Transcript Document

Los Angeles Unified School District
Owner Controlled Insurance Program
(OCIP)
Presented by:
Aristeo Aguilera, CRIS
OCIP Coordinator
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Agenda
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LAUSD background / Overview
Traditional vs. OCIP Insurance
LAUSD OCIP Risk Management
OCIP Enrollment / Coverage's
OCIP Claims Reporting Protocols‘
OCIP Risk Management contacts
Q&A
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LAUSD Background
The Los Angeles Unified School District (District) is the second largest school district
in the United States
The District will serve nearly 690,000 elementary, middle, and high school students
Over 1200 schools and centers, dispersed over an area of approximately 710 square
miles
District buildings range in age from new or currently under construction, to
buildings more than 60 years old
129 new K – 12 schools have been constructed since 1999 / opened 20 new schools
this fiscal year
Finger Facts 2013-2014 LAUSD has eight local Districts / three regions: North,
Central & South
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Background continued

The Bond Funded Construction Program includes both the repair, upgrade
and modernization of all schools and construction of new schools or
additional classrooms at existing schools.

Work on existing school campuses includes the following projects:
– improve school safety
– upgrade communications, technology access and electrical service
– replace portable bungalow classrooms with permanent structures
– install or upgrade air conditioning and heating
– accomplish deferred maintenance work
– repair plumbing and paving
– adding gymnasiums, lunch facilities, libraries, and support structures
– solar panel installation program District wide
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Traditional VS. OCIP Insurance
Traditional:
a)
Contractors required by the District to purchase & maintain
adequate insurance coverage’s naming the District as additional
insured.
b)
Passes through the cost of the insurance to the District
OCIP:
a)
Purchase insurance that covers District, contractors and
subcontractors working at the project site at no premium cost to
contractors
b)
Obtains insurance at a lower cost than most contractors /
subcontractors
c)
Administers uniform loss prevention & safety programs
d)
Manages all LAUSD OCIP claims until claims are closed
e)
Establishes centralized programs to monitor contract compliance
including enrollment and monthly payroll reporting
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Types of Insurance structures
a)
b)
c)
d)
e)
Guaranteed Cost
Retrospective
Large Deductible Program
Excess Insurance
Self Insured
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Reducing Your Premium
Three factors go into the calculation of your workers’ compensation
premium:
1)
2)
3)
Rate assigned to each payroll classification in your business
Total amount of your payroll for each classification
And your experience modification factor.
The experience modification factor is also known as “mod” or “Exmod”.
Your workers’ compensation premium is calculated:
Payroll Classification X $100.00 of payroll X experience mod. =
Premium.
The amount of risk assigned to each payroll classification is calculated
by the National Council on Compensation Insurance (NCCI); California
would be the Workers’ Compensation Insurance Rating Bureau
(WCIRB).
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LAUSD’s Risk Management
 Oversees the day to day operations of LAUSD’s OCIP
functions, including contractor enrollment, WC, GL,
contractors pollution liability, builder’s risk, marketing,
loss prevention, claims management, construction values,
contractor payroll, and all vested partner inquiries.
 Partnering with the Facilities Services Division,
Insurance Broker, Third Party Administrator, & Vested
partners to achieve continuous success.
 Provide courteous and expeditious customer service to all
LAUSD OCIP inquiries from all sources.
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OCIP Risk Management Continued
 Analyze and review LAUSD OCIP insurance exposure
data (New / Modernization Construction) using several
data sources and customized programs.
 Initiate recommendations, evaluate and administer new
policy and procedures relating to LAUSD’s OCIP for all
participants and partnered organizations.
 Perform quarterly claim reviews of all open OCIP
insurance claims, imposing best developed strategies to
resolve all litigated and non-litigated liability exposures.
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LAUSD’s OCIP
LAUSD’s Risk Managements’ department has arranged for the
Districts construction projects to be insured under an OCIP;
a single insurance program that insures the District, the
Board, all enrolled contractors and enrolled subcontractors,
and other designated parties for work performed at the
Enrolled Project Site(s). .
Coverage's under LAUSD’s OCIP include: Workers’
Compensation, Commercial General Liability, Excess
Liability, Contractors Pollution liability, and Builder’s Risk for
enrolled parties at the project site(s).
LAUSD’s OCIP is Bond funded through approved Measures:
a)
BB, K, R, & Y
b)
For both New & Existing projects
c)
The shift from New Construction, to providing LAUSD with
comprehensive repair and modernization projects has
begun; next responding bond: Measure Q.
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LAUSD OCIP Insurance Coverage’s
(site specific) $500K SIR

Workers’ Compensation (Statutory Coverage) for work related
industrial injuries/accidents.
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General Liability ($2 Million) bodily injuries / property damage
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Excess Liability ($100 Million)
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Contractor’s Pollution Liability ($50 Million) contamination /
spills
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Builder’s Risk ($10K Contractor deductible) property damaged
during the course of construction /pending project value
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Enrollment Process / Contracts
All contractors and subcontractors must each complete and
submit enrollment documents for each contract awarded, Broker
triggers: NOIA / NTP & LAUSD communication. Upon completion
of this process, Alliant will issue to the contractor and
subcontractor, a certificate of insurance (COI) evidencing
coverage in the OCIP. The completed COI and workers’
compensation insurance policy will be provided to each enrolled
Contractor and Subcontractor.
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Alliant will provide a welcome letter confirming OCIP
enrollment specific to the contract number awarded,
referencing the workers’ compensation policy issued
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Insurance information required by Alliant: 1) workers’
compensation, general liability and automobile for any outside
non – LAUSD work, providing waivers of Subrogation in favor
of the District & Additional insured endorsement required.
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Master Job Order Contracts – Alliant will need Prime contractor
award letter, including contract number, School name(s) and
certificate of insurance(s).
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Excluded Contractors
Excluded contractors must meet the insurance requirements set forth in
the OCIP Insurance Manual (GC), providing evidence of coverage to the
District.
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Hazardous material remediation
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Architects, surveyors, engineers, soil testing engineers & consultants
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Vendors, suppliers, fabricators, material dealers, pick up drivers…

Contractors & each of their respective subcontractors who do not
perform any actual labor on the project site, during term of contract
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All crane operators and crane operations
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Contracts with LAUSD
The Facilities Services Division advertises projects for the following
services:
1)
Best Value Procurement
2)
Job Order Contracts (JOC)
3)
Formal Construction Contracts
4)
Informal Construction Contracts
5)
Maintenance Material Advertisement
6)
Professional & Technical Services

General Conditions (GC) – Section 00700: An integral part of the
Owner – Prime contractor agreement; the GC of the contract sets
forth the responsibilities of the Owner, contractor and architect
during construction
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Insurance Manual – OCIP Contractors Insurance Procedures Manual
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OCIP Claims Reporting Protocol

Complete the claims report form / call the claim into the TPA,
must provide the following details:
1) Project/School site name, 2) Project/School address,
3) Employer name, 4) Prime contractor’s LAUSD contract
number, 5) Employer’s OCIP insurance policy number.
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Reporting Process / Sequence
Immediately notify your supervisor – Injury / near miss occurs

Evaluate situation / conditions
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Follow established treating (protocol):
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First Aid / band aid / ice / eye drops
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MPN provider (protocol) (authorization slip) / Provider special instructions
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911
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Commence paperwork:
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Field level Investigation
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Claim form DWC-1
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MPN information acknowledgment form B
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Complete carrier / site claim reporting paperwork call in report (procedures)
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5020
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Review claims / injury procedures: dot the “I’s” and cross the “T’s”
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Types of claims (Policy)
Definition of a claim (legal): To demand or assert as a right. Facts
that combine to give rise to a legally enforceable right or judicial
action. Demand for relief.

Workers’ Compensation – Record Only / Medical / Indemnity
(Workers’ Compensation Claim form DWC-1)
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Commercial General Liability – Coverage A, B & C
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Property Multiple levels / Builders Risk (COC)
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Professional Liability / Errors & Omissions
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Auto Liability –
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Pollution Liability –
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The Commercial General Liability policy has three general
groups of coverage, as follows:
Coverage A of the CGL is specifically intended to pay compensation for bodily injury and
property damage which the insured is held legally liable for. This means that if the
insured's business operations cause bodily injury or property damage to a third party,
coverage A will cover the damages awarded in a lawsuit up to the policy limits, as well as
the contingent legal defense costs. Some noteworthy exclusions apply to Coverage A,
including intended injury, liquor liability, contractual liability and pollution.
Coverage B of commercial general liability insurance provides protection against personal
and advertising injury, such as libel, slander, malicious prosecution, and unlawful
imprisonment, copyright and other intellectual property infringement, etc. If the offense is
committed intentionally or before the policy comes into effect, it is usually not covered by
commercial general liability policy.
Coverage C is intended to cover the medical payments of people who have suffered
bodily injuries as a result of the business operations of the insured or on the commercial
premises of the insured, regardless of legal liability. This means that the insured does not
need to be taken to court for Coverage C to come into effect. The only requirement is that
the medical bills are incurred within a year of the occurrence.
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Property Insurance :
Any type of commercial insurance that reimburses a party that has suffered a loss because
property has been damaged or destroyed. “Property” is considered to be any item that has
value, and is classified as real property, such a building; or personal property, such as
someone’s computer.
Basic property insurance policies typically cover explosions, fire, lightning, windstorm, hail,
smoke, aircraft or vehicle damage, vandalism, sprinkler leakage and sinkhole collapse.
Additional coverage can be added for water damage, damage from the weight of snow, ice or
sleet, breakage of glass and coverage for falling objects.
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Builder's risk insurance:
Is a special type of property insurance which indemnifies against damage to buildings
while they are under construction. Builder's risk insurance is "coverage that protects a
person's or organization's insurable interest in materials, fixtures and/or equipment
being used in the construction or renovation of a building or structure should those
items sustain physical loss or damage from a covered cause.
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Professional liability:
Insurance policies are generally set up based on a claims-made basis, meaning that the
policy only covers claims made during the policy period. More specifically, a typical policy will
provide indemnity to the insured against loss arising from any claim or claims made during
the policy period by reason of any covered neglect, error or omission committed in the
conduct of the insured's professional business during the policy period. Claims which may
relate to incidents occurring before the coverage was active may not be covered, although
some policies may have a retroactive date, such that claims made during the policy period
but which relate to an incident after the retroactive date (where the retroactive date is earlier
than the inception date of the policy) are covered.
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Pollution liability:
Insurance is for businesses and contractors who wish to protect against risks associated with
construction and ongoing industrial operations, such as broken pipelines, fuel spills and
release of toxic gases. It's a form of gap insurance, because most general liability policies
exclude pollution risks. Different pollution insurance carriers offer different terms, and may
exclude or charge more for risks they deem to be especially onerous.
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Overview of California claims system
Commission on Health & Safety & Workers' Compensation (CHSWC): A stateappointed body that conducts studies and makes recommendations to improve the
California workers' compensation and workplace health and safety systems.
Division of Workers' Compensation (DWC): A division within the state
Department of Industrial Relations (DIR). The DWC administers workers'
compensation laws, resolves disputes over workers' compensation benefits and
provides information and assistance to injured workers and others about the workers'
compensation system.
Workers' Compensation Appeals Board (WCAB): Consists of 24 local offices
throughout the state where disagreements over workers' compensation benefits are
initially heard by workers' compensation judges. The WCAB Reconsideration Unit in
San Francisco is a seven-member, judicial body appointed by the governor and
confirmed by the Senate that hears appeals of decisions issued by local workers'
compensation judges.
Workers' Compensation Insurance Rating Bureau (WCIRB): An agent of the
state Department of Insurance and funded by the insurance industry, this private
entity provides statistical and rating information for workers' compensation insurance
and employer's liability insurance, and collects and tabulates information to develop
pure premium rates.
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OCIP Risk Management Contacts
All OCIP Insurance coverage question/concerns are to be directed to the Risk
Management Unit.
Aristeo Aguilera, CRIS – General Liability, Builders Risk,
and Insurance Coverage questions.
(213) 241-7994, [email protected]
Don Hughes, WCCP – Claims Reporting Procedures,
Medical Provider networks (MPN), Claims Kits,
(213) 241-2210, [email protected]
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Summary / Q & A

LAUSD background

Types of Insurance

OCIP Risk Management

OCIP Enrollment / Contracts

OCIP Claims reporting procedures

OCIP Insurance / Coverage's contacts

Q&A
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