Lease Agreement 17
Specialist for purposes of determining whether the property has or does not m eet a ll applicable construction related accessibility standards pursuant to Civil Code Section 55.53. As further s pecified in California Civ il Code Section 1938: “A Certified Access Specialist (CASp) can inspect the subject premises and determine whether the subject premises comply with all of the applicable construction - related accessibility standards under state law . Although state law does not require a CASp inspection of the subject premises, the commercial property owner or lessor may not prohibit th e lessee or tenant from obtaining a CASp inspection of the subject premises for the occupancy or potential occupancy of the lessee or tenant, if requested by the lessee or tenant. The parties shall mutually agree on the arrangements for the time and manner of t he CASp inspection, the payment of the fee for the CASp inspection, and the cost of making any repairs necessar y to correct violations o f construction -related accessibility standards within the premises.”
7.16. Successors and Assigns. This Lease shall be b inding upon and inure to the benefit of Landlord, its successors and assigns (subject to the provisions hereof) and shall be binding upon and inure to the benefit of Tenant, its successors.
7.17. Further Assurances. Landlord and Tenant each agree to promptly si gn all documents reasonably requested to give effect to the provisions of this Lease.
7.18. No Prior Agreements . This Lea se, including the exhibit s and addenda attached to it, contains all agreements of Landlord and Tenant with respect to any matter referred to herein. No prior agreement or understanding pertaining to such matters shall be effective.
7.19. Applicable Law . This L ease shall be governed by , construed and enforced in accordance with the laws of the State of California. This Lease is made in Contra Cost a Cou nty, California, and any action relating to this Lease shall be instituted and prosecuted in the courts of Cont ra Costa County, California.
7.20. Time of the Essence. Time is of the essence of each and every covenant of this Lease.
Each and every covenan t, agreement or other provision of this Lease on Tenant's part to be performed shall be deemed and construed as a se parate and independent co venant of Tenant, not dependent on any other provision of this Lease or on any other covenant or agreement set fort h herein.
7.21. No Joint Venture . This Lease shall not be deemed or construed to create or establish any relationship of partnership or joint vent ure or similar relationship or arrangement between Landlord and Tenant hereunder. If requested by Landlord, Tenant shall post signs at the Premises stating that Landlord is not responsible for the day-to-day operations of the Premises.
7.22. Authority. If Tena nt is a corporation, limited liability company, trust or general or limited partnership, each individual executing this Lease on behalf of Tenant represents and warrants that he or she is duly authorized to execute and deliver this Lease on Tenant's behalf and that this Lease is binding upon Tenant in accordance with its terms.
IN WITNESS WHEREOF, the parties hereto h ave executed this Lease as of the day and year first written above.
ATTEST:
Clerk
LANDLORD: City of Richmond, a municipal corpor ation and charter city
By:
Name: Shasa Curl
Its: City Manager
Lease Agreement 18
Reviewed by:
_______________
City Attorney
TENANT: Richmond Promise
By:
Name: Christopher Whitmore
Its: Executive Director
Exhibit A
Premises
^ I ^i. l-i M£ f.< i". File iy-\ i i. fc.
CITY OF RICHMOND 2ND FLOOR SPACE PLAN
440 CIVIC CENTER PLAZA
DftTEi JANUARY 3, £009
Exhibit B
City of Richmond Insurance Requirements for Lessees
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements – Type 4:
Leases of City Property
Type 4 – Page 1 of 3
Revised: September 2011
In all instances where LESSEE or its representatives will be leasing or using City of Richmond (City) property for an extended period, the City requires the following minimum insurance requirements and limits.
LESSEE shall procure and maintain for the duration of the contract or lease agreement insurance against claims for injuries to persons or damages to property which may arise from or in connection with the LESSEE’s, its agents’, representatives’, employees’ or vendor’s use of the premises. Maintenance of proper insurance coverage is a material element of the contract or lease agreement. Failure to maintain or renew coverage or to provide evidence of renewal may be treated by the City as a material breach of contract.
LESSEE agrees that in the event of loss due to any of the perils for which it has agreed to provide Commercial General Liability insurance, LESSEE shall look solely to its insurance for recovery. LESSEE hereby grants to CITY, on behalf of any insurer providing Commercial General Liability insurance to either LESSEE or CITY with respect to the services of LESSEE herein, a waiver of any right to subrogation which any such insurer of said LESSEE may acquire against the CITY by virtue of the payment of any loss under such insurance.
Original, signed certificates and original, separate policy endorsement, naming the City as an additional insured for general liability coverage, as well as a waiver of subrogation for Workers’ Compensation insurance (if applicable), shall be received and approved by the City before occupancy may occur. However, failure to do so shall not operate as a waiver of these insurance requirements.
City reserves the right to modify or require additional coverages for specific risk exposures depending on scope of the Lease.
Minimum coverage is detailed below. The policy limits of coverage shall be made available to the full limits of the policy. The minimum limits stated herein shall not serve to reduce the policy limits of coverage of LESSEE.
Minimum Scope of Insurance – the following forms shall be provided and coverage shall be at least as broad as the following:
1. Insurance Services Office Commercial General Liability coverage (ISO Occurrence Form CG 0001).
2. Insurance Services Office Automobile Liability coverage (ISO Form CA 0001, Code 1, Any Auto).
3. Original and Separate Additional Insured Endorsements for General Liability (ISO Form CG 20 10 11/85 or its equivalent) with primary and non-contributory language.
4. Workers’ Compensation insurance as required by the State of California including Employer’s Liability (for LESSEE’s with employees).
5. Original and Separate Waiver of Subrogation for Workers’ Compensation Insurance (if applicable).
6. Property insurance against all risks of loss to tenant improvements, betterments and contents.
Required Coverage Minimum Limits
Workers’ Compensation and
Employers’ Liability
Statutory limits as required by the State of California including $1 million Employers’ Liability per accident, per employee for bodily injury or disease.
If LESSEE is self-insured, provide a certificate of Permission to Self-Insure, signed by the California Department of Industrial Relations and Self- Insurance. If Lessee is a sole proprietor (has no employees) than Lessee must sign “Contractor Release of Liability” found at:
http://www.ci.richmond.ca.us/index.aspx?nid=61.
General Liability
(primary and excess limits
combined)
$2,000,000 per occurrence for bodily injury, personal injury and property damage. If the policy includes a general aggregate, either the general aggregate shall apply separately to this project, service or location or the minimum required aggregate limit shall be twice the per occurrence limit ($4 million aggregate).
Policy shall also include coverage for liability arising out of the use and operation of any City-owned or City-furnished equipment used or operated by the LESSEE, its employees, agents or others with LESSEE’s permission.
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements – Type 4:
Leases of City Property
Type 4 – Page 2 of 3
Revised: September 2011
Automobile Liability $1,000,000 per occurrence for bodily injury and property damage.
Property Insurance – Only
applicable to leases of City
property involving tenant
improvements, betterments and
contents
Total value of all tenant improvements, betterments, and contents.
The City of Richmond shall be named as loss payee as its interest may appear. The insurer shall waive all rights against City.
Required Policy Conditions
Additional Insured Endorsement
Applicable to General Liability Coverage.
The City of Richmond, its officers, officials, employees, agents and volunteers are to be covered as insureds for all liability arising out of ownership, maintenance or use of that part of the premises leased or used by the LESSEE.
Primary and Noncontributory The LESSEE’s insurance covera ge must be primary as it pertains to the City, its officers, officials, employees, agents and volunteers. Any insurance or self insurance maintained by the City is wholly separate from the insurance of the LESSEE, shall be excess of the LESSEE’s insurance, and shall not contribute with it.
A. M. Best Rating A:VII or Better. If the A.M. Best Rating falls below the required rating, LESSEE must replace coverage immediately and provide notice to City.
Waiver of Subrogation
Endorsement Form
LESSEE’s insurer will provide a Waiver of Subrogation in favor of the City for Workers’ Compensation Insurance during the life of this contract.
SAMPLE Endorsements can be found at
http://www.ci.richmond.ca.us/index.aspx?nid=61
.
Deductibles and Self-Insured
Retentions
Any deductible or self-insured retention must be declared to and approved by the City. At the option of the City either the insurer shall reduce or eliminate such deductibles or self-insured retention as respects the City or the LESSEE shall procure a financial guarantee in an amount equal to the deductible or self-insured retention guaranteeing payment of losses and related investigations, claims administration and defense expenses.
LESSEE is responsible for satisfaction of the deductible and/or self-insured retention for each loss.
Umbrella/Excess Liability Policies
If an Umbrella or Excess Liability Policy is used to meet the liability limits, coverage shall be as broad as specified for underlying coverages and cover those insured in the underlying policies.
Sublets
LESSEE
shall not sublet the premises without the advance written consent of the City. Sublessees shall be subject to all of the requirements stated herein. Sublessee(s) must furnish to the City for review and approval, separate certificates and endorsements.
LESSEE agrees to defend and indemnify the City of Richmond for any damage resulting to it from failure of either LESSEE or any sublessee(s) to take out or maintain the required insurance policies.
The fact that insurance is
obtained by LESSEE, and/or LESSEE’s Sublessees, will not be deemed to release or diminish the liability of LESSEE, including, without limitation, liability under the indemnity provisions of this contract. Damages recoverable by CITY from LESSEE or any third party will not be limited by the amount of the required insurance coverage.
___ Exhibit F
___ Section 8
City of Richmond - Insurance Requirements – Type 4:
Leases of City Property
Type 4 – Page 3 of 3
Revised: September 2011
Verification of Coverage
All original certificates and endorsements shall be received and approved by the City before LESSEE may occupy the premises. The City of Richmond reserves the right to require complete, certified copies of all required insurance policies including endorsements affecting the coverage at any time.
Original insurance certificates and required policy endorsements shall be mailed or delivered to the Designated Project Manager for the City of Richmond.
Insurance certificates and endorsements may be faxed to the Designated Project Manager. However, Lessee must mail the original certificates and endorsements to Designated Project Manager once faxed.
Continuous Coverage
LESSEE shall maintain the required insurance for the life of the contract or lease agreement. Should the LESSEE cease to have insurance as required during this time, LESSEE’s right to use or occupy the premises may be rescinded. In the event that LESSEE fails to comply with the City’s insurance requirements, the City may take such action as it deems necessary to protect the City’s interests including but not limited to termination of the contract or lease agreement, eviction, or other actions as the City deems appropriate.
If LESSEE’s use or occupancy of the premises extends beyond the expiration dates of the required insurance policies initially approved by the City, LESSEE
must provide updated certificates and endorsements indicating that the required coverage, terms and conditions are still in place. Renewal certificates and updated endorsements shall be mailed to the Designated Project Manager.
Cancellation
LESSEE shall ensure that coverage shall not be cancelled, reduced or otherwise materially changed except after thirty (30) days’ prior written notice has been given to the City.
Reporting Requirements
Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City, its officers, officials, employees or volunteers.
Consistent with Public Policy
The insuring provisions, insofar as they may be judged to be against public policy shall be void and unenforceable only to the minimum extent necessary so that the remaining terms and provisions herein may be consistent with public policy and thus enforceable.
December 6, 2022
Fire Department
DATE: December 6, 2022
TO: Mayor Butt and Members of the City Council
FROM:
Angel Montoya, Fire Chief
Subject:
Regional Training Center for Richmond Fire Department
and Berkeley Fire Department
FINANCIAL IMPACT: There is no fiscal impact related to this item.
PREVIOUS COUNCIL
ACTION:
N/A
STATEMENT OF THE
ISSUE:
The Richmond Fire Department (RFD) is performing due
diligence to inform the City Council regarding its
proposed intention to use the Richmond Fire Training
Center as a regional training center for both agencies.
RECOMMENDED ACTION: RECEIVE a written report regarding Richmond Fire Department and Berkeley Fire Department’s effort to use the Richmond Fire Training Center as a regional training center for both agencies – Fire Department (Chief Angel Montoya 510-307-8041).
DISCUSSION:
The Richmond Fire Department (RFD) in collaboration with Berkeley Fire Department (BFD) is proposing to use the Richmond Fire Training Center located at 3506 Cutting Boulevard as a regional training center for both agencies. The objective is to regionalize training with BFD and heighten training in the various disciplines and multi-hazard response incidents.
AGENDA
REPORT
December 6, 2022
Current progress includes RFD and BFD reaching an agreement of BFD investing their monies into the RFD Training Center. Also, an architect has crafted preliminary drawings of the proposed upgrade of those monies into the training center.
RFD is performing due diligence in notifying the proper channels regarding this collaboration. Next steps include an in-depth presentation to the Richmond City Council in January 2023 to discuss and review draft architectural plans, training center operational plans, budget costs, and future funding strategies .
DOCUMENTS ATTACHED:
None
December 6, 2022
Human Resources
DATE: December 6, 2022
TO: Mayor Butt and Members of the City Council
FROM:
Nickie Mastay, Deputy City Manager
Sharrone Taylor, Director of Human Resources
Laura Marquez, Risk Manager
Subject:
Contract with Acclamation Insurance Management
Services, Inc.
FINANCIAL IMPACT: Funding for this year’s portion of the total expenditure ($610,000) is included within the proposed fiscal year
2022-2023 budget, Human Resources Management
Department, Risk Management Division (50182216). The
balance will be budgeted in future years at the
appropriate amount.
PREVIOUS COUNCIL
ACTION:
Six (6) month extension granted on July 1, 2022 while
evaluating services.
STATEMENT OF THE
ISSUE:
On February 24, 2022, the City solicited bids (RFP) for a vendor to administer the City’s workers’ compensation
claims when its current contract with Acclamation
Insurance Management Services, Inc. (AIMS) expires on
December 30, 2022. After an evaluation and review
process, City staff is recommending that AIMS be
retained to continue as the City’s provider of workers’ compensation claims administration services.
AGENDA
REPORT
December 6, 2022
RECOMMENDED ACTION:
APPROVE a contract with Acclamation Insurance
Management Services, Inc. to serve as the City's
third-party administrator of workers' compensation
claims for fiscal years 2022-2023 ($610,000), 2023-
2024 ($628,300), and 2024-2025 ($647,147) for a
total payment limit not to exceed $1,885,447 for the
contract period of January 1, 2023 through December
30, 2025. The City will have an option to extend the
term of the contract up to two years at an additional
3% cost per year for a total contract payment limit not to exceed $3,238,566 – Human Resources (Sharrone
Taylor/Laura Marquez 620-6974).
DISCUSSION:
1. Background: For the past ten (10) years, the current administrator of the City’s workers’ compensation claims program has been Acclamation Insurance Management Services, Inc. (AIMS). In 2022, in accordance with the City’s bidding and contracting guidelines, a new request for proposals (RFP) was initiated to open this contract work to other bidders.
The City generates approximately 189 new workers’ compensation claims each year and currently carries a caseload of 402 files. The highest frequency of claims filed are from the Police Department, Fire Department, and Public Works Department. Accordingly, extensive experience in handling public safety claims with special expertise and knowledge of Labor Code sections that pertain to police and fire personnel (as well as for all other employees) is essential.
2. Evaluation Process : The RFP was issued February 24, 2022, resulting in the submission of five proposals (AIMS; Innovative Claims Solutions; Innovative Claims Strategy; Intercard Holdings Insurance Services, Inc.; Lean on Me, Inc.; and Pegasus Risk Management). All proposals were timely received and accepted.
a. Minimum Proposal Requirement Review: The RFP stipulated that the bidders had to meet certain minimum requirements to be considered by the City. The City’s staff reviewed the proposals to determine if the following minimum requirements were met:
1) at least five (5) years’ experience in California adjusting claims; 2) claims service office located in close proximity to the San Francisco Bay Area or Sacramento Valley area, and bidder provided assurance of maintaining reasonable staffing for the location; and
3) presented a certificate of insurance evidencing that the proposer met the City’s insurance requirements.
December 6, 2022
b. Current Contractor: AIMS is the current third-party administrator (TPA) of the City’s workers’ compensation claims. It currently provides two (2) full time dedicated examiners and additional resources to handle future medical and medical-only claims. AIMS has been instrumental in helping the City establish its Alternative Dispute Resolution (ADR) program and is viewed as a true business partner in the execution of such.
3. Evaluation Chart:
City staff’s evaluation of the five (5) bidders narrowed the options down to two (2) potential contractors, AIMS and Intercare.
TPA/Managed
Care Name
TPA 3-Year TPA
Fees
Utilization Review
Cost
Overall
Selection
Ranking
AIMS $1,885,447 $95 Nurse Review
$225 Physician Review 1
Intercare
$1,982,310,
plus $10,000
conversion fee
$125 Nurse Review
$225 Physician Review 2
4. Managed Care Services:
The RFP also included an option for the City to receive proposals for managed care services from firms independent of the claims adjusting firms. Managed care services include bill review, utilization review, and nurse case management services. The City review committee determined that the managed care services proposals submitted by the finalists for the claims adjusting services were sufficient, as they incorporated all elements of the managed care services as well.
The City is currently more than satisfied with the services of Allied Managed Care, as proposed and provided through AIMS.
5. Recommendation:
Based on its review of the five (5) bidders and the above chart showing the cost of services for AIMS and Intercare, City staff recommends awarding the contract to AIMS for a period of three years. The pricing from AIMS is 4.5 percent above current contract pricing and increases by 3 percent on an annual basis thereafter.
At the end of th the contract term (January 1, 2023 – December 30, 2025), the City will have the option to extend the contract term for two years at a additional 3 percent cost each year, for a total payment limit not to exceed $1,353,120.
December 6, 2022
CONCLUSION:
For the past ten (10) years, the City has experienced a very satisfactory relationship with the incumbent contractor, AIMS. The examiners have established relationships with our employees and have proved themselves to be a true business partner in their efforts to help the City establish its Alternative Dispute Resolution program handling workers’ compensation claims and providing services to employees. While the bids were competitive, it is staff’s recommendation to continue the relationship with AIMS.
DOCUMENTS ATTACHED:
Attachment 1 – Original Contract
Attachment 2 – RFP
CITY OF RICHMOND
STANDARD CONTRACT
Department: Project Manager:
Project Manager E-mail:
Project Manager Phone No:
PR No: Vendor No: P.O./Contract No:
Description of Services:
The parties to this STANDARD CONTRACT do mutually agree and promise as follows:
1. Parties. The parties to this Contract are the City of Richmond (herein referred to as the “City”) and the following named Contractor:
Company Name:
Street Address:
City, State, Zip Code:
Contact Person:
Telephone: Email:
Business License No: / Expiration Date:
A California [ ] corporation, [ ] limited liability corporation [ ] general partnership, [ ] limited partnership, [ ] individual, [ ] non-profit corporation, [ ] individual dba as [specify:] , [ ] other [specify:]
2. Term. The effective date of this Contract is and it terminates unless terminated as provided herein.
3. Payment Limit. City’s total payments to Contractor under this Contract shall not exceed $ . City shall not pay for services that exceed the Contract Payment Limit unless a contract amendment has been approved by the City Council or City Manager.
4. Contractor’s Obligations. Contractor shall provide those services and carry out that work described in the Service Plan (Exhibit A) which is attached hereto and is incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.
5. City's Obligations. City shall make to the Contractor those payments described in the Payment Provisions (Exhibit B) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.
6. Authorized Representatives and Notices. This Contract is subject to the Authorized Representatives and Notices Provisions (Exhibit C) which are attached hereto and are incorporated herein by reference.
7. General Conditions. This Contract is subject to the General Conditions (Exhibit D) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein.
8. Special Conditions. This Contract is subject to the Special Conditions (Exhibit E) (if any) which are attached hereto and are incorporated herein by reference, subject to all the terms and conditions contained or incorporated herein. (Note:
other than Public Works contracts, the City will agree to Special Conditions only in unusual circumstances.)
9. Insurance Provisions. This Contract is subject to the Insurance Provisions (Exhibit F) which are attached hereto and are incorporated herein by reference.
10. Signatures. These signatures attest the parties' Contract hereto:
CITY OF RICHMOND CONTRACTOR:
a municipal corporation
By:
(* The Corporation Chairperson of the Board,
President or Vice President should sign below)
Title: By:
I hereby certify that this Contract Title:
has been approved by City Council.
Date Signed:
B y :
City Clerk
(* The Corporation Chief Financial Officer,
Secretary or Assistant Secretary should sign below)
Approved as to form:
B y :
B y : T i t l e :
City Attorney
Date Signed:
(NOTE: Pursuant to California Corporations
Code Section 313, if Contractor is a corporation
or nonprofit organization, this Contract (1) must
be signed by (a) the Chairperson of the Board,
President or Vice-President
and (b) the
Secretary any Assistant Secretary, the Chief
Financial Officer or any Assistant Treasurer.
LIST OF ATTACHMENTS:
Service Plan Exhibit A
Payment Provisions Exhibit B
Authorized Representatives and Notices Exhibit C
General Conditions Exhibit D
Special Conditions Exhibit E
Insurance Provisions Exhibit F
Standard Contract/EJ/TE 9-26-07
For the Contract between the City of
Richmond and
EXHIBIT A
SERVICE PLAN
Contractor shall, to the satisfaction of the , perform the following services and be compensated as outlined below:
For the Contract between the City of
Richmond and
EXHIBIT B
PAYMENT PROVISIONS
{PLEASE NOTE THAT THE CITY OF RICHMOND SHALL NOT PAY FOR SERVICES
THAT EXCEED THE CONTRACT PA YMENT LIMIT UNLESS A CONTRACT
AMENDMENT HAS BEEN APPROVED BY THE CITY COUNCIL OR THE CITY MANAGER}
1. Provided Contractor is not in default under this Contract, Contractor shall be compensated as provided below.
2. Any and all payments made pursuant to this Contract shall be subject to the Contract Payment Limit. The Payment Limit includes expenses (phones, photo copying, meals and travel etc). Invoices, shall be adequately detailed, based on accurate records, and be in a form reasonably satisfactory to the City. Contractor may be required to provide back-up material upon request.
3. Contractor shall submit timely invoices to the following address:
Attention: City of Richmond, Finance Department - Accounts Payable Project Manager: Department:
PO Box 4046
Richmond, CA 94804-0046
4. All invoices that are submitted by Contra ctor shall be subject to the approval of the City’s Project Manager, before payments shall be authorized.
5. The City will pay invoice(s) within 45 days a fter completion of services to the City’s satisfaction. The City shall not pay late fees or interest.
6. A Richmond business license shall be obtained before any payment under this Contract shall be authorized and the business license must be kept current during the term of this Contract for payments to continue to be authorized.
7. All insurance coverage required by this Contract shall be provided by the Contractor before this Contract shall be executed by the City. The insurance coverage must be kept current during the term of this Contract for payments to continue to be authorized.
For the Contract between the City of
Richmond and
EXHIBIT C
AUTHORIZED REPRESENTATIVES AND NOTICES
1. Notices
. All notices, demands, statements, or communications provided for by this Contract shall be in writing and may be delivered by deposit in the United States mail, postage prepaid. Notices to the City shall be addressed to the Department Head and (as delineated below in section 1.1) to the project manager responsible for the administration of or the supervision of the scope of work under this Contract. Notices to the Contractor shall be addressed to the party designated by Contractor (as delineated below in section 1.2). Notice shall be deemed delivered (a) upon personal delivery; (b) as of the fifth business day after mailing by United States certified mail, postage prepaid, addressed to the proper party; or (c) as of 12:00 p.m. on the second business day immediately after the day it is deposited with and accepted by Federal Express, or a similar overnight courier service, addressed to the proper party and marked for next business day morning delivery. For the purposes of this Contract, a "business day" means any day Monday through Friday that is not a holiday recognized by the federal government or the State of California.
1. 1 CITY hereby designates as its Authorized Representative the Project Manager whose name and address are as follows:
City of Richmond
Richmond, CA 94804-0046
1. 2 CONTRACTOR hereby designates as its Authorized Representative the Project Manager whose name and address are as follows:
General Conditions/EJ/TE 01-19-11 1 of 13
EXHIBIT D
GENERAL CONDITIONS
1. Independent Contractor . Contractor acknowledges, represents and warrants that Contractor is not a regular or temporary employee, joint venturer or partner of the City, but rather an independent Contractor. This Contract shall not be construed to create an agency, servant, employee, partnership, or joint venture relationship. As an independent Contractor, Contractor shall have no authority to bind City to any obligation or to act as City's agent except as expressly provided herein. Due to the independent Contractor relationship created by this Contract, City shall not withhold state or federal income taxes, the reporting of which shall be Contractor's sole responsibility.
2. Brokers . Contractor acknowledges, represents and warrants that Contractor has not hired, retained or agreed to pay any entity or person any fee, commission, percentage, gift, or any other consideration, contingent upon or resulting from the award or making of this Contract.
3. City Property . The rights to applicable plans, drawings, reports, calculations, data, specifications, videos, graphics or other materials prepared for or obtained pursuant to this Contract, which, upon request, are to be delivered to City within a reasonable time, shall be deemed assigned to City. If applicable, Contractor shall prepare check prints upon request. Notwithstanding the foregoing, Contractor shall not be obligated to provide to City proprietary software or data which Contractor has developed or had developed for Contractor's own use; provided, however, that Contractor shall, pursuant to Section 15 below, indemnify, defend and hold harmless City from and against any discovery or Public Records Act request seeking the disclosure of such proprietary software or data.
4. Patents, Trademarks, C opyrights and Rights in Data
. Contractor shall not
publish or transfer any materials, discoveries, developments, concepts, designs, ideas, know how, improvements, inventions and/or original works of authorship resulting from activities supported by this Contract without the express prior written consent of the City Manager. If anything resulting from activities supported by this Contract is patentable, trademarkable, copyrightable or otherwise legally protectable, City reserves the exclusive right to seek such intellectual property rights. Notwithstanding the foregoing, Contractor may, after receiving City's prior written consent, seek patent, trademark, copyright or other intellectual property rights on anything resulting from activities supported by this Contract. However, City reserves, and Contractor irrevocably grants, a nonexclusive, fully paid-up, royalty-free, assumable, perpetual, worldwide license, with the right to transfer, sublicense, practice and exploit said license and the right to make, have made, copy, modify, make derivative works of, use, sell,
General Conditions/EJ/TE 01-19-11 2 of 13
import, and otherwise distribute under all applicable intellectual properties without restriction of any kind said license.
Contractor further agrees to assist City, at City's expense, in every proper way to secure the City’s rights in any patents, trademarks, copyrights or other intellectual property rights relating thereto, including the disclosure to City of all pertinent information and data with respect thereto. Contractor shall also assist City in the execution of all applications, specifications, oaths, assignments, recordations, and all other instruments which City shall deem necessary in order to apply for, obtain, maintain and transfer such rights, or if not transferable, to waive such rights. Contractor shall further assist City in the execution of all applications, specifications, oaths, assignments, recordations and all other instruments which City shall deem necessary in order to assign and convey to City, and any assigns and nominees the sole and exclusive right, title and interest in and to any patents, trademarks, copyrights or other intellectual property rights relating thereto. Contractor further agrees that its obligation to execute or cause to be executed, when it is in Contractor's power to do so, any such instruments or papers shall continue during and at all times after the end of Contractor's services and until the expiration of the last such intellectual property right. Contractor hereby irrevocably designates and appoints City, and its duly authorized officers, agents and servants, as its agent and attorney-in-fact, to act for and in its behalf and stead to execute and file any such applications and to do all other lawfully permitted acts to further the application for, prosecution, issuance, maintenance or transfer of letters of patents, copyright and other registrations. This power of attorney is coupled with an interest and shall not be affected by Contractor's subsequent incapacity.
5. Inspection
. Contractor's performance, place of business and records pertaining to this Contract are subject to monitoring, inspection, review and audit by authorized representatives of the CITY, the State of California, and the United States Government.
If the project or services set forth in Exhibit A shall be performed on City or other public property, City shall have the right to inspect such work without notice. If such project or services shall not be performed on City or other public property, City shall have the right to inspect such work upon reasonable notice.
6. Services
. The project or services set forth in Exhibit A shall be performed to the full satisfaction and approval of City. In the event that the project or services set forth in Exhibit A are also itemized by price, City, in its sole discretion, may, upon notice to Contractor, delete certain items or services set forth in Exhibit A, in which case there shall be a corresponding reduction in the amount of compensation paid to Contractor.
General Conditions/EJ/TE 01-19-11 3 of 13
Contractor shall, at its own cost and expense, furnish all facilities and equipment necessary for Contractor to complete the project or perform the services required herein, unless otherwise provided in Exhibit A.
7. Records
. Contractor shall keep and make available for inspection and copying by authorized representatives of the City, the State of California, and the United States Government, the Contractor's regular business records and such additional records pertaining to this Contract as may be required by the City.
Contractor shall retain all documents pertaining to this Contract for a period of five (5) years after this C ontract's termination (or for any further period that is required by law) and until all Fede ral or State audits are complete and exceptions resolved for this contract's funding period. Upon request, CONTRACTOR shall make thes e records available to authorized representatives of the CITY, the State of California, and the United States Government.
Contractor shall keep full and detailed accounts, maintain records, and exercise such controls as may be necessary for proper financial management under this Contract. The Contractor’s accounting and control systems shall be satisfactory to City. Contractor's accounting systems shall conform to generally accepted accounting principles and all records shall provide a breakdown of total costs charged under this Contract, including properly executed payrolls, time records, utility bills, invoices and vouchers. The City shall be afforded prompt access to Contractor's records, books, and Contractor shall preserve such project records for a period of at least five (5 years after the termination of this Contract , or for such longer period as may be required by law.
Contractor shall permit City and its authorized representatives and accountants to inspect, examine and copy Contractor's books, records, accounts, correspondence, instructions, drawings, receipts, subcontracts, purchase orders, vouchers, memoranda and other data relating to the project or services set forth in Exhibit A, and any and all data relevant to this Contract at any reasonable time for the purpose of auditing and verifying statements, invoices, or bills submitted by Contractor pursuant to this Contract and shall provide such assistance as may be reasonably required in the course of such inspection. Contractor shall also allow City access to the record keeping and accounting personnel of Contractor.
City further reserves the right to examine and re-examine said books, records, accounts, and data during the five (5 year period following the termination of this Contract; and Contractor shall in no event dispose of, destroy, alter, or mutilate said books, records, accounts, and data in any manner whatever for five (5 years after the termination of this Contract.
General Conditions/EJ/TE 01-19-11 4 of 13
Pursuant to California Government Code § 10527, the parties to this Contract shall be subject to the examination and audit of representatives of the Auditor General of the State of California for a period of three (3) years after final payment under this Contract. The examination and audit shall be confined to those matters connected with the performance of this Contract including, but not limited to, the cost of administering this Contract.
8. Changes and Extra Work . All changes and/or extra work under this Contract shall be performed and paid for in accordance with the following:
Only the City Council or the City Manager may authorize extra and/or changed work. Contractor expressly recognizes that other City personnel are without authorization to either order extra and/or changed work or waive contract requirements. Failure of Contractor to secure the authorization for such extra and/or changed work shall constitute a waiver of any and all right to adjustment in contract price due to such unauthorized work and Contractor thereafter shall be entitled to no compensation whatsoever for performance of such extra and/or changed work.
If Contractor is of the opinion that any work which Contractor has been directed to perform is beyond the scope of this Contract and constitutes extra work, Contractor shall promptly notify City of the fact. The City shall make a determination as to whether or not such work is, in fact, beyond the scope of this Contract and constitutes extra work. In the event that City determines that such work does constitute extra work, City shall provide extra compensation to Contractor on a fair and equitable basis. A change order or Contract Amendment providing for such compensation for extra work shall be negotiated between City and Contractor and executed by Contractor and the appropriate City official.
In the event City determines that such work does not constitute extra work, Contractor shall not be paid extra compensation above that provided herein and if such determination is made by City staff, said determination may be appealed to the City Council; provided, however, a written appeal must be submitted to the City Manager within five (5) days after the staff's determination is sent to Contractor. Said written appeal shall include a description of each and every ground upon which Contractor challenges the staff's determination.
9. Additional Assistance
. If this Contract requires Contractor to prepare
plans and specifications, Contractor shall provide assistance as necessary to resolve any questions regarding such plans and specifications that may arise during the period of advertising for bids, and Contractor shall issue
General Conditions/EJ/TE 01-19-11 5 of 13
any necessary addenda to the plans and specifications as requested. In the event Contractor is of the opinion that City's requests for addenda and assistance is outside the scope of normal services, the parties shall proceed in accordance with the changes and extra work provisions of Section 8 of these General Conditions.
10. Professional Ability. Contractor acknowledges, represents and warrants that Contractor and its employees are skilled and able to competently provide the services hereunder, and possess all professional licenses, certifications, and approvals necessary to engage in their occupations.
City has relied upon the professional ability and training of Contractor as a material inducement to enter into this Contract. Contractor shall perform in accordance with generally accepted professional practices and standards of Contractor's profession. In the event that City, in its sole discretion, desires the removal of any person employed or retained by Contractor to perform services hereunder, such person shall be removed immediately upon receiving notice from City.
11. Business License
. Contractor shall obtain a Richmond Business License
before performing any services required under this Contract. The failure to so obtain such license shall be a material breach of this Contract and grounds for immediate termination by City; provided, however, that City may waive the business license requirement in writing under unusual or extraordinary circumstances without necessitating any modification of this Contract to reflect such waiver.
12. Termination Without Default. Notwithstanding any provision herein to the contrary, City may, in its sole and absolute discretion and without cause, terminate this Contract at any time prior to completion by Contractor of the project or services hereunder, immediately upon written notice to Contractor. Contractor may terminate this Contract at any time in its sole and absolute discretion and without cause upon 30 days' written notice to City. In the event of termination by either party, Contractor shall be compensated for: (1) all authorized work satisfactorily performed prior to the effective date of termination; (2) necessary materials or services of others ordered by Contractor for this Contract, prior to receipt of notice of termination, irrespective of whether such materials or services of others have actually been delivered, provided that Contractor is not able to cancel such orders. Compensation for Contractor in such event shall be determined by City in accordance with the percentage of the project or services completed by Contractor; and all of Contractor's finished or unfinished work product through the time of the City's last payment shall be transferred and assigned to City. Additionally, in the event of such termination, the City may proceed with the work in any reasonable manner it chooses.
General Conditions/EJ/TE 01-19-11 6 of 13
13. Termination in the Event of Default. Should Contractor fail to perform any of its obligations hereunder, within the time and in the manner provided or otherwise violate any of the terms of this Contract, City may immediately terminate this Contract by giving written notice of such termination, stating the reasons for such termination. Contractor shall be compensated as provided in Section 12 of these General Conditions; provided, however, there shall be deducted from such amount the amount of damage, including attorney's fees, expert witness fees and costs, if any, sustained by City by virtue of Contractor's breach of this Contract. Additionally, in the event of such termination, the City may proceed with the work in any reasonable manner it chooses.
14. Conflict of Interest. Contractor acknowledges, represents and warrants that Contractor shall avoid all conflicts of interest (as defined under any federal, state or local statute, rule or regulation, or at common law) with respect to this Contract. Contractor further acknowledges, represents and warrants that no City official or employee has any economic interest, as defined in Title 2, California Code of Regulations §§ 18703.1 through 18703.5, with Contractor that would invalidate this Contract. Contractor acknowledges that in the event that Contractor shall be found by any judicial or administrative body to have any conflict of interest (as defined above) with respect to this Contract, all consideration received under this Contract shall be forfeited and returned to City forthwith. This provision shall survive the termination of this Contract for one (1) year.
15. Indemnification.
(a) If this Contract is a contract for design professional services subject to California Civil Code Section 2782.8(a) and Contractor is a design professional, as defined in California Civil Code Section 2782.8(b)(2), Contractor shall hold harmless, defend and indemnify the City, its officers, agents, employees, and volunteers from and against any and all claims, damages, losses, and expenses including attorneys’ fees arising out of, or pertaining to, or relating to the negligence, recklessness, or willful misconduct of the Contractor, except where caused by the active negligence, sole negligence, or willful misconduct of the City. To the fullest extent permitted by law, Contractor shall immediately defend and indemnify the City and its officers, agents, employees, and volunteers from and against any and all liabilities, regardless of nature or type, that arise out of, pertain to, or relate to the negligence, recklessness, or willful misconduct of the Contractor, or its employees, agents, or subcontractors.
Liabilities subject to the duties to defend and indemnify include, without limitation, any and all claims, losses, damages, penalties, fines, and judgments; associated investigation and administrative expenses; defense costs, including but not limited to reasonable attorneys’ fees; court costs; and costs of alternative dispute resolution. Contractor’s obligation to
General Conditions/EJ/TE 01-19-11 7 of 13
indemnify applies unless it is finally adjudicated that the liability was caused by the sole active negligence or sole willful misconduct of an indemnified party.
(b) If this Contract is not a contract for design professional services subject to California Civil Code Section 2782.8(a) or Contractor is not a design professional as defined in California Civil Code Section 2782.8(b)(2), Contractor shall indemnify, defend, and hold harmless the City, its officers, agents, employees and volunteers from any and all claims, suits, or actions of every name, kind and description, brought forth on account of injuries to or death of any person or damage to property arising from or connected with the willful misconduct, negligent acts, errors or omissions, ultra-hazardous activities, activities giving rise to strict liability, or defects in design by Contractor or any person directly or indirectly employed by, or acting as, the agent for Contractor in the performance of this Contract, including the concurrent or successive passive negligence of the City, its officers, agents, employees or volunteers.
(c) It is understood that the duty of Contractor to indemnify and hold harmless includes the duty to defend as set forth in Section 2778 of the California Civil Code. Contractor shall be obligated to defend, in all legal, equitable, administrative, or special proceedings, with counsel approved by the City, the City and its officers, agents, employees, and volunteers, immediately upon tender to Contractor of the claim in any form or at any stage of an action or proceeding, whether or not liability is established. An allegation or determination that persons other than Contractor are responsible for the claim does not relieve Contractor from its separate and distinct obligation to defend under this Section 15. The obligation to defend extends through final judgment, including exhaustion of any appeals. The defense obligation includes an obligation to provide independent counsel if Contractor asserts that liability is caused in whole, or in part, by the negligence or willful misconduct of an indemnified party. (d) The review, acceptance or approval of the Contractor’s work or work product by any indemnified party shall not affect, relieve or reduce the Contractor’s indemnification or defense obligations. This Section 15 survives completion of the services or the termination of this Contract.
The provisions of this Section 15 are not limited by, and do not affect, the provisions of this Contract relating to insurance.
(e) Acceptance of insurance certificates and endorsements required under this Contract does not relieve Contractor from liability under this Section
15. This Section 15 shall apply whether or not such insurance policies are determined to be applicable to any such damages or claims for damages.
16. Safety
. Contractor acknowledges that the City is committed to the highest standards of workplace safety. Contractor shall perform all work hereunder in full compliance with applicable local, state and federal safety requirements including but not limited to Occupational Safety and Health Administration requirements, and shall assume sole and complete
General Conditions/EJ/TE 01-19-11 8 of 13
responsibility for the safety of Contractor's employees and any subContractor's employees. If a death, serious personal injury or substantial property damage occurs in connection with the performance of this Contract, Contractor shall immediately notify the City by telephone.
17. Insurance. Insurance requirements are set forth in Exhibit F to this Contract. Contractor shall abide by the insurance requirements set forth in said Exhibit F.
18. Non-Liability of Officials and Employees of the City. No official or employee of the City shall be personally liable for any default or liability under this Contract.
19. Compliance with Laws. Contractor shall comply with all federal, state and local laws, statutes, ordinances, rules and regulations, and the orders and decrees of any courts or administrative bodies or tribunals, with respect to this Contract, including without limitation environmental laws, employment discrimination laws and prevailing wage laws. Compliance under this provision includes compliance with all provisions of the Richmond Municipal Code ("Municipal Code"), including Chapters 2.50, 2.52, 2.56, and 2.60, if applicable.
Contractor acknowledges that under § 2.60.070 of the Municipal Code ("Living Wage Ordinance"), Contractor shall promptly provide to City documents and information verifying its compliance with the Living Wage Ordinance. Also as prescribed in § 2.60.070, Contractor shall notify each of its affected employees with regards to the wages that are required to be paid pursuant to the Living Wage Ordinance.
Contractor shall comply with § 2.28.030 of the Municipal Code, obligating every Contractor or subcontractor under a contract or subcontract with the City for public work or for goods or for services to refrain from discriminatory employment or subcontracting practices on the basis of race, color, sex, sexual orientation, religious creed, national origin or ancestry of any employee, any applicant for employment or any potential subcontractor.
Contractor acknowledges that the City’s Drug Free Workplace Policy, Violence in the Workplace Policy and the Policy Against Workplace Harassment, are available on the City’s website at
http://www.ci.richmond.ca.us/workplacepolicies
. Contractor agrees to
abide by the terms and conditions of said policies.
20. Limitations upon Subcontracting and Assignment. This Contract binds the heirs, successors, assigns and representatives of Contractor. The Contractor shall not enter into subcontracts for any work contemplated
General Conditions/EJ/TE 01-19-11 9 of 13
under this Contract and shall not assign this Contract, nor any portion hereof or monies due or to become due, without the prior written consent of the City Council or its designee.
Contractor acknowledges that the services which Contractor shall provide under this Contract are unique, personal services which, except as otherwise provided herein, Contractor shall not assign or sublet to any other party without the prior written approval of City, which approval may be withheld in City's sole and absolute discretion. In the event that City, in writing, approves any assignment or subletting of this Contract or the retention of subcontractors by Contractor, Contractor shall provide to City upon request copies of each and every subcontract contract prior to the execution thereof by Contractor and subcontractor. Any assignment by Contractor of any or all of its rights under this Contract without first obtaining City's prior written consent shall be a default under this Contract.
The sale, assignment, transfer or other disposition of any of the issued and outstanding capital stock of Contractor (if applicable), or of the interest of any general partner or joint venturer or syndicate member if Contractor is a partnership or joint-venture or syndicate, which shall result in a change of control of Contractor, shall be deemed an assignment. For this purpose, control shall mean fifty percent or more of the voting power or twenty-five percent or more of the assets of the corporation, partnership or joint-venture.
21. Integration
. This Contract constitutes the entire agreement between the parties concerning the subject matter hereof and supersedes any previous oral or written agreement; provided, however, that correspondence or documents exchanged between Contractor and City may be used to assist in the interpretation of the Exhibits to this Contract.
22. Modifications and Amendments. This Contract may be modified or amended only by a change order or Contract Amendment executed by both parties and approved as to form by the City Attorney.
23. Conflicting Provisions. In the event of a conflict between these General Conditions and those of any Exhibit or attachment hereto, these General Conditions shall prevail; provided, however, that any Special Conditions as set forth in Exhibit E shall prevail over these General Conditions. In the event of a conflict between the terms and conditions of any two or more Exhibits or attachments hereto, those prepared by City shall prevail over those prepared by the Contractor, and the terms and conditions preferred by the City shall prevail over those preferred by the Contractor.
24. Non-exclusivity. Notwithstanding any provision herein to the contrary, the services provided by Contractor hereunder shall be non-exclusive, and
General Conditions/EJ/TE 01-19-11 10 of 13
City reserves the right to employ other Contractors in connection with the project.
25. Exhibits. All Exhibits hereto are made a part hereof and incorporated herein by reference; provided, however, that any language in Exhibit A which does not pertain to the project description, proposal, scope of services, or method of compensation (as applicable) , or any corresponding responsibilities of City, shall be deemed extraneous to, and not a part of, this Contract.
26. Force Majeure. Neither party hereto shall be considered in default in the performance of its obligations hereunder to the extent that the performance of such an obligation is prevented or delayed by reason of acts of God, strikes, boycotts, lock-outs, inability to procure materials not related to the price thereof, failure of power, restrictive governmental laws and regulations enacted after the date of this Contract, riots, civil unrest, acts of terrorism, insurrection, war, declaration of a state or national emergency or other reasons of a like nature not within the reasonable control of such party.
27. Time of the Essence. Time is of the essence of this Contract. Contractor and City agree that any time period set forth in Exhibit A represents their best estimates with respect to completion dates and both Contractor and City acknowledge that departures from the schedule may occur.
Therefore, both Contractor and City will use reasonable efforts to notify one another of changes to the schedule. Contractor shall not be responsible for performance delays caused by others, or delays beyond Contractor's control, and such delays shall extend the times for performance of Contractor's work.
28. Confidentiality. Contractor agrees to comply with, and to require its employees, agents and partners to comply with, all applicable State or Federal statutes or regulations respecting confidentially, including but not limited to, the identity of persons served under this Contract, their records, or services provided them, and assures that:
All applications and records concerning any individual made or kept by Contractor or any public officer or agency in connection with the administration of or relating to services provided under this Contract will be confidential, and will not be open to examination for any purposes not directly connected with the administration of such service.
No person will publish or disclose or permit or cause to be published or disclosed, any list of persons receiving services, except as may be required in the administration of such service.
General Conditions/EJ/TE 01-19-11 11 of 13
29. Third Parties. Nothing herein shall be interpreted as creating any rights or benefits in any third parties. For purposes hereof, transferees or assignees as permitted under this Contract shall not be considered "third parties."
30. Governing Law. This Contract shall be construed in accordance with the law of the State of California without regard to principles of conflicts of law.
This Contract is made in Contra Costa County, California, and any action relating to this Contract shall be instituted and prosecuted in the courts of Contra Costa County, California.
31. Nonrenewal. Contractor understands and agrees that there is no representation, implication, or understanding that the services provided by Contractor under this Contract will be purchased or renewed by the City under a new contract following expiration or termination of this Contract, and waives all rights or claims to notice or hearing respecting any failure by City to continue the purchase of all or any failure to continue purchase of all or any such services from Contractor.
32. Claims. Any claim by Contractor against City hereunder shall be subject to Government Code §§ 800 et seq. The claims presentation provisions of said Act are hereby modified such that the presentation of all claims hereunder to the City shall be waived if not made within six months after accrual of the cause of action.
33. Interpretation. This Contract shall be interpreted as if drafted by both parties.
34. Warranty. In the event that any product shall be provided to the City as part of this Contract, Contractor warrants as follows: Contractor possesses good title to the product and the right to transfer the product to City; the product shall be delivered to the City free from any security interest or other lien; the product meets any specifications contained herein; the product shall be free from material defects in materials and workmanship under normal use for a period of one (1) year from the date of delivery; and the product shall be fit for its intended purpose(s). Notwithstanding the foregoing, consumable and maintenance items (such as light bulbs and batteries) shall be warranted for a period of one hundred and eighty (180) days from the date of delivery. All repairs during the warranty period shall be promptly performed by Contractor, at Contractor's expense, including shipping.
35. Severability. In the event that any of the provisions or portions or applications thereof of this Contract are held to be unenforceable or invalid by any court of competent jurisdiction, City and Contractor shall negotiate an equitable adjustment in the provisions of the Contract with a view
General Conditions/EJ/TE 01-19-11 12 of 13
toward effecting the purpose of this Contract, and the validity and enforceability of the remaining provisions or portions or applications thereof, shall not be affected thereby.
36. Authority. City warrants and represents that the signatory hereto (the Mayor of the City of Richmond or the City Manager) is duly authorized to enter into and execute this Contract on behalf of City. The party signing on behalf of Contractor warrants and represents that he or she is duly authorized to enter into and execute this Contract on behalf of Contractor, and shall be personally liable to City if he or she is not duly authorized to enter into and execute this Contract on behalf of Contractor.
37. Waiver. The waiver by City of any breach of any term or provision of this Contract shall not be construed as a waiver of any subsequent breach.
Inspections or approvals, or statements by any officer, agent or employee of the City relating to the Contractor’s performance, or payments therefore, or any combination of these acts, shall not relieve the Contractor’s obligation to fulfill this Contract as prescribed; nor shall the City be thereby stopped from bringing any action for damages or enforcement arising from any failure to comply with any of the terms and conditions of this Contract.
38. Possessory Interest. If this Contract results in the Contractor having possession of, claim to or right to the possession of land or improvements, but does not vest ownership of the land or improvements in the same person, or if this Contract results in the placement of taxable improvements on tax exempt land (Revenue and Taxation Code 107), such interest or improvements may represent a possessory interest subject to property tax, and Contractor may be subject to the payment of property taxes levied on such interest.
39. Performance and Final Acceptance.
Contractor represents that it is experienced, qualified, registered, licensed, equipped, organized and financed to perform the services under this Contract.
Contractor shall perform the services under this Contract with that degree of skill and judgment normally exercised by professional firms performing services of a similar nature in the State of California, and shall be responsible for the professional quality, technical accuracy and coordination of the services it performs under this Contract. In addition to the other rights and remedies which City may have, Contractor shall, at its own expense, correct any services which fail to meet the above standard.
General Conditions/EJ/TE 01-19-11 13 of 13
City shall provide Contractor an opportunity to cure errors and omission which may be disclosed during the review of submittals, with no increase in the authorized Contract Payment Limit. Should Contractor fail to make necessary corrections in a timely manner, such corrections shall be made by the City and the cost thereof shall be charged to Contractor.
If warranted, City shall determine, and Contractor may request such determination, that Contractor has satisfactorily completed performance of this Contract. Upon such determination, City shall issue to Contractor a written Notice of Final Acceptance, after which Contractor shall not incur further costs under this Contract. Contractor shall respond to such Notice of Final Acceptance by executing and submitting to City a Release and Certificate of Final Payment.
40. Survival
. The rights and obligations of the parties which by their nature survive termination or completion of the services covered by this Contract shall remain in full force and effect after termination or completion.
For the Contract between the City of
Richmond and
EXHIBIT E
SPECIAL CONDITIONS
The General Conditions are hereby amended to include the following modifications and/or provisions (if applicable):
For the Contract between the City of
Richmond and
EXHIBIT F
INSURANCE PROVISIONS
During the entire term of this Contract and any extension or modification thereof, the CONTRACTOR shall keep in effect insurance policies meeting the insurance requirements specified in the insurance provisions which are attached hereto and incorporated herein by this reference.
March 22, 2022 0
ELECTRONIC COPY
PROPOSAL FOR
City Of Richmond Third Party Workers'
Compensation Claims Administration
and Managed Care Services
Contact: Lynn Cavalcanti, Sr. VP Operations
10445 Old Placerville Road, Sacramento, CA 95827
Phone: (916) 563-1900
[email protected]
Attachment I
March 22, 2022 1
COVER LETTER
March 22, 2022
Laura Marquez, Risk Management
City of Richmond / Human Resources Department
Risk Management Division
Re: Request for Proposal for Third Party Workers’ Compensation Claims Administration and Managed Care Services
Dear Mrs. Marquez:
We value the relationship we have established with the City of Richmond (“City”) over the past nine plus years. This relationship involves a high level of communication, trust, and commitment. It has evolved into a true partnership, which is imperative to the success of its program.
Acclamation Insurance Management Services, Inc. (AIMS) is submitting this proposal in the hop es of continuing this partnership to provide services related to the City’s Workers’ Compensation Program. We believe the following proposal response to the City’s Request for Proposal (RFP), will not only meet but exceed the identified requirements.
As a Third Party Administrator (TPA), AIMS is the industry-leading preferred provider of Loss Portfolio Management® services. AIMS is part of the wholly owned subsidiary organization of LJR Holdings, Inc. (LJRH), which began as a family business and was originally founded in 1973 as Leonard J. Russo Insurance Services, Inc. LJRH is a privately held/owned organization incorporated in the State of California. Services include claims administration (both workers’ compensation and liability) via AIMS and medical cost containment via our sister company, Allied Managed Care (AMC), for both public and private entities which includes those organizations that are self -insured, self- administered, throughout the Continental United States and Hawaii. AIMS currently has 183 employees and AMC has 73 employees for a total of 266.
AIMS currently has over 230 Clients throughout California that range in size from small utility districts, many mid-sized Cities, to a Joint Powers Authority (JPA), which consists of 53 cities. We have been providing claims administration services for two-thirds of these Clients for greater than 10 years and 80 percent of our clients are Public Entities. We currently administer over 12,000 open claims for our California -based Clients.
Organizationally, we have a tremendous level of expertise in working with self -insured public agencies. Our technical personnel are well versed and trained in those special areas of workers’ compensation that relate to public employees, safety officers / firefighters (4850), multiple salary continuation scenarios, Public Employee Retirement System (PERS) and other public employee retirement programs and union involvement.
We have continued to partner with the City of Richmond to transition their Police Department ADR Program back into the Statutory System, which was a first for everyone (the State, City of Richmond and AIMS). And we continue to work with the City of Richmond to improve the Fire Department’s Program by providing alternative solutions to Attachment I
March 22, 2022 2
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
the ADR process. We are excited with the possibility to continue this work with the City of Richmond.
AIMS has a total of eight (8) office locations. Seven (7) of the offices are located in California, two (2) offices in Sacramento, (Corporate Office and Branch Office), Concord Office, Fresno Office, Bakersfield Office, Santa Clarita Office and Pomona Office. We also have a branch office in Honolulu Hawaii.
The AIMS Concord Office located at 1819 Willow Pass Road, Concord Ca 94521, Phone:
925-687-2822, our closest office to the City of Richmond will continue to service The City’s Program if we are the successful bidder.
Our senior operating management team has reviewed the City’s RFP in detail including the sections pertaining to the Introduction, Minimum Qualifications, Scope of Services, Proposal Requirements, Insurance Requirements, as well as the City Or dinances, Standard Services Agreement and the contents in between. Our management team has determined that we can and will fully comply with the RFP requirements as outlined without exception.
Our proposal reflects our continued commitment to provide the City with superior services and competitive rates and is valid for at least 180 days. We strongly believe, based on the experience of our team, that our solutions and work practices provide the City with excellent value. The quality of our service and our reputation can be confirmed by the references we’ve listed in our proposal.
Our designated contact for the City and for this response is Lynn Cavalcanti, Sr. VP Operations AIMS. The location of our Corporate Office and Lynn’s contact information is 10445 Old Placerville Road, Sacramento, CA 95827 / Direct: (707) 685-1138 or Corporate Office: (916) 563-1900 x259 / Email: [email protected].
As the person legally authorized to bind AIMS to the requirements in the City’s RFP, the City of Richmond can be assured it will have my full support and commitment that we can and will deliver as promised. I am always be available not only to respond to any problems or concerns but to share my insight on our solutions and offerings. Please feel free to contact me directly. I can be reached directly at (916) 563 -1900 x207 / Toll free:
(800) 444-4157 / Email: [email protected].
Also, AIMS would be delighted for an opportunity to answer any questions you may have regarding our RFP response and to further explore how we can customize a solution to enhance the overall success of the City’s program.
Sincerely,
Dominic L. Russo, President & CEO AIMS
Attachment I
March 22, 2022 3
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Our Proposal
Attachment I
March 22, 2022 4
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
TABLE OF CONTENTS
COVER LETTER ................................ ................................ ................................ ....................... 1 PROPOSAL FORMAT GUIDELINES ................................ ................................ ......................... 6 A. Vendor Cover Letter ................................ ................................ ................................ .............. 6 B. Background and Project Summary Section ................................ ................................ ............ 7 C. Methodology Section ................................ ................................ ................................ ............12 D. Staffing ................................ ................................ ................................ ................................ .13 E. Qualifications ................................ ................................ ................................ ........................16 F. Cost Information ................................ ................................ ................................ ...................17 G. Value Added Services ................................ ................................ ................................ ..........17 H. Contractor Assignment of Sub-Contract ................................ ................................ ...............17 I. Previous Contracts with the City of Richmond ................................ ................................ ........17 J. Exceptions to this Request for Proposals ................................ ................................ ..............18 K. Statement of Impartiality and Disclosure ................................ ................................ ...............18 Proposer Qualifications ................................ ................................ ................................ .............18
EXHIBITS
EXHIBIT 1 - Organizational Charts
EXHIBIT 2 - Legislative Advocate Report
EXHIBIT 3 – AIMS Transition/Implementation Plan
EXHIBIT 4 – Team Resumes
EXHIBIT 5 – Client References (CONFIDENTIAL)
EXHIBIT 6 – COST PROPOSAL
EXHIBIT 7 – Settlement Authority Request Worksheet
EXHIBIT 8 – AIMS4EXCELLENCE TOC (CONFIDENTIAL)
EXHIBIT 9 – SCOPE OF SERVICES DETAIL
EXHIBIT 10 – AIMS Sample Claims Report (2 page Sample each) EXHIBIT 11 - SSAE 18 Reports SOC1 & SOC2 Reports (CONFIDENTIAL) Attachment I
March 22, 2022 5
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
EXHIBIT 12 – URAC Reports
EXHIBIT 13 – UR Audits (CONFIDENTIAL)
EXHIBIT 14 – Certificate of Insurance
EXHIBIT 15 – PROPOSER QUALIFICATIONS
Attachment I
March 22, 2022 6
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
PROPOSAL FORMAT GUIDELINES
The proposal should be concise, well organized, and demonstrate the proposer’s qualifications and experience applicable to the Project. The proposal shall be limited to 15 double-sided pages (8.5 inches x 11 inches), inclusive of graphics, forms, pictures, photographs, dividers, etcetera, but not of cost proposal, resumes, required forms, certifications, front and back covers, or letters of commitment from sub -consultants. The required font size is 12 point, with minimum left and right margins of one-inch, and top and bottom margins of 0.7 inches.
Each proposal will adhere to the following order and content of sections. Proposal should be straightforward, concise and provide “layman” explanations of technical terms that are used.
Emphasis should be concentrated on conforming to the RFP instructions, responding to the RFP requirements, and on providing a complete and clear description of the offer.
AIMS responses to the City of Richmond (“City”) Request for Proposal (RFP) questions follow the guidelines specified in the City’s RFP to provide “Third Party Workers’ Compensation Claims Administration and Managed Care Services”. The RFP text has been extracted verbatim and is in black font and AIMS responses are in a blue 12-point Arial font.
The AIMS management team has reviewed the conditions identified in this section and implicitly agrees to them. We believe our proposal is complete and none of our responses are conditional. If there is a question about the interpretation of one our responses, AIMS would welcome the opportunity to address and provide clarification for the City.
Also, we capitalize the word, “Client” in our answers to signify the integral role and respect we have for these relationships.
Proposals, which appear unrealistic in the terms of technical commitments, lack of technical competence or are indicative of failure to comprehend the complexity and risk of this contract, may be rejected. The following proposal sections are to be included in the Vendor’s response A. Vendor Cover Letter
A cover letter, not to exceed three pages in length, should summarize key elements of the proposal and shall:
Confirm that all elements of this RFP have been reviewed and understood. Include a statement of intent to perform the services as outlined. Express company’s willingness to enter into an agreement under the terms and conditions prescribed by this RFP, insurance requirements and in the sample City or Richmond Standard Contract (Services Agreement). Submit a written description and brief history of the company’s experiences, qualifications and successes in providing California services described Attachment I
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Care Services
herein. Please indicate the number of employees, client base and location of offices.
Indicate the address and telephone number of the vendor’s office located nearest to Richmond, California and the office from which the project will be managed.
Confirm that vendor has a minimum of three (3) years verifiable California experience.
Stipulate that the proposal price will be valid for a period of at least 180 days.
Identify a single person for contact during the RFP review process; and Cover letter shall be signed by an authorized official of the company.
Our Cover Letter precedes this content and includes the name of Lynn Cavalcanti, Sr.
VP Operations, who may be contacted during the evaluation period. The requested information is provided below.
NAME / TITLE: Lynn Cavalcanti, Sr. VP Operations
ADDRESS: 10445 Old Placerville Road, Sacramento, CA 95827 EMAIL: [email protected]
PHONE: Direct (707) 685-1138 or Corporate Office (916) 563-1900 x259 Also, our Cover Letter is signed by Dominic Russo, President & CEO of AIMS /Allied Managed Care, Inc. (AMC). As an officer of the Company, Dominic is authorized to bind the offering of services and cost terms provided in our proposal. His contact information is provided in the cover letter as requested.
B. Background and Project Summary Section
The Background and Project Summary Section should describe your understanding of the City, the work to be done, and the objectives to be accomplished. Refer to description of services for this RFP.
Background: LJR Holdings, Inc. (LJRH) was incorporated in July 1996 in California to act as a holding company for its wholly owned operating subsidiaries : Acclamation Insurance Management Services, Inc. (AIMS) and Allied Managed Care, Inc. (AMC) , collectively the "Company". As the parent organization to AIMS and AMC, LJRH provides all corporate services to its subsidiaries such as Finance, Human Resources, Information Technology/Support, Marketing and Sales, and Client Information Services. LJRH does not generate revenues and is support ed by allocation methodology from its subsidiary companies.
Attachment I
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Proposal for City of Richmond
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Care Services
The Company was originally founded in 1973 as Leonard J. Russo Insurance Services, Inc. In January of 1990 there was a name change to Acclamation Insurance Management Services, Inc. (AIMS) to be tter reflect the diverse nature of our product offering. AIMS was incorporated in California in March 1990 in conjunction with and just after the name change.
The Company is a diversified service firm, which provides claims services, cost containment, and risk-management information services to insurance companies, self - insured corporations, and government entities throughout the continental United States and Hawaii.
The Company is a family-owned business and primary ownership is divided amongst the immediate family members. Leonard Russo, Chairman of the Board and Dominic Russo, President & CEO are the majority shareholders.
AIMS is a Third Party Administrator (TPA) and the industry-leading preferred provider of Loss Portfolio Management® services, includ ing claims administration (both workers’ compensation and liability) and full service medical cost containment management through our sister company, AMC. AIMS is incorporated in the State of California and as a corporation, has a board of directors and corporate officers.
AIMS has built a reputation as being one of California’s most progressive, Client -centric third party claims administrators in managing employer workers’ compensation loss portfolios. AIMS currently has over 100 Clients throughout California ranging in size from small utility districts to a Joint Powers Authority (JPA) consisting of 53 cities and all sizes in between. AIMS has been providing claims administration services for two -thirds of these Clients for greater than 10 years.
Managed Care: After having worked with other medical management firms, AIMS found that none had a thorough understanding of the needs of a workers’ compensation claims administrator and encouraged its parent company, LJRH, to form a managed care company. So, in 1995, Allied Managed Care, Inc. (AMC) was formed. AMC was first established and incorporated in California in July 1995 to provide professional medical cost containment. Having its finger on the pulse of the workers’ compensation administration issues has put AMC management in a uniquely informed and unique position when it comes to designing programs that improve claims administration workflows and reduce costs while improving injured employee outcomes.
AMC offers Medical Bill Review, Preferred Provide r Organization (PPO) networks, Utilization Review (UR), Nurse Case Management (including telephonic and on -site or field nurse case management), customized Medical Provider Networks (MPN), AlliedRx (Prescription Management), AlliedCare Complete (Early Inte rvention), and CallConnect (Call Center Services).
Qualifications: AIMS currently administers over 12,000 open indemnity claims for our Clients that are based in California. AIMS focus is to provide a program that reinforces Attachment I
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Proposal for City of Richmond
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Care Services
the strategic goals of workfor ce excellence, organizational effectiveness, and fiscal responsibility.
As a California based business, we specialize in the management of California workers’ compensation claims; we focus on identifying, addressing, and managing all areas of the workers ’ compensation program and focused on issues that are more relevant to Clients based in California. As a privately held company, we bring a transparent approach to establishing TPA programs; a unique skill set, and a different perspective versus national and publicly held third party administrators.
All AIMS offices are certified by the State of California to administer workers’ compensation claims by Self Insurance Plans.
AIMS distinguishes itself from other TPA/Managed Care organizations not only by its dedication to providing superior Client service but by its “Loss Portfolio Management®” approach to managing claims programs , which is an overall “management of assets” approach as opposed to merely processing one claim at a time. A true partnership between the Client and the administrator is imperative to the successful management of a workers’ compensation program. Our “Loss Portfolio Management ®” approach ensures that we are always focused on identifying key issues that have a large financial impact on overall claim costs and to proactively utilize all available internal and external cost containment resources to resolve these issues in an expedient fashion. As a Client- driven organization, we deliver measurable financial results to our Clients through intelligent use of innovative technology and a flexible, yet disciplined approach to service delivery with fiscal accountability.
Quality Control (QC) Program: AIMS asserts a strong Quality Control Program, in which we consistently monitor, measure performance, and review the quality of the services being provided to ensure superior Client service and cost saving results for our Clients.
In addition to the standard su pervisory audit, our Internal Audit Unit, headed by Cheryl Agee (Vice President of Workers’ Compensation) will conduct audits against our best practice standards as well as the Client’s Special Handling Instructions. The Audit Unit’s process involves notification that an audit is to be conducted in the Branch or local office.
The Manager will make available all requested information, claim files, logs, contracts, etc. In addition, the Manager shall participate in the actual audit itself. All files with deficiencies and/or recommendations are immediately returned to the Claims Examiner for corrective action. The Claims Managers review the file for compliance at each diary date. The Supervisors carry independent diaries for this purpose. Audit scores are incorporated into Performance Evaluations conducted annually for each employee. The audit conducted by our internal audit unit is comprehensive and takes into consideration all facets of claim file handling.
AIMS will continue to meet with the City periodically to discuss specific file issues and all claim denials will be approved by the Claims Supervisor prior to the denial being made.
Attachment I
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Rules and Regulation Updates: AIMS takes its commitment and responsibility to ensure its management of claims is in adherence with Workers Compensation Laws of California, Governing Statutes and Rules and Regulations of the Department of Industrial Relations, and Client Contract Service agreements while ensuring the appropriate delivery of benefits for injured workers.
To keep up on all legislative and regulatory updates that would affect our business, AIMS employs an independent Legislative Lobbyist/Advocate. AIMS’ legislative advocate is based in Sacramento and their sole function is to serve as the eyes and ears for AIMS and our Clients. We lobby on behalf of our Clients . Having familiarity with numerous legislators as well as access to the Executive Branch of California State Government, the AIMS Legislative/Lobbyist Advocate has been instrumental in helping to shape polic y in the workers’ compensation arena on behalf of our Clients, both in the public and private sectors of industry. Their year-end report on passed and pending legislation is provided to our Clients at no additional cost and has been a valuable primer in keeping our Clients aware of the potential rules and regulations that affect workers’ compensation in the State.
Medicare Second Payer: AIMS has a formal plan in place to comply with the mandatory reporting requirements of Section 111 (“Medicare Secondary Payer”) of the Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA). AIMS’ strategic partner provides Mandatory Insurer Reporting (MIR) Services to our Clients, including State Children’s Health Insurance Program (SCHIP) reporting, and ensures MSP compliance. Our strategic partner is used for all Qualified Referrals (claim settlements determined to require a Medicare Set Aside (MSA), Claim Settlement Allocation (CSA) and other services related to MSP compliance identified in their fee schedule).
Audit Results: AIMS administers all claims for workers' compensation benefits in accordance with the requirements of the workers' compensation laws of the State of California. All AIMS offices are certified by the State of California to administer workers’ compensation claims by Self Insurance Plans. Over the last 40 years, AIMS successfully passes audits conducted by Division of Workers’ Compensation’s Audit Unit, Self - Insurance Plans, California State Association of Counties/Excess Insurance Authority (CSAC-EIA), Loca l Agency Workers’ Compensation Excess Joint Powers Authority (LAWCX), other excess carriers, and Client specific auditors. This demonstrates AIMS qualifications to administer claims in full accordance of applicable rules, regulations, laws, and the City’s Scope of Work to be performed and standards to be followed.
Vendor Panel: AIMS can provide the City with the flexibility to customize a vendor panel or we can recommend vendors that have historically provided the best outcome for our Clients. This appro ach to claims administration has yielded a significant reduction in program costs and overall better results for our Clients. AIMS does not have any limitation in working with outside vendors. Our objective is to help our Client obtain the best value for the needed service.
Carve-Outs: AIMS has expertise and experience in working with our Clients in developing Carve-Outs programs (Alternative Dispute Resolution or ADR) . By working Attachment I
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with our Clients, Unions and employees there is the opportunity to alter the adversarial culture of the worker’s compensation claims process which could result in reducing cost to our Clients as well as speed up the process and improve the experience for the employees. Alternative Dispute Resolution (ADR) carve-outs have proven to significantly decrease the time-lines associated with the statutory workers’ compensation system by:
providing better care to injured workers; reduce time involved to resolve disputes over treating physicians; utilization review; and can all but elimina te lawyers in the system.
Carve-outs allow employers and labor to create a separate track for resolving disputes through mandatory mediation and arbitration before claims can go to the Workers’ Compensation Appeals Board. The parties are free to negotiat e other terms of the program, such as agreed -upon panels of doctors and independent medical Examiners (IME) to prevent disputes before they start, as well as benefit enhancements that go beyond State-mandated minimums. AIMS encourages our qualified Client s to consider this cost saving program.
AIMS Rapid Referral Portal : AIMS has developed and utilizes a web -based communication platform that connects our claims staff with all recommended/allowable service providers. Through this process, we have the abil ity to monitor assignments to preferred providers that are identified and selected for our individual Clients. AIMS has researched and vetted service providers for quality and best-value for our Client and will make our recommendations known to the City. The service provider “panel” is pre - approved by our individual Clients. Any exceptions to appropriate assignments are managed on a case -by-case basis. Through this platform, we have the ability to track, manage, and run reports on service provider usage.
Maximum number of indemnity files : The targeted average indemnity caseload for a senior Claims Examiner is based on the requirements of our Client. If no specific caseload is specified, we target 150 indemnity claims per Claims Examiner, but acknowledge that the City has an indemnity cap of 125. On a monthly basis, we review Claims Examiner activity reports that capture all new claims and closing ratios. The Claim Supervisors consistently manage the Claims Examiner’s caseloads to ensure caseload levels are managed based on our Client specific req uirements. AIMS, as matter of practice, assigns Claims Examiners in one of two ways:
1. By claims frequency and Client request warrant, the account is assigned on a fully dedicated basis. In those instances the Claims Examiner(s), work on a single account only. The City currently has two dedicated Claims Examiners handling their open active indemnity files.
2. If volume does not warrant, Claims Examiners are assigned on a designated basis.
Focus on Service: We work in partnership with our Clients to achieve o ptimal results, consistent with fair compensation for material loss and humane, competent, compassionate care for injured employees. We have built our business, and a stellar reputation, on communication and partnership with our Clients. AIMS senior management takes an active role in supervision of our dedicated account teams to assure timely response, proactive claims management and consistent quality control.
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Our goal is to customize our products and services to serve you best and to help you spend your money wisely.
Client Service: Our Clients are not just the employers, but also the employees who have sustained industrial injuries or illnesses while working within the course and scope of their employment. We focus on promptly providing these employees the benefits due to them and maintaining open and on-going communication with them during the course of their claims. Programs that provide this positive approach produce lower overall workers’ compensation costs, including significantly reduced litigation expenditures.
Primary Service Office: The Company has extensive professional management, technical and support staff in multiple offices located throughout California and Hawaii.
AIMS California offices are located in Santa Clarita, Sacramento, Pomona, Fresno and Concord.
We propose to continue to provide Claims Administration services to the City from our office in Sacramento.
AIMS Corporate Headquarters will continue to serve as the location providing loss data functions other than claims adjusting. The AIMS corporate headquarters is located at 10445 Old Placerville Road in Sacramento, CA 95827.
Please see Exhibit s 1 - Organization Charts and Exhibit 2 – Legislative Advocate Report
C. Methodology Section
Provide a detailed description of the approach and methodology to be used to accomplish the Scope of Services of this RFP. The Methodology Section should include:
1) An implementation plan that describes in detail (i) the methods, including controls by which your firm manages projects of the type sought by this RFP; (ii) methodology for soliciting and documenting views of internal and external stakeholders; (iii) and any other project management or implementation strategies or techniques that the respondent intends to employ in carrying out the work
AIMS/AMC has extensive experience in implementing and transitioning workers’ compensation and managed care programs from other industry administrators and managed care organizations. As City of Richmond is a current client, there would be no transition of data or transfer of files if the City continues their programs with AIMS/AMC.
2) Detailed description of efforts your firm will undertake to achieve client satisfaction and to satisfy the requirements of the "Scope of Services" section
AIMS is committed to achieving a high level of client satisfaction and to deliver all of the
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requirements outlined in the “Scope of Services” section. To monitor this activity and to validate the program is on course, a survey is taken every year by the City of Richmond.
The purpose of this event is to provide an opportunity for the City of express any concerns or issues with their program, the claims handling and/or their staffing. This “check-in” will occur more frequently if issues are identified that require follow-up. Once the survey is completed, the Client Services Department reports their findings back to Operations and Corporate Leadership on a monthly basis. The leadership Team addresses any weaknesses in our programs and documents the steps t aken to make the necessary improvements.
3) Detailed project schedule, identifying all tasks and deliverables to be performed, durations for each task, and overall time of completion.
Although the City of Richmond would not require any transition if the a ward of contract remains with AIMS/AMC, we have attached a sample of our Transition Plan for review on the below noted exhibit.
4) Detailed description of specific tasks you will require from City staff. Explain what the respective roles of City staff and yo ur staff would be to complete the tasks specified in the Scope of Services.
If a transition was required, AIMS would coordinate with the City on all meetings involving specific City Departments and the topic of discussion for the meeting. These meetings normally begin 60-days prior to the contract start date and are conducted every week until approximately 45-days post implementation Please see Exhibits 3 – AIMS Transition/Implementation Plan and Exhibit 9 - Scope of Services Detail
D. Staffing
Describe proposed Project team organization, including identification and responsibilities of key personnel. Indicate role and responsibility of prime consultants and all sub - consultants. If applicable, indicate how local firms are being utilized to ensure a strong understanding of state and local laws, ordinances, regulations, policies, requirements, and permitting. Indicate the extent of the commitment of key personnel for the duration of the Project and furnish resumes of key personnel. Provide an indication of t he staffing level for the Project. The City of Richmond’s evaluation of the proposal will consider the proposer’s entire team; therefore, no changes in the team composition will be allowed without prior written approval of the City of Richmond. Sub -consultant letters of
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Care Services
commitment are required and must be submitted with the proposal Kim Silas, Claims Manager : Kim will continue to serve as the City’s primary representative. Kim has worked in the California Workers’ Compensation Industry since 1990 and prior to that she worked within the Insurance Industry. Kim has her Workers’ Compensation Claims Professional (WCCP) and Workers’ Compensation Claims Administration (WCCA) designations from the Insurance Education Association (IEA) and the Self-Insurance Plans Certificate to Administer Workers’ Compensation Claims. Kim has been a Claims Supervisor since 2005 and Claims Manager since 2011.
AIMS Corporate Management Team
The AIMS corporate management team of professionals identified below has extensive claims management tenure. They understand the importance of monitoring each claim to see that every event that affects the outcome is recognized and appropriately managed.
These individuals are involved from the onset at the proposal stage, through contracting, implementation, and for the life of the program. Their objective will be to facilitate a successful program for the City.
Dominic Russo, President & CEO: Dominic has served as President of AIMS since 1994. Under his leadership, AIMS has consistently met it s corporate strategy to nurture long term relationships by providing our Clients with technically competent, experienced, and dedicated staff acting with integrity in all that we do. Prior to Mr. Russo’s position as President & CEO, he has served in vario us industry positions of management from supervisor to Vice President in Southern California, Northern California, and Hawaii.
Dominic achieved his Owner President Management Certification from the Harvard Business School.
Lynn Cavalcanti, Sr. Vice Pres ident Operations: Lynn has over 25 years of claims experience, all with public entities. Her role serves AIMS Clients by establishing critical service, program operations, and productivity criteria; benchmarking leading -edge practices; developing marketin g channels; leading commitment to quality service; evaluating service results, and representing the company to major customers (making periodic visits, exploring specific needs, and resolving problems). She has a Master of Arts as well as a Juris Doctorate degree. Lynn joined the AIMS team in 2010.
Tricia Baker, Assistant Vice President, Operations : Tricia has over 27 years of workers’ compensation claims experience with public entities and insurance. Tricia assists the Senior Vice president of Operation s with Client relations issues, managing new Client implementations and transitions, identifying and coordinating training, maintaining appropriate controls, and ensuring AIMS delivers as promised. Tricia serves as the Transition Coordinator for new progra m implementations. Tricia joined the AIMS team in 2013.
Cheryl Agee, Vice President Workers’ Compensation: Cheryl has thirty-plus years in the Workers’ Compensation sector as an Examiner, Supervisor and twenty-one years as
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Proposal for City of Richmond
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Care Services
a Claims Manager. She is responsible for the analysis of work performance against best practices, which includes compliance oversight, internal audits, and quality control. This includes the development and delivery of Workers’ Compensation training programs such as ongoing technical training, standardized work flow processes. Cheryl is responsible for best practice implementation and revision, work measurement, management oversight practices and the development of performance standards at various levels.
Cheryl also leads the company in interpreting and implementing new work flow processes following legislative enactment. Cheryl joined the AIMS team in 2005.
Rendell (“Ren”) Johnson, Vice President Information Technology: Ren has held various positions in the information technolog y industry over the last 18 years, 15 years in leadership positions, including the last 8 years as Director of Information Technology in the workers’ compensation industry. Ren has been making strategic technology decisions and providing state of the art solutions for pre -IPO, government, healthcare, workers’ compensation, and enterprise environments. Ren will be overseeing the implementation from an IT perspective. He has studied in Business Administration with training and certifications in networking, security, and Microsoft technologies. Ren joined the AIMS team in 2010.
Kristina (“Tina”) Patterson, Manager of Data Delivery Services : Tina has over 10 years workers’ compensation claims experience. She is a state -certified self-insurance administrator, as well as Workers’ Compensation Claims Administration. Tina oversees the ongoing claims system of the AIMS/AMC Data and how it interacts with various systems. Tina joined the AIMS team in 2016.
As the current incumbent, AIMS has established a staffing model that is responsive to the requirements of the City. This team consists of the following individuals:
Experienced Manager: Kim Silas
Dedicated Senior Claims Examiner: Tamala Palmer
Dedicated Claims Examiner: Tamara Nolasco
Future Medical Examiner: Nieves Sumpo
Claims Assistant: Denise Ondo
Having an experienced team in place ensures consistency and continuity for the City, but most importantly to care for City’s injured employees. This established team will maintain the program efficiencies without any disruption of a transferring of existing open claims.
As a matter of practice, AIMS designates and/or dedicates key personnel to an account and strives to maintain consistency of the assigned team for each of our valued Clients.
If claims frequency and Cli ent request warrant, the account is assigned on a fully dedicated basis. In those instances the Examiner(s), work on a single account only. If volume does not warrant, Examiners are assigned on a designated basis.
Please see Exhibits 1 - Organization Charts and Exhibit 4 - Team Resumes
Attachment I
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Describe the experience of the proposer’s Project team in detail, including the team’s Project Manager, and other key staff members, on projects of similar size, capacity, and dollar value. For each similar project, include the client’s name and correct telephone number. It is the City of Richmond’s policy to interview proposers’ references as well as references identified by the City of Richmond.
Please see above resumes and discussion on Corporate and Branch Office staffing to be assigned to the City of Richmond Account.
E. Qualifications
The information requested in this section should describe the qualifications of the firm, key staff and sub ‐contractors performing projects within the past five years that are similar in size and scope to demonstrate competence to perform these services. Information shall include:
1) Names of key staff that participated on named projects and their specific responsibilities with respect to this scope of service.
Please see above resumes and description of area of responsibility for both Corporate and Branch Office staffing who will be assigned to the City of Richmond Account.
Please see Exhibit 4 - Team Resumes
2) A summary of your firm’s demonstrated capability, including lengt h of time that your firm has provided the services being requested in this Request for Proposal.
As City of Richmond is an existing Client, AIMS has provided the services identified in this RFP for the past 10 years.
3) Provide at least three (3) references that received similar services from your firm. The City of Richmond reserves the right to contact any of the organizations or individuals listed. Information provided shall include:
a) Client Name and contact info
Telephone & e-mail address
Address
b) Description of services provided including contract amount c) Project start and end dates
We are providing the requested Information on the below noted exhibit.
Attachment I
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Please see Exhibit 5 – Client References
F. Cost Information
Provide the total direct and indirect costs to complete all tasks identified in the scope of services. Even if the method of payment to proposer will be fixed fee, a detailed cost breakdown shall be provided identifying: (1) the number of staff hours and hourly rates for each professional and administrative staff person who will be committed to this Project; (2) all other direct costs, such as materials and reproduction costs; and (3) sub-consultant services, if needed. These rates will also be used to negotiate rates for other project s (including optional tasks) that may be assigned. No additional funds will be paid above and beyond the original quote given by the selected Vendor.
Proposers will be paid at the same rates set forth in their cost proposal unless further negotiated in writing and agreed to by the City of Richmond.
AIMS is proposing a Flat Annual Fee for the Third Party Claims Administration Services part of this RFP. The Cost Proposal document outlines which costs are included in this fee. Managed Care Services Fees are outlined following the TPA Fees.
Please see Exhibit 6 – Cost Proposal
G. Value Added Services
Please provide any additional services of benefit not specifically required herein, which the Offeror offers to provide.
All services offered are identified in the Cost Proposal Document.
H. Contractor Assignment of Sub-Contract
The resulting contract shall not be assigned, transferred, or sublet, in whole or in part, without the prior written approval of the City of Richmond. If Offerors intend to subcontract any portion of the resulting contract, they must describe their process for selecting such subcontractor(s) and the quality control measures that the Offeror will employ to ensure that any subcontractor complies with the provisions of Offeror’s contract with the City.
AIMS/AMC agrees to this requirement.
I. Previous Contracts with the City of Richmond
Attachment I
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The proposer shall submit a list which indicates all prime contracts and/or amendments awarded to the proposer by the City of Richmond for the last three (3) years. The list shall include a short description of the Project, the Project scope of work, award date, completion date, name of City of Richmond’s assigned Project Manager, and contract value.
AIMS has been providing services to the City of Richmond as a Third-Party administrator for its Workers’ Compensation Program for the past 10 years.
J. Exceptions to this Request for Proposals
The proposer shall state whether or not it takes exception(s) to this RFP, including but not limited to the City of Richmond’s Standard Services Agreement – RFP. If the proposer does take exception(s) to any portion of the RFP or contract, the specific portion to which exception(s) is taken must be identified by section number and explained. Requests for changes or additions to sections of City of Richmond’s Standard Services Agreement must be shown by requesting deletion of specific words and/or by providing new requested contract language. Requests for complete replacement of the City of Richmond’s Standard Se rvices Agreement for another contract will not be granted.
Failure to make exceptions to the RFP or Standard Services Agreement within the proposal will be deemed a waiver of any objection. Exceptions will be considered during the proposal evaluation process.
AIMS/AMC does not take exception to any portion and/or requirement in the RFP.
K. Statement of Impartiality and Disclosure
The nature of this Project requires an impartial unbiased approach on the part of the proposer’s team. This proposal shall inclu de a statement declaring that the proposer’s and sub -consultants are not currently, and will not, during the performance of these services, participate in any other similar work involving a third -party with interests currently in conflict or likely to be in conflict with City of Richmond’s interests. Additionally, proposer is required to disclose any pending or active investigations or litigation that may affect the reputation or ability of the proposer to carry out the Project.
AIMS/AMC agrees to this requirement.
Proposer Qualifications
AIMS has provided a detailed description of the efforts we undertake to achieve Client satisfaction throughout our proposal and we have provided specific response to each Attachment I
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requirement. Also, AIMS has carefully reviewed the Scope of Services, the Proposer Qualifications and Attachment III - TPA Performance Expectations Sections of this RFP and will comply with ALL requirements, we have provided separate exhibits for these sections.
Please see Exhibits - 6 Cost Proposal, Exhibit - 9 Scope of Services Detail and Exhibit - 15 Proposer Qualifications.
Attachment I
RFP Attachments
And Required Forms
Attachment I
CITY OF RICHMOND
Sanctuary City Compliance Statement
The undersigned, an authorized agent of Acclamation Insurance Management Services, Inc. (AIMS) (hereafter "Contractor"), has had an opportunity to review the requirements of City of Richmond Ordinance 12 -18 (hereafter "Sanctuary City Contracting Ordinance" or “SCCO”). Contractor understands and agrees that the City may choose with whom it will maintain business relations and may refrain from contracting with any person or entity that provides Data Broker or Extreme Vetting services to the U.S. Immigration and Customs Enforcement Division of the United States Department of Homeland Security (“ICE”). Contractor understands the meaning of the following terms used in the SCCO:
a. "Data Broker” means either of the following:
i. The collection of information, including personal information about consumers, from a wide variety of sources for the purposes of reselling such information to their customers, which include both private-sector business and government agencies;
ii. The aggregation of data that was collected for another purpose from that for which it is ultimately used.
b. “Extreme Vetting” means data mining, threat modeling, predictive risk analysis, or other similar services."
Contractor understands that it is not eligible to receive or retain a City contract if at the time the Contract is executed, or at any time during the term of the Contract, it provides Data Broker or Extreme Vetting services to ICE.
Contractor further understands and agrees that Contractor's failure to comply with the SCCO shall constitute a material default of the Contract and the City Manager may terminate the Contract and bar Contractor from bidding on future contracts with the City for five (5) years from the effective date of the contract termination.
By executing this Statement, Contractor certifies that it complies with the requirements of the SCCO and that if at any time during the term of the Contract it ceases to comply, Contractor will promptly notify the City Manager in writing. Any person or entity who knowingly or willingly supplies false information in violation of the SCCO shall be guilty of a misdemeanor and subject to a $1,000 fine.
Based on the foregoing, the undersigned declares under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed this 22nd day of March , 2022 , at Sacramento , California.
Printed Name: Dominic Russo Title: President & CEO AIMS, /AMC
Signed:
Date: March 22, 2022
Business Entity: Acclamation Insurance Management Services, Inc. (AIMS)
Vendor SCCO Compliance Statement (Augt2020)
Attachment I
ADDENDUM NO. 2
March 15, 2022
Third Party Workers’ Compensation Claims Administration and Managed Care Services
This Addendum shall be considered as a part of the RFQ documents for the subject professional services as though it had been issued at the same time and shall be incorporated integrally therewith.
The revised deadline for submission of Proposals is Tuesday, March 22, 2022 at 5:00PM.
If you have any questions, please contact me at (510) 620-6732.
PATRICK MCKENZIE DATE: 3/15/22
BUYER II
CITY OF RICHMOND
450 Civic Center Plaza, Richmond, CA 94804-1630
Telephone: (510) 620-6740 Fax: (510) 620-6522 www.ci.richmond.ca.us
FINANCE DEPARTMENT
Patrick McKenzie
Attachment I
EXHIBITS
Attachment I
EXHIBIT 1 –
Organizational Charts for
AIMS & AMC
Attachment I
Organizational Charts
Attachment I
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Organizational Charts
Attachment I
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Attachment I
EXHIBIT 2 –
Legislative Advocate Report
Attachment I
3457 Castle Creek Court Roseville, CA 95661 ● PH (916) 784-7055 ● Fax (916) 784-2852 ● Web www.pvgov.com
REPORT ON THE FINAL ACTIVITIES
OF THE CALIFORNIA STATE
LEGISLATURE
FOR THE YEAR 2021
PRESENTED TO:
AIMS & AMC
BY: PHILIP M. VERMEULEN,
LEGISLATIVE ADVOCATE
October, 2021
Attachment I
“In a time when the state and country are more divided than ever, this legislative session reminds us what we can accomplish together. I am thankful for our partners in the state Legislature who furthered our efforts to tackle the state’s most persistent challenges – together, we took action to address those challenges head- on, implementing historic legislation and the California Comeback Plan to hit fast forward on our state’s recovery,” Governor Gavin Newsom said in announcing his final bill signings. He went on to say: “What we’re doing here in California is unprecedented in both nature and scale. We will come back from this pandemic stronger than ever before.”
The commencement of the new, two-year legislative session back in January saw the Democrats with their strongest super majorities yet. Currently in the Assembly there are 60 Democrats, 19 Republicans and 1 Independent which constitutes a ¾ super majority; while in the Senate the Democrats hold 31 of the 40 seats which constitutes a 78% super majority. Coupled with this is the fact that all executive branch members (Governor, Lt Governor, Treasurer, Controller, Secretary of State and Insurance Commissioner) are held by Democrats as well.
Armed with these numbers, and a legislature that grows more ‘Progressive’ with each election cycle, this session’s legislative agenda continued moving to the left. For perspective, there were a total of 2776 bills introduced, of which 836 were sent to the governor. He ultimately signed 770 and vetoed 66. This is a veto ratio of 7.89% for his third year in office. The number of vetoes for 2021 is the ninth lowest of all the years that have been tracked by Capitol staff since 1967.
The ‘New’ Form of Participatory Government
It was an interesting year in myriad ways. Simply, however, COVID-19 framed the session. It meant a continuation of 2020’s legislative COVID policies and protocols that severely limited the interaction of the legislature with both the public and members of the 3rd house (lobbyists).
While hearings continued to be held, there were crowd limits both in terms of entering the Capitol as well as entering the actual hearing rooms.
This had a serious effect on being ‘hands on’ with both the legislative staff and the members.
Indeed, since the ‘essence of lobbying is becoming as close and personal with both’, this created a major barrier for everyone within the 3rd house (lobbyists) and members of the public.
Attachment I
Business Coalitions the New Norm
To counter both the limited access within the Capitol during these COVID times, coupled with an ever-more left-leaning legislature (with the unions ‘driving the boat’), the old political phrase “strength in numbers” took on a whole new meaning. Employer coalitions have become the political tool that has proven time and again to ‘herd the disparate cats’ of employers under one roof to coordinate our efforts. While we didn’t kill all of the ‘bad’ bills, we killed most and we were able to obtain significant amendments for most of the remaining ones that ultimately became law. I will be discussing specific bills in more detail later in this report.
Effects of COVID-19 on Public Policy
As I previously discussed, much of the 2021 session revolved around COVID-19 in one form or another. From the attempted recall of Governor Newsom, the many billions of dollars received and spent in federal pandemic aid, to the ‘buckets’ of money spent on an array of new and expanded public services, all can be attributed to COVID-19. It rallied the Progressives to justify spending on health care, social services, public schools, early childhood education, and increasing personal incomes of the poor which the leadership argued made California the national leader in advancing the European-style “social democracy” model that the Democrats’ left wing wants the federal government to embrace.
Before this year’s session began, for instance, 94% of Californians had some form of medical care coverage, thanks to Obamacare and a sharp expansion of the state’s Medi-Cal program for the poor to more than a third of the state’s population. This year’s additions push California very close to universal coverage, a long-sought goal of those on the left and Newsom’s oft-expressed ambition.
The leftward tilt of the session is also evident in other ways that do not spend money, such as making ethnic studies a requirement for high school education, banning gasoline-powered lawn equipment, imposing new restrictions on guns, and compelling department stores to have gender- neutral toy and child care departments.
The Legislature and Newsom also continued to move the state’s criminal justice system leftward, reducing punishment for some crimes and cracking down on police officers who misbehave by lifting the licenses, called “certifications,” they need to be employed.
There’s every reason to expect that Newsom and the Legislature will continue to paddle California’s political canoe to the left. Certainly, with regards to this session, any paddling to the right that Newsom did by vetoing bills that our business coalition opposed was NOT due to the ever-dwindling number of Republicans in the Legislature, but instead to the power that was comprised in the makeup of the members of the coalitions (including us, of course!) and possibly Attachment I
due to the ‘scare’ of the recall and the realization that Newsom will face another election next November (2022). I should also mention that in years past the Republicans’ ‘clout’ came from both working closely with, and literally relying upon, the influence of Democratic moderates; but the ‘mod’s’ numbers and power are also waning badly. The only question is whether the economy will continue to churn out enough money to pay for the new benefits without tax increases!
About Gavin
NEWSOM’S LOFTY PROMISES: It’s an enduring source of frustration with Gov. Gavin Newsom’s leadership: the loftiness of his claims can outrun the reality.
Newsom is not shy about trumpeting his moves to make California a national leader on lodestar Progressive issues. He’s fond of calling the “nation-state” he leads “America’s next coming attraction”, and he often proclaims he’s ensuring the Golden State continues to set the pace on the environment, family welfare, coronavirus management and other issues.
I’ve heard it from many within ‘The Building’, who are his fellow Democrats and liberal interest groups, that contrary to his conservative foes who accuse Newsom of authoritarian overreach, these detractors tend to fault Newsom for making big promises that turn out, on closer inspection, to be not quite so consequential. It’s often a matter of attenuated scope or of delayed implementation. He generates national media plaudits for the broad strokes but may offer few details on how to actually get there.
That’s not to say the governor’s allies are abandoning or renouncing him — you can see that in voters repudiating the recall by a 22-point margin that’s virtually identical to Newsom’s landslide 2018 victory. Incremental progress, or executive actions that move California in a desired direction, still win praise from Progressives. Newsom has signed numerous consequential bills and an enormous budget stocked with policies and spending items that are popular among his supporters.
But there’s still a sense that the governor likes to announce now and work out the nuances later. A few examples-- a school vaccine mandate won’t take effect imminently and just kicks a fight over contentious exemption loopholes to the Legislature. Environmentalists worry his orders to move away from fossil fuels will take effect too slowly and without enough sweep.
Expanded family leave efforts and a long-sought move to single-payer health care aren’t quite matching campaign promises.
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With the 2022 election on the horizon, it will be ‘interesting’ (and scary for the business community) to see how Gavin responds to the aforementioned during the 2022 legislative session. Hold on to your hats!
Workers’ Comp Bills in 2021
The power of the public worker unions (the 500-pound gorilla) appeared daunting by mid-March after the bill introduction deadline had passed and we saw the plethora of comp bills and their key amendments they had sponsored which were now in print. Facing myriad union-sponsored ‘bad’ bills authored and moving through a ‘Progressive’ legislature, whose membership was elected in large part by these unions, was nerve wracking at best! Besides the unions, the California Society of Industrial Medicine (CSIMS) was back at it again as were the Applicant Attorneys!
With 7 presumptions bills being driven by the unions set to be heard, I was skeptical that our workers’ comp coalitions would have the ‘juice’ to stop the onslaught. Amazingly, one by one, the bills dropped by the wayside as did many of the other bad comp bills. Then, during the last two- weeks of the session, the final two presumption bills, AB 334 (Mullin) and SB 284 (Stern) were placed on the inactive file making them both two-year bills!!! The first of the two to be pulled was SB 284 in late August, followed by AB 334 on the last day of the session. Since both of these measures were ‘sailing’ and certain to be sent to the governor, what could possibly have stopped them in their tracks?
My first call was to my ‘key’ insider who has worked closely on workers’ comp matters with the unions and other stakeholders for many years. My suspensions were confirmed. To wit:
It’s hard to believe, but 2022 marks the 10th anniversary of the passage of our last major worker comp reform bill, SB 863 (de Leon). And, I’ve learned there have been some ‘behind the scenes’ discussions about a major workers’ comp reform package next year with some key folks in the industry (and in government leadership, too).
‘Word’ has it that benefit increases are being discussed as well as other ‘tweaks’ to offset these increases. So too, there are likely efforts in this process by the unions to push for a much larger presumption package that would be much more inclusive of different unions and their members! Suddenly then, if presumptions are in the mix of a union-driven reform package for next year, passing AB 334 or SB 284 this year could have resulted in the life guards and firefighters possibly losing out to an even better ‘deal’ next year. By letting both become two-year bills, the Attachment I
sponsors can do a ‘wait and see’ which allows them the leverage to either join on to a ‘better deal’ or, if not, then allows them to obtain the signature of the governor next year.
At this juncture, everything is in the ‘chatter’ stage and I’ve now been asked to become involved in the ongoing discussions during the legislative interim. Stay tuned.
From the start of the session when there were 18 comp bills staring at us, only 3 bills ultimately were signed by the governor, two of which were committee clean-up bills and one ‘bad’ disability presumption bill!
Following are the comp bills, their sponsor and their status:
Listing of Workers’ Comp Bills Introduced in 2021
AB 334 (Mullin D) Workers’ compensation: skin cancer. Presumption Sponsored by: Game Wardens Union, et al
Status – 2-Year Bill
Current law provides, among other things, that skin cancer developing in active lifeguards is presumed to arise out of and in the course of employment, unless the presumption is rebutted.
This bill would expand the scope of those provisions to certain peace officers of the Department of Fish and Wildlife and the Department of Parks and Recreation.
Position: Oppose
AB 399 (Salas D) Workers’ compensation.
Sponsored by: CSIMS
Status – 2-Year Bill
Would impose new requirements on a medical provider network, including, among other things, requiring a participating provider to participate at each location at which they treat patients for 8 or more hours per week, on a monthly average. The bill would also prohibit authorizations or certifications issued by a carrier, claims administrator, medical provider network, or utilization review entity from providing instruction or imposing a requirement as to the location of where a treatment takes place or the provider who will perform the treatment. The bill would prohibit a vendor, provider, or group within the medical provider from being preferentially cited on an authorization or certification and would require the administrative director to impose a fine of $10,000 per authorization or certification that preferentially directs care within a medical provider network.
Position: Active Oppose
Attachment I
AB 404 (Salas D) Workers’ compensation: medical-legal expenses: fee schedule.
Sponsored by: CSIMS
Status – 2-Year Bill
Under current law, fees for medical-legal evaluations are charged at a rate not to exceed a physician’s regular fee, or the fee schedule set by the administrative director of the Division of Workers’ Compensation, whichever is lower. Current law requires that the schedule set fees for procedures according to relative values and a conversion factor, allowing for modifiers, as specified. Current law requires the medical-legal fee schedule to be revised at the same time the fee schedule for medical treatment is revised. This bill would require that the medical-legal fee schedule be reviewed every 2 years, and updated, if necessary, to increase the conversion factor by the percentage increase in the most recent federal Medicare Economic Index.
Position: Watch
AB 415 (Rivas, Robert D) Employment: workers’ compensation.
Presumption
Sponsored by: SEIU, et. al
Status – 2-Year Bill
This bill would define “injury,” for certain employees of a city, county, city and county, district, or other municipal corporation or political subdivision regularly exposed to active fires or health hazards directly resulting from firefighting operations, to include cancer that develops or manifests during a period in which the individual demonstrates that they were exposed to a known carcinogen while in the employment of the city, county, city and county, district, or other municipal corporation or political subdivision. The bill would establish a presumption that the cancer in those cases arose out of, and in the course of, employment, unless the presumption is controverted by evidence that the primary site of the cancer has been established and that the carcinogen to which the person has demonstrated exposure is not reasonably linked to the disabling cancer.
Position: Active Oppose
AB 772 (Ramos D) Workers’ compensation: domestic terrorism.
Sponsored by: Assemblyman Ramos who previously served on Bd of Supes in San Bernardino when terrorist struck
Status – 2-Year Bill
This bill would clarify that an employer is not limited in its ability to insure against an act of Attachment I
domestic terrorism or to provide benefits in excess of those required by existing law following an act of terrorism.
Position: Watch
AB 845 (Rodriguez D) Disability retirement: COVID-19: presumption.
Sponsored by: Service Employee International Union, et. al
Status: Chapter #122 of 2021 Statutes
Current law prescribes various requirements for the organization and administration of public retirement systems, which typically provide pension, disability, and death benefits to their members. Current law provides that participants in certain membership categories may be entitled to special benefits if death or disability arises in the course of employment. The California Public Employees’ Pension Reform Act of 2013 (PEPRA) generally requires a public retirement system, as defined, to modify its plan or plans to comply with that act and establishes, among other things, limits on defined benefit formulas and caps on pensionable compensation.
This bill, until January 1, 2023, would create a presumption, applicable to the retirement systems that PEPRA regulates and to specified members in those systems, that would be applied to disability retirements on the basis, in whole or in part, of a COVID-19-related illness. In this circumstance, the bill would require that it be presumed the disability arose out of, or in the course of, the member’s employment. The bill would authorize the presumption to be rebutted by evidence to the contrary, but unless controverted, the applicable governing board of a public retirement system would be required to find in accordance with the presumption.
Position: Active Oppose
AB 872 (Wood D) Leave of absence: firefighters.
Sponsored by: Fire Fighters
Status Vetoed
Under current law, workers’ compensation benefits, including salary paid in lieu of disability payments, is not taxable income. Current law also provides for enhanced industrial leave benefits for specified state employees, including members of State Bargaining Unit 8, such as 52 weeks of salary less specified tax and retirement contributions. This bill would make those enhanced industrial disability leave benefits for specified state employees employed by the Department of Forestry and Fire Protection applicable only to injuries that occur prior to January 1, 2022. The bill would instead, for injuries occurring on or after January 1, 2022, make specified benefits, such as one year of salary in lieu of disability payments, available to all rank-and-file and supervisory fire fighters and members of State Bargaining Unit 8 engaged in active fire suppression or prevention employed by the Department of Forestry and Fire Protection and specified seasonal employees whose principal duties include active fire suppression or prevention services. These benefits would be subject to limitations, as specified.
Attachment I
Position: Oppose
AB 991 (Ward D) Workers’ compensation: presumed injuries.
Presumption
Sponsored by: Lifeguards, et. al.
Status – 2-Year Bill
This bill would expand presumptions for hernia, pneumonia, heart trouble, cancer, tuberculosis, bloodborne infectious disease, methicillin-resistant Staphylococcus aureus skin infection, and meningitis-related illnesses and injuries to a lifeguard employed on a year-round, full-time basis by the City of San Diego. The bill would increase the period of time after termination of employment that a lifeguard employed on a year-round, full-time basis by the City of San Diego can file a claim for skin cancer. The bill would expand the presumptions for illness or injury related to post-traumatic stress disorder or exposure to biochemical substances, as defined, to a lifeguard employed by the City of San Diego Fire-Rescue Department.
Position: Active Oppose
AB 1148 (Daly D) Workers’ compensation insurance reporting.
Sponsored by: Assembly Insurance Committee
Status – 2-Year Bill
Current law requires a licensed rating organization to establish and maintain an internet website to assist a person in determining if an employer is insured for workers’ compensation. Current law required the Insurance Commissioner to review and evaluate the establishment and operation of the internet website, assess whether the internet website is achieving its purpose, and report the findings to specified legislative and executive entities no later than July 1, 2013. This bill would require the commissioner to review and evaluate the operation of a licensed rating organization’s internet website and assess whether the internet website is achieving its purpose at least every 5 years, beginning in 2023.
Position: Watch
AB 1465 (Reyes D) Workers’ compensation: medical provider networks study.
Sponsored by: Assembly Member Reyes
Status – 2-Year Bill
Would require the Commission on Health and Safety and Workers’ Compensation, on or before January 1, 2023, to submit a study to the Legislature, the committees of the Senate and Assembly with jurisdiction over workers’ compensation, and the Division of Workers’ Compensation on Attachment I
delays and access to care issues in medical provider networks. The bill would require the study to compare specified data for injury claims in which a worker was treated by a medical provider network to that data for injury claims in which a worker was treated by a provider who is not part of a medical provider network.
Position: Active Oppose
AB 1511 (Committee on Insurance) - Insurance: omnibus.
Sponsored by: Assembly Insurance Committee
Status: Chapter #627 of 2021 Statutes
Current law generally regulates insurance and creates the Department of Insurance, headed by the Insurance Commissioner. Current law requires all public records of the department and the commissioner that are subject to disclosure under the California Public Records Act to be available for inspection and copying, as specified, at the offices of the department in the San Francisco Bay area, in the City of Los Angeles, and in the City of Sacramento. This bill would eliminate the reference to an office in the San Francisco Bay area and instead refer to the department’s offices in the City of Oakland, the City of Los Angeles, and the City of Sacramento.
Position: Watch
AB 1541 (Committee on Insurance) - Insurance: Guarantee Association.
Sponsored by: Assembly Insurance Committee
Status: Chapter #305 of 2021 Statutes
Current law establishes the California Insurance Guarantee Association (CIGA) to provide coverage against losses arising from the failure of an insolvent property, casualty, or workers’ compensation insurer to discharge its obligations under its insurance policies. Current law gives CIGA the ability to request the issuance of bonds by the California Infrastructure and Economic Development Bank to more expeditiously and effectively provide for the payment of covered claims arising from the insolvencies of insurance companies providing workers’ compensation insurance. Current law requires that any bonds that provide funds for covered claim obligations for workers’ compensation claims be issued, as specified, prior to January 1, 2023. This bill would extend the date for bonds to be issued to provide funds for covered claim obligations for workers’ compensation claims, as specified, to January 1, 2026.
Position: Watch
AB 1562 (Committee on Insurance) Workers’ compensation: reports.
Sponsored by: Assembly Insurance Committee
Status – 2-Year Bill
Attachment I
Current law requires the Commission on Health and Safety and Workers’ Compensation to issue an annual report on the state of the workers’ compensation system, including recommendations for modifications that would improve the operation of the system. Current law requires the report to be made available to the Governor, the Legislature, and the public on request. Current law also requires the commission to periodically issue a report and recommendations on the improvement and simplification of notices required to be provided by insurers and self-insured employers, as it deems necessary. This bill would require the annual report on the workers’ compensation system to be made available on the commission’s internet website and to specifically be made available to the Assembly Committee on Insurance and the Senate Committee on Labor, Public Employment and Retirement rather than to the Legislature generally.
Position: Watch
SB 213 (Cortese D) Workers’ compensation: hospital employees.
Presumption
Sponsor: Nurses Union
Status: 2-year bill
Current law, until January 1, 2023, creates a rebuttable presumption of injury for various employees, including an employee who works at a health facility, as defined, to include an illness or death resulting from COVID-19, if specified circumstances apply. This bill would define “injury,” for a hospital employee who provides direct patient care in an acute care hospital, to include infectious diseases, cancer, musculoskeletal injuries, post-traumatic stress disorder, and respiratory diseases. The bill would create rebuttable presumptions that these injuries that develop or manifest in a hospital employee who provides direct patient care in an acute care hospital arose out of and in the course of the employment. The bill would extend these presumptions for specified time periods after the hospital employee’s termination of employment. Beginning January 1, 2023, the bill would include COVID-19 in the definitions of infectious and respiratory diseases.
Position: Active Oppose
SB 216 (Dodd D) Contractors: workers’ compensation insurance: mandatory coverage.
Sponsor: Contractors License Board
Status: 2-year bill
This bill is something I have pushed the construction industry (whom I have represented for over 40 years) and the Contractors State License Board to mandate for years. There is simply too much cheating and lying by many contractors that is wasting too much time CSLB enforcement time. Since most contractors require the need for employees, mandating workers comp for all contractors is long overdue! This bill will pass next year!
Attachment I
Would, until January 1, 2025, would require concrete contractors holding a C-8 license, warm- air heating, ventilation and air-conditioning (HVAC) contractors holding a C-20 license, or tree service contractors holding a D-49 license to also obtain and maintain workers’ compensation insurance even if that contractor has no employees. The bill, as of January 1, 2025, would require all licensed contractors or applicants for licensure to obtain and maintain workers’ compensation insurance even if that contractor has no employees and would also prohibit the filing of a certificate of exemption.
Position: Support
SB 284 (Stern D) Workers’ compensation: firefighters and peace officers:
post-traumatic stress. Presumption
Sponsor: Firefighters, et. al.
Status: 2-Year Bill
Current law, under the workers’ compensation system, provides, only until January 1, 2025, that, for certain state and local firefighting personnel and peace officers, the term “injury” includes post-traumatic stress that develops or manifests during a period in which the injured person is in the service of the department or unit, but applies only to injuries occurring on or after January 1, 2020. Existing law requires the compensation awarded pursuant to this provision to include full hospital, surgical, medical treatment, disability indemnity, and death benefits. This bill would make that provision applicable to active firefighting members of the State Department of State Hospitals, the State Department of Developmental Services, the Military Department, and the Department of Veterans Affairs, and to additional peace officers, including security officers of the Department of Justice when performing assigned duties as security officers and the officers of a state hospital under the jurisdiction of the State Department of State Hospitals or the State Department of Developmental Services, among other officers.
Position: Active Oppose
SB 335 (Cortese D) Workers’ compensation: liability. Presumption Sponsor: Firefighters, et. al.
Status: 2-Year bill
Current law prohibits a claim for workers’ compensation from being maintained unless within 30 days after the occurrence of the injury, the injured person, or in case of the death, a dependent, or someone on the injured person’s or dependent’s behalf, serves notice of the injury upon the employer. Current law also requires an injured employee, or in the case of death, a dependent, or an agent of the employee or dependent, to file a claim form with the employer. Under current law, except for specified injuries, if liability is not rejected within 90 days after the date the claim form is filed with the employer, the injury is presumed compensable and the presumption is rebuttable only by evidence discovered subsequent to the 90-day period. This bill would reduce those 90-day time periods to 45 days and, for certain injuries or illnesses, including hernia, heart trouble, pneumonia, or tuberculosis, among others, sustained in the course of employment of a Attachment I
specified member of law enforcement or a specified first responder, would reduce those time periods to 30 days.
Position: Active Oppose
SB 788 (Bradford D) Workers’ compensation: risk factors.
Sponsors: Firefighters and Applicant Attorneys
Status: Vetoed
Current law establishes a workers’ compensation system, administered by the administrative director of the Division of Workers’ Compensation, to compensate an employee for injuries sustained in the course of employment. Current law requires a physician who prepares a report addressing the issue of permanent disability due to an industrial injury to address the cause of the permanent disability in the report, including what approximate percentage of the permanent disability was caused by other factors before and after the industrial injury, if the physician is able to make an apportionment determination. This bill would prohibit consideration of race, religious creed, color, national origin, gender, marital status, sex, sexual identity, or sexual orientation to determine the approximate percentage of the permanent disability caused by other factors. The bill would also express the Legislature’s intent to eliminate bias and discrimination in the workers’ compensation system.
New 2022 California Employment Laws
Most of the new employment laws signed by the governor this session had the same genesis as workers’ comp, sponsored by the public worker unions (with strong support from the Building Trades and other private sector unions). Besides their intentions of furthering the rights and abilities of their union members, much of their ulterior motives are to ‘level the playing field’ against the non-union employers and their employees and to create new laws whose effects will ‘spill-over’ to the government sector.
Some statistics to put things into perspective pertaining to unions:
Over 200,000 people work for a State of California department or agency (other than a university). More than 80% of these employees are represented by one of the state's 21 bargaining units in the collective bargaining process.
On the other hand, approximately 16% of the private sector workforce is unionized. This number continues to drop each year; hence, some of the motivation for the unions to push issues that will not only ‘level the field’ but also entice the non-union to organize, to be part of ‘the brethren’, and create further strength in numbers.
Attachment I
New Employee Laws YOU Need to Know are ‘coming down
the pike:’
Unless so noted, all new laws will take effect on January 1, 2022.
Safety and Wage Enforcement and Penalties
SB 606 Gonzalez (Chapter 336) On September 27, Governor Newsom signed Senate Bill 606, significantly expanding the California Division of Occupational Safety and Health’s (Cal/OSHA) enforcement authority. SB 606 increases potential exposure for employers with multiple worksites in the state, requires Cal/OSHA to issue “egregious violations” in certain circumstances, increase the potential monetary fines associated with citations, and expands Cal/OSHA’s authority to issue subpoenas and seek injunctions and temporary restraining orders.
The law becomes effective January 1, 2022, so employers should use the remaining months of 2021 to identify and close any compliance gaps to reduce the risk of receiving an enterprise-wide violation or an egregious violation. The following analysis comes from the National Law Review:
Enterprise-Wide Violations
For employers with multiple worksites, SB 606 creates a rebuttable presumption that a violation is “enterprise-wide” when either of the following factors is met:
1. A written policy or procedure violates a Cal/OSHA safety standard, rule, order, or regulation; or
2. Evidence of a “pattern o r practice” of the same violation committed by that employer at more than one of the employer’s worksites.
If the employer fails to rebut the presumption that a violation is “enterprise-wide,” then the division may issue an enterprise-wide citation requiring enterprise-wide abatement.
“Egregious” Violations
SB 606 also directs Cal/OSHA to issue an “egregious violation” if one or more of the following is true:
1. The employer, intentionally, through conscious, voluntary action or inaction, made no reasonable effort to eliminate the known violation.
2. The violations resulted in worker fatalities, a worksite catastrophe, or a large number of injuries or illnesses. For purposes of this paragraph, “catastrophe” means the inpatient Attachment I
hospitalization, regardless of duration, of three or more employees resulting from an injury, illness, or exposure caused by a workplace hazard or condition.
3. The violations resulted in persistently high rates of worker injuries or illnesses.
4. The employer has an extensive history of prior violations of this part.
5. The employer has intentionally disregarded their health and safety responsibilities.
6. The employer’s conduct, taken as a whole, amounts to clear bad faith in the performance of their duties under this part.
7. The employer has committed a large number of violations so as to undermine significantly the effectiveness of any safety and health program that may be in place.
The conduct underlying a violation determined to be egregious must have occurred within the five years preceding an egregious violation citation. Once a violation is determined to be egregious, that determination remains in effect for five years. After that five -year period has elapsed, additional evidence is required to support any subsequent egregious violation.
If Cal/OSHA “believes that an employer has willfully and egregiously violated” a safety standard, then Cal/OSHA “shall issue a citation to that employer for each egregious violation.” Critically “each instance” that an employee is exposed to the violation a lleged to be an egregious violation “shall be considered a separate violation for purposes of the issuance of fines and penalties.” This means that if an employee is exposed to the same cited hazard each day at work, the employer could be cited with multiple violations, which could significantly increase the associated fines.
Subpoenas, Injunctions, and Temporary Restraining Orders SB 606 authorizes Cal/OSHA to issue a subpoena if the employer fails to “promptly provide” requested information during an inspection, and may enforce the subpoena if the employer “fails to provide the requested information within a reasonable time. These time limits are not defined.
The bill also expands Cal/OSHA’s authority to seek injunctions and temporary restraining orders.
Specifically, if Cal/OSHA has “grounds to issue a citation” under section 6317, then Cal/OSHA may seek an injunction in superior court restraining the use or operation of equipment until the cited condition is corrected. Upon filing an affidavit showing that Cal/OSHA has grounds to issue a citation under section 6317, the court may issue a temporary restraining order.
Impact on Employers
These substantive amendments greatly increase the enforcement authority of Cal/OSHA.
Employers with multiple worksites in the state will typically have one set of written procedures that are used at all worksites, such as written Injury Illness and Prevention Programs, Hazard Communication Programs, and Heat Illness Prevention Programs. A deficiency in these written programs now provides a basis for issuing an “enterprise-wide” citation and potentially requiring “enterprise-wide” abatement.
Attachment I
In addition, Cal/OSHA’s new authority to issue egregious violations is broad and not clearly defined. Cal/OSHA need only establish one of the seven bases for finding an employer’s conduct “egregious.” Many of the bases contain undefined terms, such as “large number” of injuries or illness, “large number” of violations “that undermine significantly the effectiveness of any safety and health program,” “extensive history” of prior violations, or “persistently high” injury rates.
Furthermore, the bill states that Cal/OSHA “shall” issue an egregious violation if the criteria are established, meaning that Cal/OSHA is required to issue that citation. The use of the word “shall” in the bill could limit the ability of an employer to pursue a reclassification of these violations through settlement.
Employers should carefully review written programs to ensure compliance with all applicable requirements, including ensuring that required trainings are scheduled and a system is in place to document that those trainings occur. Reviewing these policies and procedures could reduce the likelihood of receiving an enterprise-wide violation or an egregious violation.
Should an employer receive a citation, the employer should promptly respond to information requests and communicate when documents will be produced to minimize the likelihood of receiving a subpoena.
I realize this law could have serious consequences for many employers who are unfortunate enough to get ensnarled in its effects. I will be watching for forthcoming webinars that many of my law firm colleagues specializing in labor law will be hosting and pass them along ASAP!
Settlement Agreements
SB 331 Leyva (Chapter 638) significantly expands on laws passed over the previous few years limiting the ability to use confidentiality clauses in severance and settlement agreements. Prior to SB 331, any settlement agreement in a case where sexual harassment, sexual assault or discrimination based on sex has been alleged couldn’t include a confidentiality provision prohibiting disclosure of information regarding the claim.
SB 331 expands the prohibition to include acts of workplace harassment or discrimination based on any characteristic protected under the Fair Employment and Housing Act, not just those based on sex. While employees cannot be prohibited from discussing underlying facts of the case, employers can still use clauses that prevent the disclosure of the amount paid to settle the claim. SB 331 will apply to agreements entered on or after January 1, 2022.
Attachment I
COVID-19
This is a bill that our business coalition played a significant role in ‘shaping.’ The Governor signed AB 654 Reyes (Chapter 522) which clarifies and cleans up last year’s COVID-19 notice and reporting bill, AB 685. The bill revises the language 685 used to describe COVID-19 notice requirements to make it more consistent throughout. This was an urgency measure that took effect immediately upon signing.
Last year’s AB 685 established the COVID-19 notification framework employers have become familiar with; that is, when an employer receives notice of a potential COVID-19 exposure, the employer must, within one business day, provide certain employees with written notice of three things: (1) the potential exposure, (2) information on COVID-19-related benefits, and (3) information on the disinfection and safety plans that the employer plans to implement.
As is typical when a new bill on a new subject matter becomes law, AB 685 contained inconsistencies, specifically in the terminology used to describe to whom notices would be given. For example, when it came to providing notice of potential exposure, employers were required to give the notice to all employees and employers of subcontracted employees “who were on the premises at the same worksite as the qualifying individual within the infection period;” but, for the information on COVID-19-related benefits, the law required employers to provide notice to “all employees who may have been exposed.” For information on disinfection and safety, the law was even broader, requiring notice to “all employees and the employer of subcontracted workers.” These different phrases suggested employers had to potentially send different information to different groups of employees.
The changes made with the newest measure, AB 654, cleans up this language and makes it more consistent. Specifically, regarding the obligations to provide information on COVID-19-related benefits and the disinfection and safety information, the language was revised to require employers to send notice to employees who were “on the premises at the same worksite as the qualifying individual within the infectious period.”
The new law also revises the time frame in which employers must give notice of COVID-19 outbreaks to local public health agencies. The prior version required notice of outbreaks within 48 hours. AB 654 revises that to “within 48 hours or one business day, whichever is later.” It also specifically exempts certain health facilities from the requirement to report outbreaks to local health agencies because those facilities already report outbreaks under other legal requirements.
The new law revises certain terminology to better correspond to the terms of federal and other state COVID-19-related provisions.
Attachment I
I will be working with my labor law colleagues to provide you with recommended changes that you should make to your COVID-19 notice and reporting policies ASAP. Stay tuned!
Under SB 336 Ochoa Bogh (Chapter 487), when the California Department of Public Health (CDPH) or a local health officer issues an order or mandatory COVID-19-related guidance, they must publish the order or guidance on their website along with the date that the order or guidance takes effect. The CDPH or local health officer must also create an opportunity to sign up for an email distribution list to receive updates on the order or guidance. This measure will hopefully make it easier for businesses to track and implement the most current COVID-19 orders and guidance. SB 336 also went into effect immediately upon signing.
Forthcoming Cal/OSHA COVID Regulation
In addition to the new laws, employers should continue to monitor additional COVID-19 regulatory developments. On October 20, 2021, California’s Division of Occupational Safety and Health (known as Cal/OSHA) issued proposed language for the second readoption of Emergency Temporary Standards (ETS) for COVID-19 Prevention. The readoption would provide for the proposed regulation to be in place from January 14, 2022, to April 14, 2022.
Highlights of the Proposed ETS Revision
The new proposal does not change the definitions of the ETS but does include substantive changes, including the following.
COVID-19 Prevention
With regard to COVID-19 prevention, the proposal changes the following sections. 3205(c)(2): During screening for employees, face coverings must be used for both vaccinated and unvaccinated employees.
3205(c)(3)(B)(5): If a case occurs in the workplace, employers would be required to provide testing for all non-symptomatic close contacts, including those who are vaccinated. 3205(c)(5): Employers are required to make COVID -19 testing available to both vaccinated and unvaccinated employees.
3205(c)(9): This section includes a few changes to exclusion protocols after a close contact. These include changes to:
• (9)(B), which states that if an employer does not exclude an employee pursuant to one of the below exceptions, then the employer must provide “information about any appl icable Attachment I
precautions recommended by CDPH [the California Department of Public Health] for persons with close contacts.”
• (9)(B)(1) & (2), which requires vaccinated workers (or those with natural immunity) who remain asymptomatic and are not excluded to wear a face covering for 14 days after close contact, maintain social distancing for 14 days, and get a COVID -19 test 3 -5 days after close contact.
3205(c)(10)(D): The proposal revises this return-to-work provision to provide that, if an individual returns to work before 14 days, he or she must wear a face mask and maintain social distancing until 14 days have passed. In other words, if an employee returns after 10 days or 7 days due to a negative polymerase change reactions (PCR) test, he or she must wear a face mask and maintain 6 feet distancing for the remaining 7 or 4 days, respectively.
Outbreaks
• 1(b): In an outbreak, employers will be required to test even vaccinated individuals in an exposed group.
Employer Provided Housing
• 3(c): Previously, ventilation ha d to be maximized only if some individuals were unvaccinated. Under the proposal, this is a requirement regardless of vaccination status.
Housing unit ventilation must be maximized no matter whether workers are vaccinated or unvaccinated.
• 3(g): All employee residents must be tested if there were 3 or more cases in their housing unit in a 14-day period.
• 3(h)(1): Housing quarantine policies presently exclude asymptomatic vaccinated close contacts from being quarantined, but this exception is being removed.
Employer Provided Transportation
• 4(c)(2): In transit, all employees, regardless of vaccination status, must be provided with and wear face masks.
Timeframe for Compliance
The California Occupational Safety and Health Standards Board will vote on these proposed changes to the ETS. However, the proposal was NOT on the meeting agenda back on October 21, 2021. Any vote to adopt the proposed regulations will occur at a future Standards Board meeting.
Additionally, a federal emergency regulation related to vaccines is on its way, after which Cal/OSHA will be required to adopt an equivalent or more stringent standard within 30 days.
Attachment I
ALL BILLS SIGNED BY THE GOVERNOR THAT IMPACT
YOUR BUSINESS BY SUBJECT MATTER
Following are the highlights of bills signed by the governor that I tracked on your behalf this session, sorted according to subject matter. To access the complete text of a bill, click on the blue bill number link and then on the Chaptered PDF. All Chaptered bills become law effective January 1, 2022 unless it states it is an urgency measure which means it became law immediately upon the governor’s signature; OR lists another effective date.
CCPA
AB 1391 (Chau) Chapter 594, Statutes of 2021. - Unlawfully obtained data.
The California Consumer Privacy Act of 2018 authorizes a consumer whose nonencrypted and nonredacted personal information, as defined, is subject to an unauthorized access and exfiltration, theft, or disclosure as a result of a business’ violation of the duty to implement and maintain reasonable security procedures and practices appropriate to the nature of the information to protect the personal information may institute a civil action, as specified. This bill would make it unlawful for a person to sell data, or sell access to data, that the person has obtained or accessed pursuant to the commission of a crime and would also make it unlawful for a person, who is not an authorized person, as defined, to purchase or use data from a source that the person knows or reasonably should know has obtained or accessed that data through the commission of a crime.
Employer/Employee
AB 654 (Reyes) Chapter 522, Statutes of 2021. - COVID-19: exposure: notification.
The California Occupational Safety and Health Act of 1973 authorizes the Division of Occupational Safety and Health to prohibit the performance of an operation or process, or entry into that place of employment when, in its opinion, a place of employment, operation, or process, or any part thereof, exposes workers to the risk of infection with COVID-19, so as to constitute an imminent hazard to employees. Current law requires that the prohibition be issued in a manner so as not to materially interrupt the performance of critical governmental functions essential to ensuring public health and safety functions or the delivery of electrical power or water. Current law requires that these provisions not prevent the entry or use, with the division’s knowledge and permission, for the sole purpose of eliminating the dangerous conditions. This bill would add the delivery of renewable natural gas to the list of utilities that the division’s prohibitions are not allowed to materially interrupt.
AB 1033 (Bauer-Kahan) Chapter 327, Statutes of 2021. - California Family Rights Act:
parent-in-law: small employer family leave mediation: pilot program.
Current law, the Moore-Brown-Roberti Family Rights Act, commonly known as the California Family Rights Act, which is a part of FEHA, makes it an unlawful employment practice for an employer, as defined, to refuse to grant a request by an eligible employee to take up to 12 workweeks of unpaid protected leave during any 12-month period for family care and medical leave, as specified. Current law defines family care and medical leave to include, among other things, leave to care for a parent. This bill would additionally include leave to care for a parent- in-law within the definition of family care and medical leave, and would make other conforming changes.
Attachment I
SB 331 (Leyva) Chapter 638, Statutes of 2021. - Settlement and non-disparagement agreements.
Current law prohibits a settlement agreement from preventing the disclosure of factual information regarding specified acts related to a claim filed in a civil action or a complaint filed in an administrative action. These acts include sexual assault, as defined; sexual harassment, as defined; an act of workplace harassment or discrimination based on sex, failure to prevent such an act, or retaliation against a person for reporting such an act; and an act of harassment or discrimination based on sex by the owner of a housing accommodation, as defined, or retaliation against a person for reporting such an act. This bill would clarify that this prohibition includes provisions which restrict the disclosure of the information described above. For purposes of agreements entered into on or after January 1, 2022, the bill would also expand the prohibition to include acts of workplace harassment or discrimination not based on sex and an act of harassment or discrimination not based on sex by the owner of a housing accommodation.
SB 657 (Ochoa Bogh) Chapter 109, Statutes of 2021. - Employment: electronic documents.
Current law regulates the wages, hours, and working conditions of any worker employed in any occupation, trade, or industry, whether compensation is measured by time, piece, or otherwise, except as specified. This bill would provide that, in any instance in which an employer is required to physically post information, an employer may also distribute that information to employees by email with the document or documents attached. The bill would specify that this does not alter the employer’s obligation to physically display the required posting.
Health
SB 336 (Ochoa Bogh) Chapter 487, Statutes of 2021. - Public health: COVID-19.
Would require, when the State Department of Public Health issues a statewide order or mandatory guidance, or when a local health officer issues an order, related to preventing the spread of COVID-19, as defined, or protecting public health against a threat of COVID-19, that they publish on their internet website the order or guidance and the date that the order or guidance takes effect. The bill would also require the department or local health officer to create an opportunity for local communities, businesses, nonprofit organizations, individuals, and others to sign up for an email distribution list relative to changes to the order or guidance.
Safety
SB 606 (Gonzalez) Chapter 336, Statutes of 2021. - Workplace safety: violations of statutes: enterprise-wide violations: egregious violations.
Current law requires the Division of Occupational Safety and Health to issue a citation for a violation of provisions relating to the spraying of asbestos, or any standard, rule, order, or regulation established pursuant to specified provisions of the California Occupational Safety and Health Act of 1973 if, upon inspection or investigation, the division believes that an employer has committed a violation. Current law imposes penalties of certain maximum amounts depending on whether the violation is serious, uncorrected, or willful or repeated. Current law authorizes the division to seek an injunction restraining certain uses or operations of employment that constitute a serious menace to the lives or safety of persons, as specified. This bill would create a rebuttable presumption that a violation committed by an employer that has multiple worksites is enterprise-wide if the employer has a written policy or procedure that violates these provisions, except as specified, or the division has evidence of a pattern or practice of the same Attachment I
violation committed by that employer involving more than one of the employer’s worksites. The bill would authorize the division to issue an enterprise-wide citation requiring enterprise-wide abatement if the employer fails to rebut such a presumption.
Workers Compensation
AB 845 (Rodriguez) Chapter 122, Statutes of 2021. - Disability retirement: COVID-19:
presumption.
Current law prescribes various requirements for the organization and administration of public retirement systems, which typically provide pension, disability, and death benefits to their members. Current law provides that participants in certain membership categories may be entitled to special benefits if death or disability arises in the course of employment. The California Public Employees’ Pension Reform Act of 2013 (PEPRA) generally requires a public retirement system, as defined, to modify its plan or plans to comply with that act and establishes, among other things, limits on defined benefit formulas and caps on pensionable compensation.
This bill, until January 1, 2023, would create a presumption, applicable to the retirement systems that PEPRA regulates and to specified members in those systems, that would be applied to disability retirements on the basis, in whole or in part, of a COVID-19-related illness. In this circumstance, the bill would require that it be presumed the disability arose out of, or in the course of, the member’s employment. The bill would authorize the presumption to be rebutted by evidence to the contrary, but unless controverted, the applicable governing board of a public retirement system would be required to find in accordance with the presumption.
AB 1511 (Committee on Insurance) Chapter 627, Statutes of 2021. - Insurance:
omnibus.
Current law generally regulates insurance and creates the Department of Insurance, headed by the Insurance Commissioner. Current law requires all public records of the department and the commissioner that are subject to disclosure under the California Public Records Act to be available for inspection and copying, as specified, at the offices of the department in the San Francisco Bay area, in the City of Los Angeles, and in the City of Sacramento. This bill would eliminate the reference to an office in the San Francisco Bay area and instead refer to the department’s offices in the City of Oakland, the City of Los Angeles, and the City of Sacramento.
AB 1541 (Committee on Insurance) Chapter 305, Statutes of 2021. - Insurance:
Guarantee Association.
Current law establishes the California Insurance Guarantee Association (CIGA) to provide coverage against losses arising from the failure of an insolvent property, casualty, or workers’ compensation insurer to discharge its obligations under its insurance policies. Current law gives CIGA the ability to request the issuance of bonds by the California Infrastructure and Economic Development Bank to more expeditiously and effectively provide for the payment of covered claims arising from the insolvencies of insurance companies providing workers’ compensation insurance. Current law requires that any bonds that provide funds for covered claim obligations for workers’ compensation claims be issued, as specified, prior to January 1, 2023. This bill would extend the date for bonds to be issued to provide funds for covered claim obligations for workers’ compensation claims, as specified, to January 1, 2026.
Attachment I
On To 2022!
SO NOW WHAT? The 2022 legislative agenda is already taking shape, particularly it appears, with workers’ compensation. While the reforms contained in SB 863 from ten years ago have been a tremendous success, saving employers billions, the unions (with major prodding from the Applicant Attorneys) believe that 2022 will be the best year to seek benefit increases, along with possible blanket presumption changes, and other ‘goodies.’ Of course, these major cost-drivers would have to be balanced with offsets.
This is where I need your assistance. As I previously mentioned, I have been asked to begin working with the key players (as I have done many times in the past) on discussing a framework of issues to be placed ‘on the table.’ I need help from all of you ‘in the trenches’ to provide me with your thoughts, ideas, and suggestions on key issues that can be brought to the table that would be ‘ripe’ for reform to help offset the cost-drivers that would result from benefit increases, presumptions, etc. I’m literally all ears to any and all suggestions you may have. Feel free to email me at: [email protected]
In terms of other things looking eminent for 2022, it’s clear lawmakers will try to place a constitutional amendment on next year’s ballot overhauling California’s recall process, the contents of which will be shaped by what can get two-thirds’ support in Sacramento and pass muster with voters . The oil spill defiling the waters off Orange County’s coast will spur efforts to entirely shut down offshore drilling in state waters. Now that California will require students to get vaccinated for coronavirus, lawmakers may try to tighten up personal belief exemptions.
There are the 2-year bills that have carried-over from 2021. While some, such as the presumption bills AB 334 (Mullin) & SB 284 (Stern), will have the entire session of 2022 to sit on the inactive file only to be brought up on a moment’s notice on the other house’s floor, those that did not move out of their house of origin have through January, 2022 to make it through their house or die. Fingers crossed most end up with this deadline fate! If that wasn’t enough, don’t forget we’re heading into an election year. A half-dozen battleground seats could swing control of the House. Newsom is up for reelection and Progressive Attorney General Rob Bonta will need to defend his seat. Insurance Commissioner Ricardo Lara will look to fend off an intraparty challenge from Assemblyman Mark Levine.
Los Angeles is choosing a new mayor. There will be ballot initiative fights over sports wagering and medical malpractice and recycling. Voters could also get the chance to ban public employee unions, expand school choice, and open battles over teacher employment rules by enshrining a right to a quality public education.
Attachment I
Before the voting will come the new maps. Prospective candidates are in a state of suspense as they wait to see the shape of new districts. Once the California Citizens Redistricting Commission releases the new contours in late December, look out: The churn of retirements and the campaign launches that follow will also reshape the political landscape. Hold on to your seat and hat! It’s going to be a long, contentious and above all, VERY interesting year!
ADDITIONAL SERVICES PROVIDED
I want to remind you of having direct access through me into “the government” to resolve any and all problems or to address any need that may arise. Regardless of the problem or issue, call me! Even if I don’t have the immediate answer or solution, my almost (ugh!) 49 years in Sacramento means that I most likely know someone who can assist us with your problem or issue! I may be reached at (916) 784-7055, or by email [email protected]
Thank you for allowing me to serve as your legislative advocate. It is truly an honor and a privilege! Finally, 2022 will be my 18th year of representing your interests before state government. I can’t wait!
Attachment I
EXHIBIT 3 –
AIMS Transition/Implementation
Plan
Attachment I
Sample
Implementation Plan
Attachment I
1 Sample Implementation Plan
Loss Portfolio Management ®
*Dates will be identified and based on the effective date of contract.
Program Management
TASK RESPONSIBILITY DUE
DATE
Obtain signed Service Agreement – Notify Operations of
changes to RFP
AIMS TBD*
Meet with the NEW CLIENT to:
• Discuss employees and the current/preferred
s
taffing plan
• Confirm banking procedures, exchange financial
information
• Determine claims systems specifics, etc.
• Determine vendor panel
VP Operations, IT, HR, and
Account Manager
Schedule
after signed
agreement
Meet with the NEW CLIENT to:
• Discuss work flow
• Establish goals for program
• Review Cost Avoidance Reports with the NEW
CLIENT. Determine which reports, to whom,
and
t
he frequency to be provided to the NEW CLIENT
• Determine schedule for annual evaluation, client
training and claim reviews
VP Operations, IT, and
Account Manager
3-days after
signed
agr
eement
Trust account funded VP Operations 90-days
after signed
agreement
Files physically transferred from Current TPA. Open and closed files stored by Current TPA will be moved and
stored by the NEW CLIENT’s choice of storage facility.
Fees associated with moving and storage of files would
be provided at cost.
VP Operations 90-days
after signed
agreement
Meeting with the NEW CLIENT to discuss conversion VP Operations, IT, and Account Manager
120-days
after signed
agreement
Review findings and status of takeover with the NEW
CLIENT
• Adjust program goals if indicated
• Priority claims identified and discussed
• Initial plan of action identified for each file
• Nuisance value claims identified
Account Manager, Supervisors 5 months
after signed
agreement
Attachment I
2 Sample Implementation Plan
Loss Portfolio Management ®
P
ersonnel
ACTION RESPONSIBILITY DUE
DATE
Send internal notice of new client to staff Operations 3-days after signed
agreement
Notify Current TPA employees of AIMS job postings and
company benefits, potential employee to provide letter of interest due TBD, request latest resume.
HR Representative 8-days after
signed
agr
eement
Post job listings on Monster.com and AIMS website HR Representative 8-days after signed
agreement
Place advertisements in regional newspapers, industry
publications
HR Representative 8-days after
signed
agreement
HR/Claims team begin interview process VP Operations and HR 12-days after signed
agreement
Request release of personnel information from viable
candidates
HR Representative 12-days
after signed
agreement
Place job orders with Temporary Staffing Agencies HR Representative 45-days after signed
agreement
Hire staff HR Representative 77-days
after signed
agreement
Complete orientation check list/schedule orientation
meeting for new hires
HR Representative 77-days
after signed
agreement
Attachment I
3 Sample Implementation Plan
Loss Portfolio Management ®
Technical
ACTION RESPONSIBILITY DUE
DATE
Provide sample letters to client/former TPA - Guidelines of transfer
VP Operations 3-days after
signed
agreement
Request passwords and obtain first trust file for
conversion from Current TPA
IT 14-days
after signed
agreement
Obtain names and addresses of claims system users IT 31-days after signed
agreement
Complete First Draft of Client Profile, review with the
NEW CLIENT
Account Manager 60-days
after signed
agreement
Provide claim kits and medical panel to each NEW
CLIENT campus
Account Manager 75-days
after signed
agreement
Set up data system with managed care provider IT 75-days after signed
agreement
Set up Banking File IT 75-days
after signed
agreement
Send letter to injured workers, service providers, etc. Account Manager and IT 75-days after signed
agreement
Data transfer IT 87-days
after signed
agreement
Final Client Profile distributed Account Manager 3-months after signed
agreement
Verify Claims Logs received Account Manager 3-months
after signed
agreement
Identify cases on delay and verify appropriate due dates and POA
Account Manager 3-months
after signed
agreement
All NEW CLIENT campuses on-line access to claims
system complete
IT 3-months
after signed
agreement
Attachment I
Sample Transition Plan
Documents
Attachment I
Month DD, 20YY 1
TRANSITION SAMPLE TIMELINE
Workers’ Compensation Third-Party Administration Services Transition Sample Timeline:
03/DD/2020: Date TPA notification/Board Contract approval obtained 03/DD/2020: TPA instruction letter sent out to all parties after Client approval obtained. Detailed letter outlining the transition plan, to include data delivery request and advance payments.
03/DD/2020: Outlook appointment requests sent to prior TPA for weekly meeting. Outlook appointment requests sent to Client for weekly meeting. Outlook appointment request sent to internal participants for weekly meeting.
03/DD/2020: Individual agendas sent out for first weekly meetings - • Internal
• Client
• Prior TPA
03/DD/2020: Estimated date test data delivered from prior TPA with balancing reports and data dictionaries. Receipts of all required elements sets the 60 day data conversion clock.
03/DD/2020: Data conversion issues completed and await delivery of final data. 03/DD/2020: Delivery of final data and images received with balancing reports.
Estimated data live date = MM/DD/2020 to MM/DD/2020.
Attachment I
Month DD, 20YY 2
SAMPLE CLIENT / AGENDA TOPICS
Workers’ Compensation Third-Party Administration Services Sample Client / Agenda Topics:
WEEK #:
1. 03/DD/2020: Overview of Process, Data Conversion Timeline, Banking, Staffing
2. 03/DD/2020: Follow-up Banking, Staffing, Claim Access, and discussion for on line training to report claims, and discuss who needs access and appropriate level. MPN and NCM for triage and transition. Discuss status of TPA call and issues and any outstanding follow up items.
3. 03/DD/2020: Discuss Organization Tree Set-Up, Excess Policy Information, and follow-up on Banking and Staffing, transition to Pharmacy Benefit Program.
Discuss status of TPA call and issues and any outstanding follow-up items.
4. 03/DD/2020: Discuss Setting-up in person meetings for initial meeting with claims team and departments for a Meet and Greet, or Open house. Begin detailed discussion for written Service Guidelines regarding authority levels, Vendor Panel, Medical Providers. Discuss status of TPA call and issues and any outstanding follow-up items.
5. 03/DD/2020: Confirm Banking Progress and Funding. Begin work on updating Medicare Reporting profile. Verify receipt of any requested documents. Discuss status of TPA call and issues and any outstanding follow up items.
6. 03/DD/2020: Discuss rough draft of written Service Guidelines for any modifications. Discuss status of TPA call and issues and any outstanding follow up items.
7. 03/DD/2020: Staffing updates, receipt of RRE information, excess policy information. Discuss status of TPA call and issues and any outstanding follow-up items.
8. 03/DD/2020: Staffing updates. Discuss status of TPA call and issues and any outstanding follow-up items.
9. 03/DD/2020: Finalize written Service Guidelines. Discuss status of TPA call and issues and any outstanding follow-up items.
10. 03/DD/2020: Staffing updates, verify special letters or forms and vendors are added to the system. Discuss status of TPA call and issues and any outstanding follow-up items.
11. 03/DD/2020: Finalize banking and verify funding. Discuss status of TPA call and issues and any outstanding follow up items.
12. 03/DD/2020: Client webinars for online reporting, Meet and Greets with claim staff and departments. Discuss hot cases with Risk Management prior to transfer.
Discuss status of TPA call and issues and any outstanding follow-up items.
13. 03/DD/2020: Confirm receipt of final data and images, advanced payments
14. 03/DD/2020: Confirm data transition complete
Attachment I
Sample Meeting Agendas
Attachment I
Agenda
CLIENT’s NAME:
TPA Transition Meeting Schedule
Location: Call in number assigned
Date/Time/: Every Tuesday, 10:00 – 10:45 am
AIMS Attendees:
NAME TITLE PHONE NUMBER / EMAIL
CLIENT Attendees: (via phone as needed)
NAME TITLE PHONE NUMBER / EMAIL
Week 1
• Exiting TPA Letter & Notice to Award to AIMS
• Expectations for the Exiting TPA Program
• Advance Payments (Disability) – Weeks Ahead
• Client involvement in Examiner selection
• Existing Bill Review & Utilization Review Cut Over
Supporting Documents:
Time Agenda Topic Artifacts Owner Notes
Attachment I
Agenda
CLIENT NAME
TPA Transition Meeting #2
Location: 1 877 309 2073, Access Code: 978-165-685
Date/Time: MONTH DD, 20YY to
Attendees:
NAME TITLE COMPANY ATTENDED
Tricia Baker AVP Operations AIMS
TBD Claims Manager AIMS
Lynn Cavalcanti Sr. VP Operations AIMS
Agenda:
ITEM # TOPIC OWNER DUE DATE
1. Data Conversion: Timeframe delivery = Tina Patterson MM/DD/YYYY
2. Banking: AIMS sets up new account? Jeff Russo MM/DD/YYYY
3. Claim Access and Reports Tina Patterson MM/DD/YYYY
4. Claim Service Guidelines TBD MM/DD/YYYY
5. Staffing TBD MM/DD/YYYY
Attachment I
1 Agenda
CLIENT NAME
TPA Transition Meeting #2
Location: 1 877 309 2073, Access Code: 978-165-685
Date/Time: MONTH DD, 20YY 11:00 a.m. to 11:30 a.m.
Attendees:
NAME TITLE COMPANY ATTENDED
Tricia Baker AVP Operations AIMS Yes
TBD Claims Manager AIMS Yes
Lynn Cavalcanti Sr. VP Operations AIMS No
AGENDA:
ITEM # TOPIC/NOTES OWNER DUE DATE
1. Data Conversion: Timeframe MONTH DD, 20YY delivery = MONTH DD, 20YY
Tricia Baker/
Tina Patterson
2. Banking: CLIENT setting up new positive pay account. CLIENT believes it will be open soon. CLIENT needs AIMS to reconcile and manage with their finance department. Targeting meeting the first week of December with AIMS and Finance departments to discuss access and responsibilities, communication.
Tricia Baker/
Chris Vergers
3. Claim Access and Reports: CLIENT will send over the reports they currently receive and want to continue to receive on monthly, quarterly, annual basis.
Tricia Baker/Tina
Patterson
4. Claim Service Guidelines: CLIENT will send over the rough draft to me and Janine by MONTH DD, 20YY 2:00 p.m. so that Janine can review the information while she is on vacation.
4. Claim Service Guidelines: Janine will contact after she returns. They will decide if they need to meet in person.
TBD
5. Staffing- Janine updated with her current contacts and status. The goal is to hire in the new employees by MONTH DD, 20YY or the first week of MONTH DD, 20YY depending on new candidate availability.
Tricia Baker/ TBD
6. MPN: needs to discuss MPN issues with Lea. They currently have their own MPN and they like to control having providers. If we are able to narrow down the MPN to fit their needs, they will consider using our MPN.
Tricia Baker/
Lea Mendez
7. Nurse Case Management: will obtain a list of NCM assignments from with a status report for mid-December. This will allow AMC TBD
Attachment I
2 ITEM # TOPIC/NOTES OWNER DUE DATE
time to review and discuss potential assignments that need to be transferred or closed out.
7. Triage: Not at this time, but maybe later. The prior administrator used the triage program to prop up the inexperience claim staff. may be open to using at a later time but would need to discuss and understand how the program would work.
Tricia Baker/
Lea Mendez
N/A
8. PBM: Tricia will need to work with Healthesystems and to update Tricia Baker/ Corporate
Compliance
on when the files can transition, when the cards will go out to the open inventory and obtain the first fill cards.
9. Reporting new claims. would like to have new claim reporting Tricia Baker/ Tina Patterson training to take place on MONTH DD, 20YY with her WC Coordinators. would like them to see the sy stem.
We can also provide a webinar at a later date for anyone who missed the training or needs additional training.
Client Contact will work on obtaining a list of the WC coordinators for their IDs. She will include their name, title, department, email and phone number. confirms they should only have access to their department.
would like a link to our reporting system for their website that takes them to our portal.
10. WC Claim Packets: needs 300 DWC 1 forms. Tricia will check to Tricia Baker/ Tina Patterson see if we can put the packets together. states her packets contain the 5020, DWC 1, Supervisor Instructions for completing the packet. WC Clinic list, MPN network information, and 1st fill prescription form.
CLIENT Contacts:
NAME/EMAIL: HR Analyst and assisting with WC transition and Claims.
NAME/EMAIL: HR Analyst and works on RTW and Employment Issues NAME/EMAIL: Clerical and billing
Weekly Transition Meeting with Client:
Starting Wednesday,
Attachment I
EXHIBIT 4 –
Team Resumes for AIMS & AMC
Attachment I
AIMS Proposed Team
Attachment I
1 www.aims4claims.com
Kim Silas, Claims Manager
SUMMARY OF EXPERTISE
Oversees the handling of all aspects of the claims assigned to the unit, maintain a current diary system, reviews job performance, review claims for reserve adequacy, maintain professional relationship and communication with client.
KEY RESPONSIBILITIES
Identify and verify that staff understands the company commitments, standards of performance and client expectations.
Attend client board meetings, claim reviews, and conduct training for clients. Attend oral evaluations for new client business.
Prepare power point presentations and present for all potential and existing clients; including client board meetings.
Assist client concerns while involving appropriate company management with client follow up.
Manage, prepare, and respond to all audits.
Manage and prepare all training needs.
Prepare and submit yearly Self Insurance Program (SIP) annual reports for all clients. Plan, organize, coordinate the work of human resource and technical staff; selects, hires, coaches, counsels, discipline and termination. As well as making other personnel decisions.
RELEVANT EXPERIENCE
2011 – Present – Acclamation Insurance Management Services – Claims Manager 2005 - 2011 – York Insurance Service Group – Unit Manager/Senior Claims Examiner 2004-2004 - Claims Management, Inc. – Sr. Claims Examiner 2002-2004 – Intercare Insurance – Claims Examiner
2001-2002 – American Commercial Claims Administrator – Claims Examiner Attachment I
2 www.aims4claims.com
Kim Silas, Claims Manager
EDUCATION / CERTIFICATIONS
1989 – 1990 College of San Mateo
Self Insurance Certificate for Worker’s Compensation
Insurance Education Association WCCA Workers’ Compensation Claims Administration Certificate
Insurance Education Association WCCA Workers’ Compensation Claims Professional Certificate
Attachment I
AIMS Corporate Management
Team
Attachment I
1 www.aims4claims.com
Dominic Russo, President & CEO
SUMMARY OF EXPERTISE
Dominic has served as President of Acclamation Insurance Management Services, Inc. (AIMS) since 1994. In 2011, he assumed the leadership role of President & CEO for both AIMS and Allied Managed Care, Inc. (AMC), (the Company). Under his stewardship, the Company consistently meets its corporate objective to – “Deliver measurable financial results to our Clients through intelligent use of sophisticated technology and a flexible yet disciplined approach to service delivery with fiscal accountability. We nurture long-term relationships by providing our Clients with technically competent, experienced, and dedicated staff acting with integrity in all that we do.”
KEY RESPONSIBILITIES
• Provides overall strategic leadership to the Company. • Works with Board of Directors and Executive Management Team to establish long-range goal
s, strategies, plans, and policies.
• Oversees compliance of State Regulations and Carrier/ Client needs. • En
sures Client satisfaction and partnership objectives.
• M
aintains and spearheads profitability of the Company.
RELEVANT EXPERIENCE
2011 – Present AIMS / AMC – President & CEO
1980 – 2011 AIMS
President & COO (1994 – 2011)
Various Management Roles (1987–1994)
Claims Examiner (1980 –1987)
EDUCATION / CERTIFICATIONS
• College of Marin, Associate Degree in Business
• Harvard Business School, Graduate of Owner President Management Program Attachment I
1 www.aims4claims.com
Lynn Cavalcanti, Sr. VP Operations
SUMMARY OF EXPERTISE
Lynn has extensive claims experience with public entities. She serves Acclamation Insurance Management Services, Inc. (AIMS) Clients by establishing critical service, program operations, and productivity criteria; benchmarking leading-edge practices; developing marketing channels; leading commitment to quality service; evaluating service results, and representing the company to Clients (making periodic visits, exploring specific needs, and resolving problems).
KEY RESPONSIBILITIES
Establishes effective lines of communication and feedback between branch offices. Oversees quality control as it pertains to Client-related concerns (monitor claims reviews, report requirements, and makes recommendations).
Develops, writes, and revises standard operating procedures; performs annual reviews and updates standard operating procedures, and works to ensure employees meet compliance standards.
Monitors implementation of procedures and standards to assure compliance with the law in coordination with the Client, and/or AIMS reporting responsibilities. Ensures compliance with all government regulated Workers’ Compensation rules, guidelines, and regulations; such as those promulgated by the State of California and Health Insurance Portability and Accountability Act.
Participates in development of system updates to achieve superior quality and reliability levels that meet regulatory and customer-related requirements. Provides leadership and mentoring to employees by participating in the planning, development, coordination, and presentation of specific training and educational programs.
RELEVANT EXPERIENCE
2010 – Present AIMS
Senior Vice President Operations
2003 – 2010 York Insurance Service Group / Gregory B. Bragg & Associate Regional Branch Manager
2002 – 2003 North Bay Schools Insurance Authority
Program Services Manager
1993 – 2002 North Bay Schools Insurance Authority
Workers’ Compensation Claims Manager
Attachment I
2 www.aims4claims.com
Lynn Cavalcanti, Sr. VP Operations
EDUCATION / CERTIFICATIONS
Long Island University, New York, BA
University of Phoenix, California, MA
Concord Law School, California, JD
Associate in Risk Management (ARM) 54-passed
Self-Insurance Certificate
COMMITTEES / ASSOCIATIONS
2002 – 2003 Chair Legislative, California Association Joint Powers Authority (CAJPA) 1996 – 2002 Subcommittee Chair, Workers’ Compensation, CAJPA Speaker/ Presenter at California Coalition on Workers’ Compensation (CCWC) & CAJPA Annual Conferences
Attachment I
1 www.aims4claims.com
Tricia Baker, Assistant VP Operations
SUMMARY OF EXPERTISE
Tricia has extensive experience in the administration of Workers’ Compensation (WC) with public entities. In her career she has served in the roles of Sr. Claims Examiner, Claims Manager, Supervisor/Branch Manager, and Assistant Vice President. Tricia assists the Sr. Vice President Operations with new Client implementations and transitions, identifies and coordinates training, maintains appropriate controls, and ensures AIMS delivers as promised.
KEY RESPONSIBILITIES
• Coordinates training and implementation of regulatory changes. • Liaison between Sr. VP and corporate departments and operating managers. • Works closely with support areas such as Data Delivery Services and Marketing/Sales for mutually agreed upon projects.
• Creates and maintains Risk Management Information System (RMIS) generated letters. • Assists with organization and refinement of RMIS (payment codes, diary codes, etc.). • Attends conferences and seminars (makes contacts / educates teams).
RELEVANT EXPERIENCE
2013 - Present AIMS
Assistant VP Operations
2005 - 2013 York Risk Services Group
Assistant Vice President
2001 - 2005 Liberty Mutual Insurance
Supervisor & Branch Manager
1999 - 2001 Pegasus Risk Management
Claims Manager
1988 - 1999 Liberty Mutual Insurance
Sr. Examiner
EDUCATION / CERTIFICATIONS
• Bachelor of Science, Business Administration – California State University of Sacramento • Self-Insured Plan Certificate
Attachment I
1 www.aims4claims.com
Cheryl Agee, VP Corporate Compliance
SUMMARY OF EXPERTISE
Cheryl has extensive experience in the administration of workers’ compensation (WC) in roles such as Examiner, Supervisor, and Claims Manager. As VP Corporate Compliance, she leads the company in interpreting and implementing new work flow processes following legislative enactment. Cheryl monitors the implementation of procedures and standards to assure compliance with the law and in coordination with the Client, and/or reporting responsibilities.
KEY RESPONSIBILITIES
• Conducts analysis of work performance against best practices, which includes compliance oversight, internal audits, and quality control. • Develops and delivers WC training programs such as ongoing technical training and s
tandardized work flow processes, best practice implementation and revision, quality control, work measurement, management oversight practices, and development of per
formance standards at various levels.
• Implements and revises best practice procedures including work measurement, m
anagement oversight practices, and development of performance standards at various levels.
• Conducts internal audits and quality control.
RELEVANT EXPERIENCE
2005 – Present Acclamation Insurance Management Services, Inc. (AIMS) VP Corporate Compensation (2014 – Present)
Director of Training and Compliance (2013 – 2014)
Claims Manager (2005 – 2013)
2004 – 2005 Southern California Risk Management Associates Branch Claims Manager
1993 – 2005 Cambridge Integrated Services Group, Inc.
Claims Manager
1977 – 1992 Within this timeframe held various WC positions with the following companies: ESIS, Inc., Kemper Insurance Company, Tokio Marine Management, Inc., Republic Indemnity Insurance Company, Fairmont Insurance Company, California Indemnity Insurance Company, Mission Insurance Company, and Fremont Insurance Company
Attachment I
2 www.aims4claims.com
Cheryl Agee, VP Corporate Compliance
EDUCATION / CERTIFICATIONS
• West Los Angeles Community College, Majored in Business/Early Childhood Education • Insurance Education Association Certificate of Completion Workers’ Compensation • Self-Insured Plan Certificate
Attachment I
1 www.aims4claims.com
Ren Johnson, VP Information Technology
SUMMARY OF EXPERTISE
Rendell (“Ren”) has extensive experience in the information technology (IT) industry. A significant amount of his IT career have been in leadership positions including Director and VP in the workers’ compensation (WC) industry. Ren makes strategic technology decisions and provides state of the art solutions for government, healthcare, workers’ compensation, and enterprise environments.
Ren oversees Client program implementation from an IT perspective.
KEY RESPONSIBILITIES
• Defines, delivers, and supports strategic plans for implementing information tec
hnologies.
• Administers the delivery of exceptional customer service. • Identifies Company opportunities and solutions for automating business processes. • Monitors costs and value of IT Services provided to Clients. • Maintains competitive edge in the Company’s technology offerings.
RELEVANT EXPERIENCE
2010 – Present Acclamation Insurance Management Services, Inc. (AIMS) VP Information Technology (2014 – Present) / IT Director (2010 – 2014)
2004 – 2010 Professional Dynamics, Inc.
Director of Information Technology
2003 – 2004 Wright on-line Systems
IT Project Manager
2000 – 2003 Xtime Inc.
MIS Manager/Director
1995 – 2000 MCI / WorldCom
Senior System Engineer (Technical Lead)
EDUCATION / CERTIFICATIONS
• University of Phoenix, Business Administration
• Microsoft (MS) Training: Designing Microsoft Windows, Directory Services Infrastructure, D
esigning MS Windows Network Security, Managing Windows Network Environment, and Wi
ndows Microsoft Certified Systems Engineer (MCSE) Core
• MS Certifications: MCSE / Microsoft Certified Professional / Microsoft Certified Systems Analyst
Attachment I
AMC Team Resumes
Attachment I
www.alliedmanagedcare.com
Mark Denison, Sr. VP Operations
SUMMARY OF EXPERTISE
Mark provides unparalleled leadership and direction to all Allied Managed Care, Inc. (AMC) staff. He oversees all operational and administrative components of AMC’s services. His experience in workers’ compensation cost containment includes strong multi-jurisdictional managed care knowledge and practical application. His involvement will ensure performance standards are met and communication is excellent.
KEY RESPONSIBILITIES
• Oversees quality control as it pertains to Client-related concerns. • Develops, writes, and updates standard operating procedures; performs annual reviews, and ensures employees meet compliance standards.
• Monitors implementation of procedures and standards to assure compliance with the law and in coordination with the Client, and/or AMC reporting responsibilities. • Develops and maintains systems to achieve superior quality and reliability levels to meet regulatory, internal, and customer requirements.
• Provides leadership and mentoring to employees to ensure appropriate quality assurance needs by participating in the planning, development, coordination, and presentation of specific training and educational programs.
RELEVANT EXPERIENCE
2008 – Present Allied Managed Care Inc., (AMC)
Sr. VP Operations
2003 – 2008 Professional Dynamics Inc.
Vice President of Managed Care Services
2001 – 2003 HealthNet, Inc.
Director of Managed Care Services
1997 – 2001 State Compensation Insurance Fund
Medical Consultant
1986 – 2001 Denison Chiropractic Inc.
President/Chief Executive Officer
EDUCATION / LICENSES / TRAINING / CERTIFICATES
• Palmer College of Chiropractic - West Brigham Young University, California: 1985 • Qualified Medical Evaluator, State of California Division of Workers’ Compensation Appointment: 1991–2005
• Certified Disability Evaluator: 1993
• Insurance Educational Association, Workers' Compensation Claims Administration: 2001 Attachment I
www.alliedmanagedcare.com
Alan E. Randle, M.D. Medical Director
/ CA Lic. G27961
SUMMARY OF EXPERTISE
Dr. Alan E. Randle (Dr. Randle) is a California-licensed physician. His experience encompasses the clinical practice of medicine, medical evaluation, management, and academia. Dr. Randle is board certified in Occupational Medicine and has ultimate oversight of all UR Department decisions, education of nurses and examiners regarding
UR rules and regulations. He is a noted industry expert on Utilization Review (UR) in California. He is a presenter and instructor on the California UR process to Physicians, Claims personnel, and employers in the private and public sectors.
Dr. Randle received his medical degree from the University of San Francisco in 1973 and became certified by the American Board of Preventive Medicine in Occupational Medicine in 1989. Dr. Randle practiced Occupational Medicine while Vice President of RediCare Industrial Medical Clinic. Since then Dr. Randle has served as Medical Director for several of the largest insurance and managed care companies in the country. He joined the Allied Managed Care, Inc. (AMC) team in 2008.
KEY RESPONSIBILITIES
• Provide oversight, leadership, and medical expertise for AIMS/AMC. • Oversee day-to-day operations of the Quality Management Program. Chairperson of the Quality Management Committee, accountable to the Company’s President & CEO and Senior Vice Presidents for both AIMS/AMC.
• Work with Clients to develop a mutually agreeable process for oversight of the Claims Examiner approvals and is actively involved in the appropriate training of the claims staff in the authorization process to recognize the most appropriate claims for medical case management services.
• Oversight of all UR Department decisions.
• Educate Nurses and Claims Examiners regarding UR rules and regulations. • Stay abreast of current changes in legislation and trains staff on new regulations. • Conduct training sessions to ensure Claims Examiners are aware of various modalities. • Conduct training for Clients on topics such as the best practices to use for UR.
RELEVANT EXPERIENCE
2008 – Present AIMS/AMC
Medical Director
1991 – Present Occupational Medicine & Utilization Review/Medical Case Management Private Consultant
1978 – 1991 Readicare/California Industrial Medical Clinic Clinical Practice of Occupational Medicine
Vice-President, Redicare Medical Group
Attachment I
www.alliedmanagedcare.com
Alan E. Randle, M.D. Medical Director
/ CA Lic. G27961
EDUCATION / SCHOLASTIC HONORS
• University of California, Berkeley, Bachelor of Science – 1970 • University of California, San Francisco, Medical Doctorate – 1973 • Regent's Scholar – University of California, Berkeley • Phi Beta Kappa – University of California, Berkeley
POST-GRADUATE TRAINING (RESIDENCY)
• University of California, Los Angeles, California
• General Surgery / July 1973 – June 1976
• University of Washington, Seattle, Washington
• General Surgery / July 1976 – December 1977
• University of Cincinnati, Cincinnati, Ohio / 1985 – 1986 • Mini-Residency, Occupational Medicine
BOARD CERTIFICATION
• Certified by the American Board of Preventive Medicine, in Occupational Medicine – January 31, 1989
MEMBERSHIP IN MEDICAL ORGANIZATIONS
• Fellow, American College of Occupational and Environmental Medicine • Western Occupational and Environmental Medical Association (Past Treasurer, Past Member – Board of Directors, Past Secretary) • California Medical Association
• San Joaquin County Medical Association
CURRENT CONSULTING/PROFESSIONAL ACTIVITIES
• Medical Director, AIMS / AMC
• Medical Director, Travelers Insurance California Utilization Review Program • Medical Advisor, Sacramento Municipal Utility District • Medical Advisor, Republic Indemnity, San Francisco
Attachment I
www.alliedmanagedcare.com
Lea Morales-Mendez
Director of Client Services
SUMMARY OF EXPERTISE
Lea has significant workers’ compensation experience and is a bilingual (Spanish) speaker. She has worked in the areas of operations and project management and has served as Director of Operations in six different states throughout the U.S.
KEY RESPONSIBILITIES
• Assists the management team in addressing all issues related to the Client’s contract as well as serving as a resource for workers’ compensation decisions that may affect our Client.
• Interfaces with AMC’s management team to resolve all issues that may arise in Utilization Review (UR), Bill Review (BR), Case Management (CM), Medical Provider Networks (MPN), and 24-hour nursing services.
• Provides timely communication to the management staff of any critical developments that may affect the product delivery; meets regularly with the management team to assess AMC’s performance, discusses business decisions, and addresses concerns to make sure the Client is always receiving optimal service.
RELEVANT EXPERIENCE
2006 – Present Allied Managed Care Inc. (AMC)
Director of Client Services
Director of Operations (2006-2008)
1991 – 2006 Concentra Integrated Services, Inc.
Director of Operations/Regional Manager
1987 – 1991 GENEX / General Rehabilitation Services
California, Supervisor Vocational Rehabilitation Counselor
COST CONTAINMENT EXPERTISE
• Case Management (1991 – Present)
• Utilization Review and Case Management (2006 – Present) • Bill Review (2009 – Present)
• Medical Provider Network (2012 – Present)
EDUCATION / LICENSES / TRAINING / CERTIFICATES
• California State University, Hayward, Bachelor of Arts, Psychology • Chabot College, Hayward, Associate of Arts
• Ergonomic Specialist – Certified
• Disability Management – Trained
• Crisis Response Trained
Attachment I
www.alliedmanagedcare.com
Lea Morales-Mendez
Director of Client Services
• HIPAA (Health Insurance Portability and Accountability Act) – Trained • URAC (Utilization Review Accreditation Committee) – Trained
Attachment I
www.alliedmanagedcare.com
Melissa Miller, Director Bill Review
SUMMARY OF EXPERTISE
Melissa has extensive experience in the Managed Care industry including working for large national bill review companies. She has amassed a strong working knowledge of the entire bill review process.
KEY RESPONSIBILITIES
• Builds and maintains collaborative relationships and alliances with Clients.
• Ensures areas of responsibility are operating at an optimal level of experience, skill, knowledge and capability.
• Develops strategic operational and tactical business plans to achieve desired business goals for responsible operation areas.
• Provides supervisory oversight and quality control of the entire medical bill review process to ensure timely processing of payments for Clients.
• Oversees all administrative and operational components of the bill review unit, including staffing, training, quality, timeliness, and accuracy of work performed in the unit to ensure efficient and optimum workflows.
• Utilizes working knowledge of the entire bill review process to ensure objectives align with specifications noted by the Clients’ Special Account Instructions. • Manages budget and control expenses while meeting operational, financial and service requirements.
RELEVANT EXPERIENCE
2009 – Present AMC
Director, Bill Review (2018)
Division Manager Bill Review (2009 – 2017)
1997 – 2009 Health Net Plus/Coventry
National Account Manager
1993 – 1997 Reviewco
Hearing Representative/ Inquiry Specialist
1990 – 1993 Reviewco
Data Enterer, Auditor, Technical Analyst
1987 – 1988 Keycorp Bank
Coder - New York, New York
EDUCATION / LICENSES / TRAINING / CERTIFICATES
• Rose State College, Oklahoma – 1990
• University of Oklahoma – Business Finance/Accounting – 1989 • California designated Bill Reviewer
Attachment I
www.alliedmanagedcare.com
Caroline Iverson, Division Manager
Peer Review Services
SUMMARY OF EXPERTISE
Caroline has extensive experience in the Managed Care sector covering workers’ compensation Utilization Review (UR). She has been a licensed Chiropractor since 1993. As AMC’s Peer Review Manager, Caroline’s role is to provide an added level of auditing of the referrals and documents sent from UR nurses to Peer Review physicians and also auditing every completed Peer Review for quality and timeliness.
Caroline works closely with the UR Manager and AMC’s Medical Director to ensure the quality and timeliness of all Peer Reviews. She coordinates our extensive Utilization Review Quality Management Program.
KEY RESPONSIBILITIES
• Oversees coordination of referrals from UR Nurses to Peer Review. • C
onfirms quality audit of Peer Reviews prior to their release. • Manages Peer Review Physician Scheduling.
• Manages and reviews invoicing and communication between Physicians and Vendor Peer panels.
• Manages Peer Review assignments and timelines as required by the California Department of Wor
kers’ Compensation (DWC).
• Coordinates the Company’s extensive Utilization Review Quality Management Program (AMC is Utilization Review Accreditation Compliant (URAC) compliant).
RELEVANT EXPERIENCE
2008 – Present Allied Managed Care Inc. (AMC)
Peer Review Manager
2003 – 2008 Professional Dynamics, Inc.
Peer Review Manager (2005 – 2008)
Manager, Chiropractic Case Management and UR (2003 – 2005) 1998 – 2004 National Health Services, Inc. (Now SHPS, Holding Inc.) Chiropractic Physician Reviewer
2003 – 2004 Cambridge Integrated Services
Chiropractic Physician Reviewer
1998 – 2003 Alternative Managed Health Care
Managed Care Consultant
1994 – 1998 Landmark Healthcare, Inc. and Landmark Healthplan Director of Chiropractic Services
1989 – 1994 Mid-Peninsula Back Pain Clinic (Chiropractic Private Practice) ChiroView, Chiropractic Physician Reviewer (1992 – 1994) Quality Health Assurance, Chiropractic Physician Reviewer (1990 – 1992)
Attachment I
www.alliedmanagedcare.com
Caroline Iverson, Division Manager
Peer Review Services
EDUCATION / LICENSES / TRAINING / CERTIFICATES
• Pre-med studies: College of San Mateo, San Mateo, California; Foothill College, Los Altos, C
alifornia
• Chiropractic: Palmer College of Chiropractic-West, Sunnyvale, California • Member, American Chiropractic Association Managed Care and Insurance Committee, 1999 – 2005
• A
dvisor, Ethics Committee; California Chiropractic Association, 1993 – 1994 • Qualified Medical Examiner, 1991 – 1996
• Industrial Injury Evaluation Certification, 1990
• Managed Care Certification; California Chiropractic Association, 1993 Attachment I
www.alliedmanagedcare.com
Shannon Buelna, LVN
Director Utilization Review
SUMMARY OF EXPERTISE
Shannon has been a licensed vocational nurse for the past 15 years. She joined Allied Managed Care, Inc. (AMC) in 2008 and was promoted to Utilization Review (UR) Manager in 2014 and Director in 2022. She has clinical experience working in a physician’s office, providing skilled nursing, and as director of a 199-bed assisted living facility. Her workers’ compensation UR experience includes nine years working with public entities to ensure performance of UR services in accordance with the state protoc
ols, guidelines, and regulations.
KEY RESPONSIBILITIES
• Collaborate with the Claims Examiners to ensure proper handling of each referral; understanding of claim status and medical/legal implications, and attention to Client specific instructions.
• Assist the Director of Nursing Services in the oversight of the UR program. • Supervise and audit the dedicated UR staff;
• Ensure State and regulatory compliance such as Utilization Review Accreditation Commission (URAC) compliance.
• Assist in the implementation of Client specific instructions, and any new processes which might arise out of Division of Workers’ Compensation (DWC) revisions and updates.
RELEVANT EXPERIENCE
2008 – Present Allied Managed Care Inc. (AMC)
2007 – 2008
2006 – 2007
2005 – 2005
2004 – 2004
Utilization Review Director (2022 - Present)
Utilization Review Manager (2014 – 2021 )
Utilization Review Supervisor (2008 – 2014)
InterMED
Cost Containment Services
Utilization Review Nurse
Oakdale Heights
of Roseville
Resident Care Director
Sunbridge Brittany Care Center
Licensed Vocational Nurse/Medicare Unit Coordinator
Capital
Allergy and Respiratory Disease
Licensed Vocational Nurse
Attachment I
www.alliedmanagedcare.com
Shannon Buelna, LVN
Utilization Review Manager
EDUCATION / LICENSES / TRAINING / CERTIFICATES
• Colorado State University – Global Campus: Bachelor of Science, Healthcare Administration and Management
• Western Career College, Vocational Nursing Program
• Licensed Vocational Nurse, 2003
• Intravenous/Blood Withdrawal Certified
• Residential Care Facilities for the Elderly – Administrator 2003 – 2004 Sunbridge Brittany Care Center
Licensed Vocational Nurse
Attachment I
EXHIBIT 6 –
Cost Proposal
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Exhibit 6 – Cost Proposal
Acclamation Insurance Management Services, Inc., (AIMS) and Allied Managed Care, Inc. (AMC)
Proposed Cost Proposal
For
Cost Proposal
For all services offered in your written proposal, complete the appropriate cost proposal worksheet in Attachment I A, B, and/or C of this RFP and include them in a separate section of your written proposal. In addition, indicate on this cost proposal a sc hedule of rates for additional related services, if any, which the City may consider, at its sole option.
Please see our detailed Proposed Annual Fee for Services below.
Claims Administration Fees: Flat annual fee for service Acclamation Insurance Management Services, Inc. (AIMS) has included the completed cost proposal worksheets: Attachments I A, I B and IC as requested by the City of Richmond (City).
The following is offered as supporting documentation of our cost proposal.
AIMS proposes a “flat annual fee” for the Workers’ Compensation Third Party Administration Services which includes the handling of all current ope n claims, new indemnity claims, and new medical only claims during the life of the contract. A flat annual fee, as opposed to the “per-claim or broken down fees”, will provide a fixed and predictable budget item for the City.
This flat annual fee eliminates the time and expense required to audit the per -claim fee or other project cost estimates which varies month-to-month.
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
In calculating the estimated flat annual rate for Claims Administration, AIMS first determines what the appropriate staffing requirements are in order to perform the required services. The required staffing is consistent with the requirements in the City’s RFP. The estimated staffing is then used to calculate the total staffing cost associated with the City’s program. The total staffing cost is then used to determine the total operating costs related to the program. Lastly, AIMS corporate overhead and a reasonable prof it are added to the total operating costs to determine a reasonable claims administration fee for the program.
AIMS proposes the use of Allied Managed Care, Inc. (AMC) to provide any necessary medical cost containment services except for Nurse Case Management Services.
AIMS estimates of the required claims staffing is calculated with the use of our recommended managed care strategic partner, AMC, for medical cost containment services. As a result of significant electronic interfaces with AMC, AIMS typically requires less staff, on a bundled basis, to complete the required work and, therefore, the fees and costs are typically lower on a bundled basis since there is more efficiency built -in for the claim handlers. AIMS has included the AMC fees for all Managed Care Cost Containment Services below.
The pricing below is based upon the staffing requirements as set forth in the subject RFP and any Addendum(s) or additional information provided:
Staffing Requirements:
o Dedicated Sr. Examiner
o Dedicated Sr. Examiner
o Designated Future Medical Examiner
o Designated Claims Assistant
The City’s AIMS staffing will have the appropriate claims supervision and Claims Manager to oversee the partially dedicated claims unit and program. In addition, the necessary corporate management, clai ms management/supervision, IT management, clerical staff and other support staff will be assigned to the City’s program.
This fee is premised on, and in reliance on, the staffing requirements as set forth in the RFP or related information provided. Should the City of Richmond require additional staffing, then both AIMS and the City will negotiate, in good faith, a reasonable fee adjustment based on any revised required staffing.
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Claims Administration
AIMS Proposed Fees:
* Annual cost of living adjustment of 3.0%
Should AIMS be selected for consideration to be the Claims Administration service provider for the City’s program then AIMS is open to negotiating a “best and final” fee arrangement that is based on any updated staffing and/or updated service requirements that will result in a fee arrangement mutually beneficial to both the City and AIMS.
The total annual flat fee proposed above contemplates handling all claims activity in a 12 - month period (claims already open at the beginning of the 12 -month term and any new claims reported during the 12 -month term). The annual fee will be invoiced in 12 equal monthly amounts in arrears. The flat annual fees quoted above include all the services detailed in this RFP proposal response including, but not limited to, the following services:
Program Implementation Included
All Claims Management Functions (currently open & new claims) Included
Client RMIS Access Included
Data Management Included
Claim File Storage Included
Claim File Retrieval Included
Account Management Included
Claim System Reporting Included
Public Self-Insurer’s Annual Report Included
OSHA Reporting Assistance Included
Year One $ 610,000.00
Year Two $ 628,300.00*
Year Three $ 647,147.00*
Total 3 Year Fixed Sum $ 1,885,447.00
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Prepare Federal form 1099 notices Included
Custom AIMS “dashboard” Included
Web Site Access (on-line) Included
Detailed Stewardship Reports/Presentations Included
Training Participation Included
MMSEA Reporting Included*
*Costs associated with Medicare Set-Aside analysis and submission or Medicare Conditional Lien negotiations are Allocated expenses and paid off of the
Program Implementation, including Data Conversion
Generally, there is a one-time, direct pass through, fee for data conversion and transfer. This fee will generally not exceed $15,000.00 per source entity. However, since the City is a current Client of AIMS there will be no data conversion and transfer fees.
Program Implementation is included in the Flat Annual Fee.
Hourly rate for customization of reports and special reports requests
Customization reports: Most ad-hoc report requests can be completed by our Data Delivery Services (DDS) team without any additional charge to the Client. Should the City have a highly specialized report that requires special programming of the system then DDS will secure and provide an estimate of the fees to complete the request and seek approval from our Client before proceeding. A typical hourly rate for these customized reports is approximately $250.00. All specialized report fees are on a “pass- through” basis.
Allocated expenses not covered under the base price
Allocated Loss Adjustment Expenses
In the normal course of administering workers’ compensation claims there will be additional fees for services provided by non -affiliated, Client approved, service providers that are paid off of and allocated to the respective claims file. These Allocated Loss Adjustment Expenses (ALAE) or adjustment expenses are linked directly to the processing of a specific claim. ALAE is included as part to the expense reserves, along with loss reserves, on a claims file and are included in the calculation for the funding of the loss trust fund in order to pay claims, both Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
losses and expenses, in a timely manner. Allocated expenses would normally include, but not be limited to, the following:
Fees of outside counsel for claims in suit, c overage opinions and litigation and for representation at hearings or pretrial conferences; Fees for court reporters;
All court cost, court fees, and court expenses;
Fees for service of process;
Costs of undercover operatives and detectives;
Costs for empl oying experts for the preparation of maps, professional photographs, accounting, chemical or physical analysis, diagrams; Costs for employing experts for the advice, opinions or testimony concerning claims under investigation or in litigation or for which a declaratory judgment is sought;
Costs for independent medical examination or evaluation for rehabilitation; Cost of legal transcripts of testimony taken at coroner’s inquests, criminal or civil proceedings;
Cost for copies of any public records or medical records; Costs of depositions and court reported or recorded statements; Non-AIMS Costs and expenses of subrogation;
Costs of engineers, handwriting experts or any other type of expert used in the preparation of litigation or used on a one-time basis to resolve disputes; Witness fees and travel expenses;
Costs of photographers and photocopy services;
Costs of appraisal fees and expenses (not included in flat fee or performed by others); Costs of indexing claimants;
Services performed outside our normal geographical regions; Costs of outside investigation, signed or recorded statements; Out of the ordinary non-AIMS expenses incurred in connection with an individual claim or requiring meeting with the Client;
Costs associated with Medicare Set-Aside analysis and submission or Medicare Conditional Lien negotiation;
Any other extraordinary services performed by AIMS at the Client’s request;
Investigation or possible fraud, including Special Investigations Unit services and related expenses;
Any other similar cost, fee or expense reasonably charged to the investigation, negotiation, settlement or defense of a claim or loss or to the protection or perfection of the subrogation rights of the Client.
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Performance-Based Compensation Alternatives: The City is willing to consider performance-based compensation alternatives. If offering such alternatives, please outline the options below and indicate the standards that would used to qualify:
AIMS is open to discussing and including the performance me asures that are important to the City. As such, the following is general in nature as AIMS believes it is important to meet with the City to clearly develop and understand the performance guarantees.
AIMS has Client specific performance clauses with several of our Clients. Mutually beneficial performance and financial incentives include bonuses for above average results and reduced fees for below average performance. Determination of performance can be evaluated by random sample audits and/or information o btained via data collected and reported by our claim system and/or bill review and/or utilization review software. Items have, in the past included topics such as staffing levels, closing ratios, penalties, timeliness of forwarding litigation files, timeliness of determining compensability, bill review savings, fee increases for subrogation recoveries, and fee increases for facilitation of Return to Work processes.
Sample Performance Clause: The following incentives are based on the score of an annual audit conducted by our Client. We are given an opportunity to discuss and review the audit with our Client. If AIMS is able to obtain a score between 85-89%, AIMS receives 1.5% of the Base Fee back, 90-94% is 3.0% and 95% or over is 4.5%. In addition, if we are able to score between 80-84%, then we are revenue neutral, 75 -79% a negative 1.5% and anything less than 75% is a negative 4.5% of base fee.
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Medical Cost Containment Services utilizing Allied Managed Care, Inc. (AMC)
Bill Review: Flat fee bill
Medical Bill Review/PPO:
Official Medical Fee Schedule (OMFS) Review:
Flat fee per bill:
$7.50 per bill (flat rate per bill) plus PPO access fee (see below)
The following is included (at no additional charge):
Full Duplicates
Appeals
Initial Setup
Technology Fees for Interface
Client Training
Re-evaluation/Provider Inquiries
Expert Testimony in Defense of Reviews
Electronic Data Interface and On-line Access
Courier Service
PPO fee for savings below fee schedule:
PPO Network Access Fee:
Anthem Blue Cross – CA 26%
First Health / Coventry 24%
Procura 22%
PRIME 19%
InterPlan 18%
ClarisPointe 18%
ASI Flex 18%
Specialty Bill Review:
Negotiation of Non-OMFS and Line-Item Audit bills, including Inpatient/Outpatient Hospital bills (non-PPO charges):
10% of Savings capped at a maximum of $5,000.00.
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Electronic billing:
Electronic and Standardized Billing Regulations: $1.00 per bill.
Utilization Review: Flat fee for UR provided by doctor, flat fee for UR provided by nurse
Utilization Review (UR)
a) Nurse Review:
$95.00 per UR (nurse) Referral. This includes unlimited treatment requests and reviews per referral.
b) Physician Review:
$225.00 per Peer Review Referral. This includes unlimited treatment requests and reviews per referral.
The following is included in the above fees:
Initial set-up at the time of award of contract
Customized Special Account Instructions
Documentation letters post UR and Peer Review
Technology Fees for interface
Production Reports & Metrics
Consultation with AMC’s Medical Director
Client Training
Nurse Case Management: Hourly fee for telephonic case management, hourly fee for field case management
Medical Management (Nurse Case Management)
a) Telephonic Case Management:
$95.00 per hour
b) Field Case Management:
$110.00 per hour*
*Travel for Field Case Management (On -Site) services will be charged at the Internal Revenue Service approved rate for mileage at the time the mileage is incurred.
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Allied Managed Care Service Entity Medical Provider Network (MPN) It is our understanding that the City currently does not utilize a medical provider network (MPN) at this time. The following information is provided to the City for their consideration.
AIMS will work with the City, if they so desire, to establish an MPN, based upon the City’s needs. AMC can install the MPN as the primary network. The following networks are available for secondary placement:
Procura
PRIME
InterPlan
ClarisPointe
ASI Flex
AMC offers custom provider networks, both MPN and PPO, to be used exclusively by our individual Clients. These workers’ compensation specific networks incorporate the medical providers with extensive, specialized experience in dealing with injuries incurred at the work place or job site.
SB 863 changes now allow for “Service Entity” MPN certification. On March 11, 2015 AMC received approval from Department of Industrial Relations, Division of Workers’ Compensation Medical Unit for the AMC MPN (MPN Identification #2360). This approval is valid for a period of four (4) years.
AMC has been approved by the Department of Workers’ Compensation (DWC) as a Services Entity MPN. What this means to a Client is that they can now join the AMC MPN without having to file an MPN on their own and take on all the regulatory requirements as an Employer.
We hope that the City takes advantage of this great opportunity to join the AMC MPN.
Some of the benefits would include:
Medical Control for the Life of the Claim, if employee has not predesigned a physician.
Elimination of providers that over-utilize narcotics or medical treatment. Quality Care from MPN providers.
Per DWC reduced medical care and reduced lost time.
Referral to specialists within MPN
Quality Care monitoring through MPN.
Medical Access Assistant to assist employees from 7am to 8pm Monday- Saturday.
Bottom-line reduced medical costs for higher quality medical care. Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
These workers’ compensation specific networks incorporate the medical providers with extensive, specialized experience in dealing with injuries incurred at the work place or job site. Employees receive the necessary treatment to relieve and resolve the effects of a work related injury.
The MPN includes Certification from the State of California and Enrollment Notices to all Employees complete monitoring of the MPN for State Compliance and reporting with toll free access/assistance for Employers and Injured Employees and all services listed below. This also includes the continued monitoring of the Enro llment Process for New Hires.
Available Services:
o Assistance with creating MPN enrollment notices
o MPN Application / Certification from State
o On-line provider locater
o 10% change monitoring
o Toll Free Network Access Assistance to help locate providers o Support for Network & Employer provided
o MPN roll-out meetings
o Reporting
We will work collaboratively with our Clients to ensure a smooth transition, including comparing the current MPN to determine which providers are already in our available Networks. Network de velopment can recruit, credential, and contract any specific qualified providers to participate in the City’s provider network.
In addition to the MPN, AMC has an ever growing list of PPOs to offer and will work with our Client to determine the best PPOs f or our Client’s program. Our broad menu of network relationships is designed to offer our Clients the ability to match their own experience with the PPO option that would maximize cost effectiveness. By not being tied to or owning any network affiliation we can provide that expertise and flexibility to our Client for all bill types in all jurisdictions. Additionally, the system allows several ways in which we can maintain and support Client specific contractual discounts.
AMC’s Bill Review software identif ies PPO and negotiated fee providers by Tax ID Number. AMC can load virtually any PPO or negotiated fee arrangement by individual provider, by Tax ID Number, into the Bill Review software engine for automated application of discounts. Certain PPO networks are better than others depending on the locations of the providers, type of contracts, specialties of the providers, discounts etc.
Pricing for these services is dependent on the size and complexity of the MPN and will be provided should the City be interested in implementing this valuable cost containment resource. Typical pricing, as a sample only, is as follows:
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Allied Managed Care Service Entity Medical Provider Network (MPN) Fee: $2000.00 per month (estimate only)
The MPN Fee includes access to an already certified DWC MPN and Enrollment Notices to all Employees complete monitoring of the MPN for State Compliance and reporting with toll free access/assistance for Employers and Injured Employees and all services listed below. This also includes the continued monitoring of the Enrollment Process for New Hires.
Included Services:
o Assistance with creating MPN enrollment notices
o MPN Application / Certification from State
o On-line provider locater
o 10% change monitoring
o Toll Free Network Access Assistance to help locate providers o Support for Network & Employer provided
o MPN roll-out meetings
o Reporting
Please see the below RFP- related Attachments:
Attachment I A - Claims Administration Cost Proposal
Attachment I B - Bill Review Services Cost Proposal
Attachment I C - Utilization Review Services Cost Proposal
End of Cost Proposal
Attachment I
Proposal for City of Richmond
Workers’ Compensation Managed Care
Services
ATTACHMENT I A
CLAIMS ADMINISTRATION COST PROPOSAL
Claims Administration Cost Proposal
Complete and include this cost proposal worksheet if you are proposing workers’ compensation claims administration services. Proposals which do not contain this cost proposal may be rejected. If non -company owned vendors are used for any services proposed, attach their proposal to you for such services.
1. Claims Administration Services
Proposed fixed sum for Workers’ Compensation Claims Administration Services to include assumption of all open claims, new indemnity, new medical only, new first aid, and all future medical claims for the proposed THREE (3) year contract period:
$ 1,885,447.00
Other costs (if any) related to claims administration for the proposed THREE (3) year contract period:
Standard reports: $ -0-
Customized reports: $ -0-
Computer access fee: $ -0-
Data transfer/conversion: $ -0-
Other: $ See Below
(Please specify): Customization of reports: Most ad-hoc report requests can be completed by our Data Delivery Services (DDS) team without any additional charge to the Client. Should the City have a highly specialized report that requires special programming of the system then DDS will secure and provide an estimate of the fees to complete the request and seek approval from the City before proceeding. A typical hourly rate for these customized reports is approximately $250.00. All specialized report fees are on a “pass- through” basis
Attachment I
Proposal for City of Richmond
Workers’ Compensation Managed Care
Services
ATTACHMENT I A
CLAIMS ADMINISTRATION COST PROPOSAL
2. Performance-Based Compensation Alternatives: The City is willing to consider performance-based compensation alternatives. If offering such alternatives, please outline the options below and indicate the standards that would used to qualify:
AIMS is open to discussing and including the performance measures that are important to the City. As such, the following is general in nature as AIMS believes it is important to meet with the City to clearly develop and understand the performance guarantees.
AIMS has Client specific performance clauses with several of our Clients. Mutually beneficial performance and financial incentives include bonuses for above average results and reduced fees for below average performance. Determination of performance can be evaluated by random sample audits and/or information obtained via data collected and reported by our claim system and/or bill review and/or utilization review software. Items have, in the past included topics such as staffing levels, closing ratios, penalties, timeliness of forwarding litigation files, timeliness of determining compensability, bill review savings, fee increases for subrogation recoveries, and fee increases for facilitation of Return to Work processes.
Sample Performance Clause: The following incentives are based on the score of an annual audit conducted by our Client. We are given an opportunity to discuss and review the audit with our Client. If AIMS is able to obtain a score between 85-89%, AIMS receives 1.5% of the Base Fee back, 90-94% is 3.0% and 95% or over is 4.5%. In addition, if we are able to score between 80-84%, then we are revenue neutral, 75-79% a negative 1.5% and anything less than 75% is a negative 4.5% of base fee.
Submitted By: Dominic Russo, President & CEO AIMS/AMC
(Firm Name) Acclamation Insurance Management Services, Inc. (AIMS)
(Signature of Individual Authorized to Bind on Behalf of Firm)
Attachment I
ATTACHMENT I B
BILL REVIEW SERVICES COST PROPOSAL
Proposal for City of Richmond
Workers’ Compensation Managed Care
Services
Bill Review Services Cost Proposal
Complete and include this cost proposal worksheet if you are proposing bill review services. Proposals which do not contain this cost proposal may be rejected. If non- company owned vendors are used for any services proposed, attach their proposal to you for such services.
1. Bill Review
Flat fee per bill: $ 7.50 per bill
Specialty Billing Percentage of Savings: 10% Savings
Specialty Billing Maximum Cap: $ 5,000 per bill Maximum Cap
2. Other Services Associated with Bill Review (Specify service and cost, if any:)
The following is included (at no additional charge):
• Full Duplicates
• Appeals
• Initial Setup
• Technology Fees for Interface
• Client Training
• Re-evaluation/provider Inquiries
• Expert Testimony in Defense of Reviews
• Electronic Data Interface and On-line Access
• Courier Service
Submitted By: Dominic Russo, President & CEO AIMS/AMC
(Firm Name) Acclamation Insurance Management Services, Inc. (AIMS)
(Signature of Individual Authorized to Bind on Behalf of Firm)
Attachment I
ATTACHMENT I B
BILL REVIEW SERVICES COST PROPOSAL
Proposal for City of Richmond
Workers’ Compensation Managed Care
Services
Utilization Review Services Cost Proposal
Complete and include this cost proposal worksheet if you are proposing utilization review services. Proposals which do not contain this cost proposal may be rejected. If non - company owned vendors are used for any services proposed, attach their proposal to you for such services.
1. Utilization Review
Flat fee per review (nurse): $ 95.00 per request of authorization Flat fee per review (Dr. peer review) $ 225.00 per request for authorization
2. Other Services Associated with Utilization Review (Specify service and cost, if any:)
The following is included in the above fees:
Initial set-up at the time of award of contract
Customized Special Account Instructions
Documentation letters post UR and Peer Review
Technology Fees for interface
Production Reports & Metrics
Consultation with AMC’s Medical Director
Client Training
Submitted By: Dominic Russo, President & CEO AIMS/AMC
(Firm Name) Acclamation Insurance Management Services, Inc. (AIMS)
(Signature of Individual Authorized to Bind on Behalf of Firm)
Attachment I
EXHIBIT 7 –
Settlement Authority Request
Worksheet
Attachment I
SETTLEMENT AUTHORITY REQUEST
(CONFIDENTIAL)
To:
RE: EMPLOYEE: EMPLOYER: City of Oxnard
DATE/INJ: CURRENT EMPLOYEE:
CURRENT AGE: OCCUPATION:
INJURY TYPE: CLAIM #:
DEFENSE ATTORNEY:
TREATING PHYSICIAN: RATING: % =
AME: RATING: % =
PANEL QME: RATING: % =
DEFENSE QME: RATING: % = $
Medicare Set Aside Apply? [Yes] [No]
STIPULATIONS: PAID TO DATE: $ BALANCE: $
Open Future Medical: Yes/No
COMPROMISE & RELEASE:
PD: %, $ PAID TO DATE: $
FUTURE MEDICAL: $
TOTAL: $ PAID TO DATE: $ BALANCE: $
Open Future Medical: [Yes] [No]
Attachment I
COMMENTS:
RECOMMENDATIONS:
CLAIMS EXAMINER:__________________ DATE:__________________
Supervisor Signature (if needed)
______________________________________ DATE:___________________
Client Settlement Request Approved as Recommended:______________________________
DATE: ___________________
Attachment I
EXHIBIT 9 –
Scope of Services Detail
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Exhibit 9 – Scope of Services Detail
SCOPE OF SERVICES
AIMS senior operating management team is familiar with the “Scope of Work” and as the current vendor has been able to meet this criteria and if selected will continue to fully comply with all requirements as presented in this “Scope of Work”.
The TPA all services required to supervise and administer the City’s self- insured workers’ shall perform compensation claims, and to act as the City’s representative in matters relating to the City’s obligations under the workers’ compensation laws for th e State of California.
We have reviewed and will comply with this requirement
Program Administration Needs: The City's Risk Management Division, in the Human Resources Management Department, coordinates all aspects of the workers' compensation program including the management of the TPA and its contract.
We have reviewed and will comply with this requirement
Permanent Disability: As soon as the TPA receives notice of permanent and stationary status, they shall communicate this information to the City so t hat permanent accommodation consideration can be initiated.
We have reviewed and will comply with this requirement
Fraud Control: The City requires the TPA to aggressively control fraud and pursue restitution in all fraud cases. Risk Management shall be n otified of all claims involving potential fraud and initiation of fraud investigation activities.
We have reviewed and will comply with this requirement
Claims Reviews: On -site quarterly claim reviews at the City are required and involve participation by City Department representatives. The TPA is expected to send claim staff to attend claim reviews and be prepared to discuss agendized claims.
We have reviewed and will comply with this requirement
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Loss Reporting and Data: The TPA shall provide basic loss reports electronically that detail payments and check runs, claim frequency, paid and incurred costs, annual OSHA reports, 1099's and the annual SIP report. In addition, the City may need on occasion to obtain other reports for various purposes including, but not limited to, actuarial studies, audits, program and departmental analysis. The City retains the right to select the risk management information system. The TPA shall not change the RIMS without advance written notice to the City and consent by the City.
We have reviewed and will comply with this requirement.
Please see Exhibit 10 – AIMS Sample Claims Reports
Claims Personnel: The City maintains the right to interview and review evidence of work experience of all personnel to be assigned to its account and to approve such personnel.
The City shall have a right to request a change of designated account staff. The claims supervisor and senior claims examiner shall possess a self -insured certification. A minimum of 5 years experience shall be required of the claims supervisor, senior claims examiner, and claims examiner.
We have reviewed and will comply with this requirement.
Please see Exhibit 4 – Team Resumes
The TPA will input all new claim reports within 24 hours of receipt.
We have reviewed and will comply with this requirement.
The City and/or the excess carrier may conduct claims performance audits to measure the TPA's performance and compliance with claims administration standard's and requirements. The TPA shall provide the results of the SAS70 audit compliance report on an annual basis.
We have reviewed and will comply with this requirement.
Please see Exhibit 11 – SSAE 18 Reports SOC 1 and SOC2 Reports (CONFIDENTIAL)
Excess Carrier: Report on all potential excess carrier claims as required to the applicable excess carrier. Provide to the City a copy of each report and pursue, when appropriate, excess reimbursements from the carrier. Maintain records on excess re - insurers and reimbursements on behalf of the City. Comply with all Sta te mandated reporting requirements (SIP, DWC, OSHA log, etc.)
We have reviewed and will comply with this requirement.
Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
Settlement Authorization: Prepare and submit settlement authorization request for approval by the City prior to initiating settlement ne gotiations. The City may, at its discretion, grant limited authority to the TPA to resolve minor claims; however, settlement authorization request forms must still be submitted to the City. Settlements involving payments of over ten thousand dollars ($10,0 00) require City Council approval. Provide at least 35 days advance notice of settlement authorization requests for settlement amounts over ten thousand dollars ($10,000).
We have reviewed and will comply with this requirement.
The TPA will provide docum entation and information as needed to enable the City to effectively coordinate return to work and the ADA interactive process.
We have reviewed and will comply with this requirement.
The TPA will maintain an electronic and/or paper file on each claim.
We have reviewed and will comply with this requirement.
The TPA will provide the City with updates and information on changes or proposed changes in statutes, rules, and regulations affecting the City's responsibility under a self-insured workers' compensation program.
We have reviewed and will comply with this requirement.
AIMS prides itself on providing the kind of pro -active Client service seldom seen in our industry. From in -person meetings with the City to year-end performance reporting on the program development, we are always available to go the extra step.
AIMS has developed a variety of training programs for employers that can be customized and incorporated into the Client’s own training programs. These programs are overseen by our Vice President Workers’ Compensation, Cheryl Agee , and our Senior Vice President Operations, Lynn Cavalcanti. Cheryl manages a team of staff who provide training on a wide range of topics including; California Education Code Benefits, “Workers’ Comp 101”, legislative changes, fraud prevention, return-to-work (RTW), and State laws, etc. When requested, training sessions on proper reporting, new case law or changes in the methodology set by the State of California on the delivery of workers' compensation servi ces training is provided as an integral part of our value -added partnership. Training sessions are held at our offices, Client locations or other specific areas designed to accommodate a number of our Clients. This service comes at no Attachment I
Proposal for City of Richmond
Workers’ Compensation and Managed
Care Services
additional charge.
Please see Exhibit 2 – Sample Legislative Advocate Report
Claims Administration Services
The AIMS senior operating management team has reviewed the Claims Administration Scope of Work outlined detail. Our team fully complies with all requirements as presented in the Scope of Work. Please see the Claims Administration response under the Specific submittal Requirements section for complete details.
A. Determine liability for claimed injuries and illnesses on a timely basis and in accordance with the California Labor Code.
We have reviewed and will comply with this requirement.
AIMS utilizes industry best practice standards, in compliance and accordance with the California Labor Code, for workers’ compensation claims management. It is AIMS protocol for the Examiner to review and investigate the claim for compensability upon claim assignment. This includes the initiation of 3-point contact within 24 hours of receipt of new workers’ compensation indemnity claims. Examiners evalua te all claims for Arising out of Employment (AOE) / Course of Employment (COE), delay, denial, subrogation, or referral for investigation of issues surrounding injury. Examiners request all required documentation from Doctors, Client, and Injured Worker. All claims which are to be denied or delayed, pending a compensability decision, shall be done in keeping with all applicable statutory rules and regulations (and/or case law). All denials and delays are approved by the team Supervisor. Authority to delay or deny a claim is first obtained from the City, unless express written authority for this purpose is granted to AIMS.
All questionable claims are investigated in a prompt, thorough, and legal manner to determine compensability or to validate issues in question. The Examiner identifies the need for investigation and will refer the case for same within three (3) days from receipt of claim, or knowledge of questionable issues which give rise to the need for investigation.
The City’s authorization is first obtained before initiati ng any field investigation. This authorization is documented in the notepad section of the claims file.
AIMS protocol is for all payments to be made in a timely and comprehensive fashion in conformance with the Official Medical Fee Schedule ( OMFS), Labor Code sec. 5307.1 and sections 9789.10 et seq. of Title 8, California Code of Regulations
B. Determine eligibility for and authorize payment of medical and indemnity benefits Attachment I