Workers’ Comp – The Life of a Claim

Summit County Safety Council March 2012

Case Studies

• • • • 2 Injuries & 2 Injured Workers Date of Injury: Accident: Alleged Claim: 1/10/12 Lifting a box, hurt back Low back sprain Physical therapy Possible herniation Possible surgery

A Tale of Two Injured Workers

• • • •

Injured Worker #1

Completed the accident report; claim was supported Sought treatment at Occupational Medicine Clinic Followed up with suggested Physical Therapy Returned to work through Modified Duty

A Tale of Two Injured Workers

• • • •

Injured Worker #2

Reported 2 weeks after injury occurred Sought treatment at Occupational Medicine Clinic 1 week after report Refused follow up physical therapy, condition became chronic Claim was allowed, but employer did not offer Modified Duty

What went right? What went wrong?

• • • • • Accident report was completed timely Investigation supported claim; no need for hearing Appropriate treatment at Occupational Medicine Clinic Followed up with suggested Physical Therapy Employer was pro-active and provided Transitional Duty, facilitating early return to work • • • • • Accident reporting policy was not followed Failure to follow reporting policy, resulted in employer’s appeal of the claim Claim was referred to IC for hearings and IW became disgruntled Condition became chronic Claim was allowed, but employer did not offer Transitional Duty

The Results

• • • • • Early treatment Early return to work Reduced lost time and reduced compensation costs Reduced medical treatment and reduced costs

Employer remains eligible for group rating or other BWC discount program

• • • • • • Failure to seek early treatment Condition becomes chronic Extended period of disability Increased medical costs and compensation costs Delayed return to work

Employer experiences increased BWC premium

Understanding your “Experience”

• Claim maturity takes 2 years • Claim is “in the experience” for 4 years • All claim costs impact BWC premium while in employer’s experience despite: Return to work Settlement of claim Termination Injured worker’s death

Following the Life of a Claim Injury Year 2012 1 st Year on Premium 2014 3 rd Year on Premium 2016 “Green Year” 2013 2 nd Year on Premium 2015 Last Year on Premium 2017

Paying for a Claim for 4 Years…

Paying for a Claim for 4 Years…

Claim Strategies to Save You Money

• Improve reporting policies • Identify local preferred medical providers – Occupational Medicine Specialists • Employ Transitional duty • Consider Salary continuation • Encourage vocational rehabilitation

Reporting

Best Practices

• • • Establish & maintain timeframes for reporting near misses, incidents & accidents Establish & maintain protocol for supervisory investigation & communication Establish safety committee to review regularly for determination as to: – Root cause – Preventative measures

Establishing Preferred Providers

• Utilize MCO services to establish injury protocol with preferred providers • Maintain relationship with occupational medicine providers

Making Transitional Duty Work for You

• • Definition: Early return to work of duties

and/or hours other than regular job assignment

Benefits: – Alternative to downtime – Allows for retention of knowledgeable, experienced employee – Can be presented & perceived as an employee benefit

Transitional Duty

Best Practices

1) If communication of offer is NOT made face to face, always send USPS & Certified Mail  Either way get it in writing 2) Payment of full wages (prior to injury) will prevent loss in wages, payment of BWC compensation and MIRA reserves

Considering Salary Continuation

• Definition: Continuation of regular, full

earnings in lieu of BWC payment of temporary total compensation

• • • Employee avoids lapse in wages Employer contains claim costs Facilitates opportunity for regular communication between employee & employer

Temporary Total vs. Salary Continuation Requires a C84 or Medco 14 and supporting medical documentation Requested through usual process Injured worker must agree to accept (C55) Rate of pay: 72% of FWW – first 12 weeks 66 2/3 % of AWW – 13 th week forward Rate of pay: Full wages from all sources of income Yearly minimums and maximums Award is not taxed or reportable income Full rate of pay Taxes and deductions as usual Payroll deductions are responsibility of employee (union dues, insurance, etc) Child support will be deducted Retirement contributions as usual Vacation pay is NOT sick pay or salary continuation

Salary Continuation

Best Practices

1. Determine appropriateness of salary continuation – Can employee return to work with restrictions – Is employee motivated to return to work – How does payment impact premium 2. Obtain medical proof of continuing disability 3. Monitor for release to restricted or full duty

Utilizing Vocational Rehabilitation

• Great benefit for employee & employer • Voluntary program for employee • Claim costs paid from the BWC surplus fund • Injured may be eligible for a higher wage rate

Potential Cost Saving Programs

• • • • • • • • • Drug Free Safety Program (DFSP) Safety Council Individual Retrospective Rating Group Retrospective Rating Group Experience Rating Deductible Programs 100% EM Cap Program One Claim Program Self Insurance

BWC News You Can Use Destination: Excellence

• Industry Specific Safety Discount – 3% upfront discount for engaging in specific safety strategies with accident reducing safety activities • Safety & Hygiene safety classes • • On site consulting by Safety & Hygiene Ohio Safety Congress & Expo – Application must be filed to receive discount

Watch for more to come…

BWC News You Can Use Destination: Excellence

• Transitional Work Grants – Potential 10% bonus for utilizing transitional work in policy year – BWC will consider the following when evaluating applications: • Was employer a previous BWC grant recipient?

– Grants awarded (2001-2006) • Is employer’s company created plan BWC approved?

– Application must be timely filed with required documentation

BWC News You Can Use Destination: Excellence

• Go Green Discount – 1% upfront discount with on-line policy (premium) management • Lapse Free Discount – 1% upfront discount for employers who have not incurred a lapse in premium in the past 60 months • Up to $1,000 every six months • A one-time forgiveness to stay current can be utilized

BWC News You Can Use 2012 Program Changes

• 100% EM Cap – Expanded participation to include credit rated employers – 4 hour industry specific training replaces 10 Step Business Safety plan requirements • Small Deductible Program – – Payments will be excluded from rate calculation Salary continuation will be permitted – No longer compatible with group experience rating

BWC News You Can Use 2012 Program Changes

• Safety Council & Group Retrospective Rating – Expanded to allow 2% participation rebate – (2% performance rebate is not permitted) • Safety Council & Group Rating – No change is expected – 2% performance rebate is permitted with a 10% reduction in frequency or severity

BWC News You Can Use 2012 Program Changes

• Wellness Grants • One Claim Program – 4 year 40% discount is eliminated – New discount schedule • 20% discount – year 1 • 15% discount – year 2 • 10% discount – year 3 • 5% discount – year 4

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BWC News You Can Use 2012 Program Changes

Increased Program Compatibility – Salary continuation is now compatible with all programs – Stacking discount programs allows employer to exceed the maximum credibility table (currently 53% - private employers, 2012 policy year)

CompManagement Recommendations

Work with your TPA to review a feasibility analysis to determine the best rating options for your business

The Life of a Claim Can Be a Long Journey

Reducing BWC Premium

• Establish and enforce accident prevention • Identify & communicate with resources – BWC, MCO, TPA • Stay abreast of BWC changes • Work with your resources to identify the best rating program and claim strategies for your business

Bobbijo Werren, Account Executive

CompManagement Inc.

[email protected]

330.352.4108