so you think you have a best practices workers' compensation program - giljum-parker 2012

7/31/2019 So You Think You Have a Best Practices Workers' Compensation Program - Giljum-Parker 2012

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So You Think You Have a BestPractices Workers

Compensation Program?

Midwest Employers Casualty CompanyDavid Parker, Practice LeaderPhil Giljum, Regional Account Manager

June 1, 2012


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Learning Objectives

What is Best Practices and who defines it?

Why is it important to always strive for BestPractices when you will probably never get all

the way there

Key components, too many to count

Is your program at Best Practices level?


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Best Practices

Unofficially, Best Practices is: Always evolving and the list keeps growing

Realizing that not everything fits well for everyorganization

Something that someone says it is

Something that works

Probably impossible to achieve fully

Is all of the above and then some


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If it is nearly impossible to ever get allthe way to Best Practices level

completely, why bother?

Self Insurance. Its your money!

Required for certain accreditations

Sets the tone for company culture of caringfor its employees

Enhances marketing advantages

Improves employee recruitment andretention


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Key Components

of Best Practices Programs

Can be different depending on your respectiveindustry

Will be different depending on your company culture

Too many components to count or review today

In order to be completely effective it requires visibleand real commitment at all levels, from top

management down


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Key Components

of Best Practices Programs

Program Coordination

Employee Health and Wellness

Safety and Loss Prevention Claims Administration (includes Medical Management)

Medical Management

Return to Work Programs Data Management, Benchmarking, Goal Setting


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Who has oversight for the Workers Compensation

program internally?

Are they well respected, highly motivated,

knowledgeable about WC issues and laws, possessexcellent communication skills, empowered to influenceculture and company decisions?

Who are their supporting players within your

organization? (HR, finance, safety team/committee,management, supervisors, peer employees)


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Are all the players trained and retrained regularly onworkers compensation issues and laws, along with

your company policies and who does the training?

Who are your insurance partners: insurance agents,claims administration company, excess insurancecarrier, attorneys, managed care, other vendors

How often do you meet with them and why?

Do you utilize them for education, training, keeping youup to date on current issues and changing laws?


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Do your insurance partners make resources availableto you?

Do they follow Best Practices standards and how do

you know? What is your process of monitoring their work on your

behalf?


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Management Commitment:

Visible presence sets tone: reinforces that employeesafety is a top priority for the organization

Attend safety team/committee meetings

Discuss workers compensation results and success

stories at company meetings


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Management Commitment:

Author and issue the official workers compensation

policy statement

Get well cards, encourage employee suggestions, leadby example

Did I mention? Be visible, very visible!


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Funding:

Where do the funds come from to cover the workers

compensation claim and program costs?

Partial or fully funded and what do you include in thecalculations? Annual actuarial analyses?

Include Indirect Costs when evaluating the Total Costof Risk of your workers compensation program


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Funding:

Consideration of Profit or Operating Margins

How do you make your business case to finance and

top management as it relates to funding?

Cost Allocation


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Keeping in mind the basic obligation to ensureworkers physical abilities are equal to the duties

they are expected to perform, you may wish to:

Hire quality individuals to start Continue with Health Risk Assessments, but make

sure to include family members and then link successto achievement of outcomes like weight reduction,blood pressure, smoking cessation, etc.

Include mental and marital promotion in programs

Consider having PT or industrial clinic physician onsite a few days a week


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Acknowledge the Aging Workforce and address issuesof productivity, workplace injuries and institutionalknowledge

Institute a Movement in the Workplace program as

employees on average will sit 9.3 hours each day.People who sit 6 or more hours each day are 40% more likely todie within 15 years than a person who sits 3 hours per day.(Stanford Center on Longevity)

Use stairways instead of elevators Consider treadmill workstations, encourage standing

when reading documents, or attending meetings


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Create workplace and personal policies to discourageunhealthy behaviors such as smoking and alcohol use,fast food, medication compliance, staying indoors formost recreation

Exercise classes on site and funding of gymmemberships

Provide employees with newsletters and bookletsinvolving medical self care tips

Institute simple stretching exercises at regular intervalsat work can help to ensure employees are prepared torespond to work situations


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Realize that training and education are different.Education is information taught, while training isobserving in practice the information that was taught

Supervisory and peer observation

Provide training to

new employees, experienced employees, agingemployees, supervisors

when new equipment is involved, new policiesimplemented, after an injury occurs that is specific to thatinjury cause or body part involved, when near missesreported, change in work assignment

Safety and Loss Prevention


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Constant review of back injury, slip/trip/fall and motorvehicle policies as they are the costliest

Enforce your own policies and procedures

Ask management to lead by example

Make use of vendor partners and their resources asemployees may be more likely to value coming froman outside source

Develop and regularly use self inspection checklists


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Discuss importance of safety in the interview processwith potential employees

Keep it creative and visible by using posters and

handouts that are eye catching, witty or simple. Changetopics frequently and at least every month

Dear John or Stall Street Journal in the bathrooms

where you have a captive audience

Consider incentives if it makes sense for your culture butmake sure that they are linked to outcomes and orinclude suggestions for improvement


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Your supervisors hold your checkbook in their hands asthey are the face of the organization, especially after aninjury occurs

Supervisors are crucial to controlling claim costs bybeing empathetic to the injured work and getting theclaims process put into motion by reporting the injuryinternally immediately after it occurs

Must fully support your Return To Work program Have a big say in whether a claim becomes litigated


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Supervisors and Accident Investigation: Dont hesitate to ask questions and dont rely only onTPA to conduct investigation

Keep disposable/digital cameras on hand for photos

Critical to get to the ROOT CAUSE. Dont settle forthe first answer or thought as the root cause. Aneasy way to get to the root cause is by using the5 Whys method. Keep asking Why until you cant

ask any longerComponents

Task, Material, Environment, Personnel, Management


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Supervisors and Accident Investigation: Root Cause Identification leads to Corrective Action

Start with root cause and then define the Action Planto help correct or eliminate the weakness

Create ownership by assigning tasks with due dates

Track and monitor progress and make sure tocommunicate any new related policy to employees

Require completed supervisory accident investigationand corrective action plan forms for all injuries

Dont forget NEAR MISSES as part of this process


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Claims Administration

Important to get all claims reported to your claimsservicing company immediately after the injury. Claimcosts go up with every passing day. So even if youhave only minimal information, report the injury to yourTPA as soon as possible. Best Practices, while

difficult, would be within 24 hours

Let your TPA be the bad guy when it comes tocompensability decisions

Gain an understanding of workers compensationregulations and case law from your attorneys whoactually handle your claims


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Hold regular file reviews with your TPA to include openclaims, settlements and large payments made

Establish guidelines for reserving and settlementauthority where appropriate

Ask your TPA claim handlers or supervisors to visityour facilities to gain a better understanding of youroperations and job hazards

Attend settlement or trial sessions on your claims ifallowed by presiding authority

Position complex or high dollar claims for defense orsettlement


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Utilize all available managed care options availableespecially since medical costs are expected to benearly 60% of every dollar spent on your claims

Participate in prescription drug review programs

Train internal staff on first aid basics and considerhire of nurse employee to conduct initial triage ofnon-emergency type injuries

Be aware of employee referral network


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Try to understand Medicare Set Aside process Ask your attorneys to provide educational sessions

annually to your internal staff on WC basics andchanging laws

Aggressively pursue suspected fraudulent claims

Trend and track your injuries and use informationgained to direct loss prevention and training

Ask supervisors to contact employees weekly whileoff work and frequently upon their return to work


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Send supervisors to emergency room visits toensure information being shared properly while alsopromoting your caring culture towards employees

Reinforce to employees the need to report all injuries

immediately, regardless of whether treatment sought


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Return to Work Programs

Are the most effective counter to a host of moralhazards that keep employees from returning

Are the only immediate and effective balance to fullsalary continuation programs

Strongly influence the cost of medical Provides an employee for 1/3 of the cost you would

already be paying 2/3 for them to sit at home (if theyjust sit at home)

Require physicians to focus upon work restrictionsinstead of just off work


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Best Practices traits include: Written transitional duty plan agreed to by employee in

writing which include start and end dates

Uniformly applied through all departments which may

require light duty jobs to be cross departmentalized Involves meaningful work that actually needs to be

done and is beneficial to the organization

Creation of a bank of those same meaningful jobs with

written job descriptions which can then be given totreating providers at time of office visit creating pro-active position rather than reactive


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Require treating provider come out to visit yourfacilities to gain understanding of job types andhazards along with physical requirements

Importance of employee to the organization isstressed repeatedly

Utilize individualized functional assessments ifnecessary along with analysis of physicalrequirements of job in question to then use to informtreating providers in consideration of light duty

Ask employees to come into facility to pick up TTDcheck as compared to mailing

Communication both internally and externally is key


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Data Management

So now your organization is doing all the right things.

How do you know?

Do you collect data and if so, from what sources?

How often do you want new data sets?

What do you do with this data?

What benchmarking methods willyou use?

What goals will you set?

How much data will you share withemployees?


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Data Management

Data sources include: Claims servicing company (TPA)

Internal systems and reporting forms

OSHA logs

Excess workers compensation carrier

Treating providers

Managed care providers

Insurance agents


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Data Management

In an effort to increase profitability or preserveoperating margin, reducing the expense associatedwith accidents is critical

Tracking / trending of data gathered by various

metrics including department, loss cause, body type,reporting lag time, average cost per claim, payroll,loss dollars, paid / incurred, department or location,age of employee, tenure of employee, job type, etc.


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Data Management

Tracking and trending of these and other data setscan give you a clearer picture of what is happeningwithin your claims and help address allocation offuture time and resources to address improvement

Tracking / trending should be done quarterly at aminimum and ideally would be done monthly andselected results should be shared with employees

Results should be communicated to senior

management, safety committees, HR and everyoneinvolved in oversight of WC including dept.management and supervisors


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Data Management

Should be used to set and communicate realisticclaim frequency reduction goals as well as measureeffectiveness of initiatives put into place at variouspoints in time

Should be evaluated in such a fashion to allow foractionable and follow up items

Benchmarking your program against yourself is fine.Benchmarking your program against your peers is

Best Practices


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Data Management

Ask your insurance partners what kind ofbenchmarking data sets are available to you

Talk to your industry peers, review their websites,attend conferences and roundtables, read blogs as

you need to know what others are doing that isperceived as producing positive results

Industry specific benchmarking availability

Research Best Practices standards for your industry

and perform related self assessment

So how does your program compare


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So how does your program compare

to Best Practices?

Your organization is the best judge of what BestPractices standards to strive to achieve, and

These standards are judged to be Best Practices for areason, because

They have produced positive results for someone atsome point in time, so

Have you done a self assessment of the Best Practicestandards most important to your organization?

Remember, you are self insured for a reason. Theyare your employees, their claims are your claims, andit is your organizations money being spent


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MECC Online ServicesSafetyLibrary

A collection ofindustry specific,

safety resources inan easy to use and

customizableonline format

ResearchLink

A medical/researchreserving and return

to work tool thatincludes 300 of themost common work

related injuries

SafetyTrainer

Over 100 industryspecific online

safety coursesmany available

in Spanish

WebEvents

Regulatory andindustry specific

events. All recordedand archived to

view at yourconvenience

For more information or to obtain aUsername & Password

Email: [email protected]: 1-877-975-2667 (ask to speak with a Client Services Coordinator)


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David ParkerPractice Leader

[email protected]

Phil GiljumRegional Account Manager

[email protected]
mailto:[email protected]:[email protected]:[email protected]:[email protected]

so you think you have a best practices workers' compensation program - giljum-parker 2012

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