HomeMy WebLinkAbout[04b] Work Comp DeductibleCM OF MT.3c )KkrR
MEETING DATE: June 2, 2011
4(b)
Council Agenda Item
AGENDA ITEM: Work Comp Deductible — Requested Action: Assign the
Workers Compensation deductible at $ 2,500 per occurrence and select coverage.
SUBMITTED BY:
Administration /Finance
BOARD /COMMISSION /COMMITTEE RECOMMENDATION:
PREVIOUS COUNCIL ACTION: Annually the City Council must establish the deductible per occurrence
for the Worker's Compensation Policy. Over the past couple of years the City has opted for a $ 2,500
deductible per occurrence. The Council has annually adopted to select coverage for elected and
appointed commissioners that serve on the EDA, Planning Commission and Park Board.
BACKGROUND INFORMATION: If the City elects a $ 2,500 the premium is reduce by 7.5% with an
estimated premium before reduction of $ 50,864. During the last premium cycle the City did not pay
more the $ 750 in deductible. The deductible is effective and staff is recommending continuation of the
$ 2,500 deductible.
BUDGET /FISCAL IMPACT: $ Reduction in Work Comp Premium of 7.5%
ATTACHMENTS: Request for Council Action ....... ............................... 8(c)•1 -2
Coverage Information .............. ............................... 8(c):3 -6
REQUESTED COUNCIL ACTION: Authorize staff to notify the insurance carrier of establishing the Work
Comp Deductible at $ 2,500 per occurrence and to provide coverage for elected and appointment
commission /board members.
4(b) :1
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4(b):2
League of M illuiesota Cities Insurance Trust
Group Self - Insured Workers' Compensation Plan
145 University Avenue West
St. Paul, MN 55103 -2044
RENEWAL DATA
The "City:"
ST JOSEPH, CITY OF
25 1ST AVE. N.W., BOX 668
ST. JOSEPH MN 56374-
Agreement No.:
Quote To:
Quote Due On:
Agreement Expires:
0200005030
7/01/11
8/08/11
Your coverage under the LMCIT Self- Insured Workers' Compensation program will expire soon. This Renewal Data sheet will be
used to generate a premium quote for the different workers' compensation plans available. A copy of the City's previous year's
selected coverages and premiums is attached for your reference.
Coverage O ptions
All of the options available to the City are outlined below, and described in the accompanying memo, Things to Think About When
Renewing Your City's Workers' Compensation Coverage. You can select any coverage options in which the City may be interested.
Premium quotes for all coverage options will be provided, and a final coverage decision can be made at the time you receive the
complete quote.
Elected Officials: Please indicate if the City would be interested in covering elected officials. Yes No
If yes, please list the estimated annual payroll for all elected officials the City would like to cover under workers' compensation.
The 2011 premium rate for mayors and council members is $ .24 per $100 of payroll. This rate is applied to the greater of either
the official's actual salary or an imputed salary of $70 per week. Note: Coverage for elected officials requires a resolution passed
by the City Council.
Payroll Description Code Amount
Elected Officials 9411 $
Members of Separate Administrative Boards: Please indicate if the City would be interested in covering members of separate
administrative boards. Yes No
If yes, please select any separate administrative boards the City would like to cover under workers' compensation. (This coverage
includes Board Members only.)
1. Utility or utility commission 5. Welfare or public relief agency
2. Port authority 6. School board -
3. Housing and redevelopment authority 7. Joint powers board
4. Hospital or nursing home board or commission 8. Other
Employees of Separate Administrative Boards: If the City has elected to cover specific Board Members above, the City can also
choose to cover employees of those boards. Please indicate which type of quote the City would like:
No quote for administrative board employees.
Combined quote to include employees of both the administrative board and the City.
Separate quote for employees of the City and each administrative board selected above.
Volunteers: Attached to this Renewal Data sheet is a memo, Accident Coverage for City Volunteers. If the city would like to cover
City volunteers, not designated as employees, and members of advisory boards and comittees, please review the memo that outlines .
the various options.
How does the city obtain a quote?
Please complete the attached application and send to LMCIT.
4(b):3
(over) LM4684 (01 /11)
League of Minnesota Cities Insurance Trust
Group Self-Insured Workers' Compensation Plan
145 University Avenue West St. Paul, MN 55103 -2044 Phone (651)215 -4173
Information Page
1. The "City" RENEWAL Agreement No.: 0200005030
ST JOSEPH, CITY OF
25 1ST AVE. N.W., BOX 668 'City" is: x City
ST. JOSEPH MN 56374 -0668 _ Joint Powers Entit!
Other (describe)
2. The Agreement Period is from 12:01 a.m. 8/08/2010 to 12.01 a.m. 8/08/2011 at the "City's" address.
3. A. Workers' Compensation Coverage: Part One of the Agreement applies to the Workers' Compensation Law of any state
of the United States of America and the District of Columbia.
B. Employers Liability Coverage: Part Two of the Agreement applies to work in each state listed in item 3.A.
The limits of our liability under Part Two are: Bodily Injury-Each Occurrence $1,500,000
Bodily Injury by Disease - Agreement Limit $1,500,000
C. Part Three of the Agreement applies to Infectious Disease Diagnostic Testing.
D. Part Four of the Agreement applies to Peace Officers' Posttraumatic Stress Syndrome Benefit.
E. This Agreement includes these amendments and schedules:
LM4660(01/10) LM4670(01/10) LM4680(08/99)
4. Retro- rating option selected? Yes x No
5. Elected Officials Covered? Yes Boards and Commissions Covered (List)
LM4681(01107)
PARK BOARD, PLANNING COMMISSION & EDA
6. The premium for this Agreement will be determined by our Manuals of Rules, Classifications, Rates and Rating
Plans. All information required below is subject to verification and change by audit.
Premium Basis Rates Entries in this item, except as specifically provided Estimated
Estimated Total Per $100 of Code elsewhere in this Agreement; Do not modify any of the Annual
Annual Remuneration No. other provisions of the Agreement Premium
Remuneration
Agent: 203949310 799.84
90045 OMANN INSURANCE AGENCY LLC
305 E CEDAR ST
PO BOX 608
ST JOSEPH MN 56374
SEE ATTACHED SCHEDULE FOR DETAILS
Manual Premium
49083.
Experience Modification .97
1472.
Standard Premium
47611.
Deductible Credit 7.5%
3571.
Premium Discount
4048.
Net Deposit Premium
39992.
4(b) :4
7/30/2010 LM4670 (12/99)(Rev.01
League of Minnesota Cities Insurance Trust
Group Self- Insured Workers' Compensation Plan
145 University Avenue West
St. Paul, MN 55103 -2044
(651)215 -4173
The "City' Agreement No.: 0200005030
Agreement Period From: 8/08/2010
ST JOSEPH, CITY OF To: 8/08/2011
25 1ST AVE. N.W., BOX 668
ST. JOSEPH MN 56374 -0668
CONTINUATION SCHEDULE FOR INFORMATION PAGE
REMUNERATION
RATE
CODE
DESCRIPTION
EST. PREM
125895.
7.90
5506
STREET CONSTRUCTION
9946.
96515.
4.03
7520
WATERWORKS
3890.
84945.
3.45
7580
SEWAGE DISPOSAL PLANT
2931.
POP 8880.
102.49
7718
FIREFIGHTERS(VOL)NON SMOKING
9101.
483965.
3.45
7721
POLICE -NON SMOKING
16697.
1500.
2.21
7722
POLICE RESERVES
33.
305890.
.80
8810
CLERICAL OFFICE EMPLOYEES NOC
2447.
3000.
4.15
9016
SKATING RINK OPERATION
125.
82600.
3.65
9102
PARKS
3015.
4000.
.58
9410
MUNICIPAL EMPLOYEES
23.
36395.
.25
9411
ELECTED OR APPOINTED OFFICIALS
91.
13240.
3.84
7600
CABLE TV COMPANY
508.
3815.
3.65
9102
DUMPSTER HELPER
139.
54600.
.25
9411
BOARDS COMMISSIONS
137.
Manual Premium
49083.
Agent: 203949310
90045 : OMANN INSURANCE AGENCY LLC
305 E CEDAR ST
PO BOX 608
ST JOSEPH MN 56374
7/30/2010
4(b):5
LM4680 (8199)
League of Minnesota Cities Insurance Trust
Group Self-Insured Workers' Compensation Plan
145 University Avenue West St. Paul, MN 55103 -2044 Phone (651)215 -4173
DEDUCTIBLE ENDORSEMENT
The "City"
ST JOSEPH, CITY OF Agreement No.: 0200005030
25 1ST AVE. N.W., BOX 668 Agreement Period:
ST. JOSEPH MN 56374 -0668 From: 8/08/2010
To: 8/08/2011
In consideration of the Estimated Deductible Premium, We agree with you that:
I. This agreement is between you and us. It does not change the rights of others under this Agreement.
2. A Deductible Per Occurrence of $ 2,500.00 in medical benefits because of bodily injury arising out of
any one accident or disease applies to this Agreement. The amount indicated above as a Deductible Per Occurence
applies separately to each accident or disease, regardless of the number of people who sustain injury by such
accident or disease.
3. We will pay the deductible amounts shown above for you but you must reimburse us within 30 days after we send
you notice that payment is due. If you fail to fully reimburse us, we may cancel the Agreement as provided in Part
Seven (Conditions), Section F. Cancellation, of the Agreement. We may keep the amount of unearned premium that
will reimburse us for the payments we made. These rights are in addition to other rights we have to be reimbursed.
4. This endorsement applies only to the coverage provided by Part One -- Workers' Compensation Coverage of the
Agreement.
5. We shall provide investigation, administration, adjustment and settlement services, and shall provide for the defense
of claims or suits.
6. We have your rights and the rights of persons entitled to the benefits of this coverage to recover all advances and
payments, including those within the deductible amount, from anyone liable for the injury or obligated to make
payments regarding the injury. You will do everything necessary to protect those rights for us and to help us enforce
them.
If we recover any advance or payment made under this Agreement from anyone liable for the injury, the amount we
recover will first be applied to any payments made by us in excess of the deductible amount paid.
7. Each Named City is jointly and severally liable for all deductible amounts under this Agreement.
8. All other terms of this Agreement, including those which govern (a) our right and duty to defend any claim,
proceeding or suit against you, and (b) your duties if injury occurs, apply.
Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, provisions,
agreements or limitations of the above mentioned Agreement, other than as stated above.
* Agency Name and Address
203949310
OMANN INSURANCE AGENCY LLC
305 E CEDAR ST
PO BOX 608
ST JOSEPH MN 56374
4(b):6
LM4681 (11 /98) (Rev.01 i