ESM Solutions School District Service Overview

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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


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


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

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

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

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

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

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

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 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

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


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!

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

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

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


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Where there are risks… there are