Transcript Slide 1
WC ISSUES & INJURY PREVENTION
PRESENTED TO
RADISSON PAPER
VALLEY HOTEL
APPLETON, WI
9/12/08
FITZGERALD CLAYTON JAMES & KASTEN
JEFF THIEL, CPCU – EXECUTIVE VICE PRESIDENT
DARREN CHEREK - LOSS PREVENTION CONSULTANT
1
AGENDA
•INTRODUCTIONS
•HOW IS YOUR RATE DETERMINED
•HOW IS YOUR EXPERIENCE MOD DETERMINED
•INJURY TRENDS
•SAFETY COMMITTEE
•IDENTIFYING LOSS TRENDS
•FLEET
•MAINTENANCE
•DRIVER
•REVIEW LOSS RUNS
•IDENTIFY REPEATERS
•CONDUCT INJURY REVIEWS
•QUESTIONS & ANSWERS
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CREATION OF CODE 7705
The following amendments to the Wisconsin Basic Manual have been approved
effective October 1, 2007, applicable to new and renewal business:
1. Ambulance and Emergency Medical Services
Wisconsin background: Wisconsin currently classifies for-profit ambulance
service providers under code 7380 and volunteer ambulance service providers
under code 7710. Thus, Wisconsin already is an exception to NCCI’s
classification of ambulances under code 7370.
Approved action: Adopt code 7705 for paid, for-profit ambulance providers while
retaining code 7710 for volunteer ambulance services. The rate for code 7705
will be the same as code 7380 until such time that the class develops sufficient
experience to determine its own rate. NCCI’s description of code 7705 will also
be adopted with the exception of striking any language indicating that volunteers
are to be included under the code. Finally, in time, if the rates for codes 7705
and 7710 do not indicate large differentials, consideration will be given to
combining the two ambulance codes, paid for-profit and volunteer, just as NCCI
proposes in this filing.
Wisconsin Compensation Rating Bureau
7705 for paid, for-profit ambulance providers
•
•
•
•
•
•
•
Code 7380
10/1/2008
$5.20
10/1/2007
$5.26
10/1/2006
$6.05
10/1/2005
$6.33
10/1/2004
$6.14
10/1/2003
$6.63
07/1/2002
$6.33
Wisconsin Compensation Rating Bureau
Code 7705
• 10/1/2008
$5.20
• 10/1/2007
$5.26
7710 for volunteer ambulance services
•
•
•
•
•
•
•
Code 7710
10/1/2008
$11.15
10/1/2007
$9.13
10/1/2006
$7.47
10/1/2005
$5.86
10/1/2004
$4.69
10/1/2003
$4.16
07/1/2002
$4.02
Description: CIVIL DEFENSE WORKERS AND VOLUNTEER RESCUE
SQUADS - INCLUDING MEMBERS SERVING AS AUXILIARY POLICE
OFFICERS AT EMERGENCIES (Actual payroll shall be taken, but in no event
less than $1,560 per individual per annum in calculating premium.)
Wisconsin Compensation Rating Bureau
WHAT IS AN EXPERIENCE MODIFICATION FACTOR?
THE EXPERIENCE MOD IS AN INDICATOR OF HOW SAFELY OR
UNSAFELY THE BUSINESS HAS OPERATED.
THE STATE OBTAINS INFORMATION ON THE NUMBER OF
ACCIDENTS, AND THE COSTS OF THE ACCIDENTS, FOR EACH
OCCUPATION, STATEWIDE.
THE STATE THEN CALCULATES WHAT THE AVERAGE NUMBER OF
ACCIDENTS AND THE AVERAGE COST OF THOSE ACCIDENTS FOR
EACH OCCUPATION. THIS IS CALLED AN “EXPECTED LOSS RATE”
THESE AVERAGES ARE BASED ON THREE (3) YEARS OF LOSSES.
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EXPERIENCE MODIFICATION EXPLANATION
FITZGERALD CLAYTON JAMES & KASTEN
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WHAT IS AN EXPERIENCE MODIFICATION FACTOR?
THE EXPERIENCE MOD IS AN INDICATOR OF HOW SAFELY OR
UNSAFELY THE BUSINESS HAS OPERATED.
THE STATE OBTAINS INFORMATION ON THE NUMBER OF
ACCIDENTS, AND THE COSTS OF THE ACCIDENTS, FOR EACH
OCCUPATION, STATEWIDE.
THE STATE THEN CALCULATES WHAT THE AVERAGE NUMBER OF
ACCIDENTS AND THE AVERAGE COST OF THOSE ACCIDENTS FOR
EACH OCCUPATION. THIS IS CALLED AN “EXPECTED LOSS RATE”
THESE AVERAGES ARE BASED ON THREE (3) YEARS OF LOSSES.
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HOW IS AN EXPERIENCE MODIFICATION FACTOR CALCULATED?
3 YEARS OF LOSSES, 3 YEARS OF PAYROLL INFORMATION ARE
USED FROM THE LAST 4 YEARS, EXCLUDING THE MOST RECENT.
EXAMPLE: 10/1/08 - 09 MOD – 4/30 UNIT STAT DATE – CLAIMS
SHOULD BE REVIEWED PRIOR TO 4/30 FOR MOST ACCURATE MOD
10/1/07 – 08
10/1/06 – 07
10/1/05 – 06
10/1/04 – 05
PAYROLL
PAYROLL
PAYROLL
PAYROLL
LOSSES
LOSSES
LOSSES
LOSSES
YOUR PAYROLL IS MULTIPLIED BY AN EXPECTED LOSS RATE
FACTOR THAT IS DETERMINED BY THE WORKERS’ COMPENSATION
BUREAU. THIS DETERMINES THE AMOUNT OF LOSSES EXPECTED
FOR THE AMOUNT OF PAYROLL YOU HAVE IN THE CLASS CODES
USED BY YOUR BUSINESS.
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HOW IS AN EXPERIENCE MODIFICATION FACTOR CALCULATED?
LOSSES ARE VALUED 18 MONTHS AFTER THE INCEPTION DATE OF
THE POLICY, AND YEARLY THEREAFTER FOR A TOTAL OF 3 TIMES.
THEREFORE, LOSSES AFFECT THE MOD FOR 3 YEARS.
THE ACTUAL LOSSES ARE COMPARED TO THE EXPECTED LOSSES
TO DETERMINE THE EXPERIENCE MOD FACTOR.
IF THE ACTUAL LOSSES ARE HIGHER THAN EXPECTED LOSSES A
DEBIT MOD RESULTS.
> 1.00 (COSTS ABOVE EXPECTED)
IF THE ACTUAL LOSSES ARE LOWER THAN EXPECTED A CREDIT
MOD RESULTS.
< 1.00 (COSTS BELOW EXPECTED)
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HOW IS AN EXPERIENCE MODIFICATION FACTOR CALCULATED?
LOSSES ARE IN 3 CATEGORIES:
MEDICAL ONLY - NO WAGES WERE PAID BY THE INSURANCE
CARRIER. (MEDICAL ONLY CLAIMS GO IN AT 30% OF THEIR VALUE.
I.E. A $100 CLAIM WILL ONLY COST YOU $30 ON THE MOD
CALCULATION.)
FREQUENCY (INDEMNITY CLAIMS UNDER $5,000) - WAGES WERE
PAID TO THE INJURED WORKER BY THE INSURANCE CARRIER.
SEVERITY (INDEMNITY CLAIMS OVER $5,000) - WAGES WERE PAID TO
THE INJURED WORKER BY THE INSURANCE CARRIER.
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WHAT IS YOUR CURRENT MOD?
1.29
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# Claim Type Comparison on Mod
32
27
20
5
5
2
1
1
0
2004-05
2005-06
Ind > 5000
Ind < 5000
2006-07
Medical Only
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$ Claim Type Comparison on Mod
$220,651
$156,857
$20,628
$24,882
$20,937
$6,726
$25,224
$4,518
2004-05
2005-06
Ind >5000
Ind < 5000
2006-07
Medical Only
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0.08170
0.5937
0.57360
0.04100
2008 MOD
BREAKDOWN BETWEEN
FREQUENCY, MEDICAL ONLY AND SEVERITY CLAIMS
2008 mod = 1.29
Min Mod
Ind > 5000
Ind < 5000
Medical Only
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COST EFFECTS OF MOD
$110,750
$69,365
$86,257
$24,493
SAVINGS
$16,892
SAVINGS
1.29 MOD
1.00 MOD
.80 MOD
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CONTUSION TO HAND
Manual Premium:
Indemnity
Medical
Claim
Claim
$3,927
$3,927
$591
$0
Total Claim Cost:
$4,518
$3,927
Value on Mod:
$4,518
$1,178
$284,793
Medical Cost:
Indemnity Cost:
(30% x
Mod Points:
3 year Premium Cost:
Salary Continuance:
Net Cost to You:
$3,927
0.017
0.0046
$14,524
$3,930
$0
$887
$14,524
$4,817
Savings:
)
*
$9,708
*WC payments are approximately 2/3 of hourly wage and are tax
exempt so the employee would have to have a larger payment to
overcome the tax liability.
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CLAIM AMOUNT:
MOD POINTS:
COST FOR 3 YEARS ON PREMIUM:
$40,641
5.68
$48,529
INDIRECT COSTS OF A CLAIM
TIME TO INVESTIGATE, REPORT, LOSS IN PRODUCTIVITY, DECREASE IN QUALITY,
PROPERTY DAMAGE, ETC.
4 TO 10 TIMES THE VALUE OF THE CLAIM
$48,529 x
4
=
$194,115
SALES PROFITS VS INDIRECT COSTS
$194,115 /
5% = $3,882,298
LOSS / PROFIT MARGIN = UNINSURABLE COST
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Where do we go from here?
Lower Payrolls?
Lower Rates?
Lower Losses?
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SALES PROFITS VS INCIDENT COSTS
It is necessary for the salespeople of a business to sell an additional $1,667,000 in products to
pay the costs of $50,000 in annual losses from injury, illness, damage or theft, assuming an
average profit on sales of 3%. The amount of sales required to
YEARLY
INCIDENT
COSTS
$1,000
$5,000
$10,000
$25,000
$50,000
$100,000
$150,000
$200,000
PROFIT MARGIN
1%
2%
3%
4%
100,000
50,000
33,000
25,000
500,000
250,000
167,000
125,000
1,000,000
500,000
333,000
250,000
2,500,000 1,250,000
833,000
625,000
5,000,000 2,500,000 1,667,000 1,250,000
10,000,000 5,000,000 3,333,000 2,500,000
15,000,000 7,500,000 5,000,000 3,750,000
20,000,000 10,000,000 6,666,000 5,000,000
SALES REQUIRED TO COVER LOSSES
5%
20,000
100,000
200,000
500,000
1,000,000
2,000,000
3,000,000
4,000,000
This table shows the dollars of sales required to pay for different amounts of claim costs. I.e. if
an organization's proift margin is 5%, it would be required to make sales of $500,000 to pay for
$25,000 in claims costs.
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MANAGER’S ROLE
1. RETURN TO WORK PROGRAM
•
PRE-IDENTIFIED TASKS
•
DO NOT SEND PEOPLE HOME
2. ACCIDENT INVESTIGATION
•
1ST DAY REPORTING
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IDENTIFY ROOT CAUSE
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I.D. CORRECTIVE ACTION
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ADVERTISE POSITIVE CHANGES TO STAFF
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MANAGER’S ROLE
3. UP HOLD SAFETY POLICIES OF YOUR DEPARTMENT /
ORGANIZATION
•
FOLLOW YOUR PROGRESSIVE DISCIPLINARY
PROGRAM
4. MAKE SAFETY PART OF EACH EMPLOYEE MEETING
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FORUM TO DISCUSS CONCERNS
•
SAFETY TOPIC OF THE MONTH
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POINTS TO PONDER
Statistical Data:
Ambulance crashes account for the bulk of EMS workplace mortality.
According to the National Institute for Occupational Safety and Health,
EMS workers have an estimated fatality rate of 12.7 per 100,000. For nonEMS workers, the estimated fatality rate is 5.0 per 100,000.
Getting struck by another vehicle at the scene is the second most prevalent
event that kills EMS personnel. Isn’t it ironic that those whose primary
purpose is to save lives have a risk of work-related death more than
twice that of the general population? How can one apply Risk
Management Principles to guarantee that all Medical Transportation
personnel “Arrive Alive and Do No Harm”?
VITALS A Weekly Safety Newsletter for Medical Transport Professionals
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POINTS TO PONDER
In the May, 2003, issue of JEMS, Les R. Becker, Ph.D., NREMT-P, used two
large national databases to show that between 1988 and 1997 there were
305 fatal ambulance crashes, 71 ambulance occupant fatalities and 9,465
injuries. Similar numbers were observed between 1991 and 2000.At the
time of the publication of the JEMS article, Dr. Becker had another
publication in press which showed a detailed statistical analysis that
indicated the following:
The fatality risk for restrained ambulance occupants involved in a crash was
nearly four times lower than for unrestrained ambulance occupants.
The risk of suffering an incapacitating injury for restrained ambulance
occupants involved in a crash was nearly 6.5 times lower than for
unrestrained occupants.
The risk of fatality vs. no injury for rear occupants of an ambulance involved
in a crash was more than five times greater than for front-seat
occupants.
VITALS A Weekly Safety Newsletter for Medical Transport Professionals
24
POINTS TO PONDER
Ambulance occupants traveling non-emergency were nearly 2.7 times more
likely to be killed than occupants traveling emergency if involved in a
crash.
Ambulance occupants traveling non-emergency were nearly 1.7 times more
likely to suffer an incapacitating injury than occupants traveling
emergency if involved in a crash.
52% of ambulance fatalities occurred among “unrestrained occupants
riding in positions other than the front seat” and restrained occupants
riding in the back accounted for another 20% of fatalities
VITALS A Weekly Safety Newsletter for Medical Transport Professionals
25
POINTS TO PONDER
Key Concepts:
1) Risk Identification
2) Risk Evaluation
3) Prioritize Risk
4) Determine and Implement Controls
5) Evaluate and Revise.
Dr. Becker clearly identified the risk, evaluated it, and showed that the
reduction of risk is indeed a priority. Everybody and everything in the
vehicle needs to be secured. There has been a recent spate of claims
regarding patients who were not “tied down” properly. Remember that
even if immobilization is not required for potential spinal or orthopedic
injuries, patients must be safely secured at all times. Also, passengers
who are not essential for patient care should be avoided. Evaluations
which lead to the development of safer ambulance interiors and personal
protective equipment specific to in transit needs also provides a
scientific basis for the revision of transport standards. It is also
estimated that emergency units cause 60,000 “wake effect” crashes 26
VITALS A Weekly Safety Newsletter for Medical Transport Professionals
annually.
194
200
180
165
150
Exposures > 85 dB may cause hearing loss
140
120
110
100
98
90
85 dB
80
60
50
30
0
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p er
ation
Pho n n Mowe
Wh is Convers
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Drye
Norm
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e Si r J et Eng
a
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H
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Chai
a
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Ro
Am b
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Loud
Possible solution – move siren to front grill vs
top
of ambulance.
NIOSH Sound Meter www.cdc.gov/niosh/topics/noise
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
BY AGE
48.28%
25.11%
18.03%
6.65%
1.93%
20 to 24
25 to 34
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
35 to 44
45 to 54
55 to 64
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
BY LENGTH OF SERVICE
37.34%
28.27%
22.57%
11.81%
Less than 3 months
3 months to 11 months
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
1 year to 5 years
More than 5 years
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
24.10%
DAYS AWAY FROM WORK (MEDIAN 5)
PER BLS
19.03%
14.16%
13.53%
12.68%
11.63%
4.86%
Cases involving
1 day
Cases involving
2 days
Cases involving
3-5 days
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
Cases involving
6-10 days
Cases involving
11-20 days
Cases involving Cases involving
21-30 days
31 or more days
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
73.72%
NATURE OF INJURY
14.74%
5.34%
Sprains, strains
Soreness, Pain
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
Back pain
2.99%
Bruises,
contusions
1.50%
1.07%
0.64%
Cuts,
lacerations,
punctures
Multiple injuries
Fractures
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
37.42%
SOURCE OF INJURY
22.83%
13.53%
13.32%
7.82%
Health care
patient
All other
Vehicles
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
Floor,
ground
surfaces
Worker
motion or
position
1.69%
1.48%
1.06%
0.85%
Furniture,
fixtures
Machinery
Parts and
materials
Containers
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
EVENT OR EXPOSURE
46.67%
14.93%
13.87%
10.13%
7.47%
2.93%
Overexertion Transportation
in lifting
accidents
Fall on same
level
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
All other
Contact w ith
object,
equipment
Fall to low er
level
2.13%
1.87%
Assault,
violent act by
person
Slips, trips
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
DAY OF WEEK
20.72%
19.87%
15.64%
15.22%
12.90%
8.03%
Sunday
7.61%
Monday
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
Tuesday
Wednesday
Thursday
Friday
Saturday
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
TIME OF DAY
24.10%
22.41%
19.45%
12.05%
10.15%
7.40%
4.44%
12:01 AM - 4:00
AM
4:01 AM - 8:00
AM
8:01 AM - 12:00 12:01 PM - 4:00
PM
PM
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
4:01 PM - 8:00
PM
8:01 PM - 12:00
AM
Not reported
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
HOURS WORKED
24.95%
19.66%
12.68%
11.42%
8.46%
7.40%
4.65%
4.65%
4.23%
1.90%
Less than
1 hour
1-2
hours
2-4
hours
BLS DAYS AWAY FROM WORK 2006 OSHA
REPORTABLE INCIDENTS 4,730 DAYS
4-6
hours
6-8
hours
8 - 10
hours
10 - 12
hours
12 - 16
hours
More than
16 hours
Not
reported
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
WHAT ALL OF THIS MEANS…..
WHO IS MOST LIKELY TO BE INJURED?
SOMEONE WHO IS 25 TO 34 YEARS OLD AND HAS BEEN
WORKING WITH YOU FOR 1 TO 5 YEARS.
WHEN ARE THEY MOST LIKELY TO BE INJURED?
ON A FRIDAY BETWEEN 8:01 AM & 12:00 PM.
WHAT WILL THEY BE DOING?
LIFTING A PERSON IN NEED OF TRANSPORT
WHAT WILL BE THE RESULT?
A STRAINED BACK RESULTING IN 3 – 5 DAYS AWAY FROM WORK.
DAYS AWAY FROM WORK FOR
AMBULANCE COMPANY PERSONNEL
2006 DATA USA
SOLUTION……
GIVE THESE PEOPLE FRIDAY MORNINGS OFF?
AMBULANCES AROUND THE WORLD
SOURCE: THE INTERNET
CANADA
AMBULANCES AROUND THE WORLD
SOURCE: THE INTERNET
INDIA
AMBULANCES AROUND THE WORLD
SOURCE: THE INTERNET
RUSSIA
AMBULANCES AROUND THE WORLD
SOURCE: THE INTERNET
FRANCE
AMBULANCES AROUND THE WORLD
SOURCE: THE INTERNET
BULGARIA