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Workers’ Compensation
Reducing risk and cost
Building a successful partnership
Presented by ESM Solutions, Inc.
Executive Summary
• Thank you for considering ESM Solutions, Inc. as a service provider to your company. This deck provides specific details as to the depth of service ESM can provide.
• Our staff of trained professionals includes individuals who have the necessary professional designations needed to carry out the required risk management services. Designations that include:• Associate in Risk Management – ARM• Associate in Enterprise Risk Management – ARM-E• Associate in Management – AIM• Certified Safety Professional – CSP• Workers’ Compensation Claims Management Professional – WCCP• Workers’ Compensation Claims Management Associate – WCCA• Certified Professional Disability Manager – CPDM• Self Insured Professional – SIP• Project Management Professional - PMP• Masters in Project Management – MBA
Please visit our website for more information: www.executivesm.com
What we Strive for
• Employer Service Objectives• Provide services focused on
reducing the frequency and severity of workplace injury
• Meet with key decision makers to create an effective safety and claims management plan
• Establish and maintain good working relationships with employers
• Provide Workers’ Compensation management training to the reduce the risk and cost of workplace injury exposure
• Provide excellent value-added service• Ensure services goals are met
“Over the past seven years, ESM served an important role in helping VSP Vision Care decrease our workers' compensation claims and costs. ESM developed a deep understanding of our unique business and is a strategic partner.”
- April Bettencourt, Manager, Benefits & Payroll,
Vision Service Plan (VSP)
ESM Engagement Strategy
INTRODUCTION Work Comp Policy written WC service needed – ESM introduced
REFERRAL Broker completes “Referral Form” sends to ESM
ESM / Broker/ Client develop a POA for client
SERVICE ESM Service plan initiated Carrier/Broker/Client maintain presence in service stream
OBJECTIVES Assist insured with mitigating Work Comp risk and cost
Client and Broker results & satisfaction
Training & Education
Training Solutions
Only ESM offers:
• Leading-edge Workers’ Compensation market intelligence and insight through: • Live Lunch & Learn • Onsite Safety Training• Webinars (live and recorded)
• Development of Computer Based Training Modules (CBTs)
• Private branding
http://www.executivesm.com/education/ Check out our 90 second
trailer!http://youtu.be/4uMtTY-QSUE
Safety Video Development
• Private Branded Safety Training Videos:• Safety Videos
• E.g. IIPP Overview • Legislative Updates
• E.g. SB863• Informative Videos
• E.g. New Hire Safety Orientation process
• “Green Screen” productions available
Check out our 30 second promotional video! http://
youtu.be/d5x6qJTOycQ
Safety Management
Ongoing, structured Safety
Committee Meetings
Ongoing, scheduled Safety
Inspections & Trending
Relevant and compliant
Safety Training
Standardization of Processes for scalability and sustainability
Risk Assessmen
t
Define prioritized scope of
work
Prepare Corporate
S&H Policy
Develop Injury & Illness
Prevention Program
Develop Safety & Health Manual
Building a Safety program
Safety Foundation
Safety Application
Risk Assessment
• Comprehensive Risk Assessment for employers
• Workers’ Comp / Safety Audit • Conduct an audit of written programs to ensure
compliance and accuracy of organizational practices
• Conduct a site inspection to identify leading exposures
• Report
• Summary of risk• SWOT analysis of Safety & Work Comp program
• Recommendations• Acceptable or unacceptable risk
• Roadmap for risk management improvement
http://www.executivesm.com/products/risk-assestment-kit/
Insured
Safety
Compliance
Claims Managem
ent
Return-To-Work
Injury & Illness Prevention Plan
• Injury & Illness Prevention Program Review and Revision • Ensure compliance with Cal-OSHA’s required 8 elements
• Code of Safe Practices (COSP) 9th element required for Construction industry
• Ensure written programs reflect field practices
• Supporting forms and checklists include:
• Accident investigation form
• Inspection checklist by industry
• Employee safety contact report
• Employee warning record
• Supervisor report of Injury
• Optional: Provide Do-It-Yourself compliance based train-the-trainer programs
• Includes training schedule, attendance forms, learner’s guide, PowerPoint Training, quizzes and answers
• Private or co-branding available
http://www.executivesm.com/products/iipp-kit/
Optional training
programs:•IIPP Overview•Bloodborne Pathogens•Distracted Driving•Ergonomics•Fire Extinguisher•Hearing Conservation•Heat Illness Prevention•Housekeeping, Slip –Trip-Fall•Material handling/back safety•Industrial Truck / Forklift
Customer Engagement
Collect BackgroundInformation
Current Injury & Illness Prevention PlanOSHA 300 log (past three years) Training records (samples)Inspection reports (samples)Loss runs if available (most current)
Complete IIPP
Evaluation Questionnai
re
Phase 1 – IIPP Review
Program Introduction
Phase 2 – IIPP Revision
Review client’s current IIPP
Analyze supporting
documentation
Prepare revised IIPP
Outline
Revise and reformat
IIPP
Ensure IIPP meets Cal-
OSHA standards
Phase 3 – IIPP Roll out
Revise / develop custom
checklists for implementation and compliance
Provide revised IIPP, action
items and Bi-monthly safety
training modules to
client
Collaborate on revised program
Ensure procedures reflect organizational practices
Adopt revised IIPP
Provide IIPP training to
Supervisors / Managers
JointClient ESM
Multiple drafts may be required
Provide bi-monthly
safety training to employees
Coordinate with client regarding questions, or additional information needed
Identify missing Cal-OSHA
compliance requirements
Provide ongoing consultation and
support, including annual refresher to
IIPP
Safety training modules include: PPT Presentation, Learner’s Guide, Quiz and Answers
Safety Management Program
• Monthly or Quarterly Safety Management program • Assist with development of or attendance at insured’s Safety Committee
meetings for the purpose of acting as a technical advisor.
• Goals include assisting insured with effectively reviewing, revising and communicating the organizations safety initiatives.
• Program includes the following functions:
• Customized IIPP
• Safety & Health Manual
• Cal-OSHA compliance policies and training for leading exposures
• E.g. Industrial truck, LOTO, Electrical safety etc.
• Inspection checklist and schedule
• Training matrix (including tailgate schedule and material)
• Onsite quarterly safety committee meetings
• Ongoing email/phone communication and support
• http://www.executivesm.com/portfolio/safetymanagement/
Return-To-Work
Return-To-Work Program
• Return To Work program • Program includes:• Written RTW management plan and policy statement
• Establishing a support team• Assign roles and responsibilities (via committee)
• Establish process and procedures for organization
• Identify and develop written Temporary Alternative Duties (TADs)
• Document physical requirement of job tasks (“Essential Functions”)
• Develop communication tools to stakeholders • Carrier, Medical provider, Supervisors, Employees
• Train supervisors and managers
• Provide ongoing consultation regarding management and ensure compliance with the “Interactive Process” per FEHA regulations
http://www.executivesm.com/portfolio/returntowork/
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 Responsibilitie
s
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
Coordinate Communicatio
n
Coordinate with Employee
Coordinate with Medical Provider
Coordinate with Claims Administrator
Train Supervisors/Manage
rs
Roll out to all
Employees
Assign RTW Coordinator
Return To Work Development Process
Member
ESM Support
FlyerPPTLetter to employees
Claims Management
Why Claims Management?
• SB899 Reform results continue to erode
• SB863 legislative changes and impact
• X-Mod analysis and control
• 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
"I have worked with Sharon Poston of ESM Solutions, Inc. for almost 7 years. She is the most knowledgeable person I have met, in the ever changing arena of workers' compensation. If you have a question, she has the answer. Sharon is a most supportive ally for any company in need of an advocate. I would not want to work without her valuable input. “
-Mary MacDonald, Safety Manager,
Robert Mondavi Winery
Analyze reserves Litigation Management
Ongoing management of open indemnity
claims
Advisor to Employer/ Agency
Referral Form
Letter of Auth from client
Q1Summary Report
Claims Review
Q2 Unit Stat
Report
X-Mod Forecast
Q4 Renewal Report
Claims Management Schedule
Policy Year Application
Policy Year Milestones
Why Claims Management?
• Ongoing oversight and management of key claims
• Ensure examiner has positioned claim for speedy, cost-effective resolution
• Act as liaison for employer on all delayed claims, ensuring 90- day decision is met timely
• Ensure current labor code and case law are applied
• Recommend litigation strategies to resolve claims
• Ensure X-Mod accuracy
• Communication: Ongoing phone call and email communication for clients and staff
• Audit of Third Party Administrators as needed
• For more on our Claims Management process please visit our website:
http://www.executivesm.com/portfolio/claimsmanagement/
Disputed Claims
Claim is classified as MO or IND
MO claim processed, closed in 90
days
Begin RTW coordination
with 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
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
Carrier processes
claim
CarrierESM Client
Claims Management Reporting & Oversight Process
The ESM Commitment
ESM’s Commitment
• Results Driven• The ESM focus is to minimize risk and cost by
reducing the frequency and severity of workplace injury and time off of work.
• Our service team will provide a diversified portfolio of services that can assist your organization with your ongoing Workers’ Compensation needs and profitability.
• Relationship Focused: • ESM is driven to establishing and maintaining
superior working relationships with all stakeholders by meeting with key decision makers and designing a mutual plan for success.
ESM is the Solution
• Expertise in Safety & Workers’ Compensation
• Established relationship and understanding of Safety and Workers’ Compensation needs
• Results driven program plan of action
• Successful partnership with strategic resources
• Designations: • WCCA, WCCP, CPDM, ARM, AIM, SIP, PMP, CSP
• Responsive and friendly
• Raising the “BAR”• Benefits from Activities that get Results
Injury Prevention and Workers’ Compensation Claims
Management
Where there are risks, there are Solutions
www.executivesm.com