Presentation on theme: "Workers’ Compensation Claims 2014 Report: Insurance and Premium Information Five Year Claims History What’s New in Workers’ Compensation University of."— Presentation transcript:
Workers’ Compensation Claims 2014 Report: Insurance and Premium Information Five Year Claims History What’s New in Workers’ Compensation University of Washington Office of Risk Management Claims Services Workers’ Compensation Program
Who Insures the University? Who Manages Our Claims? Insured through the State of Washington’s Department of Labor and Industries (L&I) – NOT self insured – NOT commercially insured (prohibited in WA) L&I’s Claims Managers manage and pay our workers’ compensation claims with careful oversight and coordination by UW’s Claims Specialists in the Office of Risk Management
Why the Significant Increase? UW Premium = Payroll Hours x UW Rate Payroll Hours Increasing 2-3%/Year State-wide rates went up for this year on average 2.7%, first time in 3 years UW rate went up 11%, driven by increase in the Experience Factor Experience Factor increase driven by unusual strengthening in case reserves on time loss claims
How Do We Compare? Experience Factors for 2014: Higher Ed Evergreen State College.70 Washington State University.85 University of Washington.94 Eastern Washington University1.10 Western Washington1.11 Central Washington University1.16
Experience Factors for 2014: Other State Agencies Department of Ecology.28 Washington State Patrol.63 Washington State Lottery.86 Department of Transportation.89 Department of Corrections1.05 Department of Social and Health Services1.14 Department of Labor and Industries1.06 Industrial Insurance Appeals Board1.37
Keeping Our Employees At Work Benefits Everyone Longer absence from work=greater risk of long term disability - 4-6 weeks=20% chance - 6 months= 50% chance Research shows that people who return to work following occupational injury are healthier than those who have not returned to work Not returning to work may cause physical effects such as deconditioning, psychological effects such as boredom and depression, and vocation effects such as loss of confidence and financial loss Peer and supervisor support is highest immediately following injury Shortens duration of lost productivity
L&I’s Stay-At-Work Incentive Program An Added Incentive to Return Injured Workers to Modified/Light Duty
How Does It Work? L&I reimburses UW for accommodating medical restrictions: -50% of base wages for up to 66 days actually worked in modified/light duty in a 24 month period, with a cap of $10,000 per claim -$2,500 for tools -$1,000 for training -$400 for clothing Risk Management administers the Program and does the work! Reimbursement goes directly to the department which provides modified/light duty.
Workers’ Compensation Claim Information Five Calendar Years 2009 – 2013 University –Wide by Departments Generating Highest Time-Loss Dollars HMC, UWMC, Facilities Services, and Student Life
Five Year Frequency by Division Red Highlighted Departments = 87% of Time Loss Claims Time Loss Claims % of Total Time Loss Claims Med Only Claims Total Claims$ of Total Harborview42036%1118 153831% UWMC29726%823 112023% Facilities24621%416 66213% School of Medicine353%382 4178% Student Life504%226 2766% Health Sciences151%183 1984% Arts & Sciences81%110 1182% Finance/Facilities192%41 601% School of Dentistry30%49 521% Bothell101%35 451% All Other615%415476 10% Total UW1164 37984962
Five Year Severity by Division (closed claims) Time Loss DaysTime Loss $ Division# Time Loss Days% of Total Harborview21,69735% Facilities17,63829% UWMC14,09723% Student Life2,6204% School of Medicine2,0523% Finance/Facilities4951% Health Sciences4001% Research/Vice Provost4771% Human Resources4500.7% Bothell3200.5% All Other1,4562% Total UW61,702100% DivisionTime Loss $% of Total Harborview$2,265,53040% Facilities$1,538,00027% UWMC$1,219,04422% School of Medicine$144,8773% Student Life$141,7113% Finance/Facilities$64,3331% Health Sciences$48,5091% Research/Vice Provost$36,9720.7% Human Resources$36,9140.7% Bothell$33,0540.6% All Other$111,8492% Total UW$5,640,794100% Red Highlighted Departments = 91% of Time Loss Days and 92% of Time Loss $
UW Time Loss Days and Dollars: Key Drivers of Workers’ Compensation Cost % of Time Loss Claims Still Open# of Time Loss Claims Open 20094%10 20105%18 20116%41 201216%97 201350%112 Top 3 DiagnosesTime Loss DaysTime Loss $% of Total UW TL $ Sprain/Strain37,290$3,388,29759% Bruise/Contusion6,017$507,7395% Fracture3,009$266,4659% Top 3 Body PartsTime Loss DaysTime Loss $% of Total UW TL $ Back 17,750$1,679,23230% Shoulder 1,1883$1,118,17620% Knee 5,746$472,3758% Red=not finalized Top 3 PositionsTime Loss DaysTime Loss $% of Total UW TL $ Registered Nurse7,490 $1,224,358 22% Hospital Assistant7,631 $589,019 10% Custodian10,150 $573,832 10% Total61,702$5,640,794 Red = not finalized
Harborview Claim Frequency# Med Only Claims# Time Loss ClaimsTotal 200920278280 201020889297 201124694340 201222284306 201323580315 Five Year Total1,1134251,538 HMC: Top 3 DiagnosesTime Loss DaysTime Loss $% of Total $ Sprain/Strain13,972$1,415,34962% Tear1,266$191,7198% Contusion1,386$120,8475% HMC: Top 3 Body PartsTime Loss DaysTime Loss $% of Total $ Back6,213$716,679 32% Shoulder3,802$357,610 16% Knee(s)2,717$226,957 10% HMC Top 3 Departments Time Loss Days Time Loss Dollars % of Total $ Psychiatry2,443$265,323 12% Nursing, General2,146$205,420 9% Neurology1,292$202,133 9% HMC: Top 3 PositionsTime Loss DaysTime Loss $% of Total $ Registered Nurse 24,668$786,14335% Hospital Assistant6,124$517,46723% Imaging Technician1,377$156,0937% Total21,697$2,265,530
UWMC Claim Frequency# Med Only Claims# Time Loss ClaimsTotal 200914545 190 201016145 206 201116873 241 201215469 223 201319367 260 Five Year Total 8212991120 UWMC: Top 3 DiagnosesTime Loss DaysTime Loss $% of Total $ Sprain/Strain8,626$855,78470% Contusion1,537$115,0389% Trigger Finger1,051$58,5365% UWMC: Top 3 Body PartsTime Loss DaysTime Loss $% of Total $ Back4,171$387,519 32% Neck1,313$181,794 15% Shoulder1,999$169,173 14% UWMC: Top 3 DepartmentsTime Loss DaysTime Loss $% of Total $ Nursing, General3376$364,287 31% Environmental Services1858$110,514 10% Materials Management1657$105,119 8% UWMC: Top 3 PositionsTime Loss DaysTime Loss $% of Total $ Registered Nurse2,729$412,04136% Hospital Assistant2,115$123,89611% Custodian1,719$99,1449% Total for all UWMC 14,097$1,219,044 Red=not finalized
Facilities Services Claim Frequency# Med Only Claims# Time Loss ClaimsTotal 20099052 142 20108446 130 20119756 153 20129050 140 20135443 97 Five Year Total 415247662 Facilities: Top 3 DiagnosesTime Loss DaysTime Loss $% of Total $ Sprain/Strain10,014$810,34353% Tendonitis1,717$221,37414% Contusion 2,133$164,22711% Facilities: Top 3 Body PartsTime Loss DaysTime Loss $% of Total $ Shoulder 5,199 $518,522 34% Back 4,390 $387,322 25% Knee(s) 1,174 $104,517 7% Facilities Top 3 DepartmentsTime Loss DaysTime Loss Dollars% of Total $ Maintenance Alterations6,967$689,524 45% Custodial6,194$353,834 23% Campus Operations2,720$352,988 23% Facilities Services: Top 3 PositionsTime Loss DaysTime Loss $% of Total $ Custodian5,520$302,36520% Pipe/Steamfitter2,244$242,53216% Elevator Mechanic1,532$206,65813% Total for all Facilities17,638$1,538,000
Student Life Claim Frequency# Med Only Claims# Time Loss ClaimsTotal 20093216 48 2010443 47 20114811 59 20124810 58 20135510 65 Five Year Total 22750277 Student Life: Top 3 DiagnosesTime Loss DaysTime Loss $% of Total $ Sprain/Strain2,123$115,83882% Carpal Tunnel229$11,8268% Contusion 48$3,8673% Student Life: Top 3 Body PartsTime Loss DaysTime Loss $% of Total $ Back1,057$30,692 22% Hand(s)479$26,054 18% Shoulder380$18,336 13% Student Life Top 3 DepartmentsTime Loss Days Time Loss Dollars% of Total $ Retail Food Services1,595$75,630 53% Residence Halls692$42,769 30% Student Activities/Union Facilities 189$12,706 9% Student Life: Top 3 PositionsTime Loss DaysTime Loss $% of Total $ Custodian653$32,27523% Food Services Worker619$30,15221% Snack Bar Lead456$26,51519% Total for all Student Life2,620$141,711
Workers’ Comp Forum Meetings Quarterly meetings for those who partner with us on Workers’ Compensation on relevant topics: – Education on medical and disability issues – New developments impacting Workers’ Compensation – New ideas and initiatives – Guest speakers Includes HR, Employee Health, Key Departments, Providers, Occupational Health, Risk Management, EH&S, L&I, and others – the forum is open! Email us to be included on the distribution list for invitations
Claims Fraud Partnering with L&I’s Fraud Prevention Program Publicizing L&I’s Claim Fraud Reporting to the UW Community Hotline: 1-888-811-5974, www.fraud.lni.wa.gov.www.fraud.lni.wa.gov Complementing L&I’s fraud investigation work with our own background checks on time loss claims and other claims with red flags UW Claims Fraud Brochure Website material on Claims Fraud http://f2.washington.edu/treasury/riskmgmt/wc http://f2.washington.edu/treasury/riskmgmt/wc Education on Red Flags to watch for!
Not Injured At Work or At All No Witnesses Conflicting stories on how injury occurred Time lapse between injury and treatment Injured while off work Injured jury prior to or after disciplinary action or change in job Injured immediately prior to being terminated from job Moves out of state shortly after alleged injury History of filing claims Unfair Benefits Fraud – Doing Inappropriate Activities Participating in recreational activities inconsistent with injury Wrongfully claim dependents or spouse Misuse drugs or display drug seeking behavior Frequently change doctors Disability Fraud – Working while on disability Working while on time loss Regularly away from home during normal business hours Receiving unemployment while on time loss Working and being paid “under the table” while on time loss Doing volunteer work while on time loss Providing care under DSHS’s COPES program while on time loss Workers’ Compensation Fraud: Spotting the Red Flags What To Do: Report Claim Fraud to L&I at 1-888-811-5974 and email email@example.com
SHIP Grant Return-to-Work Training Module and Research Study Safety & Health Investment Projects Grant granted by L&I Participation with Environmental Health’s research team led by Dr. June Spector Created and Implemented a Training Module for the injury/return to work process for supervisors and managers, piloted at Harborview. Surveys before and after to determine effectiveness and impact on time loss (ongoing) Possible future project for similar module for injured workers
UW Claims Specialization We have designated Claims Specialists assigned to major Divisions who specialize in helping find light duty and working with these areas on return-to- work. Please contact any of us to help you at any time. Wendy Winslow-Nason: UWMC 616 7510, firstname.lastname@example.org@uw.edu Pam Nathan: HMC (on HMC campus every Thursdays), Health Sciences and SOM 221 1679, email@example.com@uw.edu Elena Williams: Facilities Services, Student Life, all Upper Campus, Tacoma, and Bothell 685 4740, firstname.lastname@example.org@uw.edu Linda Chihara: Program Coordinator for all 543 0183, email@example.com@uw.edu Shari Spung, Director, Claims Services 616 3455, firstname.lastname@example.org@uw.edu
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