ESM Solutions School District Service Overview

Report
Workers’ Compensation
Reducing risk and cost
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
Online Services / Educational Portal
Training &
Education
• Develop
educational
content and
delivery
• Creating a
competitive
advantage by
empowering
district personnel
to identify and
control exposures
Return-to-Work
Solutions
• Develop
customized RTW
Program
• Ensure
communication
with all
stakeholders
• Return employees
back to work
immediately
• Mitigating legal
exposures (FEHA)
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
• Providing strategies
for claim closure
• Oversight on
indemnity claims
• Facilitating
communication
with all
stakeholders
• Supplement &
compliment efforts
• Reducing reserves
and controlling the
X-mod
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Solutions that get
Results
District Goals:
Reduce injury frequency and severity
Actual results achieved
Reduction of claim frequency
70
Total Number of Claims
66
Indemnity
60
50
53
49
40
40
30
30
20
Linear (Total Number of
Claims)
41
35
29
26
28
22
19
11
10
Medical Only
14
5
0
2008
2009
2010
2011
2012
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Reduction of claims severity
$500,000
$450,000
$437,465
$445,598
$400,000
$350,000
$300,000
$250,000
$180,365
$200,000
$150,000
$145,004
$100,000
$50,000
$-
2009
2010
2011
2012
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Training & Education
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
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Safety Management
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
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Return To Work
Reducing Lost Days and Temporary Disability costs
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
Phase 1
Foundation
Phase 2
Assessment
Phase 3
Launch
Write a management
plan and policy
statement
Review and Revise
Job Descriptions
Coordinate
communication
Build a support team
and assign roles and
responsibilities
Identify Temporary
Alternative Duties
(TADs)
Train supervisors and
managers
Establish process
and procedures
Document physical
requirements
Evaluate
Business Benefit
Launch RTW program
to all employees
ROI
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Return To Work Development Process
Program Introduction
Program
Engagement
RTW
Evaluation
Questionnaire
Collect
Background
Information
Current RTW Plan and/or Policy
Recent work status report from designated Medical Provider
Job descriptions
Alternative duties
Loss Runs
X-Mod Worksheet/WCIRB
Phase 1 - Foundation
Write
Management
Plan and Policy
Statement
Build
Support
Team
Assign
Roles and
Responsibilities
Establish
Process and
Procedures
Planning
Checklist
Assign RTW Coordinator
Phase 2 - Assessment
Review & Revise
Job Descriptions
to include
Essential Functions
Document
Physical
Requirements
Identify
Temporary
Alternative
Duties (TADs)
Phase 3 - Launch
Coordinate with Employee
Coordinate
Communication
Coordinate with Medical Provider
Train
Supervisors/
Managers
Roll out to all
Employees
Coordinate with Claims Administrator
Flyer
PPT
Letter to employees
ESM
Support
Member
Claims Advocacy
Proactive Claims Management
reduces the cost of injuries
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
Policy Year Milestones
Referral
Form
Letter of
Auth
from
client
Q1
Summary
Report
Claims
Review
Q2
Unit Stat
Report
X-Mod
Forecast
Q4
Renewal
Report
Policy Year Application
Oversight of carrier
/ TPA
Troubleshoot
challenging claims
Advisor to
Employer / Agency
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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
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Claims Management Reporting & Oversight Process
Carrier processes
claim
Claims Management
MO claim
processed, closed
in 90 days
Claim is classified
as MO or IND
IND claim:
3 point contact,
provide benefits
Begin RTW coordination
with medical provider
and client
Begin RTW coordination
with medical provider
and client
Disputed Claims
Claim is delayed and
investigated for 90
day compensability
determination
Monitors Carrier for
investigation process
and strategizes
decision
ESM
analyze at
90 days for
potential
problems
Continue 30 day
ongoing
oversight and
direction
If ACCEPTED, manage claim
to conclusion
Determination is made
to accept or deny
If DENIED and UNDISPUTED
Close in 30 days
If DENIED and DISPUTED
Develop litigation strategy
for resolution
Oversees
resolution
strategy
Large Loss Claims ( >$25,000 )
Develop a POA for
resolution
Strategize best
practices for resolution
Monitor strategy for
effectiveness and
accountability
Monitor settlement and any
future medical award
District
ESM
Carrier
Your Service Team
Expert advocates that get your District results
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
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“
“
Where there are risks…
there are Solutions…
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