HomeMy WebLinkAbout112414_ra04JEFFERSON COUNTY
BOARD OF COUNTY COMMISSIONERS
AGENDA REQUEST
TO: Board of County Commissioners
Philip Morley, County Administrator
DATE: November 24, 2014
SUBJECT: Discussion and Possible Approval re: Participation in the Association
of Washington Cities Workers' Compensation Retrospective Rating
Program
STATEMENT OF ISSUE:
For several years Jefferson County has participated in the sponsored Washington State Association of
Counties (WSAC) Select Retro Pool and Workplace Safety Alliance. WAC 296 -17B regulates retrospective
rating for workers' compensation insurance. Retrospective rating (retro) is a voluntary financial incentive
program offered by the Department of Labor and Industries to encourage improvements in workplace safety.
Participating in retro creates an opportunity to earn refunds of required premium payments. However,
participation involves risk because additional premiums can be assessed when participants are not successful
in controlling losses. Employers control losses by preventing workplace illnesses and injuries, and helping
injured workers return to work. If a sponsored group receives a net assessment for two consecutive coverage
periods, the group is placed on probationary status. If a sponsored group receives a net assessment in the
following coverage period, that group will be denied future enrollment and the sponsoring organization will
not be allowed to sponsor another group in the same industry category for the five years following the third
coverage period with a net assessment.
Members of the WSAC Select Retro Pool and Workplace Safety Alliance meet annually to review the retro
plan and decide whether or not to reenroll in the program. In the past, the WSAC Retro group has received
refunds, as well as net assessments. However, in the last two consecutive coverage periods the WSAC Retro
group received net assessments and the group anticipates a third consecutive assessment. During the annual
WSAC Retro group meeting earlier this year is was decided that the group would not continue pooling. As a
result, WSAC terminated its contract with Sedgwick, which is the agency that provides retro pool services
and third -party L &I claims administration services to the member Counties participating in the WSAC Retro
group. The termination of the contract with Sedgwick is effective December 15, 2014 and Jefferson County
will no longer have third -party claims administration services through Sedgwick as of that date.
ANALYSIS:
WSAC has been working with the Association of Washington Cities (AWC) on a proposal for AWC to
provide retro program services to WSAC member counties. In September, a final proposal was agreed to by
both WSAC and AWC. AWC's Retro Program Manager Brian Bishop attended the Board's meeting on
November 10, 2014 and gave a presentation on AWC's services and pool.
RECOMMENDATION:
The Board is being asked to take action on executing the application for group membership and the
agreement for participation in AWC's Retro Program pool and L &I claims administration services, or to take
action in executing the agreement for participating in AWC's L&I claims administration services only.
RE E BY:
Plu ip Morley, C)unty Adm' istra Date
Department of Labor and Industries
Retrospective Rating Program
retro @Lni.wa.gov I w w.retro.lni.we.gw
to
AWC Retro
1076 Franklin Street SE
Olympia, WA 98501
Jefferson County
0
APPLICATION FOR GROUP
AND AUTHORIZATION FOR RELEASE OF INSURANCE DATA
Retro ID
122
UBI
161 001 169
Account ID
004,360 -00
Application Deadline
12/15/2014
Coverage Year Beginning
01 /01 /2015
If you have more than one L &I industrial insurance account you must enroll all sub accounts that are of a similar business
nature. You may elect to enroll all dissimilar businesses.
If you want to enroll dissimilar businesses, please check the sub account box. --► Z
If you have questions about this requirement please contact the business association listed above or L &I at (360) 902 -4851.
As a member of the sponsoring organization listed above, this employer applies for enrollment in the retrospective
rating group sponsored by the organization. L&I will notify the sponsoring organization of acceptance or denial of
your application to participate in the group. It is the responsibility of the sponsoring organization to notify you of this
acceptance or denial. As a pre- requisite of enrollment each of your industrial insurance accounts must be in good
standing at the time of enrollment or you will not be allowed to participate in retrospective rating.
By signing this application, the employer named above agrees with all of the following conditions:
• L &I will automatically re- enroll the employer as a member of the group in future coverage periods provided the
employer's industrial insurance account is in good standing at the time of re- enrollment. If the employer does not want to
participate in future coverage periods the employer or sponsoring organization must notify L &I in writing prior to the
beginning of the respective coverage period.
• The employer authorizes L &I to furnish the sponsoring organization or their designee with data and information obtained
from the employer's industrial insurance account(s).
• The sponsoring organization will represent the employer in all matters applicable to retrospective rating participation and
the employer's industrial insurance account(s).
• The employer agrees to comply with L &I rules, regulations and laws and is bound by the terms of the agreement between
the sponsoring organization and L &I.
• The employer will cooperate with L &I claims management activities and will participate in the sponsoring organization's
claims management and workplace safety initiatives.
• All retrospective rating adjustments that may be earned by the employer will be given to the sponsoring organization. L &I
is not involved in the distribution of a group refund to the individual group members except in the case of defunct group.
are in effect immediately and will remain in effect through the term of any agreement between the sponsoring
organization and L &I
NOTE: L &I disclaims any interest in any other contract you may enter into with the sponsoring organization as their pre-
requisite of your participation in the retrospective rating group that they sponsor, and L &I neither approves or disapproves of
any language or provision contained in these other contracts.
RETURN this application directly to the above organization.
DO NOT send this application directly to L &I.
Signature of an owner, partner or corporate officer of the employer named above is required to participate in
this retrospective rating group.
Type or print name
Title
Date
Owner, partner, corporate officer
Signature
Index: APM
F250- 016 -000 app for group membership and authorization for release of insurance data 04 -2012
Association of Washington Cities
WORKERS' COMPENSATION GROUP RETRO PROGRAM
PARTICIPATION AGREEMENT NON -CITY ENTITIES
Government Utilities & Related Services
As a member in good standing with the Association of Washington Cities
Member Name
Account Number
Enrolls by this agreement as a participating member in the Group Retrospective Rating Plan Agreement
submitted by AWC.
This contract agreement renews provided the member submits, and is approved by Labor & Industries, a valid
"Application For Group Membership And Authorization For Release Of Insurance Data" (L &I retro application
form).
Goals of the Plan:
A. Offer participants an opportunity to qualify for refunds on Standard Premium paid to the
Department of Labor & Industries
B. Reduce the frequency and severity of industrial injuries; and
C. Reduce participants' experience factor
2. Administration & Management of the Plan:
AWC will be responsible for the day -to -day operation of the Plan. Duties include, but are not limited to:
A. Assisting plan participants in reducing the frequency and severity of industrial injuries;
B. Educating plan participants in the most appropriate ways to control costs;
C. Claims Management Services;
D. Introduction and training materials;
E. Annual Retrospective Review; and
F. Administration of State Fund claims while enrolled in AWC Group Program.
G. Loss Control and Risk Management Services.
AWC Retro Advisory Committee
A committee consisting of no more than seven member cities/towns will be assembled to advise the
AWC Retro Plan Administrator on operational issues including contract terms, distribution of refunds,
program enhancements, conditions for continued participation and other issues. This committee shall
meet at least once per year to develop policy, review participants, adjust the contract terms or address
any other issues regarding the successful administration of the plan.
3. Member Agrees To:
A. During contract term, maintain an individual account for workers' compensation insurance in good
standing with the Department of Labor & Industries;
B. Comply with all applicable laws, rules and regulations set forth by L &I;
C. Participate in safety and loss control programs available as an AWC Retro Plan member;
D. Maintain membership in the Association of Washington Cities through the final retro year
adjustment;
E. Pay a Service Fee of seven percent (7.0 %) of total Industrial Insurance Premium, billed annually in
January.
F. If you do not pay your service fee as agreed the member will forfeit any refund.
4. Refunds /Adjustments:
A. It is understood and agreed by the employer that all refunds, exceeding Service Fees of seven
percent (7.0 %) of Industrial Insurance Premium, will be made on the basis of a merit rated formula
based on performance. However, should the Member's retro premium exceed their standard
premium, the member will not be eligible for a refund beyond their service fee. Plan participants
also acknowledge that returns are based on a number of factors, such as premium size, claim
costs, and related factors, therefore returns are not guaranteed.
B. Employers acknowledge that AWC is enrolled in a Premium Plan with a Maximum Loss Ratio
(MLR) of 0.9725. If a group assessment develops for any Plan Year, those members that caused
the assessment will be assessed first, up to a maximum liability of fifteen percent (17.5 %) of the
participating member's Standard Premium. If necessary to cover the assessment, the remaining
members shall pay the balance on the basis of their individual percentage of the total group
premium. Penalties become due and payable within 30 days of notification of the amount. If you do
NOT re- enroll in the program, any refund will be held until the final adjustment of that Retro year.
S. Indemnification /Liability:
Each party shall indemnify and hold harmless the other and its directors, officers, employees, agents,
parents, subsidiaries, successors and assigns from and against any and all liabilities, claims, suits,
actions, demands, settlements, losses, judgments, costs, damages, and expenses (including
reasonable attorney's fees) arising out of or resulting from, in whole or part, the acts or omissions of the
indemnifying party, its employees, agents or contractors and the indemnifying party's affiliated
companies and their employees, agents or contractors.
Authorized By:
(Signature)
(Printed Name)
(Title)
(Address/Street)
(Non -City Entity Applicant) (Date)