Transcript ESM Solutions School District Service Overview
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 www.executivesm.com
Services
Training & Education • • Develop educational content and delivery Creating a competitive advantage by empowering district personnel to identify and control exposures Online Services / Educational Portal 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 www.executivesm.com
Solutions
that get Results
District Goals: Reduce injury frequency and severity
Actual results achieved
Reduction of claim frequency
70 60 50 40 30 20 10 0
49 19 30 2008 66 26 40 2009 41 11 29 2010 53 14 35
Total Number of Claims Indemnity Medical Only Линейная (Total Number of Claims)
28 22 2011 5 2012
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Reduction of claims severity
$500 000 $450 000 $400 000 $350 000 $300 000 $250 000 $200 000 $150 000 $100 000 $50 000 $-
$437 465 2009 $445 598 2010 $180 365 $145 004 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 www.executivesm.com
Training solutions
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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 www.executivesm.com
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 www.executivesm.com
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 www.executivesm.com
Playground Inspections
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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 www.executivesm.com
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 www.executivesm.com
Return To Work Implementation
Phase 1
Foundation Write a management plan and policy statement Build a support team and assign roles and responsibilities Establish process and procedures
Phase 2
Assessment Review and Revise Job Descriptions Identify Temporary Alternative Duties (TADs) Document physical requirements
Phase 3
Launch Coordinate communication Train supervisors and managers Launch RTW program to all employees Evaluate Business Benefit
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 RTW Coordinator Assign Roles and Responsibilities Establish Process and Procedures Planning Checklist
Phase 2 - Assessment
Review & Revise Job Descriptions to include Essential Functions Identify Temporary Alternative Duties (TADs) Document Physical Requirements
Phase 3 - Launch
Coordinate Communication Coordinate with Employee Coordinate with Medical Provider Coordinate with Claims Administrator Train Supervisors/ Managers Flyer PPT Letter to employees Roll out to all 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! www.executivesm.com
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 www.executivesm.com
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 www.executivesm.com
Claims Management Reporting & Oversight Process
Claims Management
Carrier processes claim Claim is classified as MO or IND MO claim processed, closed in 90 days IND claim: 3 point contact, provide benefits Begin RTW coordination with medical provider and client Begin RTW coordination with medical provider and client Continue 30 day ongoing oversight and direction
Disputed Claims
Claim is delayed and investigated for 90 day compensability determination Monitors Carrier for investigation process and strategizes decision Determination is made to accept or deny If ACCEPTED, manage claim to conclusion If DENIED and UNDISPUTED Close in 30 days If DENIED and DISPUTED Develop litigation strategy for resolution
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 ESM analyze at 90 days for potential problems Oversees resolution strategy 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 •
B
enefits from
A
ctivities that get
R
esults www.executivesm.com
“
Where there are risks… there are
Solutions
…
“ www.executivesm.com