Today s Objectives. Perspective. Reducing WC Costs through Claims Management and Risk Control. Empire State Building. WC Costs: Where Are We?

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1 Perspective Reducing WC Costs through Claims Management and Risk Control Lunchtime What a great time to just unwind and relieve stress with no worries Ernesto Galindo and Stacy Corluccio Empire State Building 1931 construction photos $40,000,000 project (under budget) Frame grew as much as 4.5 stories a week during construction A little more than one year to complete More than 3400 workers on the job at the same time Only five workers died during the project Today s Objectives Costs Where does Texas rank? Risk control techniques and loss reduction Pre-loss reduction Risk identification, safety programs, training programs Post-loss reduction Timely claims reporting Return to work WC Costs: Where Are We? Average Benefit Payment per Claim with More Than 7 Days of Lost Time, 2013/2014 WC Costs: Where Are We? Claims with More Than 7 Days of Lost Time as Percentage of All Paid Claims, 2013/2014 1

2 Risk Management Loss Control Techniques Avoidance Prevention Transfer (contractual and physical) Loss Reduction Frequency = Number of Losses Severity= Cost of Losses Reduction Segregation /Duplication Goal = Reduce Severity of Losses not Prevented Successful Safety Programs Training and Education Management Support Pre-Loss Reduction Techniques Proactive Attitude Understanding Risk Exposures Employee Involvement Management Support Management Supervisors Line Personnel Foundation for a Safety Program Management Support Accident Investigation Training & Education Analysis Recordkeeping Risk Identification Review and Revision 2

3 OSHA Top 10 Citations Fall Protection 1. Fall Protection 2. Hazard Communication 2. Hazard Communication 3. Scaffolding 3. Scaffolding 4. Respiratory Protection 4. Respiratory Protection 5. Electrical, Wiring methods 5. Lockout/Tagout 6. Power Industrial Trucks 6. Power Industrial Trucks 7. Ladders 7. Electrical, Wiring methods 8. Lockout/Tagout 8. Ladders 9. Electrical General Requirements 9. Machine Guarding 10. Machine Guarding 10. Electrical General Requirements Top Five Workers Compensation Claims Motor Vehicle Miscellaneous Causes Strain or Injury Struck or Injured By Fall, Slip, or Trip Workers Compensation Claims by Occupation Juv Probation, Collectors, Sales Bldg. Maintenance & Janitors Clerical Road Employees-Paving, Repaving Law Enforcement Accident Investigation Accident Investigation Root Cause Determination WC Compensability Accident Investigation All accidents must be investigated Accident investigations are fact findings process Accident investigation should identify possible solutions Accident investigations are never a fault finding tool Training & Education Safety Training Programs Determine what training is needed New / transferred personnel, new equipment Determine safety learning activities Lecture Hands-on training Evaluate training needs on a regular basis Post-Loss Reduction Techniques Reporting claims information Timely and complete forms DWC-1: First Report of Injury DWC-6: Supplemental Report of Injury DWC-3: Employer s Wage Statement 3

4 Injury Reporting DWC-1: First Report of Injury cost-related elements Date of return to work, if applicable Employee may not be eligible for TIBs Wage information: Rate of Pay and Last Paycheck Used to compute TIBs before Wage Statement is received Must be accurate to avoid overpayments and underpayments Injury Reporting (continued) Subrogation (third party recovery for claim payments) Nature of injury, how did it happen, who was involved? Need evidence and specific information about contractors or third party Automobiles, mobile equipment, all other rented equipment Accident scene condition must be preserved and evidence kept! Restitution- names of suspects and information from assaults Work Status Reporting Who is the first person to know when an injured worker has returned to work? Supervisor! They must be workers compensation savvy Report using the DWC-6 form Date RTW, modified or full duty? Rate of pay? Report resignation or termination dates if TIBs are being paid Wage Reporting When employee misses 8 calendar days from work, TIBs are due Employers required to report wages using DWC-3: Wage Statement within 30 days after 8 th day missed from work Why is it important to file the DWC-3 accurately and early? Late reporting = overpaid or underpaid TIBs TIBs are based on an average weekly wage (13 weeks) Working Works! The Alliance 4

5 Return to Work in the Alliance Return to Work Steps Measure Alliance Care Non-Network Care Percent of Injured Workers RTW after the Injury 98%* 88% Average Number of Weeks Injured Worker Reported Off Work Because of the Work- Related Injury Percent of Injured Workers Who Haven t RTW, but Doctor Released with or without Restrictions % 65% *Highest rate from all employee surveys Source: 2015 Workers Compensation Network Report Card, Texas Department of Insurance Send the DWC-74: Description of Employee s Employment to the treating doctor When the DWC-73: Work Status Report is received Offer temporary and productive modification of employee s job or a position in another department. Both must comply with restrictions. Bona Fide Offer must be in writing with wages, schedule, location, description, and a statement that you will only assign tasks consistent with the knowledge and skills of the injured worker Get proof of offer receipt to protect your county in the event of a dispute RTW by the Numbers Building/Maintenance Worker: TIB Rate = $374/week - sprain/strain $374 x 6 weeks= $2244, 12 weeks = $4488 Total incurred $26,529 - $4488 = $22,041 17% savings if RTW was offered Tax Assessor: TIB rate = $ multiple injuries - MVA $ x 6 weeks = $ , $ x 12 weeks = $ Total incurred: $62,987 - $ = $55, % savings if RTW was offered Road and Bridge Employee- TIB Rate = $ fracture $ x 6 weeks = $ , x 12 weeks = $ Total Incurred = $15,467 - $ = $ % savings if RTW was offered Successful return to work program 10% to 40% savings on claims Source: 1998 Business Insurance Report Thank You Questions? Please contact Stacy Corluccio and Ernesto Galindo county.org 5