Post on 18-Dec-2015
transcript
Workers’ Compensation Reducing risk and cost
SUPPORTING SCHOOL DISTRICTS WHO ARE CREATING A BETTER TOMORROW
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What we Strive for
• School District Service Objectives• Reduce costs by reducing the frequency and
severity of workplace injury • Establish a customized safety and claims
management plan• Maintain an open line of communication and
trusted working relationships with school district personnel
• Provide ongoing training to ensure a safe work environment
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Services
Training & Education
Return-to-Work
Solutions
Safety Management
Claims Management
• Customized safety management plans
• Focused on reducing injury exposures
• Developing compliant Cal/OSHA programs
• Enhancing communication strategies and training programs
• Conducting inspection to reduce hazards
• Develop customized RTW Program
• Ensure communication with all stakeholders
• Return employees back to work immediately
• Mitigating legal exposures (FEHA)
• Develop educational content and delivery
• Creating a competitive advantage by empowering district personnel to identify and control exposures
• Providing strategies for claim closure
• Oversight on indemnity claims
• Facilitating communication with all stakeholders
• Supplement & compliment efforts
• Reducing reserves and controlling the X-mod
Online Services / Educational Portal
Solutions that get ResultsDistrict Goals:
Reduce injury frequency and severityActual results achieved
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Reduction of claim frequency
2008 2009 2010 2011 20120
10
20
30
40
50
60
70
49
66
41
53
28
19
26
1114
5
30
40
2935
22
Total Number of Claims
Linear (Total Number of Claims)
Indemnity
Medical Only
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Reduction of claims severity
2009 2010 2011 2012 $-
$50,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$437,465 $445,598
$180,365 $145,004
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Principal Safety Committee
Principal Safety Committee Program:
• Develop Principal Safety Committee Guide • Establish committee at each site
• Consists of Principal and three – four other designees
• Establish general policies and procedures for the safety committee meetings, timeline, expectations, attendance forms etc…
• Prepare binder with monthly agenda and guidelines for Principals
• Curriculum for school year, including:
• Hazard identification presentation based on inspection reports and leading exposures
• Inspection checklist based on monthly presentation
• Recorded webinar for principal review
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Training solutions
• Customized safety videos• E.g. Principal Safety Program Strategic Plan,
IIPP Overview, Slip, Trip, Fall • Legislative Updates
• E.g. SB863
• Customized Computer Based Training (CBT) Modules• Develop and host CBTs• Utilize Learning Management System
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Why Safety Management?
• Ensure written Cal/OSHA compliance programs• E.g. HazCom, MSDS management, PPE
• Provide training based on leading exposures and safety policies (SOPs in hazardous tasks)
• Conduct inspections identifying exposure trends• Implement customized scorecard inspection program
• Utilize dashboard analytics for management decisions on resource allocation
• Optimize District wide safety understanding
• Legislative changes including Assembly Bill 2774
• Focus on reducing injuries and injury exposure
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Interior & Exterior Site Inspections
• School Site Inspections• Focused on safety, fire and
property / liability exposures.
• Conduct inspection program to satisfy IIPP
• Development of inspection binder for corrective action
• Present findings to District management
• Inspections will include all buildings and grounds, which include (but not limited to):
• Alternate each year between exterior and interior inspections
• 100% of school grounds: • Gates, fences, parking lots,
sidewalks /walkways, fields, buildings, classrooms, locker rooms, gymnasiums, bathrooms etc…
• Hazard identification• Electrical hazards• Slip, trip and fall hazards• Structural hazards • School grounds hazards• Housekeeping hazards• Fire hazards/safety• “Fall on” hazards• Life safety hazards• Chemical hazards
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Playground Inspections
• Playground Inspections• Inspect all elementary playgrounds and middle
school athletic grounds• Inspections include:
• Identifying hazards on playground equipment and the playground
• Ranking the hazards according to injury potential• Recommendations on removing/correcting the
hazards• Utilize established playground inspection
checklist, complying with IIPP & playground inspection requirements• Per the National Playground Safety Institute (NPSI)
• Provide summary report to District management
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Return To Work Benefits
• Reduce or avoid temporary or permanent disability payments
• Reduce medical costs as injured workers experience faster recoveries when they remain at work in a work environment that is congenial with their physical capacity
• Reduce or avoid litigation
• Discourage fraudulent claims
• Improve productivity and morale among all employees
• Eliminate disability discrimination and comply with FEHA
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Return To Work Implementation
Foundation Assessment Launch
Write a management plan and policy statement
Build a support team and assign roles and responsibilities
Establish process and procedures
Review and Revise Job Descriptions
Identify Temporary Alternative Duties (TADs)
Document physical requirements
Coordinate communication
Train supervisors and managers
Launch RTW program to all employees
Phase 1 Phase 2 Phase 3
Evaluate Business Benefit ROI
ProgramEngagement
Collect BackgroundInformation
Current RTW Plan and/or PolicyRecent work status report from designated Medical ProviderJob descriptions Alternative dutiesLoss RunsX-Mod Worksheet/WCIRB
RTW Evaluation
Questionnaire
Phase 1 - Foundation
Program Introduction
Phase 2 - Assessment
Write Management Plan and
Policy Statement
Assign Roles and Responsibiliti
es
Planning Checklist
Review & Revise Job Descriptions
to include Essential Functions
EstablishProcess and Procedures
IdentifyTemporary Alternative
Duties (TADs)
Phase 3 - Launch
Build Support
Team
DocumentPhysical
Requirements
Member
ESM
Coordinate Communicati
on
Coordinate with EmployeeCoordinate with Medical
ProviderCoordinate with Claims
Administrator
Train Supervisors/Manage
rs
Roll out to all Employees
Assign RTW Coordinator
Return To Work Development Process
Support
FlyerPPTLetter to employees
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Why Claims Management?
• Reform results continue to erode• Medical cost inflation • Increase in Medicare Set Aside • Abuse of medical lien process• Increase in cost containment factors• Legislative changes• New case law impact• Increasing litigation• Turnover in claims examiners
• Recent Result: $61,000 reserve reduction on two claims for a District that is Self Insured!
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Claims Mgmt Service Schedule
Oversight of carrier / TPA
Troubleshoot challenging
claims
Advisor to Employer /
Agency
Referral Form
Letter of Auth
from client
Q1 Summary Report
Claims Review
Q2 Unit Stat
Report
X-Mod Foreca
st
Q4Renewal Report
Policy Year Milestones
Policy Year Application
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Claims oversight and support
• Ongoing Communication • Phone call, email and webinar communication for District claims
management staff
• Develop written claims handling procedures• Work in conjunction with CUSD Workers’ Compensation coordinator to
develop written policies and procedures.
• Ongoing claims Oversight & Direction• Ensure examiner has positioned claim for speedy, cost-effective resolution• Analyze reserves for accuracy and negotiate potential reduction • Act as liaison on all delayed claims, ensuring denial decision is met timely• Obtain current status of claim including work status, medical prognosis and
recommend a resolution strategy• Ensure appropriate California laws and regulations are applied
• Recommend litigation strategies to resolve claims • Create vendor list (e.g. Defense Attorney, Nurse Case Management etc..)• Create First Aid policy
Disputed Claims
Claim is classified as MO or IND
MO claim processed, closed in 90
days
Begin RTW coordinationwith medical
provider and client
If ACCEPTED, manage claim
to conclusionClaim is delayed and investigated
for 90 day compensability determination
Large Loss Claims ( >$25,000 )
Continue 30 day ongoing
oversight and direction
CarrierDistrict ESM
IND claim: 3 point contact, provide benefits
Monitors Carrier for investigation
process and strategizes
decision
Determination is made to accept or
denyIf DENIED and UNDISPUTED
Close in 30 daysIf DENIED and DISPUTED
Develop litigation strategy
for resolution
Develop a POA for resolution
Strategize best practices for
resolution
Monitor strategy for effectiveness and
accountability
ESM analyze at 90
days for potential problems
Monitor settlement and any future medical
award
Claims Management
Oversees
resolution
strategy
Begin RTW coordinationwith medical provider
and client
Claims Management Reporting & Oversight Process
Carrier processes
claim
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ESM is YOUR Advocate
• Expertise in school district risk management• Designations:
• Associate in Risk Management – ARM• Worker’s Compensation Claims Professional - WCCP• Associate in Management - AIM • Certified Playground Safety Inspector – CPSI• Certified Professional Disability Manager – CPDM• Self-Insured Professional – SIP
• ESM’s consultants are fingerprinted for criminal compliance per the educational code, sections: 45125.1 & 45125.2
• Established relationships with school districts
• Results driven• Always raising the BAR
• Benefits from Activities that get Results