WORKERS COMPENSATION CLAIMS MANAGEMENT

Transcription

1 WORKERS COMPENSATION CLAIMS MANAGEMENT November 13 th, 2014 Angela Wheeler Claims Consultant

2 AGENDA Carrier Selection & Relationship Building Pre-Loss Time Of Loss Post-Loss November 12,

3 CARRIER SELECTION & RELATIONSHIP BUILDING

4 CARRIERS ARE EVALUATING YOU! Safety Programs Workers Compensation Programs Large Losses Frequency/Severity Experience Modification Rating 5-year Loss Experience Loss Ratio November 12,

5 BAD LOSS RATIO 140% 120% 121% 100% 80% 67% 82% 84% 90% 60% 40% 20% 0% Total Loss Ratio Break Even November 12,

6 CARRIER SELECTION Carrier Reputation Adjuster Case Load Claim Handling Process Defense Counsel Claim Reviews Cost vs. Service November 12,

7 CARRIER RELATIONSHIP BUILDING Responsiveness Communication!! Accountability Whose $$ is it? November 12,

8 PRE-LOSS

9 PRE-HIRE Criminal Background Checks Professional Certification Verification Pre-Employment Physicals Character Testing CANNOT LOOK INTO PRIOR WC HISTORY!! 8

10 TRAINING Educate Employees on Insurance Costs Workers Compensation Orientation Prompt Reporting Stay-At-Work Program Supervisor Training 9

11 WORKERS COMPENSATION Exclusive Remedy Injury or Illness Arising Out of/course and Scope Coming and Going Rule Proximate Cause Employee Hired As Is Caused, Aggravated or Accelerated November 12,

12 REPETITIVE TRAUMA INJURIES Examples Carpal Tunnel Syndrome Shoulder Impingement Back Injuries Common Questions What Constitutes Notice? What Date Should Be Used For Date Of Injury? Duty to Inquire?

13 WAITING PERIOD Waiting Period For Wage Benefits Begins Day Of Injury State Specific Waiting Period Retroactive Period November 12,

14 STATUTORY BENEFITS Medical Only (M.O.) Indemnity Claims (Lost Time) Temporary Total Disability (TTD) Temporary Partial Disability (TPD) Permanent Partial Disability (PPD) Maximum Medical Improvement (MMI) Independent Medical Exam (IME) November 12,

15 INJURY KIT First Report Of Injury Form Claim Coordinator Contact Information Employee Information Sheet State Specific Accident Investigation Form Workability Witness Statement Forms Carrier Contact Information November 12,

16 INJURY KIT Medical Facility Contact Information Job Descriptions Regular Stay-At-Work Transitional Duty Commitment Statement November 12,

17 DEVELOP WRITTEN PROTOCOL Workers Compensation Policy Who Is Responsible For The Stay-At-Work Program? Who Will Continue To Contact The Employee? Who Completes? Injury Kit First Report of Injury Form Accident Investigation Form Witness Statement Form Will We Pay Time Lost Due To Doctor s Visits? Will We Pay The Employee For A Full Day On The Date Of Injury? November 12,

18 PROVIDER RELATIONSHIPS Benefits Consistency From The Provider Familiarity With Your Company Select Multiple Providers Interview Clinic Confirm Office Hours / Contacts Offer Facility Tours Share Stay-At-Work Program Provide Job Descriptions

19 Litigation 5% Litigation Rate Is Very Good 10-15% Litigation Rate Is Good 20% Litigation Rate Is A Red Flag NCCI States That Litigated Claims Cost 40% More Than Non-Litigated Claims 18

20 TIME OF LOSS

21 TIMELY REPORTING 24 Hours First Report Of Injury (FROI) Injury Worsens Without Treatment Attorney Involvement Fraud Potential Increased Indemnity Undirected Medical Care Less Cooperative Memories Fade Employer Statement November 12,

22 TIMELY REPORTING Study By The Hartford Claim Costs Increased: - 18% When Reported After 1 Week - 29% When Reported After 2 Weeks - 31% When Reported After 3 Weeks - 45% When Reported After 4 Weeks Claim Costs On Back Injuries Increased 40% When Reported After 1 Week November 12,

23 TIMELY REPORTING 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% 22% 29% 34% 47% 0-10 Days Days Days 31+ Days LITIGATION INVOLVEMENT November 12,

24 IMMEDIATE CARE OPTIONS First aid OSHA Guidelines Soft Tissue Injuries? When In Doubt, Have Employee Seek Treatment Traditional care Occupational Health Clinic Urgent Care Clinic General Practice Clinic Chiropractor Emergency Room Other Options On-Site Nurse Triage Nursing

25 MEDICAL BILLS In Minnesota, it is ILLEGAL for employers to pay medical bills UNLESS the employer has been approved by the Department of Commerce for Workers Compensation Benefits November 12,

26 Injury KIT Remind Employee Of Company Contact Contact Provider Employee Name Type Of Injury Insurance Information

27 POST LOSS

28 FRAUD PREVENTION : POST-INJURY COMMUNICATION Employee - Listen - Find Common Ground - Be Available - Show Compassion 27

29 EMPLOYEE COMMUNICATION Proactive Contact General Welfare Check Transitional Duty Accommodations Stay-At-Work Agreement Consequences Of Non-Compliance Termination Of Employment

30 Internal Communication Manager Schedule HR Representative FMLA / Leave Of Absences ADA HIPAA Safety Representative Accident Investigation

31 External Communication Provider Transitional Duty Accommodations Appointment Schedule Work Status Adjuster Compensability Work Status Agent Issues

32 STAY-AT-WORK

33 STAY-AT-WORK Transitional Duty Reduces Cost, Direct And Indirect - Indemnity Costs Decrease - Medical Costs Decrease Speeds Healing Reduces Litigation Risk Improves Employee Morale Promotes Good Relationships And Trust November 12,

34 STAY-AT-WORK Transitional Duty Must Be Meaningful But Does Not Need To Be: Related To Regular Job Fun In The Assigned Location Regular Shift 33

35 STAY-AT-WORK Stay-At-Work Job Offer Should Be In Writing Within Physical Restrictions At Or Near Pre-Injury Wage Employee Obligated To Respond Within Reasonable Time Unreasonable Refusal = Forfeiture Of TTD Benefits 34

36 STAY-AT-WORK Financial Impact: Employee On Restrictions Average Weekly Wage (AWW) = $600/wk With Job Offer Indemnity $0 Medical $10,000 Without Job Offer TTD $400/wk Medical $10,000 TPD $133.33/wk 35

37 STAY-AT-WORK Employer Benefits: - Controlled Direct And Indirect Claim Costs - Reduced Production Overtime - Reduced Need To Train Replacement Workers - Increased Morale - Reduced Workers Compensation Fraud - Reduced Likelihood Of Litigation - Maintained Skill Set For Valuable And Experienced Workers Employee Benefits: - Speeds Recovery - Supports Self-Worth - Prevents Disruption Of Salary And/Or Benefits - Creates Ownership/Accountability In Program November 12,

38 QUESTIONS

39 Safety Program Design Presented by: David Rumsey, CSP, CRM, ARM, OHST, STS Risk Consultant, Marsh & McLennan Agency

40 AWAIR -Required In Writing for Work in Minnesota -Train Employees Program must describe each requirement: Responsibilities & Duties Communication Accountability Inspection Accident Investigation Set Clearly Stated Goals & Objectives Review & Update Annually Show Date of Review Note: Federal OSHA I2P2 Being Considered

41 MN Safety Committee Requirements Written Scope/Purpose Statement Employers with more than 25 employees must have a joint labor/management committee 40

42 Right To Know - GHS Provide Access to MSDS/SDS Label all Containers Written Program Required Training Annually (MN) Noise Heat/Cold, Infectious Agents Formaldehyde/Asbestos/Lead/CO

43 Personal Protective Equipment Written Certified Hazard Assessments Required Initial Training Requirements Then as needed or when PPE needs change, or when inadequacies are observed

44 Emergency Action Plans Training Required for New & Existing Employees Re-train as needed or if changes to the plan occur Written Plans Required if more than 10 employees 43

45 Lockout / Electrical Safety Lockout / Tagout Requires written policies Training is required Annually: Periodic Inspection for Authorized Safety Electrical Work-practices for: Trouble-shooting over 50V NFPA 70E

46 Respiratory Protection Identify Hazards & Assess (Air Sampling) Voluntary Use Read Appendix D Required Use: Medical Evaluation Required Proper Respirator Selection Annual Training Annual Fit Testing Written Policies

47 Permit Required Confined Space Written Policies Required & Permit System Training is Required: Before assigned When Changes Occur Rescue Practice Annually unless non-entry rescue 46

48 Bloodborne Pathogens Training for Those with Occupational Exposures Written Plan Required: BBP Diseases Exposures Universal Precautions/Housekeeping Work Practice Controls Hep B Vaccinations Post Exposure Evaluations 47

49 Process Safety Management Written Programs Required if Quantities of Hazardous Materials Exceed those shown in Appendix A of Subpart H (Hazardous Materials) Extensive Initial Training Requirements Then every 3 years 48

50 Other Possible Programs: Hearing Conservation Safe Patient Handling Hot Work Permit Program Mechanical Power Presses Lab Safety Hygiene Plan 49

51 Other Possible Programs: FA/CPR First Responders Combustible Dust/Grain Handling Fire Prevention & Protection Servicing Rims & Wheels Overhead Cranes Rigging 50

52 Powered Industrial Trucks Certification Training Every 3 Years Daily Pre-Shift Inspection

53 Postings & OSHA 300 Log 52

54 Password: 111safety November 12,

55 Safety Program Design Questions, Comments, or Discussion? David Rumsey, CSP, CRM, ARM, OHST, STS Risk Consultant, Marsh & McLennan Agency