Emerging Issues for a Workers’ Compensation ManagerPresented by Ben Reynolds

Leighton Contractors Pty Limited

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As a Workers’ Compensation Manager I see the following emerging issues as something we all need to consider;

Available Resources

Comcare

Management of claims

Provider Networks

Scheme Changes

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Each Business is different

My issues may not be your issues

My solutions may not be your solutions

I have plenty of questions too, but that’s where it starts....

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Available Resources

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Available Resources

Money – There just isn’t enough!

How do you fund your initiatives? • How do you convince management to spend money?

How do you fund your day to day operations? • Continued justification?

What does value look like?

What does ROI look like?

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Available Resources

In general availability of Funds across the scheme is limited;

• Fund Scheme agents borderline profitability

• Authorities in varying states of financial status

• Fee limitations on providers

• Increasing salaries of employees

• Increasing operational costs

• Downward pressure on premiums

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Shortage of quality workers’ comp professional

Scheme improvements have impacted on the available resource pool;•Decrease case loads•Increased salaries•More time spent managing cases•Higher level of skills needed•Reduced spend on provider fees (lawyers, allied health etc).

No one ever leaves school wanting to be a workers’ comp manager

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Increasing case manager

salaries

Case loads decreasing

Limited availability of quality staff

Decrease Salaries?

Increase Case Loads?

Employ less qualified staff?

Downward premium pressure

Increase Premiums?

Insurer Resources

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Comcare

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ComcareWhy is Comcare such a hot topic?

• Self Insurance has for some time been seen as a solution to the high cost of workers’ compensation premiums

• Comcare being a single, national program solution could potentially remove significant administrative burden

• Allows employers to manage their own destiny

• Current changes provide an enhance attraction• Widening the eligibility criteria • Group Licenses• Comcare as WHS regulator

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Comcare

Why do I consider Comcare an emerging issue?

• Large, national premium payers leaving scheme

• Taking the good people with them

• Pressure from Management and others who see it as “the” solution

• Scheme’s providing alternate options to avoid an exodus

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Comcare

So is Comcare “the” solution?

No, it’s just “a” solution

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Management of Claims

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Management of Claims

There is a shift in the approach to the management of workers compensation cases from a claims management approach to an injury management approach

People generally accept that early intervention injury management is “best practice”

What is the difference? • Claims Management is to resolve the claim• Injury Management is to resolve the injury

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Management of Claims

Schemes are trying to move to Injury Management, but do Authorities and Insurers really understand Injury Management?

Can you legislate the flexibility needed? • Provisional Liability in NSW• S.58b in SA• Large Vs Small employers• Good Vs Bad employers

Do we really want Authorities to drive this agenda?

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Management of Claims

How do you achieve best practice injury management?

How do you achieve this and keep your Management, Employees, Insurers and Authorities happy?

Is it possible to shift the mindset of your stakeholders?

How do you show value?

What if you don’t change focus?

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Providers Networks

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Provider Networks

It’s important to realise that we cannot always achieve what we need on our own. How do you manage to have a sustainable provider network?

Insurers, Doctors, Rehab, Lawyers, Investigators, Brokers face all the same challenges we do;• How do they keep quality employees?• How do they remain profitable when regulators limit fees?

How do they remain relevant and viable when employers are getting smarter and more involved?

Why is that an issue? What happens if they don’t evolve?

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Scheme Changes

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Scheme Changes

Currently NSW, NT, QLD, SA, WA and Comcare are in the process of significant change or review.

Some changes will have significant impacts on employees and/or employers

Employers need to have a voice•Employer needs often seen as anti employee•Everyone who submits feedback to a scheme is biased.

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Conclusion

What am I doing about resources?

How will I manage the Comcare changes?

How will I manage our workers compensation claims?

What will I need from providers and can they deliver?

What will the scheme changes mean to me? How can I impact them?

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Conclusion

Two last questions;

If you were injured at work would you be happy with the treatment provided?

Would your CEO go through your workers compensation process?

Thank you.

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Silver Sponsor Bronze SponsorRisk Manager of the Year

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