CCSF WORKERS COMPENSATION COUNCIL MINUTES Regular Meeting March 7, 2016 9:00 a.m. ROOM 408, CITY HALL 1 Dr. Carlton B. Goodlett Place CALL TO ORDER 9:00 a.m. ROLL CALL Micki Callahan, Human Resources Director Kate Howard, Mayor s Budget Director Naomi Kelly, City Administrator (Represented by Marissa Pereira Tully) (Represented by Peter Goldstein) Norm Nickens, Retirement Board Secretary, Retirement System Todd Rydstrom, Deputy Controller, Controller s Office Dyana Lechuga, Deputy City Attorney PUBLIC REQUESTS TO SPEAK ON ANY MATTER WITHIN THE JURISDICTION OF THE WORKERS COMPENSATION COUNCIL NOT APPEARING ON THE AGENDA (Item No. 1) Public Comments: NONE APPROVAL OF MINUTES (Item No. 2) Action: Adopted as amended (Vote of 4 to 0)
REPORTS FROM THE WORKERS COMPENSATION DIVISION Discussion Items: Item No. 03 Speaker: Peggy Sugarman, Deputy Director, Workers Compensation Division Reported on Claims: Cost & Frequency Analyses: Peggy Sugarman began the meeting by discussing claim filing frequency; both indemnity and medical are represented. The chart depicts the second quarter numbers. Looking at the top 10 departments, there has been an overall decrease in both Indemnity and Medial Only claim filings. For expenditures, Peggy compared the first six months from this year to first six months of last year. The deficit in this category means, deficit compared to the budgeted amount. For the Department of Public Works there is half a million deficit so far. This is due to a large claim that was settled at the beginning of this fiscal year. Going forward, numbers should even out more. Peggy reported on costs by category. For the second quarter has been an 18.5% decrease in TD (temporary disability) payments. This is good since TD rates go up every year and the number of city employees keeps growing. PD (Permanent Disability) remains on an uptake. This is due to the higher number of claims being closed and increases in the Permanent Disability Rating Schedule. Micki asks if TD has gone down due to the efforts of getting employees back to work. Peggy says that would be her first guess. It also has to do with skilled claims adjusting. Medical costs have gone down due to the state fee schedule and utilization review. Last year there was a 10% decrease in overall medical expenditures. Peggy reported on other performance measures. Worker s Compensation Division reported these measures to the Controller s Office. The numbers reflect closure ratios. For the first six months, Worker s Compensation Division is at 107%, and the TPA is at 102%. For the end of the fiscal year, the targeted combined is 105%. Last year the combined closing percentage was 116%. Taking inventory of claims that have been open for more than five years, 2006-2011, the amount is 5.73%. Looking at claims from 2001-2011, these represent 3% of open claims. Micki asks if there are claims open before 2001. Both Peggy and Dyana Lechuga verify that there are, but very few. Peggy continued to discuss the top 5 departments that have claims by severity and frequency. They are Police, Fire, Sheriff, Public Health, and Recreation & Parks. The timeline for these claims is all open claims as of the second quarter of this fiscal year. The amounts reflect everything that is being paid on a claim plus reserves. Todd asks if the graphs can show the comparison between each quarter. Peggy says that can be done.
Looking at the Claim Causes by Frequency, the top 5 departments are Police, Fire, Sheriff, Public Health, and Recreation & Parks. Workers Compensation, MTA, and their TPA have been working on categories for claim causes to make everything consistent. There is now a list with definitions that will be implemented. As claims come in the supervisors will be assigning the claim cause. Micki asks Peggy to remind everyone what the expectation is from the adjusters and supervisors when there is a spike in a type of injury. Peggy says it is not part of the regular review, but if a trend jumps out, then there will be a meeting. Some departments have people constantly analyzing injuries and how to prevent them. Peter Goldstein asks Peggy if there is ever a time where someone from Organized Labor, in addition to safety officers, asks about injury trends. Peggy says there is a SEIU Labor Management Committee and that she is a co-chair. They meet once a quarter for discussions about SEIU concerns on injuries. Todd asks if there is correlation with claim causes and claim stratification. Peggy states she does not know the answer, but will check for the next time. Organizational Initiatives- PUC Temporary Transitional Work Pilot Launched February 1, 2016 SEIU L-M safety initiative is continuing to have meetings. These include a review of assaults per the SEIU MOU A new RFP was posted for Bill Review/Utilization. Allied Managed Care was selected. For Excess Liability Insurance- More information is being gathered to turn into Risk Management. MD Guidelines, a web-based software program, is in the pilot phase. This will give adjuster a better idea on typical disability duration by diagnoses. This is budgeted to roll out next year to all adjusters. In collaboration with the District Attorney s Office, CCSF is planning to host a fraud summit in May 2016. Exploring a pay card system for indemnity, instead of paper checks. So far we have talked to US Bank and the State of California about options. MPN Update- WCD is working on Fast Track preauthorization for the first 90 days of the claim. Nonie Devens, RN is helping with this. It was implemented on August 24, 2015. A new option in the Allied Managed Care contract will provide immediate advice nurse triage services when an injury occurs. This will be a pilot. There has been a reach-out to UCSF to treat psychiatry claims. Micki asked where everything is with the TPA negations and timing. Peggy says she and Dan Roach have looked over the RFP and are waiting for approval from the City Attorney s office. Dyana says their review will be done in the next day or two.
In the last meeting Micki asked Peggy to check and see if regular volunteers can sue the City for injuries related to their duties and how are they covered. Volunteers that are not city employees are covered through State Compensation Insurance Fund. If a volunteer gets hurt they can sue the City. Micki asked if disaster volunteers show up and don t register and get badged, will they still be covered by Labor Code. Peggy says they will not. Disaster volunteers have to sign in and get badged to be covered. Dyana clarifies that even if non disaster volunteers get injured, they will still have to prove it is the City s fault that they got hurt to have a claim. Dyana says she will look into to see if there is a way to delineate the volunteer claims from all other claims. Micki asked if Peggy can report, at the next meeting, what other counties do to cover their volunteers when they get injured. Todd asks if Peggy can report on the Well-Being Assessment for the next meeting. Public Comment: NONE REPORT FROM THE MTA WORKERS COMPENSATION DIVISION Discussion Item: Item No. 04 Speaker: Dan Roach, Municipal Transportation Agency Dan Roach mentions that SF MTA has major challenges for their department. These are current and ongoing. MTA increased their staff by 20% in the last fiscal year. There are three separate trends that are reflected in the date because of this. The first is more claims by new operators. Enforcement officers, Transit Fair and Parking Enforcement officers have had higher claim frequency. Dan explained that the MTA report is a rolling 12 month report. He will be reporting up to the end of January 2016. The monthly average is up to 54 claims. The ratio of Indemnity claims versus Medical Only is about even. Peter asks if there is a measure on reporting claims. Dan says they go by number of injuries per 100 employees. This is utilized city-wide. Dan mentions that claim are having a corresponding increase as well. There were two catastrophic claims last May and June that affect the numbers. These two claims total 5 million which includes paid plus reserves. Micki asks when getting quotes for excess liability if there can be quotes that she MTA and Workers Compensation together and separately. Dan says this this possible. Reporting on Open Claims by Stratification by Severity the million dollar claims have increased to 19. This is due to exposure and new medical findings, along with higher TD and PD. The claims are being reviewed regularly with the TPA.
Peter asks if the 19 claims are mostly reserved costs, or mostly paid. Dan says he will look into it, but believes they are mostly reserved. Dan mentions that with the larger claims, MTA is looking at what can be refined and what safety gear maybe needed. For litigation statistics, there has been a downward trend. Dan attributes this to good customer service by the TPA and agency. Reporting on Cause Analysis, repeated motion is still the highest. Assaults and Vehicle Accidents are high also. As the new categories are implemented, the numbers will reflect for accurately. Dan hopes that not only new claims can be properly organized, but the past claims could be re-categorized. Currently the injury rate is at 10.38 per 100 employees. MTA s goal is to get the number below 10. Dan clarifies that the 10 could reflect that one employee could have multiple claims. Compared to the industry, these numbers are low. There were 8 denied claims in January. This went down from 17 denied claims in December. Division Statistics show the Transportation Operators and other front line employees have the highest injury rate. They are 77% of the claims. Woods and Potrero locations have the highest claim frequency. Public Comment: NONE OPPORTUNITY TO PLACE ITEMS ON FUTURE AGENDAS Speaker: Micki Callahan Discussion Item: Item No. 05 Council Comment: NONE OPPORTUNITY FOR THE PUBLIC TO COMMENT ON ANY MATTERS WITHIN THE COUNCIL S JURISDICTION Discussion Item: Item No. 06 Speaker: Vickie Wells, Department of Public Health Vickie comments on the volunteers during a disaster. She suggests that the department take a closer look types of injuries to volunteers would be covered. Vickie also mentions that there is quite a bit of collaboration with union representatives on injuries and prevention. NEXT REGULAR MEETING: June 6, 2016 ADJOURNMENT 10:07 A.M.