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The development & evolution The development & evolution of of a successful risk a successful risk basedbasedinjury management system injury management system
for employers.for employers.
Informa – Return to work forumMelbourne 29-30 July 2014
Presented by Bill NevinManager XtraCare
Are there any Questions?
In Closing In Closing
Actuarial Assessment of Estimated Outstanding Liability
Copper - 47%
Coal - 64%
Reductions In Outstanding Liability Reductions In Outstanding Liability
2007 2008 2009 2010 2011 2012 2013
Coal - 64%
Our Company has developed an employer based injury management systemthat incorporates risk management principles
to promote early assessment and consistent allocation of injury management resources
Documented Intent Documented Intent
consistent allocation of injury management resources
to assist injured workers achieveearly and sustainable
return to work outcomes.
The primary goal of returning injured workers to pre-injury duties is critical
and any significant risks to achieving this goal are
escalated for management intervention
Clarified Intent Clarified Intent
escalated for management intervention and development of strategies
to resolve issues andachieve sustainable outcomes.
Web Based Web Based ––Injury Management SystemInjury Management System
On Line On Line -- Risk Assessment ProcessRisk Assessment Process
The development & evolution of a successful risk based injury
management system for employers.
Initial principals, philosophies and beliefs
Simple agreements to get you started
Developing a model with the future in mind
Topic on the Brochure Topic on the Brochure
Developing a model with the future in mind
Adopting a new paradigm to achieve better outcomes
Payment Profile in QLD
Claims Payments Claims Payments
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Paid to Date
Payment & Stat Est. Profile in QLD
Claims Payments & Stat EstimatesClaims Payments & Stat Estimates
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Paid to Date Stat Est.
Payment & Stat & C/Law Est. Profile in QLD
Payments + Stat & C/Law EstimatesPayments + Stat & C/Law Estimates
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014
Paid to Date Stat Est. C/Law Est.
104
75
58 58
98
70
40
60
80
100
120
Overview of Stat Claims & Common Law Claims Lodged
Statutory & C/Law ClaimsStatutory & C/Law Claims
15
6 6 52 0
0
20
40
2008 2009 2010 2011 2012 2013
Stat Claims C/Law Claims
104
75
58 58
98
70
60
80
100
120
Overview of Stat Claims,High Risk & Common Law Claims Lodged
Introducing High Risk CasesIntroducing High Risk Cases
21
15 13 15
22
1215
6 6 52 0
0
20
40
2008 2009 2010 2011 2012 2013
Stat Claims High Risk C/Law Claims
20
40
60
80
100
120
21 15 13 15 2212
83
60
45 43
76
58
Claims by Current Risk AssessmentOperations 2008 to 2013
Total Incurred Cost by Risk Assessment Operations 2008 to 2013
Total Total Incurred Incurred –– Based Based on Risk on Risk
0
2008 2009 2010 2011 2012 2013
15 13 15 12
High Risk Low/Medim Risk
2008 2009 2010 2011 2012 2013
High Risk Low/Medium
Strategy - A plan designed to achieve a particular long term aim.
Are we Naturally Strategic? Are we Naturally Strategic?
Or are we more like the frog in slow boiling pot of water ?
Planning to achieve a particular long term aim ?
Where do you sit? Where do you sit?
Or are you following the process to see where it leads ?
Successful Employers Successful Employers –– The Evidence The Evidence
Christine Randall presentation 2008
What are the principals and philosophy
that provides the best strategy
for your business?
We chose risk based principals and adopted an employer based
Principals & Philosophy Principals & Philosophy
adopted an employer based injury management philosophy.
A risk based approach is an integral part of many safety systems that are heavily promoted by employers and
enforced through legislation.
First Aid Minor Moderate Major Serious
Injury Management Matrix
IMM
A
B 247 12 17 21
L
I
K
E
L
CONSEQUENCE
20 23 2511 16
Why a Risk a based approach? Why a Risk a based approach?
D
E
C
1 3 6 10 15
9 14 19
4 8 13 18L
I
H
O
O
D
2 5
22
The aim was to create an Injury Management/Rehabilitation process that mirrored what was already operationally accepted
Injury Management Review
AIM - To develop a system that provides a method for assessing andmanaging risks associated with workplace injuries.
The system should provide:-
A method for rating various levels of incapacity;
Appropriate control measures for each level of incapacity; Appropriate control measures for each level of incapacity;
A mechanism to assess potential escalation factors;
A rating process consistent with current risk management practices.
The Original Presentation The Original Presentation
Injury Consequence
Incapacity Type Max Period of
Incapacity Medical Treatment Injury (MTI)
Restricted Work Injury (RTI)
Loss Time Injury (LTI)
First Aid As Per TARP
Minor
Moderate
Up to 14 Days
Up to 14 Days on Normal Shift, no reduced hours
Building an Injury Consequence TableBuilding an Injury Consequence Table
* Major
# Serious
* To include all stress related conditions regardless of time frames
# To include all injuries requiring hospitalisation and immediate surgery following injury
Injury Consequence
Incapacity Type Max Period of Incapacity
Medical Treatment Injury (MTI)
Restricted Work Injury (RTI)
Loss Time Injury (LTI)
First Aid As Per TARP _ _ _
Minor Up to 14 DaysUp to 14 Days on Normal Shift, no reduced hours
_ 14 Days
Moderate> 14 Days -< 8 Weeks
> 14 Days -< 8 Weeks
1 to 14 days 8 Weeks
Injury Consequence Table Injury Consequence Table
* Major > 8 Weeks -< 20 Weeks
> 8 Weeks -< 20Weeks
> 2 Weeks -< 4 Weeks
20 Weeks
# Serious > 20 Weeks > 20 Weeks > 4 Weeks Unlimited
* To include all stress related conditions regardless of time frames
# To include all injuries requiring hospitalisation and immediate surgery following injury
20
30
40
50
60
70
5 7
119 16 13
15
914
1711 12
19 1316 13
14 1814
2229
38
17
27
2517
20
25
23 26
22
34
27
11
25
1521 22
5 4
4
3
2
6
3
2
1
32
12
2
2
4
3
3 2
Injury Management cases opened since 01/01/2012 by Consequence
Does this graph assist Management?Does this graph assist Management?
0
107
2 2 6 7 5 5 1 1 1 1 3 2 61 4 2 1 2
56 2
17
61
16 4 3
60
44
42 0
3
9 16 13 14
811 12
11
16 14 1814
Serious Major Moderate Minor Other
Injury Management & Resource Matrix
Injury Consequence
Treatment Provider Workers'
Compensation Cert Required?
Work Capacity Assessment
RequiredAppoint a RRTWC
Meetings with Manager
Referral Required to External Provider?
First Aid Occup. F/Aider, Nurse or Doctor
Minor Doctor
Moderate Doctor
Major Doctor
# Serious Doctor
Management & Resource MatrixManagement & Resource Matrix
# Serious Doctor
Responsible Party
AS Per TARP Injured
Employee
Work Capacity Assessment Required
Appoint a RRTWC Meetings with Manager
Injury Management & Resource Matrix
Injury Consequence
Treatment Provider Workers'
Compensation Cert Required?
Rehab File Required?
Registration in Injury Management
System
Risk Assessment Required?
Referral Required to External Provider?
Workers' Compensation
Claim Required?
Line Management Notification
First Aid Occup. F/Aider, Nurse or Doctor
No No No No Not Required No Supervisor
Minor Doctor Yes Short File Only Registered as
Short File No Not Required
Only if Worker Requests
Superintendent
Moderate Doctor Yes Yes Yes YesTo be reviewed
at 15 Days Claim Must be
Lodged Manager
Major Doctor Yes Yes Yes YesImmediate Claim Must be Operations
Here’s one completed earlierHere’s one completed earlier
Major Doctor Yes Yes Yes YesImmediate
Referral Claim Must be
LodgedOperations Manager
# Serious Doctor Yes Yes Yes YesImmediate
Referral Claim Must be
LodgedSenior Site Executive
Responsible Party
AS Per TARP Injured
Employee RRTWC RRTWC RRTWC RRTWC
Injured Employee
RRTWC to Advise
The Injury Consequence & Resource and Management Matrix should be discussed and
developed with Employees, Management, Rehab professionals and the Insurer.
By obtaining approval by Management and the Insurer to the Matrix; -RRTWCs are now empowered to:-• take action • incur costs
Seek & Obtain Approval Seek & Obtain Approval
• incur costs• engage providers and• engage management
It is important to ensure every early intervention strategy that might be required is listed in the matrix.
Injury Management Review
AIM - To develop a system that provides a method for assessing andmanaging risks associated with workplace injuries.
The system should provide:-
A method for rating various levels of incapacity;
Appropriate control measures for each level of incapacity; Appropriate control measures for each level of incapacity;
A mechanism to assess potential escalation factors;
A rating process consistent with current risk management practices.
Back to the Original Presentation Back to the Original Presentation
First Aid Minor Moderate Major Serious
Injury Management Matrix
IMM
A
B 247 12 17 21
L
I
K
E
L
CONSEQUENCE
20 23 2511 16
Step 1: Step 2:
Risk Assessment Components Risk Assessment Components
D
E
C
1 3 6 10 15
9 14 19
4 8 13 18L
I
H
O
O
D
2 5
22
LowMediu
mHigh
The risk assessment process should be designed to assess:-
the risk of a worker not returning tonormal pre-injury duties
following a work related injury.
Determine the Risk to be assessed.Determine the Risk to be assessed.
Note :- The primary rehabilitation goal of returning the worker to pre-injury duties does not change because of the risk assessment.
The next step is to determine:-
1. the likelihood of the worker returning to pre-injury duties &
2. other factors that may cause escalation in the risk of the worker not returning to pre-injury duties.
Likelihood & Escalation FactorsLikelihood & Escalation Factors
returning to pre-injury duties.
Note - whilst 2 workers may sustain the same injury and receive the same level of rehabilitation and treatment the likelihood of them returning to work may be vastly different.
On Line On Line -- Risk Assessment ProcessRisk Assessment Process
2
2
3
3
4
4
5
5
0
1
0
1
1
0 0
20
0 0
1
Single Site Injury Management cases opened since 01/01/2013 by Risk Assessment
Single Site Single Site
0
1
1
2
1
0 0
2
0
1
0 0 0
1
2
1
0
0 0 0
0
0 0 0
0
1
0 0
0
0 0 0
0 0
0 0
0
0 0 0
High Medium Low No Assess
2
3
4
5
6
7
8
33
3
2
1
2
1
2
2
2
2
1
1
1
1
0
0
0
1
1
0
0 0
0
Multi Site Injury Management cases opened since 01/01/2013 by Risk Assessment
Multiple Sites Multiple Sites 33
0
1
0 0 0
3
1 1
0 0 0 0 0 0 0 0 0 0 0
11
3
1
1
2
0 0
1
0
1
0
2
0
1
0
02
1
1
0
0
1 1
0
1
00
0
0 0 0 0 0 0
High Medium Low No Assess
Flow Chart Flow Chart
Model Presentations Model Presentations
Continuous Improvement Continuous Improvement
Create a list words, terms and phrases that:-◦ are consistent with the language used in your company
◦ provide a positive message
◦ reinforce the desired behaviours
◦ are business orientated
Choose a Language Choose a Language
◦ are business orientated
◦ limit expectations
◦ avoid insurance or medical terminology
◦ SIMPLIFY the message
Employer based injury management Striving for better outcomes Early intervention – early resolution Resource allocation Risk management Injury consequence Activity based rehabilitation
Some Suggestions Some Suggestions
Activity based rehabilitation Sustainable return to work Information gathering Stage management
XtraCare review conducted in 2007 in the face of rising costs and outstanding liabilities.
In QLD 90% of costs came from common law claims where the claim centred on no employment or that current employment was not sustainable.
Workers’ Compensation was a problem for the company in each state in Australia.
Solution had to be Employer based as being compliant in each state meant different things in different states. (Outside the QLD Insurance Silo Thinking.)
The XtraCare Evolution The XtraCare Evolution
the QLD Insurance Silo Thinking.) The holistic view became to develop a consistent employer
based injury management system based on risk principals that could operate any where in the world.
Focus on “Sustainable return to work Outcomes” and early resolution as these save costs in any Workers’ Compensation System.
Created a language that was consistent with the company’s strategic objectives and business terminology. (Sustainability & Risk)
Developed flow charts and diagrams that reflected the message, developed & promoted the system and demonstrated the thought process through new injury management models.
Defined management’s time as a valuable resource used for strategic decisions, created forums to engage management and health and
The XtraCare Evolution The XtraCare Evolution –– cont.cont.
forums to engage management and health and safety.
Most importantly moved the responsibility for Injury Management to the Employer through the promotion of employer based injury management.
Vision Holistic - All encompassing EMPLOYER view based on the knowledge of the nature, functions, and properties of the components, their interactions, and their relationship to the whole. Philosophy - can refer to "the most basic beliefs, concepts, and attitudes of an individual or group” Do you want an Employer or Insurer philosophyIntent - A readily grasped declaration of the course that the company needs to take into the future to
Vision, Philosophy & Documented intent Vision, Philosophy & Documented intent
that the company needs to take into the future to deliver better outcomes. The intent needs to be easily understood by every member of the company and be consistent with current strategic goals
How relevant is the term Injury Management to the CEO, the Board or Shareholders
People waiting on top down approach to People waiting on top down approach to Injury ManagementInjury Management