Transcript PERI-AGRIP
Day of Injury Study 2005-2006 Schools Insurance Authority Co-Presenters: Martin Brady, Director, SIA Dennis Chandler, DAY-1 Systems Debra Russell, WC Manager, SIA SIA Background Joint Powers Authority (JPA) Self Insured-Self Administered Administers workers’ compensation, property & liability & prevention services Staff CA Comp Day of Injury Study PERI Funded Research Study of Schools Insurance Authority (SIA) workers’ compensation program. Nurse “First Call”/Structured Return to Work Program implemented in 2000. SIA represents 34 school districts, 19,500 employees in several counties in northern California. Day of Injury Study Comparative data analysis within industry and similar programs in CA. National data on RN “first call’ telephonic reporting. Develop a best practices manual for injury reporting, medical management and return to work Day of Injury “Controlling the workers’ comp line of scrimmage” Comp & Football Team Sport Involves strategies Employer is always plays defense. Focus on controlling the line of scrimmage, day of injury. Holding the offense to no gain or short gain plays. RE-THINK YOUR CURRENT SCHEME It’s All About Xs & Os High Tech… High Touch Game Plan What is the impact of using a nurse “first call” process to : Employees? Supervisors? Claims management, frequency/severity? Litigation? Medical Providers? Return to Work? DAY of INJURY The most important play to execute. The employer’s response on the day of injury significantly determines the nature, duration, cost and eventual outcome of a claim. Day of Injury Three Distinct Processes: injury reporting & notification assessing & managing the medical treatment process return to work. Time is Money COST OF LATE REPORTING The Hartford Study, 2000 45% 30% 18% Increased Claim Cost 3-D Colum n 1 1-2 w eeks 3-4 w eeks >4 w eeks Injury Reporting Medical-Legal Event Notification process Data collection of facts to determine cause and claim compensability. Medical situation/triage assessment. Shared information to all primary stakeholders. Injury Reporting- Notification Nurse “First Call’ Telephonic Report “Invite the call” philosophy. TLC approach by intake RN. Comprehensive data gathered on the day of injury by RN. Better claims decisions on compensability. Effective medical channeling to occupational providers in spite of employee’s right to predesignate treating physician. Nurse “First Call” Structured Return to Work Program Injury report telephonically to Occupational RN. Medical triage to preferred providers. Immediate return to work in modified duty with pre-identified tasks (>100 modified duty options) Ongoing RTW case management integrated with claims management. Claims Management Claims examiners & RN assigned to district. Balance/interface of claim & medical goals. RN–RTW Coordinator continually develops provider relationships, attends significant medical appointments with employee. SIA’s Utilization Review (UR) program. Nurse “First Call” Study Findings Promotes communication at the onset of an incident between all parties. Litigation dropped 65%. RN viewed as an employee advocate. Claims data: how, when, where, is more complete & detailed. Within minutes the simultaneous processes of claims management, medical treatment and return to work are engaged. SIA 5 Year Results Telephone reports-averages 1450 incidents (calls) annually. 40% of reports are RN self-care or report only, not resulting in a claim. 30% of claims are classified medical only/restricted duty due to immediate return to work in modified duty within 3 days in CA. 42% of claims are medical only. 28% of claims result in lost time/indemnity. W.C. Incidents & Claims / Types Comparison 1589 1577 1526 1500 1403 995 1015 908 864 839 811 841 594 662 562 600 564 654 654 254 210 184 174 163 676 303 235 231 247 215 Incidents RO/RN 3-D Column 1 Claims 2001 Indemnity 2002 2003 MO 2004 2005 MO-RD RN First Call Results During the last 3 years, 1826 injury reports were handled as RN Self-care/Report Only. 94 % of those incidents remained as RN Self-care/Report Only (no further medical treatment) after 90 days. Top three nature of injury categories were: strain/sprain, bruise/contusion, & laceration. RN First Call Results 26% of all calls were classified as Medical Only/Restricted Duty. i.e. Claims with medical restrictions, back to work within 3 calendar days. In a review of the past 3 years of MO/RD claims, 92 % of those claims remained as a Medical Only claim after 90 days. First Year Performance Schools Insurance Authority, Sacramento First Year Evaluation, 2000 vs. 1999 34% decrease in all claims. 44% decrease in indemnity claims. 46% decrease in total paid. 37% decrease in incurred costs. 1,589 incidents reported, 995 claims filed, 37% of all incidents did not result in opening a claim. First Year Performance Redwood Empire Schools Insurance Group, Windsor First Year Evaluation, 2004 vs. 2003 Total Incurred costs decreased 42%. Total paid costs decreased 20%. 871 incidents reported, 503 claims filed, 42% of all incidents did not result in opening a claim. 148 claims were placed in modified duty within the first 3 days to avoid an indemnity lost time claim. Structured Return to Work RN “FIRST CALL” Systematic return-to-work decision process. Immediate response to employee disability using RTW Coordinator. Utilizes planned or pre-identified RTW options . Structured Return to Work Formal mod. duty program at all districts. Goal: Fully engage RTW within 3 calendar days to avoid indemnity claim. RTW Coordinator case manage all mod duty claims until RTW full duty resolved. Program requires ongoing efforts to keep program viable at site levels. Employer’s Role Prompt reporting using Nurse Line Set a return to work expectation through policy and training. Develop RTW options (plan) in all major job classifications subject to injury claims. Maintain close contact with employee, RTW Coordinator and claims examiner. Temporary Work Assignment Tasks might be . . . Part of existing job Supervisor assistance Administrative; special projects Maintenance/p.m., benchwork, cleaning Inventory/sorting/labeling/ordering Quality; visual tasks Safety/hazard inspection Training Ongoing or periodic/seasonal Unified School District. Temporary Work Assignment JOB TITLE: Shop Tasks SUMMARY: Performs a variety of light tasks within maintenance/electrical shop. task can include sorting parts, labeling, bin straightening, filing paperwork, painting, cleaning/painting light fixtures, assisting regularly assigned personnel in benchwork tasks as available. HOURS AVAILABLE: 8 daily Essential Job Function Analysis Job Description Job Title: Custodian District: The Best USD Equipment & Tool Repair Technician Return-to-Work Process Work Injury Employee/Supervisor Call Nurse Report Injury Triage Medical Complete Report Immediate notification/reports to all parties Nurse Directs/channels Employee to Medical Treatment Physician completes work status report Employee returns work status report to employer. Employee/Supervisor & RTW Coordinator Review work status report Assign modified duty/TWA Complete RTW agreement Monitor Employee’s Progress to Full Duty