Rolling Contractor Controlled Insurance Program INSURANCE ... · Rolling Contractor Controlled Insurance Program INSURANCE Manual ARIZONA RCCIP AZ Insurance Manual (08/03) Page 1

Rolling Contractor Controlled Insurance Program

INSURANCE Manual

ARIZONA

RCCIP AZ Insurance Manual (08/03) Page 1 of 23

TABLE OF CONTENTS

INTRODUCTION 3 DIRECTORY 4 DEFINITIONS 5 CONTRACTOR REPONSIBILITIES 7 INSURANCE COVERAGES PROVIDED IN THE RCCIP 8 INSURANCE COVERAGES NOT PROVIDED IN THE RCCIP 11 ADMINISTRATION OF THE RCCIP 15 SAFETY AND LOSS CONTROL PLAN 18 CLAIMS 19 RCCIP FORMS 23


INTRODUCTION The Austin Commercial (Austin) Rolling Contractor Controlled Insurance Program (RCCIP) is an ongoing consolidated insurance program under which Worker’s Compensation, Employer’s Liability, Commercial General Liability, and Excess Liability (described herein) are centrally procured and provided on a project basis for all contractors who have been properly enrolled while performing operations at project sites. The RCCIP produces several advantages including: • Providing broad and uniform insurance protection; • Providing extended completed operations coverage; • Providing a single coordinated safety, loss prevention and claims handling program; • Reducing potential litigation between contractors. Generally, the insurance coverages and limits provided are broader than are normally available under a contractor’s individual program. Benefits are gained by using one insurance carrier in administering loss control activities and claims. This minimizes the possibility of confusion and conflict among insurance carriers in the event of a loss and minimizes inter-company litigation in an attempt to determine ultimate responsibilities. By reducing extensive and expensive litigation through the use of one insurer, the contractors are spared the expense of tying up key personnel for extended periods of time. This manual: • Identifies, defines and assigns responsibilities related to the administration of the RCCIP; • Describes the RCCIP and details the insurance-related responsibilities of the various parties

involved; • Does not and is not intended to provide coverage interpretations. The terms and

conditions of the policy alone govern how coverage is applied. • Will be updated as changes dictate during the course of this project. The information herein is not intended to alter any provisions of the actual contract documents of the contractors, including insurance provisions, and if such conflict occurs, the contract documents and policies of insurance will govern.


DIRECTORY

ADMINISTRATION: RCCIP SPONSOR: Austin Industries/Austin Commercial Phone: (214) 443-5700 P.O. Box 2879 Dallas, Texas 75221-2879 RCCIP MANAGEMENT: Austin Service Center Phone: (214) 443-5784 Fax: (214) 224-4366 E-mail: [email protected] Carolyn Downing Manager – Service Center / Claims Staci Johnson Manager - RCCIP RCCIP INSURANCE BROKER/AGENT: Willis Phone: (972) 385-9800 One Galleria Tower Phone: (800) 445-0115 13355 Noel Road, Suite 400 Fax: (972) 386-5561 Dallas, Texas 75240-6643 Bonnie Edwards - Insurance Manager Phone: (214) 749-3367 Fax: (214) 749-3641 Mobile: (214) 215-0554 E-mail: [email protected] CLAIMS: Crawford & Company Phone: (602) 216-9422 x125 Third Party Administrator (TPA) Fax: (602) 216-9478 PO Box 26981 E-mail: [email protected] Phoenix, Arizona 85068 Shirley Allen – TPA Claims Manager


mailto:[email protected]

mailto:[email protected]

DEFINITIONS

Awarding Contractor Any contractor who awards or sublets a contract to another contractor (tier contractor).

Austin Service Center (ASC)

Located in Dallas, Texas. The ASC manages all administrative and claim paperwork for the RCCIP.

Certificate of Insurance

Written evidence, issued by an insurance agent or carrier, indicating that specified insurance policies and coverages are in place at the time that the certificate is issued. Certificate does not amend, extend or alter the coverage afforded by a policy.

Construction Safety Program

The safety and loss prevention program established by Austin to control the hazards and risks.

Contractor All contractors, including construction managers, prime contractors,

general contractors and subcontractors at all tiers that perform work on the project site.

Contractor’s Project Manager

The person who has the overall responsibility to see that the work is completed satisfactorily.

Contractor’s Safety Manager

A full time on-site safety professional employed by the contractor to manage the contractor’s safety effort. Safety Manager will have a minimum of three years hands-on construction experience, plus one-year experience in construction safety or equivalent training as determined by Austin.

Contractor’s Safety Representative

A contractor’s on-site employee hired to perform various tasks, including safety and other related duties.

Crawford & Co. The entity that will serve as the Third Party Administrator (TPA) for the

RCCIP. Enrolled Contractors

Enrolled contractors include all contractors providing direct labor on the Austin RCCIP project site. Temporary labor services and leasing companies are contractors.

Insured Austin and contractors who are properly enrolled in the RCCIP and who

have been named on a policy or certificate of insurance signed by a duly authorized representative of the insurers.

Insurer(s) All insurance companies participating in the RCCIP.


Loss Control Representative (Insurance Rep)

A representative from the insurance company involved in field safety program auditing.

Modified Duty Program

A RCCIP program where health care providers and physicians treating injured workers will prescribe work restrictions for injured workers rather than prescribing days away from work.

Non-Enrolled Contractors

The RCCIP does not cover factory representatives, suppliers, vendors, material dealers, guard services, janitorial services, truckers (including trucking to the project site where delivery is the only scope of work performed) and other temporary project services.

Occupational Safety and Health Administration (OSHA)

The federal government agency responsible for providing the rules and regulations on safety and health requirements in the work place.

On-Site Activities Those construction activities at the project site. The RCCIP does not

provide insurance coverage for permanent yards or other locations of any contractor unless specifically named in the policy and on file with the insurer.

Pre-task Planning Consists of implementing a written pre-task plan for each construction

activity from all contractors on a daily basis. Project Site Project site(s) as defined in contract documents, offsite office space,

offsite contractor parking, offsite storage areas and offsite staging areas as approved in writing by RCCIP Management.

Rolling Contractor Controlled Insurance Program (RCCIP)

An ongoing consolidated insurance program under which Worker’s Compensation, Employer’s Liability, Commercial General Liability and Excess Liability (described herein) are centrally procured and provided on a project basis for all contractors and subcontractors who have been properly enrolled, while performing operations at project sites.

RCCIP Insurance Broker/Agent

Willis

Subcontractor A contractor that has a subordinate relationship to another contractor.

Also, referred to as a tier contractor. Tier Contractor A contractor that has a subordinate relationship to another contractor.

Also, referred to as subcontractor. Third Party Administrator (TPA)

The entity that performs all RCCIP claims-related duties traditionally performed by an insurance carrier. Examples of such duties include, but are not limited to management of the loss escrow fund, payment of bills invoiced by medical providers, ordering Independent Medical Examinations, auditing medical bills for conformance with the approved fee schedule, payment of Workers’ Compensation benefits and settlement of liability claims.


CONTRACTOR RESPONSIBILITIES

Contractors are required to cooperate with all parties listed on the directory pages under "Administration" and "Claims" concerning the administration and operation of the RCCIP. The contractor’s responsibilities include, but are not limited to: • Inclusion of the RCCIP provisions in all contracts at any tier. RCCIP coverage is not

automatic. Contractors must be properly enrolled in the RCCIP to receive coverage and before access to the project site is allowed. To be enrolled properly in the RCCIP, all contractors must submit the RCCIP enrollment documents (refer to Administration/Enrollment section).

• Immediate notification to the Austin project staff of all contracts awarded. • Maintain accurate records of payroll for operations at the project site and other records as

necessary for premium computation and other reports. • Compliance with applicable insurance administration, claims reporting and safety and loss

control guidelines.


INSURANCE COVERAGES PROVIDED IN THE RCCIP

Austin sponsors a Rolling Contractor Controlled Insurance Program (RCCIP) to furnish certain insurance coverages (described herein) for on-site activities. The RCCIP is only for the benefit of Austin and all contractors who have been properly enrolled in the RCCIP. Such coverage applies only to work performed under agreements at the project site and all enrolled contractors must provide their own insurance for off-site activities. The RCCIP does not cover non-enrolled contractors. Non-enrolled contractors are required to maintain their own insurance with coverages and minimum limits required in their respective contracts. RCCIP coverage is not automatic. Contractors are not covered under RCCIP until they have been properly enrolled. Contractors must be properly enrolled before access to the project site is allowed. The RCCIP is not intended to meet all the insurance needs of an enrolled contractor. Contractors should discuss the RCCIP with their insurance agents or brokers to assure that other proper coverages are maintained. The contractor’s agent or broker should also be notified that the project will be constructed under Austin’s RCCIP. The intent of this notification is to inform the contractor’s standard program underwriters that the insurance coverages provided under the RCCIP are primary on the project site. However, any contractor who elects to endorse its standard program coverages to apply as excess and/or difference in condition over the RCCIP coverages shall do so at no expense to Austin. The RCCIP policies are available for review by enrolled contractors upon request to Austin Commercial. The terms of such policies or programs, as such policies or programs may be from time to time amended, are incorporated herein by reference. The Contractor hereby agrees to be bound by the terms of coverage as contained in such insurance policies and/or self-performed programs. SPECIAL NOTES: Effect on Future Experience Modification: All payroll and loss experience incurred by each enrolled contractor will be reported to the appropriate rating authorities and used in the normal manner for calculating future experience modifiers for each contractor. After an enrolled contractor has completed work at the project site, that contractor will no longer be provided with RCCIP coverages. Any warranty work or other miscellaneous work after completion is performed under the contractor’s own insurance coverages (approved by Austin) and not those provided by the RCCIP.


INSURANCE PROVIDED - ENROLLED CONTRACTORS

I. WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY INSURANCE Carrier: St. Paul Fire & Marine Insurance Company Scope of Coverage:

A. Limits

1. Workers’ Compensation-Statutory Limits 2. Employer’s Liability

$1,000,000 Bodily Injury by Accident, Each Accident $1,000,000 Bodily Injury by Disease, Policy Limit $1,000,000 Bodily Injury by Disease, Each Employee

B. Coverages

Benefits as prescribed by statutes for enrolled contractors' and subcontractors' employees who incur a compensable occupational injury or illness while performing work at the job site. The policy will contain a waiver of subrogation in favor of contractors and subcontractors of every tier. Each contractor will receive a separate policy. Off-site operations are excluded.

II. COMMERCIAL GENERAL LIABILITY INSURANCE Carrier: St. Paul Fire & Marine Insurance Company Scope of Coverage:

A. Limits

$4,000,000 General Aggregate/Per Project/Reinstated Annually. $4,000,000 Products and Completed Work Total Limit/Reinstated Annually for Project

term.* (Completed Operations) $2,000,000 Personal and Advertising $2,000,000 Each Event Limit $1,000,000 Premises Damage Limit (any one fire) * Products and Completed Work Total Limit coverage will be extended for 10 years from

completion of each project. B. Coverages

St. Paul Commercial General Liability Protection Coverage Form 47500 Ed. 1-96 Occurrence Basis. Covers third party bodily injury and/or property damage claims resulting from construction at the project sites. Additional insureds include all enrolled contractors and subcontractors of every tier. The policy will contain a waiver of subrogation in favor of contractors and subcontractors at every tier. Off-site operations are excluded.

C. Maintenance Deductible

Property damage claims on Austin RCCIP projects shall be subject to a maintenance deductible of $1500, payable by the contractor filing the claim.


INSURANCE PROVIDED - ENROLLED CONTRACTORS III. EXCESS LIABILITY INSURANCE Lead Excess Carrier: St. Paul Fire & Marine Insurance Company – Commercial

Umbrella Excess Liability Protection Form

Scope of Coverage

A. Limits

$25,000,000 Annual General Total Limit (Per Project) $25,000,000 Products and Completed Work Total Limit * (Completed Operations) $25,000 000 Each Event Limit * Products and Completed Work Total Limit includes an extension for 10 years from

completion of each project with one reinstatement. B. Coverages

Coverage will follow form with primary RCCIP Commercial General Liability and Employer's Liability coverage. Off-site operations are excluded.

Excess Carrier: Allied World Assurance Company, Ltd. Scope of Coverage:

A. Limits

$25,000,000 General Total Limit (Per Project) $25,000,000 Products and Completed Work Term Limit * (Completed Operations) $25,000,000 Each Event Limit * Products and Completed Work Total Limit includes a 10 year extension.

B. Coverages

Coverage in excess of lead St. Paul Umbrella/Excess Liability policy and underlying insurance. Off-site operations are excluded.


INSURANCE COVERAGES NOT PROVIDED IN RCCIP

ENROLLED CONTRACTORS

FOR ANY WORK UNDER THIS CONTRACT UNTIL COMPLETION AND FINAL ACCEPTANCE OF THE WORK, ALL ENROLLED CONTRACTORS, AT THEIR OWN EXPENSE, ARE REQUIRED TO HAVE THE FOLLOWING COVERAGES IN FORCE. I. WORKERS’ COMPENSATION AND EMPLOYER’S LIABILITY INSURANCE (For Off-Site

Operations) A. Contractors shall provide, at their own expense, Workers’ Compensation to cover full

liability under the laws in which the project is located and shall provide the statutory limits required by said laws.

B. Contractors shall provide, at their own expense, Employer’s Liability with the following

minimum limits of liability: $1,000,000 Bodily Injury Each Accident $1,000,000 Disease-Policy Limit $1,000,000 Disease-Each Employee C. This policy shall be endorsed to include a waiver of subrogation in favor of Austin and

other entities as required by the prime contract and will show evidence of coverage by endorsement on the face of the certificate of insurance.

II. COMMERCIAL GENERAL LIABILITY INSURANCE (1993 ISO form or its equivalent) A. Contractors shall provide, at their own expense, Commercial General Liability

Insurance, on an “occurrence” basis, including insurance for premises and operations, independent contractors, products-completed operations, and contractual liability. The insurance required by this paragraph shall be in limits not less than the following:

$1,000,000 General Aggregate $1,000,000 Products-Completed Operations Aggregate $1,000,000 Personal and Advertising Injury $1,000,000 Each Occurrence $50,000 Fire Damage (any one fire) $5,000 Medical Expense (any one person) B. This required policy shall be endorsed to name Austin and other entities as required

by the prime contract as additional insureds, utilizing form CG2010 (11/85 Edition) – Additional Insured – owners, lessees or contractors, or its equivalent and waive all rights of subrogation. Endorsement CG2503, amendment - aggregate limits of insurance - shall also be attached to the policy. Evidence of coverage by endorsement shall be shown on the face of the certificate of insurance.


INSURANCE NOT PROVIDED - ENROLLED CONTRACTORS III. AUTOMOBILE LIABILITY INSURANCE A. Contractors shall provide, at their own expense, Automobile Liability Insurance for

claims arising out of the use of a motor vehicle at, upon or away from the project site. The insurance shall cover all owned, non-owned and hired automobiles used in connection with the work, with the following minimum limits of liability:

$1,000,000 Each Accident Limit (bodily injury and property damage) B. This policy shall be endorsed to name Austin and other entities as required by the

contract as additional insureds, and will show evidence of coverage by endorsement on the face of the certificate of insurance and waive all rights of subrogation.

IV. EXCESS LIABILITY INSURANCE A. Contractors shall provide, at their own expense, Following Form Excess Liability

Insurance with coverages at least as broad as those of the primary policies set out in section-III above.

B. The Excess Liability Insurance shall be scheduled over all underlying primary liability

policies, with no break or gap in coverage or limits between them. $1,000,000 Each Occurrence $1,000,000 Each Aggregate V. AIRCRAFT LIABILITY INSURANCE Should the contractor use aircraft of any kind in connection with the project, the operator must maintain liability insurance naming the owner and respective contractors as an additional insureds with primary and non-contributory wording. In addition, the limit of liability must be satisfactory to Austin in a minimum amount of $5,000,000 per occurrence, Combined Single Limit for Bodily Injury and Property Damage including passenger liability.


INSURANCE NOT PROVIDED - ENROLLED CONTRACTORS VI. MISCELLANEOUS Contractors shall provide to the RCCIP a Certificate of Insurance setting out the above coverages and limits on the certificate. The certificate shall state that the policies required by this RCCIP Insurance Exhibit have been endorsed to provide that the insurers issuing the policies shall give Austin, (and all other entities as required by the prime contract) not less than 30 days prior written notice in the event of cancellation or change in coverage there under. All insurance required by the RCCIP (Form 140AZ) shall be maintained without interruption from the date of commencement of the work until acceptance of the work as scheduled in the subcontract agreement. The insurance requirements set out in the RCCIP (Form 140AZ) are independent from all other obligations of Subcontractor under this agreement and apply whether or not required by any other provision of this agreement. Coverage must be with an insurance carrier having an A-VII rating or higher from A.M. Best or an equivalent rating group or a financial size acceptable to Austin. Providing false or misleading information may subject the provider thereof to administrative penalties, criminal penalties, civil penalties or other civil actions under law.


INSURANCE COVERAGES NOT PROVIDED IN RCCIP (Con’t)

NON-ENROLLED CONTRACTORS

ALL NON-ENROLLED CONTRACTORS, AT THEIR OWN EXPENSE, ARE REQUIRED TO HAVE INSURANCE COVERAGES IN ACCORDANCE WITH THEIR SUBCONTRACT AGREEMENT.


ADMINISTRATION OF THE RCCIP Administration is an integral part of the success of the RCCIP. To properly manage the RCCIP, the following guidelines must be followed:

ENROLLMENT

The Austin project staff will provide copies of the RCCIP Insurance Manual as an exhibit to the subcontract agreement to all first tier contractors who are awarded work on the project site. Each contractor shall be responsible for furnishing the Insurance Manual and obtaining all completed forms from its lower tier subcontractors. RCCIP coverage is not automatic. Contractors must be enrolled properly in the RCCIP to receive coverage before access to the project site is allowed. All enrollment documentation should be transmitted to the Austin Service Center (ASC).

Contractors awarded work on the RCCIP shall provide:

• Enrollment Form (Form 130AZ): enrolls each contractor in the RCCIP. Contractor’s insurance policy declarations and rate sheets for workers’ compensation / employer’s liability and commercial general liability insurance policies.

•

• Certificate of Insurance (Form 140AZ): workers’ compensation / employer’s liability (off site), commercial general liability, excess liability, and automobile liability.

Austin will enroll all contractors that have been issued a subcontract or purchase order. If the project manager is authorized and elects to waive the requirement for a contractual agreement, RCCIP enrollment is still required for subcontractors and/or vendors who are providing permanently incorporated materials. If a contractor will be using a leasing company to carry and administer their workers’ compensation policy and/or provide employees, the leasing company must be enrolled in the RCCIP as well. The leasing company will be subject to normal enrollment guidelines. Contractors shall price all work (including change orders) to EXCLUDE normal insurance cost and premiums. The final insurance cost will be subject to review and audit of actual insurance policy(ies) rate information, actual payrolls and revenues for the initial contract amount, plus any change orders. Austin will have the right to recover all costs that are in addition to those initially declared by the contractors. Austin will recover these costs through a deductive change order. Once a contractor is enrolled, should its succeeding policy rates increase or decrease upon renewal, Austin has the right, but not the obligation, to recalculate the contractor’s insurance premium based on the effective renewal dates. All contractors should contact their insurance agents or brokers for assistance in completing the Enrollment Form (Form 130AZ) if necessary. Failure to provide complete enrollment documentation within 14 calendar days of the enrollment date will result in contractor payments being withheld. The Documents Needed to Release Payment (Form 170AZ) will be transmitted to contractors identifying deficient enrollment items. Notices concerning lower-tier contractors will also be transmitted to the awarding contractor. Contractors re-enrolling on subsequent RCCIP projects shall provide:

• Enrollment Form (Form 130AZ): site specific information for the new project is required. • Contractor’s insurance policy declarations and rate sheets will be required if the contractor’s

insurance policies have renewed since original enrollment .


• Certificate of Insurance (Form 140AZ): a new certificate for re-enrollment is required if the previous certificate contains project specific language, or if the previous master certificate has expired.

Upon receipt of all required enrollment forms and supporting documents Willis will issue a certificate of insurance providing evidence of the RCCIP coverages.

MONTHLY PAYROLL REPORTS Payroll must be submitted to the ASC using the Monthly Site Payroll Report (Form 160AZ). Payroll reporting periods end with each calendar month. Payroll reports are due to the ASC by the fifth day following the reporting month (example: August payroll reports are due on September 5). First tier contractors should collect all sub-tier monthly reports and submit them collectively for the reporting period. Once a contractor begins the monthly payroll reporting process, zero dollar payroll reports are necessary should there be a month within the contractor’s schedule where there is no activity. ASC will notify contractors concerning delinquent reports, using the Documents Needed to Release Payment (Form 170AZ). Notices concerning lower-tier contractors will also be transmitted to the awarding contractor. Failure to provide this information will delay contractor’s payment. Monthly payroll reports may be submitted electronically, or by fax. For insurance purposes, each contractor agrees to keep and maintain an accurate record of payroll for operations at the project site. Contractors further agree to furnish Austin full and accurate payroll data and information in accordance with the requirements of the RCCIP. All contractors shall permit examination and/or audit of its books and records. All contractors will also provide any additional information to Austin as may be required.

CHANGE ORDERS Contractors shall price all change orders to EXCLUDE normal insurance cost and premiums. Contractors will complete a Change Order Worksheet (Form 177AZ) for every Austin Commercial issued change order. The completed form will be submitted to the ASC.

NOTICE OF WORK TERMINATION Upon completion of all work on the Project by a contractor, the contractor shall provide the information on the Notice of Work Termination (Form 180AZ) including all lower tier contractors. The Notice of Work Termination shall be transmitted to the ASC. ASC will communicate with Austin’s project staff to review the accuracy of the information. Once verified, ASC will transmit to Willis. Receipt of the Notice of Work Termination by Willis will initiate the closeout process for that contractor.

CLOSEOUT PROCEDURES Closing out of each contract as the contractor completes its work is a critical component of running the RCCIP program. No retainage should be released until the closeout has been completed. The basic steps of the closeout process are:

• ASC receives Notice of Work Termination (Form 180AZ) and transmits to Willis. • ASC contacts Austin project management to verify final contract amount.


• Willis will review contract and payroll information, and determine if the payroll received is

“reasonable” for the contract value. If the payroll is determined to be out of line, the contractor’s files will be reviewed to determine the reason for the variance. A physical audit may be required. Austin shall have the right to adjust the contractor’s final contract amount, accordingly.

• ASC notifies Austin project staff to procure proof of insurance coverage as RCCIP coverage is terminated, should a contractor need to return to the project site for punch list or warranty work.

Austin reserves the right to terminate or to modify the RCCIP or any portion thereof. To exercise this right, Austin shall provide 30 days advance written notice of termination or material modification to all contractors covered by the RCCIP. Each contractor shall promptly obtain appropriate replacement insurance coverage acceptable to Austin. Austin will reimburse the reasonable cost of such replacement insurance. Written evidence of such insurance shall be provided to Austin prior to the effective date of the termination or modification of the RCCIP.


SAFETY AND LOSS CONTROL PLAN

Austin is committed to an active and effective safety and loss control plan that will result in a safe workplace. The safety and loss control plan applies to all contractors at all tiers. SAFETY SHALL NEVER BE COMPROMISED OR SACRIFICED FOR PRODUCTION. The Safety and Loss Control Plan for Austin includes the following key elements: • Austin’s Safety, Health and Environmental Program - a unified set of minimum standards. • Pre-assignment Process – consists of a test for prohibited substances. Copies of the

Certification of Employer’s Drug and Alcohol Testing Policy (Form 125AZ) filed with the Industrial Commission of Arizona must be on file with the Austin Service Center prior to contractors beginning work at the site.

• Substance Abuse Policy – consists of testing for post-accident, random and for cause at any time.

• Pre-task Planning – consists of implementing a written pre-task plan for each construction activity from all contractors on a daily basis.

• Modified Duty Program – each contractor working on the Austin project shall institute and maintain a Modified Duty Program for injured workers. In all cases possible, health care providers and physicians treating injured workers from the Austin RCCIP will prescribe work restrictions for injured workers consistent with the Modified Duty Program rather than prescribing days away from work.

Austin’s supervision and safety personnel play a significant role in bringing contractors at every tier to a level of safety above what they may have experienced in the past. As always, Austin expects all enrolled contractors to comply with both the spirit and the letter of our safety program. Items of significant importance:

• Austin, through the Third Party Administrator (TPA), is responsible for payment of workers’ compensation claims for all enrolled contractors.

• Austin, through the Third Party Administrator (TPA), is responsible for payment of general liability claims for all enrolled contractors.

• Claims adversely affect each contractor individually as it pertains to their experience modifier. Austin is providing the insurance for enrolled contractors; however, claims follow each contractor’s safety record.


CLAIMS

This section of the manual explains the guidelines to be followed in the event of a claim or accident. It is important that Austin’s superintendent or on-site safety representative and the Austin Service Center are immediately notified of any claims situation. The RCCIP is designed to provide certain coverages to enrolled contractors; however, the program does not change any of the contractor’s contractual and/or statutory responsibilities for reporting claims.

INTRODUCTION This manual is for use as a general guideline in reporting claims. If you have questions about any of these guidelines or encounter a special situation where the guidelines do not seem to apply, contact Austin’s superintendent or on-site safety representative or the Austin Service Center for specific instructions. Contractors at any tier are responsible for their own Automobile Liability Coverage. All Automobile Liability accidents should be reported to the primary auto insurance carrier. Contractors are also responsible for their own off-site workers’ compensation, commercial general liability and excess liability. All off-site claims should be reported to your primary carriers.

LAWSUIT OR CITATION GUIDELINES The RCCIP Third Party Administrator (TPA) must be notified by fax upon service of all lawsuits or citations filed against Austin, contractors at any tier or any other entities related to work performed on the RCCIP Projects. The named defendant shall, upon service, forward all lawsuits or citations by certified mail to: Original: Austin Industries Copy to: Willis P. O. Box 1590 One Galleria Tower Dallas, TX 75221-1590 13355 Noel Road, Suite 400 Attention: Dan Howard Dallas, Texas 75240-6643 (214) 559-4887 Attention: Jeanise Mulcahy (800) 964-4242 Claims Coordinator (972) 385-9800 Copy to: Austin Commercial, L.P. Copy to: Files of Named Defendant P.O. Box 2879 Dallas, TX 75221-2879 Attention: Austin Service Center (214) 443-5784 If failure to timely forward a lawsuit or citation to the entities noted above results in a Default Judgment against the Insured, the contractor receiving the lawsuit or citation will be financially responsible for attorney fees, court costs, judgment cost and other expenses associated with a Default Judgment.


WORKERS' COMPENSATION GUIDELINES

TREATMENT Austin must be notified immediately of any injury or incident. The injured employee’s foreman and/or safety representative shall see that first aid is administered promptly where appropriate. If the injured worker requires transportation to the designated medical facility, the foreman/safety representative will provide transportation. Post-accident drug testing (the SAME DAY of the injury) is a requirement on this project. If the injured worker requires immediate emergency medical treatment, call 911 (unless Austin instructs otherwise). Complete Authorization for Medical Treatment (Form 220AZ/230AZ) to send with injured worker to the designated medical facility, if off-site medical attention is required. Contractor shall use the designated medical facility as their Occupational Health Facility (Austin will provide specific instructions for each job site). Report all injuries and incidents to the Austin superintendent or on-site safety representative and to the Austin Service Center (214/443-5784). INITIAL CLAIM REPORTING In every accident involving an injured worker, the Employer must complete the Employer’s Report of Industrial Injury (Form ICA 04-0101) as required by state law. Copies of these forms will be supplied to each contractor upon enrollment in the RCCIP. They will also be available at Austin’s project office. Any employer who fails to file the report without good cause may be assessed an administrative penalty as prescribed by state law for the late reporting of job-related accidents. The Employer should complete this standard form with special attention to:

Item 8. MUST be completed as follows: Type the name of the employer, then type "/Austin RCCIP".

Item 9. MUST indicate the Workers’ Compensation policy number assigned to the contractor upon enrollment into the RCCIP.

Contractors shall require the employer of the injured employee to complete the Form ICA 04-0101 within 24 hours after the incident. The completed form shall be submitted to the Austin Service Center. Austin’s superintendent or on-site safety representative should verify the accuracy and completeness of form. Austin’s safety representative should contact the Austin Service Center to confirm that the Form ICA 04-0101 has been received. The RCCIP Third Party Administrator (TPA), Crawford & Company will coordinate the investigations of all workers’ compensation claims. REFER TO WORKERS’ COMPENSATION INJURY/CLAIM PROCEDURES (FORM 210AZ).

All invoices for medical or hospital services should be forwarded directly to the TPA identifying the injured employee and all particulars of the accident to which the invoice applies. The Authorization for Medical Treatment Form (Form 220AZ - English or Form 230AZ - Spanish) directs the medical provider to submit medical treatment invoices (excluding substance abuse screening invoices) directly to the TPA.


SERIOUS INJURIES OR FATALITIES (WORKERS' COMPENSATION) Serious injuries or fatalities must be reported immediately to the Austin’s superintendent or on-site safety representative and the Austin Service Center BY TELEPHONE (214/443-5784). "Serious Injury" includes but is not limited to:

• Fatalities

• All spinal cord injuries

• Burns to 10 percent or more of the body's surface

• Amputations or crushing injuries

• Eye injuries which may cause partial or full loss of sight

• Severe head injuries

• Occupational diseases of any kind

• Exposure to toxic substances

• Any single occurrence resulting in hospitalization of three or more persons.

MODIFIED DUTY PROGRAM Each contractor working on the Austin project shall institute and maintain a Modified Duty Program for injured workers. In all cases possible, health care providers/physicians treating injured workers from the Austin RCCIP will prescribe work restrictions for injured workers consistent with the Modified Duty Program rather than prescribing days away from work. Austin’s superintendent or on-site safety representative shall monitor cases involving surgeries or other treatments requiring a worker to miss work. As soon as the injured worker can be returned to work on modified duty, the employer shall review the injured worker's job restrictions and agree on a modified duty job consistent with work restrictions. The employer shall accommodate the injured worker by providing a Bona Fide Offer of Modified Duty (Form 280AZ-English/285AZ-Spanish) employment which describes the modified duty and the pay rate proposed for the modified duty, consistent with the doctor’s restrictions. Distribution of the Bona Fide Offer of Modified Duty should be as follows:

Mail originals to: Austin Service Center Copy to: Injured worker Copy to: Injured worker’s employer LOST TIME INJURIES OR ILLNESSES In the event of a lost time injury or illness, an employer must notify the Austin Service Center and the Third Party Administrator. OSHA RECORDS Maintenance of records required by the Federal Occupational Safety and Health Act and all other applicable regulations are the responsibility of each contractor.


COMMERCIAL GENERAL LIABILITY GUIDELINES

REPORTING Any occurrence involving Bodily Injury or Property Damage not a result of an automobile accident should be reported to the Austin’s superintendent or on-site safety representative and the Austin Service Center immediately. The subcontractor experiencing the claim must report the claim on a General Liability Claim Reporting Guide (Form 290AZ). The completed form shall be submitted to the Austin Service Center and the TPA within twenty-four hours. The TPA will coordinate the investigations of Commercial General Liability claims.


ARIZONA RCCIP FORMS

AUSTIN’S PROJECT MANAGEMENT Form 100AZ Site Reporting Form

Form 110AZ Procedures Checklist

Form 120AZ Austin’s Pre-bid Instructions

CONTRACTORS Form 125AZ Cert of Empl Drug & Alcohol Testing Policy

Form 130AZ Enrollment Form

Form 140AZ Insurance Requirements

Form 150AZ Designated Workplaces Excl Endorsement

Form 160AZ Monthly Site Payroll Report (Excel)

Form 160AZ Monthly Site Payroll Report (Word)

Form 180AZ Notice of Work Termination

Form 210AZ Workers Comp Injury/Claim Procedures

Form 220AZ Authorization for Medical Treatment– English

Form 230AZ Authorization for Medical Treatment– Spanish

Form ICA-0101 Employer’s Report of Industrial Injury

Form 280AZ Bona Fide Offer of Modified Duty - English

Form 285AZ Bona Fide Offer of Modified Duty - Spanish

Form 290AZ General Liability Claim Reporting

AUSTIN SERVICE CENTER Form 050AZ Notification of Project Enrollment

Form 135AZ Deduct Confirmation Worksheet

Form 137AZ Enrollment Confirmation Memo

Form 170AZ Documents Needed

Form 175AZ Change Order Notification

Form 177AZ Change Order Worksheet

Form 190AZ Closeout Form
