City Commission Policy 200 - Claims Settlement Policy
DEPARTMENT: Treasurer-Clerk
DATE ADOPTED: October 1, 1986
DATE OF LAST REVISION: May 24, 1995
200.01 Authority: This policy adopted by the Tallahassee City Commission on October 1, 1986 and becomes effective immediately upon such adoption.
200.02 Scope and Applicability: This policy, and the procedures implemented to accomplish its objective, shall be applicable to all third-party claims brought against the City covered under the self-insured automobile and general liability program established by the City Commission effective October 1, 1986.
200.03 Policy Statement: It is the policy of the City of Tallahassee to promptly respond to and investigate all claims for personal injury and/or property damages filed as third-party actions against the City. The City, through its Risk Management Office, shall implement a claims administration process that resolves each claim by payment of fair and equitable compensation for those claims the City is determined to be liable for and denial and defense of those without merit and liability.
200.04 Procedures:
All claims filed against the City shall be investigated initially within the City Risk Management Office. After a determination is made as to actual involvement of City operations and the likelihood of liability exposure, claims are assigned to the City's Third-Party Claims Administrator. As prescribed and defined within this policy and the City's contract with the Claims Administrator, they shall complete full investigation and handle each claim as appropriate up to and including negotiating and settlement of all claims with merit.
The Claims Administrator shall make final determinations as to the merits of each claim. If the investigation fails to support the claims allegation of negligence of the City, the claimant is notified of the denial of their claim and damages demanded. Claimants, if they so choose, may pursue the denial of any claims through the courts. Should this final step of resolution be necessary, the City Attorney shall coordinate and defend the City's position up to and including civil trial.
All claims, as determined by the Claims Administrator, that are found to be meritorious shall be negotiated and settlement made as authorized by this policy and incorporated into the City Claims Administration Contract.
Claims settlement limits are established by this policy to define the Levels of authority for settlement given to the Claims Administrator, City staff and the City Commission.
Sewer Back-up Claim Procedures:
- When a sewer back up occurs on the City maintained portion of the service or main and unless the cause can be attributed to some definitive third party, the City will cover the clean-up costs associated with the back-up which occurred inside the building. This coverage shall apply to both commercial and residential exposures.
- Claims resulting from rising water, whether mixed with sewage or not, will not be covered by the City. This lack of coverage shall not restrict or limit the City's Wastewater Division from responding to and sanitizing or treating such affected areas as they deem necessary and appropriate.
- Property damage claims shall be adjusted on an actual cash value basis (replacement cost less depreciation) by the City's TPA. Only direct damage resulting from the back up will be considered, with the TPA having the option to repair or replace damaged items at their discretion and consistent with standard insurance policy and practice.
- The City will pay for up to four (4) days of reasonable food and lodging expenses when a residence is inhabitable as determined and authorized by the City's TPA consistent with current standard insurance policy and practice. No further additional living expenses or loss of use expenses will be covered. This coverage (per diem) shall not extend to commercial exposures.
- The City's responsibility for each back up claim shall not exceed the actual costs of direct structural damage including carpet replacement (flooring) that is necessary to make the dwelling/building inhabitable as determined by the City's TPA.
The City's responsibility for each back up relative to contents that suffer direct damage from sewage shall not exceed the lesser of actual damages or $10,000 per occurrence.
- Any payments by the City shall be made only to the extent that the loss exceeds any purchased coverage that a claimant may have.
This entire policy does not of course apply to situations where the City is either negligent or otherwise obligated by law to pay such claims.
200.05 Settlement Authority:
A. Liability Claims:
The Claims Administrator shall determine the City's percentage of liability in all claims found to have merit. They shall negotiate and make settlement for all such claims as authorized by this policy as prescribed herein.
Level I - The Claims Administrator is authorized to negotiate and make settlement of all liability claims up to $15,000 per claim.
Level II - The Claims Administrator is authorized to negotiate and make settlement of all liability claims up to $25,000 with the review and approval of the City's Risk Manager.
Level III - The Claims Administrator is authorized to negotiate and make settlement of all liability claims between $25,000 and up to $50,000 upon review and approval of the City's Liability Oversight Committee (LOC). The committee shall consist of the City Attorney, City Manager, City Treasurer-Clerk, Director of OMB and Director of the department involved in the claim. Review and approval at this Level requires a quorum of LOC members present for action to be taken.
Level IV - All claims reviewed at Level III which are recommended for settlement in excess of $50,000 shall be agendaed and brought before the City Commission for final approval and authorization.
Level V - SETTLEMENT OFFERS AT TRIAL - Prior to trial on any claim, the Risk Manager/City Attorney may, by agenda request, jointly seek a pre-authorized settlement authority above the $50,000 limit. Often, developments at and during trial may encourage a settlement offer by either party. Since a recess by the court for any extended period is highly unlikely, City staff would be unable to agenda a request for such authority. This process maximizes the City's options and position for resolution up through this final step allowed in civil procedures.
B. Workers' Compensation Claims:
The Claims Administrator shall determine the compensability of each workers' compensation claim filed. They shall adjust the claim and make any and all payments required and/or deemed necessary in accordance with Florida Statute 440 and applicable case law. If the City and the claimant (employee) decide that a lump sum settlement is in their best interest, such settlement shall proceed as follows:
Level I - The Claims Administrator is authorized to negotiate and make settlement and/or payments on all workers' compensation claims up to $15,000 per claim.
Level II - The Claims Administrator is authorized to negotiate and make settlement and/or payments on all workers' compensation claims up to $25,000 with the review and approval of the City's Risk Manager.
Level III - The Claims Administrator is authorized to negotiate and make settlement and/or payments on all workers' compensation claims exceeding $25,000 with the review and approval of the Workers' Compensation Oversight Committee (WCOC). This committee shall consist of the City Treasurer-Clerk, City Attorney, City Manager or their representative(s), the Risk Manager and the Workers' Compensation Adjuster.
200.06 Administration: The City Treasurer-Clerk, through the Risk Management Office, shall be responsible for administering, updating and revising this policy as required. Any substantial changes, additions or deletions shall be approved by the City Commission.
200.07 Sunset Review: This policy shall be reviewed annually by the Risk Management Office and is subject to sunset review on October 1, 2000.
Revisions:
July 17, 1991
December 7, 1994
May 24, 1995