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So You Think You Have A Best Practices Workers' Compensation Program - Giljum-Parker 2012
So You Think You Have A Best Practices Workers' Compensation Program - Giljum-Parker 2012
Midwest Employers Casualty Company David Parker, Practice Leader Phil Giljum, Regional Account Manager June 1, 2012
Learning Objectives
What is Best Practices and who defines it? Why is it important to always strive for Best Practices when you will probably never get all the way there Key components, too many to count Is your program at Best Practices level?
Best Practices
Officially, Best Practices is:
A method or technique that has consistently shown results superior to those achieved with other means Used as a Benchmark
Best Practices
Unofficially, Best Practices is:
Always evolving and the list keeps growing Realizing that not everything fits well for every organization Something that someone says it is Something that works Probably impossible to achieve fully
If it is nearly impossible to ever get all the way to Best Practices level completely, why bother?
Self Insurance. Its your money! Required for certain accreditations Sets the tone for company culture of caring for its employees Enhances marketing advantages
Program Coordination
Who has oversight for the Workers Compensation program internally?
Are they well respected, highly motivated, knowledgeable about WC issues and laws, possess excellent communication skills, empowered to influence culture and company decisions? Who are their supporting players within your organization? (HR, finance, safety team/committee, management, supervisors, peer employees)
Program Coordination
Are all the players trained and retrained regularly on workers 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 insurance carrier, attorneys, managed care, other vendors How often do you meet with them and why?
Do you utilize them for education, training, keeping you up to date on current issues and changing laws?
Program Coordination
Do your insurance partners make resources available to you? Do they follow Best Practices standards and how do you know? What is your process of monitoring their work on your behalf?
Program Coordination
Management Commitment:
Visible presence sets tone: reinforces that employee safety is a top priority for the organization Attend safety team/committee meetings Discuss workers compensation results and success stories at company meetings
Program Coordination
Management Commitment:
Author and issue the official workers compensation policy statement Get well cards, encourage employee suggestions, lead by example
Program Coordination
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 the calculations? Annual actuarial analyses?
Include Indirect Costs when evaluating the Total Cost of Risk of your workers compensation program
Program Coordination
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
Use stairways instead of elevators Consider treadmill workstations, encourage standing when reading documents, or attending meetings
Provide employees with newsletters and booklets involving medical self care tips
Institute simple stretching exercises at regular intervals at work can help to ensure employees are prepared to respond to work situations
Consider incentives if it makes sense for your culture but make sure that they are linked to outcomes and or include suggestions for improvement
Claims Administration
Important to get all claims reported to your claims servicing company immediately after the injury. Claim costs go up with every passing day. So even if you have only minimal information, report the injury to your TPA as soon as possible. Best Practices, while difficult, would be within 24 hours Let your TPA be the bad guy when it comes to compensability decisions
Gain an understanding of workers compensation regulations and case law from your attorneys who actually handle your claims
Claims Administration
Hold regular file reviews with your TPA to include open claims, settlements and large payments made Establish guidelines for reserving and settlement authority where appropriate Ask your TPA claim handlers or supervisors to visit your facilities to gain a better understanding of your operations and job hazards Attend settlement or trial sessions on your claims if allowed by presiding authority Position complex or high dollar claims for defense or settlement
Claims Administration
Utilize all available managed care options available especially since medical costs are expected to be nearly 60% of every dollar spent on your claims Participate in prescription drug review programs Train internal staff on first aid basics and consider hire of nurse employee to conduct initial triage of non-emergency type injuries Be aware of employee referral network
Claims Administration
Try to understand Medicare Set Aside process Ask your attorneys to provide educational sessions annually to your internal staff on WC basics and changing laws
Ask supervisors to contact employees weekly while off work and frequently upon their return to work
Claims Administration
Send supervisors to emergency room visits to ensure information being shared properly while also promoting your caring culture towards employees Reinforce to employees the need to report all injuries immediately, regardless of whether treatment sought
Provides an employee for 1/3 of the cost you would already be paying 2/3 for them to sit at home (if they just sit at home)
Require physicians to focus upon work restrictions instead of just off work
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?
Data Management
Data sources include:
Claims servicing company (TPA)
Internal systems and reporting forms OSHA logs
Data Management
In an effort to increase profitability or preserve operating margin, reducing the expense associated with 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.
Data Management
Tracking and trending of these and other data sets can give you a clearer picture of what is happening within your claims and help address allocation of future time and resources to address improvement Tracking / trending should be done quarterly at a minimum and ideally would be done monthly and selected results should be shared with employees Results should be communicated to senior management, safety committees, HR and everyone involved in oversight of WC including dept. management and supervisors
Data Management
Should be used to set and communicate realistic claim frequency reduction goals as well as measure effectiveness of initiatives put into place at various points in time Should be evaluated in such a fashion to allow for actionable and follow up items
Benchmarking your program against yourself is fine. Benchmarking your program against your peers is Best Practices
Data Management
Ask your insurance partners what kind of benchmarking 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 is perceived as producing positive results Industry specific benchmarking availability
Research Best Practices standards for your industry and perform related self assessment
Research Link
A medical/research reserving and return to work tool that includes 300 of the most common work related injuries
Safety Trainer
Over 100 industry specific online safety courses many available in Spanish
Web Events
Regulatory and industry specific events. All recorded and archived to view at your convenience
For more information or to obtain a Username & Password Email: help@mwecc.com Call: 1-877-975-2667 (ask to speak with a Client Services Coordinator)