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Workers’ Comp – The Life of a Claim Summit County Safety Council March 2012.

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Presentation on theme: "Workers’ Comp – The Life of a Claim Summit County Safety Council March 2012."— Presentation transcript:

1 Workers’ Comp – The Life of a Claim Summit County Safety Council March 2012


3 Case Studies 2 Injuries & 2 Injured Workers Date of Injury:1/10/12 Accident:Lifting a box, hurt back Alleged Claim:Low back sprain Physical therapy Possible herniation Possible surgery

4 A Tale of Two Injured Workers Injured Worker #1 Completed the accident report; claim was supported Sought treatment at Occupational Medicine Clinic Followed up with suggested Physical Therapy Returned to work through Modified Duty

5 A Tale of Two Injured Workers Injured Worker #2 Reported 2 weeks after injury occurred Sought treatment at Occupational Medicine Clinic 1 week after report Refused follow up physical therapy, condition became chronic Claim was allowed, but employer did not offer Modified Duty

6 What went right? What went wrong? Accident report was completed timely Investigation supported claim; no need for hearing Appropriate treatment at Occupational Medicine Clinic Followed up with suggested Physical Therapy Employer was pro-active and provided Transitional Duty, facilitating early return to work Accident reporting policy was not followed Failure to follow reporting policy, resulted in employer’s appeal of the claim Claim was referred to IC for hearings and IW became disgruntled Condition became chronic Claim was allowed, but employer did not offer Transitional Duty

7 The Results Early treatment Early return to work Reduced lost time and reduced compensation costs Reduced medical treatment and reduced costs Employer remains eligible for group rating or other BWC discount program Failure to seek early treatment Condition becomes chronic Extended period of disability Increased medical costs and compensation costs Delayed return to work Employer experiences increased BWC premium

8 Claim maturity takes 2 years Claim is “in the experience” for 4 years All claim costs impact BWC premium while in employer’s experience despite: Return to work Settlement of claim Termination Injured worker’s death Understanding your “Experience”

9 Injury Year 2012 “Green Year” 2013 1 st Year on Premium 2014 2 nd Year on Premium 2015 3 rd Year on Premium 2016 Last Year on Premium 2017 Following the Life of a Claim

10 Paying for a Claim for 4 Years…

11 Claim Strategies to Save You Money Improve reporting policies Identify local preferred medical providers – Occupational Medicine Specialists Employ Transitional duty Consider Salary continuation Encourage vocational rehabilitation

12 Reporting Best Practices Establish & maintain timeframes for reporting near misses, incidents & accidents Establish & maintain protocol for supervisory investigation & communication Establish safety committee to review regularly for determination as to: – Root cause – Preventative measures

13 Establishing Preferred Providers Utilize MCO services to establish injury protocol with preferred providers Maintain relationship with occupational medicine providers

14 Making Transitional Duty Work for You Definition: Early return to work of duties and/or hours other than regular job assignment Benefits: – Alternative to downtime – Allows for retention of knowledgeable, experienced employee – Can be presented & perceived as an employee benefit

15 Transitional Duty Best Practices 1)If communication of offer is NOT made face to face, always send USPS & Certified Mail Either way get it in writing 2)Payment of full wages (prior to injury) will prevent loss in wages, payment of BWC compensation and MIRA reserves

16 Considering Salary Continuation Definition: Continuation of regular, full earnings in lieu of BWC payment of temporary total compensation Employee avoids lapse in wages Employer contains claim costs Facilitates opportunity for regular communication between employee & employer

17 Temporary Total vs. Salary Continuation Requires a C84 or Medco 14 and supporting medical documentation Requested through usual process Injured worker must agree to accept (C55) Rate of pay: 72% of FWW – first 12 weeks 66 2/3 % of AWW – 13 th week forward Rate of pay: Full wages from all sources of income Yearly minimums and maximumsFull rate of pay Award is not taxed or reportable incomeTaxes and deductions as usual Payroll deductions are responsibility of employee (union dues, insurance, etc) Child support will be deducted Retirement contributions as usual Vacation pay is NOT sick pay or salary continuation

18 Salary Continuation Best Practices 1. Determine appropriateness of salary continuation – Can employee return to work with restrictions – Is employee motivated to return to work – How does payment impact premium 2. Obtain medical proof of continuing disability 3. Monitor for release to restricted or full duty

19 Utilizing Vocational Rehabilitation Great benefit for employee & employer Voluntary program for employee Claim costs paid from the BWC surplus fund Injured may be eligible for a higher wage rate

20 Potential Cost Saving Programs Drug Free Safety Program (DFSP) Safety Council Individual Retrospective Rating Group Retrospective Rating Group Experience Rating Deductible Programs 100% EM Cap Program One Claim Program Self Insurance

21 BWC News You Can Use Destination: Excellence Industry Specific Safety Discount – 3% upfront discount for engaging in specific safety strategies with accident reducing safety activities Safety & Hygiene safety classes On site consulting by Safety & Hygiene Ohio Safety Congress & Expo – Application must be filed to receive discount Watch for more to come…

22 BWC News You Can Use Destination: Excellence Transitional Work Grants – Potential 10% bonus for utilizing transitional work in policy year – BWC will consider the following when evaluating applications: Was employer a previous BWC grant recipient? – Grants awarded (2001-2006) Is employer’s company created plan BWC approved? – Application must be timely filed with required documentation

23 BWC News You Can Use Destination: Excellence Go Green Discount – 1% upfront discount with on-line policy (premium) management Lapse Free Discount – 1% upfront discount for employers who have not incurred a lapse in premium in the past 60 months Up to $1,000 every six months A one-time forgiveness to stay current can be utilized

24 BWC News You Can Use 2012 Program Changes 100% EM Cap – Expanded participation to include credit rated employers – 4 hour industry specific training replaces 10 Step Business Safety plan requirements Small Deductible Program – Payments will be excluded from rate calculation – Salary continuation will be permitted – No longer compatible with group experience rating

25 BWC News You Can Use 2012 Program Changes Safety Council & Group Retrospective Rating – Expanded to allow 2% participation rebate – (2% performance rebate is not permitted) Safety Council & Group Rating – No change is expected – 2% performance rebate is permitted with a 10% reduction in frequency or severity

26 BWC News You Can Use 2012 Program Changes Wellness Grants One Claim Program – 4 year 40% discount is eliminated – New discount schedule 20% discount – year 1 15% discount – year 2 10% discount – year 3 5% discount – year 4

27 BWC News You Can Use 2012 Program Changes Increased Program Compatibility – Salary continuation is now compatible with all programs – Stacking discount programs allows employer to exceed the maximum credibility table (currently 53% - private employers, 2012 policy year)

28 CompManagement Recommendations Work with your TPA to review a feasibility analysis to determine the best rating options for your business

29 The Life of a Claim Can Be a Long Journey

30 Reducing BWC Premium Establish and enforce accident prevention Identify & communicate with resources – BWC, MCO, TPA Stay abreast of BWC changes Work with your resources to identify the best rating program and claim strategies for your business

31 Bobbijo Werren, Account Executive CompManagement Inc. 330.352.4108

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