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Monday, May 20, 2013 1 National Council of Self-Insurers Annual Meeting.

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Presentation on theme: "Monday, May 20, 2013 1 National Council of Self-Insurers Annual Meeting."— Presentation transcript:

1 Monday, May 20, 2013 1 National Council of Self-Insurers Annual Meeting

2 A double play in baseball requires a number of players to coordinate their actions to obtain a quick and effective resolution We use the term Double Play in Workers Compensation to describe a comprehensive strategic process to resolving complex exposure (or high value) workers compensation claims 2

3  Closed cases (at the appropriate cost)  Consistent reserving practices  Quality control for claims office and processes  Builds a positive culture for closing cases within claim departments  Determines the quality and effectiveness of vendors  Consistent application of laws, rules and regulations 3

4  Consistent adherence to internal procedures  Helps train examiners to resolve large claims  Helps management understand current claims administration issues and challenges  Adequate (appropriate) settlement authority for the defense counsel  Injury prevention opportunities for the Employer 4

5  Claims Examiner – team captain  Claims Supervisor  Claims Manager  Defense Attorney  VP Claims  Investigator (AOE/COE or Subrosa vendor)  Clinical lead/Medical Professional  Excess carrier and Structural Settlement  Employer  MSA Partner 5

6 Selection will vary depending upon claims office and staffing (not necessarily all of these claims)  All claims set for trial conference hearing or litigation event  All claims with a defined level of opioid use  High reserves  If there is subrosa video evidence  Serious medical conditions (catastrophic claims)  Employees with multiple claims or multiple body parts  Suspected fraud (vendor as well as claimant)  Identified claimants based on BMI  The first claims when implementing new processes or procedures within the claims office 6

7  They drive the bus  They are accountable for ultimate outcome of the claims  Are supported by the team  Have to prepare the claim for presentation  Must make sure that every party has the information and are prepared for the Double Play 7

8 The timing for Double Play depends upon the individual case exposure  Most litigated events will need a Double Play several weeks prior to the scheduled hearing/deposition  Opioid cases should be scheduled as soon as the first prescription for opioids is filled at a pharmacy  Subrosa cases should be scheduled as soon as subrosa film depicting questionable activity is received  When large settlement authority is needed  When intractable cases have no forward momentum 8

9 Use a standardized form and standardized process for all Double Plays  Determine who will participate on that Double Play  Develop your own form - Safeway uses a form based on negotiating skills training with a starting point, a target, a walk away point, reserves and paids as well as the facts of the case  The Double Play form should be a forwarded to participants prior to meeting  Have a standing scheduled time for Double Play sessions 9

10 Team Dynamic  Do they know the case?  Are work habits and work product efficient?  Are they engaged?  Are they prepared?  Team in sync?  Do they know their roles? 10

11 Each participant must prepare for the meeting focusing on their own specialty  MSA provider must be prepared to discuss MSA issues  Subrosa vendor must bring film  Defense attorney must be able to talk (in-depth) about the key legal issues, venue, applicant’s attorney skills and the proclivities of the projected judge  Every participant should have read the synopsis of the case prior to the Double Play Session 11

12  It is highly recommended that all Double Plays be done in person. (You may create some exceptions for calling in due to conflicts in schedules or geographic issues)  The length of time spent on the Double Play process will vary greatly depending upon the file facts, the complexity of the claim and issues needing to be resolved. (The Bloom vs. Zachry Double Play philosophy question)  During the session access to a computer and the claims system is important  It is nice to have coffee and appropriate refreshments available 12

13  Civil polite interaction should be a primary rule of engagement within the team  The goal is to create a effective plan of action to resolve the claim  All participants are equal during the double play sessions  Double Play is not the time to go through the battle field and bayonet the wounded  Participants should not focus or make a comment on how the file got into such an awful mess 13

14  Convey Double Play results (Plan of Action) to all parties  Convey the settlement authority and negotiations tactics to the defense counsel  Provide feedback to Employer concerning injury prevention  Schedule follow up with the team (to determine if the efforts were a success) 14

15 Issues to review during a Double Play  Defend vs. settle (be realistic)  Release video evidence  Reserves adequacy review  Anticipate potential issues and determine strategy to address prior to their developing  Strategize the issues to develop the most appropriate POA given the known facts of the case from multiple perspectives and experience  Excess Carrier informed and fully on board 15

16 Measure your efforts, the costs and your success  Case closure  Financial impact (salvage and changes in reserving)  Impact on litigation  Quality control of the team  Ability to extend the learning from one claim to another 16

17 Double Play can... Provide a fair and adequate assessment of issues to break down barriers to case resolution from multiple perspectives Speed up the process to provide resolution to outstanding issues and avoid unnecessary benefit delays 17

18  Issues addressed holistically  Accelerates claim closure  Attorneys get to lawyer  Claims Examiner recognized  Reserve consistency and adequacy  Learning experience to apply to future cases  Claims administrator can enhance relationship with Employer 18

19 Thank you! Barry D. Bloom, Consultant, The bdb Group Suzanne Guyan, Principle, Guyan Consulting Bill Zachry, VP Risk Management, Safeway Inc. 19

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