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HomeMy WebLinkAboutHamid Mir, MD - 2021-04-01 PROFEMONAL SERVICES CON'I IZAC'1' Hl."1'P-EI?ly THE-', CITY OF I-IUN"l'1NCl'1'ON 31 ACl-I AND H 4m i-d—mi c D FOR INDEPENDBN'f MEDICAL EVALUATIONS WITI-I RESPL?CT I'O WORKBRS' COMPENSATION CLAIMS THIS AGR$IiMI N'I'("Agreement") is We and entered into by and Moen the City of Huntington Beach, a municipal corporation of the State of California, hereinafter referred to as "CITY," and uo1`duaL hereinafter referred to as"PHYSICIAN." WIIERI:AS, CITY desires to engage the services of a physician to provide independent medical cvaivations with respect to workers' compensation claims; and Pursuant, to documentation on Hie in the office of the City Clerk, the provisions of th:: Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional smvicc contracts have been complied with; and PHYSICIAN has been selected to perfornh said scI'viees, NOW, 'fHLKBPORE, it is agreed by CITY and PI-IYSiCIAN as follows: I. SCOPE OF SERVICE'S PHYSICIAN shall provide all services as described in Kxldbit "A," which is allached hereto end incerpo!ated into this Agreement by this reference. These services shall sometimes hereinafer be referred to as the "PROIEC I'." PI IYSICIAN (hereby designates �_ — who shall represent it and be its sole contact and ngenl in all consultations with CITY during the performance of this j i Agreement. APPROVED AS TO FORM MIC Dy r,ICHAEL E.GATES t CITY ATTORNEY 10318WIMB•"Stnndard Contract - Revised I CITY OF HUNTINGTON©EACH i 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with PI-IYSICIAN in the performance of this Agreement. 3, TRAE OF PERFORMANCE Time is of the essence of this Agreement. The services of 111-IYSICIAN are to commence on _��ri-1_� � � (the "Commmmement Data. 'fibs Agreement shall automatically renew three (3) years from the Commeneconent Date, unless terminated as provided herein. The time for peNnElmtce of the tasks identified in Exhibit ".A" are generally to be shown in Exhibit "A." This schedule may be amended to benefit tho PROIECI' if nrtdually ngreed to in writing by CITY fund PHYSICIAN. In the event me Conunencement Date precedes the Effective bate, PHYSICIAN shall be bound by all terms end conditions as provided herein. 4. CO3MPF.NSA"1'I0N In consideration of the performance of the services deseribed herein, CPI'Y agrees to pay PHYSICIAN, on a time and materials basis at the rates speeified in Exhibit "13 " attached hereto and incorporated by reference into (his Agreement, n fee, including all costs and expenses, not w exceed Twenty-nine Thousand Ninc:hunched Dohms ($0900 00). 5, EXTRA VIORK in the event CITY requires additional services not included ill Exhibit "A" or changes in the scope ofserSes described in Exhibit "A," PHYSICIAN will undertake such work only after receiving written authorization from CITY. Additional compensation for such extra work shall be allowed only H the prior written approval of CITY is obtained. 12-3 t87nrnr•, Standard Contract - Revkccl 2 G. METHOD OF PAYMENT PHYSICIAN shnII be paid pursuant to the terms of Exhibit "IW' 7. DISPOSITION Oh PLANS ESTIMATES AND OTHF'R DOCUMENTS PHYSICIAN agrees that title to all materials prepared hereunder, including, but not limited to: all original drawings, designs, reports, both field and office notices, cnlc11111110118. computer code, language, data or programs, maps, niemoramda, letters and other documents, shall belong to CITY, and PHYSICIAN shall turn these materials over to CITY upon temlinatiom of this Agreement or upon PROJECT comlpletion, whichever sbalt o:cur filsl. These materiats may be used by CI7 Y as it secs fit. 8. 11O1,1) 1IARMLESS PHYSICIAN hereby agrees to protect,defend, indemnify and hold haimicss CITY, its officers, elected or appointed officials, employees, agents anti volunteers from and against any and all claims,damages, losses,expenses,judgm.cnts,demands and defense costs(including without limitation, costs and fees of litigation of eery mature or liability of any kind or nature) arising out of or in connection with 11HYSICIAN's (or PHYSIC1AN's subeontraelors, if any) negligent (or alleged negligent) performance of this Agreement or its failure to comply with any of its obligations contained in this Agreement by 11HYSIC1AN, its officers, agents or cnyllovccs except such loss or damage which was caused by the sole negligence or willful misconduct of CITY. PHYSICIAN will conduct all defense at its sole cost and expense and CITY shall approve selection of PHYSICIAN's counsel. This indemnity shall apply to all claims and liability regardless of wheiller ally insurance policies tire applicable. The policy limits do not wm as limitation upon the anlountol'indenutificatiom to be provided by PHYSICIAN. 12-3187/1M8 Sttuldard C.011traet - Rcviscd 3 i 9, PROFESSIONAL LIABILITY INSURt1NCG PHYSICIAN shall obtain and furnish to CITY a professional liability insurance policy covering the work performed by it hercuuder. This policy shall provide coverage for i PHYSICIAN's professional liability in en amount not less than One Million Dollars i (31,000,000.00) per occurrence and in the aggregate. The above-mentioned insurance shall not contain a self-insured retention without the express written consent of CITY; however tun insurance policy "deductible" of Ten Thousand DoHms QI0,000.00) at less is permitted. A claims-made Policy shall be acceptable if the policy ftnther provides that: A. "I'hc policy retroactive date coincides with or precedes Hie initiation of the scope of work (including subsequent policies purchased as renewals or replacements). D. PHYSICIAN shall notify CITY of circumstances or incidems that miglil give rise to future claims. PHYSICIAN will make every effort to maintain similar insurance during the required extended period of cevefage following PROJECT completion. If insurance is terminated for any reason, PHYSICIAN agrees to purchase al extended reporting provision of at [cast two (2) years to repot( claims arising from work performed in connection with Ibis Agreement, If PHYSICIAN faits or refuses to produce or nithnWin the insurance required by this section or fails or refuses to furnish the CITY with required proof that insurance has been pm ured and A in force and paid for, the CITY slutll have the right, at the C:ITY's election, to forthwith terminate this Agreement, Such termination shall not affect PHYSICIAN's fight to be paid Pot its time and materials expended prior to notification of termination. PIIYSiCIAN waives 153I RWIME Standard Contract - Revised 4 the right to receive compensation and agrees to indemnify file CITY for any work performed prior to approval of insurance by the CITY. 10. CLRTIFICATSS OF INSURANCE: i Prior to commencing performance of the worst hereunder, PHYSICIAN shall furnish to CITY certi(icafes of insurance subject to approval of(he Ci!y Attorney evidencing the foregoing insurance coverage as required by this Agreement; the ecif ficalc shall: A. provide the name and policy number ofcach carricrand policy; IT state that the policy is currently in force; and C. promise that such policy AT not be suspended, voided or canceled by either party, reduced in coverage or in limits except after thirty (30) days' prior written notice; however, ten(10)days' prior written notice ill the event of cancellation for nonpayment of premium. PHYSICIAN shall maintain the foregoing insurance coverage in force until the work onder this Agreement is fully completed and accepted by CITY. Ile requirement for carrying the foregoing insurance coverage shall not derogate from PHYSICIAN's defense, hold harmless and indemnification obligations as set forth in this Agreement. CITY or its represeutntive shall at all limes have the right to demand the original or a copy of the policy of insurance, PHYSICIAN shall pay, in a prompt and timely manner, the prcoliums on the insurance llCr'ClmlbpVe required. 11. INDEI'LNDEN'I' C;ON"fRAC'1'OR PHYSICIAN is, and shall be., acting al all times in the performance of (his Agrecnient as an independent contractor herein and not as an employee of CITY. PHYSICIAN shall secure at its own cost and expense, and be responsible for any and all payment of all taxes, 1231RMW Standard Connet - Revised 5 i social security, state disability insurance compensation, unemployment compensation and other payroll deductions for PHYSICIAN aol its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder. I 12, "TERMINATION OF AGRHEW NNI: All work required iicremnder shall be performed in a good and workmanlike menncr. CITY may lerminate PHYSICIAN'S services hereunder at any time with or without cause, and whether or not the PROJECT is fully complete. Any lcrininalfon 9 this Agreement by CITY Shall be made in writing, notice of which shall be delivered to PHYSICIAN as provided herein, in the even of termination, all finished and unfinished docunicmts, exhibits, report, and e:-idcnce shall, at the option of the CITY, become its properly and shall be promptly delivered to it by PHYSICIAN. 13, ASS1(3NM1:?NT AND IJ_FF!LEGATION This Agreement is a pcm mhi service contract and the work hea'cunder shall not be assigned, delegated or subcontracted by PHYSICIAN to [illy other pu'son or entity without the prior express written emmmi: of CITY. If an assignment, delegation or subcontract is approved, all approved assignees, delegates and subcontractors must satisfy the insurance remuirements as set forth in Sections 9 and 10 itcrcinabove. lei. CO1)YRIGf-ITS/PA'I'ENTS CITY shall own all rights to any patent or copyright oh any work, item or material produced as a result of this Agreement. II CnAmAPLOYLBS JAINED OFFICIALS PHYSICIAN shall employ no CITY official nor any regular CITY employee in the work performed pursuant to this Agreement. No officer or employee of CITY shall have any 12-3187/1MR St audard Contract Rcvisei1 6 financial interest in this AgrcennwH in violation of the applicable provisions oC the California Oovernmcnt Code. 16. NOTICES Any notices, certificates, or other communications hereunder shall be given either by personal delivery to PI iY:SICIAN's agent (as designated in Section 1 horeinabove) or to CITY as the situation AN warrant; or by enclosing the same in a scaled envelope, postage prepaid, and depositing the same in Hie United Status Postal Service, to the ed(resses specified below. CITY and PHYSICIAN may designate different addresses to which subsequent notices, certificates of other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U.S. certified mail-return receipt requested: TO CffY: TO PIIYSICIANI: 3S O ) J t b��� z I°( City of Iuntington Reach ATTNI: Ris:ti Ivianager _Nz W_Pc,a T 13eac1, 2000 Main Shoot Huntington Beach, CA 92648 17. CONSENT When CITY's consent/approval is required under this Agrectnew, its couscnt/approval Cor one u'ausaclion or event shall not be deemed to be a consent/approval to any subsequent occurrence;of tic Anne or any other transaction or evert. Is. VVI OIDIFF11C:ATION No waiver or niolilionlion of any language in this Agreement shall be valid unless in writing and duly executed by both parties. 12-7187/1NIE' Standard Contract - Revised 7 19. SECTION HEADINGS The titles, captions, section, paragraph and subject headings, and descriptive phrases at the beginning of the various sections in this Agreement tine merely descriptive and are included solely for convenience of reference only and are not representative of matters included or exclncied front such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties or affect the consuvcHon or iv.lcrprelntion of any provision of this Agreement. 20. 1NTl'RPRETA'rION OF TH[S AGREEMENT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not su'ietly for or against any of the parties. ff any provision of this Agreement is held by nn arbitmor or court of competent jurisdiction to be unent'orccable, void, illegal or invalid, such bolding shall not invalidate or affect the remaining covenants and provisions of this Agreement- No covenant or provision shall be deemed dependent upon any other unless so expressly provided here. As used in this Agreement, the masculine o' neuter gender and singular or plural number shall be deemed to include the other whenever the context so indicates or requires. Nothing contained herein shall be construed so as to require the commission of any act contrary to law, and wherever there is any conflict between any provision contained herein and any present or We stabile, law, ordinance or regulation contrary to which the parties have no right to contract, then the latter shall prevail, and the provision of this Agreement which is hereby affected shall be curtailed and limited only to (he extent necessary to bring it within the requireutcnls of the law. 21. DUPLICA'fEORIOINAL 'the original of this Agreement and one or more copies hereto have been prepared and signed in counterparts its dookMe orlgimils, each of which so executed shall, irrespective of 12-3189 ME. Standard Contract - Revised 8 i I Be date of its execution and delivery, be deemed an original, Each duplicate original shall be deemed an original instrwncnt as against any party who has signed it. 22. EMWGRATION PHYSICIAN' shall be responsible for full compliance with the immigration and naturalization laws of the United States and small, in particular, comply with the provisions of the Unites!Stores• Code regarding employment verification. 23. LEGAL SEWVICL'•S SMICONMAC1'ING PROHMITED I41YSICIAN and CI"fY agree that CITY 0 not liable for payment of any subcontractor work involving IcgA services, and that such legal services arc expressly outside the scope of services eoi Anoated heinunden PHYSICIAN undcrstaads that putmalm to flu dhiglon Beach Ci(1) Ch<nrer Section 309, the City Attorney is the exclusive legal counsel for CITY and CITY shall not be liable For payment of any legal services expenses incurred by PHYSICIAN. 211. ATTORNEY'S FI Ir.S In the event suit is brought by either party to construe, interpret and/or enRAce the terms and/or provisions of this Agreement or to secure the per&trounce hereof, each party shall bear Its own allorncy's fees, such that the prevailing party shall not be calUled to recover its ituorney's fees Front the non-prevailing party. 25. SURVIVAL "terms and conditions of this Agreement, which by (heir sense and context survive Be ternninn(ion of this Agreement, shall so survive. 26. GOVERNING LAW This Agmetnou shall be governed and construed in necoi'dance AM Be haws of the State of California. 12-318711102 Standiird Contract- Revised 9 27. S icy NATORII;S Fach undersigned represents and warrants At its signature hurein below has the power, MOW an(! tight to bind their respective parties to each of the terms of this Agreement, gird shall indenuufy CITY fully for any injuries or damnges to CITY in the event that such+ authority or power is not, in fact, held by the signatory or is withdrawn. i NINI ICIAN's initials 28. FN,rIRF.TY The parties acknowledge and agree tint they arc entering into this Agrccment ficely and voluntarily following extensive arm's length negotiation,and that each has bald the opportunity to consult with legal counsel prior to executing this Apt'eement. "I'hc parties also acknowlcclgO and agree dwt no representations, inducciraWs, promises, agreements or warranties, or<l or otherwise, have been merle by that party or anyone acting on that partv's behalf, which arc not embodied in this Agreement, and that that party has not executed this Agreement iu reliance on any representation, iuduccntant, promise, agreement, warranty, fact or circumstance not expressly set forlh in this Agreement. 'this Agreement, and the attaches! OM AN, contain the entire agreement betwcen the parties respecting the sui�ject matter of [his Agrccment find supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. 29. F IT,PFCTIVI:IT)ATE 'this Agrccment shall be effective on the date of its approval by the City Attorney. This Agreement shall expire when wninhatcd as providal humof. IN WITNESS WIILREOF, the parties hcrclo have caused this Agmennmt to be executed by and through their anllrOrlZCI officers. IW318711MIJ Standard Contract - Revised to PHYSICIAN L rnt t r CITY OF HUNTINGTON BEACH, e TYPPhRMPNrEiC1AN•sMAIL municipal corporalion of the State of California sig�,eune �- Di, ctor of Human Resources i AAPP—ROVED AS TO FORM: .3,,C:ity Attomey Receive and File 'LQy� City Clerk �a�zl 12-3 187J1ML Standard Contract- Revised 11 PROITSSIONAL SERVICES CONTRACT 13ETWEEN THH CITY OF I-JUNf1NGTON 111"ACH AND H9mi.d_mi.r�m_� FOR INDEP13NllEN"l'MLiDICA], EVALUATONS WITH RESPECT"I'O WORKERS' COMPENSATION CLAIMS 'fable of Contents 1 Scope of Services.....................................................................................................1 2 City Staff Assistance................................................................................................2 3 Time ofPu(brmsmce...............................................................................................2 Compensation ..........................................................................................................2 5 Extra Work...............................................................................................................2 6 Mcthoci of Payment..................................................................................................3 7 Disposition o`Plans, Estimates and Othu Documents ... ......... .............................3 8 Hold Harmless .........................................................................................................3 9 Professional Liability Insurance..............................................................................4 10 Certificates of Insurance.........................................................................................5 11 Indepelldent Contractorr............................................................................................5 12 Tenninalion of Agreencnl.......................................................................................6 13 Assignulent and Suhcontracting..............................................................................6 14 Copyrights/1'atenis...................................................................................................6 15 Cily Employees and Officials..................................................................................6 16 Nol(ces .....................................................................................................................7 17 Consult ....................................................................................................................7 18 [Modification.............................................................................................................7 19 Section Headings .....................................................................................................8 20 Interpretation of this Agreement..............................................................................8 21 Duplicate Original....................................................................................................8 22 I m m i gra i f on..............................................................................................................9 23 Lcgal Services Subcontracting Prohibited ...............................................................9 24 Attorncy's Fees.........................................................................................................9 25 Smvival....................................................................................................................9 26 Governing Um. ........................................................................................................9 27 Signstodes...............................................................................................................JO 28 Entirety.....................................................................................................................10 29 l ffcctiveDatc ..........................................................................................................10 12-3187/75880 EXIIIBj'r "A j i i i STATEMt NT OF WORK: I) A013—COR EXAMS (exams For the determination of industrial causation). 2) Evaluation for necessity of appropriate medical treatment. 3) Assessment of employee's present ability to rewtlt to work,whether full duty or utodif ed. 4) Advise on condition of nrcxinunn medical improvement s(atus. 5) Determine nahue and extent of permanent disability, including factors of apportionment and need far future medical one. 6) Resolve utilization review disputes. 7) Determine Ilse need Im spinal surgery pta'suanl t Labor Code section 4062(b). PHYSICIAN shall perform the evaluation in full accordance with the standards dcMwd by the Division of`.Yorkers' Compensation of the State of California aid tits AMA Guides to the Evaluation of Permanent Impairment, Fifth Edition. This rcquitl s a report of the injury, prior s(atus, clinical chronology, current slants, and past medical history. The physical examina(ion will document all pertinent positive, negative, and non-pftysiololgical findings. For extremity injuries, measurements nmst be documented bilaterally. Additionally, PHYSICIAN agrees to: 0) provide drat medical exams will be set within thirty (30) dayi of the date of appohm"wit request, and (ii) prepare a written report of findings within thirty (30) clays of the date of exam or evaluation and provide a copy to the parties within said time fro ne, i i 1 2-3 1 87/7 5 880 j I EXHIBIT 11W, Payment Schedule 1. Missed Appointments • Fee: $503.75 • Code: M1,200 Applies' ,vhen: Interpreter does not appear for evaluation. • Injured worker leaves before completion of the evaluation. • Cancellation within 6 hUSiness days of the scheduled appointrncnt. 2. Comprehensive Nledical-Legal Evaluations • Pea S2,015.00 • Code: ML201 • Applies to the initial evaluation or the first evaluation in an i 8-month period. • The evaluation includes review of up to 200 pages of records. • It must involve an examination of the employee. • Review of records in excess of 200 pages is reimbursed at a rate of S3.00 pa page. 3. Follow-up Medical-Legal Evaluations • fee: $1.316.25 • Code: ivIL202 • Applies to any subsequent comprehensive evaluation within 18 months of the initial evaluation. • This fee includes review of up to 200 pages of records that were not reviewed as part of the initial evaluation. • Review of records in excess of 200 pages (records not reviewed at initial evaluation) reimbursed at a rate of$3.00 per page. 4. Supplemental l'ledical-Legal6:valuations • Fcc: S650.00 • Codc: M203 • Does not involve an examination of the patient. • Results in preparation of a narrative medical report. • Review of records in excess of 50 pages reimbursed at a rate of$3.00 per page. • Pees for a supplemental report are not allowed if: o Records reviewed were provided to the physician for review before the initial or follow-up evaluations. o Supplemental report addresses an issue the parties asked the physician to address in a prior med-legal evaluation. 12-3187nsno i i 5. medical-legal Testimony • Fee: 5455.00 per hour (or physician's usual and customary fee, if lower) • Code: b1L204 • Physician is entitled to bill a minimum of2 hours for depositiat. • If the deposition is canceled within fewer than 8 calendar days prior notice, physician is entitled to bill I hour of time. 6. Medical-Legal Review of Sub Rosa Evidence • Fee: 5325.00 per hour (or physician's usual and customary fee, if lower) • Code: M1,205 • No minimum time allotment. • Physician must capture time spent reviewing evidence to the nearest quarter-hour, verilied under penalty of perjury. • The fee does not include production of a medical-legal report. The fee for time spent reviewing the recording will be included in the billing for the initial, follow-up or supplemental medical- report. 7. Court-Ordered Evaluations • When a medical-legal evaluation is ordered by it Workers' Compensation Judge, the ,Judge has authority and discretion to apply the appropriate modifier to that evaluation. 8. The parties agree that the City is not obligated to pay compensation to the PHYSICIAN except for agreed upon medical services and care. Failure of PHYSICIAN to provide a written medical report within 30 days of the date of the exam subjects PHYSICIAN to non- payment for services rendered. 9. PHYSICIAN billing shall conform to the requirements listed in section 9795 of Title 8 of the California Codc. of' Regulations. Charges for services rendered will be reviewed in accordance with section 9795 to determine appropriate level of service. 10. City shall pay PHYSICIAN within forty-five (45) days following receipt from PHYSICIAN of invoices for services rendered and for which payment has not previously been made, provided that PHYSICIAN shall submit all invoices within ninety (90) days after the date of service. i 12-3187l75880 2 104 THEDOCTORSCOM PANY CERTIFICATE OF INSURANCE Issue Date: 05/17/2021 Effective Date: 06115/2021 A Claims-Made Professional Liability Policy First Named Insured: IMPORTANT NOTICE: This document is issued as Hamid R Mir MD a matter of information and does not confer rights 3501 Jamboree Road, Suite 1250 to any recipient. This document is not binding, is Newport Beach, CA 92660 not part of the Policy described below, and does not change or extend the coverage provided by that Policy. Insured: Hamid R Mir MD Specialty: ORT02 -Orthopedic Surgery (with Spinal) Policy Number Policy Period: 0072901 From: 06/15/2021 To: 06/15/2022 Retroactive Date: Departure Period: 09/15/2004 From: N/A To: N/A The Insured above is: Agency and Address. © A Named Insured The Doctors Company Insurance ❑ A Locum Tenens Services ❑ An Additional Insured P.O.Box 2900 185 Greenwood Road Napa, CA 94558 (800)852-8872 LIMITS OF LIABILITY APPROV90 AS TO Claim Limit: $1,000,000 Aggregate Limit: $3,000,000 BY' E. TES I. Locum Tenens and Additional Insureds share Limits of Liability with the applicable EAA%9H*"ell"31 II. Individuals who occupy a "slot' share Limits of Liability with all others who occupy the same "slot"during the Policy Period. III. Photocopies of this document are deemed as valid as the original. IV. The Policy, including Endorsements, determines the coverage provided. Some Claims may not be covered by the terms of the Policy, or may be subject to restrictions such as lower Limits of Liability. V. If the Policy, or coverage for any person, is canceled for any reason or if the terms of the Policy are changed, we will notify the First Named Insured (and any additional Named Insureds as required by applicable state law). Coverage is not in effect unless and until all payments are received when due. VI. If a Departure Period is indicated, the Policy will not respond to Probable Claim Events arising from Professional Services Incidents or Review Incidents that take place during the designated period; however, the Policy will respond if we receive a Claim Report during this period. MPL003 (04/15) 960 Page 1 or 1 MCO2003 32888729-00 Insured 185 Greenwood Road:P.O. Box 2900:Napa.CA 94558-0900:(707)226-0100:(800)421.2368:www1hedoctors.com