WORKERS’ COMPENSATION PROGRAM OVERVIEW, BEST PRACTICES & AUDITING Tuesday, February 9, 2016 Presented by: Lisa Overholt, Claims Analyst Keenan & Associates

2 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Opening Remarks Moderator R. Kinney Poynter Executive Director NASACT Speaker Lisa Overholt Claims Analyst Keenan & Associates Open and close your control panel Join audio: Choose Mic & Speakers to use VoIP Choose Telephone and dial using the information provided Submit questions and comments via the Questions panel Your Participation

3 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Polling Question 1 of 2 For individuals: Please be sure to answer the polling questions as they are also your attendance checks for today’s webinar. For groups: Please answer in a way that reflects the consensus of the group. –Attendance for groups is still monitored via the sign-in sheet. Don’t forget to send in your questions!

4 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. About Keenan Keenan is the largest privately held insurance brokerage/consulting firm in California. Keenan’s innovative solutions provide high quality, cost- effective insurance, employee benefits, and financial services. We specialize in proprietary programs for public agencies and health care organizations. Our expertise in risk management, claims services, and technology consistently exceeds customer expectations.

5 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Overview of Workers’ Compensation No fault system Medical benefits to cure/relieve the effects of the injury Temporary Disability benefits to help compensate while unable to work Permanent Disability benefits to help compensation if there is an inability to compete in the open labor market

6 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Defining Fraud Fraud occurs when someone knowingly tells a lie with the intent to obtain a benefit that is not due or cause a benefit to be denied. The lie must be material (make a difference). Think “MILK” M-Material I-Intent L-Lie K-Knowledge

7 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Fraud vs. Abuse Fraud – Lie to obtain a benefit not due or cause a benefit to be denied Abuse – Any practice that uses the system contrary to the intent of the law Missing appointments Lies about past unrelated injury

8 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Types of Workers’ Compensation Programs Self Insured/Self Administered Self Insured/TPA Administered Fully Insured/Carrier Administered Hybrid Programs (Large Deductible Programs, etc.)

9 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Best Practices for a Workers’ Compensation Program Employer Controlled Wellness Programs – Healthy employees less likely to be injured Claims Reporting – The potential impact of late reporting Accident Investigations – Getting to the root cause, injury prevention, safety culture Frontline Providers – Getting your injured employees to the best occupational medicine physicians continued…

10 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Best Practices for a Workers’ Compensation Program Employer Controlled Communication Post Injury – Why staying in touch is important Get well cards Formal Return-to-Work Program ADA/FEHA Compliance – The Interactive Process File Reviews - Staying engaged and connected with your TPA

11 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Best Practices for a Workers’ Compensation Program Claims Handling Experienced Examiners – California has continuing education requirements Caseloads – Are they reasonable? Closing Ratios – How quickly are claims being resolved?

12 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Best Practices for a Workers’ Compensation Program Medical Cost Containment Medical/Physician Networks (MPN in California) Utilization Review – To ensure appropriate medical care Pharmacy Program – Controlling opioids Nurse Case Managers – Facilitating return to work and medical care Bill Review – Making sure employers aren’t paying more than they should for medical care

13 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Best Practices for a Workers’ Compensation Program Litigation Containment Defense Attorney Panel – What is the value? Preventing Litigation – What the employer and the claims team can do File Reviews Why you should consider having a regularly scheduled file review Elements of a productive file review

14 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Best Practices for a Workers’ Compensation Program Loss Prevention How are you preventing injuries from happening?

15 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Polling Question 2 of 2 For individuals: Please be sure to answer the polling questions as they are also your attendance checks for today’s webinar. For groups: Please answer in a way that reflects the consensus of the group. –Attendance for groups is still monitored via the sign-in sheet. Don’t forget to send in your questions!

16 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Key Performance Indicators Paid to Incurred Ratios – Are reserves accurate? Loss Development Triangles/Stratifications Return-to-Work and Modified Duty Days Frequency & Severity of Claims

17 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Key Performance Indicators Closing Ratios Indemnity to Medical Only Ratios Average Cost of an Indemnity Claim –Workers’ Compensation Rating Bureau - –WC Research Institute -

18 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Workers’ Compensation Claim Audits Internal Audits – What your TPA or carrier should be looking at External Audits – Why to consider hiring an independent auditor and what an auditor will review State Audits

19 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Issues and other Emerging Risks to Consider Active Shooters/Workplace Violence Opioids Medicare

20 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Question and Answer Session Moderator R. Kinney Poynter Executive Director NASACT Please continue to submit your text questions and comments using the Questions panel Please raise your hand to be unmuted for verbal questions. Your Participation Speaker Lisa Overholt Claims Analyst Keenan & Associates

21 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Attendance Check – FOR INDIVIDUALS ONLY  Please type “I have completed the webinar.” in your Question toolbar.  Be sure to hit the send button after typing your response.

22 LICENSE NO This presentation is for informational purposes only - not intended as legal advice. Thank you for your participation today! Disclaimer – Keenan & Associates is an insurance brokerage and consulting firm. It is not a law firm or an accounting firm. We do not give legal advice or tax advice and neither this presentation, the answers provided during the Question and Answer period, nor the documents accompanying this presentation constitutes or should be construed as legal or tax advice. You are advised to follow up with your own legal counsel and/or tax advisor to discuss how this information affects you.