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(A) There is hereby created a fund of the city to be known as the insurance services fund.
(1) The purpose of the insurance services fund is to provide a source of funds to pay all costs of providing insurance coverage and insurance-related services required by the city, and to finance any self-insurance program which the City Commission may from time to time determine to be in the best interest of the city.
(2) Monies in this fund may be expended for the payment of insurance premiums and all other costs of providing insurance coverage and insurance-related services required by the city. Upon a determination by the City Commission that the city shall become self-insured as to any type of coverage, authorized expenditures from this fund shall thereafter include the payment of all costs of a self-insurance program.
('58 Code, §§ 2.25 and 2.26)
(B) There shall be appropriated into the insurance services fund out of the revenues of the city for each fiscal year such sums as may be required for the payment of insurance premiums and all other costs of providing insurance coverages and insurance-related services required by the city during the year. In addition, upon recommendation of the City Manager, there may be appropriated into the fund in each fiscal year sums as the City Commission may deem appropriate for the purpose of accumulating a reserve to be used to finance a self-insurance program. Upon a determination by the City Commission that the city shall become self-insured as to any type of coverage, there shall thereafter be appropriated annually into the fund additional sums as may be required to maintain a reserve sufficient to finance a self-insurance program.
(1) There shall also be deposited into the insurance services fund sums as may be realized by the city from recovery of tort claims against other parties, and any charges which may be levied against departments of the city as a result of being found responsible for preventable accidents.
(2) The Finance Director shall invest any surplus funds in the insurance services fund in the same manner as other surplus funds of the city. For purposes of this section, the term SURPLUS FUNDS is defined as any funds in the insurance services fund which will not be needed for any purposes of the fund within a period of 30 days from the date of the investment. All income accruing from investment of the insurance services fund shall be deposited into the fund.
('58 Code, § 2.27) (Ord. 77-47, passed 5-24-77)
(C) The city is hereby authorized and empowered to be a self-insurer as to the following types of claims.
(1) All claims for workers' compensation pursuant to the Florida Workers' Compensation Law.
(2) Tort claims for all risks for which commercial insurance coverage is not specifically authorized by the City Commission.
(3) Claims not covered by commercial insurance policies for damage to, or loss of vehicles owned by, leased to, or loaned to the city due to causes and within limits to be established by administrative policy of the City Manager.
(4) Claims not covered by commercial insurance policies for damage or loss of real or personal property owned by, leased to, or loaned to the city due to causes and within limits to be established by administrative policy of the City Manager.
(5) Claims not covered by commercial insurance policies for damage to or loss of real or personal property owned by, leased to, or loaned to the city due to burglary, larceny, robbery, or theft with scope, limitations, and exclusions to be established by administrative policy of the City Manager.
(6) Such employee health insurance benefits as may be approved by the City Commission by resolution adopting a specific health insurance plan document.
(D) The City Manager shall establish procedures for the processing, adjustment, and settlement of tort, workers’ compensation, employee severance and separation agreements, and employee health insurance claims subject to the limitations below.
(1) The risk manager shall have overall responsibility for the processing, adjustment, and settlement of claims.
(2) Independent claims adjustment or administration services may be utilized. The procedures established by § 32.39 of this code shall be followed in contracting for or otherwise obtaining independent claims adjustment or administration services. Each independent claims adjustment or administration service shall be assigned the duties and responsibilities, not inconsistent with this chapter, as may be deemed by the City Manager to be in the best interest of the city in establishing the most expeditious method of processing claims.
(3) If the risk manager concludes that settlement of a specific tort claim would be in the best interest of the city, the risk manager shall obtain from the City Attorney subject to the levels of authorization an assessment of the probable liability of the city and the concurrence of the City Attorney in the recommended settlement or compromise of the claim.
(4) Upon the concurrence of the risk manager and the City Attorney in a recommendation that a claim be settled, issuance of checks in settlement of claims may be authorized as follows. The following levels of authorization for the issuance of checks in settlement of claims and receipt of restitution from other parties shall apply:
(a) Risk Manager, $0 – 4,999.99.
(b) Risk Manager, City Attorney and City Manager, $5,000 – $75,000.
(c) Any settlement in an amount exceeding $75,000 must be approved by the City Commission.
(5) The risk manager shall be the Plan Administrator for the adopted employee health insurance plan. In the event that a health insurance claim is denied by the Claims Administrator, the claimant shall have a right to appeal to the Plan Administrator. The Plan Administrator shall refer the appeal to the Employee Health Insurance Committee herein established. The Committee shall decide the appeal in accordance with procedures set forth in the adopted health insurance plan document. The decision of the Committee shall be final.
(E) All tort claims resulting in litigation shall be referred to the City Attorney immediately upon service of the summons and complaint. Based upon the workload in the City Attorney's office, the complexity of the litigation, and other factors the City Attorney may deem it necessary to take into account, the City Attorney shall make a determination either to handle the litigation in-house or to refer the case to outside counsel. The City Attorney is hereby given authority to act on behalf of the city in arranging with outside counsel for defense of a tort claim against the city in all cases where a determination is made to retain outside counsel. Compensation of outside counsel shall be in accordance with a fee schedule approved by the City Commission.
(F) Whenever a workers' compensation claim requires representation of the city by legal counsel, the risk manager shall refer the matter to an attorney who specializes in the handling of workers' compensation claims. Selection of an attorney shall be made from a list of specialists compiled by the risk manager and approved by the City Attorney. Fees for representation shall be in accordance with a fee schedule approved by the City Commission.
(G) (1) There is hereby created an Employee Health Insurance Committee whose duties shall be as follows:
(a) To decide appeals from the denial of health insurance claims by the Claims Administrator.
(b) To conduct reviews of the operation and soundness of the adopted employee health insurance plan when requested to do so by the City Manager or the City Commission and to make appropriate recommendations.
(c) To perform such other functions as may be assigned from time to time by City Commission.
(2) The membership of the Employee Health Insurance Committee shall consist of the Risk Manager/ Plan Administrator, one representative from each of the three employee bargaining units (to be appointed by the City Commission upon recommendation of the bargaining unit), and three additional members to be appointed by the City Commission. Terms of members other than the Risk Manager/Plan Administrator shall be one year.
(‘58 Code, § 2.28) (Ord. 78-17, passed 11-22-77; Am. Ord. 78-29, passed 2-14-78; Am. Ord. 81-88, passed 10-6-81; Am. Ord. 89-15, passed 11-29-88; Am. Ord. 94-31, passed 4-5-94; Am. Ord. 2017-48, passed 5-23-17)