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HomeMy WebLinkAboutCarl Marusak, MD - 2021-04-01 PROFFSSONAL. SLIMCLS CON'TRAC'f B1 9'WL'I N THE CITY OF ]1UNTINGTON BLACI I AND �r_Lfr19 r_u S�.ka_Cn,_D_ FOR INDETENDENT MEDICAL EVALUATIONS WITH R13SPI CTTO WORKERS' COMPENSATION CLAIMS i '('Ills AGRI?LMI N"1' ("Agreement") is matte and entered into by and between the City of Huntington Beach, a municipal corporation of the State of Cnlifornia, hereinafter referred to as "C['1'Y," and Carl E. Marusak, M.D. a❑ individual, hereinafter referred to as"PHYSICIAN." WTILRLAS, CITY desires to engage the services of a physician to provide independent medical evaluations with respect to workers' compensation claims; and Pursuant to documentation on file in (tic office of the City Clerk, the provisions of the IIun(inglon Beach Municipal Code, Chapter 3,03, relating to procurement of professional service contracts have been complied wills; and PHYSICIAN has been selected to perform said services, NOW, "TH[ RBFORIi, it is agreed by CITY and Phla'SICIAN as follows: I. SCOPE Oh' SERVICES PHYSICIAN shall provide all services as described in Vxhibit "A," wliich is attached hereto and incorporated into this Agreement by this reference. 'These services shall sonnelimcs hereinafter be referred to as the "PROJF:C'1'." PI-IYSICIAN hereby designates Charline Talbert-Munoz who shall represent it and be; its sole contact and agent in all Consultations with CITY during the pCrforntancc of this Agreement. APPROVED AS TO FORM/(r' -N`- t¢Q all By, IICHAEL E. GATES CITY ATTORNEY 17.-3187/IM1; Standard COIIHaCt - RCVISCd I CITY OF HUNTINGTON BEACH 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly with PHYSICIAN in the performance of this Agreement. 3. T1ME-', OP PERFORMANCE". Time is of the essence of Ihis Agreement. The services of PHYSICIAN are to commence on -(�pr�l �. -7_�zL_. (the "Commencement Date"). This Agreement shall automatically renew three(3) years from the Commencement Date, unless terminated as provided herein. The time for performance nce of the tasks identified in EA dbit "A" Fire generally to be shown in Fxhibit "A." AS schedule may be amended to benefit the PROJECT if mutually agreed to in writing by CITY and PHYSICIAN. In the event the Commencement Datc precedes the 1300ctive Date, PHYSICIAN shall be bound by all terms and conditions as provided herein. it. COMPENSATION In consideration of the performance of the services described herein, CITY agrees to pay PHYSICIAN, on a time and materials basis at the rates specified in exhibit "I3," attached hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses, not to excced 'fwenty-nine Thousand Nine-Hundred Dollars ($29,900.00). 5. EXTRA WORK In the event CITY requires additional services not included in Whibit NO% or changes in file scope of services described in Whibit "A ' PHYSICIAN will undertake such work only after receiving written authorization from CITY. Additional compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. 12-318NMMP. Standard Contract - Revised 2 6. Mf"fI-IOD OF PAYMENT PHYSICIAN shell be paid pursuant to the terms of Exhibit "Il." 7. DISPOSITION OF I)LANS LSTIMATLS AND OTHI.;R DOCUMENTS Pl-IYSICIAN agrees that title to all materials prepared hereunder, including, but not I United to: all original drawings, designs, reports, both field and office notices, calculations, computer code, language, data or programs, maps, memoranda, letters and other documents, shall belong to CITY, and PHYSICIAN shall turn these materials over to CITY upon termination of this Agreement or upon PROJECT completion, whichever shall occur first. These materials may be used by CITY as it sees fit. 8. 1101.,E IIARMLESS PHYSICIAN hereby agrees to protect,defend, indmmd y and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims,damages, losses,expenscsJudgmmis,demands and defense costs (including without limitation, costs and fees of litigation of every nature or liability of any kind or nature) arising out of or in aautection with 11HYSICIAN's (or PIIYSICIAN's subcontractors, 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 PHYSICIAN, its officers, agents or employees except such loss or damage which was caused by the sole negligence or willful miscmnducl of CYPY. PHYSICIAN will conduct all defense at its sole cost and expense and Cl'1'Y shall approve selection of PHYSICIAN'S counsel. 'Phis indemnity shall apply to all claims and liability regardless of whoher any insurance pot ides are applicable, The policy limits do not act as limitation upon To amountof indemnification to be provided by PHYSICIAN. la.-318 = Standard Contract- Revised 3 9. PROFESSIONAL LIABILITY INSURANCE PHYSICIAN shall obtain tend furnish to CffY a professional liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for PHYSICIAN's professional linbHky in an amount not less than One Million Dollars ($1,000,000.00) per occurrence and in the aggregate. 'Me abovo-mentioned insurance shall not contain a self-insured retention without llic express written consent of CITY; however an insurance policy "deductible" of An Thousand Dollars ($10,000.00) or less is permitted. A claims-made policy shall be aeceplable if the policy further provides that: A. The policy retroactive date coincides with or precedes tine initiation of the scope of work (including subsequent policies purchased as renewals or replacements). B. PIYSICIAN shall notify CITY of circumstances Or incidents that might give rise to future claims. PHYSICIAN will make every effort to maintain similar insurance during the required extended period of coverage following PROJECT completion. If insurance is terminated for any reason, PHYSICIAN agrees to purchase an extended rcpordlig provision of at [cast two (2) years to report claims arising from work perfornlai in connection with this Agreement. If PHYSICIAN fails or refuses to produce or maintain the insurance required by this section or foils or refuses to furnish the CffY with required proof that insurance has been procured and is in force and paid for, the CITY shall have the right, at the CITY's election, to fortinvith terminate this Agreement. Such termination sliall not affect PHYSICIAN's right to be paid for ins time and materials expended prior to notification of termination. PHYSICIAN waives 12-9IR7/IM Standard Contract - Revised 4 the right to receive condensation and agrees to indenmify the CITY for any work performed prior to approval of insurance by the CITY. 10, URTIPICATLS OF INSUI ANCE Prior to commencing performance of the work hereunder, PHYSICIAN shall furnish to CITY certificates of insurance subject to approval of the City Attorney evidencing the foregoing insurance coverage as required by this Agrccmcnt; the ecru ficatc shall: A. provide the name and policy number of each carrier and policy; B. state that the policy is currently in force; and C. promise that such policy shall not be suspeucled, 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 in the event of cancellation for nonpayment of premium. PHYSICIAN shall maintain the foregoing insurance coverage in force until the work under this Agreement is fully completed and accepted by CITY. Ile requirement for carrying the foregoing insurance coverage shall not derogate front PHYSICIAN's defense, hold harmless and iudcnntifica % obligations as set forth ill this Agreement. CITY or its representative shall at all times 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 premiums on lire instnance hereinabove required, 1 1 . INDEPENDT;NT CONTI+A= PHYSICIAN is, and shall bc, acting at all times in the performance o1' this Agrccmcnt as an independent contractor hcrcin and not as an employee of CITY. PHYSICIAN shall secure at its own cost and expense, and be responsible for any and all paytucnt of all taxes, 12-3187/1ME Standard Contract - Revised 5 social security, stale disability insurance compensation, unemployment compensation and other Payroll deductions for PHYSICIAN and its officers, agents and employees and all business licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder. 12. TERMINATION OP AGItI FMI,N'I: All work required hereunder shall be performed in a good kind workmanlike manner. CITY may tcrmimHc Pi IYSICIAN's services hereunder at any time with or without cause, and whether or not the PROJECT is fully complete. Any termination of this Agreement by CITY shall be made in writing, notice of which shall be delivered to PHYSICIAN as provided herein. In the event of termination, all finished and unfinished documents, exhibits, report, and evidmac shall, at the option of the CITY, become its properly and shall be promptly delivered to it by PHYSICIAN. 13, ASSIGNMENT AND DELLGATION This Agreement is a personal service contract and the work hereunder shall not be assigned, delegated or subcontracted by PHYSICIAN to any other person or redly without lie prior express written consent of CITY. if en assignment, delegation oi- subcontract is approval, all approved assignees, delegates and subcontractors immt satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove. 14. COIIYRIGI-ITS/PATENTS- CITY shall own all rights to any patent or copyright on any work, item or material produced as a result of this Agreement. 1.5 CITY EMPLOYEES AND OFFICIALS Pi IYSICIAN 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 12-3I SMAR Standard Contract - Revised 6 financial iutcrest in this Agreeniont in violation of (he applicable provisions of the California Government Code. 16. NO'fIC13S Any notices, eertificates, or other communications hereunder shall he given either by personal delivery to PHYSICIAN's agent(as designated in Section I hercinabove) or to CITY as the situation shall warrant, or by enclosing the same in a sealed envelope, postage prepaid, and depositing the same in the United Slates Postal Service, to the addresses specified below. CITY and PHYSICIAN may designate different addresses to which subsequent notices, certificates or other communications will be sent by notifying the other party via personal delivery, a reputable overnight carrier or U.S. certified mail-rchum receipt requested: TO CITY: TO PHYSICIAN: City of Huntington Beach Carl E. Marusak, M.D. A"fTN: Risk Manager 11721 Whittier Blvd., #198 2000 Maio Slrcct Whittier, CA 90601 HimUngtan Beach, CA 92648 17. COMENT When CITY's consent/approval is required under this Agreement, its consenl/approval for one transaction or event shad not be deemed to he. a consent/approval to any subsequent occurrence of the same or any outer transaction or event. 18, MODIFICATION No waiver or modification of any language in this Agreement sliall be valid unless in writing and duly executed by both parties. 12-3187MMG 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 are merely descriptive and are included solely for conveuicnce of reference only still are not representative of matters included or excluded from such provisions, and do not interpret, define, limit or describe, or construe the intent of the parties of affect the construction of interpretation of an}' provision of this Agreement. 20. INTERPRETATION OF THIS AGRE N13NT The language of all parts of this Agreement shall in all cases be construed as a whole, according to its fair meaning, and not strictly for or against any of the parties. If any provision of this Agreement is held by an arbitrator or court of competent jurisdiction to be unenforceable, void, illegal or invalid, such holding shall not invalidate or affect line remaining covenants fund provisions of this Agreement. No covenant or provision shall be deemed dependent upon any other unless so expressly provided litre. As used in this Agreement, the masculine or neuter gender and singular or plural number shall be deemed to include the other whenever the coutext so indicates or requires. Nothing contained herein shall be construed so as to require the commission of'ally act contrary to law, and wherever there is any conflict betwcar any provision contained herein and any present or fuhu•e statute, law, ordinance or regulation contrary to which the parties have no right to contract, then the later shall prevail, and the provision of this Agreemenl which is hereby affected shall be curtailed and limited only to the extent necessary to bring it within the requirements of the law. 21. DIIYLICATE ORIGINAL The original of this Agreement and one or more copies hereto have been prepared and signed in counterparts as duplicate originals, each of which so executed shall, irrespective of 12-318711ME Standard Contract - Revised 8 the date of its execution and delivery, be deemed an original. Each duplicate original shall be deemed an original instrument as against any party who has signed it. 22. IMMIGRATION PHYSICIAN shall be responsible for full compliance with the immigration and naturalization laws of the United States and shall, in particular, comply with (lie provisions of the United Smies Code regarding employment verification. 23. LEGAL SERVICES SUBCONTRACTING PROHIBITED PHYSICIAN and CITY agree that CITY is not liable for payment of any subcontractor work involving legal services, and that such legal services are expressly outside the scope of services cm9cmplated hereunder. PIIYSICIAN understands that pursuant to Ilunlinglon Beach Qp Chao ter Seclion 309, (lie City Attorney is the exclusive legal counsel for CITY and CITY shall not be liable for payment of any legal services expenses incurred by PhIYSICIAN. 24. ATTORNEY'S FEES In the event suit is brought by either party to construe, interpret and/or enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall bear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorneys fees from the uou-prevailing party. 25, SURVIVAL Terms and conditions of this Agreement, which by their sense and context survive Qrc termination of this Agreement, shall so survive. 26. GOVERNING LAW 'this Agreement shall be governed and construed in accordance with the laws of the State of California. 1 2-3 1 8 711ME Standard Contract- Revised 9 27. SIGNATORIES Rach undersigned represents and warrants (bat its signature herein below has file power, authority and right to bind their respective parties to each of the terms of this Agreement, and shall indemnify CPfY fully for any injuries or damages to CITY in the event that such i authority or power is not, in fact, held by the signatory or is withdrawn. 1'HYSICIAN's initials CEM 28. EN'f11213'fY 'file parties acknowledge and agree that they arc entering into this Agreement freely and voluntarily following extensive arnn's length negotiation, and that each has had the opportunity to consult Will legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no mpmsmitahont inchwernu ts, premiseq agreennen(s or warranties, oral or otlerwise, have been made by that party or anyone acting on that party's behalf, which are not embodied in this Agreement, and that that party has not executed this Agrecmcnt in reliance on any representation, inducennent, promise, agreement, warranty, fact or circumstance not expressly set forth in this Agreenent. This Agrecmcnt, and the attached exhibits, contain the entire agreemcnl between the parties respecting the subject matter of (his Agreement and supersede all prior understandings and agmwneMs whelher oral or in writing between the parties respecting the subject matter hereof. 29. EFFECI_IVEDAT_E'_ This Agreement shall be effective on the date of its approval by the City Attorney. This Agreement shall expire when terminated as provided hucof. IN WITNESS WHEREOF, file parties hereto have caused (his Agrecmcnt to be executed by and through their authorized officers. 12-71871tMF,Standard Contract - Revised 10 PHYSICIAN Carl E Marusak, M.D. CITY OF HUNPINGTON BLEACH,a -- rrrenawrnrrsic�w sruaie municipal corporation of the State of California Slgnature - Di for of Human Resources l APPROVED AS TO FORM: U ,, _.,4,City Attorney Receive and File 1 1. l G� Ctty Clerk -7/8 2� 12-3 18711MC Standard Contract- Revised ]t PROFESSIONAL SI-71MCBS CONTRACT BETWEEN TWEEN 'ITIE CITY OE I-]UNTINGTON 13EAC11 AND G—gri marus4k._m. D- FOR INIaI P);NDLN"I' M1 DICA1, EVALIJATONS WITH RESPECT"fO WORKI3RS' COMPENSATION CLAIMS Table of Contents IScope of Services.....................................................................................................1 2 City Staff Assistance................................................................................................2 3 Time of Performance ...............................................................................................2 } Compensation ..........................................................................................................2 5 Exira Work...............................................................................................................2 6 Method of Payment..................................................................................................3 7 Disposition of Plans, Estimates and Other Documents ...........................................3 8 Hold Harmless .........................................................................................................3 9 Professional Liability Insurance..............................................................................4 10 Certificates Of Insurance..........................................................................................5 11 Independent Contractorr............................................................................................5 12 'Termination of Agreement.......................................................................................6 13 Assignment and Subcontracting ..............................................................................6 14 Copyrights/Patents...................................................................................................6 15 City Employees and Officials...................................................... ...........................6 16 Notices .....................................................................................................................7 17 Consent ....................................................................................................................7 18 tvlodification.............................................................................................................7 19 Section IIcadings .....................................................................................................8 20 Interpretation of this Agreement..............................................................................8 2.1 Duplicate Original....................................................................................................8 2.2 Immigration..............................................................................................................9 23 Legal Services Subcontracting Prohibited...............................................................9 24 Attorney's Fces.........................................................................................................9 25 Survival....................................................................................................................9 2.6 Governing Law ........................................................................................................9 27 Signatories................................................................................................................10 28 I ntirety.....................................................................................................................10 29 Effective Date ..........................................................................................................10 12_3187/75880 EXIIJBIT "A" STAT MENTOF WORK: 1) AOE—COF.EXAMS (exams for the determination of industrial causation). 2) l vnivalion for necessity of appropriate medical treatment. 3) Assessment of employee's present ability to rehu•n to work, whether full dirty or modified. 4) Advise on condition of maximunt medical improvement status. 5) Determine nature and extent of permanent disability, including factors of apportionment and need for future medical care. G) Resolve utilization review disputes. 7) Determine the need for spinal surgery pursuant to Labor Code section 4062(b). PHYSICIAN shall lim1br n the evaluation in full accordance with the standards defined by the Division of Workers' Canpcnsation of the State of California and tite AMA Guides to the Evaluation of Permanent hnpahinw,t, Fifth Edition. This requires a report of the injury, prior status, clinical chronology, current status, and past medical history. 'rho physicui examination Will doetmlCllt all pertinent positive, negative, find non-physiological findings. For extremity injuries, measurements Hurst be documented bilaterally. Additionally, PHYSICIAN agrees to: (i) provide that medical exams will beset within thirty (30) days of the date of appointment request, and (ii) prepare a written report of findings within thirty (30) days of the date of exam or evaluation and provide a copy to the parties tvilhfn said time IYanie. 12-3187ns880 EXHIBIT "B" Payment Schedule 1. Missed Appointments • Fee: $503.75 • Code: ML200 ftpplies when: • Interpreter does not appear for evaluation. • Injured worker leaves before completion of the evaluation. • Cancellation within 6 business days of the scheduled appointment. 2. Comprehensive Medical-Legal Evaluations • Fee: $2,015.00 Code: Ml.,201 • Applies to the initial evaluation or the first evaluation in an 18-month period. • The evaluation includes review of up to 200 pages of records. • It nutsl involve an examination of the employee. • Review of records in excess of 200 pages is reimbursed at a rate of$3.00 per page. 3. Follow-up Medical-Legal Evaluations • Fee: $1,316.25 • Code: ML202 • 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 Medical-Legal Evaluations • Fee: $650.00 • Code: \4203 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. Tees for a supplemental report arc not allowed if: o Records reviewed were provided to the physician for review hefore the initial or follow-up evaluations. o Supplemental report addresses an issue the parties asked the physician to address in a prior mcd-legal evaluation. 12-3187/75880 I 5. Medical-Legal Testimony • Fcc: $455.00 per hour (or physician's usual and customary fee, if lower) • Cock: ML204 • Physician is entitled to bill it minimum of 2 hours for deposition. • If the deposition is canceled within Iower than 8 calendar days prior notice, physician is entitled to bill 1 hour of time. G. Medical-Legal Review of Sub Rosa Evidence • I'cc: $325.00 per hour (or physician's usual and customary Ice, if lower) • Code: ML205 • No minimum time allotment. • Physician must capture time spent reviewing evidence to the nearest quarter-hour, verified under penalty of perjury. • 'file fee does not include production of a medical-legal report. 'file. 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 it medical-legal evaluation is ordered by a Workers' Compensation Judge, the Judge has authority and discretion to apply the appropriate modifier to that evaluation. S. 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 Code 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 PI IYSICIAN shall submit all invoices within ninety (90) clays after the date of service. 12-3187/75880 2 A IJ 10 THEDOCTORSCOMPANY CERTIFICATE OF INSURANCE Issue Date: 02/16/2021 Effective Date: 04/0112021 A Claims-Made Profesional Liability Policy First Named Insured: IMPORTANT NOTICE: This document is issued as Carl E Marusak MD a matter of information and does not confer rights 2444 Wilshire Boulevard, Suite 311 to any recipient. This document is not binding, is Santa Monica, CA 90403 not part of the Policy described below, and does not change or extend the coverage provided by that Policy. Insured: Carl E Marusak MD Specialty: PSY01 •Psychiatry Policy Number: Policy Period: 0030695 From: 04/01/2021 To: 04/01/2022 Retroactive Date: De rture Period: 04/01/1983 From: N/A To: WA 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 APPROVED AS TO FORM (800)852-8872 AEL E. GAT IITS OF LIABILITY Claim Limit: CITY ATTORNE $1,000.000 CITY OF HUNTINGTON BEACH Aggregate Limit: $3,000,000 I. Locum Tenens and Additional Insureds share Limits of Liability with the applicable Named Insured. 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. MPI-003 (04/15) 960 Pagel of 1 MCO2003 32143040-00 Insured 185 Greenwood Road:P.O.Box 2900:Napa,CA 94558-0900:(707)226-0100:(800)421-2368:www.lhedoctom.com