Workers’ Compensation Reducing risk and cost

SUPPORTING SCHOOL DISTRICTS WHO ARE CREATING A BETTER TOMORROW

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What we Strive for

• School District Service Objectives• Reduce costs by reducing the frequency and

severity of workplace injury • Establish a customized safety and claims

management plan• Maintain an open line of communication and

trusted working relationships with school district personnel

• Provide ongoing training to ensure a safe work environment

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Services

Training & Education

Return-to-Work

Solutions

Safety Management

Claims Management

• Customized safety management plans

• Focused on reducing injury exposures

• Developing compliant Cal/OSHA programs

• Enhancing communication strategies and training programs

• Conducting inspection to reduce hazards

• Develop customized RTW Program

• Ensure communication with all stakeholders

• Return employees back to work immediately

• Mitigating legal exposures (FEHA)

• Develop educational content and delivery

• Creating a competitive advantage by empowering district personnel to identify and control exposures

• Providing strategies for claim closure

• Oversight on indemnity claims

• Facilitating communication with all stakeholders

• Supplement & compliment efforts

• Reducing reserves and controlling the X-mod

Online Services / Educational Portal

Solutions that get ResultsDistrict Goals:

Reduce injury frequency and severityActual results achieved

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Reduction of claim frequency

2008 2009 2010 2011 20120

10

20

30

40

50

60

70

49

66

41

53

28

19

26

1114

5

30

40

2935

22

Total Number of Claims

Linear (Total Number of Claims)

Indemnity

Medical Only

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Reduction of claims severity

2009 2010 2011 2012 $-

$50,000

$100,000

$150,000

$200,000

$250,000

$300,000

$350,000

$400,000

$450,000

$500,000

$437,465 $445,598

$180,365 $145,004

Training & Education

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Principal Safety Committee

Principal Safety Committee Program:

• Develop Principal Safety Committee Guide • Establish committee at each site

• Consists of Principal and three – four other designees

• Establish general policies and procedures for the safety committee meetings, timeline, expectations, attendance forms etc…

• Prepare binder with monthly agenda and guidelines for Principals

• Curriculum for school year, including:

• Hazard identification presentation based on inspection reports and leading exposures

• Inspection checklist based on monthly presentation

• Recorded webinar for principal review

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Training solutions

• Customized safety videos• E.g. Principal Safety Program Strategic Plan,

IIPP Overview, Slip, Trip, Fall • Legislative Updates

• E.g. SB863

• Customized Computer Based Training (CBT) Modules• Develop and host CBTs• Utilize Learning Management System

Safety Management

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Why Safety Management?

• Ensure written Cal/OSHA compliance programs• E.g. HazCom, MSDS management, PPE

• Provide training based on leading exposures and safety policies (SOPs in hazardous tasks)

• Conduct inspections identifying exposure trends• Implement customized scorecard inspection program

• Utilize dashboard analytics for management decisions on resource allocation

• Optimize District wide safety understanding

• Legislative changes including Assembly Bill 2774

• Focus on reducing injuries and injury exposure

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Interior & Exterior Site Inspections

• School Site Inspections• Focused on safety, fire and

property / liability exposures.

• Conduct inspection program to satisfy IIPP

• Development of inspection binder for corrective action

• Present findings to District management

• Inspections will include all buildings and grounds, which include (but not limited to):  

• Alternate each year between exterior and interior inspections

• 100% of school grounds: • Gates, fences, parking lots,

sidewalks /walkways, fields, buildings, classrooms, locker rooms, gymnasiums, bathrooms etc…

• Hazard identification• Electrical hazards• Slip, trip and fall hazards• Structural hazards • School grounds hazards• Housekeeping hazards• Fire hazards/safety• “Fall on” hazards• Life safety hazards• Chemical hazards

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Playground Inspections

• Playground Inspections• Inspect all elementary playgrounds and middle

school athletic grounds• Inspections include:

• Identifying hazards on playground equipment and the playground

• Ranking the hazards according to injury potential• Recommendations on removing/correcting the

hazards• Utilize established playground inspection

checklist, complying with IIPP & playground inspection requirements• Per the National Playground Safety Institute (NPSI)

• Provide summary report to District management

Return To WorkReducing Lost Days and Temporary Disability

costs

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Return To Work Benefits

• Reduce or avoid temporary or permanent disability payments

• Reduce medical costs as injured workers experience faster recoveries when they remain at work in a work environment that is congenial with their physical capacity

• Reduce or avoid litigation

• Discourage fraudulent claims

• Improve productivity and morale among all employees

• Eliminate disability discrimination and comply with FEHA

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Return To Work Implementation

Foundation Assessment Launch

Write a management plan and policy statement

Build a support team and assign roles and responsibilities

Establish process and procedures

Review and Revise Job Descriptions

Identify Temporary Alternative Duties (TADs)

Document physical requirements

Coordinate communication

Train supervisors and managers

Launch RTW program to all employees

Phase 1 Phase 2 Phase 3

Evaluate Business Benefit ROI

ProgramEngagement

Collect BackgroundInformation

Current RTW Plan and/or PolicyRecent work status report from designated Medical ProviderJob descriptions Alternative dutiesLoss RunsX-Mod Worksheet/WCIRB

RTW Evaluation

Questionnaire

Phase 1 - Foundation

Program Introduction

Phase 2 - Assessment

Write Management Plan and

Policy Statement

Assign Roles and Responsibiliti

es

Planning Checklist

Review & Revise Job Descriptions

to include Essential Functions

EstablishProcess and Procedures

IdentifyTemporary Alternative

Duties (TADs)

Phase 3 - Launch

Build Support

Team

DocumentPhysical

Requirements

Member

ESM

Coordinate Communicati

on

Coordinate with EmployeeCoordinate with Medical

ProviderCoordinate with Claims

Administrator

Train Supervisors/Manage

rs

Roll out to all Employees

Assign RTW Coordinator

Return To Work Development Process

Support

FlyerPPTLetter to employees

Claims AdvocacyProactive Claims Management

reduces the cost of injuries

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Why Claims Management?

• Reform results continue to erode• Medical cost inflation • Increase in Medicare Set Aside • Abuse of medical lien process• Increase in cost containment factors• Legislative changes• New case law impact• Increasing litigation• Turnover in claims examiners

• Recent Result: $61,000 reserve reduction on two claims for a District that is Self Insured!

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Claims Mgmt Service Schedule

Oversight of carrier / TPA

Troubleshoot challenging

claims

Advisor to Employer /

Agency

Referral Form

Letter of Auth

from client

Q1 Summary Report

Claims Review

Q2 Unit Stat

Report

X-Mod Foreca

st

Q4Renewal Report

Policy Year Milestones

Policy Year Application

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Claims oversight and support

• Ongoing Communication • Phone call, email and webinar communication for District claims

management staff

• Develop written claims handling procedures• Work in conjunction with CUSD Workers’ Compensation coordinator to

develop written policies and procedures.

• Ongoing claims Oversight & Direction• Ensure examiner has positioned claim for speedy, cost-effective resolution• Analyze reserves for accuracy and negotiate potential reduction • Act as liaison on all delayed claims, ensuring denial decision is met timely• Obtain current status of claim including work status, medical prognosis and

recommend a resolution strategy• Ensure appropriate California laws and regulations are applied

• Recommend litigation strategies to resolve claims • Create vendor list (e.g. Defense Attorney, Nurse Case Management etc..)• Create First Aid policy

Disputed Claims

Claim is classified as MO or IND

MO claim processed, closed in 90

days

Begin RTW coordinationwith medical

provider and client

If ACCEPTED, manage claim

to conclusionClaim is delayed and investigated

for 90 day compensability determination

Large Loss Claims ( >$25,000 )

Continue 30 day ongoing

oversight and direction

CarrierDistrict ESM

IND claim: 3 point contact, provide benefits

Monitors Carrier for investigation

process and strategizes

decision

Determination is made to accept or

denyIf DENIED and UNDISPUTED

Close in 30 daysIf DENIED and DISPUTED

Develop litigation strategy

for resolution

Develop a POA for resolution

Strategize best practices for

resolution

Monitor strategy for effectiveness and

accountability

ESM analyze at 90

days for potential problems

Monitor settlement and any future medical

award

Claims Management

Oversees

resolution

strategy

Begin RTW coordinationwith medical provider

and client

Claims Management Reporting & Oversight Process

Carrier processes

claim

Your Service TeamExpert advocates that get your District results

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ESM is YOUR Advocate

• Expertise in school district risk management• Designations:

• Associate in Risk Management – ARM• Worker’s Compensation Claims Professional - WCCP• Associate in Management - AIM • Certified Playground Safety Inspector – CPSI• Certified Professional Disability Manager – CPDM• Self-Insured Professional – SIP

• ESM’s consultants are fingerprinted for criminal compliance per the educational code, sections: 45125.1 & 45125.2

• Established relationships with school districts

• Results driven• Always raising the BAR

• Benefits from Activities that get Results

“Where there are risks…there are Solutions…

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