The Liability program provides defense and indemnity coverage against claims and suits arising from covered occurrences. Members choose a member retention level (MRL) of $5,000, $10,000, $25,000, $50,000, $125,000, $250,000, or $500,000. Members jointly fund losses above the members’ retentions up to $1,000,000. PERMA is a member of the Public Risk Innovation Solutions and Management (PRISM) for excess liability coverage. PERMA has a $1 million retention and PRISM provides coverage from $1 million to $50 million.
In 2021 PERMA began using AdminSure personnel to augment claim handling services and also transitioned its liability claims data to AdminSure’s claim system. PERMA’s Claim Manager, Yumi Augustus, continues to handle high-severity claims and maintains oversight of the program. This approach allowed time to contemplate succession planning, allocation of staffing, reduce exposure to PERMA, and ensure positive and professional claim handling for the members. To continue ensuring efficiency and cost effectiveness, AdminSure is performing Medicare reporting and will soon be writing checks associated with the program.
As has been the case for the last several years, the liability insurance industry remains in a hard market cycle, which means another year of significantly higher liability premiums. The factors that continue to fuel these hard market conditions are varied and many, but they all result in more and larger claims…frequency and severity. PRISM, PERMA’s excess/reinsurance partner, prepared a stakeholder communications document which describes in detail the challenges being faced by every California public entity.
Auto Liability Cards
State law requires evidence of financial responsibility be carried at all times in all vehicles. Vehicle Code section 16020(b)(4) states that “Evidence of financial responsibility” means “A showing that the vehicle is owned or leased by, or under the direction of, the United States or any public entity, as defined in section 811.2 of the Government Code.”
In other words, for a public entity, the vehicle registration should be sufficient to meet the requirement of evidence of financial responsibility.
Members should consider placing a copy of the current Automobile Liability Card (which includes the applicable Vehicle Code) in the vehicle with the registration. See the right sidebar “Auto Liability Card” for the current fiscal year’s cards.
Vehicle Accident Kit
The following items are suggested to be carried in your vehicle glove box to help in the event you are involved in an accident:
- Pencils or pens
- Note pad
- Camera (disposable; although most employees have mobile phones which can be used instead)
- Tape measure
- Vehicle registration
- What to Do in Case of Accident
- Accident Checklist
- Vehicle Accident Report
- Witness Information Card
- Automobile Liability Coverage Card (documents found in the sidebar)
Other information you may want to consider carrying in the glove box:
|Claim intake, enter financial transactions, scan paper files, streamline administrative operations||Carol Reed|
|Adjust property damage only claims (limit 75)||Diana Cordova|
|Adjust lower severity claims & litigation (limit 160)||Stacy Goopio|
|Adjust lower severity claims & litigation (limit 160)||Diana Cordova|
|Adjust high severity claims; perform TPA contract oversight, excess reporting, presentations to member Boards/Councils||Yumi Augustus|
Yumi Augustus – Claims Manager – Yumi has over 25 years of claims experience with 19+ years in public entity liability. Prior to joining PERMA, she handled third party claims for a variety of pools including colleges, water districts, school districts and Cities and 16 years handling the County of Los Angeles matters. She receives, reviews coverage for initial claims and directs disposition of claims, is responsible for management of data and loss history. Yumi attends Board and Executive Committee & Member Council meetings, as well as negotiates claims at settlement conferences. She has a case load of higher exposure and/or complicated litigation issues. Yumi directs adjusters and attorneys in the handling of claims, coordinates with general counsel for legal opinions and is responsible for maintaining reporting to excess providers. She is responsible for review and approval of all service billings related to claims and formulates and implements procedures for claims handling and litigation management.
Diana Cordova – Claims Administrator – Diana has over 20 years of claims handling experience nationwide in commercial liability, construction defect, transportation/auto, food/beverage, premises, and product liability claims. She has evaluated exposures in multi-states for first party and third-party matters, assessed contracts, risk transfer and litigation management. Diana is focused on responsiveness and is customer-service-oriented.
Stacy Goopio – Claims Administrator
Stacy has 18 years in the auto liability insurance claims industry and over three years handling public entity claims and litigation. She is knowledgeable of California tort claims requirements, Government codes and statutes, has knowledge of legal proceedings, and excellent customer service skills with the ability to calm claimants.
Carol Reed – Liability Claims Assistant
Carol previously worked for two different state agencies developing ADA testing procedures. Her experience includes background investigations of attorneys, coordinating/logistics for bar exams, supervising and training up to 20 employees, handling confidential materials, small claims hearings, and streamlining administrative processes.
Declarations of Liability Coverage
In the past, the “Declarations of Coverage” documents were posted on the PERMA website and emailed to the members (historical declarations of coverage).
Beginning with the 2022-23 Program Year, the information has been integrated into the Memorandum of Coverage (MOC; see link in sidebar) document and thus will no longer be provided separately. Please see pages 2 (Declarations) and 3 (Schedule of Covered Members which includes retentions).
The Declarations of Coverage previously listed a variety of member departments, commissions, or boards. These entities are covered as long as they are part of the city and/or meet the definition of “Covered Parties” in Section II – Definitions on pages 4-5 of the MOC.
If your agency receives a request from a third party to provide proof of coverage, you can provide the MOC as proof. If the agency will not accept the MOC (e.g. it requested to be named as an “Additional Covered Party” (aka additional insured)), please request a “Certificate of Insurance” from PERMA’s website.
Medicare Reporting Compliance
Medicare is the nation’s health insurance program for individuals who are age 65 or older and individuals with certain disabilities. Medicare is funded by the taxpayers. Under Medicare Secondary Payer (MSP), if Medicare makes payments on an injured party’s behalf when the treatment should have been covered by the tortfeasor (in this case, the PERMA member), then the Medicare payment is deemed “conditional” and Medicare is entitled to reimbursement. In other words, if a third party is injured, files a claim against the public agency, and the claim settlement includes payment for bodily injury, the public agency is responsible for reporting those payments to Medicare.
As the member’s third-party claim administrator, PERMA has the responsibility of timely and accurate reporting all injury claimants to the Centers for Medicare & Medicaid Services (CMS). CMS coordinates Medicare benefits as well as recovery of conditional payments. Diligent efforts must be made, and documented, by PERMA staff to report all claims which may involve Medicare. Failure to do so results in monetary penalties as the conditional payment obligation is required under law. Improper reporting may also result in civil monetary penalties of up to $1,000/day of noncompliance with respect to each claimant.
To ensure proper reporting is made, a revised blank Government Claim for Damages (liability claim form in the sidebar) has been created for member use. Each member agency is requested to utilize the template (please first customize it with information specific to your agency) which collects the mandatory information required by Medicare. Note: personal identifiable information has been added to the form such as date of birth, social security number, email address, and a box for Yes/No to indicate if claimant is a Medicare/Medicaid/Medi-Cal receipt. If a public record act request is received for a claim form, this information should be redacted.
Members are also reminded that all liability program claims, and corresponding back-up, should be submitted electronically to firstname.lastname@example.org email box to ensure proper processing. If the file size is too large to send through email, a link to a share file will be provided so the document(s) can be uploaded.