County of Los Angeles County of Los Angeles Workers’ Compensation TPA Workers’ Compensation TPA

Performance Evaluation MeetingPerformance Evaluation Meeting

Dates: November 12, 2010 (Unit 2)Dates: November 12, 2010 (Unit 2)

November 19, 2010 (Unit 1)November 19, 2010 (Unit 1)

December 03, 2010 (Unit 3)December 03, 2010 (Unit 3)

December 21, 2010 (Unit 4)December 21, 2010 (Unit 4)

January 18, 2011 (RTW Seminar)January 18, 2011 (RTW Seminar)

Workers’ Compensation Claim VolumeWorkers’ Compensation Claim Volume

Impact of 2003-2004 LegislationImpact of 2003-2004 Legislation

$352

$414

$487

$572

$674

$792

$931

$1,095

$310$332

$355$380

$407$435

$185$205

$258

$292

$324

$273 $279 $285 $288 $298$290

$263

$0

$200

$400

$600

$800

$1,000

$1,200

FY 99/00 FY 00/01 FY 01/02 FY 02/03 FY 03/04 FY 04/05 FY 05/06 FY 06/07 FY 07/08 FY 08/09 FY 09/10 FY 10/11

Projected before reform Anticipated post reform (2/2005) Actual expense experience

Workers’ Compensation Expenses Workers’ Compensation Expenses Excludes LC 4850 & SCExcludes LC 4850 & SC

$324,414,785

$330,000,000$330,000,000

$236,400,000

$295,000,000

$352,000,000

$414,500,000

$380,000,000

$335,000,000

$310,000,000

$288,377,294

$298,138,460$257,633,464$293,006,526

$272,735,278

$263,053,690

$279,991,751

$285,055,563

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

$300,000,000

$350,000,000

$400,000,000

$450,000,000

FY 2001-02 FY 2002-03 FY 2003-04 FY 2004-05 FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 FY 2009-10

Budgeted Actual

LC 4850

$ 6 6 2 , 8 9 4$ 19 8 , 9 6 6 $ 2 2 0 , 5 5 1 $ 2 0 0 , 14 4 $ 10 9 , 8 2 7 $ 2 6 5 , 9 2 0 $ 2 9 9 , 3 4 6$ 5 7 4 , 5 4 1

$ 4 4 6 , 8 10$ 3 6 8 , 6 10$ 3 7 0 , 6 7 6$ 2 7 2 , 5 4 0$ 4 4 5 , 4 18$ 4 6 3 , 3 4 0$ 1, 0 4 8 , 3 5 6$ 8 7 8 , 5 4 3

$ 7 , 0 2 0 , 4 4 6 $ 7 , 0 7 3 , 8 8 0

$ 8 , 5 6 9 , 12 7

$ 7 , 6 5 6 , 3 12

$ 6 , 3 9 8 , 5 13

$ 7 , 6 0 8 , 9 16

$ 7 , 0 9 7 , 0 3 8$ 8 , 2 0 7 , 5 9 1

$ 18 , 4 4 3 , 6 8 9$ 17 , 5 10 , 8 8 9

$ 13 , 7 3 6 , 3 0 6

$ 12 , 9 2 2 , 17 8$ 13 , 0 9 4 , 3 6 5$ 13 , 5 7 9 , 0 5 8

$ 14 , 18 6 , 10 6

$ 16 , 0 5 4 , 9 5 7

$ 2 2 , 0 9 9 , 13 7

$ 14 , 7 2 3 , 4 0 0$ 16 , 9 7 9 , 8 7 8

$ 12 , 2 6 0 , 6 0 1

$ 14 , 7 0 8 , 3 4 1

$ 18 , 2 6 5 , 5 7 6

$ 2 3 , 6 7 9 , 5 18

$ 2 3 , 3 5 4 , 3 2 4

$ 0

$ 5,000,000

$ 10,000,000

$ 15,000,000

$ 20,000,000

$ 25,000,000

FY 2002-03 FY 2003-04 FY 2004-05 FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 FY 2009-10

Distr ict Attor ney Offi ce of P ubl ic Saf ety P r obation Fir e LASD

Benefit Expense TypeBenefit Expense Type

$140,287,388

$94,434,996 $96,188,760 $96,431,414 $97,097,109 $103,549,355 $108,415,580

$62,440,000

$62,420,000 $65,910,000 $67,122,000 $63,682,588$60,585,732

$67,545,626

$33,730,000

$30,220,000$27,347,000 $27,242,000 $25,861,460 $23,384,637

$22,359,098

$0

$50,000,000

$100,000,000

$150,000,000

$200,000,000

$250,000,000

FY 2003-04 FY 2004-05 FY 2005-06 FY 2006-07 FY 2007-08 FY 2008-09 FY 2009-10

TD

PD

Medical TX

Factors to Consider (Medical)Factors to Consider (Medical)

Medical Payout Trend Public Self-Insured EmployersOSIP Annual Report DataIn Millions

$932.5

$777.6 $768.9$779.0

$887.3

$949.4

$140.3

$94.4 $96.2 $96.4 $97.1 $103.5

$157.6

$108.1 $108.8 $107.6 $111.3$120.9

$0.0

$100.0

$200.0

$300.0

$400.0

$500.0

$600.0

$700.0

$800.0

$900.0

$1,000.0

FY 03-04 FY 04-05 FY 05-06 FY 06-07 FY 07-08 FY 08-09

All Public SI Employers Medical Payout County Medical Treatment Payout GIFW County Medical Payout

- 16.6%

-31.4%

+21.9% 2YRs

+12.4% 2YRs

Workers’ Compensation Program GoalOperational Effectiveness

• Strategy 1: Fiscal Sustainability • Strategy 2: Service Excellence and Organizational Effectiveness

I. Promote the sound and expedient delivery of workers’ compensation benefits through evidenced based claims administration (communication, documentation, and timeliness). (SOW 1.0 & 1.2)

II. Maintain accurate and thorough decision logs to ensure compensability of injuries and illnesses are made in accordance with State Workers’ Compensation laws. (SOW 1.2.2)

III. Ensure decisions to provide and/or approve benefits related to medical need are based on the treating physician’s recommendations and MTUS (examiners must know the triggers). (SOW 1.3 & 2.4)

IV. Maintain close liaison with the treating physician and County department to promote the early-return-to-work process by procuring meaningful temporary work restrictions. Submit a request for Temporary Work Restriction Letter to the treating physician on or near the 30th day of disability. (SOW 1.3 & 1.7)

Workers’ Compensation Program GoalOperational Effectiveness

• Strategy 1: Fiscal Sustainability • Strategy 2: Service Excellence and Organizational Effectiveness

V. Report, monitor, and actively address issues (action plans) related to claims where state rate temporary disability benefits are paid (see Workers’ Compensation Long-Term Leave memo – 10/26/2010). (SOW 1.7 & 2.1)

VI. Ensure the timeliness and accuracy of all work restriction letters. (SOW 1.7)

VII. Establish and maintain an adequate separation of duties between personnel who process and enter payment, address, and vendor data. Ensure management utilize reports to periodically (at least monthly) verify compliance with such processes. Secure and maintain confidentiality of all workers’ compensation claim information. (SOW 1.9)

VIII. Utilize the Medical Treatment Verification form in a timely and logical manner to evaluate potential billing abuse or fraud.

Workers’ Compensation Program GoalOperational Effectiveness

• Strategy 1: Fiscal Sustainability

• Strategy 2: Service Excellence and Organizational Effectiveness

IX. Customer service – provide accurate information and guidance to injured workers on benefits directed by state law in a respectful and prompt manner. Respond to injured worker and department inquiries as soon as necessary. However, in no event shall the response be provided later than 24 hours from the inquiry. (SOW 1.4)

X. Provide sufficient and competent staff to fulfill the contract and establish an effective management and organizational structure. (SOW 2.3)

WC TPA Generated Reports

• TPA Memo 10/26/10

• Open Claim Report A

• Open Claim Report B

• TD Paid Report

Emphasis on Disability ManagementEmphasis on Disability Management

• Sound Long-Term Leave Management Protocols Sound Long-Term Leave Management Protocols

• FEHA Compliance EffortsFEHA Compliance Efforts

• Early-Return-To-Work Efforts (Transitional Modified Work)Early-Return-To-Work Efforts (Transitional Modified Work)

• Return-To-Work Efforts (Permanent Placement in Modified or Return-To-Work Efforts (Permanent Placement in Modified or Alternate Positions)Alternate Positions)

• Los Angeles County Probation (Unit 4)Los Angeles County Probation (Unit 4)