Innovative Claims Solutions - 2016 Agreement - Amendment No. 2SECOND AMENDMENT TO WORKERS COMPENSATION THIRD PARTY CLAIMS
ADMINISTRATION AGREEMENT BETWEEN THE CITY OF GILROY AND
INNOVATIVE CLAIMS SOLUTIONS, INC.
WHEREAS, the City of Gilroy, a municipal corporation ( "City "), and Innovative Claims
Solutions, Inc. entered into that certain agreement entitled Agreement for Services — Workers
Compensation Third Party Claims Administration, effective on July 1, 2016, hereinafter referred to as
"Original Agreement "; and
WHEREAS, City and Innovative Claims Solutions, Inc. have determined it is in their mutual
interest to amend certain terms of the Original Agreement.
NOW, THEREFORE, FOR VALUABLE CONSIDERATION, THE PARTIES AGREE AS
FOLLOWS:
1. Article 1. Term of Agreement of the Original Agreement shall be amended to read as follows:
This amendment will become effective on July 1, 2018 and will continue in effect through June 30,
2019, unless extended by addendum or unless terminated in accordance with the provisions of Article
7 of the Original Agreement.
2. Article 4. Compensation of the Original Agreement shall be amended to read as follows: In
consideration for the services to be performed by CONSULTANT, CITY agrees to pay
CONSULTANT the amounts set forth in the attached revised Exhibit D ( "Payment Schedule "). In no
event however shall the total compensation paid to CONSULTANT EXCEED $87,182.00 for the
period July 1, 2018 — June 30, 2019. The total amount paid under this Council approved (May, 2016)
agreement is $256,794 (FY 17 = $80,612; FY 18 = $89,000; FY 19 = $87,182).
3. This Amendment shall be effective on June 30, 2018.
4. Except as expressly modified herein, all of the provisions of the Original Agreement shall
remain in full force and effect. In the case of any inconsistencies between the Original Agreement and
this Amendment, the terms of this Amendment shall control.
5. This Amendment may be executed in counterparts, each of which shall be deemed an original,
but all of which together shall constitute one and the same instrument.
IN WITNESS WHEREOF, the parties have caused this Amendment to be executed as of the
dates set forth besides their signatures below.
CITY O,FGIGILROY
By:
[signature]
Gabriel A. Gonzalez
[employee name]
City Administrator
[title /department]
Date: 7 �1g,-
:,• .
�U• ro- S- Ill
-1-
INNOVAT VE CL IMS S LUTIONS, INC.
V-1�1/ignature]
Cheryl esteren
[name]
President/COO
/ n [titlel
/
Date: ( R 7 / Y
APPROVED AS TO FORM:
City Attorney - --
4845 - 8215- 5540v1
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j
-2-
City Clerk
EXHIBIT D
PAYMENT SCHEDULE
CONSULTANT'S Claims Administration fee for the period July 1, 2018 through June 30,
2019 shall be $88,182.00 payable in monthly installments of $7,265.17.
The Claims Administration fees are payable monthly in advance by the City of Gilroy upon
receipt of CONTRACTOR'S invoice.
The City of Gilroy shall establish, maintain, and reconcile the workers compensation trust/bank
account as such there will be no charge from CONTRACTOR for these services.
The City of Gilroy shall be responsible for all Managed Care Services and Loss Adjustment
Expenses. Managed Care Services shall include medical bill review, utilization review, and medical
case management. Costs for such services are documented in Exhibit B; however, bill review services
shall be billed at a rate not to exceed $30.00 per bill. Loss Adjustment Expenses shall include all
reasonable expenses necessary to the adjustment of a claim in accordance with the Service Agreement,
including, but not limited to, fees for engaging defense counsel, court reporters, expert witnesses and
field investigators, incurred on behalf of the City of Gilroy.
On behalf of the City of Gilroy, Innovative Claims Solutions, Inc. will perform all workers
compensation claims reporting services required by the Medicare, Medicaid, and SCHIP Extension Act
(MMSEA) Section 111 Mandatory Reporting to the Centers for Medicare & Medicaid Services (CMS)
for the periods stated above.
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