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Risk Management User Group

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Presentation on theme: "Risk Management User Group"— Presentation transcript:

1 Risk Management User Group
November 29, 2006


3 MEETING AGENDA 8:30 – 9:00 Healthcare Networks Jonathan Bow
9:00 – 9:30 Return to Work Gordon Leff FY06 Claims Update 9:30 – 10:30 Travel Safety Officer Garry Parker 10:30 – 10:45 BREAK 10:45 – 11:15 SORM 200 Update Mary Loza 11:15 – 11:30 Training Updates Brad Prais 11:30 – 12:00 Loss Trending Benny Vanden Avond Cost of Risk

4 Jonathan Bow Executive Director
HEALTHCARE NETWORKS Jonathan Bow Executive Director

5 Gordon Leff Deputy Director Claims Operations
CLAIMS UPDATE Gordon Leff Deputy Director Claims Operations







12 Return to Work and Stay at Work
Bona Fide Offers of Employement

13 Texas Workers' Compensation Act (Labor Code, Title 5, Subtitle A, Section 412.051)
A program designed to assist employees who sustain compensable injuries to return to work

14 Immediate savings when TIBS cease
Potential benefits in return-to- work program Immediate savings when TIBS cease

15 Other Benefits to the Employer - Direct Savings:
Productivity increases and human resources are utilized to the maximum extent Wage costs for substitute employees are saved. Litigation costs are normally prevented or reduced Possible reduction or ending of medical costs

16 Benefits to the Employer - Indirect Savings:
Work delays and business interruptions are eliminated when the experienced employee returns to work. Co-workers are not required to perform extra duties to compensate for the absent employee. Communications and relations between employees and management are enhanced. Recruitment and staff training costs of new or substitute employees are saved. Goodwill and a positive image with the public and employees are created, as the employer is perceived as a caring employer

17 Benefits to the Injured Workers:
Employee concerns about continued employment are resolved. Full or partial wages are earned which brings the employee's income closer to pre-injury wages than workers' compensation temporary income benefits alone. They remain active and mobile when returned to the productive workforce. Self-esteem, morale and personal security are maintained or restored through gainful employment and a productive life style. Stress, boredom, and depression associated with the injury/illness and being out of work are reduced or eliminated, not only for the injured worker, but for the family or significant others. Physical conditioning through a work-life discipline is maintained.

18 Your front-line supervisors must be on board!

19 Successful return-to-work programs
Knowledgeable, proactive return to work coordinator Continuous education and training Job descriptions Job hazard analysis On-going identification of positions suitable for alternate duty assignments Written communications Early intervention and prompt, sympathetic regard Consistent application of a detailed return to work policy and procedures Forms Accurate and systematic evaluation

20 You and Your front-line supervisors must be on board!

21 http://www. sorm. state. tx
Workers-Compensation/ Return to Work Programs "Position Description” DWC 73 "Return-to-Work Status" SORM 85 Return To Work Policy Bona-fide Job Offer of Employment Notification

22 Bona-Fide Offer of Employment

23 First: a) An employer or insurance carrier may request the treating doctor provide a Work Status Report by providing the treating doctor a set of functional job descriptions which list modified duty positions which the employer has available for the injured employee to work. The functional job descriptions must include descriptions of the physical and time requirements of the positions.

24 Second: (b) An employer may offer an employee a modified duty position which has restricted duties which are within the employee's work abilities as determined by the employee's treating doctor.

25 Third: In the absence of a Work Status Report by the treating doctor, an offer of employment may be made based on another doctor's assessment of the employee's work status provided that the doctor made the assessment based on an actual physical examination of the employee performed by that doctor and provided that the treating doctor has not indicated disagreement with the restrictions identified by the other doctor.

26 This is Critical

27 Fourth: c) An employer's offer of modified duty shall be made to the employee in writing and in the form and manner prescribed by the Commission. A copy of the Work Status Report on which the offer is being based shall be included with the offer as well as the following information: 1) the location at which the employee will be working; 2) the schedule the employee will be working; 3) the wages that the employee will be paid; 4) a description of the physical and time requirements that the position will entail; and 5) a statement that the employer will only assign tasks consistent with the employee's physical abilities, knowledge, and skills and will provide training if necessary. None of these elements may be overlooked and the offer MUST be made in writing.

28 Fifth: d) A carrier may deem an offer of modified duty to be a bona fide offer of employment if: 1) it has written copies of the Work Status Report and the offer; and 2) the offer:  a) is for a job at a location which is geographically accessible as provided in subsection (e) of this section;   b) is consistent with the doctor's certification of the employee's work abilities, as provided in subsection (f) of this section; and was communicated to the employee in writing, in the form and manner prescribed by the Commission and included all the information required by subsection (c) of this section.

29 Sixth: (e) In evaluating whether a work location is geographically accessible the carrier shall at minimum consider: (1) the affect that the employee's physical limitations have on the employee's ability to travel;  (2) the distance that the employee will have to travel;  (3) the availability of transportation; and  (4) whether the offered work schedule is similar to the employee's work schedule prior to the injury.

30 Seventh: (f) The following is the order of preference that shall be used by carriers evaluating an offer of employment:  (1) the opinion of a doctor selected by the Commission to evaluate the employee's work status;  (2) the opinion of the treating doctor;  (3) opinion of a doctor who is providing regular treatment as a referral doctor based on the treating doctor's referral;  (4) opinion of a doctor who evaluated the employee as a consulting doctor based on the treating doctor's request; and  (5) the opinion of any other doctor based on an actual physical examination of the employee performed by that doctor.

31 Eighth: (g) A carrier may deem the wages offered by an employer through a bona fide offer of employment to be Post-Injury Earnings (PIE), as outlined in §129.2 of this title (relating to Entitlement to Temporary Income Benefits), on the earlier of the date the employee rejects the offer or the seventh day after the employee receives the offer of modified duty unless the employee's treating doctor notifies the carrier that the offer made by the employer is not consistent with the employee's work restrictions. For the purposes of this section, if the offer of modified duty was made by mail, an employee is deemed to have received the offer from the employer five days after it was mailed. The wages the carrier may deem to be PIE are those that would have been paid on or after the date the carrier is permitted to deem the offered wages as PIE. (Post Injury Earnings)

32 Important Concept Coming Up

33 The employee may decline the employer's offer of an alternate duty job and remain on leave. However, the Texas Workers' Compensation Act allows income benefits to be reduced when an employee refuses a bona-fide offer of employment. This reduction in benefits is permitted regardless of FMLA.

34 Changes in the Designated Doctor and Required Medical Examination rules As of January 1, Rule (c), the Designated Doctor’s role has expanded to include the resolution of questions regarding (1) impairment caused by employees compensable injury (2) the attainment of MMI (3) the extent of the employees compensable injury (4) whether the employee’s disability is a direct result of the work-related injury; We are already being warned not to use this rule for # 3 or # 4, but that’s a different class. (5) the ability of the employee to return to work (RTW); or (6) issues similar to those described in 1-5.

35 Sample RTW forms are provided on SORM’s website at

36 Bona Fide Offer of Employment Letter (SAMPLE)
Delivery Confirmation Requested Dear (claimant): Our office is in receipt of medical information from Dr. _____________ outlining the restrictions under which you are able to return to work. Pursuant to Workers' Compensation Commission Rule 129.6, this letter is a Bona Fide Job Offer for you to return to work consistent with information provided herein. Our office will abide by the physical limitations as outlined by the physician. The office will only assign tasks consistent with your physical abilities, knowledge and skills and will provide training if necessary. Position title 2. Hours of duty: ____a.m. / p.m. until ____ a.m. / p.m. 3. Wages: $____Hourly $____Weekly $____Monthly 4 Job description, including duty hours, and maximum physical requirements of the position (lifting and approximate lbs.; approximate time stooping, pushing, standing, sitting, etc.): 5.Address, location, and approximate distance in miles from employee’s residence Beginning date of the position _________ Ending date of the position________ Should you have any questions, please contact the undersigned below. Sincerely,

37 For more information about return to work, please go to SORM’s website at:

38 Officer Garry Parker Texas Department of Public Safety
Travel Safety Officer Garry Parker Texas Department of Public Safety

39 BREAK See you in 15 minutes

40 SORM 200 DATA Mary Loza, ARM, AIC

41 SORM 200 The State Office of Risk Management 200 (SORM 200) is the sole source for collecting statewide information from state agencies regarding their expenditures for risk management activities, insurance purchases and non-workers’ compensation claims made or settled against the agency. The intent of the SORM 200 is to capture costs associated with agency Risk Management Programs, and to compile information necessary for SORM to include the administrative costs of risk in the Office's biennial report to the legislature.

42 SORM 200 The SORM 200 is divided into two parts:
Part I - Risk Management Expenditures: the intent of this section is to capture those costs associated with agency’s direct risk management costs. Part II - Insurance and Risk Related Expenditures: used to submit non workers’ compensation insurance information for the current fiscal year.

43 SORM 200 Data for SORM 200 is requested from each agency for online input by October 30 of each fiscal year. Database is closed on October 30 and any additions or corrections can only be entered by SORM personnel. Data is being analyzed for data integrity.

44 Cost of Risk FY 03, 04, 05 CASH BASIS Risk Management Programs
Workers’ Comp Claims Cost Containment Settlements & Judgments Bonds, Insurance & Deductibles Actuarial Services Court Costs & Attorney Fees Risk Management & Claims Admin Lost, Damaged & Destroyed Property FY 03 $ 27,262,588 67,571,177 1,279,956 3,512,080 11,732,279 12,000 1,901,062 6,086,276 539,687 FY 04 $ 33,029,737 54,650,872 1,146,711 5,653,484 15,417,895 4,500 1,866,369 6,458,034 504,585 FY 05 $ 26,171,311 52,534,024 1,380,950 4,190,858 14,934,033 13,000 971,006 6,525,055 3,103,681 ACCRUED COSTS Reserves for Future Claims Incurred But Not Reported TOTAL COST OF RISK 63,259,241 67,860,000 $251,016,345 50,99,367 84,966,000 $254,690,553 54,103,732 77,929,244 $241,856,894

45 Expenditures vs COR % Cost of Risk $ 251,016,345 $ 254,690,553
FY 03 FY 04 FY 05 Cost of Risk $ 251,016,345 $ 254,690,553 $ 241,856,894 Risk Management Expenses $ 27,262,588 $ 33,029,737 $ 26,171,311 Percentage RM Expenses/COR 11% 13%

46 Loss Prevention Effect Ratios
FY 03 FY 04 FY 05 RM Expenditures $ 27,262,588 $ 33,029,737 $ 26,171,311 Cost of Risk (Cash Basis) $ 92,880,759 $ 85,702,449 $ 83,652,607 Ratio COR/RM Expenditures 3.4 2.6 3.2

47 Property & Casualty Claims
Virtually, any event, where damages to persons or property, that may cause a financial loss to the agency must be reported. This includes: 1. Injuries or damages (insured or uninsured); automobile accidents involving agency owned vehicles whether owned, non-owned or hired; 2. Agency owned vehicle damage (automobile physical damage) or third party vehicle damage (automobile liability - property damage); 3. Property damage which may includes theft/vandalism of personal property. ;

48 Property & Casualty Claims
4. Right to sue notices from EEOC or Department of Human Rights (employment practices type), injuries to volunteers (accident type); 5. Injuries to the public within/on state owned/managed facilities or premises (slips and falls).

49 Auto Liability Claims FY 06

50 Insured Auto Claims FY 06

51 Uninsured Auto Claims FY 06

52 EPL Claims FY 06 Employment Practices Claims

53 Uninsured EPL Claims FY 06

54 Property Claims FY 06

55 Uninsured Property Claims FY 06

56 Insured Property Claims FY 06


58 Agency Outreach & Training
Bradley Prais Training Specialist

59 Regional Open Enrollment Results
3 Completed: 700+ Students, 32 Agencies Most Popular: Bloodborne Pathogens Stress Management Anger & Conflict in the Workplace Problems: Limited attendance by smaller field offices Limited announcements to field offices

60 Sample Schedule: AM Day 1 Day 2 Day 3 Room 1 Room 2 Room 3 9:00 9:15
Day 1 Day 2 Day 3 Room 1 Room 2 Room 3 9:00 9:15 Stress Notary Office 9:30 Public Safety 9:45 CPR Supervisor's 10:00 ADSO Accident Claims Role 10:15 Investigation Coordinator in 10:30 Vicki Ergo 10:45 Anger & 11:00 HAZCOM Diane Workplace 11:15 Conflict 11:30 11:45 12:00

61 Sample Schedule: PM Day 1 Day 2 Day 3 Room 1 Room 2 Room 3 12:45 1:00
Day 1 Day 2 Day 3 Room 1 Room 2 Room 3 12:45 1:00 1:15 1:30 Solving Slips, Trips Back Inj 1:45 ADSO Conflict & Falls Lifting Workplace 2:00 (Cont) Violence 2:15 for 2:30 Defensive First Claims Managers 2:45 Driving Aid Coordinator 3:00  (Cont) Confined Bloodborne (Cont)  3:15 Spaces Pathegons 3:30 15 Pax Short 3:45 Van 4:00 4:15 4:30 4:45 5:00

62 Regional Open Enrollments Schedule
Harlingen: February Hosted by TSTC Nacogdoches: June Hosted by SFA Open Dates: April, August, October

63 New Classes Driving Safety: 4hrs
CPR & First Aid: 8hrs, Limited availability Office Safety: 1hr Claims Coordinator: 2 days Supervisors Role in Safety: 3hrs

64 Pinpointing your Exposures:
Loss Trending and Benchmarking through the State Office of Risk Management Presented by: Benny Vanden Avond SORM Risk Management Specialist

65 Risk Management Process
Step 1: Risk Identification Step 2: Risk Analysis Step 3: Consider Alternatives Risk Control Risk Finance Step 4: Implement Step 5: Monitor

66 Risk Identification Techniques
Insurance Surveys Property Inspections Internal Resources External Resources

67 Risk Identification through SORM
Onsite Consultations & Risk Management Program Reviews Risk Tex Articles Risk Management User Groups Insurance Policy Reviews Risk Evaluation and Planning System (REPS)

68 Risk Identification through REPS

69 Risk Identification through REPS

70 Risk Identification through REPS

71 Risk Identification through REPS: Questions, Questions, Questions

72 Identified Risks Two Employees complained about indoor air quality
22 Automobile Accidents occurred in Fiscal Year 2005, but only six occurred in Fiscal Year 2006 Our agency spends 17.04% of our Risk Management Program Expenditures on Employee Salaries Blah, Blah, Blah…

73 Risk Identification through REPS
Blah, Blah, Blah…

74 Identified Risks Two Employees complained about indoor air quality
Have you had previous complaints? 22 Automobile Accidents occurred in Fiscal Year 2005, while six occurred in Fiscal Year 2006 Has your fleet size significantly changed? Our agency spends 17.04% of our Risk Management Program Expenditures on Employee Salaries How does this compare to other state agencies?

75 Risk Management Process
Step 1: Risk Identification Step 2: Risk Analysis Step 3: Consider Alternatives Risk Control Risk Finance Step 4: Implement Step 5: Monitor

76 Risk Analysis Techniques
Loss Trending Benchmarking

77 Loss Trending (Trend Analysis)
Loss forecasting technique that identifies past loss patterns and uses them to forecast future losses

78 Loss Trending through SORM
REPS Online Property and Casualty Claims Reporting System (OPCC)

79 Loss Trending through REPS

80 Loss Trending through REPS: Data, Data, Data

81 Loss Trending through REPS: Statewide Trends
REPS also helps SORM to conduct Statewide Loss Trending October 2006 Risk Tex Article: ‘Smart’ System: REPS Helps Agencies Identify Risk, Helps SORM Recognize Trends

82 Loss Trending through OPCC

83 Loss Trending through OPCC

84 Loss Trending through OPCC

85 Benchmarking An entity’s use of information about other entity’s in the same industry to set standards and goals for itself

86 Benchmarking through SORM
REPS Cost of Risk Report (CORR)

87 Benchmarking with REPS

88 Benchmarking with REPS

89 Benchmarking with REPS

90 Benchmarking with REPS

91 Benchmarking with CORR
Agencies can use the CORR information to benchmark their risk management expenditure performance compared to statewide totals Individual agency expenditure data for the past four years is available within the RMIS section of the SORM website. Agencies should find the percentage columns particularly useful for benchmarking efforts.

92 Benchmarking with CORR
What Where When

93 Benchmarking with CORR

94 Benchmarking with CORR

95 Benchmarking with CORR

96 Benchmarking with CORR

97 Benchmarking with CORR

98 Benchmarking with CORR
F - Salaries $13,550 17.04% G – Benefits $5,500 6.92% H – Travel $1,200 1.51% Total Expenditures $79,500 100.00%

99 Summary Risk Analysis is a vital piece of the Risk Management Process
Loss Trending and Benchmarking are just two of many risk analysis techniques available REPS, OPCC, and CORR are valuable risk analysis tools provided through SORM

100 Risk Management User Group
Thank you for attending Happy Holidays!!

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