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Workers’ Compensation Reducing risk and cost Building a successful partnership Presented by ESM Solutions, Inc.

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Presentation on theme: "Workers’ Compensation Reducing risk and cost Building a successful partnership Presented by ESM Solutions, Inc."— Presentation transcript:

1 Workers’ Compensation Reducing risk and cost Building a successful partnership Presented by ESM Solutions, Inc.

2 Executive Summary Thank you for considering ESM Solutions, Inc. as a service provider to your company. This deck provides specific details as to the depth of service ESM can provide. Our staff of trained professionals includes individuals who have the necessary professional designations needed to carry out the required risk management services. Designations that include: Associate in Risk Management – ARM Associate in Enterprise Risk Management – ARM-E Associate in Management – AIM Certified Safety Professional – CSP Workers’ Compensation Claims Management Professional – WCCP Workers’ Compensation Claims Management Associate – WCCA Certified Professional Disability Manager – CPDM Self Insured Professional – SIP Project Management Professional - PMP Masters in Project Management – MBA Please visit our website for more information: www.executivesm.comwww.executivesm.com

3 What we Strive for Employer Service Objectives Provide services focused on reducing the frequency and severity of workplace injury Meet with key decision makers to create an effective safety and claims management plan Establish and maintain good working relationships with employers Provide Workers’ Compensation management training to the reduce the risk and cost of workplace injury exposure Provide excellent value-added service Ensure services goals are met “Over the past seven years, ESM served an important role in helping VSP Vision Care decrease our workers' compensation claims and costs. ESM developed a deep understanding of our unique business and is a strategic partner.” -April Bettencourt, Manager, Benefits & Payroll, Vision Service Plan (VSP)

4 ESM Engagement Strategy INTRODUCTION Work Comp Policy written WC service needed – ESM introduced REFERRAL Broker completes “Referral Form” sends to ESM ESM / Broker/ Client develop a POA for client SERVICE ESM Service plan initiated Carrier/Broker/Client maintain presence in service stream OBJECTIVES Assist insured with mitigating Work Comp risk and cost Client and Broker results & satisfaction

5 Training & Education

6 Training Solutions Only ESM offers: Leading-edge Workers’ Compensation market intelligence and insight through: Live Lunch & Learn Onsite Safety Training Webinars (live and recorded) Development of Computer Based Training Modules (CBTs) Private branding http://www.executivesm.com/education/ Check out our 90 second trailer! http://youtu.be/4uMtTY-QSUE

7 Safety Video Development Private Branded Safety Training Videos: Safety Videos E.g. IIPP Overview Legislative Updates E.g. SB863 Informative Videos E.g. New Hire Safety Orientation process “Green Screen” productions available Check out our 30 second promotional video! http://youtu.be/d5x6qJTOycQ http://youtu.be/d5x6qJTOycQ Check out our 30 second promotional video! http://youtu.be/d5x6qJTOycQ http://youtu.be/d5x6qJTOycQ

8 Safety Management

9 Ongoing, structured Safety Committee Meetings Ongoing, scheduled Safety Inspections & Trending Relevant and compliant Safety Training Standardization of Processes for scalability and sustainability Risk Assessment Define prioritized scope of work Prepare Corporate S&H Policy Develop Injury & Illness Prevention Program Develop Safety & Health Manual Building a Safety program Safety Foundation Safety Application

10 Risk Assessment Comprehensive Risk Assessment for employers Workers’ Comp / Safety Audit Conduct an audit of written programs to ensure compliance and accuracy of organizational practices Conduct a site inspection to identify leading exposures Report Summary of risk SWOT analysis of Safety & Work Comp program Recommendations Acceptable or unacceptable risk Roadmap for risk management improvement http://www.executivesm.com/products/risk-assestment-kit/ InsuredSafetyCompliance Claims Management Return- To-Work

11 Injury & Illness Prevention Plan Injury & Illness Prevention Program Review and Revision Ensure compliance with Cal-OSHA’s required 8 elements Code of Safe Practices (COSP) 9 th element required for Construction industry Ensure written programs reflect field practices Supporting forms and checklists include: Accident investigation form Inspection checklist by industry Employee safety contact report Employee warning record Supervisor report of Injury Optional: Provide Do-It-Yourself compliance based train-the- trainer programs Includes training schedule, attendance forms, learner’s guide, PowerPoint Training, quizzes and answers Private or co-branding available http://www.executivesm.com/products/iipp-kit/ Optional training programs: IIPP Overview Bloodborne Pathogens Distracted Driving Ergonomics Fire Extinguisher Hearing Conservation Heat Illness Prevention Housekeeping, Slip –Trip-Fall Material handling/back safety Industrial Truck / Forklift

12 Customer Engagement Customer Engagement Collect Background Information Collect Background Information Current Injury & Illness Prevention Plan OSHA 300 log (past three years) Training records (samples) Inspection reports (samples) Loss runs if available (most current) Complete IIPP Evaluation Questionnaire Complete IIPP Evaluation Questionnaire Phase 1 – IIPP Review Program Introduction Phase 2 – IIPP Revision Review client’s current IIPP Analyze supporting documentation Prepare revised IIPP Outline Revise and reformat IIPP Revise and reformat IIPP Ensure IIPP meets Cal-OSHA standards Phase 3 – IIPP Roll out Revise / develop custom checklists for implementation and compliance Provide revised IIPP, action items and Bi-monthly safety training modules to client Collaborate on revised program Ensure procedures reflect organizational practices Adopt revised IIPP Provide IIPP training to Supervisors / Managers JointClientESM Multiple drafts may be required Provide bi-monthly safety training to employees Provide bi-monthly safety training to employees Coordinate with client regarding questions, or additional information needed Identify missing Cal-OSHA compliance requirements Identify missing Cal-OSHA compliance requirements Provide ongoing consultation and support, including annual refresher to IIPP Safety training modules include: PPT Presentation, Learner’s Guide, Quiz and Answers Safety training modules include: PPT Presentation, Learner’s Guide, Quiz and Answers

13 Safety Management Program Monthly or Quarterly Safety Management program Assist with development of or attendance at insured’s Safety Committee meetings for the purpose of acting as a technical advisor. Goals include assisting insured with effectively reviewing, revising and communicating the organizations safety initiatives. Program includes the following functions: Customized IIPP Safety & Health Manual Cal-OSHA compliance policies and training for leading exposures E.g. Industrial truck, LOTO, Electrical safety etc. Inspection checklist and schedule Training matrix (including tailgate schedule and material) Onsite quarterly safety committee meetings Ongoing email/phone communication and support http://www.executivesm.com/portfolio/safetymanagement/

14 Return-To-Work

15 Return-To-Work Program Return To Work program Program includes: Written RTW management plan and policy statement Establishing a support team Assign roles and responsibilities (via committee) Establish process and procedures for organization Identify and develop written Temporary Alternative Duties (TADs) Document physical requirement of job tasks (“Essential Functions”) Develop communication tools to stakeholders Carrier, Medical provider, Supervisors, Employees Train supervisors and managers Provide ongoing consultation regarding management and ensure compliance with the “Interactive Process” per FEHA regulations http://www.executivesm.com/portfolio/returntowork/

16 Return-To-Work Implementation Foundation Assessment Launch Write a management plan and policy statement Build a support team and assign roles and responsibilities Establish process and procedures Review and Revise Job Descriptions Identify Temporary Alternative Duties (TADs) Document physical requirements Coordinate communication Train supervisors and managers Launch RTW program to all employees Phase 1 Phase 2 Phase 3 EvaluateBusiness BenefitROI

17 Program Engagement Collect Background Information Current RTW Plan and/or Policy Recent work status report from designated Medical Provider Job descriptions Alternative duties Loss Runs X-Mod Worksheet/WCIRB RTW Evaluation Questionnaire Phase 1 - Foundation Program Introduction Phase 2 - Assessment Write Management Plan and Policy Statement Assign Roles and Responsibilities Planning Checklist Review & Revise Job Descriptions to include Essential Functions Establish Process and Procedures Identify Temporary Alternative Duties (TADs) Phase 3 - Launch Build Support Team Document Physical Requirements Coordinate Communication Coordinate with Employee Coordinate with Medical Provider Coordinate with Claims Administrator Train Supervisors /Managers Roll out to all Employees Assign RTW Coordinator Return To Work Development Process MemberESM Support Flyer PPT Letter to employees

18 Claims Management

19 Why Claims Management? SB899 Reform results continue to erode SB863 legislative changes and impact X-Mod analysis and control Medical cost inflation Increase in Medicare Set Aside Abuse of medical lien process Increase in cost containment factors Legislative changes New case law impact Increasing litigation Turnover in claims examiners "I have worked with Sharon Poston of ESM Solutions, Inc. for almost 7 years. She is the most knowledgeable person I have met, in the ever changing arena of workers' compensation. If you have a question, she has the answer. Sharon is a most supportive ally for any company in need of an advocate. I would not want to work without her valuable input. “ -Mary MacDonald, Safety Manager, Robert Mondavi Winery

20 Analyze reserves Litigation Management Ongoing management of open indemnity claims Advisor to Employer/ Agency Referral Form Letter of Auth from client Q1 Summary Report Claims Review Q2 Unit Stat Report X-Mod Forecast Q4 Renewal Report Claims Management Schedule Policy Year Application Policy Year Milestones

21 Why Claims Management? Ongoing oversight and management of key claims Ensure examiner has positioned claim for speedy, cost-effective resolution Act as liaison for employer on all delayed claims, ensuring 90- day decision is met timely Ensure current labor code and case law are applied Recommend litigation strategies to resolve claims Ensure X-Mod accuracy Communication: Ongoing phone call and email communication for clients and staff Audit of Third Party Administrators as needed For more on our Claims Management process please visit our website: http://www.executivesm.com/portfolio/claimsmanagement/

22 Disputed Claims Claim is classified as MO or IND MO claim processed, closed in 90 days Begin RTW coordination with medical provider and client Begin RTW coordination with medical provider and client If ACCEPTED, manage claim to conclusion If ACCEPTED, manage claim to conclusion Claim is delayed and investigated for 90 day compensability determination Large Loss Claims ( >$25,000 ) Continue 30 day ongoing oversight and direction IND claim: 3 point contact, provide benefits IND claim: 3 point contact, provide benefits Monitors Carrier for investigation process and strategizes decision Determination is made to accept or deny If DENIED and UNDISPUTED Close in 30 days If DENIED and UNDISPUTED Close in 30 days If DENIED and DISPUTED Develop litigation strategy for resolution If DENIED and DISPUTED Develop litigation strategy for resolution Develop a POA for resolution Strategize best practices for resolution Monitor strategy for effectiveness and accountability ESM analyze at 90 days for potential problems Monitor settlement and any future medical award Claims Management Oversees resolution strategy Begin RTW coordination with medical provider and client Begin RTW coordination with medical provider and client Carrier processes claim CarrierESM Client Claims Management Reporting & Oversight Process

23 The ESM Commitment

24 ESM’s Commitment Results Driven The ESM focus is to minimize risk and cost by reducing the frequency and severity of workplace injury and time off of work. Our service team will provide a diversified portfolio of services that can assist your organization with your ongoing Workers’ Compensation needs and profitability. Relationship Focused: ESM is driven to establishing and maintaining superior working relationships with all stakeholders by meeting with key decision makers and designing a mutual plan for success.

25 ESM is the Solution Expertise in Safety & Workers’ Compensation Established relationship and understanding of Safety and Workers’ Compensation needs Results driven program plan of action Successful partnership with strategic resources Designations: WCCA, WCCP, CPDM, ARM, AIM, SIP, PMP, CSP Responsive and friendly Raising the “BAR” Benefits from Activities that get Results

26 Injury Prevention and Workers’ Compensation Claims Management Where there are risks, there are Solutions www.executivesm.com


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