CITY OF RICHMOND
GENERAL LIABILITY CLAIMS HANDLING AND
ADMINISTRATION
RFP ................................ ................................ .......................... Submitted : May 16, 2024
George Hills
PO Box 278, Rancho Cordova, CA 95741
Phone: (916) 859 -4800 , Fax: (916) 859 -4805
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TABLE OF CONTENTS
CITY OF RICHMOND ................................ ................................ ................................ ............ 1 General liabilitY CLA IMS HANDLING AND ADMINISTRATION ................................ ................... 1 Table of Contents ................................ ................................ ................................ ...................... 2 Cover Letter ................................ ................................ ................................ .............................. 4 PART 1: ORGANIZATION OF FIRM ................................ ................................ .......................... 7 A. FIRM INFORMATION ................................ ................................ ................................ ..... 7 B. FIRM STRUCTURE ................................ ................................ ................................ .......... 7 C. OFFICERS, PARTNERS, OWNERS ................................ ................................ ................... 7 D. RELATIONSHIPS ................................ ................................ ................................ ............. 7 E. AUTHORIZED NEGOTIATOR ................................ ................................ ........................... 7 F. STAFFING ................................ ................................ ................................ ........................ 7 PART 2: STAFFING ................................ ................................ ................................ .................. 9 A. RESUMES & STAFF INFORMATION ................................ ................................ ............... 9 B. ADJUSTER ASSIGNMENT AND ROTATION PROCEDURES ................................ .......... 13 C. ORGANIZATIONAL STRUCTURE ................................ ................................ .................. 13 D. CONTRACT ADMINISTRATOR ................................ ................................ ...................... 14 E. LOCATION ................................ ................................ ................................ .................... 14 F. TRAINING ................................ ................................ ................................ ..................... 15 G. ADJUSTER RETENTION ................................ ................................ ................................ 16 PART 3: EXPERIENCE ................................ ................................ ................................ ............ 18 A. PUBLIC ENTITY EXPERIENCE ................................ ................................ ...................... 18 B. REFERENCES ................................ ................................ ................................ ................. 20 C. PAST CLIENTS ................................ ................................ ................................ .............. 20 PART 4: SCOPE OF WORK ................................ ................................ ................................ ..... 22 PART 5: QUALITY CON TROL PROCEDURES ................................ ................................ .......... 26 A. AUDIT CONTROL PROCEDURES ................................ ................................ .................. 26 B. SUPERVISOR REVIEW ................................ ................................ ................................ ... 26 George Hills, City of Richmond RFP
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C. BUSINESS NATURE OF OTHER ENTITY CLAIMS ................................ ......................... 27 D. CUSTOMER SERVICE AND QUALITY ASSURANCE ................................ ...................... 27 PART 6: REPORTS ................................ ................................ ................................ ................. 36 A. SAMPLE REPORTS ................................ ................................ ................................ ........ 36 B. COMPUTER SYSTEM ................................ ................................ ................................ ..... 36 C. INTERNET SERVICES ................................ ................................ ................................ .... 36 D. MMSEA ................................ ................................ ................................ ......................... 37 PART 7: FEES ................................ ................................ ................................ ........................ 39 A. FEE STRUCTURE ................................ ................................ ................................ ........... 39 FEE SECTION TERMS ................................ ................................ ................................ ........ 41 B. ALLOCATED EXPENSES ................................ ................................ ................................ 43 OPTIONAL SERVICES ................................ ................................ ................................ ....... 45 PUBLIC ENTITY ................................ ................................ ................................ .................. 47 TESTIMONIAL STATEMENT ................................ ................................ ................................ 47 PART 8: CONTRACTUAL REQUIREMENTS ................................ ................................ ............. 50 A. EXCEPTIONS ................................ ................................ ................................ ................ 50 PART 9: INSURANCE COMPLIANCE ................................ ................................ ...................... 55 A. EVIDENCE OF INSURANCE REQUIREMENTS ................................ .............................. 55 PART 10: APPENDICES ................................ ................................ ................................ .......... 57 FORMS ................................ ................................ ................................ .............................. 57 SAMPLE REPORTS ................................ ................................ ................................ ............ 68 SAMPLE PLAN OF ACTION ................................ ................................ .............................. 73 RESUMES ................................ ................................ ................................ .......................... 75 SAMPLE CONTRACT ................................ ................................ ................................ ......... 83
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COVER LETTER
May 17, 2024
City of Richmond
Attn: Laura Marquez, Risk Manager
PO Box 4046
450 Civic Center Plaza
Richmond, CA 94804
RE: RFP for General Liability Claims Handling and Administration Dear Ms. Marquez,
As Chief Executive Officer of George Hills, I thank you for the opportunity to submit a proposal for the continuation of our services for the City of Richmond – a long -term relationship we truly value.
Through our sustained partnership, we will continue to provide services that exceed the City’s expectations and requirements. Our team will provide exemplary services while increasing efficiencies and reducing the City’s total cost of risk. We have extended considerable effort in our response to demonstrate our interest in the extension of our current partnership.
George Hills will continue to provide the City with excellent claims handling, focused on the protection of your assets. Our 70 years in business have provided us a best -in-class reputation for being highly responsive and proactive.
Responsiveness to the RFP: We are proud to know that we meet, and in some cases exceed the City’s requirements and evaluation criteria. George Hills is prepared and ready to continue to fulfill the needs of the City.
Publ ic Entity Experience: George Hills has an established record of consistent professional service and reputation within the industry, with specific emphasis on public entities and knowledge of public safety benefits, laws, and immunities.
High Quality Refere nces: Our clients are a testament to the quality of service we provide. We serve nearly 500 California public entities, including nearly 20 JPAs and the City of Richmond itself.
Staffing and Experience: George Hills selectively recruits and retains the industry’s best of the best claims professionals. Our team is dedicated to setting the standard for client satisfaction.
Cost Benefit Advantages: With our claims handling best practices to guide us, George Hills’ approach for the city is focused on efficient , cost-effective, and strategic resolutions. As a boutique - style firm, we are customized to fit the needs of the City.
Core Values: George Hills is set apart from other candidates by our core values, which direct and maintain all that we do. George Hills f osters values of honesty, accountability, transparency, loyalty, commitment, resilience, continuous improvement, financial stewardship, and client satisfaction.
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Our claims handling success is focused on fostering meaningful relationship with our clients, including the one we already share with the City. As CEO and sole owner of George Hills, I promise that you will continue to experience the best George Hills has to offer and feel confident in your decision to continue working with us. Thank you for considering George Hills for this vital role.
Respectfully submitted,
John Chaquica, CPA, MBA, ARM
Chief Executive Officer, George Hills Company
Company Contacts: John Chaquica, CEO/Owner & Chris Shaffer, Chief Operating Officer Office: (916) 859-4824 & )916) 859-4826
Email: [email protected] & [email protected] Mailing Address: PO Box 278, Rancho Cordova, CA 95741
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PART 1:
ORGANIZATION OF
FIRM
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PART 1: ORGANIZATION OF FIRM
A. FIRM INFORMATION
George Hills Company was established on December 27, 1954, and has provided liability and property claims administrations to the public sector for more than five decades. Since its inception, George Hills has expanded, grown, and branched out in ways consistent with our value of continuous improvement. In addition to third -party claims administration, we provide industry -leading litigation management services, subrogation recovery, investigative services, and JPA management. Today, we work with more public entities in California than any other TPA. Our business address is PO Box 278 Rancho Cordova, CA 95741.
B. FIRM STRUCTURE
George Hills is a sole proprietorship.
C. OFFICERS, PARTNERS, OWNERS
George Hills has a single owner: John Chaquica, Chief Executive Officer.
D. RELATIONSHIPS
George Hills has no relationship to a parent company or organization.
E. AUTHORIZED NEGOTIATO R
The individual with authority to negotiate on behalf of the firm and who may be contacted during the proposal evaluation period is John Chaquica. Mr. Chaquica can be reached via phone at (916) 859 - 4824 and via email at [email protected]. The mailing address for Mr. Chaquica is PO Box 278 Rancho Cordova, CA, 95741.
F. STAFFING
George Hills employes nearly 100 professionals company-wide, 4 of whom are part-time employees.
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PART 2: STAFFING
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PART 2: STAFFING
A. RESUMES & STAFF INFORMATION
Personnel Role for the City
John Chaquica
CPA, MBA, ARM
CEO, Owner
Role: Executive Contact Contract liaison for the
City’s total satisfaction with George Hills’ services
and steward of George Hills’ values throughout the
engagement.
Qualifications: With over 33 years of experience in risk and JPA management, Mr. Chaquica applies a virtually unmatched level of experience and talent. Mr. Chaquica holds an MBA from Golden Gate University and a BS in Accounting from California State University, Sacramento. In addition, he holds an Associate in Risk Management (ARM) designation from the Insurance Institute of America.
Chris Shaffer
ARM/P
Chief Operating Officer
Role: Oversees firm operations and provides
executive oversight as needed. His role includes
strategic efforts for growing the company and
further developing George Hills as the leading
California TPA.
Qualifications: Mr. Shaffer has an exceptional 30 -year record of achievement in the management of corporate, risk
management, business systems, and information systems
operations. He earned a Bachelor of Arts from the University of Utah. He holds an Associate in Risk Management (ARM)
designation.
Tom Baber
ARM
Assistant Vice President of
Claims, Claims Supervisor
Role: Supervisor overseeing client relationships.
Supervises claims adjusters and the claims process
while ensuring quality control.
Qualifications: Mr. Baber has 36 years’ experience in the insurance claims and risk management industry, primary
serving self -insured public and private clients. Mr. Baber earned a Bachelor of Science in Physiological Psychology from University of California, Santa Barbara. He holds an Associate in Risk Management (ARM) designation.
Kathleen Proctor
WCCA, CFE
Client Services Manager
Role: Assure client satisfaction, including
developing detailed Claims Handling Instructions
tailored to the City’s needs and scheduling regular
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and ongoing meetings with the service team to address any service needs or concerns.
Qualifications: Ms. Proctor holds a BA in criminal justice from California State University, Sacramento. She is experienced with public entity claims, public records, and business development. Ms. Proctor has a decade of experience as a Risk Manager, and nearly a decade of operation management.
Marizel Bajao
Sr. Claims Adjuster
Role: Senior Claims Adjuster and secondary point
of contact for all claims-related matters for the City.
Qualifications: Ms. Bajao has more than 30 years
of experience in the industry. She earned her BA in Business Administration from San Jose State University.
Wesley Mao
Sr. Claims Adjuster
Role: Senior Claims Adjuster and secondary point
of contact for all claims-related matters for the City.
Qualifications: Mr. Mao has experience with
transit-related claims and more than 20 years in the insurance industry. He earned his BS degree from California Polytechnic University. Mr. Mao is fluent in Vietnamese.
Tammy Hunt
CCLS
Subrogation Supervisor
Role: Supervises subrogation department and
oversees the subrogation process to ensure quality
control. Ms. Hunt is the primary point of contact for
the design and overall operation of the recovery
program.
Qualifications: Ms. Hunt has 26 years of experience in the industry. She has been focused on subrogation recovery for public entities for 15 years.
Edie Yamamura
Sr. Subrogation Specialist
Role: Identify, analyze, and evaluate subrogation
potential before coordinating the recovery of
claims payments on behalf of the City.
Qualifications: Ms. Yamamura has 20 years of experience as a senior adjuster handling claims and litigation. She has a remarkable small claims court win ratio and investigation is her forte.
TBD
Claims Processor
Role: Responsible for support for the designated liability claims team. Enters all new claims into the CMIS and general claims processing. The Claims Processor is instrumental in our quality assurance reporting.
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Resumes
Full resumes of the proposed personnel can be found in Part 10: Appendices on page 75.
John Chaquica , CEO & Owner
Mr. Chaquica has over 30 years of management experience and JPA leadership. He is known for his exceptional public -sector knowledge and his ability to assemble efficient and productive cross - functional teams. Before joining George Hills, Mr. Chaquica was the CEO of Bickmore, a leading US- based risk management company servicing both the public and private sector. At Bickmore, he led the strategic plan of the firm and was accountable for more than 100 employees at five office locations. In addition to his rol e as CEO, Mr. Chaquica served as Executive Director for several California public entity self -insurance pools and as a strategic advisor to several other entities.
Before joining Bickmore, Mr. Chaquica was a Partner i n Gilbert Accountancy Corporation, specializing in small and medium -sized private businesses, non -profit organizations, and governmental agencies. At Gilbert Accountancy Corporation, Mr. Chaquica served as the Audit Partner and was the Industry Team Leader on public entity self-insured groups.
Mr. Chaquica is a CPA, MBA, ARM, CGMA and a licensed Independent Insurance Adjuster and Property/Casualty Agent.
Chris Shaffer , Chief Operating Officer
Mr. Shaffer has an exceptional record of achievement in the management of corporate client, risk management, business systems, and information systems operations. He has proven his ability to improve business performance, increase capabilities and efficiency, reduce costs, minimize risk, and streamline workflow by implementing technology and process enha ncement solutions. Mr.
Shaffer has special expertise in automating manual procedures, selecting and deploying enterprise- level applications, and implementing technologies to keep pace with industry and business needs.
Mr. Shaffer excels at building and lea ding top -performing teams. His outstanding project management and decision-making skills make him an asset to George Hills and those with whom we partner.
Tom Baber , Assistant Vice President of Claims Administration & Claims Supervisor Mr. Baber has more than 35 years of experience in the insurance claims and risk management industry, primarily serving self -insured public and private clients. He has extensive experience managing large exposure and complex claims for both stand -alone and JPA pool clien ts. He is committed to providing clients with innovative, high quality claims administration services that add value and drive down the total cost of programs. Mr. Baber provides leadership, depth, and experience to George Hills’ presence in Southern California.
Kathleen Proctor , Client Services Manager
Ms. Proctor is a seasoned Risk and Operations manager. She has excellent leadership, communication, and interpersonal skills. In her capacity as Client Services Manager, Ms. Proctor acts as liaison between client, broker, and the claims team. She ensures any issues are handled efficiently and is well -versed in internal escalation procedures. Before joining George Hills, Ms.
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Proctor was the Risk Manager for the City of Stockton, where she developed and admin istered a comprehensive risk management program.
Marizel Bajao , Senior Claims Adjuster
Ms. Bajao has been with George Hills since 1998 as a Senior Claims Adjuster. She is a multi -line claims adjuster, specializing in adjusting and investigations of minor to complex casualty, property, and professional liability claims for public entity and insurance company clients. Previously, she worked for Crawford & Company as a Liability Claims Adjuster and Liability Claims Supervisor. She has provided risk management services for self-insured and national accounts.
Wesley Mao , Senior Claims Adjuster
Mr. Mao came to George Hills from Carl Warren & Company, where he fulfilled the role of Senior Claims Specialist. During his time with Carl Warre n & Company, Mr. Mao handled litigation files, correspondence, and analysis of bus and train losses with great efficiency. Mr. Mao has been in the industry since 2000 and since joining George Hills, has showcased his skills with many city clients.
Tammy H unt , Subrogation Supervisor
Tammy Hunt came to George Hills from the City of Stockton, where she worked on criminal and civil litigation cases in the City Attorney’s office for 11 years. Her work at the City of Stockton included the handling of the city’s subrogation cases – a little more than 1,000 cases at any given time. She also maintained property, general liability, auto, crime, council bonds, notary public, and numerous other insurance programs for the city. Ms. Hunt is highly knowledgeable an d experienced in both public and private sector claims administration and litigation management processes and procedures.
Edie Yamamura , Senior Subrogation Specialist
Ms. Yamamura has more than 20 years of experience as a senior adjuster handling claims and litigation. She has a remarkable small claims court win ratio and investigation is her forte. Ms.
Yamamura enjoys site visits and working directly with clients, as well as preparing client employees for testimony and in-person witness statements.
Desi gnated Claims Adjuster : George Hills proposes both Ms. Bajao and Mr. Mao continue as the Designated Claims Adjuster s for the City. Their current salaries are between $75,000 - $95,000 and their resumes can be found in Part 10: Appendices on page 75.
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B. ADJUSTER ASSIGNMENT AND ROTATION PROCEDURES
George Hills adjuster assignment procedures and rotation procedures are closely monitored for each client. As indicated prior in thi s response, Tom Baber will supervise and monitor the Cit y’s account activities, as well as George Hills’ and the City’s team caseloads. George Hills claim adjuster assignments and caseloads are based on the complexity of their claims; typically, account managers’ or supervisors’ caseloads are 50-75 pending files, senior bodily injury adjusters’ caseloads are 125-150 pending files, and senior property adjusters’ caseloads are 150 -200 pending files. Adjusters handling auto, property, and subrogation claims average between 100-125 pending files.
We attempt to impose a maximum caseload of 150 pending files, but we recognize that th ere are occasions when files on an adjuster’s pending list are dormant as they await the expiration of the statute following a claim rejection.
With Ms. Marizel Bajao and Mr. Wesley Mao continuing to operate as the Senior Claims Adjusters for the City, the flexibility and balance of assignments and workload will continue. In addition, the City can expect ample coverage when illness or absences arise. Whenever needed, George Hills’ deep bench of adjusters throughout the State of California are always available as a backup resource.
C. ORGANIZATIONAL STRUCTURE
George Hills is a values-based company. Our values are honesty, accountability, customer satisfaction, loyalty, commitment, financial stewardship, and continuous improvement. These values influence everything we do.
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Commitment
Our approach as a third-party administrator is based on our commitment to protect your assets. Our goal is to continue to reduce the number of claims and claims paid amounts by identifying cost drivers, performance gaps, and opportunities for cost reductio n. Our project approach centers on transparency and frequent communication with internal and external stakeholders. Our methodology is refined by your expectations. Our approach to continuing to fulfill the City’s needs stems from our company’s experience, values, personnel, and our best practice approach to claims handling.
Customer satisfaction is paramount and one of our core values – one which guides us in all we do.
Our commitment to superior customer service is bolstered by our exceptional, highly qua lified staff supported by our unparalleled training and certification program. Our structure will continue to evolve to exceed your expectations and deliver quality claims results. We welcome your input.
D. CONTRACT ADMINISTRATOR
The person acting as contract administrator if awarded is John Chaquica, Chief Executive Officer of George Hills. He has full authority to resolve disputes with the City.
Phone: (916) 859-4824
Address: [email protected]
E. LOCATION
George Hills serves all of California from our four (4) offices, located in Agoura Hills, Alameda, Ontario, and our principal office in Folsom, near Sacramento. The City’s claims will be managed virtually, with Ms. Bajao assigned to our Alameda office, located at 24 90 Mariner Square Loop Suite 213, Alameda, Ca 94501.
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F. TRAINING
George Hills has provided training to clients on a regular, as -requested basis. Examples include legislative updates, recent settlements, AB 218 and AB 452, and most significant ly, providing access to George Hills Claims University (GHCU) as an additional, optional service.
Our monthly training program includes:
• Monthly training sessions facilitated by industry experts on current and emerging claims - related topics, such as legislative changes, new case laws, and claim trends. We also use this monthly session to refresh our claims administration staff on industry a nd internal best practices.
• An annual two-day, in-person event for all claims staff, targeted at technical training, overall staff development, and team building. This annual session includes in -depth training and panel discussions on claims technical topics, claim system utilization, and corporate issues. A recent sample event included discussion about AB 218, the recent legislation extending the statute of limitations for childhood sexual abuse and molestation claims. • Online resources and training throug h George Hills’ Learning Management System. This Learning Management System is a robust resource and reference library for a wide variety of claims and risk management technical topics, as well as structure training courses ranging from entry-level to advanced.
• Company-paid training courses leading to an Associate in Claims (AIC) and other pertinent professional designations.
• Active participation in industry associations, such as Public Agency Risk Management Association (PARMA), California Association of Joint Powers Authorities (CAJPA), the League of California Cities, California State Association of Counties, Association of Governmental Risk Pools, and Claims and Litigation Management Alliance. George Hills encourages employee attendance at their annual conferences and other training events through the year.
George Hills Claims University
It is George Hills’ philosophy to deliver a comprehensive and effective training program for our Claims Administration Division (CAD) that aligns with the vision, values, and goals of the company.
By utilizing i nternal and external resources, our program is cost - effective and presents relevant technical information.
The genesis of GHCU was the reality that students were not going to college to seek a career in insurance claims adjusting, and even fewer in claims adjusting in the public sector. We felt called to establish a sustainable education forum to continue to cultivate knowledgeable and experienced public entity adjusters.
Currently, we use the University to train all staff to obtain the Public Entity Claims Professional (PECP) Certificate. This ensures each client we serve has a trained adjuster on their team. Our training ensures all claims staff receive the information and skills to perform the duties of their position successfully. Additionally, programs within GHCU are available to our clients for free or reduced costs, including a basic Risk Management/Claims Program for Analysts.
GHCU uses a Learning Management System (LMS) to provide continuous matriculation for our current and future employees. Upon completing the training courses and passing the exam, individuals are
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awarded a certificate and Public Entity Claims Professional (PECP) designation. We have created the Public Entity Claims Professional – Risk Management (PECP-RM) designation that focuses on those in the public sector that may interface with the claim process, and we have additional versions in development for other areas. Another option for our clients is GHCU’s Risk Management 101 course.
George Hills Claims University is available to o ur clients. If City staff express interest in our training program, we are pleased to make the courses available to them.
Incentive Programs
GHC incentive programs are created in collaboration with Human Resources and the Finance Department and are approved by the corporate team and the CEO. Program plans identify the triggers for top performers (i.e., individuals, divisions, offices, teams) and identify clear cut objectives for employees’ Key Performance Indicators (KPIs). Depending on the program they ma y include any of the following compensation components as defined in the GHC compensation plan:
• Base Compensation
• Merit Pay
• Equity
• Paid Time Off (PTO)
• Professional Development
G. ADJUSTER RETENTION
The average tenure of managers and supervisors with Georg e Hills is 25 years. We have historically maintained a low turnover of staff and clients. In the last two years, our turnover rate has averaged less than 4% per year. We maintain an ongoing client retention rate of 98%.
George Hills’ employees hold professional licenses, BA/BS/MA and JD degrees, and industry certifications, including: Independent Insurance Adjuster, Associate in Risk Management (ARM), Registered Professional Adjuster (RPA), Casualty Claim Law Associate (CCLA), California Self -Insured Administrator (SIA), Certified Public Accountant (CPA), Charter Global Management Accountant (CGMA), Certified Litigation Management Professional (CLMP), Property/Casualty Agent, and the California State Bar.
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PART 3: EXPERIENCE
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PART 3: EXPERIENCE
A. PUBLIC ENTITY EXPERIENCE
George Hills has made public entity casualty claims adjusting its focus. We put forth considerable effort in recruiting, retaining, and training employees. George Hills provides third -party
administration services to nearly 500 public entities,
including n early 20 JPAs. For more than half a century, we have specialized in California public entity multi -line claims adjusting (property and liability) while also providing litigation management and investigative services. We understand and have the program in place to continue to manage claims for the City. The success of our demonstrable best practice approach to providing investigation and claims administration services is evidenced by our firm’s reputation for exceeding client expectations through our client retention rate of 98%.
Our general approach as a third-party administrator is based on our commitment to protecting your assets. Our goal is to continue to help you reduce the number of claims and claims paid amounts by identifying cost drivers, performance gaps, and opportuniti es for further cost reduction. Our project approach centers on transparency and frequent communication with multiple internal and external stakeholders. At the onset, we seek to determine your expectations, which refine our methodology.
George Hills’ appro ach to fulfilling the City’s needs stems from our company’s experience, values, personnel, and our best practices approach to claims handling. At George Hills, customer satisfaction is paramount and one of our core values – one which guides us in all we do . Our commitment to superior customer service is bolstered by our exceptional, highly qualified staff. George Hills’ adjusters are the life blood of the company, and as such we have developed a Claims Handling Best Practice Manual to guide and support our adjusters toward success and client satisfaction.
For 70 years we have built our reputation by nurturing relationships. Close attention to the needs of our clients and stakeholders drives strong results in managing risk. Our program is continually improving. We are proud to be a boutique firm and know our unique approach will continue to be of value to the City. Our innovative spirit and value of continuous improvement has allowed us opportunities to present new ideas and solutions to our clients, as demons trated by our 35 -year partnerships with the Counties of Sacramento and El Dorado, and the JPAs PRISM and CIRA.
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Benefits of George Hills
George Hills Advantage Over Comparable Firms
George Hills selectively recruits and
retains the industry’s best of the
best public entity claims adjusters.
Other TPAs have experienced adjusters that may focus on private entities or are not as experienced in public entity claims adjusting.
A boutique organization by design,
we provide customized services to
meet your needs, not have you fit
into our system. George Hills has one owner,
who is involved, available, and committed to
meeting regularly.
Several TPA firms are large companies that may not have the time and focus on providing customized services to
meet the needs of the City. Our Public Entity Management team is comprised of leaders in the industry.
Providing expert liability, property,
med -mal, and subrogation services
for public entities is our one and
only focus. George Hills has nearly 500
California public entities including over
nearly 20 JPAs.
Many other TPA firms provide multi -line services to a
variety of private and public entities, and therefore don’t specialize in the specific needs that public entities require.
George Hills has developed
our own comprehensive
and effective public entity claims training
program, George Hills Claims University
(GHCU).
George Hills is the first and only TPA to launch its own learning program. Managed through a Learning
Management System, GHCU provides continuous
matriculation for our current and future employees and
now to our clients, and soon the general public.
George Hills’ use of our CMIS, and our
Trademarked iMetrics r eports, give
our clients unique access to the claims
process at every stage and allow clients to
run customized reports.
Although some TPAs have their own claims system, which
may be multi -line and private sector, our CMIS provides enhanced, customizable s ystem reporting that is specific to public entities and unparallel to other firms’ capabilities.
George Hills has developed a client -
facing portal, which provides
dashboards and secure online areas
for file sharing and collaboration.
We are one of the few TPAs that offer a resourceful, web - based portal that our clients can customize to fit their risk management and reporting needs.
George Hills has two in -house
attorneys that serve as our
Litigation Managers, as well as
assist clients and adjusting st aff by applying
their extensive public entity experience.
Although a couple of larger TPAs may have legal
resources, our in -house attorneys are readily accessible and are routinely utilized by our claims adjusters and are available to our clients.
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B. REFERENCES
Name of Client Primary Contact Services Provided
County of
Stanislaus
Derick Holt
Insurance & Claims Manager
(209) 525-5710
[email protected]
Liability & Property Claims
Adjusting
County of San
Joaquin
Tanya Moreno
Safety & Risk Manager
(209) 468-3274
[email protected]
Liability & Property Claims
Adjusting and Subrogation
County of Alameda Lucretia Akil
Risk Manager
(510) 520-8887
[email protected]
Liability & Property Claims
Adjusting
Small Cities
Organized Risk
Effort (SCORE)
Marcus Beverly
SCORE Administrator
(916) 643-2704
[email protected]
Liability & Property Claims
Adjusting
City of Fairfield Erika Milton
Management Analyst
(707) 428-7500
[email protected]
Liability & Property Claims
Adjusting
C. PAST CLIENTS
• VCSSFA: Moved to Athens, won through a competitive RFP • LAUSD: Moved to Carl Warren & Company, won through a competitive RFP
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PART 4: SCOPE OF
WORK
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PART 4: SCOPE OF WORK
A. Tort Claims Handling
1. George Hills will promptly make a claim file after receipt of the tort claim from the City.
George Hills will investigate claims and incidents which may be the subject of such claim against the City. We will recommend acceptance or rejection of submitted claims.
2. George Hills will provide claims adjusting for liability claims.
3. George Hills will assess and evaluate the nature and extent of each claim, and establish claim reserves for indemnity, medical, and legal expenses.
4. George Hills will ensure timely claims handling, including follow -up with claimants regarding claims issues and processing.
5. George Hills will determine the need for defense representation and monitor litigation activity. We acknowledge that the City Attorney’s Office will select defense and subrogation counsel.
6. George Hills will report claims to the excess insurer, and coordinate w ith the excess insurer on a claim’s progress in accordance with the excess insurer’s reporting requirements. George Hills will submit requests for reimbursement on behalf of the City to the excess insurer.
7. George Hills will coordinate Medicare and Medicaid set aside agreements in compliance with Section 111 of the MMSEA, including required reporting.
8. George Hills will tender and demand indemnification from responsible persons, agencies, and/or agents in an effort to recover losses suffered by the City from claims filed against the City.
9. George Hills will provide a designated claims adjuster for the City. We acknowledge that the claims adjuster may not be changed without mutual written consent of the City during term of contract.
B. Litigation
1. George Hills will assist with litigation management and support the City in the defense of litigated cases. We acknowledge this may include timely provision of claim files, assisting with investigation and discovery as needed, and advising on defense activities.
2. George Hills will assist and advise on potential exposure and ensure cases are reported to excess carriers as required.
3. George Hills will monitor and track litigation costs and set reserves for indemnity, medical, and legal expenses with input from the City and defense counsel. We acknowledge this may also include providing data and information relating to incurred litigation costs to the City and its excess carrier as required.
C. Financial Accounting
1. George Hills will maintain a trust fund for the purpose of payi ng expenses for claims.
The amount that will be maintained in the trust fund shall be determined by the parties and confirmed in writing.
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2. George Hills will provide to the City a copy of all checks, vouchers, or warrants drawn by George Hills to pay benefits on City claims.
3. George Hills will provide a monthly check/voucher register of all transactions made for the period.
4. George Hills acknowledges the City’s right to conduct a financial audit of the trust account to ensure the integrity of the account.
D. Data Products
1. George Hills will provide a computerized loss run and summary report each month covering activity on all newly reported, open, and newly closed claims for the period.
This report will be customized for the City’s needs and will provide the follow ing by claim year:
a. Monthly listing of open claims by date of loss, department, location, and alpha by name showing expense categories, reserves, and total incurred. b. Various responsive reports on demand, at no additional charge, such as claim frequency reports, i.e., by cause, site, department, etc. c. Provide monthly claim summary reports, within 15 days of month end.
2. George Hills will provide loss run data and required reports for actuarial, auditing, and reserve analysis purposes.
3. George Hills’ software syst ems will be Windows -based, available 24 hours/day, 7 days/week, and able to provide email exchanges.
4. George Hills will provide a report writer function for City staff to design customized ad hoc and standard reports to be printed at City offices, as well a s training on usage of report writer function.
5. George Hills will transfer all current and past loss data from SIMS to our software system.
6. George Hills will provide compliance with required reporting requirements for liability (including self-insurance) un der Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA).
7. George Hills will provide training, support, and software access to the City’s Risk Manager to look up claim information and data as required, and to run reports as needed.
E. Additional Services
1. George Hills acknowledges claim adjuster attendance at hearings, settlement conferences, conferences with defense counsel, small claims court proceedings, meetings with City staff, and departments when required.
2. George Hills acknowledges the importance of communication – written, oral, and in person – with City staff by the Claims Adjuster.
3. George Hills acknowledges that all records, files, transcripts, computer tapes, and other materials on claims adjusting activity developed on the City of Richmond claims is the property of the City of Richmond and must be relinquished in good order and condition upon termination of this contract with the adjusting firm. The City shall not be required to pay any additional cost for the transfer of files to the City.
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4. George Hills will attend all meetings with City Staff as requested.
5. George Hills will be available for file audit checks by the City when requested.
6. George Hills will cooperate with file and program audits with City designated auditors.
7. George Hills will be available to respond, potentially upon short notice, to a major emergency or catastrophe involving potential claims.
8. George Hills will provide a monthly claims diary of all open files and enter review notes on the claim reporting system.
9. Upon request, George Hills will provide training to City managers and supervisors on general liability issue s, loss control, management responsibility, and practices to improve reduction of filed claims.
10. George Hills will provide internet email communications for the designated claims adjuster to City staff.
11. George Hills will provide an administrative manual on claims processing.
12. If available, George Hills will provide loss control, investigative services (Sub -rosa, fraud investigation), specialized training or workshops, including additional costs for such services.
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PART 5: QUALITY
CONTROL PROCEDURES
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PART 5: QUALITY CONTROL PROCEDURES
A. AUDIT CONTROL PROCEDURES
Tom Baber, Vice President of Claims Administration, Property/Liability, and Kathleen Proctor, Client Services Manager, conduct the best practice oversight and internal claims handling audits for all George Hills clients to ensure quality management and proper resources are always at optimum levels. In addition, outside client vendor evaluations an d claim audit reviews are conducted for consistency in external evaluations. We are happy to work with the City to develop tailored quality control reviews and metrics to suit the City’s unique needs.
Essentially, George Hills’ proprietary best practices w ritten in our firm’s Claims Procedures Manual set forth policies and procedures, which must be followed in accordance with the specific rules and requirements of a client. These are tracked per adjuster, per claim.
B. SUPERVISOR REVIEW
George Hills uses a review system to ensure accurate data in adjuster diaries, including manual reviews by the adjuster responsible for any particular account and the Account Manager when appropriate. Diary reviews include an update of the Plan of Action (POA ), or strategy geared toward resolution of the case and review of reserve adequacy. Each file should contain all reports generated and documentation of communications between relevant parties. Diaries are reviewed weekly and will be as such by the City’s Account Manager to be certain all files are given the attention they deserve.
Should a file be found lacking, follow -through with the assigned adjuster will occur. Diary reviews always take place when loss runs are generated to ensure the information forwarded to the client by that loss run is accurate.
Each adjuster’s open file count is reviewed monthly by the Vice President of Claims Administration, Mr. Baber. Limited audits are conducted quarterly. These reviews and audits help us judge and measure the performance of claims work at George Hills and whether company standards and best practices have been followed. These reviews also assist in evaluating whether the adjuster has effectively:
• Reduced overall pending
• Reduced litigated file pending
• Reduced the average lifespan of their cases
• Established and monitored defense counsel budgets
• Reduced litigation expense
Five adjuster files are chosen randomly for each quarter for every adjuster and reviewed. Should a file be missing anything, the adjuster assigned to the account is followed up with.
Account teams meet monthly regarding watch list claims, which are active, potentially high exposure claims. These files are analyzed for data accuracy, thought comparison, or challenging claims analysis to enhance the claim settlement.
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C. BUSINESS NATURE OF OTHER ENTITY CLAIMS
Ms. Bajao and Mr. Mao currently work with California public agencies.
D. CUSTOMER SERVICE AND QUALITY ASSURANCE
George Hills has developed best practices in claims management, and we believe our process and specific alignment with your needs and expectations collectively results in a reduction of claims expenses.
Best Practices Claims Approach
George Hills’ Best Practices General Liability Claims Handling Manual and Best Practices General Liability Litigation Manual are followed by all George Hills claims processors, adjusters, and supervisors in addition to the specific rules, regulations, and requirements of each individual client. These manuals support the scope of work, procedures, processes, and requests of the City. Our stated mission is always “to provide the highest level of quality, customer -focused claims service”. We accomplish this by assigning teams of experienced individuals who have managed similar accounts for many years.
Our best practice approach to claims management centers around early communication and transparency of information. Early communication with claimants leads to faster claim resolution, and the transparency of information provided to the City gives insight to the claims process from inception to close.
Best Practice Quality Control
Our processes, procedures, and methodologies center around adjuster accuracy and cust omer satisfaction. Quality control comes at the technological (automated) level, and at the human (adjuster/supervisor) level by George Hills’ Supervisors and Client Services Managers.
Communication
Phone calls and emails will be returned within 24 hours. All other written communication will be responded to within three (3) business days.
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Contacts
• 24-hour emergency contact will be made within one (1) hour of assignment or phone call. • Initial contact will be made with the insured/client, claimant, and witne ss within one (1) business day of receipt of their information. If no contact is made with the claimant, two (2) subsequent contact attempts via telephone will be made within the first 48 hours after receipt of the claim. If we do not have contact information for the claimant, or have incorrect information, extra attempts will be made to secure correct contact information, such as a Google or online ‘white pages’ search. If the City’s protocols are such that a claimant is not to be contacted, this will be documented in the adjuster’s file notes. • An acknowledgement letter or email will be sent to all pertinent parties containing the adjuster’s contact information and claim number, unless instructed otherwise.
Best Practices Claim Data and Information Management
George Hills’ ability to develop and maintain the City’s data metrics for decision -making as well as to provide accurate statistical reporting is due solely to our commitment to best practices in our Information Technology processes. Our Claims Management Information System (CMIS) provides George Hills and our clients with exceptional expert resources. We can rely on our system’s commitment to security to ensure your data is safe; to demonstrate this commitment, our team completes an annual disaster recovery exercise to safeguard against potential data loss.
Timely resolution of claims is another best practice we employ. Generally, the longer a file is open the costlier it is for our clients. Superfluous open reserves on a client’s boo k of business can negatively affect financial results. As such, one of the items reviewed by supervisors when they audit files is timeliness of closures. The supervisor will also review whether the adjuster is continuing to update the claim diary. Every ti me an adjuster interacts with a file, they should do everything necessary to move the file closer to resolution.
Reporting New Claims
Depending on the nature and urgency of an incident, new claims can be reported to George Hills in several ways:
• Routine, n on-urgent tort claims can be sent via email through our dedicated intake portal, which is monitored by our claims support team to ensure timely setup in the claims system within one (1) business day.
• More urgent matters can be reported directly by phone through your designated adjuster, supervisor, or claims processor.
• After -Hours Critical Incident Response: The City will be provided with the after -hours contact information for your primary designated adjuster s, who can usually respond to the scene of a critical incident within one (1) hour of contact.
File Setup
Within one (1) business day of receiving notification of a new claim – usually the same day – the claims processor will take the following steps:
1. Enter the data into CMIS, including assignment of the adjuster.
2. Attach any paperwork received with the claim to the CMIS.
3. Notify the assigned adjuster of the newly assigned claim.
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a. These actions trigger the CMIS to set an automatic diary for the adjuster and their supervisor.
4. Send an acknowledgement of new a ssignment to the City, including claim number and assigned adjuster information.
5. Make initial phone contact with the claimant or their attorney, if so instructed, with the claim number and contact information for the adjuster, including a follow -up acknow ledgement letter.
Adjuster Initial Review and Contacts
Upon notification of a new assignment, the adjuster will:
• Review the information in CMIS for accuracy
• Review all attached documents and notes in the file
• Review the tort claim for timeliness and sufficiency and take appropriate action, including recommendations for sending tort claims notices
• Set initial reserves
• Make initial contact with the insured/client, claimant, and witness(es) within one (1) business day of receipt of their information. If not contact is made with the claimant, two (2) subsequent contact attempts via telephone will be made within the first 48 hours after receipt of the claim.
Investigation
An investigation plan is developed for each claim to assess the liability and damages exposure efficiently and effectively. Applying their experience and expertise, the adjuster tailors the scope of investigation to the nature and exposure of the claim. The investigation may include:
• Gathering all internal documents from the City, including reports, maintenance logs, photos, contracts, easements, certificates of insurance, etc.
• Conducting a scene inspection with photos and diagrams as warranted • Interviewing City staff
• Obtaining official reports
• Interviewing and obtaining statements from the claimant and witnesses • Obtaining damage estimates, invoices, and/or damage appraisals • Obtaining all pertinent medical records
George Hills will identify and engage an interpreter/translator that is acceptable to the City. When possible, we will utilize one of our bilingual employees to assist with translation. Where warranted, we will seek authority from the City to engage experts.
Risk Transfer and Indemnity Rights
During our investigation, we actively seek to identify all risk transfer and indemnity/defense rights owed to the City through contracts, agreements, additional insured statuses, easements, etc. With the City’s approval, we promptly and vigorously pursue t ender/cross-complaints on behalf of the City against all potentially responsible parties and/or their insurance carriers.
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Notification and Updating of Excess Insurers
It is the responsibility of the adjuster to promptly report (within 30 days of receivin g notice of a reportable claim) any case meeting the reporting requirements of the excess carrier, or as instructed by the City. The adjuster will also provide status reports to the excess carrier/pool (including reports from defense counsel) at the required intervals.
George Hills will notify the City’s excess carrier(s) in any number of situations according to the requirements of the excess policy carrier’s stipulations. First, the excess carrier is notified no later than 30 days after receipt of a report able claim. Second, notification is sent when reserves are set on any reportable claim or suit involving multiple claims or suits arising out of one occurrence, or any claims or reserves amounting to 50 percent or more of the retained limit. Third, excess carriers are notified regarding Title 42 USC 1983 cases in which a complaint has been served and the plaintiff is represented by legal counsel or with reserves of 25 percent or more of the retained limit.
Lastly, regardless of the reserve, notification is sent on any claim involving the following:
• One or more fatalities
• Loss of a limb
• Loss of use of any sensory organ
• Quadriplegia or Paraplegia
• Third degree burns involving 10 percent or more of the body • Serious facial disfigurement
• Paralysis
• Closed Head injuries
Litigation Management
Through our extensive experience managing claims for hundreds of different public agencies, George Hills has developed the expertise to adapt our litigation management services to fit a wide range of litigation management pro gram structures. This ranges from full litigation management responsibility, including retention and direction of defense counsel and management of defense costs, to basic litigation support for the City’s in-house defense team.
George Hills’ philosophy and guidelines for providing litigation management services are focused on achieving the best result for our client while aggressively managing costs. This is driven by our litigation best practices, which include:
• Securing the litigation budget within 45 days of assignment to defense counsel. Our adjusters review defense counsel bills in detail to ensure that are reasonable and in line with the litigation budget.
• Training our adjusters to perform a risk weighted analysis early in litigation to establish a target settlement number before incurring extensive defense costs, pursuant to the City’s risk protocols.
• Utilizing adjusters to complete tasks when possible, in lieu of an attorney. • Using statutory settlement offers, such as 998s, when appropriate to possibly recover costs if a favorable verdict is received.
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When a claim becomes litigated, George Hills’ claims adjusters do not simply assign a file to defense counsel and vanish but operate as true litigation managers. We believe it is the responsibility of ou r claims adjusters to work closely with defense counsel until the case is resolved and the claim file is closed. A good early investigation, coupled with an experienced litigation manager, helps bring the case to an earlier resolution. We strategize early and often with the client and defense counsel and monitor the case to ensure counsel stays on track.
Our full litigation management services – available as an optional service in Part 7: Fees on page 45, include the following:
• Within five (5) days of the a ssignment by the City, contact will be made by the lead claims adjuster and with any assigned defense counsel. An appropriate plan of action will be discussed, and initial case analysis will be reviewed to determine what course of discovery and motion/defense strategy to implement.
• Within 60 days following the assignment of a case, defense counsel will complete and return a complete case analysis to the City, the George Hills adjuster, and the claims supervisor. The case analysis will include a comprehensive evaluation of the case and formalize the defense strategy crafted by the team.
• In addition to the initial case analysis, counsel will provide an accurate estimate of defense costs for all litigated cases as set forth in the exhibits. Defense counsel is expected to stay within the estimated case budget throughout the litigation and to report on fees expended in relation to the budget as requested.
• After the initial case analysis, defense counsel will provide mandatory written status reports at 60-day intervals, setting forth all substantive developments. The defense attorney handling the claim will prepare the status reports. Defense counsel will report only on new developments since the last report, as it is not necessary to repeat case facts o r information previously reported. Status reports will be as objective and straightforward as possible to allow the George Hills adjuster and claims supervisor to meaningfully analyze the case and determine the course of action to be taken.
• George Hills monitors defense counsel to ensure that counsel stays true to the plan of action and within the defense budget. This includes monitoring defense counsel procedures, mandating regular reporting by defense counsel, and reviewing legal bills for appropriateness as directed by the American Bar Association standards or by the City’s instructions to ensure the claim is resolved in the most cost-efficient manner. • George Hills has developed specific guidelines that include creating and monitoring a watch list of any claims that, because of allocated expenses, expense reserves, case reserves, or a combination thereof, may present a threat to pooled funds or have already reached pooled funds. Though the City may wish to assign claims to their watch list for the Litigation Manager, George Hills’ watch list typically starts at the primary level. If chosen to provide third -party administration services, George Hills will continue to follow these guidelines to create a watch list of claims that have the potential to exceed the City’s SIRs and monitor those claims until the case resolves.
Electronic File Management
Claims Progress Notes – All file activity is documented in the Notepad of the electronic claim file as it occurs. Dropdown boxes for notepad types allow the adjust er to be specific as to the type of activity (i.e., phone call, correspondence received or sent, claim filed). The subject line allows for George Hills, City of Richmond RFP
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further specific yet brief information for an at -a-glance review in CMIS. Notepads are important to document phone conversations or receipt of materials; they serve as a chronological outline of what activity has taken place.
Claim Documents – All claim documents are attached to the electronic claims files as they are obtained. This includes text/PDF, spreadsheets, photos, audio and video files, in all electronic media formats. Each document is annotated with a description and a corresponding N otepad entry.
Diaries – Upon setup in CMIS, a file review diary is automatically set for the adjuster. Our best practices ensure that each assigned case is reviewed at least one every 30 days for active files, 90 days for extended diaries awaiting activity by others, and up to 180 days on files in which the adjuster is awaiting the expiration of the statute of limitations. All diaries are maintained through CMIS. All activity during the diary review is documented in the Notepad. No claim is re -diaried without specific indication why no further action was taken.
George Hills’ claim supervisor will maintain separate diaries and other audit controls necessary to review and ensure timeliness in handling, as well as ensuring other claims standards and reporting requirements are being met.
Plan of Action (POA) – The Plan of Action (POA) is a special Notepad document that provides the current summary of the claim, including current financials (payments and reserves), investigation findings, assessment of the exposur e, status of litigation (if applicable), and the plan for moving the claim to resolution. The POA is reviewed and regularly updated at each diary review, or whenever there are material changes in the claim. The POA has proven to be an effective tool for ma naging the file and a valuable resource for our clients, auditors, and when conducting file reviews. The City will have online access to the POA entries in the claim summary view. A sample POA can be found in Part 10: Appendices on page 73.
Reserving of Cl aims
The establishment of reserves is one of the most important tasks we perform for our clients – it impacts critical areas, such as funding levels and budgets. George Hills’ philosophy is to set reserves on a “most probable outcome” basis. Our best practice is to establish separate reserves for indemnity and expense; however, we will reserve according to the City’s policy. Adjusters are required to set initial file reserves for indemnity and expenses (legal and adjusting) within five (5) days of assignment.
Adjusters review claim reserves each time they interact with a file, and specifically on each diary date.
Reserves take into consideration liability as to the City and comparative fault of the claimant/plaintiff, type of injury, damages, prognosis, expe nses (e.g., medical and wage), and any anticipated general damages. Litigated files include separate reserves for legal expenses based on a current litigation plan and budget.
Payments and Settlements
George Hills has extensive experience managing trust ac counts for our clients, from which all claim payments can be processed, issued, and captured in financials for the claim. We are also able to record any payments made directly by our clients with the same level of detail. All payments through live checks or manual transactions require sufficient approved reserves prior to processing. Additionally, we record all recoveries, including payments by excess carriers.
We will obtain proper authority from the City and secure all supporting documents (releases, settlement agreements, dismissals, invoices, W9 forms, OFAC checks, etc.) prior to issuing or recording any payments.
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Timeline of the Claims Handling Process
The following takes place from receipt of a new claim:
Within 24 Hours
• Index new correspondence and n ew claims for damages to determine if they belong to an existing claim
• Claims data entered into ClaimsXpress, our CMIS
• Acknowledgement of new assignment sent to the City
• Claimant/Claimant’s attorney is called, emailed, or both to acknowledge and provide claim and adjuster information
Within 2 Days
• Two-point contact made with claimant (or their attorney) and the City Within 5 Days
• Reserves Set
Within 30 Days
• Claim tendered (if appropriate)
• Liability determination
• Excess carriers notified
Monthly
• Monitor closing ratios
• Statistical report (all claims activity) provided to the City • Payment register provided to the City
• Plan of Action (POA) updated
• Watch list claims meetings
• Case reviews (90 days if waiting for activity by others, 180 days if waiting on expiration of a statute of limitations)
Cost Saving Methods
Through our efficient and thorough investigation, there is a two-point contact within one (1) business day of receipt of each claim. We ensure the liability investigation is completed early, and many claims are not pursued when they are denied or rejected early in the process. In these instances:
• Attorneys Will Likely Pass On The Case: Attorneys are less likely to take a case that has already been denied.
• Establishing Defense Early: By not establishing your defense position early, a claimant is often more likely to think they will receive a settlement. • Securing Witness And Claimant Statements Early: This action is essential, lest they forget critical details or revise the facts to help their position. • Indexing Claimants Pursuing Injury Claims: We verify if they have made similar claims in the past, and/or have prior injuries that are unrelated to our matter.
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• Secure Complete Medical Records: If there is liability and injuries are claimed, we secure complete medical records to check for pre-existing conditions.
We explore all tender possibilities based on the claimants’ allegations, because allegations trigger coverage regardless of liability.
Small Claims
George Hills claims adjusters have extensive experience successfully representing our clients in Small Claims courts. When served with a notice of Small Claims Hearing, the adjuster will work closely with City staff and legal counsel to prepare the case for presentation at the hearing, incl uding witnesses and supporting documents.
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PART 6: REPORTS
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PART 6: REPORTS
A. SAMPLE REPORTS
Sample reports can be found in Part 10: Appendices on page 68.
B. COMPUTER SYSTEM
Please s ee below.
C. INTERNET SERVICES
Claimsxpress Claims
George Hills has used ClaimsXpress as our Claims Management Information System (CMIS) for 9 years.
ClaimsXpress (CXP) is a secure cloud browser-based software system that allows our claims adjusters to work anywhere, from the scene of an incident to our corporate office. Similarly, the system being browser-based allows the City 24-hour, read-only real-time access of its claims information. George Hills owns perpetual licenses to CXP, and we contract with Spe ar Claims to provide the Microsoft Azure-based secure cloud, in which our clients’ data is housed.
Searching within CXP for specific claims data is simple, but to minimize the need to search, George Hills has developed dashlets within ClaimsXpress to allow the City and adjusters quick access to relevant claims information right on their homepage.
As part of your renewal process, George Hills will hold a training session with all potential client -side ClaimsXpress users, ensuring that everyone has the desired level of access and understanding of the system.
ClaimsXpress has a set of standard claims handling reports avail able to every client, but the system can also be customized to produce unique reports specific to the City. The City can safely and securely access their reports via an automated encrypted email from their Client Services Manager or the dedicated reporting team. All these reports can be exported to Microsoft Excel or Adobe PDF formats on demand by either George Hills staff or City staff.
ClaimsXpress Claims is an entirely paperless system. All claim files are stored electronically in a secured Microsoft Azu re cloud hosted by Spear Claims, available to any authorized user, using any browser, at any time.
George Hills’ ability to maintain data and provide enhanced statistical reporting is due to our long use of best practices with technology. George Hills’ pro prietary iMetrics Business Intelligence Reporting service provides optimum targeted, on-demand data for liability and property claims decision-making.
ClaimsXpress is configured to enforce additional security measures when necessary. It can limit a user’s access to claim information by a client’s organization structure, for example allowing access to view claims for a single location or for the entire organization. CXP also includes identifiers for highly sensitive or confidential claims. When a claim is flagged as confidential, ClaimsXpress will limit access to that claim by individual User ID.
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The use of ClaimsXpress increases our firm’s service capabilities for the City and enhances our service workflow efficiencies and custom reporting capabilities. The alignment of these technologies with George Hills’ services is of great value to the City by providing real -time access to decision -making data, metrics, and trends. When it comes to read -only access, reporting, and modification abilities to meet the City’s needs, our technology offering is unmatched. Samples of the reports available can be found in Part 10: Appendices on page 68.
Client Portal
George Hills is thrilled to launch our self -service client portal. The City will continue to have its own dedicated portal for all members and staff to access. We can tailor this portal to directly complement the City’s members -only website access. This new web -based platform provides our clients with exclusive access to the following features:
• Secure file sharing and document management
• Quick reporting and metrics on dashboard
• Simple user interface
• George Hills’ news and alerts
D. MMSEA
ExamWorks performs the MMSEA Mandatory Insurer Reporting function for George Hills and our clients.
George Hills acknowledges we will comply with the mandatory reporting requirements of Section 111 (“Medicare Secondary Payer”) of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA).
We have contracted with a highly respected and well -known MMSEA firm – ExamWorks – for work in this area and have created an internal Medicare Compliance Team, who are responsible for knowing MSP, SCIP, MIR, and Medicare Set Aside Allocation policy, rules, and updates. The team acts, in accordance with our MMSEA fir m’s support, to ensure George Hills is compliant with Medicare regulations. They respond immediately to George Hills’ Medicare -related questions, concerns, or challenges, and ensure all necessary paperwork and documentation are completed in a timely manner and that all monthly data and progress reports are accurate and current.
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PART 7: FEES
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PART 7: FEES
A. FEE STRUCTURE
Adjusting Services Fees – Options
Option A1: Time and Expense – George Hills believes, as in the legal field, services surrounding claims and potential litigation are best captured by directed effort. In this case, the client only pays for the services requested. In a time and expense environment, George Hills applies its best practice approach to all claims; unless the client adjusts, restricts, or expands such services. A general administrative file will be established and maintained to track effort related to services necessary to fulfill our contractual obligations not otherwise associated with a claim.
Time and Expense for Adjusting Services
Supervisor $131/hour
Adjuster $105/hour
Claims Processing $86/hour
Option A2: Time and Expense with a Cap – George Hills believes that this can be the best of both worlds. This pricing model allows for the realities of the unknown to dictate service results but retains some budget certainty. The cap will always be more than the fixed fee to protect the unknown, but often can result in less cost too. The cap is a movable target and should be adjusted annually until the services and relationship have settled.
The above hourly rates by position are the same for both options A1 and A2. The only difference shall be that George Hills will commit to an annual maximum fee for adjusting services for option A2, in the amount of $220,000. Please note that the catastrophic pricing is applicable, and therefore outside of the annual maximum fee.
All fee options are subject to the Annual Fee Escalator described below.
Option B: Fixed Fee – George Hills believes this is a workable solution for public agencies seeking budget certainty. Unfortunately, it has its challenges. First, every other significant component of a claim (settlement and legal fees) is not predictable and as such, making the adjusted costs fixed will ensure that 100 percent of the time the fee will be wrong. Secondly, the result could be that the client is receiving far more resources than they are paying for, or the client is paying for far more resources than they are receiving in services on any one claim. Either outcome is wrong.
In this environment, George Hills makes every effort to be resource -sensitive in applying our best practices to ensure we balance the economics. No matter what, we put forth the right effort to resolve the claim. We do, however, adjust our clients’ fees that can and should be adjusted to meet our clients’ budget goals.
George Hills has developed a hybrid Fixed Fee Proposal. California Public Entities have seen dramatic increases in claims frequency in contrast to pandemic years. As such, we wanted to create a simple fee model that allows for fee adjustments down or up due to claims frequency, as hopefully frequency George Hills, City of Richmond RFP
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drops back down. S ince claims activity is the main indicator for TPAs and the number of resources needed to perform quality services, it is important that adjustments can be made to resources provided and resulting costs for the benefit of the client and TPA.
Our model provides for an assessment of claims frequency twice a year – after six (6) and twelve (12) months. We have established the change must be at least 10% to trigger an adjustment and no more than 25%, as greater than that warrants a contract modification. For th e City’s proposal the model would result in an adjustment in the event claims frequency dropped below the current estimate of new claims per year of 165. In the event claims dropped below 149 or increased above 181, an adjustment would automatically occur during the 7th and/or 13th month. The claims base would be adjusted to this new level for future year calculations.
For the City, the financial result would be calculated based on the percentage increase or decrease ranging from 10 -25%. For example, if the increase/decrease was 10%, the fee would decrease from $190,000 to $171,000. Conversely, if there was a 10% increase the fee would increase from $ 190,000 to $209,000.
Fixed Fee
Fixed Fee—Claims Only $190,000
GENERAL ADMINISTRATIVE FEES – ADDITIONAL TO ADJUSTING FEES Fixed Fee and Cap pricing will be based on the current average. Should the claim volume change more than 10% in severity or frequency in a year, we request a reevaluation of our pricing agreement.
General Administrative Fee Sec tion – Applicable to each fee option.
One Time Start-Up Fee $0 (waived)
Annual Administration Fee $10,000
Mileage - Adjuster Current IRS Rate
One Time MMSEA Setup Fee (paid to ExamWorks) - if
applicable.
Annual Reporting Fee (paid to ExamWorks)
$300/one-time
$500/year
Adjuster travel expenses for mediations, settlement
conferences, trials; subject to prior approval.
Actual
CXP access fee (up to 5 users) Included
Custom reports, if exceeds three hours and is client
specific
$185/hour
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All fee options are subject to the Annual Fee Escalator described above.
Subrogation
The Subrogation Fee is in the amount of 30% for each recovery obtained. The minimum amount to be paid to GH will be $250 per claim upon recovery. Please note, on most claims George Hills can recover our fee, thus the net cost is zero.
FEE SECTION TERMS
One Time Startup Fee – The process of onboarding a new client covers many areas , from establishing expectations, policies, and procedures, to designing the infrastructure to meet the needs of risk management, council, and department heads. It also involves time and effort in establishing the Trust Account or check writing, W -9, and a ll federal and state reporting requirements. Most importantly, this process involves the establishment of effective claims triage. Note that this is not time spent on the actual data conversion. As the City of Richmond is a current client, this fee has been waived.
Annual Administration Fee – George Hills has determined it takes a company -wide effort to ensure we exceed the expectations of our clients. As such, we feel it transparent to separately identify and charge for those critical functions that are no t directly tied to claims handling. We include an annual administration fee, which covers the following activities:
• Claims Management Information System (CMIS) services and reports • Access to CMIS and training
• Monthly listing of open claims, showing expense categories, reserves, and total incurred • Monthly claim summary reports
• Monthly hours and claims data detail for billing
• Providing loss run data and required reports
• Access to GH Client Portal
• Providing annual reports to outside agencies
• Filing of regulatory reports, such as 1099s, W-9s, etc. • Trust Account
• Establishment and maintenance of a trust account to pay indemnity and expenses that may be due on claims; the amount to be maintained in the trust account shall be determined by the City. If the trust account is set up with the GH preferred bank (California Bank and Trust), then George Hills covers the cost of Positive Pay and Payee Match.
Allocated File Expenses (see attached details) At cost
Conversion Fee (waived if client for 5 years, see below “Conversion Fees”)
See Notes below
Storage – if applicable TBD – Actual cost
Catastrophic Pricing Current hourly rate
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o If the City prefers an alternate bank, there may be an additional setup fee, as other banks’ processes can be extraordinarily time consuming. • New bank account setup, including signature cards, test checks, online access, and setup of bank in CXP
• Discussion and agreement on the approval process
• Preparation of W-9s
• Processing of checks weekly
• Submission of positive pay (if applicable) and monitoring of positive pay (review of daily emails from bank for exceptions)
• Maintenance of a copy of all checks drawn by George Hills to pay claims and claims -related expenses
• Monitoring of account balance, preparation of replenishment requests as needed (custom requests for each client’s needs)
• Monthly bank reconciliation (prepared and sent to the City) • Payment of invoices that are pass -throughs, such as invoices for medical record copies, ExamWorks, etc.
• Certificates of insurance as required by the Contract • Annual service
• Response to outside financial auditors
• Provision of reports to the City’s actuaries and claims auditors • Submission of GH SSAE 16 reports, or the current equivalent • Account Management
Mileage: Adjuster – Mileage is paid at the current IRS rate.
MMSEA – Both the one-time setup fee and the annual reporting feeds to offset fees paid directly to ExamWorks.
Adjuster Travel Expenses – For mediations, settlement conferences, trials, etc.; subject to prior approval and submitted with receipts.
CXP Access Fee – Included in the annual administration fee is the setup and management of five (5) user accounts through our CMIS: CXP.
iMetrics Report Fee – There will be no charge for our iMetrics business intelligence repo rts with executive in-person debriefs.
Custom Reports – Additional charged for custom reporting are defined as being client-specific and needing a third-party programmer for three (3) hours or more.
Conversion Fees – This fee is intended to cover costs ass ociated with data conversion, transition, and contract closeout. The data conversion fee is dependent on many factors which will need to be discussed. If George Hills is retained for five (5) years, we will entirely absorb the conversion fee. If George Hills is not retained for the full length of the proposed contract, then the client shall be subject to a fee of 20 percent each year not retained, not including shipping, storing, scanning, copying, or otherwise handling open or closed paper claim files (thi s shall be a separate charge based on the Scope of Work).
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George Hills will charge for any agreed services related to conversion storage, copying, scanning, shipping, and disposal.
Catastrophic Pricing – Applicable only to Fixed Fee and Time And Expense W ith A Cap Fee agreements. George Hills recognizes that in the event of a catastrophe, additional hours will need to be applied to the handling of such claims. As such, to preserve the quality and efficiency of service for which we are known, George Hills p roposes that should a catastrophic event occur resulting in 10 or more claimants or claims from a single occurrence, the client shall be billed at the current hourly rate.
Annual Fee Escalator – The Annual Fixed Fee and all hourly rates shall be adjusted at the beginning of each of the remaining years of the term by the lesser of 5%, or in accordance with the changes in the Consumer Price Index (CPI -U) for all Urban Consumers for the Western Region using the most recently published annual percentage change, but in any event such increase shall not be less than 3%.
Termination Fee – In the event of contract termination, George Hills’ procedures and cost for run - off claims will be billed at the current hourly rate; no charge for historical loss summaries. George Hills believes that the successful transition of claims requires preparation, so we ask for 90 days’ notice if the contract is terminated without cause to facilitate the transition of claims management properly and efficiently.
General File – A general administrative file shall be established and maintained to track effort related to services necessary to fulfill our contractual obligations and not otherwise associated with a claim.
Storage – George Hills will charge for any services related to storage, retrieval, copying, scanning, shipping, and disposal of paper files.
B. ALLOCATED EXPENSES
Typically, allocated expenses are those expenses that are generated by a claim (by outside vendors other than George Hills) that cannot be foreseen nor included in this Contract. These expenses are generally allocated back to the specific claim file for which the cost was incurred and then charged back to the entity whose claim incurred that cost. In most situations these are pass -through costs (with processing fees) for services and/or fees not directly generated by the TPA, but rather by a third- party consultant where the TPA has acted as an agent on behalf of the entity to necessarily outsource services to a third-party consultant and/or miscellaneous fees applicable to the specific claim applied by an outside entity, such as a court or copy services. Below, George Hills has provided a non - exhaustive list of typical allocated expenses.
Paid to GH
• CMS reporting costs and fees (ExamWorks)
Paid to Others as Authorized by Client
• Fees of outside counsel for claims in suit, coverage opinions, and litigation, and for representation and hearings or pretrial conferences
• Fees of court reporters
• All court costs, court fees, and court expenses
• Fees for service of process
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• Costs of undercover operatives and detectives (if initially paid by GH) • Costs for employing experts for the preparation of maps, professional photographs, accounting, chemical or physical analysis, or diagrams
• Costs for employing experts for the advice, opinions, or testimony concerning claims under investigation or in litigation for which a declaratory judgement is sought • Costs for independent medical examination or evaluation for rehabilitation • Costs of legal transcripts of testimony taken at coroner’s inquests, or criminal or civil proceeding
• Costs for copies of any public records or medical records • Costs of depositions and court reporting
• Costs and expenses of subrogation (if not George Hills) • Costs of engineers, handwriting experts, or an y other type of expert used in the preparation of litigation or used in a one-time basis to resolve disputes • Witness fees and travel expenses
• Costs of photographers and photocopy services (if not George Hills; our costs for this are included in our rate)
• Costs of appraisal fees and expenses not included in flat fee or performed by others • Costs of indexing claimants
• Services performed outside the TPAs normal geographical regions • Costs associated with Medicare Set -Aside analysis and submission of Medicare Con ditional Lien negotiation
• Investigation of possible fraud including SIU services and related expenses Any other similar cost, fee, or expense that is not otherwise included in the TPAs service fees that is reasonably chargeable to the investigation, negotiation, settlement, or defense of a claim or loss or to the protection or perfection of the subrogation rights of the entity, including travel related expenses.
Travel Related
Costs of travel related to claims including mileage drive, such as for attendance at inspections, mediations, and trial, shall be allocated to the specific claim and reimbursed to GH based on the actual cost incurred. Mileage shall be reimbursed at the current IRS rated at the time the mileage is traveled.
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OPTIONAL SE RVICES
Full In -House Litigation Management – Use of George Hills’ Attorneys Name and Title
Years of
Experience
Role for the Client
Neil Callahan, Esq.
Litigation Manager
25 Serves as a Litigation Manager for several
clients, monitoring counsel, and as a
resource to our claims staff.
Benjamin Oram, Esq.
General Counsel/Litigation
Manager
15 Serves as a Litigation Manager for several
clients, monitoring counsel, and as a
resource to our claims staff.
Cornelius (Neil) Callahan, Esq., Litigation Manager: Mr. Callahan has over 25 years of experience defending public entities on high profile claims in state and federal courts. Mr. Callahan commenced his career practicing law in New York, New Jersey, and Connecticut. In 1999 he began practicing law in California, where he served as lead trial counsel for public entities in the areas of civil rights, police practices, and dangerous condition defense. He has tried multiple cases to jury verdict in both state and federal court having been the lead defense attorn ey in 13 trials, with 12 defense verdicts. His emphasis has been on defending and advising public entities involved in civil litigation.
Past cases include officer-involved shootings, excessive force, unlawful seizure, dangerous condition, discrimination, and harassment. He is experienced in all aspects of litigation including discovery, depositions, motion practice, arbitrations, administrative hearings, mediations, and trials.
Benjamin Oram, Esq., General Counsel/Litigation Manager: Ben serves as George H ills’ General Counsel/Litigation Manager. He currently serves as a Litigation Manager for several clients, monitoring counsel, and as a resource to our claims staff.
George Hills’ proactive approach is founded on our commitment to the preservation of the City’s assets. Early contact with all involved parties maintains lines of communication and rapport (not only with the insured but also with the claimant); hence, cost -saving opportunities to resolve claims efficiently are more plentiful.
Here is an outline of their role and how it would work for the City:
1. Serve as Litigation Manager (Specifics of the role below) i. Actively manage all watchlist files (parameters of a watchlist to be agreed upon through subsequent discussions)
ii. Manage and supervise all litigated files – claims adjusters will track the nonserious and/or non-active litigated files, with the support of Claims Processors, and report to the City
iii. Accessible to the entire GH adjuster team to advise and instruct as needed
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i. Work closely with the City with confidential analysis and problem -solving for managing risk and avoiding unnecessary litigation
ii. Provide immediate access to legal advice to the City, which includes analyzing coverage issues, Public Records Act requests, tort claim handling and strategy, conflicts of interest, oversight of outside litigation counsel, and providing legal opinions on potential and active litigation
iii. Advise on sensitive and political issues/claims
3. Coverage counsel consultation
i. Review and analysis of memorandums of coverage and excess/umbrella policies to address and offer advice and consultation regarding coverage issues ii. Advise on potential changes to all coverage documents iii. Assist City and George Hills staff in interpretation of coverage issues
4. Resource to a broker of record for coverage needs
5. Trial/Mediation/Board Meeting attendance
i. Attend board/executive/coverage/claims meetings (as necessary) ii. Attend trials, mediations, and other cour t hearings, including appearing before Courts of Appeal as needed
iii. Provide analysis and consultation before, during, and after these significant litigation events – to reduce exposure and maximize opportunities for resolution
6. Legal training and seminars
i. Provide customized seminars and training upon request – to City staff, brokers, members, and GH staff
ii. Subject areas include memorandums of coverage, all aspects of risk management, claims handling and litigation, employment law, and general liability claims iii. Courses are customized to address the client’s specific needs and to work closely with safety and loss staff, defense firms, and others
Rates for Optional Legal Service
Litigation Management $225/hour
This rate is subject to the annual fee escalator.
Please note that George Hills can provide a monthly/annual fixed fee for the above services upon discussion and agreement on level of effort.
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1st Party Subrogation Recovery
George Hills provides subrogation recovery services to many of our clients. In 2013, George Hills created a dedicated Subrogation Recovery Unit to handle recovery opportunities for our clients who have requested or contracted with us for subrogation recovery services .
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George Hills has a dedicated team with extensive experience in the public entity environment who handle all 1st party subrogation matters for our clients who choose this service. Below are testimonials from a few of George Hills’ subrogation clients:
PUBLIC ENTITY TESTIMONIAL STATEMENT
Client of
Sacramento
Risk & Loss Control
“We have utilized the George Hills Subrogation unit for several years, and simply put - they get results. They have a wealth of knowledge and expertise. Our 1st and 3rd party claims are always handled promptly and professionally. Partnering with George Hills for subrogation has proven to be a wise decision for our Client.” City of Sacramento
Risk Management
“We are pleased to be partnering with George Hills for our subrogation recovery services. They provide quality staff and services.”
City of Oakley
Kevin Rohani, Public
Works Director/City
Engineer
“The City of Oakley has utilized the services of George Hills Subrogation Team for several years, and we have been very happy with this service and the professional approach that the George Hills Team brings towards the subrogation process. The knowledge and expertise of the George Hills Team has been invaluable for the City of Oakley, and we are very grateful for their great work in resolving our assortment of third -party claims and we are looking to many more years of successful collaboration with the George Hills Team.” City of Redlands
Human
Resources/Risk
Management
“The City of Redlands is always pleased and impressed at the excellent service, attention and professionalism that is used by their claims adjusters. In particular, Tammy Hunt and Vicky Jimenez. They are a pleasure to work with an d make the claims recovery process run smoothly and effectively. We are very happy with the results and recovery efforts that they deliver. We highly recommend their services and appreciate the level of excellence that they offer to us as the client.” Quick Stats on George Hills’ Subrogation Recovery Results 2,139 - Average number of subrogation claims handled
yearly
91% - of claims handled result in a Recovery
80% - of claims result in a full recovery (including GH Fees) 84% - of amounts sought for our clients are recovered
Average recovery: $ 4,239 /claim
George Hills’
subrogation recovery
unit has performed
spectacularly,
recovering several
million dollars on
behalf of our clients.
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City of Oakland
Human Resources
Management/Risk
Management Unit
“We have utilized the George Hills Subrogation unit for several years, and they get excellent results. They have a wealth of knowledge and expertise, and their professionalism and prompt attention to our needs is second to none. There’s no better service out there that can beat them, and the rates are below the typical rates offered by other vendors. Our third -party claims are always handled promptly and professionally. Our partnership has proven itself to be the best decision for our City.”
Our standard subrogation fee is 30% of the amount collected, however George Hills has been successful more than 80% of the time collecting our feeds, this equating to recovery essentially free of charg e. The minimum amount to be paid to George Hills will be $250 per claim. However, George Hills also has the authority to reject any claim for any reason, dismissing the City of any financial responsibility for rejected claims only.
Generally, no recovery shall be agreed to involving payment plans if the recovery is less than $5,000 and/or greater than a one-year term. Exceptions can be made on a case-by-case basis. If a recovery is agreed to above this amount, the subrogation fee shall be 45%. In the event a payment plan is authorized and entered, the subrogation fee will be based upon the total amount of the lien and will be invoiced to the City.
If authorized, small claims court appearances for recovery of funds will be priced at $150 per appearance.
The benefits of George Hills’ subrogation recovery:
• High-level expertise of subrogation recovery
• Recovery of damages to property, utilities, hazardous material cleanup • Small claims
• Preparation of proof of loss statements
• Claim reporting activity, demand letters, final demand to claimant with suspended license, closing and/or payment transmittal
• Settlements
• File retention
• Development of policy and procedures
• Provision of account manager and lead subrogation adjuster
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PART 8: CONTRACTUAL
REQUIREMENTS
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PART 8: CONTRACTUAL REQUIREMENTS
A. EXCEPTIONS
The City expects to retain an adjusting firm to serve for a period of at least 3 calendar years with annual extensions thereafter. A 60 -day cancellation clause will be included.
In this part, provide information regarding any special contractual requirements your firm desires. The awarding firm shall execute the attached sample contract with the City. Identify any exceptions to the City contra ct form.
PROPOSED CONTRACT EXCEPTIONS TO
CITY OF RICHMOND STANDARD CONTRACT
George Hills Company, Inc. hereby submits the following explanation and recommendation for exceptions, alterations, and/or modifications to the sample contract. George Hills Compan y has reviewed the Standard Contract and is willing to submit to the terms and conditions therefore with the following proposed change identified below. Alternatively, George Hills Company has included a copy of its standard contract in Part 10: Appendices on page 83 as an option for the City to consider.
Standard Contract
Section 9. Insurance Provisions. This Contract is subject to the Insurance Provisions (Exhibit F) which are attached hereto and are incorporated herein by reference.
Exhibit D: General Conditions
Section 17. Insurance. Insurance Requirements are set forth in in Exhibit F to this Contract.
Contractor shall abide by the insurance requirements set forth in said Exhibit F.
Exhibit F: Insurance Provisions
City of Richmond - Insurance Requirements - Type 2 Professional Services Original Language in City documents:
The section entitled “Required Coverage” and “Minium Limits” states:
$2,000,000 per occurrence for bodily injury, personal injury and property damage. If the policy includes a general aggregate, either the gene ral aggregate shall apply separately to this project, service or location or the minimum required aggregate limit shall be twice the per occurrence limit.
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
1) Explanation of Reason for Change:
It is proposed that the highlighted section be deleted. The insurance obtained by George Hills meets all limits.
2) Proposed Alternative Language:
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$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.
Policy shall be endorsed to name the City of Richmond as an additional insured per the conditions detailed below.
3) Description of Impact to Price:
This change has no impact on price.
The section entitled “Required Policy Conditions” references specific ISO form numbers as the standard for policy language and coverage.
1) Explanation of Reason for Change:
Through consultation with the broker for George Hills, the carriers providing coverage use proprietary forms generally accepted and in common use in the insurance industry, but which do not always bear any specific ISO number. While George Hills believes all of its forms would be compliant with the requirements of the City, it has not undertaken the legal analysis to guarantee a finding of “at least as broad as” any specific ISO form. George Hills will provide for insurance forms to the City for analysis consistent with this requirement. 2) Proposed Alternative Language:
George Hills proposes that the above highlighted sections be changed to read, “…written on an occurrence form reasonably acceptable to the City and in common use in the insurance industry for the identified coverage.”
3) Description of Impact to Price:
This change has no impact on price.
The section entitled “Required Policy Conditions” includes this subsection:
Primary and Non-Contributory. The contractor’s insurance coverage must be primary coverage 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 contractor and in no way relieves the contractor from its responsibility to provide insurance. 1) Explanation of Reason for Change:
Through consultation with the insurance broker for George Hills, it is understood that establishing a policy as Primary & Non -Contributory is appropriate for the Commercial General Liability policy, however, the workers’ compensation, profess ional liability and umbrella/excess policies are not Primary & Non-Contributory for Additional Insureds. 2) Proposed Alternative Language:
Primary and Non-Contributory. The contractor’s General Liability insurance coverage must be primary coverage 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 contractor and in no way relieves the contractor from its responsibility to provide insurance. 3) Description of Impact to Price:
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This change has no impact on price.
The section entitled “Required Policy Conditions” includes this subsection:
A.M. Best Rating. A:VII or better. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immediately and provide notice to City. 1) Explanation of Reason for Change:
George Hills recommends including insurers that are rated “A -” rather than “A”. “A -” is still a secured rating from A.M. Best. Arthur J. Gallagher, the insurance broker for George Hills, has stringent guidelines for insurers that we do business with and “A-” rated insurers provide high quality policies and services but gives George Hills much more flexibility when placing insurance coverage where an “A” rated insurer may not be available at an acceptable price. 2) Proposed Alternative Language:
A.M. Best Rating. A -:VII or better. If the A.M. Best Rating falls below the required rating, CONTRACTOR must replace coverage immediately and provide notice to City 3) Description of Impact to Price:
This change has no impact on price.
The section entitled “Required Policy Conditions” includes this subsection:
Cancellation. Each required policy shall be endorsed to state that coverage shall not be cancelled, reduced or otherwise materially changed except after thirty (30) days’ prior written notice by certified mail, return receipt requested, has been given to the City. 1) Explanation of Reason for Change:
Contractor cannot agree to thirty (30) days notice in connection with “any other cancellation or policy change. George Hills may not be provided with notice within that time frame and therefore could not provide more notice that it was given by the carriers making the change. 2) Proposed Alternative Language:
In the event George Hills receives notice of cancellation from the insurer of any of the insurance required under this agreement, George Hills will provide City of Richmond written notice of such pending cancellation within five (5) business days of receipt of such notice from the insurer. George Hills shall use all reasonable efforts to remedy the cause of such cancellation notice, or will find replacement insuranc e meeting the requirements of this agreement, and shall provide City of Richmond with written notice that such cancellation has been rescinded, or shall provide a new Certificate of Insurance evidencing the replacement insurance, prior to the date the pend ing cancellation was to become effective, such that no lapse in the required insurance shall occur.
3) Description of Impact to Price:
This change has no impact on price.
The section entitled “Verification of Coverage” includes this paragraph:
All original certificates and endorsements shall be received and approved by the City before work may begin. 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.
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1) Explanation of Reason for Change:
George Hills cannot control the production of certificates from an insurance carrier. George Hills will provide certificates within a reasonable time following receipt of a request from the City.
2) Proposed Alternative Language:
All original certificates and endorsements shall be received and approved by the highlighted sentence of the requirement. The City of Richmond reserves the right to require request complete, certified copies of all required insurance policies including endorsements affecting the coverage at any time.
3) Description of Impact to Price:
This change has no impact on price.
Original insurance certificates and required policy endorsements shall be mailed or delivered to the Designated Project Manager for the City of Richmond.
George Hills requests that certificates of insurance be emailed to the City upon request rather than utilizing US Mail.
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PART 9: INSURANCE
COMPLIANCE
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PART 9: INSURANCE COMPLIANCE
A. EVIDENCE OF INSURANCE REQUIREMENTS
The successful firm must be able to provide evidence of insurance coverage as follows:
A. Professional Liability including Errors and Omissions coverage of at least $1,000,000 per occurrence.
B. Comprehensive General or Commercial General Liability (including for each Bodily Injury, Personal Injury, and Property Damage) of at least $2,000,000 per occurrence, and $4,000,000 general aggregate; and Auto Liability with limits of at least $ 1,000,000 combined single limit. The City will require an Additional Insured endorsement.
C. Worker’s Compensation Insurance with statutory limits and Employer’s Liability Coverage of $1,000,000 per accident.
D. Refer to the attached City contract for specific r equirements related to insurance.
George Hills can affirm insurance coverage and will be able to provide evidence of insurance coverage upon award. Please see the exceptions in Part 8: Contractual Requirements on page 50.
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PART 10: APPENDICES
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PART 10: APPENDICES
FORMS
Ban the Box Form & Attached George Hills Job Application
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Disclosure Statement for Limited Liability Companies
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Sanctuary City Compliance Statement
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SAMPLE REPORTS
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SAMPLE PLAN OF ACTION
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RESUMES
John Chaquica
CPA, MBA, ARM
Chief Executive Officer
[email protected] (916) 859 -4824
George Hills Job Description
The Chief Executive Officer (CEO) establishes and lives by the corporate vision; develops and implements the George Hills’ Strategic Plan’ provides leadership; and fosters the culture through our values to achieve plan objectives. As lead on George Hills’ Corporate Management Team (CMT), the CEO works with management to establish long -term goals, plans, and policies that align with organizational goals. The CEO provides coaching, guidance, and support to the team while setting professional development plans to assure all managers reach their full potential and deliver the highest standard of Division, cross-Divisional, and cross-Company teamwork and customer service.
Professional Experience
• George Hills, CEO
• Bickmore Risk Services, CEO
• Multiple Public Entity Self-Insurance Pools, Executive Director/Consultant • Gilbert Accountancy Corporation, Audit Partner and Industry Team Leader on Public Entity Self-Insured Groups
• Executive Director of: Independent Cities Risk Management Authority (ICRMA), Bay Cities Joint Powers Insurance Authority, Valley Insurance Program (VIP), Santa Cruz/San Benito JPA, North Valley Schools Insurance Group (NVSIG)
Professional Affiliations
• American Institute of Certified Public Accountants (AICPA) • California Society of Certified Public Accountants (CSCPA) • Court Appointed Special Advocates (CASA), Sacramento
Education
• Golden Gate University – M.A., Business Administration/Finance • California State University, Sacramento – B.S., Accounting • Insurance Institute of America – Associate in Risk Management (ARM)
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Chris Shaffer
ARM/P
Chief Operating Officer
[email protected]
George Hills Job Description
Responsible for managing operations for the Claims Administration Division. Works with the CEO and other managem ent to establish long -term goals, plans, and policies that align with organizational goals. Provides coaching, guidance, and support to the team while setting professional development plans to ensure all employees reach their full potential and deliver the highest standard of departmental, cross -departmental, and cross -Company teamwork and customer service.
Professional Experience
• George Hills, Vice President of Claims
o Oversees all Division personnel, specifically in the areas of performance, productivity, profitability, and client satisfaction. Technical Liaison to CMIS for Claims regarding all claims reports, reporting controls, s ecurity, and consistent report quality. Direct supervisorial duties and overall internal and external audit proces ses, reporting, and changes to best practices as suitable. Develops and orchestrates adjuster trainings in collaboration with the Client Service Manager and CMIS, to include assessment of staff, planning and training events, and individual trainings compan y-wide.
Responsible for litigation audits and oversight.
• York Risk Services Group, Managing Vice President Client Services o Promoted to oversee a $125M business unit. Responsible for contract renewals and renegotiations, upselling and cross-selling of ancillary and new services to the existing client base, and implementation of services for existing and new accounts. Supervised 14 account managers and 4 analysts. Directed system deployment and process improvement initiatives. Administered a $2M budget.
• York Risk Services Group, Vice President of Information Services & Chief Business Systems Officer
o Member of the Senior Management Team, responsible for management reporting, business analysis, business advocacy within the IT unit, process improvement, and the delivery of business system solutions and changes to maximize efficiency and reduce risk. Worked closely with the Project Management Office (PMO) and IT development teams. Supervised 8 analysts and 4 developers. Provided support for renewal, marketing, sales, and client services efforts. • Bragg & Associates, Vice President – Information Services o Oversaw critical technology initiatives for this $18M company that was acquired by York Risk Services Group in 2008. Supervised teams of develo pers and analysists.
Planned and led complete enterprise project life cycles. Developed policies and procedures. Created process enhancements.
Education
• University of Utah - BA
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Tom Baber
ARM
Assistant Vice President of Claims
[email protected]
George Hills Job Description
Responsible for managing operations for the Claims Administration Division. Works with the CEO and other management to establish long -term goals, plans, and policies that align with organizational goals. Provides coaching, guidance, and support to the team while setting professional development plans to ensure all employees reach their full potential and deli ver the highest standard of departmental, cross -departmental, and cross -Company teamwork and customer service.
Professional Experience
• George Hills, Assistant Vice President
• York Insurance Services Group, Inc., Vice President Liability Claims Operations • Gregory B. Bragg & Associates, Vice President - Liability Education
• UC Santa Barbara – BS, Physiological Psychology
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Kathleen Proctor
WCCA, CFE
Client Services Manager
[email protected]
George Hills Job Description
The Client Services Manager ensures that existing customers are retained, satisfied, and their needs are fulfilled. Builds relationships with customers and uses independent judgment and discretion to facilitate resolution of problems, issues, and concerns. Understands the balance, inter-relation, and nuances between operations, sales, and customer service. Wor ks as a liaison between customers and George Hills to support the Company’s business operations.
Professional Experience
• Heringer Estates Winery, Sales Director
o Developed and implemented sales strategies with associates. Assisted with business decisions by creating annual business sales and marketing plans. Analyzed market trends and identified expansion opportunities. Worked closely with marketing staff to develop and implement marketing strategies. Managed and supported private label and whole sale clients and sales. Directed and supervised managers and their channels, including developments of annual budgets and staff scheduling. • George Hills, Quality Assurance Operations Manager
o Reviewed and evaluated the performance of managers and production of annual client reports. Reviewed and evaluated office performance, including: financial and expense management, technical growth, training, quality assurance, customer service, staffing, and recruiting. Ensured office compliance with state regulations.
Focused on facility training to guarantee quality services. • City of Stockton, Risk Manager
o Developed and administered a comprehensive risk management program. Operated as the City’s designated Safety Officer and ADA Compliance Officer. Served as a Director of the Board and actively participated in the California Joint Powers Risk Management Authority Insurance Pool. Developed and administered the City’s Subrogation program, designed to reduce the frequency and severity of loss to City personnel and property. Reviewed all City contracts and leases for risk exposure and transfer.
Education
• California State University, Sacramento – BS, Criminal Justice • Insurance Educational Association – Workers Compensation Claims Administrator (WCCA) • Association of Certified Fraud Specialists – Certified Fraud Examiner (CFE)
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Marizel Bajao
Senior Claims Adjuster
[email protected] (408) 260 -0153
George Hills Job Description
The Senior Claims Adjuster handles multi -line claims, including investigating and adjusting minor to complex property and liability claims for clients including municipalities, schools (public and charter), and private companies. Investigates, negotiates, and settles a variety of claim types, including general liability bodily injury and property damage, auto liability bodily injury and property damage, first part y property claims, due process claims, and subrogation claims.
Maintains timely contact with clients, including reporting on claim files to clients and various excess carriers. Manages litigated files, monitors and directs defense counsel on litigation, an d attends settlement conferences and mediations.
Professional Experience
• George Hills, Senior Claims Adjuster
o Multi-line claims adjuster specializing in adjusting and investigations of minor to complex casualty claims for public entity clients and insurance company clients.
Extensive experience investigating, negotiating, and settling bodily injury claims, physical damage, product, and food -related illness claims, as well as general liability claims including construction defect litigation.
• Crawford & Company, Liability Claims Adjuster & Liability Claims Supervisor o Provided professional staff support to Casualty Adjusters and Vehicle Appraisers.
Responsible for restoration of confidence of major corporate accounts. Developed under-performing units into high quality, productive, service-oriented units achieving management goals for excellent client relations and high revenue growth.
Improvement of respective units using inherited staff, thus demonstrating motivational and mentoring abilities.
o Provided Risk Management services for major, self -insured, and national accounts.
Assisted national insurance carriers with complete accident investigations and claims handling. Investigated, negotiated, and settled all bodily injury, property damage, physical damage, uninsured motorist bodily injury, product, and food borne illness claims. Managed litigated files and attended court -ordered settlement conferences and mediations. Maintained timely written reports to all clients.
Education
• San Jose State University - BA
George Hills, City of Richmond RFP
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Wesley Mao
Senior Claims Adjuster
[email protected]
George Hills Job Description
The Senior Claims Adjuster handles multi -line claims, including investigating and adjusting minor to complex property and liability claims for clients including municipalities, schools (public and charter), and private companies. Investigates, negotiates, and settles a variety of claim types, including general liability bodily injury and property damage, auto liability bodily injury an d property damage, first party property claims, due process claims, and subrogation claims.
Maintains timely contact with clients, including reporting on claim files to clients and various excess carriers. Manages litigated files, monitors and directs defe nse counsel on litigation, and attends settlement conferences and mediations.
Professional Experience
• Carl Warren & Company, Senior Claims Specialist
o Analyzed and determined extent of commercial general liability concerning Metro bus and train losses or damages, and attempted to affect settlement with claimants and attorneys. Corresponded with and interviewed medical specialists, bus and train operators and supervisors, agents, police, medical professionals, witnesses, or claimants to compile in formation for investigation. Handled litigated files effectively and in constant communication with defense counsel throughout the duration of the claims.
• Progressive Insurance, Claims Specialist
o Investigated, evaluated, and negotiated injury settlements with claimants and attorneys. Calculated and executed payment of claims. Consistently exceeded company performance standards by maintaining a low number of pending files. • GMAC Insurance, Claims Representative
o Investigated, evaluated, and negotiated bodily injury, property damage, medical, uninsured motorist bodily injury, and collision claims. Maintained daily contact with insureds, claimants, attorneys, and auto body repair specialists while handling and negotiating property damage and bodily injury claims. Performed field inspections of damaged vehicles to determine repairs or total.
Education
• California State Polytechnic University – BS, Business Administration
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Tammy Hunt
CCLS
Subrogation Supervisor
[email protected]
George Hills Job Description
Oversees the subrogation division and manages claim assignments. Maintains subrogation client relations, including face-to-face meetings and the client’s convenience and need. Prepares for, files, and attends small claims trials on behalf of all clients. Pursues all legal remedies available for post- judgment collection after small claims judgements. Aggressively pursues s ubrogation recovery services for clients and prepares specialized reports for clients as appropriate and necessary.
Professional Experience
• George Hills, Subrogation Supervisor
o Oversees the subrogation recovery division. Investigates and pursues potential subrogation opportunities. Maintains timely contact with claimants, including reporting on claim files. Manages litigated files and attends settlement conferences and mediations.
• City of Stockton, Recovery Analyst, Human Resources Program Assistant, Legal Secretary II o Worked on criminal and civil litigation cases in the City Attorney’s office. Handled subrogation cases. Operated with approximated 1,000 case workload. Maintained property, general liability, auto, crime, council bonds, notary public, and other insurance programs.
Education
• Humphreys College – BS, Paralegal Studies
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Edie Yamamura
Senior Subrogation Specialist
[email protected]
George Hills Job Description
The Senior Subrogation Specialist deals directly with clients, exercising their independent judgment and personal discretion on matters relating to claims analy sis, claims management, and claims resolution/settlement with multipart cases, including but not limited to spending time on the phone with claimants, clients, and attorneys; conducting initial investigations; negotiating resolution of complex claims; inte rviewing and recommending legal counsel for retention by Company clients; and collaborating with counsel in preparation for litigation including assembling evidence.
Professional Experience
• Risk Management Services, Field Claims Adjuster
o Performed field investigation as a TPA for various insurance carriers and government entities for general liability claims as well as subrogation. Duties included contact with insureds and claimants to set up in -person recorded statements, reporting to the carrier, analysis of damages, negotiation of settlements, work with both defense and plaintiff attorneys to effectuate eventual settlement, and attendance in small claims court, mediations, and settlement conferences in both State and Federal Courts. • Claims Unlimited, Field Claims Adjuster
o Performed field investigation as a TPA for various insurance carriers and government entities for general liability claims as well as subrogation. Duties included contact with insureds and claimants to set up in -person r ecorded statements, reporting to the carrier, analysis of damages, negotiation of settlements, work with both defense and plaintiff attorneys to effectuate eventual settlement, and attendance in small claims court, mediations, and settlement conferences in both State and Federal Courts.
Education
• Associate in Claims (AIC)
• St. Louis Community College – Associate Degree: Retail Management
George Hills, City of Richmond RFP
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SAMPLE CONTRACT
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