HomeMy WebLinkAboutFredric Edelman, MD - 2021-04-01 PRONESSONAL SERVICES CONTRACT BETWEEN
THE. CITY OR HUNTINGTON BEACH AND
Fredric, Edelman I m
POR
INDEPENDENT MEDICAL EVALUATIONS WITH
RESPECT TO WORKERS' COMPENSATION CLAIMS
THIS AGREEMENT ("Agreentent'� is made and entered into by and between the City of
Huntington Beach, a numicipal corporation of the State of California, hereinafter referred to as
n..9.
"CITY,"and FkrEppu l_ EDELMAN an individual, hereinafter referred to as "PHYSICIAN."
WHEREAS, 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 the office of the City Clerk, the Provisions of the
Huntington Beach Municipal Code, Chapter 3.03, relating to procurement of professional service
contracts have been complied with; and
PHYSICIAN has been selected to perform said services,
NOW, THEREFORE, it is agreed by CITY and PHYSICIAN as follows:
I. SCOPE OF SERVICES
PHYSICIAN shall provide all services as described in Exhibit "A," which is
attached hereto and incorporated into this Agreement by this reference. These services shall
sometimes hereinafter be referred to as the "PROJECT."
D
PHYSICIAN hereby designates FKik-'6IuC L QN nA4 1 who shRll represent it
and be its sole contact and agent in all consUltations with CITY during the performance of this
Agreement.
APPROVED AS TO FORM/F tte
�ICHAEL E. GATES
CITY ATTORNEY
MY OF HUNTINGTON BEACH
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2. CITY STAFF ASSISTANCE
CITY shall assign a staff coordinator to work directly with PHYSICIAN in the
performance of this Agreement.
3. TIME OF PERFORMANCE
Tithe is of the essence of this Agreement. The services of PHYSICIAN are to
commence on April I 2QZ1 (the "Commencement Date'"). This Agreement sliall
automatically renew three (3) years from the Commencement Date, unless terminated as provided
herein. The time for performance of the tasks identified in Exhibit"A" are generally to be shown
in Exhibit "A." This schedule may be amended to benefit the PROJECT if mutually agreed to in
writing by CITY and PHYSICIAN.
In the event the Commencement Date precedes the Effective Date, PHYSICIAN
shall be bound by all terms and conditions as provided herein.
4. COMPENSATION
In consideration of the performance of the services described herein, CITY agrees
to pay PHYSICIAN, on a time and materials basis at tho rates specified in Exhibit "13," attached
hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses,
not to exceed 'rwenty-nine Thousand Nine-Hundred Dollars ($29,900.00).
5. EX'1'2A W OI IBC
III tite event CITY requires additional services not iuciuded in Exhibit "A", of
changes in the scope of services 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 if the prior wrillen approval of CITY is obtained.
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G. NETHOD OF PAYM
PHYSICIAN shall be paid pursuant to the terms of Exhibit "B,"
7. DISPOSITION Of PLANS FST1MATES AND OTHER 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, 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. UOLD HARMLESS
PHYSICIAN hereby agrees to protect,defend, indemnify and hold hariniess CITY,
its officers, elected or appolaled officials, employees, agents and volunteers front and against any
and all claims, damages, losses,expenscs,judgments,demands and defense costs(including without
limitation, costs and fees of litigation of every iwture or liability of any kind or nature) arising out
of or in comiection with PHYSICIAN's (or PHYSICIAN's subcontractors, if any) noghgent (or
alleged negligmit) 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 die sole negligence or willful misconduct of CITY. PHYSICIAN will
conduct ill[ 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 whether any insurance
policies are applicable. The policy limits do not act as limitation upon the amountof hidenmificatiou
to be provided by PHYSICIAN.
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9, PROFESSIONAL LIABILITY INSURANO_E.
PHYSICIAN shall obtain and furnisli to CITY a professional liability insurance
policy covering the work performed by it heretu'der. This policy shall provide coverage for
I'MYSICIAN's professional liability in an amount not less dean One Million Dollars
($1,000,000.00) per occurrence and in the aggregate. The above-mentioned insurance shall not
contain a self-insufed retention without the express written consent of CITY;however nn insurance
policy "deductible" of Ten Thousand Dollars ($10,000.00) or less is permitted. A claims-made
policy shall be acceptable if the policy further provides that:
A. The policy retroactive date coincides with or precedes the initiation of the
scope of work (including subsequent policies purchased as renewals or
replacements).
B. PHYSICIAN shall notify CITY of circunistaulces or incidents that might
give rise to future claims.
PHYSICIAN will make every effort to Maintain silllllar illSrlllnlce during the
required extended period of coverage following PROJECT completion. If insurance is terminated
for any reason,PHYSICIAN agrees to purchaso an extended reporting provision of at least two(2)
years to relort claims arising from work performed in connection will' this Agreement.
If PHYSICIAN fails or refuses to produce or maintain the insurance required by
this section or fails or refuses to furnish the CITY with required proof that insurance has been
procured and is in force and paid for, the CITY shall have the right, of the CITY's election, to
forthwith terminate this Agreement. Such termination shall not affect PHYSICIAN's right to be
paid for its little and materials expended prior to notification of termination. PHYSICIAN waives
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the right to receive compensation and agrees to indemnify the CITY for any work performed prior
to approval of insurance by the CITY.
10. CERTIFI ATF.S OF SURANCE
Prior to commencing performance of the work hereunder, PHYSICIAN shall
f mtish to CITY certificates of insurance subject to approval of the City Attorney evidencing the
foregoing insuranco coverage as required by this Agreement; the,certificate shall:
A. provide the name and policy number of each carrier and policy;
B. state that the policy is cturaitly in force; and
C. promise that such policy shall 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 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,
Tile 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 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, tlm
premiums on the insurance herein above required.
It. INDEPENDENT CONTRACTOR
PHYSICIAN Is, and shall be, acting at all times in the performance of this
Agreement as an independent contractor herein and not as an eniplbyee of CITY, PHYSICIAN
shall secure at its owl) cost and expense, and be responsible for any and nil payment of all taxes,
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social security, state disability insurance compensation, unemployment compensation and other
payroll deductions for PHYSICIAN and Its officers, agents and employees and all business
licenses, if any, iu connection with the PROJECT and/or the services to be performed hereunder.
12, TERMINATION OF AGREEMENT
All work required hereunder shall be perfumed in a good and workmanlike
manner. CITY may terminate PHYSICIAN's services hereunder at any time with orwithout 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 unfinislied documents, exhibits, repot, and evidence
shall, at the option of the CITY, become its properly and shall be promptly delivered to it by
PHYSICIAN.
13. ASSIGNMENT AND DELEGATION
This Agreement is a personal service contract and the work hereunder shall not be
assigned, delegated or subcontracted by PHYSICIAN to tiny other person or entity without the
prior express written consent of CITY. If an assignment, delegation of subcontract is approved,
all approved assignees, delegates and subcontractors must satisfy the insurance requirements as
set forth in Sections 9 Find 10 hareinabove.
14. COPYRIGHTS/PATENTS
Cl'fY shall own all rights to any patent or copyright of any work, item or material
produced as a result of this Agreement,
15. f'1TY EMPLOYEES AND OFFICIALS
PHYSICIAN shall employ no CITY official nor any regular CITY employee in the
woic performed pursuant to this Agreement. No officer or eanployee of CITY shall have any
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financial interest in this Agreement in violation of the applicable provisions of the California
Goverrmieut Code,
16. NOTICES
Any notices, certificates, or other communications hereunder shall be given either
by personal delivery to PTIYSICIAN's agent(as designated in Section I hereinabove) or to CITY
as the Situation shall warrant, or by enclosing the santc in a sealed envelope,postage prepaid, and
depositing the same in the United Stales Postal Service, to the addresses specified below. CITY
and P14YSICIAN 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-return receipt requested:
TO CITY: TO PHYSICIAN:
City of Huntington Beach FKD R-' C L 60 -UWI tJ M t�
ATTN: Tusk Manager rA3 S U/VO NJ(4s 61-- " 1 Iq
2000 Main Street 1p�gr1i}IJ CA<j. C 1
Huntington Beach, CA 92648 QlutL3
17, CONSENT
When CITY's consent/approval is required under this Agreement, its
consent/approvol for one Transaction or event sliall not be deemed to be a consent/approval to any
subsequent occurrence of the same or any other transaction or evenl.
18. MODIFICATION
No waiver or modification of ally language in this Agreement shall be valid unless
in writing and duly executed by both parties.
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19. SECTION HCAPINQS
The titles, captions, section, paragraph and subject headings, and descriptive
phrases at the beginning of the various sections in this Agreement are inerely descriptive and are
included solely for convenience of reference only and are not representative of natters included
or excluded front such provisions, and do not interpret, define, limit or describe, or construe the
intent of the parties or affect the construction or interpretation of any provision of this Agreement.
20, INTERPRETATION OF THIS AGREEMENT
The language of all parts of this Agreement shall in 0 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 all. arbitrator or court of competent jurisdiction to be
unenforceable, void, illegal or invalid, such holding shall not invalidate or affect the remaining
covenants Ond provisions of this Agreement. No covenant or provision shall be deemed dependent
upon any other lmless so expressly provided here. As used in this Agreement, the masculine or
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 future statute, 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 the extent necessary to
bring it witbin the requirements of the law.
21. pUPLICATL 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
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the date of its execution Ford delivery, be deemed an original. Each duplicate original shall be
deemed an original inshvnrent as against any party who has signed it.
22, IMMIGRATION
PHYSICIAN shall be responsible for full coniplintice with the immigration and
naturalization laws of the United States and shall, ill particular, comply with the provisions of the
United States 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 tho
scope of services contemplated hereunder. PHYSICIAN understands that pursuant to Huntington
Beach Clh, Charter Swim) 309, the City Attorney is the exchusive legal counsel for CITY and
CITY shall not be liable for payment of any legal services expenses incurred by PHYSICIAN.
24. ATTORNEY'S PEES
In the event suit is brought by either-party to construe, interpret and/or enforce the
terms and/or provisions of this Agreement o to secure the performance hereof, each party shall
bear its own attorney's fees, such that the prevailing party shall riot be entitled to recover its
attorney's fees fron the nou-prevailing party.
25. SURVIVAL
Terms and conditions of this Agreement, which by their sense and context survive
the termination of this Agreement, sliall so survive.
26. GOVERNING LAW
This Agreement shall be governed and constived in accordance with the laws of the
Slate of California,
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27. SIGNATORIES
Each undersigned represents and warrants that its signature herein below has the
power, authority and right to bind their respective parties to each of the terms of this Agreement,
and shall indemnify CITY fully for any injuries or damages to CITY in the event that such
authority or power is not, in fact, held by the signatory or is withdrawn.
T'HYSICIAN's initial.,
28. ENTIRETY
The parties acknowledge and agree that they are entering Into this Agreement fieely
and voluntarily following extensive arm's length negotiation,and Thal each has had the opportunity
to consult with legal counsel prior to executing this Agreement. The parties also acluiowledge and
agree that uo representations, inducements, promises, agreements or warranties, oral or otherwise,
have been made by that early or anyone acting on that party's behalf, which are not embodied in
this Agrecment, and that that party has not executed this Agreement, in reliance on any
representation, inducement, promise, agreement, Warranty, fact or circumstance not expressly set
forth in this Agreement. This Agreement, and the attached exhibits, contain the entire agroentottl
between the parties respecting the subject matter of (his Agreement and supersode all prior
understandings and agreements whetlrcr oral or in writing between the parties respecting rite
subject matter hereof,
29. EFFECTIVE DATE
'this Agreement shall be effective oil the date of its approval by the City Attorney,
This Agreement shall expire when terminated as provided hereof.
IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
by and through their authorized officers.
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PHYSICIAN
COP 1C_ L-M Di; M,� CITY OF HUNIINOTON BEACH, a
6 40- T J 1 E t' municipal corporatio0 of the Siate of Caiifbmia
Slat ft e
Dit ec(or of Human Resources
APPROVE+ AS TO FORM;
�i Attotuey
Receive and File
rL ZQ�xGZ/Q�t,t)
City Clerk
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PROFESSIONAL SERVICES CONTRACT BETWEEN
THE CITY OF HUNTINGTON BEACH AND
Fredric Edelman . mi)
FOR
INDEPENDENT MEDICAL EVALUATONS WITH
RESPECT TO WORKERS' COMPENSATION CLAIMS
Table of Contents
IS(;ol)eof Services.....................................................................................................1
2 City Staff Assistance...................................,............................................................2
3 Time of Performance .......................................................................•...............•...••..2
4 Compensation ..........................................................................................................2
5 Extra 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 Contractor............................................................................................5
12 TenninationofAgreement.............•..••.....••....••....•.•......••..•.•••.•••......•.......................6
13 Assignment and Subcontracting .................................................•......•.•...............•...6
14 Copyrights(Patents........................•..........................................................................6
15 City Employees and Oflicials..................................................................................6
16 Notices •...•....................•...........•..•.••............•..................••.•.•....................................7
17 Commit ........................................................................•..••.....••................................7
18 Modification.............................................................................................................7
19 Section Headings •••.................•••.....................................•••••„•.........•...........•..........•8
20 Interpretation of this Agreement••...............•...................•........................................8
21 Duplicate Original....................................................................................................8
22 Immigration.....................................................................................•........................9
23 Legal Services Subcontracting Prohibited •................•....•....•.........••.•.•....,........•.,.•..9
24 Attorney's Foes..............................................................................................•....•.....9
25 Survival....................................................................................................................9
26 Governing Law ...........................•..........................................•.................................9
27 Signatories................................................................................................................10
28 Butirety...,.....................................•...........................................................................10
29 EffecliveDate ...............................................•..........•......................•..••....................10
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EXHIDIT "A„
STATEMENT OF WORK:
1) AOE—COE EXAMS (exams for the determination of industrial causation).
2) Evnlualion for necessity of appropriate medical treatment.
3) Assessment of employee's present ability to return to work, whether full duty or
modified.
4) Advise on condition of maximum medical improvement status.
5) Determine nature and extent of permanent disability, including factors of apportionment
and need for firture medical care.
6) Resolve utilization review disputes.
7) Determine the need for spinal surgery pursuant to Labor Code section 4062(b).
PHYSICIAN shall perform the evaluation in full accordance with the standards defined by the
Division of Workers' Compensation of the State of California and the AMA Guide-c to the
Evaluation of Permanent Impairment, Fifth Edition. This requires a report of the injury, prior
status, clinical cluonology, current status, and past medical history. The physical examination
will dOCURlelll all pertinent positive, negative, and non-physiological, findings. For extremity
injuries, measurements must 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 within said time frame,
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EXHIBIT "B"
Payment Schedule
1. Missed Appointments
• Fee: $503.75
• Code: ML200
Applies 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: ML201
• 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 must 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: M1,202
• 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: 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.
• Fees 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.
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5. Medical-Legal Testimony
• Fee; $455.00 per hour (or physician's usual and customary fee, if lower)
• Code: ML204
• Physician is entitled to bill a minimum of 2 hours for deposition.
• If the deposition is canceled within fewer than 8 calendar days prior notice, physician is
entitled to bill 1 hour of time.
6. Medical-Legal Review o1 Sub Rosa Evidence
• Fee: $325.00 per hour (or physician's usual and customary fee, 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.
• 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 a 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 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 PHYSICIAN shall submit all invoices within ninety (90) days
after the date of service.
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�THEDOCTORSCOMPANY
CERTIFICATE OF INSURANCE Issue Date: 08l1t/2o2/
Effective Date: t18/0112021 Professional U&MIity Policy Occurrence Coverage
First Named Insured IMPORTANT NOTICE: This document is issued as
Fredric L Edelman MD a matter of information and does not confer rights
4835 Van Nuys Blvd Suite 114 to any recipient. This document is not binding, is
Sherman Oaks, CA 91403 not part of the Policy described below, and does
not change or extend the coverage provided by that
—,--- Policy.
Insured: Fredric L Edelman MD
Specialty: SUR01 - Surgical SPk.Offim Min Sung and Procedures only
Polic Number__ Policy Period:
OC494434 From: 08V1=1 To: 0=112022
The Insured above is Agency and Address'
(� A Named Insured Hub International Insurance
n A Locum Tenons Services Inc.
An Additional Insured STE 200
3633 E Broadway
Long Beach, CA 90803
r..r (562)439-9731
lRlr�E LIMITS OF LIABILITY
Claim Limit: $1,000.000
Aggregate Limit: $3,000,000
L Locum Tenons and Additional Insureds share 111. Photocopies of this document are deemed as
Limits of Liability with the applicable Named valid as the original.
Insured.
IV. If the Policy, or coverage for any person, is
If. The Policy, including Endorsements, determines canceled for any reason or if the terms of the
the coverage provided. Some Claims may not be Policy are changed, we will notify the First Named
covered by the terms of the Policy, or may be Insured (and any additional Named Insureds as
subject 10 restrictions such as lower Limits of required by applicable state law). Coverage is not
Liability. in effect unless and until all payments are
received when due.
APPROVED PS TO FORM
MICHAEL E.GATES
3 CITY ATTORNEY
CITY OF HUNTINGTON BEACH
8
X
3
4
MPL00003 (04/15) 20979 page 1 01 1 0002003 33413145 -00 Insured
105 Greanwood Road P.O.Box 2900 Napa,CA 94558-0900:(707)226-0100 (800)421-2368:www.Ihadactofs com
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