HomeMy WebLinkAbout036 11In the Matter of Updating the
Jefferson County
COUNTY OF JEFFERSON
STATE OF WASHINGTON
Risk Management Policy } RESOLUTION N0. 36 -11
WHEREAS, Jefferson County has the responsibility to its taxpayers and citizens to
assure that modern loss control practices are employed in the administration of the public
business; and
WHEREAS, there exists a need to update the established program for the processing,
handling and disposition of claims and claims lawsuits filed or brought against the County and/or
County officers and employees; and
WHEREAS, there exists a further need to provide a coordinated and economically
efficient means for dealing with the risks facing the County without expanding the County's
liability for claims or claims lawsuits.
NOW, THEREFORE, BE IT RESOLVED, that the Jefferson County Board of County
Commissioners hereby adopts the proposed, updated Risk Management Policy attached hereto as
Exhibit "A" along with the following forms: Claim for Damages, Instructions for Completing the
Jefferson County Claim for Damage Form; Vehicle Collision Form; and the Authorization for
Release of Protected Health Information (PHI) to Jefferson County Risk Management.
BE IT FURTHER RESOLVED that this Resolution and Policy repeals and replaces the
Risk Management Policy adopted with Resolution 85 -95 and any forms used for that policy.
q r. PROVED AND SIGNED this day of 2011.
On
Raina Randall,
Deputy Clerk of the Board
JEFFERSON COUNTY
BOARD OF COMMISSIONERS
Phil Johnson, Member
David Sullivan, /101m
Attachment "A"
Jefferson County Risk Management Policy
Section1.0 Objectives .................................................................................... ...............................
1
Section2.0 Purpose ......................................................................................... ...............................
2
2.1 Coordinated Program ........................................................................... ...............................
2
2.2 Bases of Liability ................................................................................. ...............................
2
Section3.0 Affected Parties ............................................................................ ...............................
2
Section4.0 References .................................................................................... ...............................
2
Section5.0 Definitions ................................................................................... ...............................
2
Section 6.0 Risk Management Program and Policies ..................................... ...............................
4
6.1 Risk Manager Appointment: ...............................................................................................
4
6.2 Risk Manager General Duties .............................................................. ...............................
4
6.3 Risk Management Committee (RMC) Duties ..................................... ...............................
6
6.4 Risk Management Committee Membership/Meetings ........................ ...............................
7
6.5 Claims - Filing - Investigation — .......................................................... ...............................
8
6.6 Claims Lawsuits — Service - Investigation — Disposition .................... ...............................
9
6.7 Self- Insurance Funds ......................................................................... ...............................
10
6.8 Duties of County Agencies, Officers and Employees ....................... ...............................
10
6.9 Defense of County Officers and Employees ...................................... ...............................
11
6.10 Safety and Loss Prevention ................................................................ ...............................
12
6.11 Program Purpose ................................................................................ ...............................
12
Section 1.0 Objectives
1.1 To protect the people, property, and finances of Jefferson County against issues of risk in a
cost effective and efficient manner.
1.2 The Legislative Authority recognizes the need to manage public funds wisely. The intent of
this policy is to proactively preserve and protect from losses the assets of County operations
in the most economical and efficient manner. Further, to provide a safe, secure, and
healthful working environment for County employees.
The risk management program must function within the financial abilities of the County
consistent with related legal requirements. This policy applies to all risks of accidental loss,
such as fire, liability, theft, property damage, malpractice, illness, and injury, both direct
and indirect, as relates to all County employees including elected officials, quasi - officials,
and documented volunteers.
The success of our risk, claims and safety management program is impacted by the sincere,
constant, and cooperative effort at all levels of management and the participation of all
county elected and appointed officials, employees, quasi - employees, and volunteers to fully
support the risk reduction efforts associated with this critical program.
Exposures to loss are either retained primarily through self - insurance or transferred through
purchased insurance or contractual transfer. Insurance funds are established and maintained
to pay pooling contributions /assessments, insurance premiums, bonds, deductibles, and
uninsured claims.
Jefferson County Risk Management Policy
Section 2.0 Purpose
2.1 Coordinated Program: The purpose of this policy is to provide a coordinated program for
processing, handling and disposition of claims and claims lawsuits filed or brought against
the County and/or its past and present officers, employees and quasi - employees.
It is also intended to establish a procedure for the County to defend and indemnify its past
and present officers, employees, or quasi- employees who, as the result of their good faith
performance of County business or activities, are the subject of complaints.
2.2 Bases of Liability: This chapter shall not be construed to expand the bases of County
liability for claims or claims lawsuits.
Section 3.0 Affected Parties
County departments, including elected or appointed department heads, employees, and quasi -
employees (e.g. Election workers, Jurors, Advisory Board members, volunteers) and quasi -
employees working under the direction of County personnel are subject to this policy.
Section 4.0 References
RCW 42.30 Washington State Open Public Meetings Act
Resolution No. 87 -86 — Indemnification and Tort Representation for County Employees
Resolution No. 81 -88 — Authorization to Join the Washington Counties Risk Pool
Resolution No. 85 -93 -- Jefferson County Loss Control Program and County -wide Safety Manual
Resolution No. 81 -96 — Establishing Procedures and Guidelines for the Development and Review
of Contracts
Resolution No. 42 -03 -- County Policy on the Complaint Review and Enforcement
Resolution No. 92 -03 — Jefferson County Personnel Administration Manual
Resolution No. 23 -07 -- Appointing the County's Representative Pursuant to the Bylaws of the
Washington Counties Risk Pool
Resolution No. 21 -08 — Designating members to serve on the Jefferson County Risk Management
Committee
Washington Counties Risk Pool Inter -local Agreement (dated August 18, 1988) and Adopted By-
Laws (as provided in RCW 39.34 and 48.62)
Section 5.0 Definitions
These terms shall mean the following for the purposes of this Risk Management Policy:
5.1 Claim: A formal demand for monetary compensation as a result of injury or damages
allegedly caused by the County, its officers, employees, or quasi- employees and does not
include claims that have been transformed into civil lawsuits filed and /or initiated in
District, Superior or U.S. District Court. (See also "Covered Claim ").
5.2 Claims lawsuit: A lawsuit alleging that the County and/or its officers, employees, or quasi -
employees while acting within the scope of their official duties, have caused injury or
damages to the plaintiff and the plaintiff is seeking redress.
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Jefferson County Risk Management Policy
5.3 Claims Coordinator: The employee of the County Administrator's Office that is
designated to handle and process the claims and claims lawsuits for the County at the
direction of the Risk Manager and to serve as the County's liaison with the Pool regarding
the administration of the County's claims. This person serves as the Secretary to the Risk
Management Committee. This person also manages and retains the records relating to Risk
Management including, but not limited to, serving as the repository of all insurance policies
and contract bonds in which the County is a named or additional insured.
5.4 County: Jefferson County, State of Washington.
5.5 County Safety Officer: A person designated by the Risk Manager to serve in the role of
"County Safety Officer" as required by the Washington Counties Risk Pool. The Safety
Officer shall work with the Safety Committees to consider all recommendations of the Pool
concerning the development and implementation of a loss control program to prevent
unsafe practices.
5.6 Covered Claim: Means a demand by a third party for monetary damages because of an
occurrence as defined in the applicable Joint Self Insurance Liability Policy (JSILP). (Refer
also to Item 5.1).
5.7 Defense: County indemnification and hold harmless for any County officer, employee or
quasi - employee against any allegation or request for relief made against a County officer,
employee or quasi - employee that seeks punitive damages against that County officer,
employee or quasi - employee and/or his or her marital community.
5.8 Joint Self Insurance Liability Policy (JSILP): The coverage document which defines
who is covered, the events that are covered and the extent of coverage for the named
insured.
5.9 Member: Jefferson County as a member of the Washington Counties Risk Pool.
5.10 Pool: Means the Washington Counties Risk Pool.
5.11 Protected Health Information (PHI): Individually identifiable health information which is
received by a municipality if a properly executed Authorization for Release of Medical
Records is obtained.
5.12 Quasi - Employee: A person acting on behalf of the county who may or may not receive
wages, with temporary rights and authority relevant to the situation as outlined by the quasi -
employee's description of duties or verbal instructions provided by the Departmental
Director, e.g., jurors, poll workers, advisory board members and volunteers.
5.13 Risk Management Committee (RMC): A County committee with specific purpose as
defined by these policies and procedures.
5.14 Risk Coordinator /Assistant Risk Manager: An employee of the County who is
designated by the Risk Manager and who has completed the required Risk Management
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Jefferson County Risk Management Policy
Certification classes provided by the Washington Counties Risk Pool. He /she shall also be a
member of the RMC.
5.15 Risk Management: A coordinated and continuous program for the identification, analysis,
control, prevention and financing of risk and exposures to loss, including, but not limited to
property and liability.
5.16 Risk Manager: The appointed County Administrator acts as the County Risk Manager and
is responsible for the County risk management function and serves as the formal contact
between the County and Pool (the County designee) as to risk management. The Risk
Manager is also a voting member of the County RMC.
5.17 Risk Pool: Means Washington Counties Risk Pool
5.18 Washington Counties Risk Pool (WCRP or Risk Pool): A joint local government entity,
known as the Washington Counties Risk Pool established under Chapters 48.62 and 39.34,
RCW to provide its member counties with joint programs and services including self -
insurance (see JSILP), purchasing of insurance, and contracting for or hiring of personnel to
provide administrative services, claims handling and risk management.
Section 6.0 Risk Management Program and Policies
6.1 Risk Manager Appointment: Pursuant to the By -laws of the Washington Counties Risk
Pool, the Board of County Commissioners has, through adoption of Resolution No. 23 -07,
appointed the County Administrator as the Risk Manager for Jefferson County.
6.2 Risk Manager General Duties: The Risk Manager is charged with directing, leading and
implementing actions intended to minimize the County's financial loss through the
identification, mitigation and/or transfer of risks. The Risk Manager shall:
6.2.1 Identification, Mitigation and Transfer of Risks: Identify, mitigate and transfer risks
that face the County and shall have authority to make recommendations to the
County Commissioners concerning insurance coverage or insuring options, self -
insurance, reserves, deductible levels, loss prevention, and other techniques, actions
or decisions for the sound management of risk.
6.2.2 Loss Prevention Program:
A) Be responsible for developing and implementing programs for the reduction
of risk and exposure to loss.
B) Assist all legal counsel with the defense of Claims Lawsuits against the
County and insure that County departments, divisions and agencies are also
assisting and cooperating in said defense.
6.2.3 Insurance Policies and Information: The County Commissioners/ County
Administrator's Office shall be the repository of all insurance policies and contract
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Jefferson County Risk Management Policy
bonds in which the County is a named insured. Such policies shall be maintained in
a current fashion and shall include all riders and endorsements.
A) Synopsis oflnsurance Policies: The Risk Manager shall prepare and
maintain a synopsis of each insurance policy carried by the County. Such
synopses shall, at a minimum, include: a description of coverage provided,
policy term, coverage limit, deductible, premium, and the carrier's agent.
B) Certificates oflnsurance: County departments are responsible for obtaining
and forwarding to the Claims Coordinator, a Certificate of Insurance from
any third party, where a third -party, e.g., a vendor for the County, is
contractually obligated to provide the County with proof of adequate
insurance (typically names the County as an "additional insured ") as a
precondition to performing services or providing goods to the County, or any
of its elected officials, agencies or divisions and any contract of insurance or
performance bonds in which the County is the named insured or a named
insured.
6.2.4 Risk Transfer /Contract Review:
A) Implement, maintain and update the uniform system of contract review and
monitoring of all County contracts, inter -local agreements and other agreements
as established in Resolution No. 81 -96 for risk transfer and indemnification.
B) The contracting authority of the County is the Board of County Commissioners
or Legislative Authority. No employee or agent can commit the County to a
legally binding contract without the express, written consent of the Board of
County Commissioners, nor can a County Elected Officer bind the County to
any contract which exceeds the budgetary authority authorized by the
Legislative Authority.
6.2.5 Records: Maintain, with the cooperation and assistance from the Prosecuting
Attorney's office, complete and accurate records as are required by the Risk Pool.
Satisfaction of the Risk Pool requirements may require retaining records with
respect to insurance, claims against the County, claims lawsuits filed against the
County, losses incurred by the County, all accidents or incidents giving rise to
possible liability against the County, and an inventory of all property in which the
County has an insurable interest. Such records shall be maintained in a fashion such
that statistical data can be readily extracted from the records. Maintenance of said
records by the Claims Coordinator shall satisfy the requirements of this section.
6.2.6 Claims and Claims Lawsuits: Have the duties and responsibilities with respect to
claims and claims lawsuits as specified in Sections 6.5 and 6.6
6.2.7 Extraordinary Investigations or Review: Be authorized to retain an outside
investigator or legal counsel (or such other person or persons having the skill or
expertise in the opinion of the Risk Manager necessary to perform the required
investigation) for preparation of a report or document regarding the County's
potential liability with respect to a Claim filed with the County.
A) Make the determination when an "Authorization for Release of Medical
Records" (aka PHI) is necessary during the course of an investigation and assure
that a Authorization is obtained.
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B) All investigations, whether internal or by an outside person or entity shall be
conducted in anticipation of litigation and treated as attorney work product
and/or, where applicable, a privileged attomey- client communication.
6.2.8 Confer and Consult with the Prosecuting Attorney's Office or "PAO ": The Risk
Manager and an attorney representative of the PAO, consistent with their training
and job responsibilities shall:
A) Confer with the Risk Pool as necessary to determine the legal counsel that
will defend the Claims Lawsuit brought against the County or its employees,
officials or representatives and to discuss the legal status of the County and
the defenses, if any, available to the County.
B) Review all contract forms utilized by the County to identify and reduce any
contractual liability being assumed by the County, and attempt to transfer
such liabilities.
C) Request and receive legal advice from the PAO.
D) Notify the appropriate County employees, representatives and officials of
changes in State /Federal statutes and common law which affect municipal
liability.
E) Provide assistance to the insurer(s) in the investigation and settlement of
claims against the County from both employees and the public.
F) Provide legal assistance in the examination of insurance and bond contracts
entered into by the County.
G) File and serve Notice's of Appearance if circumstances delay formal
assignment(s) of Pool- designated defense counsel.
6.2.9 Contact with the Washington Counties Risk Pool: The Risk Manager shall serve as
the formal contact between the County and the Washington Counties Risk Pool on
matters related to risk and loss control.
A) The Risk Manager shall meet the requirements and perform the duties as defined
as a participating County by the WCRP Membership Compact.
6.3 Risk Management Committee (RMC) Duties: The RMC shall be the primary mechanism
by which the County manages risk, including but not limited to, the review, disposition and
oversight of claims and claims lawsuits, assuring and implementing the County's
compliance with the terms and obligations imposed upon it pursuant to:
A) The Washington Counties Risk Pool Joint Self- Insurance Liability Policy and
B) Its membership in that Risk Pool.
The RMC may make periodic recommendations through the Risk Manager to the Board of
County Commissioners concerning insurance coverage, self - insurance, deductible, reserves,
loss prevention, and any other technique for the sound management of risk.
6.3.1 Claims and Claims Lawsuits: The RMC shall have those duties and responsibilities
with respect to claims and claims lawsuits as specified in Sections 6.5 and 6.6.
6.3.2 Appeals of Risk Pool Decisions: The RMC shall have authority to authorize the
Risk Manager or the Prosecuting Attorney's Office to file with the Risk Pool a
formal appeal of any correspondence from the Risk pool, including but not limited
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to, any correspondence denying coverage or providing coverage with a reservation
of rights.
6.3.3 Liability Assessment: The RMC with the assistance of the Prosecuting Attorney's
Office shall as needed and with reasonable promptness convey to the Risk Pool any
new information, records, testimony or other material that changes or may change
the potential liability of the County with respect to either a pending claim or pending
claims lawsuit.
6.4 Risk Management Committee Membership/Meetings: The RMC shall be composed of
the following members:
6.4.1 Voting Members: The RMC shall have five (5) voting members.
Risk Coordinator /Assistant Risk Manager, who shall Chair the RMC
Risk Manager
County Safety Officer
1 Elected Official other than a Commissioner
1 FLSA Exempt Employee as listed on the Exempt Wage Matrix (From a different
Department than the Elected Official serving on the Committee.)
Only appointed members will be counted to establish a quorum and vote. Alternates
or designees are not recognized for that purpose.
6.4.2 Non - Voting Members:
Legal Advisor to the RMC: The Prosecuting Attorney or a designated Civil Deputy
Prosecuting Attorney shall attend all meetings and be the legal adviser to the RMC.
Secretary of the RMC: The designated Claims Coordinator shall serve as the
Secretary to the RMC.
6.4.3 Meetings: The RMC is subject to the provisions of the Washington State Open
Public Meetings Act.
A) Regular Meetings: The RMC shall meet regularly at a time established by
the Secretary. In the event that there is no business to transact, a meeting
may be canceled by the Secretary by giving notice to the remaining members
and posting a notice on the door of the room where the meeting was to be
held.
B) Quorum: A quorum of the RMC shall be not less than 3/5`h of the number of
voting positions currently on the RMC, whether said positions are empty or
not. A majority of the quorum is needed to approve any action of or decision
by the RMC. A voting member shall abstain from voting on a claim being
reviewed that involves a Department or Division they manage, except that
this provision shall not bar the County Administrator from voting on a matter
relating to one of the departments having an appointed Department Head that
he or she supervises as the County Administrator.
C) Special Meetings: A special meeting may be called per RCW 42.30 by any
member. The Secretary shall give twenty -four (24) hours advance notice to
the remaining members and notify those newspapers that have a request for
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notification on file with the Secretary. Such notice shall specify the time,
place and purpose of the special meeting and the special meeting shall be
limited to discussion and action on the purpose of the meeting as stated in
the required notice.
D) Executive Session: In the event that the RMC is considering the disposition
of or strategies for a specific claim or claims lawsuit, it may adjourn to
executive session in a manner consistent with State law.
6.4.4 Records of the RMC: All records of the RMC will be maintained by the Secretary in
the County Administrator /County Commissioner's Offices.
A) Agendas and Minutes: The Secretary shall give notice of all the meetings of
the RMC as provided in the Open Public Meetings Act. The Secretary shall
prepare the agenda, record and keep the minutes of actions taken at all
meetings of the RMC, the notices given thereof, the names of those present
at the meetings and the proceedings.
B) Records: The Secretary shall keep, in the Commissioner's /County
Administrator's offices, the official RMC documents and records, including
the minutes of RMC meetings and a list of all RMC members, and shall, to
the extent needed, work with the attorney from the Prosecuting Attorney's
office assigned to the RMC on any correspondence required by the RMC and
shall have such other powers and duties as may be prescribed by the RMC.
C) Insurance Information: See Section 6.2.3.
6.5 Claims - Filing - Investigation — Disposition
6.5.1 Filing Claims: Claims must be filed with the Office of the Clerk of the Board of
County Commissioners. A claim form will be available upon request from that
Office.
6.5.2 Transmittal of Claims: Immediately upon receipt of a claim the Claims Coordinator
shall transmit a copy of the claim to the Risk Pool and to the Chief Civil Deputy
Prosecuting Attorney. The Claims Coordinator shall also coordinate with the Risk
Pool on who will investigate the claim. The County will comply with the mandated
procedure for notifying the Risk Pool of a new claim.
6.5.3 Duties of the Claims Coordinator: Upon receipt of a claim the Claims Coordinator
shall create a file, notify the Risk Manager and immediately give notice thereof to
any insurance carrier providing insurance which may cover the claim and provide
proof of such notice to the Risk Manager, the Risk Pool, and the Prosecuting
Attorney's Office.
6.5.4 Duties of the Risk Manager: An investigation shall be conducted into the merits of
the claim and a report of the investigation will be forwarded to the Claims
Coordinator. The investigation and adjustment of the claim may be contracted to an
outside person or entity at the discretion of the Risk Manager and the Risk Pool.
A) In an investigation done by the County, determine if Medical Records (aka
Protected Health Information) is needed and if so assure that "Authorization
for Release of Medical Records" is signed by the Claimant.
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6.5.5 Duties of the Risk Management Committee
A) The RMC shall not review the claim until an investigation or review is
complete and /or the Claims Coordinator has received a written report from
the agency, division or office of the County government where the allegedly
tortious or unlawful action or omission occurred (or failed to occur.)
B) The RMC shall make a recommendation on all claims to the Board of
County Commissioners.
1) The RMC is authorized to accept the Claims in whole or in part,
reject the Claim in whole or in part and /or take no action on the
claim.
2) The RMC is authorized to direct the Risk Manager to convey that
decision in writing to the claimant.
3) The RMC is also authorized to take any other step, including, but not
limited to, requesting more information from the claimant and/or
seeking further investigation (internal or external) it deems necessary
for effective resolution of the claim.
C) Effect of No Action Taken: If a claim received by the Claims Coordinator is
not accepted or denied, in whole or in part, within 60 days of the receipt of
same then said claim shall be deemed "Denied."
D) All decisions of the RMC to accept a claim, in whole or in part shall be
forwarded to the County Administrator as a recommendation of the RMC
with final authority to approve the expenditure of County funds resting with
the County Commissioners.
E) The County Administrator will coordinate claim evaluation with the Pool
including determining if the County has authority to settle a claim within its
deductible level. Regardless of delegation authority, the Pool will actively
monitor all claims.
6.6 Claims Lawsuits — Service - Investigation — Disposition
6.6.1 Service of Process: Service of process for claims lawsuits shall be made in a manner
consistent with State law.
6.6.2 Transmittal by the Auditor: Immediately upon receipt of a claims lawsuit, the
Auditor shall time and date stamp said claims lawsuit, state method of delivery, e.g.,
mail, in person or otherwise, and transmit a copy of same to the Clerk of the Board
of Commissioners (on behalf of the County Commission) and the Office of the
Prosecuting Attorney.
6.6.3 Duties of the Claims Coordinator: Upon receipt of a claims lawsuit, the Claims
Coordinator shall create a file therefore and shall notify the Washington Counties
Risk Pool.
6.6.4 Duties of the Prosecuting Attorney with Respect to Claims Lawsuits:
A) The responsibility for the litigation of claims lawsuits whose allegations are
such that there is no coverage under the Risk Pool's Joint Self- Insurance
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Liability Policy shall be with the Prosecuting Attorney, unless otherwise
decided by the BOCC upon the recommendation of the RMC.
B) The responsibility for the litigation of claims lawsuits whose allegations are
such that there is coverage provided by the Risk Pool's Joint Self - Insurance
Liability Policy shall be with the attorney assigned by the Risk Pool.
However, the Prosecuting Attorney's Office shall provide outside assigned
counsel assistance as needed and requested.
C) If necessary to protect the legal position or status of the County in the claims
lawsuit, the Prosecuting Attorney's Office may file pleadings, attend
hearings or otherwise participate in the claims lawsuit on behalf of the
County before the next meeting of the RMC.
D) The RMC and the County Commission shall be informed of the status of
claims lawsuit litigation periodically or upon the request of either the RMC
or the County Commission.
E) The office of the Prosecuting Attorney shall prepare each year and deliver to
the Auditor a list of the pending lawsuits against the County.
6.6.5 Duties of the Risk Management Committee: At its first meeting following receipt of
a claims lawsuit, the RMC shall review that claims lawsuit.
6.6.6 Disposition of Claims Lawsuits:
A) Claims lawsuits for which the Risk Pool has provided coverage shall be
disposed of by the Risk Pool and assigned counsel.
B) Claims lawsuits for which the Risk Pool does not or has not provided
coverage shall be disposed of in accordance with the decisions of the County
Commission.
6.7 Self- Insurance Funds: The County shall from time to time establish various funds to assist
in the implementation of this policy. Such funds may be dedicated to and used for only
those purposes as may be set forth in the resolutions establishing them.
6.7.1 The County will maintain a fund known as the `Risk Management Reserve" Fund
for payment of claims, deductible amounts and costs incurred. The County will
work with WCRP when it establishes reserves for pertinent third party liability
claims. WCRP will calculate reserves to address the extent of the exposure for
indemnity and defense costs.
6.7.2 When the County has or acquires knowledge regarding liability or damages that will
affect the claim reserve determination, that information shall be conveyed promptly
to the WCRP. The County may appeal any claim reserve determination utilizing the
procedures established by the WCRP.
6.8 Duties of County Agencies, Officers and Employees:
6.8.1 Cooperation: All County officers, employees and quasi - employees shall cooperate
to the fullest extent with the Risk Manager, RMC, the Prosecuting Attorney, and
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assigned outside counsel in defending claims, actions or lawsuits against the County
and investigations by an outside agency on behalf of the County. They shall:
A) Assist with Information: Providing information that will assist in the
implementation and/or operation of the Risk Management program.
B) Help implement the Risk Management Program. Issuing directives to
subordinate officers, employees or quasi - employees necessary to implement
the Risk Management program.
C) Report Accidents and Incidents: County officers and employees shall
immediately report to the County Administrator any accident or incident
which a reasonable person would expect to result in the eventual filing of a
claim or suit. Known traffic collisions and incidents involving County
officials, employees, quasi- employees, volunteers, invitees, automobiles or
property which could or do subject the County to claims for damages should
be reported immediately to the County Administrator. Statements shall not
be made to, or in the presence of, third parties or witnesses to the traffic
collision or incident. "Fault" shall not be acknowledged. "Fault" is a legal
determination that will be made within the appropriate legal forum.
D) Provide Fullest Assistance: Provide information, testimony, exhibits and
documents in a timely manner in preparation for the County's defense in
litigation or investigations by outside agencies. In response to notification by
the Prosecuting Attorney, designate a department representative to assist the
Prosecuting Attorney during discovery and, preparations for trial in claims
lawsuits.
E) Obtain Certificates of Insurance: County departments are responsible for
obtaining and forwarding to the Claims Coordinator, a Certificate of
Insurance from any third party, where a third -party, e.g., a vendor for the
County, is contractually obligated to provide the County with proof of
adequate insurance (typically names the County as an "additional insured ")
as a precondition to performing services or providing goods to the County,
or any of its elected officials, agencies or divisions and any contract of
insurance or performance bonds in which the County is the named insured or
a named insured.
6.8.2 Prohibited Acts: Shall not do any of the following without the prior authorization of
the Risk Manager, Prosecuting Attorney or assigned outside legal counsel:
A) Encourage the filing of a claim or claims lawsuit against the County
B) Attempt to settle a claim, or claims lawsuit or interfere in any way with an
investigation of an employee who is being defended by the County by a
professional oversight or regulatory entity
C) Make an admission of liability involving a claim or a claims lawsuit or a
complaint to any person or entity; or
D) Discuss incidents that have led to or could lead to claims, lawsuits or
complaints against the County with persons who are not employed by the
County.
6.9 Defense of County Officers and Employees: County officers, employees and quasi -
employees may request of the County a "Defense" (as defined in this policy) in order that
past and present County officers, employees and quasi - employees may act in good faith
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with the course of employment on the County's behalf without fear of personal liability. In
accordance with RCW 4.96.041, as that law may thereafter be amended, the County is
authorized to pay punitive damages assessed against a County officer, employee, or quasi -
employee pursuant to the process established in this policy.
6.9.1 Alternative Protection: Portions of this section provide a means of protection for
County officers, employees and quasi - employees that are in addition to the coverage
provided to the County by its membership in the Washington Counties Risk Pool.
6.9.2 Application for Defense: After receipt of a Summons and Complaint, a past or
present County officer, employee or quasi - employee who desires that the County
provide a Defense, as that term is defined in this Chapter, shall immediately make
an application for defense to his or her direct supervisor, who shall pass the request
along to the Risk Manager so that it may be brought to the attention of the County
Commissioners.
6.9.3 Duties of the Risk Manager: Upon receipt of an application for a Defense and if
requested to do so by the County Commissioners, the Risk Manager, shall review
the application for a Defense immediately. The Risk Manager shall investigate the
allegations of the Claims lawsuit. If the Risk Manager determines that a lawsuit or
complaint was the result of the officer, employee or quasi- employee's good faith
performance of the County's lawful business, then the Risk Manager shall
recommend to the County Commissioners that they adopt a resolution pursuant to
State law memorializing the Commissioner's decision to provide such a Defense.
6.9.4 Establishment of Good Faith: If the County Commissioners determine the suit,
complaint or investigation relates to the officer, employee or quasi - employee's good
faith performance of the County's lawful business, then the County will provide the
Defense and/or pay a judgment, sanction or settlement.
6.10 Safety and Loss Prevention: Safety and Loss Prevention Policies and Procedures shall be
maintained by the designated County Safety Officer. The County has designed and manages
a safety and loss prevention program with the cooperation of all County Officials and
Safety Committee representatives.
6.10.1 Records of all mandated training shall be maintained in the Office of the Clerk of
the Board and approved by the Human Resource Manager.
6.10.2 Policies and procedures will be reviewed and updated to ensure compliance.
6.10.3 County Officials shall post all required safety related literature.
6.11 Safety Program Purpose: The purpose of the safety program is to reduce accidents
causing injuries to County employees and the public, and to reduce the frequency and
severity of all property losses.
Page 12 of 13
Jefferson County Risk Management Policy
6.11.1 The County will make full use of the expert services of the Pool, insurers, brokers,
and departmental safety personnel whenever possible to develop better safety and
loss prevention procedures.
6.11.2 The County's program shall comply with Washington State Labor and Industries
regulations and shall include but is not limited to:
A) Periodic inspection of facilities.
B) Investigation into the causes of accidents and property losses.
C) Development of safety training programs for employees.
D) Communicating safety literature to all departments.
6.12 All accidents and losses shall be reported promptly to the Risk Manager and in accordance
with prescribed procedures.
6.13 The County Safety Policy designates the position that will serve as Safety Officer.
Page 13 of 13
Claim #:
JEFFERSON COUNTY
Claim for Damages
This Claim Form is provided solely as an accommodation to claimants, and the County makes no representations as to
its legal sufficiency. Responsibility for complying with all requirements of State law regarding claims rests with the
claimant. No County Employee is authorized to advise a claimant in completing this form or reviewing its sufficiency.
The County expressly disclaims responsibility for any such advice or review. Information requested on this form may be
subject to public disclosure. This claims form must be Presented with an original signature and cannot be submitted
electronically (by e-mail or fax.)
PLEASE TYPE OR PRINT IN INK
RISK MANAGER
JEFFERSON COUNTY COURTHOUSE Business Hours:
Mail or Deliver SON STREET Mon. -Fri. 8:30 a.m. to 4:30 p.m.
1820 JEFFERSON Original claim to: 18 BOX FER Closed on weekends and officials
PORT TOWNSEND, WA 98368 State and Federal Holidays
CLAIMANT INFORMATION
1, AS THE CLAIMANT, HEREIN BELIEVE THE CONTENTS OF THIS CLAIM TO BE
TRUE. I HEREBY PRESENT A CLAIM FOR DAMAGES AGAINST JEFFERSON
COUNTY, WASHINGTON, BASED UPON THE FOLLOWING INFORMATION AS
REQUIRED BY RCW 4.96.020 AND 36.45.010:
If more space is needed to answer any items, attach additional sheet and specify the item number.
My name, address and phone number at the time of presenting and filina this claim is:
1) Name
2) Physical Residence Address:
3) Mailing Address (if different than residence):
4) Daytime Phone Numbers:
of Birth:
(mm /dd/yy)
5) Physical Residential address for six (6) months immediately prior to the date of the incident (if different from current
address):
6) Your e-mail address:
INCIDENT INFORMATION
7) Date Incident Occurred:
mm
Time:
Q11
AM.
Pit
or P.M.
8) If the incident occurred over a period of time, date of first and last occurrences:
FROM: Time: Q
❑;
TO: Time:
m�
n11
Q"
A.M. or
„„
P.M. �
AM.
or P.M.
9) Location of incident:
(State B CWMY)
(City, d ePooaue)
((Rare where acccum3tl)
10) If the incident occurred on a street or highway:
(Name of sft a gt Wx
(Milepost)
a
11) The nature of the damages or injury I sustained are:
12) Jefferson County Department(s) or employee(s) allegedly responsible for damagetiinjury:
13) Name(s) address, and telephone number(s) of all persons involved in, or witness to, this incident:
14) Name(s), address, and telephone number(s) of all Jefferson County department(s) or employee(s) having
knowledge of this incident:
15) Name(s), address, and telephone number(s) of all individuals not already identified in (12) and (13) above that have
knowledge regarding the liability issues involved in this incident, or knowledge of the claimant's resulting damages.
Please include a brief description as to the nature and extent of each person's knowledge.
16) Describe the cause of the damages or injury. Explain the extent of property loss or medical expenses.
17) Has the incident been reported to law enforcement, safety or security personnel? If so, when was it reported and to
whom ?:
18) Provide name(s) addresses, and telephone number(s) of treating medical providers. Attach copies of all medical
reports and billings:
19) Please attach all documents which support your claim:
20) 1 claim damages from Jeffrson County in the sum of $
The amount of damages sustained must be itemized
21) If you are injured, are you a Medicare beneficiary?
Yes No
If Yes, please provide your Medicare #
22) The name of my insurance agency is:
23) If your claim involves a motor vehicle accident, complete, sign and include the attached vehicle collision form. Two
(2) estimates of the cost of repairs must be attached to this claim with the amount of damages sustained itemized.
24) If you are presenting a personal injury claim, complete, sign and include the attached Medical Release form
This claim form must be signed by the Claimant, a person holding a written power of attorney from the Claimant to serve
as the attorney in fact for the Claimant, by an attorney admitted to practice in Washington State on the Claimants
behalf, or by a court- approved guardian or Guardian Ad litem on behalf of the Claimant.
I declare, under penalty of perjury under the laws of the State of Washington, that the foregoing is true and
correct.
Mate Plata (msdentlal add.)
a canpa )
INSTRUCTIONS FOR COMPLETING
The JEFFERSON COUNTY CLAIM FOR DAMAGE FORM
Before presenting a Jefferson County Claim for Damages Form please read these
instructions and the Claim for Damages Form in its entirety.
Type or print clearly in ink and sign the Claim for Damages Form. The Jefferson County
Claim for Damages Form must be signed by:
Claimant; or
Person holding a written power of attorney from the Claimant; or
Attorney in fact for the Claimant; or
Attorney admitted to practice in Washington State on the Claimant's behalf; or
A court- approved guardian or guardian ad litem on behalf of the Claimant
Provide all requested information and any available documents or evidence supporting
your claim, such as medical records or bills for personal injuries, photographs, proof of
ownership for property damages, receipts for property value, etc.
If the requested information cannot be supplied in the space provided, please use
additional blank sheets so your claim can be easily understood.
The following are examples on how to complete the numbered items on the Claim for Damage form:
1) Smith, John Conner, 12/01/1910
2) 222 One Way Street, Apt. Z, Port Townsend, WA 98368
3) Post Office Box 101, Quilcene, WA 98376
4) 360 - 123 -4567 360- 123 -4567 360- 123-4567
5) 222 One Way Street, Apt. Z, Port Townsend, WA 99201
6) claimantl @comcast.net
7) 01/01/2009, 8:00 a.m.
8) From: October 31, 2009 8:00 p.m. To: November 2, 20097:00 a.m.
9) Washington, Jefferson; Chimacum County maintained road.
10) Center Road northbound, milepost 4.0 Egg & I Road
11) Please describe the incident that resulted in the injury, or damages, specifically answering the
questions who, what, where, when and why.
12) Jefferson County Roads Department
Smith, Jenny, 222 One Way Street, Apt. Z, Port Townsend, WA 98368, (360)123 -4567, riding
13) in the car at the time of the incident; Fitzgerald. Who sits, 3287 Wonderful Lane, Brinnon, WA
98331, (360)111 -1111; witnessed the incident.
14) List address and telephone numbers of all County Departments and employees having
knowledge about this incident.
List all other witnesses having knowledge of the incident in question, with their names,
addresses, and telephone numbers that are not listed within items (12) and (13). Also include
15) a description of their knowledge. For example, if your sister was with you, when the alleged
incident occurred, please include her name, address, and telephone number, and indicate
she witnessed the incident.
Instructions for Completing Jefferson County Claim for Damages Form
16) Describe how the damages or injury was caused.
If you reported this incident to law enforcement, safety or security personnel, please provide
17) the name of the person you spoke with, and the date and time you spoke to them and include
a copy of the report or contact information for the person with whom you spoke.
Please provide a list of all your medical providers, including their names, address, telephone
18) numbers, and the type of treatment. Please attach copies of all medical records and billings if
you were treated for a personal injury under this claim.
19) Attach documents which support the claim's allegations.
20) Please provide the dollar amount for your damages, including your time loss, medical costs,
property damage loss, etc. This amount should represent your opinion of total damages.
21) If you were injured, please indicate if you are Medicare eligible and provide your Medicare
number. If you are presenting a personal injury claim, submit the Medical Release form.
22) Please provide the name of the company that provides you insurance for this type of claim.
23) If your claim involves vehicle accident, submit the Vehicle Collision Form
Page 2 of 2 - Claim Form Instructions
VESICLE COLLISION FORM
PLEASE TYPE OR PRINT IN INK
Please attach this form to your standard tort claim form, if the claim involves a vehicle collision.
SP 132 poly 2009)
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COMPLETE ALL DETAILS
Describe conduct and circumstances causing injury or damages and ocplain the extent of medical, physical or mental injuries. Please
identify name, address, and telephone number of treating physicians and other medical providers. Please attach property damage
estimates and/or all medical bills in support of your claim. If necessary, attach additional pages containing information in this format.
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A se aaeate claim form should be submitted for each claimant.
This information is being provided to aid in resolving the claim.
I dedm underpenaby ofperjw under the km OtheSWe of WashhW= OW the foregoing is true and corrcet
Siv apw oftTrrlmartt Date and Place liresfdenad ad*=, c1V and county)
Name:
AUTHORIZATION to Release of Medical Records
Last, First, Middle Initial or Middle Name
Date of Birth: Month
Name of facility or provider:
Address:
Street Address
Day
INFORMATION TO BE RELEASED FROM
Zip Code
INFORMATION TO BE SENT TO
To the Provider or Records Custodian: Please send legible copies of all records to:
County Administrator, Jefferson County Risk Manager
C/O County Administrator's Office
PO Box 1220
Port Townsend, WA 98368
Please mark "Confidential: Personal Health Information" on outside of envelope.
INFORMATION TO BE RELEASED (check one)
I hereby authorize disclosure of my protected health information to Jefferson County for the purpose of
investigating my claim for damages. I understand that by signing this document, I authorize the release of
the following information:
The most recent 2 years of pertinent information (chart notes, labs, x -rays and special tests)
All medical records
_ Specific information (please
I understand the purpose for which this disclosure is being made is a Claim I filed with
Jefferson County. I also understand the following: (Please Read and Initial all Statements)
I understand that my records are protected under HIPAA/PHI regulations (federal law) and the
Washington State Health Care Information Act (RCW 70.02).
1 understand that my health information may be subject to re- disclosure by Jefferson County and not
protected for purposes of evaluating and investigation of the claim I have filed with Jefferson County.
I understand that the specific information to be disclosed in my medical record may include information
regarding alcohol, drug or other controlled substance use, counseling referrals and /or a history of testing or
treatment of acquired immune deficiency syndrome.
I understand that I may revoke this authorization at any time by notifying Jefferson County in writing, and
that revocation will be effective as of the date Jefferson County receives it. Any records obtained pursuant
to this Authorization for Release of PHI prior to the revocation will be deemed authorized by me for release
and use by Jefferson County.
I understand that this Authorization for Release will expire 90 days from the date signed or on
(date) for the release to be valid.
Authorization to Release Medical Records to Jefferson County Risk Management
A Photostat of this Authorization carries the same authority as the original for purposes of releasing my records to
Jefferson County.
PATIENT AUTHORIZATION
I understand that my records may contain information regarding the diagnosis or treatment of HIV /AIDS,
sexually transmitted diseases, drug and /or alcohol abuse, mental illness, or psychiatric treatment. I give
my specific authorization for these records to be released.
EXCLUDE the following information from the records released (please initial)
Drug /Alcohol abuse/treatment & diagnosis
Sexually transmitted disease
HIV /AIDS diagnosis /treatment/testing
Mental illness or psychiatric diagnosis /treatment
MY RIGHTS
I understand I do not have to sign this authorization. I may revoke this authorization in writing. The
process for revoking this authorization is listed above. I understand that once the health
information I have authorized to be disclosed reaches the noted recipient, that person or
organization may re- disclose it, at which time it may no longer be protected under Privacy laws.
Signature:
(Patient, Guardian *, or Authorized representative *)
Date of Signature:
Where the signer is not the subject of the records:
I am authorized to siqn this because I am the (Check
Other — Explain
Telephone number
Page 2 of 2
JEFFERSON COUNTY BOARD OF COMMISSIONERS
Consent Agenda. Item
FOR THE WEEK OF: August 15. 2011
I. Description — A brief description of the agenda item.
Updating the Jefferson County Risk Management Policy
II. Issues — A short outline of the major issues or areas that should be given
particular attention.
The Risk Management Policy is a document that identifies how claims against the County will
be received, and processed The Washington Counties Risk Pool that provides the County's
insurance, developed a "model" risk management policy for its' member counties to consider
and this update reflects the policy and procedures proposed by the Risk Pool.
The intent of this policy is to pro - actively preserve and protect from losses the assets of County
operations in the most economical and efficient manner while at the same time provide a safe,
secure, and healthful working environment for County employees. The risk management
program must function within the financial abilities of the County consistent with related legal
requirements.
This policy applies to all risks of accidental loss, such as fire, liability, theft, property damage,
malpractice, illness, and injury, both direct and indirect, as relates to all County employees
including elected officials, quasi - officials, and documented volunteers.
After being review by the Board and pulled from the agenda on July 25, 2011 the policy and the
Authorization form were updated as follows:
Policy - Section 5.11 now includes a definition of Protected Health Information
- Section 6.23A says that the Risk Manager makes the determination when the
"Authorization for Medical Records" is necessary
- Section 6.5.4A says that the Risk Manager will determine if Medical Records are needed
and assure that an Authorization to Release is obtained.
Form - The name of the form was changed to "Authorization and Release of Medical Records"
to clarify to the Claimant what is being requested. The form also allows the Claimant to
Exclude specific types of records and advises them that they do not have to sign the
Authorization and that if they do it expires in 90 days or it can be revoked in writing.
III. Action — What is the nature of the action the Board is being asked to take
(discussion, approval of a contract, support for a grant, etc.).
Adopt this updated Policy for risk management.
Reviewed By-
Date