2,000,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
2017‐18 2016‐17
#8..
- 544 -
As of 5/31/2018
Benefit Type 2017‐18 2016‐17 Dollar Variance (%) Variance Year 1 %Year 2 % Death $ 582,609 $ 119,767 $ 462,842 386.5% 4.7% 1.0% Investigation $ 114,064 $ 117,099 $ (3,036) ‐2.6% 0.9% 1.0% LC 4850 $ 400,906 $ 368,105 $ 32,801 8.9% 3.2% 3.0% Legal $ 707,343 $ 667,251 $ 40,093 6.0% 5.7% 5.4% Medical $ 3,733,885 $ 4,144,172 $ (410,287) ‐9.9% 30.2% 33.8% Other Expense $ 590,665 $ 562,285 $ 28,380 5.0% 4.8% 4.6% Permanent Disability 1,702,975 $ $ 1,687,381 $ 15,594 0.9% 13.8% 13.8% SJDB $ 9,409 $ 7,733 $ 1,676 21.7% 0.1% 0.1% Temporary Disability 4,517,255 $ $ 4,591,773 $ (74,518) ‐1.6% 36.6% 37.4% Total $ 12,359,111 $ 12,265,567 $ 93,544 0.8% Payout Comparison by Benefit Type
• Enter Description Here
• Enter Description Here
• Enter Description Here
1.%
1.%
3.% 5.4%
33.8%
4.6%
0.1% 13.8%
37.4%
2016‐17
Death
Investigation
LC 4850
Legal
Medical
Other Expense
Permanent Disability
SJDB
Temporary Disability
4.7% 0.9% 3.2%
5.7%
30.2%
4.8%
0.1% 13.8%
36.6%
2017‐18
Death
Investigation
LC 4850
Legal
Medical
Other Expense
Permanent Disability
SJDB
Temporary Disability
#8..
- 545 -
As of 5/31/2018
Category 2017‐18 2016‐17 Dollar Variance (%) Variance Year 1 %Year 2 % All Other Medical $ 48,195 $ 98,673 $ (50,478) ‐51.2% 1.3% 2.4% Attending Physician $ 951,130 $ 934,158 $ 16,971 1.8% 25.5% 22.5% Drugs $ 207,325 $ 272,822 $ (65,497) ‐24.0% 5.6% 6.6% Durable Medical Equipment $ 11,939 $ 171 $ 11,768 6884.7% 0.3% 0.0% Hospital $ 155,102 $ 406,629 $ (251,527) ‐61.9% 4.2% 9.8% Hospital Outpatient $ 380,841 $ 446,030 $ (65,189) ‐14.6% 10.2% 10.8% Medical Legal $ 305,841 $ 339,309 $ (33,468) ‐9.9% 8.2% 8.2% Medical Supplies $ 130,663 $ 132,012 $ (1,348) ‐1.0% 3.5% 3.2% Medical Travel $ 64,049 $ 48,862 $ 15,187 31.1% 1.7% 1.2% Medicare Trust $ 202,197 $ 159,924 $ 42,273 26.4% 5.4% 3.9% Nurse Case Management $ 749,113 $ 633,382 $ 115,732 18.3% 20.1% 15.3% Physical Therapy $ 304,376 $ 320,190 $ (15,814) ‐4.9% 8.2% 7.7% Radiology $ 63,154 $ 80,596 $ (17,442) ‐21.6% 1.7% 1.9% Settlement $ 55,276 $ 144,723 $ (89,448) ‐61.8% 1.5% 3.5% Surgeon $ 104,644 $ 126,301 $ (21,657) ‐17.1% 2.8% 3.0% Total $ 3,733,845 $ 4,143,782 $ (409,937) ‐9.9% Medical Detail Payout Comparison
• Enter Description Here
• Enter Description Here
• Enter Description Here
1.3%
25.5%
5.6%
0.3%
4.2% 10.2%
8.2%
3.5%
1.7%
5.4%
20.1%
8.2%
1.7%
1.5%
2.8%
2017‐18
All Other Medical
Attending Physician
Drugs
Durable Medical Equipment
Hospital
Hospital Outpatient
Medical Legal
Medical Supplies
Medical Travel
Medicare Trust
Nurse Case Management
Physical Therapy
Radiology
Settlement
Surgeon
2.4%
22.5%
6.6%
9.8%
10.8% 8.2%
3.2%
1.2%
3.9%
15.3%
7.7%
1.9% 3.5% 3.%
2016‐17
All Other Medical
Attending Physician
Drugs
Durable Medical Equipment
Hospital
Hospital Outpatient
Medical Legal
Medical Supplies
Medical Travel
Medicare Trust
Nurse Case Management
Physical Therapy
Radiology
Settlement
Surgeon
#8..
- 546 -
As of 5/31/2018
Top 10
Settlements by Amount
Claim # Claimant Name Loss Date Settlement Date Settlement Type Amount 14001881 Claimant Name 1 1/21/2014 10/13/2017 Compromise and Release $ 750,000 94630039 Claimant Name 2 1/11/1994 9/1/2017 Compromise and Release $ 300,000 91853674 Claimant Name 3 3/4/1990 9/1/2017 Compromise and Release $ 300,000 71902552 Claimant Name 4 9/11/1991 9/1/2017 Compromise and Release $ 300,000 12122688 Claimant Name 5 10/29/2002 9/1/2017 Compromise and Release $ 300,000 12010111 Claimant Name 6 10/18/2011 9/1/2017 Compromise and Release $ 300,000 12000881 Claimant Name 7 10/18/2011 9/1/2017 Compromise and Release $ 300,000 11002508 Claimant Name 8 3/15/2011 9/1/2017 Compromise and Release $ 300,000 08000076 Claimant Name 9 4/1/2004 9/1/2017 Compromise and Release $ 300,000 07000992 Claimant Name 10 1/8/2007 9/1/2017 Compromise and Release $ 300,000 • Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
Settlements
$373,314 $1,121,140 $850,939
$169,136
$2,187,203
$5,172,750
$542,450
$3,308,343
$6,023,689
22 23 24 97 3 3 130 61 2 93
$0
$2,000,000
$4,000,000
$6,000,000
$8,000,000
2015‐16 2016‐17 2017‐18
Claim Settlements
Stipulations C & R Total Cost
#8..
- 547 -
As of 5/31/2018
Year of Loss # Indemnity # Litigated (%) Litigated Litigated Non‐Litigated 2008‐09 381 58 15.2% $ 84,129 $ 11,141 2009‐10 332 65 19.6% $ 116,904 $ 12,775 2010‐11 335 64 19.1% $ 78,212 $ 12,547 2011‐12 414 72 17.4% $ 156,095 $ 11,639 2012‐13 379 81 21.4% $ 104,004 $ 14,410 2013‐14 367 60 16.3% $ 92,210 $ 16,306 2014‐15 405 64 15.8% $ 101,831 $ 14,202 2015‐16 462 84 18.2% $ 107,067 $ 12,665 2016‐17 391 52 13.3% $ 73,742 $ 13,954 2017‐18 355 25 7.0% $ 33,483 $ 12,069 As of 5/31/2018
Location # Litigated Total Claims (%) Litigated Litigated Non‐Litigated Location 1 1 3 33.3% $ 102,570 $ 8,780 Location 2 4 12 33.3% $ 63,766 $ 18,346 Location 3 155 468 33.1% $ 119,846 $ 11,224 Location 4 1 4 25.0% $ 25,453 $ 4,336 Location 5 14 59 23.7% $ 103,844 $ 11,176 Location 6 1 7 14.3% $ 246,015 $ 12,137 Location 7 440 3193 13.8% $ 93,898 $ 13,373 Location 8 9 68 13.2% $ 98,646 $ 14,341 Location 9 0 1 0.0% $ 0 $ 2,229 Location 10 0 2 0.0% $ 0 $ 8,810 Total 625 3817 16.4% $ 100,579 $ 67,135 Ten Year History ‐ Indemnity Claim Litigation
Average Total Incurred
• Enter Description Here
• Enter Description Here
• Enter Description Here
Average Total Incurred
Ten Year History ‐ Top 10 Locations by % Litigated
• Enter Description Here
• Enter Description Here
• Enter Description Here
#8..
- 548 -
As of 5/31/2018
OPEN CLAIM STRATIFICATION BY INCURRED VALUE
Incurred Value #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred ‐1E+13 $0 ‐ $4,999 43 6.0% $ 100,519 0.1% $ 2,338 5000 $5,000 ‐ $9,999 28 3.9% $ 211,496 0.3% $ 7,553 10000 $10,000 ‐ $24,999 95 13.3% $ 1,573,310 2.0% $ 16,561 25000 $25,000 ‐ $49,999 122 17.1% $ 4,402,476 5.6% $ 36,086 50000 $50,000 ‐ $99,999 176 24.7% $ 13,610,619 17.4% $ 77,333 100000 $100,000 ‐ $149,999 93 13.0% $ 11,564,006 14.8% $ 124,344 150000 $150,000 ‐ $199,999 69 9.7% $ 12,164,456 15.5% $ 176,296 200000 $200,000 ‐ $249,999 28 3.9% $ 6,449,395 8.2% $ 230,336 250000 $250,000 ‐ $499,999 47 6.6% $ 15,566,699 19.9% $ 331,206 500000 $500,000 ‐ $999,999 10 1.4% $ 6,423,396 8.2% $ 642,340 1000000 1M ‐ 2 Million 0 0.0% $ 0 0.0% $ 0 2000000 > 2 Million 2 0.3% $ 6,314,228 8.1% 3,157,114 $ 1E+20 Total 713 100.0% $ 78,380,600 100.0% 109,931 $
OPEN CLAIM STRATIFICATION BY AGE OF CLAIM
Age of Claim #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred 0 ‐ 6 Months 123 17.3% $ 2,195,509 2.8% $ 17,850 6 ‐ 12 Months 56 7.9% $ 2,391,518 3.1% $ 42,706 1yr ‐ 3yr 212 29.7% $ 19,080,677 24.3% $ 90,003 3yr ‐ 5yr 111 15.6% $ 12,015,667 15.3% $ 108,249 5yr ‐ 7yr 66 9.3% $ 15,091,906 19.3% $ 228,665 7yr ‐ 10yr 44 6.2% $ 7,592,462 9.7% $ 172,556 10yr ‐ 15yr 42 5.9% $ 6,177,875 7.9% $ 147,092 15yr ‐ 20yr 35 4.9% $ 5,586,680 7.1% $ 159,619 > 20 yrs 24 3.4% $ 8,248,305 10.5% $ 343,679 Total 713 100.0% $ 78,380,600 100.0% 109,931 $ • Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
Open Claim Stratification
#8..
- 549 -
As of 5/31/2018
OPEN CLAIM STRATIFICATION BY AGE OF CLAIMANT
Age of Claimant #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred 0 0 ‐ 17 Years Old 0 0.0% $ 7,000 0.0% $ 0 18 18 ‐ 20 Years Old 0 0.0% $ 0 0.0% $ 0 21 21 ‐ 25 Years Old 3 0.4% $ 388,457 0.5% $ 129,486 26 26 ‐ 35 Years Old 59 8.3% $ 5,757,907 7.3% $ 97,592 36 36 ‐ 45 Years Old 166 23.3% $ 18,766,609 23.9% $ 113,052 46 46 ‐ 55 Years Old 313 43.9% $ 36,356,796 46.4% $ 116,156 56 56 ‐ 65 Years Old 159 22.3% $ 16,134,905 20.6% $ 101,477 66 66 ‐ 75 Years Old 13 1.8% $ 975,927 1.2% $ 75,071 76 76 + Years Old 0 0.0% $ 0 0.0% $ 0 99999 Total 713 100.0% $ 78,387,600 100.0% 109,941 $
OPEN CLAIM STRATIFICATION BY JOB TENURE
Job Tenure #Claims (%) of Total Total Incurred (%) of Total Avg. Incurred 0 ‐ 6 Months 9 1.3% $ 431,932 0.6% $ 47,992 6 ‐ 12 Months 18 2.5% $ 1,634,562 2.1% $ 90,809 1yr ‐ 3 yr 82 11.5% $ 7,003,563 8.9% $ 85,409 3yr ‐ 5yr 61 8.6% $ 5,445,575 6.9% $ 89,272 5yr ‐ 7yr 75 10.5% $ 7,734,414 9.9% $ 103,126 7yr ‐ 10yr 98 13.7% $ 11,762,368 15.0% $ 120,024 10yr ‐ 15yr 123 17.3% $ 17,287,139 22.1% $ 140,546 15yr ‐ 20yr 105 14.7% $ 9,990,067 12.7% $ 95,143 > 20 yrs 142 19.9% $ 17,090,979 21.8% $ 120,359 Total 713 100.0% $ 78,380,600 100.0% 109,931 $ Open Claim Stratification
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
• Enter Description Here
#8..
- 550 -
As of 5/31/2018
Type
Severity # Claims Avg. Incurred # Claims Avg. Incurred # Claims Avg. Incurred Low 932 $ 19,061 221 $ 1,874 1,186 $ 15,337 Medium 168 $ 12,853 1 $ 150 169 $ 70,882 High 179 $ 42,319 00 $ 179 $ 220,344 As of 5/31/2018
Claim # Date of Loss Location Occupation PM Score Total Incurred 12003373 12/5/2009 Location 1 Occupation 1 99.5 $ 352,947 07000737 9/25/2012 Location 2 Occupation 2 99.4 $ 406,076 16001672 9/7/2012 Location 3 Occupation 3 99.4 $ 505,158 10000070 6/11/2011 Location 4 Occupation 4 99.4 $ 714,414 11004517 1/15/2012 Location 5 Occupation 5 99.3 $ 354,785 12122669 3/11/2008 Location 6 Occupation 6 99.3 $ 505,854 48504991 1/5/2004 Location 7 Occupation 7 99.3 $ 361,198 11270317 12/19/1998 Location 8 Occupation 8 99.1 $ 464,518 12003316 11/8/2012 Location 9 Occupation 9 99.1 $ 250,994 17212725 10/29/2012 Location 10 Occupation 10 99.1 $ 353,315 • Enter Description Here
• Enter Description Here
• Enter Description Here
Predictive Model Scores
• Enter Description Here
• Enter Description Here
• Enter Description Here
Indemnity Medical Only Total
Top 10 Open Claims By PM Score
$19,061
$12,853
$42,319
$1,874 $0.00 $150
$5,000.00
$10,000.00
$15,000.00
$20,000.00
$25,000.00
$30,000.00
$35,000.00
$40,000.00
$45,000.00
Low Medium High
Avg Incurred
Predictive Model Severity
Average Incurred by PM Severity
Indemnity Medical Only
#8..
- 551 -
As of 5/31/2018
Date of Loss Location Occupation Cause Total Incurred 3/14/2012 Location 1 Occupation 1 Misc; cumulative (NOC) $ 3,253,602 10/31/1991 Location 2 Occupation 2 Misc; cumulative (NOC) $ 3,060,626 12/19/2015 Location 3 Occupation 3 Defensive Tactics $ 983,584 7/7/2009 Location 4 Occupation 4 Fall; on same level $ 746,716 6/11/2011 Location 5 Occupation 5 Fall ‐ Different Level/Elevation $ 714,414 10/24/2002 Location 6 Occupation 6 Fall, slip or trip, NOC $ 680,869 10/14/1985 Location 7 Occupation 7 Lifting $ 657,030 7/9/1980 Location 8 Occupation 8 Misc; person in act of crime $ 575,897 3/17/2012 Location 9 Occupation 9 Act Of Other $ 527,905 11/24/1997 Location 10 Occupation 10 Fall, slip or trip, NOC $ 525,968 As of 5/31/2018
Location Total Dollars Total Claims Avg. $ Per Claim
Location 1 $ 309,803 288 $ 1,076 Location 2 $ 169,404 1656 $ 102 Location 3 $ 419 4 $ 105 Location 4 $ 396 66 $ 6 Location 5 $ 161 32 $ 5 Location 6 $ 43 14 $ 3 Location 7 $ 27 21 $ 4 Location 8 $ 12 43 $
Location 9 $ 0 0 $ ‐ Location 10 $ 0 0 $ ‐ As of 5/31/2018
Claim # Location Body Part Date of Birth Total Dollars 7000737 Location 1 Multiple Body Systems & Body Parts 9/11/1951 $ 217,259 12003057 Location 2 Knee 7/15/1964 $ 33,019 16001672 Location 3 Upper Arm, Left 1/6/1982 $ 19,536 16001129 Location 4 Shoulder(s) 9/4/1954 $ 12,859 48505479 Location 5 Multiple Body Systems & Body Parts 1/26/1960 $ 11,923 91845504 Location 6 Lower Back Area: Lumbar/Sacral 11/7/1938 $ 11,120 13004066 Location 7 Toe(s) 1/25/1975 $ 9,167 75608300 Location 8 Multiple Body Systems & Body Parts 4/19/1927 $ 7,740 11004517 Location 9 Multiple Body Systems & Body Parts 10/11/1948 $ 7,458 19212043 Location 10 Multiple Neck Injury 3/27/1962 $ 7,346 Top 10 Open Claims By Incurred Value
Open and Closed Claims ‐ Top 10 Claims by Pharmacy Spend between 2016‐18 Top 10 Locations by Pharmacy Spend between 2016‐18
• Enter Description Here
• Enter Description Here
• Enter Description Here
#8..
- 552 -
Athens Administrators
Workers’ Compensation Best Practices
1. Caseload
All Claims Examiners will have reasonable caseloads taking into account the type of claims and the level of service requirements. The optimum number of active indemnity claims for a Senior Examiner is 150. Future Medical caseloads should not exceed 250. The supervisor will not carry a caseload.
2. Claim File Documentation
All claims activity, including correspondence, plans of action, referrals, reserve rationale, claim status reviews, medical and legal referrals, emails and approvals will be clearly documented in the computer notepad. A copy of all written documentation, notices, letters, reports, etc., will be maintained in the claim file as electronic attachments.
3. Coverage
The Athens claims team will verify coverage for each claim and document that verification in the claim notes. If applicable, Athens will exercise due diligence in joining applicable co-defendants. All activity to verify coverage and join co-defendants will be clearly documented in the computer notepad.
4. Forms and Attachments
Each file will include a copy of requiredforms,includingthe Employer’sReport of Injury,DWCForm1, benefit notices, awards, settlement documents,medical reports, panel requests, URreferrals,investigative reports and legal correspondence. Athens will send the employee the DWC Form 1 if the employer has not provided one to the injured worker.
5. Claim File SetUp
Upon receipt of the Employer’s Report of Occupational Injury or Illness or Application for Adjudication of Claim, Athens will set up an individual claim file within three business days. Preparation of the claim file will include entering each new claim into the computer system and establishing a claim number.
6. Diary Review
All claim files will have a future diary review depending on the type of claim. Active indemnity claims will be reviewed every 30 to 60 calendar days for active claims and at least every 180 calendar days for claims that have settled but are open for the employee’s future medical care. Supervisory reviews are performed every 90 days for active indemnity claims and every 180 days for future medical claims.
7. Employer Contact
Athens examiners will contactthe employer within 48 hours of notice of claim. The examiner will confirm the detailsandfactsofthe claims, collect additional information,determine workstatus,identify witnesses,and #8..
- 553 -
provide initial information back to the employer. The employer contact will be documented in the claim file notes.
Phone calls will be returned within one business day. All correspondence from employers will be responded to within five business days of receipt.
8. Employee Contact
Telephonicpersonal contactwill beestablished withtheinjuredemployee withintwo businessdaysof receipt of notice of claim on all non-litigated, lost time cases. The examiner will discuss entitlement to benefits and the options available to the claimant should they disagree with the benefit decision. The examiner will also encourage the claimant to contact Athens with any questions once they receive their benefit notices. Such contact will continue as often as necessary, but at least monthly on all non-litigated claims as long as the injured worker is off work. Such contact with the employee will be clearly documented in the computer notepad.
As required,Athens will confer with and assistinjuredemployees in resolvingproblems that arise frominjury or illness claims.Examiners will return phone calls ofunrepresented employees within one business day.
Examiners will respond to correspondence from employees within five business days of receipt. Upon claim resolution, Athens will contact unrepresented claimants to discuss the resolution of their claim and address any remaining issues.
9. Reserves
Appropriate reserves will be established within three business days based on the information available.
Reserve rationale will be documented in the claim file.
Reserves will be established based on the facts of the claim and should reflect the ultimate probable cost of the claim. All reserve categories will be reviewed on a regular basis but not less than at least every 90 calendar days. Such detailed reviews will be clearly documented in the computer notepad.
10. Medical Management
The treating doctor’s office will be contacted within three business days of notice of all new claims to obtain medicalstatusanddiscussreturntofullormodifiedwork.Athenswillmaintaincontactwithtreatingphysicians to ensure that the injured worker receives proper medical treatment and is returned to full or modified duty atthe earliestpossibledate.The resultsofthis contact will be clearlydocumented inthe computernotepads.
Athens will arrange medical evaluations when needed, reasonable, and/or requested in compliance with the current California Labor Code.
Athens will ensure that medical bills are reduced to the Official Medical Fee Schedule (OMFS) and recommended rates established by the Administrative Director of Workers’ Compensation.
Athens will make referrals for utilization review (UR) and/or professional managed care services on an asneeded basis in accordance with UR approved guidelines.
Telephonic and field nurse case management will be assigned when appropriate and with the approval of the employer. Results will be closely monitored and assignments will be promptly terminated if the nurse is unable to or is no longer adding value. Task assignments will be made whenever possible to control unnecessary costs.
#8..
- 554 -
Medical Provider Networks (MPNs) and Pharmacy Benefit Management (PBMs) services will be utilized as agreed upon with the employer.
11. Medical Payments
Medical bills will be reviewed for accuracy, approved for payment on the appropriate claim file, and paid within time limits established by Labor Code Section 4603.2. If all or part ofthe bill is being disputed, Athens will notify the medical provider, on the appropriate form letter, within time limits established by Labor Code Section 4603.2.
12. Plan of Action
A current plan of action will be included in the file notes. The plan of action on new claims will be developed within fourteen calendar days of initial claim set-up. Such plan of action will be clearly stated including the reasoning, strategy, and course of action(s) for the plan. The plan of action will be updated every 90 calendar days for active indemnity claims and every 180 days for future medical claims.
13. Future Medical Claims
Claims that remain open to monitor future medical care only will continue to be monitored for appropriate medical treatment and potential settlement. Claims will be reviewed every 180 days. The claim notes will include settlement information, an outline of future medical care, potential excess reporting, and reserve rationale.
Athens will evaluate the claim at least annually to determine a reasonable amount for settlement of future medical benefits and any remaining benefits due.
14. Investigation
All indemnity claims will be reported to the Index Bureau. ISO results will be reviewed for prior injuries, potential co-defendants, and possiblefraud.
Claims will be promptly investigated when red flags are identified. The scope of the investigation will be determinedbyfactsandinformationobtained.Outsideinvestigativefirmswillbeusedforstatements,factual investigations and sub rosa.Authorization for investigation will be obtained fromthe employer or client, and all activities will be clearly documented in the computer notepads.
15. Fraudulent Claims
Any claim with suspected fraudulent activity will be referred to Athens’ special investigation process for further investigation and potential referral to the District Attorney.
16. Compensability
The compensability determination (accept claim, deny claim, or delay acceptance pending the results of additional investigation) and the reasons for such determination will be made and documented in the file within fourteen calendar days from the employer’s date of knowledge of the claim. Delay of benefit notices will be mailed in compliance with the Division of Industrial Relations’ guidelines. Copies of benefit notices will be maintained in the applicable claim file.
#8..
- 555 -
17. Provision of Benefits
Athens will provide all compensation and medical benefits in a timely manner and in compliance with statutory requirements. Benefits will be computed and paid to injured employees based upon earnings information and authorized disability periods.
18. Initial Indemnity Payment
The initial indemnity payment or voucher will be issued and mailed to the injured employee along with a properly completed DWC notice within fourteen calendar days of knowledge of the first day of disability.
Copies of benefit notices will be maintained in the applicable claim file.
Self-imposed penalties must be entered by a Claims Supervisor.
19. Subsequent Indemnity Payments
All indemnity payments or vouchers subsequent to the first payment will be verified and paid every two weeks. Copies of benefit notices issued with subsequent benefits will be maintained in the applicable claim file.
Self-imposed penalties must be entered by a Claims Supervisor.
20. Return to Work
Athens will assist the employer in establishing a modified work program that is appropriate for injured employees while recovering and prior to their return to regular duties.
Athens will consult with the employer on a regular basis in those cases where the injury might involve permanent work restrictions and/or disability retirement potential. This contact will be documented in each claim file.
Athens will notify the employer immediately upon receipt of an employee’s permanent work restrictions so thatthe employer can determine the availability of permanent modified or alternative work. Notification will clearly be documented in the computer notepad.
All applicable benefit notices will be sent to the employee as required by the California Labor Code. Copies of benefit notices will be maintained in the applicable claim file.
21. Transportation Expense
Transportation reimbursement will be reviewed for accuracy, approved for payment, and paid timely.
Advance travel expense payments will be mailed to the injured employee at least ten working days prior to the anticipated date of travel.
#8..
- 556 -
22. Permanent Disability
Athens will provide information to and assistinjured employees in completing the necessary forms to obtain a permanent disability evaluation or rating. Athens will contact eachunrepresentedemployee with potential permanent disability, discuss the level of permanent disability and address any questions or concerns.
Athens will determine the nature and extent of permanent disability and arrange for an informal disability rating whenever possible to avoid Workers’ Compensation Appeals Board (WCAB) involvement. Athens will address and pursue any potential apportionment to prior claims, disabilities, and impairments. Athens will also advise the employer of potential credits and increases to permanent disability benefits based upon the employer’s ability or inability to accommodate permanent/alternative work for at least twelve months.
All permanent disability benefit notices will be sentto the employee as requiredby theCalifornia LaborCode.
Copies of benefit notices will be maintained in the applicable claim file.
23. Litigated Cases
The legal aspect of all cases will be timely and appropriately evaluated. Examiners will justify the need for defense counsel and will obtain the employer’s authorization and consent prior to referring claims to legal.
When defense counsel is not necessary, Athens will work closely with the applicant’s attorney to attempt informal resolution and avoid unnecessary litigation costs.
Athens will maintain control of claims referred to defense counsel and will direct counsel to avoid unnecessary costs. Activities that are within the examiner’s scope of expertise (such as scheduling appointments, subpoenaed records requests and file and serve letters) will remain the responsibility of the claims examiner and/or assistant examiner.
Athens will prepare clear and concise litigation referrals to outside counsel outlining the issues of the claim and duties that will be handled by defense counsel. An initial litigation budget will be requested at the time of referral. Defense counsel will clearly outline a written plan to defend the litigated issues and provide an estimated litigation budget, a written initial analysis and subsequent written updates timely. The employer will be kept informed of outside counsel’s progress.
Athens will monitor outside counsel’s progress and will audit all defense counsel’s bills before payment is authorized. Athens will confirm the defendant is properly named on all legal documents.
When preparing for trial, Athens will confer with the employer, so that all material evidence and witnesses are utilized to obtain a favorable result.
24. Settlements
Athens will seek settlement authority from the employer. All requests for settlement authority will include a written claim summary, estimate of permanent disability, and the defense counsel’s comments and recommendations, if any.
Every settlement must consider appropriate use of a Medicare Set Aside (MSA) with documentation to support the decision whether or not to proceed with an MSA. Athens will identify an approved vendor to prepare and submit the MSA for approval.
#8..
- 557 -
25. Subrogation
Athenswillpromptlyinvestigatecaseswithsubrogationpotential.Inallcaseswhereathirdpartyisresponsible for theinjurytotheemployee,Athenswill requestauthorityfromtheemployer topursuesubrogation.Athens will contactthe responsible party withinten businessdaysofidentification andnotify themofthe employer’s rightto subrogation and the recovery of certain claim expenses. Ifthe third party is a governmental agency, a claim will be filed with the governing board within six months of the injury or notice of injury.
Periodic contact will be made with the responsible party and/or insurer to notify them of the amount of the estimated recovery for which we will be seeking reimbursement.
If the injured worker brings a civil action against the responsible party, Athens will discuss the value of the subrogation claim and other considerations with the employer to determine the best course of action. Upon authorization from the employer, subrogation counsel will be assigned to file a Lien or a Complaint in Intervention in the civil action within the applicable Statute of Limitations.
Whenever practical, Athens will attempt to resolve the civil claim and the workers’ compensation claim together, by means of a Third-PartyCompromise and Release. If such attempt does not succeed, every effort will be made to obtain a credit to offset future claim expenses when the case in chief is settled before the WCAB.
Athens will obtain approval from the client for all subrogation waivers.
26. Vocational Rehabilitation/Supplemental Job Displacement Benefits (SJDB) In accordance with all applicable California Labor Code and Regulation requirements, Athens will:
A. Determine the Qualified Injured Worker/Non-Qualified Injured Worker status B. Advise the injured worker of his/her right to rehabilitation benefits/SJDB C. Provide appropriate vocational rehabilitation benefits/SJDB D. Control rehabilitation/SJDB costs
E. Attempt to secure the prompt conclusion of vocational rehabilitation benefits/SJDB F. Promptly provide notification to the employer should work restrictions require permanent or modified, alternative accommodations
27. Excess Insurance
Cases with potential to exceed the self-insured retention will be timely reported to the excess carrier in accordance with the carrier’s reporting criteria.
28. Excess Reimbursement/Subrogation Recovery
Athens will be responsible for collecting reimbursements and recoveries from the excess carrier and appropriate third party on a quarterly basis. A copy of the request for reimbursement will be maintained in the claim file.
29. Overpayments
Athens will attempt recovery of overpayments on all files. Attempted recovery will be documented in the claims file. Credit may be taken, when allowed, against future benefits. #8..
- 558 -
30. Award Payment
Award payments will be issued within 20 calendar days of the approved settlement. Late payments will include the self-imposed increase and appropriate interest in accordance with the Labor Code.
31. Penalties and Self Imposed Increases
Late payment of all benefits mustinclude the self-imposed increase,in accordance with California law, upon verificationthatafullyexecutedDWC-1formisonfile.Athenswillprovidetheemployerwithaquarterlylisting of any administrative penalties/increases and will identify the party responsible for the penalty/increase. If the penalty/increase was the responsibility of Athens, Athens will issue a reimbursement check payable to the employer.
32. Case Closure
All cases will be closed within sixty calendar days ofthe final financial transaction or final correspondence to the injured worker, as required by law. Future medical cases will be closed within 60 days following two full years of financial inactivity, except in cases where future treatment is reasonably anticipated.
33. Claims Reporting
Athens will assist in the preparation of all reports that are now, or will be, required by the State of California or other government agencies. Athens will also assistin the preparation of all reports or databases required by statistical database organizations, or as requested by the employer. Costs associated with custom data programming may be charged to the employer with the employer’s prior agreement.
34. Claim Supervision
Athens claim supervisors will regularly review the work product ofthe claims examiners. The Supervisor will review all new claims within the first thirty days of receipt from any source. Active indemnity claims will be reviewed by the supervisor no less often than every 90 days. Such reviews will include redirection, recommendations and/or appropriate feedback, which will be clearly documented in the computer notepad.
The supervisor will review medical only claims open beyond ninety calendar days from the date of entry for potential closure or conversion to indemnity claim status. #8..
- 559 -
4/28/2021 Page 1
To Our Valued Legal Partners:
Athens Administrators values a strong and collaborative relationship with our defense counsel. As legal counsel, trusted to handle matters on behalf of Athens Administrators, we feel it is important for you to understand Athens Administrators case handling philosophy and billing rules.
We have developed these Guidelines and Rules to ensure our claims professionals as well as our legal partners possess an awareness of our case handling requirements. Please familiarize yourself with these guidelines and communicate them to any counsel and/or staff who may be involved in the defense, billing or administration of Athens Administrators cases.
Please note that our Guidelines and Rules have been carefully drafted to provide you with specific guidance on our expectations for your work and billing for all legal assignments referred to you by Athens Administrators.
We also are pleased to have you note that wherever possible our Guidelines and Rules contain similar requirements and expectations as found in the Defense Research Institute (DRI) “Recommended Case Handling Guidelines for Insurers” and the Council on Litigation Management (CLM) “Litigation Guidelines.” Athens Administrators expects to work with defense counsel to achieve the best result in an efficient and costconscious manner consistent with the law firm’s ethical obligations. Thus, nothing contained herein is intended to nor shall restrict or otherwise interfere with any ethical directive governing the conduct of counsel.
Athens Administrators intends to utilize consistent processes to facilitate prompt and appropriate responses to all cases. Identifying obstacles early and moving matters to resolution is our primary objective. We expect that counsel will work together with our claims professionals to define what a successful resolution is for each specific matter and to work efficiently to reach that resolution.
We believe that our Guidelines and Rules are relatively simple and straightforward. However, should you have any question on any part of the Guidelines or Rules, please feel free to consult with Sunny White, Athens Administrators Division Manager.
Litigation Guidelines
Representation and Billing
#8..
- 560 -
4/28/2021 Page 2
Guidelines on Legal Representation
Initial Referral
Cases will be referred by the claims examiner with a letter explaining the referral, any pleadings and pertinent file material, and their views on resolution of disputes in the claim. The letter is intended to explain the basis for the referral and outline of disputes.
• Case Acknowledgement: Within five business days after assignment of a new case, counsel should acknowledge receipt of the assignment by e-mail. Counsel should also address any matters of immediate concern and/or information that may result in early resolution of the case.
Counsel should take the necessary steps to preserve our position on disputed issues. Counsel should review the claim materials and provide an initial file review.
• Initial File Review and Budget: Within ten business days after receipt of the claims file, counsel should provide a comprehensive review to include coverage and liability, medical outlook, further handling recommended by Athens, and further handling recommended for counsel. This review should include the disputed issues to be resolved, any issues of law, most realistic outcome for each disputed issue, key opportunities for resolving all disputed issues, and legal services that will pursue resolution of disputed issue. The budget should include all activity reasonably anticipated to achieve final resolution of the claim.
Conflicts of Interests: At counsel’s expense, counsel is also required to complete a conflict of interest review immediately upon receipt of the assignment. Counsel is required to affirmatively confirm that no conflicts exist and that the firm is able to handle the matter. Counsel must continue to review conflicts throughout the representation. Any conflict identified is to be reported immediately via phone and e-mail to the claims examiner and claims supervisor. Requests for a waiver must be via e-mail and must contain a clear description of the conflict, scope of the contemplated representation and scope of the waiver. All waivers for conflicts of interests must be approved by the claims supervisor prior to beginning substantive work on the assigned matter.
Philosophy of Staffing
A file should be assigned to a dedicated attorney, rather than the law firm. The attorney to whom the file is assigned should be the person who communicates with Athens Administrators, who attends depositions, hearings and pre-trial conferences, and who tries the case. In essence, Athens Administrators requires that attorney be responsible for the entire case until the case is closed or until a mutual decision is made to involve other counsel. Reassignment within the firm is not allowed without advance written approval of Athens and XXXX.
Law firm will provide a dedicated attorney list/spreadsheet to Athens Administrators quarterly along with the quarterly legal report.
Use of Associates & Paralegals: Wherever possible, lower billing personnel (such as associates and paralegals) should be used to promote efficiency and cost effectiveness. As such, a partner should not perform work more appropriately assigned to a lower billing associate and neither a partner nor an associate attorney should perform work more appropriately assigned to a paralegal. Similarly, a paralegal should not be assigned secretarial or other clerical tasks. This tracks with an attorney’s ethical duty and settled case law on using lower billing or even non-billing personnel whenever possible to do so.
As Athens Administrators must approve the use of billing staff in advance, please let the claims examiner know which associate or paralegal may be used to assist the attorney assigned a case and why it would be beneficial to use the associate or paralegal. Please note that if certain associates or paralegals are approved to do work in the files, it is expected that they will continue to work on the case as needed throughout the life of the case. Therefore, their work should not be reassigned to other associates or paralegals in the firm except for reasons beyond the #8..
- 561 -
4/28/2021 Page 3
firm's control. In this regard, please note that work reassignments necessitated by vacation schedules or the need for approved staff to work on other client files would not be considered beyond the firm’s control.
Use of Administrative/Clerical Support: Work which can be performed by administrative assistants or support staff are overhead firm expenses and should not be billed to Athens Administrators. Examples of administrative and clerical work include, but are not limited to,
• Receiving and distributing mail,
• New file set up or closing file activities,
• Maintenance of office and attorney calendars and schedules, • Transcribing, copying, Bates-stamping, posting, faxing, emailing copies of documents, and inserting documentsinto the file,
• Retrieving documents from a file,
• Communicating with vendors including copy services, subpoena services, interpreters, or court reporters,
• Communicating with court clerks, medical offices, or other law offices for the purpose of scheduling, • Checking an electronic or court database or calling court clerk to check on status of a matter, • Routine recurrent tasks otherwise considered as overhead such as: processing bills, word processing and faxing,
• File assembly, organization or maintenance activities, • Updating lists, and
• Preparing acknowledgement letters or cover letters which contain no substantive information including letters to court clerks with documents for filing.
Planning & Budgeting
Athens Administrators places great emphasis on the planning process and believes it is vital to ensure a highquality, cost-effective legal defense in each and every file. A sound legal defense is the objective of counsel and Athens Administrators and should be developed in a timely manner.
Case Work Plan: Once an objective has been established for the file, counsel must draft a case work plan to meet the objective along with a case budget. This litigation work plan and case budget should be completed within 10 business days of the assignment. The case work plan contains key work tasks that counsel and the claims examiner agree best meet the goal of successfully resolving the matter according to the agreed to objective. See Appendix for a sample Case Work Plan/Case Budget Worksheet form to be used as a guide in preparing the case work plan.
Please note that it is important the case work plan include specific dates when certain tasks are to be completed.
The case work plan should also include key report dates as required by the claims examiner. The case work plan should consider reasonable contingencies and be updated or changed as information is developed or subsequent circumstances dictate. When changes in the case work plan need to be made, counsel will need to make sure the claims examiner is involved and agrees to the changes.
As part of the referral, a case budget is to be established on each matter consistent with the litigation work plan.
The budget should reflect when the anticipated expenses for various stages of the litigation process will occur.
The case budget should track with the case work plan prepared. Please see the Case Budget portion of the Case Work Plan in the Appendix and use it as a guide in developing a case budget plan for your assignment.
Negotiation: Athens Administrators seeks a successful resolution of all contested matters. When an opportunity for counsel to negotiate presents itself, counsel should contact Athens Administrators at once and obtain settlement authority from the claims examiner before beginning negotiations. Athens Administrators also welcomes Counsel’s ideas and insights on how negotiations might successfully resolve the assigned matter.
Settlement documents and any additional language increasing exposure for the District require Athens #8..
- 562 -
4/28/2021 Page 4
Administrators oversight and approval. This includes negotiations to mitigate liens and any release of third party liability for subrogation, co-defendants, contribution and apportionment.
Penalties: Counsel should immediately advise the claims examiner when counsel is aware of any exposure to penalties. Counselshould also provide recommendations to the claims examiner regarding resolution of any penalty issue. Counsel must obtain authorization from the claims examiner to resolve any penalty. Authority to resolve a penalty may only be issued by the claim supervisor. It is the responsibility of the claims examiner to obtain authority from claims supervisor before issuing authority to counsel. Counsel must confirm with the claims examiner that the claims supervisor has agreed with the authority issued prior to extending any offers or resolving any penalty. Authorization to try a penalty must come from the claims supervisor directly.
Communications
Unless otherwise directed, all communications including reporting should be sent to the claims examiner, claims supervisor, XXXX and the WC claims consultant. All correspondence should include a caption with the name of the claimant and claim number(s), along with document type label. As to attachments, the document type label is to be clearly listed on the documents first page.
Initial Report: Counsel’s initial report should be provided as a part of the case work plan which is due 10 business days from the receipt of the file. In providing the required information, counsel should not include lengthy recaps of what is already in the Athens Administrators file in counsel’sinitial report.
Interim Status Reports: Athens Administrators discourages “rote reporting” every 30 or 60 days. It is expected that subsequent planning conversations will be event driven rather than time driven. These should be conducted upon occurrence of any event that may significantly impact liability, damages or the budget, with revised plans of action submitted to the claims examiner. Counsel is expected to keep the claims examiner informed on essential items as the assigned matter progresses. In the event that there has not been any progress within 90 days, an e-mail to the claims examiner should be sent stating that there has not been any change in the status since the last report and what, if anything, can be done to move the matter along. Interim status reports should cover only the activity since the previous report. Normally, interim status reports should be driven by events (e.g., a hearing) and should be set out in the case work plan. Reporting on routine information (e.g., acknowledgement of service) should be done in the next interim status report.
Significant Development Report: Counsel should communicate and apprise Athens Administrators of significant developments within 48 hours or as soon as practical. If applicable, the report should include counsel’s opinion on whether the case work plan or the case budget should be changed due to the significant development.
Calendars and Caseload Report
Counsel should provide their monthly calendars to the claims supervisor, XXXX and WC claims consultant every 1st of the month. Counsel should provide their quarterly caseload reports to Athens Administrators within the first week of the ending quarter.
Litigation Review
Litigated claim reviews are scheduled quarterly. Defense counsel will prepare a proper report of the claim file to include demographics, current matters on calendar, case summary, outstanding issues/liens, exposure/settlement potential, and recommendations to conclude matter, estimated legal fees, and additional comments. Defense counsel will attend claim reviews in person to present the claim file and litigation strategy. Reports are due 14 days #8..
- 563 -
4/28/2021 Page 5
prior to the claim review. Counsel should provide follow-up plan of actions 30 days after every litigation review to Athens Administrators claims supervisor.
Requests
Upon receipt of requests from XXXX and Athens Administrators, counsel shall send acknowledgement within 24 hours and provide a timeframe to produce the information requested. Counsel should copy the claims examiner on all correspondence directed to anyone other than the examiner.
Discovery
Athens Administrators has found that the majority of defended cases are resolved without the necessity of trial. Consequently, it is generally preferable to target discovery to only that which will enhance the client’s position or enable a better job of evaluating and settling the case early on without the necessity of preparing for a trial.
Also, some cases have claim files that are quite developed. In such cases, Athens Administrators may require little, if anything else, to be able to evaluate the claim and negotiate a settlement. Thus, counsel’s assistance may simply be required to protect the answer date and advise Athens Administrators on due dates or to obtain certain information via the discovery process.
Interrogatories, Requests for Admission: Athens Administrators normally requires unsummarized copies of information received through interrogatories and requests for admission. If there is a need to call something to the attention of the claims examiner, it should be briefly stated in an e-mail. Entire documents should not be summarized unless asked to do so.
Depositions, Independent Medical Exams: Depositions must be conducted with a specific goal and defense theory in mind. Aimless or misdirected depositions are unacceptable. Even though they are provided for in the case work plan, counsel must check with the claims examiner before actually scheduling or taking depositions or requesting an IME for the injured party. The necessity of each deposition and IME must be considered in light of the status of negotiations, exposure, and probable outcome.
Ordinarily, counsel’s notes taken at depositions and mental impressions of the witnesses will suffice for reporting and evaluation purposes and are expected to be submitted within 7 days following the deposition. When a verbatim summary of a deposition is prepared, Athens Administrators views this as a task that a competent paralegal can complete.
Counselshould discuss potentialsettlement opportunities with the claims examiner 14 days prior to all depositions.
The claims examiner will need 14 day notice to prepare settlement authority request prior to deposition.
Settlement of claim at deposition is a desired outcome.
Pleadings, Motions, & Research
Transmittal of Pleadings & Other Documents: Counsel should provide to Athens Administrators copies of pleadings, including amended pleadings and motions, or deposition transcripts. Counsel shall send copies of all settlement demands. When transmitting requested pleadings and other documents to Athens Administrators, counsel should do so with just a simple no substantive cover letter or e-mail from counsel’s legal assistant which merely identifies the documents. There is no need to dictate a substantive cover letter unless a significant development has occurred in the interim that should be brought to the attention of Athens Administrators. It is not necessary to summarize the pleadings. If Athens Administrators has questions about the pleadings or documents, the claims examiner will contact counsel.
Motions: Counsel should consult with the claims examiner before filing any motions not previously identified and #8..
- 564 -
4/28/2021 Page 6
approved in the initial case work plan or any supplements thereto.
Research: Counsel should consult with and get approval from Athens Administrators before undertaking a legal research project that will take one hour or more to complete. Copies of all research memoranda shall be provided to Athens Administrators upon request.
Experts & Outside Investigators; Site Inspections; Outsourcing Athens Administrators policy is to use its claims examiner to investigate claims. Athens Administrators only uses outside investigators under unusual circumstances, and then such use requires advance approval. The use of surveillance and sub rosa investigations also requires advance approval from Athens Administrators.
Occasionally, a consulting engineer, independent medical examiner, or other expert is required for a good defense. Athens Administrators appreciates counsel’s recommendations and welcomes referrals to experts counsel has used successfully. Athens Administrators must authorize experts before counsel employs them. Prior to their retention, all experts and investigators need to submit budgets for approval to the claims examiner.
Pre-approval isrequired for all site inspections. Also, outsourcing of legal work without prior approval from Athens Administrators will not be permitted or reimbursed.
Hearing/Trials
Authority to proceed to trial must be secured from XXXX’s WC Consultant. A legal analysis of the issues should be sent to the claims examiner, claims supervisor, XXXX, and claims consultant. No later than 15 days prior to the expected start date of a hearing or trial, Athens Administrators requires that counselsubmit a pre-trial report.
Counsel should notify the claims examiner of a settlement conference, court appearance, trial or hearing as soon as the date is set. Counsel should contact the claims examiner in advance of the court date to discuss issues to be addressed, review pertinent discovery, obtain authority and discuss anticipated outcome. Within one business day of a settlement conference, award issuance, or qualifying order, counsel will provide communication to claims examiner, and in all other instances within three business days. The reporting should include: events of the hearing and their impact on the case, a summary of any testimony presented and its impact on the case, counsel’s impression of any witnesses, evidence submitted, issues addressed, outcome and recommendation for further handling. During any workers’ compensation trial, counsel must communicate with the claims examiner at least once during each trial day, and provide a recap at the end of each trial via email.
Settlements and Awards
Counsel should communicate all awards, settlements, findings, minutes of hearing, and orders within 24 hours to the claims examiner, claims supervisor, XXXX and WC claims consultant. The email communication should include that there is an order, award or stipulation to pay attached along with the amount due, supporting calculation, the date the payment is due, the tax I.D. and mailing address of the payee (when applicable), beginning and ending dates of the period covered (when applicable). Recommendations for appeal, exposure and likelihood of success on appeal should be included when applicable. #8..
- 565 -
4/28/2021 Page 7
Billing Rules
Billing Review Standards
Athens Administrators has taken care to see that all of the substantive Billing Rules mirror counsel’s ethical duties pursuant to the applicable professional conduct rules and settled case law.
Expectations of Counsel in Charge
Athens Administrators will construe each billing statement for fees and costs as a representation by the counsel in charge of the assigned that the counsel has reviewed the billing statement and has determined it accurately reflects work and expenses reasonably and necessarily incurred; the statement directly relates to the matter listed; and the fees and chargesreflected in the statement comply with Athens Administrators Rules.
Counsel’s Retention of Documents
Counsel shall maintain for review by Athens Administrators any documentation, receipts, etc. in support of all disbursements for 2 years after the file was closed by the law firm. Original time sheets for any Athens Administrators files should be retained for at least 2 years after the final closure of the file by the counsel or firm.
Billing records should be maintained and available to permit a determination of total hours billed per individual on any given day. Any billing information contained in the original time sheets relating to a non-Athens Administrators matter (including the names of other clients and any billing entries for work performed on those other matters) may be redacted. However, the time billed on non-Athens Administrators matters should not be redacted.
Athens Administrators Right of Review and Audit
Billing to Athens Administrators must be supported by the underlying work product in the file. A copy of all such work product will be made available to Athens Administrators upon request. We reserve the right to review all charges for services and disbursements pertaining to the matter.
A copy of file work product will also be made available to any auditor retained by Athens Administrators for the purposes of a file audit. It will be at the discretion of Athens Administrators whether your legal bills will be audited periodically or on a monthly basis, by an auditing firm.
Payment of legal bills and expenses on a file does not constitute a waiver of our right to request reimbursement resulting from an evaluation or audit of your firm’s bills. Athens Administrators reserves all rights to decline to pay or to seek reductions and/or refunds with respect to charges that fail to comply with the Guidelines and Rules as set forth herein and which are not fully explained or documented by the firm after reasonable inquiry. Athens Administrators shall allow the law firm to appeal any declination of payment. Athens Administrators agrees to pay the undisputed portion of bills received from counsel within 30 days.
Arbitration
In the event of a dispute between retained defense counsel and Athens Administrators as to accuracy, reasonableness, or necessity of any charge for fees or costs, the dispute should be amicably and promptly resolved through discussions directly between defense counsel and Athens Administrators. If a dispute cannot be resolved by such discussions, the parties agree that the dispute shall be submitted to binding arbitration. The parties shall mutually select a single neutral arbitrator, or, if they are unable to agree, each party shall appoint one arbitrator and the two arbitrators shall, in turn, appoint a third, impartial arbitrator. No matter how the arbitrator(s) is/are chosen, the arbitrator(s) must have experience in arbitrating fee bill dispute claims. The decision of the arbitrator(s) shall be final and binding with no right of appeal. The cost of the arbitration shall be borne by the losing party or in such proportions as the arbitrator(s) may decide.
Billing for Professional Fees
Agreed Hourly Rates: Athens Administrators will pay fees at the agreed hourly rates for professional services (i.e., only those services that require the skill or the acumen of an attorney) by approved attorneys. Athens #8..
- 566 -
4/28/2021 Page 8
Administrators will also pay the fees of paralegals who are performing professional services that would normally be performed by an attorney in the absence of a paralegal. The agreed upon rates in effect at the commencement of the matter will remain the same to the conclusion of the file, unless Athens Administrators agrees in writing to a change. All requests for a change in fees shall be directed to the Athens Administrators claim supervisor.
Fees for Travel Time: Athens Administrators agrees to pay 50% of the billing rate for all approved travel time outside counsel’s local area. Counsel’s local area is defined as any travel within 25 miles (one way) of counsel’s office.
Fees and expenses for travel within a 25 mile radius of counsel’s office will not be paid.
Fees for Research: Athens Administrators will not pay for legal research considered to be routine or elementary including research on issues considered to be common knowledge among reasonably experienced counsel in the counsel’s local area. Athens Administrators also expects counsel to utilize previously prepared research whenever possible. Although Athens Administrators will not pay for research (or any other work) previously prepared for other matters, Athens Administrators will pay for that portion of the research that updatesthe work product.
Where research is appropriate in an assigned matter, counsel should consult with and obtain the approval of Athens Administrators before undertaking a legal research project requiring over one hour of research time. When billing for research time of one hour or more, please note in the billing entry the name of the claims examiner who authorized the research project. Copies of all research memoranda shall be provided to Athens Administrators upon request. Athens Administrators will not pay the costs for Lexis, Westlaw or other electronic or computer assisted research.
Reviewing & Summarizing Medical Records: It is expected that the initial review and summary of all medical services records from providers such as hospitals, physicians, therapists, pharmacies, etc. will be done by a competent paralegal. Where an attorney does the initial review and summary of medical records, the attorney billing rate will be reduced to a paralegal billing rate. Counsel should consult with and get approval from Athens Administrators before undertaking a legal research project that will take one hour or more to complete. Copies of all research memoranda shall be provided to Athens Administrators upon request.
In billing for review and summary of medical records from providers, the billing entry should include the following information: the name of each provider, a description of each provider’s records reviewed, the number of records (including pages) reviewed, and the time for the review of each provider’s records. Billing entries lacking this information will be considered as lacking “adequate descriptions.” Also, it is recognized that multiple copies of the same medical records may be produced through different sources including through the claimant (either informally or through formal discovery), the claimant’s attorney, or the medical services provider by way of third party discovery. When copies of the same records are provided, Athens Administrators will only pay for the summary of one set of the medical records and will not pay for multiple summaries of the same medical records.
Task Itemization and Charges: All billing entries shall be based on the actual time taken to complete a function/task by counsel or the paralegal performing the task or function. With hourly fee billing, only time charges in increments of .1 of an hour will be permitted. Where Athens Administrators detects that a counsel is engaging in form or pattern billing (e.g., charging a minimum amount of time for all task or for specific tasks such as phone calls, letters, etc.), Athens Administrators reservesthe right to reject all such charges and reassign its files.
The time charge for a service that takes less than .1 of an hour will be zero or no charge (NC). A task such as a telephone call that is 3 minutes or more may be rounded up to .1 of an hour (or 6 minutes), while a legal task that takes less than 3 minutes such as listening to or leaving a telephone message (LMTCB) or reviewing a file marked copy of a document filed by counsel should be rounded down to zero or no charge. Time billed in excess of .1 hour (or 6 minutes) can similarly be billed by rounding up or down to the nearest higher or lower increment.
Block Billing: “Block billing” (grouping multiple activities under a single time charge greater than .1 hour) is #8..
- 567 -
4/28/2021 Page 9
prohibited. The only exception would be where a series of small related tasks (e.g., reviewing a short letter from opposing counsel, drafting a reply, and then e-mailing the claims examiner about the letter or reviewing several short documents), each taking less than .1 of an hour to perform, are grouped together in order to be able to bill .1 of an hour. Block billed entries in a bill will not be paid.
Adequate Descriptions: All billing entries for professional services must include an adequate description of the legal task or service performed as it is impossible for Athens Administrators to determine the reasonableness of the fee or the task unless the task is adequately described. This requirement mirrors an attorney’s ethical duty to adequately describe tasks in their legal bills. See Statement of Principles, ABA Lawyer Task Force on Lawyer Business Ethics (1996) (“Each invoice should clearly identify the legal services provided in such specificity as the client requests.").
Below are examples of “incorrect” and "correct" descriptions of a billed for service:
Example: Incorrect: Letter to counsel.
Correct: Letter to opposing counselsetting out proposed terms of settlement.
Similarly, such entries as “reviewed documents” or “attention to file” would be considered vague and inadequate descriptions without an explanation of what documents were reviewed (and their relevance to the matter if not readily apparent) or what specifically was done in providing “attention to the file” (and its relevance to advancing the file if not readily apparent). Inadequately described entries in bills will not be paid.
Non-Reimbursable Fees
Athens Administrators will not pay as reasonable, fees billed by attorneys or paralegals for the following:
Billing individual fees and chargesfor documents(e.g., notices orsubpoenas) prepared for multiple parties when only one document is prepared.
More than .1 hour for preparing pre-printed or computer generated forms, documents, letters, pleadings, notices, discovery, settlement agreements, etc., where only basic information (e.g., names, addresses, court information, amounts,and dates) is added. More than .1 hour for preparing all documents necessary to request one set of medical records from an employer, hospital, doctor, pharmacy, etc.
Trial or hearing preparation work including preparation of arguments, trial notebooks, exhibits, etc. when a hearing or trial is not imminent.
Initial summaries of medical records by attorneys, unless billed at paralegal rates. Work that could have been performed by Athens Administrators personnel unless approved in advance by Athens Administrators.
Time billed to perform a task that takes less than .1 hour to complete such as time billed to listen to a recorded phone message or time billed to leave a recorded phone message or draft a brief cover letter or e-mail.
Excessive time to revise or edit documents or multiple reviews of the same documents by one attorney or a review of the same document by multiple attorneys. Fees resulting from inappropriate staffing (e.g., partners performing research, associates drafting chronologies, and paralegals performing tasks that non-billing legal secretaries/clerks can do).
Intra-office conferences unless preauthorized.
Time spent on supervision including providing instructions to staff or receiving reports on assigned work. Attendance by more than one attorney at any deposition, conference, trial or other hearing without prior approval from the claims examiner.
Any file review or any work done when the file is transferred to a new attorney. Research in excess of one hour, unless previously authorized by Athens Administrators. #8..
- 568 -
4/28/2021 Page 10
Comprehensive file reviews other than by the primary attorney. Charges for preparation of bills and/or negotiation of disputes or overbills. Administrative services including secretarial and clerical functions. Fees to check or resolve conflicts.
Fees for filing documents with a court or administrative tribunal. Work performed by employees other than approved attorneys and paralegals. Extraneous fees incurred on a case after the date of settlement. Attorney or paralegal time spent on preparation of budget or on invoice and audit preparation and responding to billing inquiries.
Staff overtime charges.
File opening and/or closing charges.
Fees for out of state travel that has not been pre-approved. Fees that cannot be substantiated by attorney daily record slips or timesheets.
Billing for Costsand Expenses
Reimbursement Policy: Subject to the policies and procedures set out infra, Athens Administrators will reimburse counsel for all reasonable and necessary expenses incurred in handling the assigned matter at the actual net cost to counsel or the law firm. Copies of receipts in support of all billed for costs and expenses should be submitted by counsel to Athens Administrators. Counsel should pay individual invoices under $500 and include any disbursement (with receipt) on the firm’s next invoice. Individual invoices over $500 may be sent to Athens Administrators for payment.
Legal Costs: Counsel is requested to send Athens Administrators any invoice for payment of approved legal costs (e.g., expert witness fees, court reporters) for direct payment by Athens Administrators. Where counsel pays an approved legal cost, a copy of any paid invoice for which reimbursement is sought from Athens Administrators must be included with the legal bill.
No Mark-ups or Surcharges: Unless approved by Athens Administrators in advance, Athens Administrators will only pay for the actual net cost (after deducting for any discount) to counsel or the law firm of the billed for cost or expense. Examples: if counsel uses a “temporary” lawyer or paralegal to do approved work on the assigned matter, Athens Administrators expects to be billed on an hourly basis based upon the actual hourly costs for the temporary employee as billed to counsel; if a copy service or court reporter provides counsel a discount or reduced rate, such discount or reduction will be passed along to Athens Administrators. In-house photo-copying will be reimbursed at 10 cents a page. Number of pages and the documents to which the copies apply must be included on the invoice.
Travel: Athens Administrators will reimburse counsel for necessary and reasonable travel expenses outside counsel’s local area (i.e., over 25 miles one way). Athens Administrators will not pay for any out of area travel expenses including meals/airfare/hotel charges unless pre-approved by Athens Administrators. Out of area overnight or day travel should be at the lowest available fare booked 14 days or more in advance, unless notice is not received within this time frame. It is expected that counsel will seek the best rates for air travel, hotel, car rental and meals. Entertainment, dry cleaning or other non-essential charges will not be reimbursed.
Receipts must be submitted to Athens Administrators for all travel expenses. Luxury (first class) travel and accommodations are not reimbursable as reasonably incurred expenses.
The following below outlines Athens Administrators policies regarding reimbursable travel expenses:
Air Travel: Coach Fare
Ground Transportation: Taxi’s and ride sharing services (such as Uber and Lyft) are preferable over rental car, unless rental car will result in cost savings Rental Car: Intermediate Size Car
#8..
- 569 -
4/28/2021 Page 1
Lodging: Reasonable business accommodation. No additional charges for hotel amenities such as in-room movies, in-room bar charges, dry cleaning, or fitness clubs
Meals/Beverages: Reasonable meal cost. No reimbursement for alcoholic beverages.
Express Mail and Messenger Services: Athens Administrators will not pay for express mail, overnight delivery, outside courier or messenger service unless Athens Administrators requests it, or as the result of an emergency not of the law firm's making. If these items are billed, an explanation must be provided.
Pre-Approved Costs and Expenses
Pre-approval is required on the following disbursements in order to be considered for reimbursement:
Consultants,
Expert Witnesses (including IME’s),
Surveillance’
Imaging,
Overnight travel,
Volume photocopy charges (in excess of 100 pages).
Non-Reimbursable Costs and Expenses
Athens Administrators will not pay as reasonable, costs billed for the following:
Mileage in excess of the current IRS rate for mileage reimbursement, Charges for facsimile transmissions other than the appropriate long distance charges for the transmission,
Normal (regular) postage,
Computerized research such as Westlaw or Lexis,
In-house messenger service to deliver/pick-up documents to other offices, courts, etc. Routine expenses otherwise considered as overhead such as: local telephone bills, word processing and faxing.
In-town (i.e., within 25 miles one-way or 50 mile radius) automobile rentals.
Billing Format
The billing format must include the following:
Heading - The first page of the bill must be prepared with entries stating:
Caption,
Law firm’s IRS number,
Name of the claimant,
Claim number,
Time period for which the bill applies.
Body - The bill must be prepared with entries showing:
Date the work was performed,
Initials of the person providing the service,
Description of the work performed (single activities), Actual time in 1/10th of an hour increments, and
Dollar cost of the work.
#8..
- 570 -
4/28/2021 Page 1
Example of line item entry to be used in legal bill:
Date ID DESCRIPTION TIME COST
2/10 JC Review of opposing counsel’s 1/30/16 demand letter. .2 $30 End of Bill Summary - Must include:
Full name of each timekeeper with initials used in legal bill, Level of each timekeeper (i.e., partner, associate, paralegal), Hourly rate for each timekeeper,
Total hours and total amount charged for each timekeeper during the billing period, Total billed to date on the file including current billing, Any paymentsreceived on the case, and
Balance due on the file.
When task coding is required by Athens Administrators, counsel should use the uniform billing codes as endorsed by the American Bar Association and the Association of Corporate Counsel.
Split Billings: When work can be performed for other clients while also performing work on the assigned Athens Administrators matter, Athens Administrators would expect only to be billed for a proportionate share of counsel’s time. Such situations commonly arise when making court appearances, when waiting for depositions or meetings, or in other circumstances where delays are common.
Any time split between more than one file, including work billed to other clients, or other carriers where joint defense agreements are established, either within the same matter or within the same series of matters should be split between the files at appropriate ratios. Any time split between files must state: total time split, numbers of files for which the time was billed; and time allotted to each file.
Cumulative Totals: Each legal billsubmitted for payment is to include a cumulative total of the amount billed to date on the case and also reflect the budget established for the case.
Billing Schedule: Unless other arrangements have been agreed to, counsel may submit bills to Athens Administrators on a 30 day basis via mail. Resolved cases must be final billed within 20 days of resolution #8..
- 571 -
4/28/2021 Page 1
APPENDIX
Case Work Plan/Case Budget Worksheet
• Case caption
• [Other identifying information such as name of claimant] • Claim or file number
Case Work Plan
TASKS TARGET DATE
(E.g., Visit the accident scene at store location;
photograph the sprinkler heads; provide photos to
building code expert for an opinion whether the
height of the sprinklers conformed to the Code or was
a de minimus variant.)
Visit & photograph by 1-07-
20;
Obtain expert opinion by 3-
30-20
(E.g., File a Notice of Deposition of claimant; Depose
Claimant.)
File Notice by 3-25-20;
Deposition by 4-25-20.
(Note: List of tasks can be expanded.)
Case Budget (Excluding trial expenses)
ITEM AMOUNT
Estimated length file will remain open: # months
Depositions $
Medical Records $
Mediation $
Travel $
Filing Fees $
Other
ESTIMATED TOTAL
$
$ 0.00
Notes:
#8..
- 572 -
#8..
- 573 -
LICENSE NUMBER: 2743958
Issue Date: 03-29-2007 Expiration Date: 05-31-2022
Independent Adjuster
ATHENS INSURANCE SERVICE, INC.
DBA: ATHENS INSURANCE ADMINISTRATORS
2552 STANWELL DRIVE
CONCORD, CA 94520
is authorized to transact business as described above
License No: 2743958 Issue Date: 03-29-2007 Expiration Date: 05-31-2022 Generated by Sircon 212340380
THIS IS TO CERTIFY THAT
ATHENS INSURANCE SERVICE, INC.
DBA: ATHENS INSURANCE ADMINISTRATORS
2552 STANWELL DRIVE, CONCORD, CA 94520
IS HEREBY AUTHORIZED TO TRANSACT BUSINESS
IN ACCORDANCE TO THE LICENSE DESCRIPTION
SHOWN BELOW:
Independent Adjuster
Generated by Sircon 212340380
#8..
- 574 -
#8..
- 575 -
Evaluation Criteria
Possible
Points
Athens
Admin.
Innovative
Claims
Intercare
Insurance
Pegasus
Risk
Manag.
Sedgwick
Claims
Manag.
Tristar
Insurance
References 15 14 11 12 15 7 11
Specific Requirements 35 34 27 31 28 28 29
Programs 15 14 13 13 11 12 11
Third-Party Administrator Questionnaire 15 14 12 13 11 11 11 Cost 20 17 20 16 17 16 16
TOTAL 100 92 83 85 81 73 79
Ranking (# according to score highest to lowest) 1 3 2 4 6 5 Workers' Compensation Claims Management Program
Scoring Abstract
Project No. 2021-44
4/27/2022
#8..
- 576 -
CITY OF MODESTO
COUNCIL AGENDA REPORT
DATE OF MEETING:
June 14, 2022
Date: May 18, 2022
TO: Mayor and City Council
THROUGH: Joseph P. Lopez, City Manager
FROM: Bill Sandhu, Director of Public Works
SUBJECT: Reject Bids for RFB No. 2122-23 for Building Intrusion Alarm Services CONTACT: Patrick Crowley, Facility Manager/ Building Administration, [email protected], 209-342-2274
DESCRIPTION:
Consider rejecting all bids received for Request for Bid No. 2122-23 for Building Intrusion Alarm Services, and authorizing staff, to re-evaluate and re-issue at a future date. (Funding Source:
Various Funds)
STRATEGIC PLAN ELEMENT:
This action supports the 2020-2025 City of Modesto Strategic Plan Area of Focus: Service Delivery Goals and Strategies; “build community trust in City government through responsive, transparent and efficient service delivery”; Goal H: “achieve long-term financial sustainability.” BACKGROUND:
The City of Modesto, Public Works Department, Building Services Division is responsible for maintaining facilities within the City of Modesto which includes the intrusion alarm systems within those facilities. There has not been a city-wide agreement for intrusion alarm system services which includes the detection of unauthorized entry, video/image coverage and thirdparty central office monitoring of these systems. On November 24, 2021, the Purchasing Division issued Request for Bids (RFB) No. 2122-23 for the Building Intrusion Alarm Services and posted the RFB on the City’s website and formally advertised as required by law. On December 28, 2021, bids were formally opened by the City Clerk’s office, where four companies chose to download the RFB documents, and submitted bids to the City.
DISCUSSION:
After reviewing the bids received, it was determined that staff needed to amend the original Scope of Services to ensure a more competitive process and eliminate ambiguity in the original scope. This determination was based on the significant price variances between vendors ($2,105 - $49,904). In addition, further amendments may be needed to the Pricing Schedule and Bidding Process.
#9..
- 577 -
City Council, June 14, 2022
Reject Bids for RFB No. 2021-75 for Building Intrusion Alarm Services
In accordance with Modesto Municipal Code Sec. 8-3.203, Formal Bid Procedures, the Council shall have the authority to accept or reject any or all bids. The rejection of all bids for the RFB No. 2122-23 for Building Intrusion Alarm Services conforms to Modesto Municipal Code 8-
3.203, subsection (e).
FISCAL IMPACT:
If Council approves the rejection of all proposals, there will be nominal additional costs of staff time to rebid the project. Funds for Building Intrusion Alarm Services have been budgeted in various funds and will be available when the revised Scope of Work has been completed.
COMMITTEE RECOMMENDATION:
This item was presented to the Finance Committee on May 23, 2022, and the Committee recommended forwarding to Council for approval.
RECOMMENDED COUNCIL ACTION:
Staff Recommendations:
Resolution considering rejecting all bids received for Request for Bid (RFB) No. 2122-23 for Building Intrusion Alarm Services and authorizing staff to re-evaluate and re-issue at a future date.
Approved by:
Bill Sandhu, Director of Public Works
Joseph P. Lopez, City Manager
Attachment:
1. Resolution
#9..
- 578 -
MODESTO CITY COUNCIL
RESOLUTION NO. 2022-XXX
RESOLUTION CONSIDER REJECTING ALL BIDS RECEIVED FOR
REQUEST FOR BID (RFB) NO. 2122-23 FOR BUILDING INTRUSION ALARM
SERVICES AND AUTHORIZING STAFF, TO RE-EVALUATE AND RE-ISSUE
AT A FUTURE DATE
WHEREAS, the City of Modesto, Public Works Department, Building Administration and Maintenance Division is responsible for maintaining facilities within the City of Modesto which includes the intrusion systems within those facilities; and WHEREAS, there has not been a city-wide agreement for intrusion system services which includes the detection of unauthorized entry, video/image coverage and third-party central office monitoring of these system; and WHEREAS, on November 24, 2021, the Purchasing Division issued Request for Bid (RFB) No. 2122-23 for the Building Intrusion Alarm Services, and posted the RFB on the City’s website and formally advertised as required by law; and WHEREAS, on December 28, 2021, bids were formally opened by the City Clerk’s office; and
WHEREAS, four companies chose to download the RFB documents; and WHEREAS, after reviewing the bids received, it was determined that staff needed to amend the original Scope of Services to ensure a more competitive process and eliminate ambiguity in the original scope. This determination was based on the significant price variances between vendors ($2,105 - $49,904); and WHEREAS, staff will work with the Finance Department to amend the Scope of Services to better define the project, and Purchasing will work on updating the bid process.
#9..
- 579 -
NOW, THEREFORE, BE IT RESOLVED, by the Council of the City of Modesto that it hereby consider rejects all bids received for RFB No. 2122-23 for Building Intrusion Alarm Services.
BE IT FURTHER RESOLVED, that staff, is hereby authorized to re-evaluate and re-issue the RFB at a future date.
The foregoing resolution was introduced at a regular meeting of the Council of the City of Modesto held on the 14th day of June, 2022, by Councilmember __________, who moved its adoption, which motion being duly seconded by Councilmember ________, was upon roll call carried and the resolution adopted by the following vote:
AYES: Councilmembers:
NOES: Councilmembers:
ABSENT: Councilmembers:
ATTEST: _____________________________
DIANE NAYARES-PEREZ, City Clerk
(SEAL)
APPROVED AS TO FORM:
BY: __________________________________
JOSE M. SANCHEZ, City Attorney
#9..
- 580 -
CITY OF MODESTO
COUNCIL AGENDA REPORT
DATE OF MEETING:
June 14, 2022
May 23, 2022
TO: Mayor and City Council
THROUGH: Joseph P. Lopez, City Manager
FROM: William Wong, Director of Utilities
SUBJECT: Third Amendment to the Agreement with e-Builder, Inc.
Construction Management Software
CONTACT: Robert Davalos, Acting Engineering Division Manager [email protected], (209) 571-5869
DESCRIPTION:
Consider approving a Third Amendment to the Agreement with e-Builder, Inc., Plantation, FL, for a one-year extension for Construction Management Software in an amount not to exceed $79,013 for System Maintenance, Support and Licensing. (Funding Source: Capital Improvement Support Fund)
STRATEGIC PLAN ELEMENT:
The recommended action supports the 2020-2025 City of Modesto Strategic Plan Initiatives, Goal D: Provide safe, efficient, and reliable infrastructure through proactive community investment, maintenance, and sustainability efforts.
BACKGROUND:
The Construction Administration group in the Utilities Department provides inspection, management and administration of the majority of the City’s capital improvement program (CIP) projects and their respective construction contracts. Additionally, this group provides inspection and invoicing for encroachment permits.
The City’s standard documentation procedure for these projects consisted of one comprehensive, paper file structure as the official file for archiving and federal auditing purposes. All of the documenting, processes and tracking of these contracts utilized various unlinked databases, Word and Excel documents, that were then printed and filed. Official correspondence between City staff and contractors was by fax or mail.
While these practices were used to facilitate successful completion of projects in the past, it is inefficient and more cost-prohibitive due to electronic file documentation and storage technology advancements.
#10..
- 581 -
City Council, June 14, 2022
Third Amendment to the Agreement with e-Builder, Inc.
Construction Management Software
On April 5, 2016, by Resolution 2016-136, Council approved an agreement with e-Builder, Inc., Plantation, FL, for the purchase and implementation of the e-Builder software as a solution to the City’s need to digitally manage, track, and report on various CIP projects for the City.
On February 13, 2018, by Resolution 2018-77, Council approved a first amendment to the agreement with e-Builder, Inc., Plantation, FL, for the purchase and installation of a “Portfolio Level Funding” Cost Module to the City's construction management software.
On June 22, 2021, by Resolution 2021-228, Council approved a second amendment to the agreement with e-Builder, Inc., Plantation, FL, for a one-year extension for construction management software.
DISCUSSION:
The term of the second amendment is set to expire on June 30, 2022. While e-Builder has presented certain efficiencies, technology has changed over the last five years and new systems have become available that may provide similar services at a lower cost. During the past year, staff has started to explore other electronic construction management systems. Staff is currently testing another system on two projects Staff is therefore requesting a one-year extension option to allow continued use of the software system, while working with Finance and Information Technology Departments to explore a new procurement effort to evaluate e-Builder and other potential construction management software systems that will best meet the City’s needs.
FISCAL IMPACT:
The original agreement included a 5-year contract period with an estimated total cost of $559,628, which included initial implementation, training and annual system maintenance support and licensing.
Staff is requesting Council approval of a third amendment in the amount of $79,013 that would cover the period of July 1, 2022 to June 30, 2023.
Construction Administration has budgeted sufficient funds in Fiscal Year 2022-23 to cover the cost associated with the second one-year extension option in the following operating account:
1300-42020-52170 - PC Software and Supplies
ANTICIPATED EXPENDITURES:
Original Agreement $559,628
First Amendment $11,550
Second Amendment $94,250
Third Amendment $79,013
TOTAL $744,441
COMMITTEE RECOMMENDATION:
No Committee action has been taken on this item.
#10..
- 582 -
City Council, June 14, 2022
Third Amendment to the Agreement with e-Builder, Inc.
Construction Management Software
RECOMMENDED COUNCIL ACTION:
Staff Recommendations:
Resolution approving a Third Amendment to the Agreement with e-Builder, Inc., Plantation, FL, for a one-year extension for Construction Management Software in an amount not to exceed $79,013 for System Maintenance, Support and Licensing, and authorizing the City Manager, or his designee, to execute the Amendment.
Approved by:
William Wong, Director of Utilities
Joseph P. Lopez, City Manager
Attachments:
1. Resolution
2. eBuilder - Agreement
3. eBuilder - First Amendment
4. eBuilder - Second Amendment
5. eBuilder - Third Amendment
#10..
- 583 -
1 2022-
MODESTO CITY COUNCIL
RESOLUTION NO. 2022-XX
RESOLUTION APPROVING A THIRD AMENDMENT TO THE AGREEMENT WITH E-BUILDER, INC., PLANTATION, FL, FOR A ONE-YEAR EXTENSION
FOR CONSTRUCTION MANAGEMENT SOFTWARE IN AN AMOUNT NOT TO EXCEED $79,013 FOR SYSTEM MAINTENANCE, SUPPORT AND LICENSING,
AND AUTHORIZING THE CITY MANAGER, OR HIS DESIGNEE, TO EXECUTE
THE AMENDMENT
WHEREAS, the City of Modesto has the need for e-Builder software as a solution to the City’s requirement to digitally manage, track and report on various Capital Improvement Projects; and
WHEREAS, prior to e-Builder, the City’s standard documentation management system consisted of one comprehensive paper file structure as the official file for archiving and audit purposes, and
WHEREAS, on April 5, 2016, by Resolution 2016-136, Council approved an agreement for $559,682 with e-Builder, Inc., Plantation, FL, to purchase and implement e-Builder software; and
WHEREAS, on February 13, 2018, by Resolution 2018-77, Council approved an amendment to the agreement with e-Builder, Inc., Plantation, FL, for the purchase and installation of a “Portfolio Level Funding” Cost Module to the City's construction management software; and
WHEREAS, on June 22, 2021, by Resolution 2021-228, Council approved a second amendment to the agreement with e-Builder, Inc., Plantation, FL, for a one-year extension option for construction management software; and WHEREAS, the term of the second amendment is set to expire on June 30 of 2022 and Staff is therefore requesting a one-year extension option to allow for continued #10..
- 584 -
2 2022-
use of the construction management software system, while a new procurement effort can be conducted to evaluate e-Builder and other potential construction management software systems.
NOW, THEREFORE, BE IT RESOLVED by the Council of the City of Modesto that it hereby approves a third amendment to the agreement with e-Builder, Inc., Plantation, FL, in the amount of $79,013, for a one-year extension option for construction management software.
BE IT FURTHER RESOLVED that the City Manager, or his designee, is hereby authorized to execute the amendment in a form approved by the City Attorney.
The foregoing resolution was introduced at a regular meeting of the Council of the City of Modesto held on the 14th day of June 2022, by Councilmember ?, who moved its adoption, which motion being duly seconded by Councilmember ?, was upon roll call carried and the resolution adopted by the following vote:
AYES: Councilmembers:
NOES: Councilmembers:
ABSENT: Councilmembers:
ATTEST:
DIANE NAYARES-PEREZ, City Clerk
(SEAL)
APPROVED AS TO FORM:
By: _______________________________________
JOSE M. SANCHEZ, City Attorney
#10..
- 585 -
#10..
- 586 -
#10..
- 587 -
#10..
- 588 -
#10..
- 589 -
#10..
- 590 -
#10..
- 591 -
#10..
- 592 -
#10..
- 593 -
#10..
- 594 -
#10..
- 595 -
#10..
- 596 -
#10..
- 597 -
#10..
- 598 -
E-BUILDER
Work Order
THIS ADDENDUM dated: April 21, 2022
BETWEEN:
e-BUILDER, INC.
("e-Builder")
– and –
City of Modesto, CA
(“Customer”)
WHEREAS, Customer wishes to amend their Agreement with e-Builder, Inc. dated 4/5/2016 to amend the Products described below. The terms of the Agreement apply to this Work Order unless otherwise stated below. In the event there is a conflict between the terms and conditions of any Associated Customer Purchase Order (PO) and this Work Order, the terms of this Work Order will take precedence.
DESCRIPTION OF PRODUCTS
License Renewal: Customer will renew their existing unlimited e-Builder Enterprise licenses subscription at a cost of $79,012.50 based on an “Average Annual Capital Spend” of up to $35 million. “Annual Capital Spend” are the expenses incurred to demolish, plan, design, build, repair, remodel and furnish a building or site over a period of one year. The “Average Annual Capital Spend” is an average of the estimated next three completed fiscal years of the customers annual capital spend. e-Builder reserves the right to adjust the fee accordingly to align with the Customer’s actual average annual capital spend.
Term: The Renewal Term for the License Subscription will be from 7/1/2022 to 6/30/2023 Renewal Terms: Annual Software Subscription will automatically renew at the end of each license term in increments of one-year periods unless e-Builder or Customer provides written notice of non-renewal at least sixty (60) days prior to expiration of the then-current term. Upon renewal, e-Builder has a right to increase license fees up to the greater of CPI plus two (2%) percent or five (5%) percent if the Annual Capital Spend stays constant. If the Annual Capital Spend increases, the Annual Software Subscription amount will change based on the tier level of Annual Capital Spend.
Termination: Customer may terminate the Annual Software Subscription for convenience on not less than sixty (60) days’ written notice to the other Party hereto. If Customer terminates for convenience, all fees properly due, but not paid, and all previously paid subscription fees (both used and unused) for the current contract year shall be non-refundable and forfeited.
Payment Terms: The Total Annual Software Subscription for the Renewal Term of $79,012.50 is due upon signing this Work Order. The Total Annual Software Subscription will be billed in advance of each anniversary date at the then agreed upon amount and payment is due 30 days before anniversary date.
Audit Rights: e-Builder will have the right, during normal business hours and upon at least five (5) days’ prior written notice, to have an independent firm audit the amount of Annual Capital Spend that the customer has incurred. The audit will be conducted at e-Builder’s expense, unless it reveals that Customer has not complied in which case Customer will (i) reimburse e-Builder for all reasonable costs and expenses incurred by e-Builder regarding such audit; and (ii) pay e-Builder any annual license fee underpayment disclosed by the audit.
#10..
- 599 -
Validity: This Work Order is effective until 5/31/2022. e-Builder has the right to not offer the products presented at the prices in this Work Order after 5/31/2022.
Roadmap Disclaimer. CUSTOMER AGREES THAT IT’S PURCHASES ARE NOT CONTINGENT ON
THE DELIVERY OF ANY FUTURE FUNCTIONALITY OR FEATURES, OR DEPENDENT ON ANY ORAL
OR WRITTEN PUBLIC COMMENTS MADE BY TRIMBLE REGARDING FUTURE FUNCTIONALITY OR FEATURES.
Termination: Customer may terminate the Annual Software Subscription for convenience on not less than sixty (60) days’ written notice to the other Party hereto. If Customer terminates for convenience, all fees properly due, but not paid, and all previously paid subscription fees (both used and unused) for the current contract year shall be non-refundable and forfeited.
#10..
- 600 -
CLIENT INVOICING INFORMATION
Billing Address:
Attention To Whom:
Email Address:
Associated PO: __________________________
IN WITNESS WHEREOF e-Builder and Customer have executed this Agreement under the hand of its officer duly authorized in that regard on the date first written above.
E-BUILDER, INC.
Print Name: _______________________________
Signature: _______________________________
Title: _______________________________
Date: _______________________________
CUSTOMER: City of Modesto, CA
Print Name: _______________________________
Signature: _______________________________
Title: _______________________________
Date: _______________________________
Attn: [email protected]
#10..
- 601 -
CITY OF MODESTO
COUNCIL AGENDA REPORT
DATE OF MEETING:
June 14, 2022
Date: May 24, 2022
TO: Mayor and City Council
THROUGH: Joseph P. Lopez, City Manager
FROM: Bill Sandhu, Public Works Director
SUBJECT: Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
CONTACT: Rosene Salmo, Integrated Waste Manager, [email protected], 209-577- 5453
DESCRIPTION:
Hearing to consider approving the Annual Rate Adjustment to the Maximum Rate Schedule for Implementation of Senate Bill (SB) 1383 provisions and Solid Waste Collection Service Contractual Agreements provided by solid waste haulers for an increase of $8.40 per month for residential services, an increase of $9.95 per cubic yard for commercial services, and an increase of $8.05 per pull for industrial services to become effective July 1, 2022, and an increase of $5.40 per month for residential services, an increase of $25 per cart (recycling/organics) for commercial services to become effective January 1, 2023, and rescinding Resolution No. 2021-217, and increasing the fuel rates by $0.33 for residential and $0.47 for commercial to become effective on July 1, 2022, and rescinding Resolution No. 2021- 217. (Funding Source: Solid Waste Funds, Compost Funds) STRATEGIC PLAN ELEMENT:
This item is in conformance with City of Modesto Strategic Plan Area: Quality of Life: “Engage partners across the community to ensure the safety, resilience, and attractiveness of Modesto”; Goal D: “Provide safe, efficient, and reliable infrastructure through proactive community investment, maintenance and sustainability efforts”.
BACKGROUND:
The Solid Waste Division is responsible for the overall management of residential, commercial, and industrial garbage and recycling collection for the City. It oversees Service Agreements with two major garbage collection companies, Gilton Solid Waste and Bertolotti Modesto Disposal, as well as, a Joint Power Authority (JPA) Agreement between the City, Stanislaus County, and Covanta Stanislaus for the transformation of the City’s garbage at the Waste-toEnergy Facility. The Solid Waste Division responds to all municipal code violations related to solid waste, including the enforcement of illegal dumping in streets and alleys, and litter #11..
- 602 -
City Council, June 14, 2022
Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
abatement throughout the City’s main thoroughfares. The Division is also responsible for compliance with the State recycling mandates including: AB 939, AB 341, AB 1826, and SB 1383. In September 2016, Governor Brown signed the Short-Lived Climate Pollution Reduction Act Senate Bill (SB 1383)1 into law, establishing emission reduction targets statewide by reducing organic waste to landfill by 75% and recovering 20% of edible food waste for human consumption by 2025. SB 1383 outlines extremely ambitious targets and specific details for implementation, monitoring, and documentation. As of 2022, the Department of Resources Recycling and Recovery (CalRecycle) monitors implementation and compliance with the following areas of SB 1383:
Identifying, educating, and monitoring edible food generators and edible food recovery programs
Residential and commercial organic collection services Processing, sorting, and recycling of organic waste
Procurement of recycled paper content products by the City and vendors Donation of material produced at the City’s Composting Facility in compliance with a citywide organic procurement target
Inspections and enforcement related to organic collection and recycling Public education and outreach
The City does not set the actual rate the collection companies can charge to pick up the garbage. Instead, the City sets the maximum rate that the collection companies can charge for each type of service. Per the Service Agreement with the garbage collection companies, an internal review is to be conducted annually to be effective on July 1 of every year. A computer modeling formula is used by solid waste and budget staff to analyze the audited financial data submitted by the garbage collection companies. The maximum rate that the collection companies may charge for each service is then based on the lowest cost hauler’s rates. These maximum rates can change when costs increase or decrease. The audited financial for the previous Fiscal Year (FY) 20/21 were used in determining this fiscal year rate increase. New fees where added to the solid waste rate to support funding SB 1383 implementation.
DISCUSSION:
On June 22, 2021, by Resolution 2021-227, Council approved an agreement with R3 Consulting Group, Inc. to provide a gap analysis between the City’s solid waste program and SB 1383 mandates and recommendations for future action to ensure compliance.
The City chose to coordinate with an independent consultant with expertise in implementing SB1383 in lieu of developing a compliance plan internally, because SB 1383 will lead to significant changes in waste collection, waste processing, administrative responsibilities, and cost of service. Including an independent consultant in this process ensures that the City receives an impartial recommendation for changes resulting from the State’s unfunded mandate that will impact Modesto’s residents and businesses.
On May 23, 2022 staff presented the Finance Committee with four different collection options.
Based on a public survey conducted by the City, staff recommended option B which is a threecontainer collection program, with a 96-gallon organic container that accepts yard, food, and paper waste, a 96-gallon recycling container that accepts glass, metals, plastics, and clean 1 https://www.calrecycle.ca.gov/organics/slcp
#11..
- 603 -
City Council, June 14, 2022
Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
cardboard, and a 96-gallon garbage container that accepts other household garbage. The garbage container would be serviced weekly, and the recycling and organic containers would be serviced bi-weekly. Commercial accounts that produce organic waste and/or recyclables would need another commercial bin or, in some cases where less waste is produced, would need a 96-gallon organic and/or recyclable container.
The following recommendations were made:
Fuel Rate Adjustment
On June 27, 2006, by Resolution No. 2006-410, Council approved making routine quarterly adjustments as needed to the component of the maximum rates attributable to the cost of fuel.
This was because of severe fluctuations in the cost of diesel fuel, which is a significant cost factor for the collection companies. The methodology approved by the Council uses the average diesel fuel prices from the Department of Energy/Energy Information Agency (DOE/EIA) for a prior quarter to set the fuel component for a subsequent quarter. The rate gets adjusted accordingly whether fuel goes up or down.
The fuel rates were analyzed for the July 1, 2022 adjustment. Haulers will receive a fuel rate increase of $0.33 for the residential accounts and $0.47 for the commercial accounts. To calculate the residential fuel component, a factor of 0.27 gallons of diesel fuel per residence per month was used, and for the commercial fuel component, a factor of 0.078 gallons of diesel fuel per cubic yard was used. For this rate review, the average diesel fuel prices from July 1, 2021 to March 31, 2022 were analyzed, and staff recommends a fuel adjustment for both residential and commercial maximum rates based on the prices of diesel fuel during that time frame.
Organic Waste Pre-Processing
The City’s haulers currently deliver “green container” organic waste to the City’s compost facility that contains contaminants (such as garbage) that are costly for the City to process. The presence of these contaminants in the organic waste is inimical to cost-effective and efficient composting at the facility, and consequently the City desires for its haulers to “pre-process” (i.e., remove contaminants from) the organic waste prior to delivery. The goal is to comply with the state requirement of less than 1 percent contamination in pre-processed organics.
Compost Facility Improvements
The City’s compost facility is an asset to the City’s solid waste system but is underfunded and requires improvements to be compliant with State regulations. At a minimum to achieve compliance with regulations and operate effectively, the City needs to complete grading, paving and drainage improvements to the site, remove accumulated stockpiles, and upgrade key operating equipment.
City SB 1383 Implementation
The City will retain primary responsibility for implementation of – and compliance with – the SB 1383 regulations. The proposed fees will fund program staff and supervisors; costs for design, printing and mailing of outreach and education materials; costs for enforcement of the City’s updated municipal code with respect to SB 1383; cost for inspection and enforcement, route review, and contamination monitoring, and costs to comply with SB 1383’s organic waste product procurement requirements.
#11..
- 604 -
City Council, June 14, 2022
Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
SB 1383 Collection Program
While the City currently utilizes a two-container program for collection of garbage and organic waste, the City’s current collection program does not comply with the SB 1383 regulations because it does not utilize a high diversion organic waste processing facility for processing of garbage to recover organic waste. To comply with the regulations, the City must modify its collection service program to a three-container system.
FISCAL IMPACT:
The fiscal impact related to the necessary proposed adjustments for residential, commercial, and industrial garbage and recycling collection services are as follows:
Residential Maximum Rate Recommendation
The proposed collection system is a 3-container system: a 96-gallon can for garbage collected weekly and a 96-gallon can for organics and recycling containers both collected bi-weekly. The proposed maximum monthly rate for this standard service is $51.25 per household per month.
Rate adjustments will occur in two phases:
Phase 1: Rates will take effect on July 1, 2022. The adjustment will include fees collected from base rate adjustment, fuel rate adjustment, compost facility improvements, organic waste preprocessing, and City SB 1383 Implementation. The residential increase for phase 1 is $8.40 per month.
Phase 2: Rates will take effect on January 1, 2023. The adjustment will include fees from SB 1383 collection program. The residential increase for phase 2 is $5.40 per month.
Based on the cost structure of the lowest cost hauler utilizing R3 SB 1383 study, and the rate analysis conducted by staff, the following rate changes are proposed:
#11..
- 605 -
City Council, June 14, 2022
Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
MAXIMUM RATE FOR STANDARD CONTAINER SERVICE
A. Commercial Maximum Rate Recommendation (Detachable Containers) The proposed maximum rate for commercial detachable container service for onecubic yard picked up once weekly is $54.09 per month effective July 1, 2022.
Starting January 1, 2023, businesses that do not qualify for a waiver will pay $25 per cart (collected once per week) for organics and/or recycling services Based on the cost structure of the lowest cost hauler utilizing R3 SB 1383 study, and the rate analysis conducted by staff, the following rate changes are proposed:
Current Proposed Difference
Base Rate $ 31.13 $ 34.73 + $ 3.60
Fuel Rate Adjustment - $ 0.33 + $ 0.33
Compost Facility
Improvements
- $ 1.70 + $ 1.70
SB 1383 Collection
Program Fee
- $ 5.40 + $ 5.40
Organic Waste PreProcessing- $ 1.72 + $ 1.72
SB 1383 Implementation - $1 .05 + $ 1.05
Recycling Fee $ 0.46 $ 0.46 -
Green Waste Fee $ 5.01 $ 5.01
-
Carpenter Rd Landfill Fee $ 0.70 $ 0.70 -
Geer Rd Landfill Fee $ 0.15 $ 0.15 -
Total Maximum Rate $ 37.45 $ 51.25 + $ 13.80
#11..
- 606 -
City Council, June 14, 2022
Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
MAXIMUM RATE FOR DETACHABLE CONTAINER SERVICE
Commercial Customers who do not qualify for waivers will need to have either the organics and/or recycling cart service at an additional cost of $25.00 per cart. 96 Gallon Cart Maximum Rates
Material Type Number of Collection Per Week
1 2 3 4 5
Recycling/Organics $ 25.00 $ 50.00 $ 75.00 $ 100.00 $ 125.00 B. Industrial Drop Box/Roll-Off Compactors Maximum Rate Recommendation The maximum rates for industrial drop boxes and roll-off compactors are set for the pick-up charge and daily rental rate only. The actual disposal charge is negotiated directly between the garbage company and the customer. These services are open to competition between the two authorized collection companies in the City. The proposed maximum rate per pick-up is $439.24.
Current Proposed Difference
Base Rate $ 41.53 $ 42.92 +$ 1.39
Fuel Rate Adjustment $ 0.47 + $ 0.47
Compost Facility
Improvements
$ 3.08 + $ 3.08
Organic Waste PreProcessing$ 3.11 + $ 3.11
SB 1383 Implementation $ 1.90 + $ 1.90
Recycling Fee $ 0.63 $ 0.63 -
Green Waste Fee $ 10.18 $ 10.18
-
Litter Abatement $ 0.59 $ 0.59 -
Carpenter Rd Landfill Fee $ 0.95 $ 0.95 -
Geer Rd Landfill Fee $ 0.21 $ 0.21 -
Total Maximum Rate $ 54.09 $ 64.04 + $ 9.95
#11..
- 607 -
City Council, June 14, 2022
Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
MAXIMUM RATE PER PICK-UP INDUSTRIAL DROP BOXES
The current AB 939 Green Waste Diversion Fee is $17.10 per ton and will remain the same for FY 22/23
C. Commercial Front Loader Compactors Maximum Rate Recommendation Commercial Front Loader compactors typically contain three times the amount of solid waste as a regular commercial bin. The maximum rates are therefore based on a multiple of three times the cubic yard of the commercial bin maximum rate.
The estimated fiscal impact to the City for the proposed FY 22/23 adjustments are shown in the table below:
Funds FY 22/23
Solid Waste Fund $ 1,144,671
General Fund $ 204,812
Streets Fund $ 102,420
Compost Fund $ 1,854,072
Total $ 3,305,975
Current Proposed Difference
Base Rate $ 375.16 $ 383.21 +$ 8.05
Recycling Fee $ 19.71 $ 19.71 -
Carpenter Rd Landfill
Fee
$ 29.77 $ 29.77 -
Geer Rd Landfill Fee $ 6.55 $ 6.55 -
Total Maximum Rate $ 431.19 $ 439.24 +$ 8.05
#11..
- 608 -
City Council, June 14, 2022
Annual Adjustment to Maximum Rate Schedule for Solid Waste Collection Services
COMMITTEE RECOMMENDATION:
This item was reviewed by the Finance Committee on May 23, 2022, and the Committee recommended forwarding to Council for approval.
CEQA/NEPA REQUIREMENTS:
This is an administrative action to adjust maximum rates for existing services, and therefore does not require environmental review.
RECOMMENDED COUNCIL ACTION:
Staff Recommendations:
Resolution approving the Annual Rate Adjustment to the Maximum Rate Schedule for City Solid Waste Collection Services provided by the garbage haulers and by R3 Consultants, for an increase of $8.40 per month for residential services, an increase of $9.95 per cubic yard for commercial services, and an increase of $8.05 per pull for industrial services to become effective July 1, 2022, and an increase of increase of $5.40 per month for residential services, an increase of $25 per organics and/or recycling cart (collected once a week) for commercial services to become effective January 1, 2023 and rescinding Resolution No. 2021-217 for the July 1, 2022 and the January 1, 2023 rate adjustment.
Resolution approving a quarterly fuel rate adjustment to the maximum rate schedule for City Solid Waste Collection Services provided by the haulers, for an increase of $0.33 per month for residential services, and an increase of $0.47 per cubic yard for commercial services, to become effective July 1, 2022, and rescinding Resolution No. 2021-217 for the July 1, 2021 Annual Rate Adjustment.
Approved by:
Bill Sandhu, Public Works Director
Joseph P. Lopez, City Manager
Attachments:
1. Resolutions (2)
2. Attachment A – Maximum Charges for Garbage Service Effective July 1, 2022
3. Attachment B – Maximum Charges for Garbage Service Effective January 1, 2022 #11..
- 609 -
\ -1-
MODESTO CITY COUNCIL
RESOLUTION NO. 2022 -
RESOLUTION APPROVING THE ANNUAL RATE ADJUSTMENT TO THE
MAXIMUM RATE SCHEDULE FOR CITY SOLID WASTE COLLECTION
SERVICES PROVIDED BY THE GARBAGE HAULERS AND BY R3
CONSULTANTS, FOR AN INCREASE OF $8.40 PER MONTH FOR
RESIDENTIAL SERVICES, AN INCREASE OF $9.95 PER CUBIC YARD FOR COMMERCIAL SERVICES AND AN INCREASE OF $8.05 PER PULL FOR INDUSTRIAL SERVICES TO BECOME EFFECTIVE JULY 1, 2022, AND AN INCREASE OF $5.40 PER MONTH FOR RESIDENTIAL SERVICES, AN INCREASE OF $25 PER ORGANICS AND/OR RECYCLING CART
(COLLECTED ONCE A WEEK) FOR COMMERCIAL SERVICES TO
BECOME EFFECTIVE JANUARY 1, 2023, RESCINDING RESOLUTION NO. 2021-217 FOR THE JULY 1, 2022 AND THE JANUARY 1, 2023 RATE
ADJUSTMENT
WHEREAS, with the adoption of Ordinance No. 3068-C.S. in November of 1997, the City no longer sets rates for the collection of garbage in Modesto, and instead performs a comprehensive review of cost information submitted by the contract garbage haulers; and
WHEREAS, the City sets the maximum rate that the haulers may charge for the various types of services provided under the contracts based on cost data provided by the lowest cost hauler; and
WHEREAS, Section 2 (f) of the City’s Service Agreements with its solid waste collectors requires that when the City adjusts the collection services provided under the Agreements, any additional costs should be covered by adjustments to the maximum rates; and
WHEREAS, in addition, maximum rates for solid waste collection services are reviewed annually as per the Agreements with the City’s garbage collection companies; and
#11..
- 610 -
\ -2-
WHEREAS, on June 8, 2021 by Resolution No. 2021-217, Council approved a mid-year rate adjustment to the Maximum Rate Schedule for Solid Waste Services to become effective July 1, 2021; and
WHEREAS, based on the current analysis conducted by staff and a third-party consultant, R3, utilizing SB 1383 City implementation needs and the pricing information provided by the haulers, and based on the cost structure of the lowest cost hauler; and
WHEREAS, the waste allocation for FY 20/21 was 53.62% residential, 26.51% commercial, and 19.87% industrial; and
WHEREAS, the changes in waste allocation reflect the actual amount of waste from each sector, and residential and commercial allocations decreased, and industrial allocation increased as compared to FY 19/20, and these percentage allocations were then utilized in applying fees accordingly; and
WHEREAS, the Recycling and Green Waste Diversion Program Fees, stayed the same as FY 21/22; and
WHEREAS, the current maximum monthly rate for standard residential service is $37.45 per household per month; and
WHEREAS, based on the cost structure of the lowest cost hauler, the rate analysis conducted by staff and a third-party consultant, a $8.40 increase in the maximum residential rate is recommended for a new maximum residential rate of $45.85, to be effective July 1, 2022, and a $5.40 increase in the maximum residential rate is recommended for a new maximum residential rate of $51.25, to be effective January 1, 2023; and
WHEREAS, the current base maximum rate for commercial detachable container #11..
- 611 -
\ -3-
service is $54.09 for one-cubic yard picked up once weekly per month; and WHEREAS, based on the cost structure of the lowest cost hauler, the rate analysis conducted by staff and a third-party consultant, a $9.95 increase in the maximum commercial rate is recommended for a new maximum rate for commercial detachable container service of $64.04 for one-cubic yard picked up once weekly per month, to be effective July 1, 2022, and an additional $25 increase per organics and/or recycling cart to be effective January 1, 2023; and
WHEREAS, the maximum rates for industrial drop boxes and roll-off compactors are set for the pickup charge and daily rental rate only; and WHEREAS, the actual disposal charge is negotiated directly between the garbage collection company and the customer; and
WHEREAS, the current maximum rate per pick-up is $431.19, and a $8.05 increase in the maximum drop boxes and roll-off compactor rate is recommended for a new maximum rate for boxes and roll-off compactor service of $439.24 for one-cubic yard picked up; and
WHEREAS, the current AB 939 Green Waste Diversion fee is $17.10 and shall remain the same for FY 22/23; and
WHEREAS, it was found and determined by the Council of the City of Modesto that the existing schedules of rates and charges for garbage service in the City of Modesto should be revised as recommended; and
WHEREAS, the fiscal impact related to the proposed adjustments for residential, commercial and industrial garbage and recycling services will increase revenue to the Solid Waste Fund by $1,144,671, the General Fund by $204,812, the Streets Fund by $102,420, and the compost fund $1,854,072.
#11..
- 612 -
\ -4-
NOW, THEREFORE, BE IT RESOLVED, by the Council of the City of Modesto that it hereby approves the Maximum Charges for Garbage Services provided by the garbage haulers, as attached hereto as Attachment A, dated July 1, 2022, Attachment B, dated January 1, 2023 and incorporated herein by reference. Said Maximum Charges for Garbage Service shall include all other services as stipulated in the Service Agreements and shall become effective July 1, 2022 and January 1, 2023 and shall remain in effect until revised or rescinded by Council.
BE IT FURTHER RESOLVED, that Resolution No. 2021-217 for the July 1, 2021 annual rate adjustment is hereby rescinded effective July 1, 2022 and January 1, 2023.
The foregoing resolution was introduced at a regular meeting of the Council of the City of Modesto held on the 14th day of June, 2022 by Councilmember ?, who moved its adoption, which motion being duly seconded by Councilmember ?, was upon roll call carried and the resolution adopted by the following vote:
AYES: Councilmembers:
NOES: Councilmembers:
ABSENT: Councilmembers:
ATTEST: __________________________
DIANE NAYARES-PEREZ, City Clerk
(SEAL)
APPROVED AS TO FORM:
BY: _______________________________
JOSE M. SANCHEZ, City Attorney
#11..
- 613 -
\ -1-
MODESTO CITY COUNCIL
RESOLUTION NO. 2022-
RESOLUTION APPROVING A QUARTERLY FUEL RATE ADJUSTMENT TO
THE MAXIMUM RATE SCHEDULE FOR CITY SOLID WASTE COLLECTION SERVICES PROVIDED BY THE HAULERS, FOR AN INCREASE OF $0.33 PER MONTH FOR RESIDENTIAL SERVICES, AND AN INCREASE OF $0.47 PER
CUBIC YARD FOR COMMERCIAL SERVICES, TO BECOME EFFECTIVE JULY 1, 2022, AND RESCINDING RESOLUTION NO. 2021-217 FOR THE JULY 1, 2021 ANNUAL RATE ADJUSTMENT
WHEREAS, with the adoption of Ordinance No. 3068-C.S. in November of 1997, the City no longer sets rates for the collection of garbage in Modesto, and instead performs a comprehensive review of cost information submitted by the contract garbage haulers; and
WHEREAS, the City sets the maximum rate that the haulers may charge for the various types of services provided under the contracts based on cost data provided by the lowest cost hauler; and
WHEREAS, Section 2 (f) of the City’s Service Agreements with its solid waste collectors requires that when the City adjusts the collection services provided under the Agreements, any additional costs should be covered by adjustments to the maximum rates; and
WHEREAS, in addition, maximum rates for solid waste collection services are reviewed annually as per the Agreements with the City’s garbage collection companies; and
WHEREAS, the City analyzes the audited financial statements provided by the garbage haulers, supplemental data provided by the garbage haulers, and fuel price information and forecast prices developed by the United States Department of Energy; and
#11..
- 614 -
\ -2-
WHEREAS, on June 27, 2006, by Resolution No. 2006-410, Council approved making routine quarterly adjustments as needed to the component of the maximum rates attributable to the cost of fuel; and
WHEREAS, the fuel rates analyzed for this rate adjustment were based on the Department of Energy average diesel fuel prices from July 2021 through March 2022; and
WHEREAS, this action is to adjust maximum rates for fuel and therefore does not require environmental review; and
WHEREAS, it was found and determined by the Council of the City of Modesto that the quarterly adjustment to the fuel component of the maximum rates should be made.
NOW, THEREFORE, BE IT RESOLVED by the Council of the City of Modesto that it hereby approves the quarterly fuel adjustment from July 2021 through March 2022 to the Maximum Rate Schedule for Garbage Services, Attachment A, dated July 1, 2022, for an increase of $0.33 per month for residential services and an increase of $0.47 per cubic yard per month for commercial services and shall become effective July 1, 2022 and shall remain in effect until rescinded.
BE IT FURTHER RESOLVED that Resolution No. 2021-217 for the July 1, 2021 annual rate adjustment is hereby rescinded effective July 1, 2022. #11..
- 615 -
\ -3-
The foregoing resolution was introduced at a regular meeting of the Council of the City of Modesto held on the 14th day of June, 2022, by Councilmember? who moved its adoption, which motion being duly seconded by Councilmember? was upon roll call carried and the resolution adopted by the following vote:
AYES: Councilmembers:
NOES: Councilmembers:
ABSENT: Councilmembers:
ATTEST: __________________________
DIANE NAYARES-PEREZ, City Clerk
(SEAL)
APPROVED AS TO FORM:
BY: _______________________________
JOSE M. SANCHEZ, City Attorney
#11..
- 616 -
-1-
ATTACHMENT A
MAXIMUM CHARGES FOR GARBAGE SERVICE - JULY 1, 2022
STANDARD CONTAINERS - Maximum Monthly Rate
Standard container service includes the following:
1 container for garbage picked up weekly, 1 container for organics waste, and 1 container for recycling picked up bi-weekly
2 bulky item collections per year by appointment
City tree maintenance; collection & composting of green waste and forestry materials Removal of illegally dumped items in streets and alleys Drop off program for household hazardous waste
Additional Garbage Container - $ 13.00 each per month picked up once a week Additional Organics Container - $8.00 each per month picked up bi-weekly Additional Recycling Container - $8.00 each per month picked up bi-weekly *Containers must be placed in a location set forth in Section 5-5.111 of the MMC.
DETACHABLE CONTAINERS - Maximum Monthly Rate
Weekly rental for Detachable Containers shall not exceed the rate for 1 pick-up per week for each size container.
Base Rate $ 34.73
*Fuel Rate Adjustment $ 0.33
Compost Facility Improvements $ 1.70
Organic Waste Pre-Processing $ 1.72
City SB 1383 Implementation $ 1.05
Recycling Fee $ 0.46
Green Waste Fee $ 5.01
Carpenter Rd Landfill Fee $ 0.70
Geer Rd Landfill Fee $ 0.15
MAXIMUM MONTHLY RATE $ 45.85
#11..
- 617 -
-2-
Bin Maximum Rates
Number of Collection Per week
Container Size 1 2 3 4 5 6
1 CY $ 64.04 $ 128.08 $ 192.12 $ 256.16 $ 320.20 $ 384.24 2 CY $ 128.08 $ 256.16 $ 384.24 $ 512.32 $ 640.40 $ 768.48 3 CY $ 192.12 $ 384.24 $ 576.36 $ 768.48 $ 960.60 $ 1,152.72 4 CY $ 256.16 $ 512.32 $ 768.48 $ 1,024.64 $ 1,280.80 $ 1,536.96 5 CY $ 320.20 $ 640.40 $ 960.60 $ 1,280.80 $ 1,601.00 $ 1,921.20 6 CY $ 384.24 $ 768.48 $ 1,152.72 $ 1,536.96 $ 1,921.20 $ 2,305.44 *Residential and Commercial Fuel Component adjustments - The fuel component is set annually as part of the base cost. It is reviewed quarterly and adjustments shall be made as needed. The adjustment shall be based on the average price of fuel From July 1, 2021 to March 31, 2022. Average prices shall be determined based on published prices for California from the Department of Energy, Energy Information Agency and a fuel factor based on the haulers’ audited financials at annual rate review each year.
DROP BOX CONTAINERS – Maximum Rate Per Pick-Up
Actual disposal charges are paid and negotiated directly between the customer and the garbage company. The garbage company will provide up to 40CY Drop Box containers for stated charges subject only to load limit of transfer vehicle.
Base Rate $ 42.92
*Fuel Rate Adjustment $ 0.47
Compost Facility
Improvements
$ 3.08
Organic Waste PreProcessing$ 3.11
City SB 1383
Implementation
$ 1.90
Recycling Fee $ 0.63
Green Waste Fee $ 10.18
Litter Abatement $ 0.59
Carpenter Rd Landfill Fee $ 0.95
Geer Rd Landfill Fee $ 0.21
MAXIMUM RATE 1 CU YD $ 64.04
#11..
- 618 -
-3-
An AB 939 Green Waste Diversion Fee of $17.10 per ton is added to the disposal charges.
Base Rate $ 383.21
Recycling Fee $ 19.71
Carpenter Rd Landfill Fee $ 29.77
Geer Rd Landfill Fee $ 6.55
MAXIMUM RATE PER PICK-UP $ 439.24
Rental Fees
$0.85 per day up to 7-day maximum rental
$3.00 per day for boxes kept 7 or more days without servicing $10.00 per day for boxes kept 21 or more days without servicing
COMPACTORS – Maximum Monthly Rate
Front Loader Compactors
Compactor Rates
Container Size Number of Collection per week
1 2 3 4 5 6
3 CY $ 576.36 $ 1,152.72 $ 1,729.08 $ 2,305.44 $ 2,881.80 $ 3,458.16 4 CY $ 768.48 $ 1,536.96 $ 2,305.44 $ 3,073.92 $ 3,842.40 $ 4,610.88 6 CY $ 1,152.72 $ 2,305.44 $ 3,458.16 $ 4,610.88 $ 5,763.60 $ 6,916.32 Roll-Off Compactors
6CY to 40CY $431.19 per pick-up
Hospital waste compactors $265.00 per pick-up
Washing compactor $30.00
Disposal Charge Actual charge to be paid by customer
AB939 Green Waste Diversion Fee $17.10 per ton
EXTRA PICKUPS
Standard containers or equivalent $3.50 plus $2.30/container Detachable containers $12.00 plus $4.15/cubic yard
SPECIAL SERVICE CONDITIONS
In situations where none of the above maximum rates reasonably apply, the cost of service is to be negotiated between the garbage company and the customer. #11..
- 619 -
-4-
DETACHABLE CONTAINER ONLY–Replacement and Cleaning Services 1 CY 1½ CY 2 CY 3 CY 4 CY 5 CY 6 CY
$10.12 $11.00 $12.10 $15.40 $20.24 $25.08 $29.92
NOTATION: Pursuant to Section 11-6.16(c)(2) of the Modesto Municipal Code, the solid waste company may require a deposit equivalent to two months service charge from customers prior to beginning service. The deposit will be credited back to the customer after 18 months under specified conditions.
#11..
- 620 -
-1-
ATTACHMENT B
MAXIMUM CHARGES FOR GARBAGE SERVICE - JANUARY 1, 2023
STANDARD CONTAINERS - Maximum Monthly Rate
Standard container service includes the following:
1 container for garbage picked up weekly, 1 container for organics waste, and 1 container for recycling picked up bi-weekly
2 bulky item collections per year by appointment
City tree maintenance; collection & composting of green waste and forestry materials Removal of illegally dumped items in streets and alleys Drop off program for household hazardous waste
Additional Garbage Container - $ 13.00 each per month picked up once a week Additional Organics Container - $8.00 each per month picked up bi-weekly Additional Recycling Container - $8.00 each per month picked up bi-weekly *Containers must be placed in a location set forth in Section 5-5.111 of the MMC.
DETACHABLE CONTAINERS - Maximum Monthly Rate
Weekly rental for Detachable Containers shall not exceed the rate for 1 pick-up per week for each size container.
Base Rate $ 34.73
Fuel Rate Adjustment $ 0.33
SB 1383 Collection Program $ 5.40
Compost Facility Improvements $ 1.70
Organic Waste Pre-Processing $ 1.72
SB 1383 Implementation $ 1.05
Recycling Fee $ 0.46
Green Waste Fee $ 5.01
Carpenter Rd Landfill Fee $ 0.70
Geer Rd Landfill Fee $ 0.15
MAXIMUM MONTHLY RATE $ 51.25
#11..
- 621 -
-2-
Bin Maximum Rates
Number of Collection Per week
Container Size 1 2 3 4 5 6
1 CY $ 64.04 $ 128.08 $ 192.12 $ 256.16 $ 320.20 $ 384.24 2 CY $ 128.08 $ 256.16 $ 384.24 $ 512.32 $ 640.40 $ 768.48 3 CY $ 192.12 $ 384.24 $ 576.36 $ 768.48 $ 960.60 $ 1,152.72 4 CY $ 256.16 $ 512.32 $ 768.48 $ 1,024.64 $ 1,280.80 $ 1,536.96 5 CY $ 320.20 $ 640.40 $ 960.60 $ 1,280.80 $ 1,601.00 $ 1,921.20 6 CY $ 384.24 $ 768.48 $ 1,152.72 $ 1,536.96 $ 1,921.20 $ 2,305.44 96 Gallon Cart Maximum Rates
Material Type Number of Collection Per Week
1 2 3 4 5
Recycling/Organics $ 25.00 $ 50.00 $ 75.00 $ 100.00 $ 125.00 *Residential and Commercial Fuel Component adjustments - The fuel component is set annually as part of the base cost. It is reviewed quarterly and adjustments shall be made as needed. The adjustment shall be based on the average price of fuel From July 1, 2021 to March 31, 2022. Average prices shall be determined based on published prices for California from the Department of Energy, Energy Information Agency and a fuel factor based on the haulers’ audited financials at annual rate review each year.
Base Rate $ 42.92
*Fuel Rate Adjustment $ 0.47
Compost Facility
Improvements
$ 3.08
Organic Waste PreProcessing$ 3.11
SB 1383 Implementation $ 1.90
Recycling Fee $ 0.63
Green Waste Fee $ 10.18
Litter Abatement $ 0.59
Carpenter Rd Landfill Fee $ 0.95
Geer Rd Landfill Fee $ 0.21
MAXIMUM RATE 1 CU YD $ 64.04
#11..
- 622 -
-3-
DROP BOX CONTAINERS – Maximum Rate Per Pick-Up
Actual disposal charges are paid and negotiated directly between the customer and the garbage company. The garbage company will provide up to 40CY Drop Box containers for stated charges subject only to load limit of transfer vehicle.
An AB 939 Green Waste Diversion Fee of $17.10 per ton is added to the disposal charges.
Base Rate $ 383.21
Recycling Fee $ 19.71
Carpenter Rd Landfill Fee $ 29.77
Geer Rd Landfill Fee $ 6.55
MAXIMUM RATE PER PICK-UP $ 439.24
Rental Fees
$0.85 per day up to 7-day maximum rental
$3.00 per day for boxes kept 7 or more days without servicing $10.00 per day for boxes kept 21 or more days without servicing
#11..
- 623 -
-4-
COMPACTORS – Maximum Monthly Rate
Front Loader Compactors
Compactor Rates
Container Size Number of Collection per week
1 2 3 4 5 6
3 CY $ 576.36 $ 1,152.72 $ 1,729.08 $ 2,305.44 $ 2,881.80 $ 3,458.16 4 CY $ 768.48 $ 1,536.96 $ 2,305.44 $ 3,073.92 $ 3,842.40 $ 4,610.88 6 CY $ 1,152.72 $ 2,305.44 $ 3,458.16 $ 4,610.88 $ 5,763.60 $ 6,916.32 Roll-Off Compactors
6CY to 40CY $431.19 per pick-up
Hospital waste compactors $265.00 per pick-up
Washing compactor $30.00
Disposal Charge Actual charge to be paid by customer
AB939 Green Waste Diversion Fee $17.10 per ton
EXTRA PICKUPS
Standard containers or equivalent $3.50 plus $2.30/container Detachable containers $12.00 plus $4.15/cubic yard
SPECIAL SERVICE CONDITIONS
In situations where none of the above maximum rates reasonably apply, the cost of service is to be negotiated between the garbage company and the customer.
DETACHABLE CONTAINER ONLY–Replacement and Cleaning Services 1 CY 1½ CY 2 CY 3 CY 4 CY 5 CY 6 CY
$10.12 $11.00 $12.10 $15.40 $20.24 $25.08 $29.92
NOTATION: Pursuant to Section 11-6.16(c)(2) of the Modesto Municipal Code, the solid waste company may require a deposit equivalent to two months service charge from customers prior to beginning service. The deposit will be credited back to the customer after 18 months under specified conditions.
#11..
- 624 -
CITY OF MODESTO
COUNCIL AGENDA REPORT
DATE OF MEETING:
June 14, 2022
Date: May 23, 2022
TO: Mayor and City Council
THROUGH: Joseph Lopez, City Manager
FROM: Christina Alger, Director of Human Resources
SUBJECT: Rehire of Retired Annuitant
CONTACT: Christina Alger, Director of Human Resources
[email protected], 209-571-5126
DESCRIPTION:
Consider approving a resolution authorizing the City of Modesto to utilize the services of David Savidge on an interim basis to fulfill the duties of Wastewater Division Manager for a limited duration of up to six (6) months or until the recruitment is completed, whichever is first. (Funding: Wastewater Fund- 4210)
STRATEGIC PLAN ELEMENT:
This item supports the 2020-2025 Strategic Plan’s Service and Delivery Goals & Strategies - Building a High-Performing Organization by Attracting and Retaining High Performance Employees.
BACKGROUND:
The California Public Retirement System (CalPERS) recognizes that retirees can play an important role in maintaining city operations, particularly in short-term or emergency situations; however, they also specify limitations on a retiree’s service when returning to work for a CalPERS agency. Government Code §7522.561 & 21221 (h)2 provides specific guidance on employing a CalPERS retiree without interruption to retirement benefits or reinstatement from retirement. Key terms of hiring a retired annuitant under the Government Code and by which the City will be following are:
The retiree must wait 180 days after his or her retirement date before he or she can return to work for a CalPERS employer, unless there is a qualifying exception.
1 https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=GOV§ionNum=7522.56. 2 https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=GOV§ionNum=21221. #12..
- 625 -
City Council, June 14, 2022
Rehire of Retired Annuitants