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Synergy Coverage Solutions Workers Compensation Training.

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Presentation on theme: "Synergy Coverage Solutions Workers Compensation Training."— Presentation transcript:

1 Synergy Coverage Solutions Workers Compensation Training

2 Synergy Coverage Solutions Overview History of Workers Compensation History of Workers Compensation Claims Claims Claims Reporting Claims Reporting Accident Analysis Accident Analysis Accident Investigation Accident Investigation Early Return to Work Early Return to Work Post Accident Drug Testing Post Accident Drug Testing Hiring Practices Hiring Practices Slips & Falls Slips & Falls Back Safety Back Safety Personal Protective Equipment Personal Protective Equipment Ergonomics Ergonomics Defensive Driving Defensive Driving OSHA Regulations OSHA Regulations

3 Synergy Coverage Solutions History of Workers Compensation Workers' Compensation in the U.S. began in 1911 during the Progressive Era when Wisconsin passed the first statutory system. Other U.S. jurisdictions followed suit. In general, statutory Workers' Compensation systems strike a compromise, guaranteeing workers medical care and payment for lost time on a no-fault basis. Prior to the enactment of Workers' Compensation laws, injured workers had to file suit against employers (usually for the tort of negligence), and such legal actions had significant drawbacks for workers. At the same time, a successful suit could impose very large and unpredictable costs on an employer. Statutory Workers' Compensation systems provide for prompt payment of medical, rehabilitation, and lost time costs to injured workers, while placing limits on the cost of the system for employers. This trade-off became known as the "workers' compensation bargain"; that is, the worker traded his/her right to bring a tort suit against their employer in exchange for prompt medical care and disability payments (indemnity payments). Thus workers compensation is the original "Tort Reform." Workers' Compensation in the U.S. began in 1911 during the Progressive Era when Wisconsin passed the first statutory system. Other U.S. jurisdictions followed suit. In general, statutory Workers' Compensation systems strike a compromise, guaranteeing workers medical care and payment for lost time on a no-fault basis. Prior to the enactment of Workers' Compensation laws, injured workers had to file suit against employers (usually for the tort of negligence), and such legal actions had significant drawbacks for workers. At the same time, a successful suit could impose very large and unpredictable costs on an employer. Statutory Workers' Compensation systems provide for prompt payment of medical, rehabilitation, and lost time costs to injured workers, while placing limits on the cost of the system for employers. This trade-off became known as the "workers' compensation bargain"; that is, the worker traded his/her right to bring a tort suit against their employer in exchange for prompt medical care and disability payments (indemnity payments). Thus workers compensation is the original "Tort Reform."1911Wisconsin1911Wisconsin

4 Synergy Coverage Solutions History of Workers Compensation Workers' compensation provides insurance to cover medical care and Indemnity payments. While plans differ between jurisdictions, weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (PPD, TPD and PTD), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependents of workers killed during employment (functioning in this case as a form of life insurance). General damages for pain and suffering, and punitive damages for employer negligence, are generally not available in worker compensation plans. Workers' compensation provides insurance to cover medical care and Indemnity payments. While plans differ between jurisdictions, weekly payments in place of wages (functioning in this case as a form of disability insurance), compensation for economic loss (PPD, TPD and PTD), reimbursement or payment of medical and like expenses (functioning in this case as a form of health insurance), and benefits payable to the dependents of workers killed during employment (functioning in this case as a form of life insurance). General damages for pain and suffering, and punitive damages for employer negligence, are generally not available in worker compensation plans.insurancedisability insurancehealth insurancelife insurancepain and suffering punitive damagesnegligenceinsurancedisability insurancehealth insurancelife insurancepain and suffering punitive damagesnegligence

5 Synergy Coverage Solutions Claims Injury by Accident – there must be an accident Injury by Accident – there must be an accident Specific Traumatic Incident – Back injuries/Hernias Specific Traumatic Incident – Back injuries/Hernias Occupational Disease – Asbestosis, Carpal Tunnel Occupational Disease – Asbestosis, Carpal Tunnel Claim – Accepted or Denied Claim – Accepted or Denied Denied Claim – Form 33 Request for Hearing Denied Claim – Form 33 Request for Hearing Mediation Mediation NCIC Hearing NCIC Hearing

6 Synergy Coverage Solutions Reporting Claims The Employer should file a NC Industrial Commission Form 19 with the workers compensation insurance company within 24 hours following the accident. The Employer should file a NC Industrial Commission Form 19 with the workers compensation insurance company within 24 hours following the accident. The Employee can file a NC Industrial Commission Form 18. The Employee can file a NC Industrial Commission Form 18.

7 Synergy Coverage Solutions NC Form 19 – First Report of Injury

8 Synergy Coverage Solutions NC Form 18 – Employees Claim

9 Synergy Coverage Solutions Claims Reporting According to an article published in April 1995 issue of NATIONAL UNDERWRITER, prompt claim reporting significantly reduces the cost of a claim and likeliness of attorney involvement. According to an article published in April 1995 issue of NATIONAL UNDERWRITER, prompt claim reporting significantly reduces the cost of a claim and likeliness of attorney involvement. Timely reporting allows for better coordination of medical treatment and rehabilitation efforts to get the injured employee back to work. Indemnity costs make up more than 50% of the total claims cost. Timely reporting allows for better coordination of medical treatment and rehabilitation efforts to get the injured employee back to work. Indemnity costs make up more than 50% of the total claims cost.

10 Synergy Coverage Solutions Prompt Claims Reporting NATIONAL UNDERWRITER Report Time Ave. Cost of Claim Increase Cost % Litigation increase % Within 10 days $12,8280%0% 11 – 20 days $17,56637%23% 21 – 30 days $18,12541%36% After 30 days $18,85847%50%

11 Synergy Coverage Solutions Why Investigate Accidents? To Prevent Future Accidents To Prevent Future Accidents

12 Synergy Coverage Solutions Direct Costs Medical & Indemnity costs associated with the injury.Medical & Indemnity costs associated with the injury. Indirect Costs Can be at least 4 times greater than direct costs Loss of productivityLoss of productivity Employee moraleEmployee morale Lack of experienced employee replacing injuredLack of experienced employee replacing injured Time taken away to investigate accidentTime taken away to investigate accident Time taken away to deal with claims issuesTime taken away to deal with claims issues Cost of broken equipmentCost of broken equipment Higher Workers Comp. premiums due to higher experience mod.Higher Workers Comp. premiums due to higher experience mod. The Cost of an Accident

13 Synergy Coverage Solutions Conducting an Accident Investigation Respond immediately. Respond immediately. Investigate to find the facts. Investigate to find the facts. Analyze the facts to determine the root cause. Analyze the facts to determine the root cause. Develop specific corrective actions. Develop specific corrective actions. Review findings with employees (Lessons Learned from Losses). Review findings with employees (Lessons Learned from Losses).

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19 Early Return to Work Program A formal written Plan designed to return injured employees back to work in some limited or modified duty capacity as quickly as medically feasible. A formal written Plan designed to return injured employees back to work in some limited or modified duty capacity as quickly as medically feasible.

20 Synergy Coverage Solutions Benefits of ERTW Reduce workers compensation costs Reduce workers compensation costs Brings the injured employee back to wage earning capacity sooner Brings the injured employee back to wage earning capacity sooner Shortens length of medical treatment Shortens length of medical treatment Lowers cost of claim (TTD) Lowers cost of claim (TTD) Prevents malingering and symptom magnification Prevents malingering and symptom magnification Gives injured worker an opportunity to contribute to the company Gives injured worker an opportunity to contribute to the company Injured worker remains active and productive Injured worker remains active and productive

21 Synergy Coverage Solutions The objectives of a modified duty program Familiarize/educate each employee with the modified duty programs prior to an injury. Familiarize/educate each employee with the modified duty programs prior to an injury. To provide each employee with support during recuperation due to an on-the-job injury. To provide each employee with support during recuperation due to an on-the-job injury. To provide employees with a means to maintain a productive lifestyle. To provide employees with a means to maintain a productive lifestyle. To control claim cost. To control claim cost. To help reduce experience modification factor To help reduce experience modification factor

22 Synergy Coverage Solutions Early Return to Work Commitment to the program by management and supervisors Commitment to the program by management and supervisors Written policy in place Written policy in place Determine restricted duty jobs Determine restricted duty jobs Follow Doctors restrictions Follow Doctors restrictions Work closely with your W. C. claims dept. Work closely with your W. C. claims dept.

23 Synergy Coverage Solutions ERTW Process Prepare in advance written modified duty job descriptions Prepare in advance written modified duty job descriptions Have these job descriptions given to the initial medical care provider selected by the employer. Have these job descriptions given to the initial medical care provider selected by the employer. The adjuster or employer should have the medical doctor sign off on the modified duty job description The adjuster or employer should have the medical doctor sign off on the modified duty job description Have these job descriptions ready to give to the claims adjuster. Have these job descriptions ready to give to the claims adjuster. Offer the modified duty job to the injured employee in writing and we recommend via certified letter. Offer the modified duty job to the injured employee in writing and we recommend via certified letter.

24 Synergy Coverage Solutions Post Accident Drug Test NCGS NCGS Law changed 2005 Law changed 2005 Burden of Proof Burden of Proof –2005 law changed from the Employer having to prove the drug was a proximate cause to the Employee having to prove it was not a proximate cause –What did this change?

25 Synergy Coverage Solutions Hiring Practices and Workers Compensation Claims Typically a bad hiring decision results in a Bad workers compensation claim

26 Synergy Coverage Solutions Hiring Application Application Interview Interview Background checks Background checks Reference checks Reference checks Motor Vehicle Record evaluations Motor Vehicle Record evaluations Criminal background checks Criminal background checks Pre-employment drug screening Pre-employment drug screening Post Offer Medical Questionnaire Post Offer Medical Questionnaire

27 Synergy Coverage Solutions Loss Prevention Slips, Trips, and Falls Slips, Trips, and Falls Back Safety Back Safety Personal Protective Equipment Personal Protective Equipment Ergonomics Ergonomics Defensive Driving Defensive Driving OSHA Regulations OSHA Regulations

28 Synergy Coverage Solutions Significance of Slips and Falls Over 540,000 slips and falls each year requiring hospitalization Over 540,000 slips and falls each year requiring hospitalization Slips and falls account for over 300,000 disabling injuries each year Slips and falls account for over 300,000 disabling injuries each year One in three serious bone breaks for seniors result in death, within one year of the accident. One in three serious bone breaks for seniors result in death, within one year of the accident. It is the second leading cause of accidental death and disability after automobile accidents. It is the second leading cause of accidental death and disability after automobile accidents. Slip and fall accidents account for 30% of all reported injuries. Slip and fall accidents account for 30% of all reported injuries.

29 Synergy Coverage Solutions Slips & Falls Periodic safety evaluations of each business location. Periodic safety evaluations of each business location. Improve employee awareness to slips & falls at office and their clients locations. Improve employee awareness to slips & falls at office and their clients locations. Conduct initial and periodic employee safety training on slip & fall prevention. Conduct initial and periodic employee safety training on slip & fall prevention. Require proper shoe wear. Require proper shoe wear.

30 Synergy Coverage Solutions Back Safety - Patient Handling Health Care is the only profession that thinks 100 pounds is light. Health Care is the only profession that thinks 100 pounds is light. Employee Safety Training - Review proper lifting techniques with all employees on a regular basis. Employee Safety Training - Review proper lifting techniques with all employees on a regular basis. Employee Safety Training - Periodic review on how to handle patients within the home and work environment. Employee Safety Training - Periodic review on how to handle patients within the home and work environment. Use mechanical lifts whenever possible. Use mechanical lifts whenever possible.

31 Synergy Coverage Solutions Back Safety - General Techniques – bend at the knees Techniques – bend at the knees Keep load close to the body Keep load close to the body Plan the lift – synchronize Plan the lift – synchronize Stay healthy – diet/regular exercise Stay healthy – diet/regular exercise Stretching exercises Stretching exercises

32 Synergy Coverage Solutions Personal Protective Equipment Engineering Controls Engineering Controls Protect employees from chemical and physical hazards Protect employees from chemical and physical hazards Safety glasses, face shields, steel-toed shoes, gloves, respirators, etc. Safety glasses, face shields, steel-toed shoes, gloves, respirators, etc. Policy development and enforcement Policy development and enforcement

33 Synergy Coverage Solutions Ergonomics Musculoskeletal; Repetitive Motion Musculoskeletal; Repetitive Motion Engineering Controls – task redesign; fitting the task to the employee, ergonomic tools Engineering Controls – task redesign; fitting the task to the employee, ergonomic tools Administrative Controls – employee rotation, exercise programs Administrative Controls – employee rotation, exercise programs Workstation evaluation Workstation evaluation

34 Synergy Coverage Solutions Vehicle Accidents are Expensive Motor Vehicle Accidents are the No. 1 cause of workplace fatalities. Motor Vehicle Accidents are the No. 1 cause of workplace fatalities. According to the National Highway Traffic Safety Administration, motor vehicle crashes cost employers more than $50 billion every year in medical care, legal expenses, property damage, and lost productivity. According to the National Highway Traffic Safety Administration, motor vehicle crashes cost employers more than $50 billion every year in medical care, legal expenses, property damage, and lost productivity. When a worker has an on-the-job crash that results in injuries, the cost to the employer is more than $24,000. When a worker has an on-the-job crash that results in injuries, the cost to the employer is more than $24,000. In one year, employer medical care spending on crash injuries was nearly $9 billion. Another $9 billion was spent on sick leave and life and disability insurance for crash victims. In one year, employer medical care spending on crash injuries was nearly $9 billion. Another $9 billion was spent on sick leave and life and disability insurance for crash victims.

35 Synergy Coverage Solutions Vehicle Accident Prevention MVR review upon hire and annually thereafter. MVR review upon hire and annually thereafter. Periodic employee training on Defensive Driving is critical. Periodic employee training on Defensive Driving is critical. Training can take 30 minutes to 1 hour in length. Training can take 30 minutes to 1 hour in length. Defensive Driving training presentation (video or PowerPoint), and short test to validate transfer of knowledge. Defensive Driving training presentation (video or PowerPoint), and short test to validate transfer of knowledge. Do hands-on training for preventative maintenance. Do hands-on training for preventative maintenance. Written test remains in training file Written test remains in training file

36 Synergy Coverage Solutions Defensive Driving Topics Reviewed Defensive Driving Techniques Defensive Driving Techniques Cell phone policy and usage Cell phone policy and usage Preventative Maintenance Preventative Maintenance Daily, Weekly, Monthly Vehicle inspection Daily, Weekly, Monthly Vehicle inspection 2 and 3 second rules – Following Distance 2 and 3 second rules – Following Distance Adverse driving conditions Adverse driving conditions Speed kills Speed kills Seat belts Seat belts

37 Synergy Coverage Solutions OSHA Regulations 29 CFR Part CFR Part 1910 Hazard Communication Hazard Communication Means of Egress Means of Egress Powered Industrial Trucks (Forklifts) Powered Industrial Trucks (Forklifts) Hearing Conservation Hearing Conservation Machine Guarding Machine Guarding Electrical Electrical

38 Synergy Coverage Solutions Safety Resources Your Insurance Carrier (workers compensation, auto, property, liability, etc.) Your Insurance Carrier (workers compensation, auto, property, liability, etc.) Federal OSHA website…..www.osha.gov Federal OSHA website…..www.osha.gov Centers for Disease Control and Prevention…www.cdc.gov Centers for Disease Control and Prevention…www.cdc.gov National Safety Council…www.nsc.org National Safety Council…www.nsc.org NC Occupational Safety and Health Division…www.dol.state.nc.us/osha/osh.htm NC Occupational Safety and Health Division…www.dol.state.nc.us/osha/osh.htm North Carolina Industrial Commission…http://www.comp.state.nc.us/ncic/pages/safe ty.htm North Carolina Industrial Commission…http://www.comp.state.nc.us/ncic/pages/safe ty.htm NC Dept. of Labor Video Library NC Dept. of Labor Video Library

39 Synergy Coverage Solutions Summary Safety begins with upper management. Safety begins with upper management. To be a successful company, safety is everyones responsibility. To be a successful company, safety is everyones responsibility. Designate a person responsible for Safety. Designate a person responsible for Safety. Ask for assistance. Ask for assistance. Do NOT quit on your Safety Program. Do NOT quit on your Safety Program. Comply with OSHA (www.osha.gov). Comply with OSHA (www.osha.gov).


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