HomeMy WebLinkAboutResolution 88-R-26 Authorizing CM to Execute a One Year Extension with CCMSI04/27/2026
88-R-26
A RESOLUTION
Authorizing the City Manager to
Execute a One-Year Contract Extension with Cannon Cochran
Management Services Inc. for Third Party Administration of General
Liability and Worker’s Compensation Claims
WHEREAS, the City of Evanston and Cannon Cochran Management Services Inc.
(“CCMSI”) executed a Professional Services Agreement (“Agreement”) for third party
administration of general liability and worker’s compensation claims in 2021 and
subsequently executed two one-year extensions in 2024 and 2025; and
WHEREAS, the Evanston City Council believes entering into a one-year extension
from May 1, 2026 to April 30, 2027 to this Agreement with CCMSI is in the best interests
of the citizens of Evanston,
NOW, THEREFORE, BE IT ORDAINED BY THE CITY COUNCIL OF THE
CITY OF EVANSTON, COOK COUNTY, ILLINOIS:
SECTION 1: That the City Manager is hereby authorized and directed to sign, and
the City Clerk is hereby authorized and directed to attest on behalf of the City of Evanston,
a one-year extension to the Agreement between the City and CCMSI.
SECTION 2: That the City Manager is hereby authorized and directed to negot iate
any terms of an Agreement as may be determined to be in the best interests of the City.
SECTION 3: That this Resolution shall be in full force and effect from and after
its passage, approval, and publication in the manner provided by law.
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88-R-26
_______________________________
Daniel Biss, Mayor
Attest:
______________________________
Stephanie Mendoza, City Clerk
Adopted: __________________, 2026
Approved as to form:
______________________________
Alexandra B. Ruggie, Corporation Counsel
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April 27
SA-Life of Agreement 5 1 26
SERVICE AGREEMENT BETWEEN
CITY OF EVANSTON AND
CANNON COCHRAN MANAGEMENT SERVICES, INC.
THIS SERVICE AGREEMENT is made and entered into this 1ST day of May, 2026, by and between
City of Evanston (the “Client”), and Cannon Cochran Management Services, Inc. (“CCMSI”), a Delaware
corporation. It is agreed between the parties hereto as follows:
A. APPOINTMENT OF CCMSI. The Client hereby appoints CCMSI, and CCMSI hereby agrees to serve, as
Third Party Administrator (“Administrator”) of the Client’s insurance program as described within
Exhibit A Fee and Payment Schedule (“Exhibit A”). All functions of CCMSI shall be performed until
[termination of this Agreement (“Life of Agreement”).
B. FUNCTIONS OF CCMSI. During the term of this Agreement, the regular functions of CCMSI as the
Client’s Administrator shall include the following:
1. Claim Administration.
(a) Claim Management and Administration. In compliance with its Best Practices, CCMSI will
manage and administer all claims of the Client that occur during the period of this
Agreement. All claim payments shall be made with Client funds. CCMSI will act on behalf of
Client in handling, monitoring, investigating, overseeing and adjusting all such actual and
alleged claims.
(b) Claim Settlement. CCMSI will settle claims of the Client with Client funds.
(c) Claim Reserves. CCMSI will establish reserves for unpaid reported claims and unpaid claim
expenses.
(d) Allocated Claim Expenses. CCMSI will pay, at market rates, all Allocated Claim Expenses with
Client Funds. Allocated Claim Expenses are charges for services provided in connection with
specific claims by persons or firms which are eligible claim expenses under the Client’s
program. Notwithstanding the foregoing, Allocated Claim Expenses will include all expenses
incurred in connection with the custody, investigation, adjustment, settlement or defense
of Client claims, even if such expenses are incurred by CCMSI. Allocated Claim Expenses will
include, but not be limited to, charges for:
1) Independent medical examinations of claimants;
2) Managed care expenses, which may include the services provided by comp mc™,
CCMSI’s proprietary managed care program;
3) Fraud detection expenses, which may include the services provided by FIRE, CCMSI’s
proprietary Special Investigation Unit (SIU), and other related expenses associated with
the surveillance, detection, reporting and prosecution of fraudulent claims, including
legal fees;
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4) Attorneys, experts, and special process servers;
5) Court costs, fees, interest and expenses;
6) Depositions, court reporters and recorded statements;
7) Independent adjusters and appraisers;
8) Index bureau and OFAC (Office of Foreign Assets Control) charges;
9) MMSEA/SCHIP compliance charges;
10) Electronic Data Interchanges (“EDI”) charges if required by state law;
11) CCMSI personnel, at their customary rate or charge, but only with respect to claims
outside the state of their assigned office and only if such customary rate is
communicated to the Client prior to incurring such cost;
12) Actual reasonable expenses incurred by CCMSI employees outside the state of their
assigned office for meals, travel, and lodging in conjunction with claim management;
13) Police, weather and fire report charges that are related to claims being administered
under Client’s program;
14) Charges associated with accident reconstruction, cause and origin investigations, etc.;
15) Charges for retrieval of medical records, personnel documents, and other documents
necessary for adjudication of claims under Client’s program;
16) Charges associated with Medicare Set-Aside Allocations and other related MSP
Services;
17) Legal bill review expenses, which include the services provided by CLEAR, CCMSI’s
proprietary legal bill review program;
18) Other expenses normally recognized as Allocated Loss Adjustment Expenses (“ALAE”)
by industry standards.
(e) Subrogation. CCMSI will monitor claims for subrogation.
(f) Provision of Reports. CCMSI will provide reports to the Client as mutually agreed upon by
the parties.
(g) Service Plan. CCMSI will cooperate with the Client in the drafting and periodic revision of a
Quality Service Plan (QSP), claim handling instructions, or similar document if applicable that
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contains claim handling instructions, a schedule of reports, and other details of Client’s
insurance program as mutually agreed upon by the parties. The document shall be
maintained in CCMSI’s iCEBAR software application.
2. CLEAR Legal Bill Review Services. CCMSI will provide the Client with CLEAR Legal Bill Review
Services upon mutual agreement of the parties and in exchange for payment of the applicable
CLEAR fees stated in Exhibit A. The CLEAR Legal Bill Review Services shall include:
(a) Audit of all legal invoices submitted by Client-approved law firms for adjudication in
compliance with Client’s Defense Counsel Billing Guidelines and generally accepted legal
billing principles;
(b) Generation of an analysis report for each legal invoice reviewed. The report will be included
with each check to the appropriate law firm and include details and supporting
documentation for any deductions applied to the original billing; and
(c) Generation of periodic standard reports summarizing Client’s overall savings results with
metrics to analyze individual law firm performance.
3. comp mc™ Managed Care Services. CCMSI will provide the Client with comp mc™ managed care
services upon mutual agreement of the parties and in exchange for payment of the applicable
comp mc™ fees stated in Exhibit A. The comp mc™ Managed Care Services may include but not
be limited to usual and customary medical bill re-pricing, state fee schedule medical bill re-
pricing, preferred provider organization medical bill re-pricing, specialty medical and hospital bill
negotiation, medical bill state reporting, pharmacy network services, field case management
services, telephonic case management services, utilization review services, nurse triage services,
and First Notice of Loss reporting services.
4. MMSEA/SCHIP Compliance Services. CCMSI, in conjunction with it reporting agent/MSP vendor,
will comply with applicable MMSEA and Section 111 reporting requirements on behalf of the
Client in exchange for payment of the applicable MMSEA/SCHIP fees stated in Exhibit A and
conditioned upon Client’s provision of an active Responsible Reporting Entity Number and
written authority for CCMSI to report data on Client’s behalf. The MMSEA/SCHIP Compliance
Services shall include:
(a) Querying of all qualifying claims to CMS for determination of Medicare eligibility on a
monthly basis;
(b) Collection of additional mandatory data regarding claims with verified Medicare eligibility;
and
(c) Reporting of all claims meeting CMS reporting guidelines.
C. CLIENT RESPONSIBILITIES. Client agrees to:
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1. Report all claims, incidents, reports or correspondence relating to potential claims in a timely
manner.
2. Reasonably cooperate in the disposition of all claims.
3. Claim Funding.
a. Provide Funds in a timely manner to pay all claims and expenses. If utilizing an escrow
account, provide Funds on a periodic basis as mutually agreed upon per the Quality Service
Plan, claim handling instructions, or similar document if applicable. Funds shall include those
required to pay all claims and expenses covered by insurance carriers or other parties. CCMSI
will work with Client to obtain timely reimbursement of such covered payments from
insurance carriers or other parties but will not advance any such amounts.
b. If utilizing an escrow account, provide Funds in an amount that maintains a Claim Deposit
equal to one and a half (1.5) times the average total of claim and expense payments for the
previous six (6) months, adjusted for funding frequency. The required Claim Deposit will be
monitored and adjusted as necessary per this calculation. The Claim Deposit is and shall
remain the property of the Client. CCMSI will return excess Funds to Client in a timely manner
upon recalculation of Claim Deposit or termination of the Agreement.
c. If utilizing an escrow account, provide advance funding (“Prefunding”) to pay all claim and
expense transactions in excess of a mutually agreed upon amount per the Quality Service
Plan, claim handling instructions, or similar document if applicable.
d. If utilizing an escrow account, provide all manner of Funds and Prefunding via Automated
Clearing House (ACH) Electronic Funds Transfer (ETF).
4. Respond to reasonable information requests in a timely manner.
5. Identify in writing all insurance carriers applicable to CCMSI’s claim handling responsibilities
contemplated in this Agreement that CCMSI will have claim or data reporting requirements. In
this regard, Client agrees to provide CCMSI with a complete copy of the current excess or other
insurance policies, including applicable endorsements and audits, applicable to Clients insurance
program and this Agreement. CCMSI assumes no responsibility of any kind for not reporting an
otherwise reportable claim to any carrier that Client has failed to disclose to CCMSI and/or
provide CCMSI with a copy of the applicable insurance policy and reporting instructions relative
to that carrier.
6. When applicable, obtain and provide CCMSI with an active Registered Reporting Entity (RRE)
number through the Centers of Medicare & Medicaid Services that CCMSI is explicitly authorized
to use for mandatory MMSEA Section 111 reporting. When applicable, client agrees to maintain
this RRE # by fulfilling CMS’s annual recertification process.
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7. Pay any fees or costs charged by any carrier or prior Administrator of Client for the conversion of
data associated with CCMSI handling run-off claims for Client, or for the general transfer of data
to CCMSI’s operating systems.
8. Promptly pay all fees to CCMSI as outlined in Exhibit A.
D. OPERATING EXPENSES. The Client agrees to be responsible for and pay all of its own operating
expenses other than service obligations of CCMSI. Such operating expenses shall include but not be
limited to charges for the following:
1. All costs associated with Client meeting its state security and licensing requirements;
2. Certified Public Accountants
3. Attorneys, other than provided for in Section B.1. (d) 3) and B.1. (d) 4) of this Agreement;
4. Outside consultants, actuarial services or studies and state audits;
5. Independent payroll audits;
6. Allocated Claims Expenses incurred pursuant to Section B. 1. (d) of this Agreement;
7. All applicable regulatory fees and taxes;
8. Educational and/or promotional material, industry-specific loss control material, customized
forms and/or stationery, supplies and extraordinary postage, such as bulk mailing, express mail
or messenger service.
9. National Council on Compensation Insurance, NCCI, charges;
10. Excess and other insurance premiums;
11. Costs associated with the development, record keeping and filing of fraud statistics and plans, but
only if required by any state or regulatory authority having jurisdiction over Client;
12. Other operating costs as normally incurred by the Client.
E. BOOKS AND RECORDS.
1. (a)CCMSI shall maintain all claim information relating specifically to the Client which is necessary to
the performance of CCMSI’s obligations under this Agreement (the “Records”). The Records and
implicated privileges shall remain at all times the sole property of the Client if self-insured or the
Client’s respective Carrier if subject to a deductible insurance policy.
(b)The Records shall not include any manuals, forms, files and reports, documents, customer lists,
rights to solicit renewals, computer records and tapes, financial and strategic data, or information
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which documents CCMSI’s processes, procedures and methods, or which CCMSI employs to
administer programs other than the Client. The items specified in this Paragraph E. 1. (b) shall at
all times be and remain the sole and exclusive property of CCMSI, and the Client shall not have
any ownership, interest, right to duplicate or right to utilize these items except for the above
documentation or information that relates solely to Client’s program.
2. During the term of this Agreement, CCMSI shall provide the Client with copies of the Records, if
so, requested by the Client. Any reasonable costs of reproduction of the Records shall be borne by
the Client.
3. CCMSI shall make the Records available for inspection by any duly authorized representative of
the Client, any governmental or regulatory authority having jurisdiction over CCMSI or the Client,
or pursuant to court order.
F. NON-SOLICITATION OF EMPLOYEES. During the term of the Agreement and for two (2) years
thereafter, the Client and CCMSI mutually agree not to recruit, solicit or hire any employee of the
other without written permission.
G. OTHER INSURANCE. If CCMSI places any specific or aggregate excess insurance, reinsurance, or other
insurance product associated with this Agreement, then customary commissions and fees will be
retained by CCMSI.
H. TERM AND TERMINATION.
1. Term of Agreement. The first term of this Agreement shall be for one (1) years beginning on May
1, 2026 and terminating on April 30, 2027. Unless the Agreement is terminated as set forth in
paragraph H. 2., it will automatically renew for a successive one (1) year term. At least ninety (90)
days prior to the expiration of each one (1) year term of this Agreement, the parties shall enter
into good-faith negotiations regarding any proposed change in Agreement terms or fees. If there
are no changes requested by either party, then the Agreement will automatically renew under the
same terms and fee arrangement as the prior term.
2. Termination of Agreement. This Agreement may be terminated:
(a) By mutual agreement of the parties hereto;
(b) Upon expiration of the current term of this Agreement if either party has given the other at
least ninety (90) days written notice of its intention to terminate as set forth in paragraph H.
1.;
(c) Upon dissolution of the Client’s self-insurance program whether voluntary or due to cessation
of Client’s authority to self-insure;
(d) Upon dissolution of the Client’s self-insurance program due to Client insolvency or
bankruptcy;
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(e) Upon ninety (90) days written notice by either party if the other party is in material breach of
any term, covenant or condition contained herein; provided, however, that as a condition
precedent to termination under this Section H. 2. (e), the terminating party shall give written
notice to the other party, who shall have sixty (60) days from the date of such notice to cure
or correct the grounds for termination. If the grounds of termination are not corrected or
cured during the sixty (60) day period, this Agreement may be terminated on the termination
date specified in the notice, but not prior to the expiration of the ninety (90) day period
described herein.
3. Services Following Termination of Agreement. In the event that CCMSI’s services are being
provided on a Life of Agreement basis and this Agreement is terminated or non-renewed for any
reason, CCMSI will cease providing services and turn over to the Client all Records in CCMSI’s
possession, which shall include all open and closed files.
Upon the Client’s request and subject to agreement by CCMSI, CCMSI will be paid a reasonable
negotiated fee to:
(a) Provide for continued administration of the open claim files;
(b) Cooperate with any successor Administrator in the orderly transfer of all functions, including
providing a runoff listing of open claim files if desired by the Client and any other records
reasonable and necessary for a successor administrator; and
(c) Provide an electronic transfer of data if such is feasible, with the cost of providing such borne
by the Client. The electronic transfer of data will be subject to a flat fee of $10,000.
I. SERVICE FEE PAYMENTS. The Client shall pay to CCMSI a service fee as outlined in the Fee and
Payment Schedule attached hereto as Exhibit A.
J. ARBITRATION. If an irreconcilable difference of opinion or claim should arise between the Client and
CCMSI as the interpreters of any matter relating to this Agreement, such matter will be submitted to
mediation and arbitration as the sole remedy available to both parties. Any such mediation or
arbitration will take place in the City of Chicago, Illinois and will be conducted in accordance with the
then-current rules of the American Arbitration Association.
K. RELATIONSHIP OF PARTIES. With respect to the services provided by CCMSI in this Agreement, CCMSI
is considered an independent contractor. Nothing in this Agreement shall be construed to create a
relationship of employer/employee, partners or joint ventures between the Client and CCMSI. This
Agreement is non-exclusive, and CCMSI shall have the right to perform services on behalf of other
individuals, firms, corporations and entities.
L. INDEMNIFICATION.
1. Indemnification by Client. The Client agrees that it will indemnify and hold harmless CCMSI and
CCMSI’s directors, officers, employees, agents, shareholders, subsidiaries and other affiliates from
and against any and all claims, losses, liability, costs, damages and reasonable attorney’s fees
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incurred by CCMSI as a result of breach of this Agreement by the Client, explicit instruction by the
Client, or alleged misconduct, error or omissions by the Client, or by any of the Client’s trustees,
directors, officers, employees, agents, shareholders, subsidiaries, or other affiliates in connection
with the performance of this Agreement. Agents as used herein include third party vendors
selected by Client.
2. Indemnification by CCMSI. CCMSI agrees that it will indemnify and hold harmless the Client and
the Client’s trustees, directors, officers, employees, agents, shareholders, subsidiaries, members,
or other affiliates from and against any and all claims, losses, liability, costs, damages and
reasonable attorney’s fees incurred by the Client as the result of breach of this Agreement by
CCMSI or alleged misconduct, error or omissions by CCMSI, or by any of CCMSI’s directors, officers,
employees, agents, shareholders, subsidiaries or other affiliates in connection with the
performance of this Agreement.
M. CHANGE IN CIRCUMSTANCES. In the event the adoption of any statute, rule or regulation materially
changes the nature of the relationship between the parties hereto or the legal or economic premises
upon which this Agreement is based, the parties hereto shall undertake good faith negotiations to
amend the terms of this Agreement to account for such changes in a reasonable manner. This
includes the happening or development of a local, regional, national or global health situation, crisis,
pandemic, or catastrophic event that would impact the volume and type of claims to be administered
by CCMSI under this Agreement. In the event of any such occurrence, either party may contact the
other in good faith and seek to amend the terms and / or service fees applicable to this Agreement.
N. SOFTWARE ACCESS. The Client may be provided with the right to use one or more CCMSI Applications
in connection with the services provided by CCMSI in this Agreement. CCMSI Applications include iCE,
MyReports, and Loss Control Resources. The right to use CCMSI Applications is non-exclusive, limited
to the term of this Agreement per paragraph H.1., non-transferable and is solely for the internal
business use of Client.
CCMSI owns and reserves all rights, title, and interest in and to the CCMSI Applications. Client has no
right to receive a copy of the object code or source code to the CCMSI Applications. Client may not
attempt to:
1. License, sell, lease or otherwise make the CCMSI Applications available to any other party. Client
will not provide any access, passwords or other information regarding the CCMSI Applications to
any third parties and/or competitors of CCMSI without the prior written consent of CCMSI;
2. Use the CCMSI Applications in any way that violates any law, regulation or mandate, or the term
of this Agreement; or
3. Take any action that jeopardizes confidential or proprietary information held by CCMSI.
Client is responsible for any confidential or proprietary information accessed or downloaded by Client
from the CCMSI Applications, including the implementation of appropriate information security
controls surrounding such information.
Except as expressly provided in this Agreement, CCMSI Applications are provided “as-is”. CCMSI
disclaims all other warranties, express, implied, or statutory, including the implied warranties or
merchantability, satisfactory quality, title, fitness for a particular purpose, non-infringement,
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compatibility, security, quiet enjoyment, or accuracy. Without limiting the foregoing, CCMSI does not
warrant that access to or use of the CCMSI Applications will be uninterrupted or error-free. CCMSI will
provide support for the CCMSI Applications in the two most recent two versions of the Internet
Explorer, Chrome, Firefox and Safari browsers.
O. MISCELLANEOUS.
1. Governing Law. This Agreement shall be governed by and construed in accordance with the
internal laws of the State of Illinois without regard to principles of conflicts of law.
2. Timing of Services. CCMSI may exercise its own reasonable judgment, within the parameters set
forth herein and in compliance with state regulations, as to the time and manner in which it
performs the services required hereunder. Additionally, CCMSI will be held to a standard of like
administrators performing like services for customers such as Client.
3. Successors in Interest. This Agreement shall be binding upon, and inure to the benefit of, the
successors in interest and permitted assigns of the parties hereto.
4. Severability. The invalidity or unenforceability of any particular provision of this Agreement shall
not affect the other provisions hereof, and this Agreement shall be construed in all respects as if
the invalid or unenforceable provision had been revised to the minimum extent necessary to make
it valid and fully enforceable under applicable law.
5. Paragraph Headings. All paragraph headings in this Agreement are for reference purposes only
and shall not affect in any way the meaning or interpretation of this Agreement.
6. Waiver. The failure of any party to enforce any provisions of this Agreement shall not constitute a
waiver by such party of any provision. A past waiver of a provision by either party shall not
constitute a course of conduct or a waiver in the future with respect to that same provision.
7. Notice Provision. All notices, requests and other communications required under this Agreement
shall be in writing and delivered by hand or mailed, registered or certified, return receipt
requested, postage paid, or sent via a nationally recognized overnight courier to the other party
at the following address:
Client: City of Evanston
909 Davis St
Evanston, IL. 60201
CCMSI: Cannon Cochran Management Services, Inc.
2 E. Main St.
Danville, IL 61832
Attn: Chief Financial Officer
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8. File Destruction Policy. CCMSI will maintain electronic claim file records or hard copy files (where
applicable) on behalf of Client for as long as necessary to protect the applicable statute of
limitations and in accordance with CCMSI’s Client Record Retention Policy.
9. Insurance. CCMSI will purchase and maintain insurance coverages for its performance of the
services contemplated in this Agreement. Minimum policy limits are as follows:
Workers Compensation – Statutory
Professional - $5,000,000
General Liability - $1,000,000 / $2,000,000
Umbrella - $5,000,000
Cyber Coverage - $5,000,000
10. Escheatment. CCMSI is responsible for complying with all applicable abandoned property or
escheat laws, making any required payments, and filing any required reports on CCMSI escrow
accounts.
11. Confidential Information. Confidential Information includes nonpublic information that is
exchanged between the Client and CCMSI, including, without limitation, information relating to
the business, financials, personnel, customer data and operating procedures. Confidential
Information includes information whether in written, electronic, or oral form created and relating
to services provided under the Agreement. All Confidential Information is proprietary. Client and
CCMSI may use the other party’s Confidential Information only for the purpose of this Agreement
and will limit its disclosure to only those persons or entities reasonably necessary to perform
under the Agreement.
12. Information Security. CCMSI is responsible for the protection of the confidentiality, availability,
privacy and integrity of Client information in our custody. CCMSI has implemented an Information
Security Policy that has been developed to comply with applicable federal and state laws or
regulations and industry best practices. The Information Security Policy applies to all CCMSI
personnel, including temporary employees, independent contractors and vendors with access to
CCMSI systems.
13. Entire Agreement/Amendment. This Agreement sets forth the full and final understanding of the
parties hereto with respect to the matters described herein and supersedes any and all prior
agreements and understandings between them, whether written or oral. This Agreement may be
amended only by written document executed by the Client and CCMSI.
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Executed this ____ day of ________________, 20__.
CANNON COCHRAN MANAGEMENT SERVICES, INC.
By:___________________________________________
John E. Kluth II
Its: Chief Financial Officer
CITY OF EVANSTON
By:___________________________________________
It’s:___________________________________________
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EXHIBIT A
FEE AND PAYMENT SCHEDULE
Service Agreement Term: 5/1/2026 – 4/30/2027
Services Fees
Claims Administration (minimum)
$97,500
CCMSI will manage all claims for the Life of Agreement for a fee as follows:
Claims will be analyzed by the number and type of claim on an ongoing basis
and priced on a per claim basis as outlined below.
Workers’ Compensation:
Indemnity Claims - $1,100 Per Claim
Medical Only Claims - $175 Per Claim
Complex/Enhanced Medical Only Claim Surcharge - $350 Per Claim
Incident Only - $41 Per Claim
Liability
Auto Liability Bodily Injury - $1,000 Per Claim
Auto Liability Property Damage – $515 Per Claim
Auto Collision/Comprehensive – $500 Per Claim
FPPC - $550 Per Claim
General Liability Bodily Injury - $1,000 Per Claim
General Liability Property Damage - $515 Per Claim
Error & Omission - $1,159 Per Claim
Professional Liability - $1,159 Per Claim
Annual Increases:
There will be a 3% fee increase to Claim Administration Fees per year. This
does not apply to the Complex/Enhanced medical only surcharge fee, Admin
fee or other annual fees.
Workers’ Compensation Claim Definitions
▪ Indemnity Claims – Claims involving lost-time, questionable
compensability, legal involvement/client attorney representation,
subrogation, second injury fund, probable permanent impairment,
jurisdictional issues, coverage issues and complex medical issues that are
assigned or transferred to indemnity adjusters for claims handling.
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▪ Medical Only Claims – Claims which have no issues of lost time, no
evidence of other indemnity benefit exposure, no obvious question of
compensability, no evidence of potential subrogation or second injury
recovery, no evidence of problematic medical issues and no requirement
or need for any formal statements (3-point or 2-point verbal contact is not
required).
▪ Complex/Enhanced Medical Only – Medical only claims that have 6 or
more paid medical transactions and total paid dollars greater than $2,500.
▪ Incident Only Claims – Reported claims which require only input into RMIS
system and requires no claims management activity.
Annual Administration Fee
• Dedicated client service team
• Development of specific client service requirements
• Monthly loss reporting
• Quarterly claim reviews at client’s request
• Issuance of 1099’s
• Assistance in filing all required state forms including state mandated
assessments.
o If Client has directed CCMSI to utilize a third-party vendor
selected by Client for the provision of services, then such
assistance will be the responsibility of the third-party vendor.
• Preparation for, compliance with and response to regulatory audits
• Account Management and Administration
$15,000
Subrogation Fee
20% of recovery with
a cap of $50,000 per
claim.
comp mc™ Managed Care Service Fees
Fee Schedule, Usual & Customary Re-pricing $10.00 per bill
PPO Network Access 33% of savings below
state fee schedule
Hospital/Specialty Review 33% of savings below
state fee schedule
Pharmacy Benefit Program 33% of savings
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Telephonic Case Management Market Rate
Utilization Review Market Rate
FNOL Reporting / Nurse Triage Market Rate
Medical Bill State Reporting (for applicable medical bills to reportable state) $1.50
Ancillary Fees
State Reporting / EDI Fees
Current - $15.00 per Initial Report, $10.00 per Subsequent Report
Market Rate
Index Bureau
Current - $20.00 per Index
Market Rate
MMSEA/SCHIP Compliance Fee
Current - $25.00 per Claim.
Market Rate
Annual RMIS Fees
Risk Management Information System (iCE) cost to include: 5 User ID’s (each
additional user is $200 per user per year). Internet access to claim files; the
ability to email your adjuster and Account Manager; access to our library of
template risk management reports together with initial training and ongoing
support.
$2,500
Annual OSHA Fees
Access to OSHA reporting module
$7,500
CLEAR Legal Bill Review Fees
Guarantee: If Legal Bill Review savings achieved for Client is less than the
2.2% total service fee incurred on an annual basis, the Client will be refunded
the difference between the service fee incurred and the amount actually
saved on invoices. Therefore, service fees will never exceed the savings
achieved for Client on an annual basis.
2.2% of billed legal
expenses
Other Fees
Custom Reporting
CCMSI will provide special reports (reports not currently programmed or
written) for a fee of $150 per hour for system programming time. CCMSI will
provide an estimate of charges before any work is done.
TBD
Data Feeds
TBD
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CCMSI will provide data feeds as requested by Client. CCMSI will provide an
estimate of one-time and ongoing charges before any work is done.
Carrier Fees
If applicable, Client will be responsible for payment of any carrier fees
associated with the transition of claim handling responsibilities to CCMSI.
TBD
Taxes
CCMSI fees will be increased by any applicable Sales, Gross Receipts, or
similar (excluding income) taxes imposed by Federal, State or Local bodies.
TBD
Billing Schedule
The quarterly installments of $30,625 will be due on the 1st day of May,
August, November, and February.
Any additional charges over the $97,500 minimum claim fee will be billed
quarterly thereafter.
$122,500
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