The Cost of Workers Compensation Benefits. Summer Conference 2013

Transcription

1 The Cost of Workers Compensation Benefits Summer Conference 2013

2 FY 2013 Comparisons WC Benefits Paid FY13 Indemnity FY13 Medical $ 23,648,377 $32,924,949 Total: $ 56,573,326 FY12 Indemnity FY12 Medical $22,414,804 $32,621,320 Total: $55,036,124

3 FY 2013 Comparisons State and Local Benefits Paid WC Payments FY 12 FY 13 Total Paid $55,306,125 $56,573,326 Total Local Paid $7,437,755 $7,417,730 Total State Paid $47,598,369 $49,155,597 Average Payment Per Day $150,783 $154,995

4 As of Date Injury FY 6/30/2009 6/30/2010 6/30/2011 6/30/2012 6/30/2013 Prior to 2009 Open Claims 1, Total Claims Reported 72,370 72,399 72,408 72,412 72,412 Paid in Period $31,984,221 $20,393,195 $17,838,318 $16,523,966 $14,717,237 Total Paid to Date $334,602,786 $354,995,981 $372,834,299 $389,358,265 $404,075,502 Total Reserves $78,856,081 $65,221,270 $71,337,812 $67,934,124 $67,524,929 Total I ncurred $413,458,867 $420,217,251 $444,172,111 $457,292,388 $471,600,430 FY 2009 Open Claims 2, Total Claims Reported 6,743 6,894 6,918 6,918 6,915 Paid in Period $10,874,680 $12,561,664 $8,694,091 $5,878,448 $4,668,554 Total Paid to Date $10,874,680 $23,436,344 $32,130,435 $38,008,882 $42,677,437 Total Reserves $14,217,990 $11,957,151 $12,325,209 $11,771,570 $10,356,123 Total I ncurred $25,092,670 $35,393,495 $44,455,643 $49,780,453 $53,033,559 FY 2010 Open Claims 2, Total Claims Reported 7,259 7,436 7,452 7,454 Paid in Period $9,829,474 $13,979,467 $9,591,089 $5,438,805 Total Paid to Date $9,829,474 $23,808,907 $33,400,086 $38,838,891 Total Reserves $12,503,843 $14,827,787 $14,003,606 $13,721,443 Total I ncurred $22,333,317 $38,636,694 $47,403,692 $52,560,333 FY 2011 Open Claims 2, Total Claims Reported 5,895 6,076 6,083 Paid in Period $9,878,679 $12,974,024 $6,986,458 Total Paid to Date $9,878,554 $22,853,379 $29,839,842 Total Reserves $17,007,565 $13,224,185 $11,694,147 Total I ncurred $26,886,118 $36,077,564 $41,533,989 FY 2012 Open Claims 2, Total Claims Reported 6,079 6,291 Paid in Period $10,068,597 $14,234,237 Total Paid to Date $10,068,597 $24,302,834 Total Reserves $18,847,470 $15,438,179 Total I ncurred $28,916,067 $39,741,013 FY 2013 Open Claims 2,543 Total Claims Reported 6,085 Paid in Period $10,669,717 Total Paid to Date $10,669,717 Total Reserves $19,902,987 Total I ncurred $30,572,704 Total Open Claims 3,597 3,750 3,721 3,970 4,342 Total Claims Reported 79,113 86,552 92,657 98, ,240 Total Paid in Period 42,858,901 42,784,333 50,390,555 55,036,123 56,715,007 Total Paid to Date 345,477, ,261, ,652, ,689, ,404,222 Total Reserves 93,074,071 89,682, ,498, ,780, ,637,807 Total Reserves 438,551, ,944, ,150, ,470, ,042,029

5 SB43 Make Recommendations Regarding Management of Workers Compensation Signed by Governor 23 July 2013 Identify Expenses, How Budgeted and Paid Study TPA and Legal Fees - How Allocated Recommend Alternative Budgeting Methods Increase Flexibility of Settling WC claims Motivate Agencies to Return Employees Back to Work as soon as possible

6 SB174 Act to Disapprove Certain Rules Adopted by the NCIC Signed by Governor 18 th July 2013 Revised Expedited Medical Motion requiring injured worker to go through the Commission, as employer has the right to contest the motion. Commission decides outcome and has up to 35 days days for emergency Form 23 revised. Application to Reinstate Temporary Total Disability Benefits. Workers will be required to file a Request for Hearing (Form 33). Commission will decide whether there is sufficient basis to reinstate TTD Benefits Court Costs may be shifted from employer to shared cost between employee and employer.

7 Bid Time Third Party Administrator RFP posted for TPA End of 2013 Services Processing of First Report of Injury Split Funding Requirements Claim Adjusting & Administration Medical Provider Network All other Services Network Data Collection & Warehouse Claim Resolution Contract Award May 2014

8 Maximum Medical Improvement What is it? What does it Mean??? MMI is the turnkey to closing WC File Final word from Treating Physician Employee reaches a state where medical condition & treatment have plateaued Treating Physician provides rating -- permanent, partial or no disability (NCGS 97-31) Treating Physician may incorporate job restrictions within MMI MMI means treatment options have been reached Return employee back to work or settle claim.

9 Drug Testing NCGS Use of intoxicant or controlled substance, willful neglect, willful disobedience of statutory duty, safety regulation or rule. 1) Not supplied by employer 2) Under the influence where controlled substance was not prescribed 3) Willful intention Who has burden of proof?

10 Proximate Cause Employer must prove that employees intoxication was more probable than not a proximate cause of the accident resulting in injury.

11 Job Descriptions Written Job Description Actual Work Activities Treating Physician must approve Job must be real

12 Suitable Employment Employment offered to employee - Before Reaching MMI Employment within employee work restrictions - After reaching MMI - Employment that employee is capable of performing - Located within 50 mile radius of employee residence Without Suitable Employment - Vocational Rehabilitation - Continue with Weekly Indemnity Payments

13 Terminating An Employee While On Workers Compensation Benefits Employee sustains a compensable WC injury Returned to work and provided light duty or rehabilitative employment Is terminated from such employment for misconduct or other fault Will termination initiate lost time payments for Temporary Total Disability? Prove employee s loss of, or reduction of wage earning capacity is attributable to the wrongful act resulting in the loss of employment. In which case, WC benefits will be barred. Wage loss or reduction in wage earning capacity due to employee s work-related disability, will entitle employee to benefits.

14 Separation Due To Unavailability Will Separation Due to Unavailability terminate an employee s workers compensation benefits? Have you considered Separation Due to Unavailability?

15 How Can We Lower Workers Compensation Expenses? Report claims timely Utilize PPO Network provided by TPA Complete Wage Statement (Form 22) Accurately Know status of every open WC claim Work with adjuster on Return to Work Provide Accurate Job Descriptions Follow employee s MMI status Get disability paperwork to employee s if eligible Settle with Resignation and before Employee Retires

16 THANK YOU Eileen Townsend, CPCU, AU Chief of Insurance