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HomeMy WebLinkAboutDavid S. Kim, MD - 2021-04-01 PROFESSONAL SERVICES CONTRACT BETWEEN THE CITY OF HUNTINGTON BEACH AND i M. 0. i FOR INDEPENDENT MEDICAL EVALUATIONS WITH RESPECT TO WORKERS' COMPENSATION CLAIMS THIS AGREEMENT("Agreement") is made and entered into by and between the City of Huntington Beach, a municipal corporation of the State of California, hereinnfter referred to as "CITY,"and gay4 S.W4, M D, 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 compiled with;and PHYSICIAN has been selected to perform said services, NOW,THEREFORE, it is agreed by CITY and PHYSICIAN as follows: 1. 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 I i someGnies hereinafter be referred to as the"PROJECT." PHYSICIAN hereby designates who shall represent it I and be its sole contact and agent in all consultations with CITY during the perfomnance of this Agreement. APPROVED AS TO FORM/ Ftt� Y' ICHAEL E.GATES C[TY ATTORNEY 12-3187AM13 Standard Contract-Revised I CrTY OF HUNTINGTON BEACH 2. CITY STAFF ASSISTANCE CITY shall assign a staff coordinator to work directly will, PHYSICIAN in the performance of this Agreement. 3. TIME OF PERFORMANCE Time is of the essence of this Agreement. The services of PHYSICIAN are to continence on April I 2 M (the "Commencement Date"). This Agreement shall automatically renew three(3) years from the Commencement Date,unless terminated as provided haain. The time for performance of the tasks identified in Cxhibit"A"are generally to be shown in Exhibit "A." Tlus 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 ternns and conditions as provided herein. 4. COMPF..NSATION In consideration of the performance of the services described herein, CITY agrees to pay PHYSICIAN,on a time and materials basis at the rotes specified in Cxbibit"R," nitnched hereto and incorporated by reference into this Agreement, a fee, including all costs and expenses, not to exceed Twenty-nine Thousand Nine-Hundred Dollars($29,900.00). 5. EXTRA WORK In the event CITY requires additional services not included in Exhibit "A", or changes in the scope of services described in Exhibit"A," PHYSICIAN will undertake such work only after receiving written authorization front CITY. Additional compensation for such extra work shall be allowed only if the prior written approval of CITY is obtained. I2-7 1871rMn Standard Contract-Revised 2 i i C. METHOD OF PAYMENT I PHYSICIAN shall be paid pursuant to the terms of Exhibit "B." 7. DISPOSITION OF PLANS ESTIMATES 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 those 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. HOLD HARMLESS PHYSICIAN hereby agrees to protect,defend,indemnify and hold harmless CITY, its officers, elected or appointed officials, employees, agents and volunteers from and against any and all claims,damages,losses,expenses,judgments,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 connection with PHYSICIAN's (or PHYSICIAN'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 willfltl 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 clainns and liability regardless of whether any insumnce polirks tire applicable. The pol icy limitsdo not act aslimitat ion upon the amountof!"denttifrcntion to be provided by PHYSICIAN. 12-3I8711ME Standard Contract- Revised 3 i 9. PROFESSIONAL LIABILITY INSURANCE � PHYSICIAN shall obtain and furnish to CITY a professional liability insurance policy covering the work performed by it hereunder. This policy shall provide coverage for PhIYSICIAN's professional liability in an amount not less than One Million Dollars � l ($1,000,000.00) per occurrence and in the aggregate. The above-mentioned insurance shall not contain a self-insured retentionwithout thecxpress written consentof CITY;howeveran insurance policy "deductible" of Ten Thousand Dollars ($10,000,00) or less is permitted. A claiuts-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 circumstances or incidents (lint 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 termiuntcd i for any reas0n,PHYSICIAN agrees to purchase an extended reporting provision of at least two(2) years to report claims arising from work performed in connection with this Agreement. If PHYSICIAN fails or refuses to produce or maintain the insuranco 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, at the CITY's election, to forthwith terminate this Agreement. Such terinination shall not affect PHYSICIAN's right to be paid for its time and materials expended prior to notification of termination. PHYSICIAN waives 12-318711M8 Standard Contract-Revised 4 i (the right to receive compensation and agrees to indemnify the CITY for any work performed prior to approval of insurance by the CITY. 10. CERTIFICATES OF INSURANCE 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 Agreement;the cettiticate 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 sucli 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 prenuum. PHYSICIAN shall maintain the foregoing insurance coverage in force until the work under this Agreement is fidly completed and accepted by CITY. The 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, the Premiums on the insurmnce lrereinabove require([ 11. INDPPENDENI'CONTRACTOR PHYSICIAN is, and shall be, acting M all times in the performance of this Agreement 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 end all payment of all taxes, 12.31871IME Standard Contract-Revised 5 i V social security, state disability insurance compensation, unemployment compensation and other i payroll deductions for PHYSICIAN and its officers, agents slid employees and all business licenses, if any, in connection with the PROJECT and/or the services to be performed hereunder. 12. TERMINATION OP AGREEMENT i . All work required hereunder shall be performed In a good and worlaninlike manner. CITY may terminate PHYSICIAN's services hereunder at any time with or without cause, and whether or not the PROJECT is filly 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 evidence shall, at the option of tine 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 tine work hereunder shall not be assigned, delegated or subcontracted by PHYSICIAN to any other person or entity without the prior express written consent of CITY. If an assignment, delegation or subcontract is approval, all nppioved assignees, delegates and subcontractors must satisfy the insurance requirements as set forth in Sections 9 and 10 hereinabove. 14. COPYRIGHTS/PATENTS CITY shall own all rights to any patent or copyright on any work, item.of material produced as a result of this Agreement. 15. CITY EMPLOYEES AND 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 ally 12-3187/IMF Standard Contract- Revised 6 i i financial interest in this Agreement in violation of the applicable provisions of the California avermncut Code. 16. NOTICES Any notices, certificates, or other communications hereunder shall be given either I i by personal delivery to PHYSICIAN's agent(as designated in Section I ha•einabove)or to CITY as the situation shall warrant,or by enclosing the same in it scaled envelope,postage prcpald,and depositing the same ill the United States 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 ntai I-return receipt requested: TO CITY: TO PHYSICIAN: 1 r City of Huntington Beach 0V'')"\qUQCe&c_ ATTN: Risk Manager ISIo2 Z V1.lW 6w. SL.t C- I01 2000 Main Street fus l tn ( C%Z-7XO Huntington Beach, CA 92648 17. CONSENT' When CPTY's consent/approval is required under this Agreement, its consent approval for one transaction or event shall not be deemed to be it consent/approval to any subsequent occurrence of the same or any other transaction or event. 18. MODIFICATION No waiver or modification of any language in this Agreement shall be valid unless in writing and duly executed by both panes. 1 2-7 1 8711ME Standard Contract- Revised 7 i 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 convenience of reference only and 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 or affect the consuvction or interpretation of tiny provision of this Agreement. 20. INTERPRETATION OF THIS 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 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 the remaining covenants 8nd 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 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 conslmed 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 within the requirements of the law. 21. DUPLICATE 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 12-9187/IME Standard Contract -Revised 8 i the date of its execution and delivery, be deemed an original Each duplicate original shall be deemed an original instrument as nguinsl 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, ill particular, comply with the provisions of the I United Scales 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 contemplated hereunder, PHYSICIAN understands that pursuant to flanlinglon Beach CI(t, Charter 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. 24. ATTORNEY'S PEES In the event suit is brought by either party to cotlsir'tle, interpret andlor enforce the terms and/or provisions of this Agreement or to secure the performance hereof, each party shall hear its own attorney's fees, such that the prevailing party shall not be entitled to recover its attorney's fees from the non-prevailing party. 25. SURVIVAL Terms and conditions of(his Agreement,which by their sense and context survive (Ire termination of this Agreement, shall so survive. 26. GOVERNING 1,AW This Agreement shall be governed and construed in accordance with the laws of the State of California. 12.9187/IMB Standard Contract-Revised 9 i i 27. SIGNATORIES Each undersigned represents and warrnnts that its signature herein below has the power, authority and right to bind their respective parties to each of the terms of this Agreement, I and shrill 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. I PHYSICIAN's initials 28. ENTIRETY The parties acknowledge and agree that they are entering into this Agreement freely and voluntarily following extensive arm's length negotiation,and that each has had the opportunity to consult with legal counsel prior to executing this Agreement. The parties also acknowledge and agree that no representations,inducements,promises,agreements or warranties,oral or otherwise, 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 Agreement in reliance on any representation, inducement, promise, agreement, wnrrnnty, fact or circumstance not expressly set forth in this Agreement. This Agreement,and the attached exhibits, contain the entire agreement between the parties respecting the subject matter of this Agreement and supersede all prior understandings and agreements whether oral or in writing between the parties respecting the subject matter hereof. 29. EFFF.CTIVEDATE I This Agreement shall be effective on the dale of its npproval 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 Bud through their authorized officers. i 1 2-7 1 8 711MC Standard Contract-Revised 10 i i i i PHYSICIAN fnY1 S. O CITY OF HUNPINGTON BEACH,a rrrdma reraa�rwAu■ municipal corporation of the State of California Sigyuhn ""Yr✓' 1 Y( LI� bii for of Human Resources APPROVED AS TO FORM: -V-Ply A W mey Receive and File City Clerk 12.7187AME Standard Contract-Rovised 1 t i PROFESSIONAL SERVICES CONTRACT 13ETWEE14 THE CITY Ot HUNTINGTON BEACH AND DQVitl 5. Kim , M, D. FOR INDEPENDENT MEDICAL EVALUATONS WITH RESPECT TO WORKERS' COMPENSATION CLAIMS I i � Table of Contents 1 Scope of 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 Contrnctor......................................................................................I.....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 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 Fees.........................................................................................................9 25 Survival....................................................................................................................9 26 Governing Law........................................................................................................9 27 Signatories................................................................................................................to 28 Entirely.....................................................................................................................to 29 Effective Date..........................................................................................................10 12-3187/75880 I i I I EXHIBIT"A" i STATEMENT OF WORK: I) ACE—COF.EXAMS(exams for the determination of industrial causation). 2) Evaluation 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 apportiomnent and need for future medical care. t 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 fill accordance with the standards defined by the Division of Workers' Compensation of the State of Califm•nin and the AMA Guides to the Evaluation of Permanent hupnirment,Fifth Edition. This requires a report of the injury, prior status,clinical chronology,current status, and past medical history. The physical examination j will document 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 be set within thirty (30)days of the date of appointment request,and (ii) prepare it 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. � i I I 12.3187n5860 i 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 au 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: 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: 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 au issue the parties asked the physician to address in a prior med-legal evaluation. 12-3187n5880 1 i i 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 of 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 of 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 ofthe 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. i 12-3187/75880 2 �,1P NORCAL MUTUAL! Certificate of Insurance Certificate Holder: Insured's Name and Address: Producer: David S Kim, MD David Sangpum Kim,MD 18102 Irvine Boulevard 181021rvine Boulevard Suite 107 Suite 107 Tustin,CA 97780 Tustin,CA 92780 Policy Number: 607769N Effective Date:01/01/2021 Expiration Date:01/01/2022 Insured Type: ® Named Insured ❑ Insured ❑ Locum Tenens Coverage A Type: ❑Shared Limits ©Separate Limits Specialty:Surgical Specialist(No Surgery) Important:This certificate certifies that the policy shown above has been Issued and Includes coverage for the Insured shown for the period indicated,subject to the policy's provisions and the required payment of premium.It Is not an insurance policy and is Issued for Informational purposes only. It confers no rights upon the certificate holder and does not create a contract between NORCAL Mutual Insurance Company(NORCAL Mutual)and the certificate holder, nor does it amend,extend,or alter the policy's coverage.Notwithstanding any requirement or provision of any contract or other document with respect to which this certificate may be issued or may pertain,the insurance afforded bythe policy is subject to the provisions of the policy. The Insured is responsible for informing certificate recipients of any policy changes,including declination of Issuance or cancellation before the expiration date.An Insured's failure to provide such notice imposes no obligation or liability of any kind upon NORCAL Mutual,Its agents or representatives. Coverages and Limits of Coverage Provided APP OVED AS TO FORM Coverage A"Medical�P�mfessllanaal Limits of Coverage: _ [ lJatiilliylns�urance=Ualms_Made/ By _ ---- -- MICHAEL E. GATES Retroactive Date: 11/02/1992 $1,000,000 Each Claim limit /Ll C1TY ATTORNEY CITY OF HUNTINGTON BEA31 $3,000,000 Aggregate Limit Per Policy Period Coverage B:Administrative Limits of Coverage: Defense Insurance-Claims Made Retroactive Date: 11/02/1992 $50,000 Each Administrative Proceeding or Employment-Related Civil Action Limit $50,000 Aggregate Limit Per Endorsement Period Coverage C:Information and Limits of Coverage: Network Security Insurance- Clalms Made Retroactive Date: 11/02/1992 $100,000 Each Claim,Regulatory Privacy Proceeding,or Loss Limit $100,000 Aggregate Limit Per Endorsement Period By:NORCAL Mutual Insurance Company Date Issued: November7,2020 T.Scott Diener Kellie N.Sorenson President& CEO Secretary HCPCOI-001 Page 1 of 1 12/01/2014 575 MARKET SrREEI,SUITE 1000,SAN FRANCISCO,CA 94105 T WANORCAL NORCALMUTUALCOM