Injury Management Overview Axiom Medical Consulting, LLC I encourage questions? Ask at anytime. With any discussion on skin disorders, there will be graphic pictures Caring is the Best Medicine® 25511 Budde Rd., Suite 801, The Woodlands, TX 77380 (281) 419-7063 www.AxiomLLC.com

Mission Statement We are committed to providing the highest quality and cost-effective medical management services available to promote a safe and healthful environment for your employees - Dr. Michael J. DeLitta President & CEO

Service The high road to service is traveled with integrity, compassion and understanding. People don’t care how much we know until they know how much we care.

Partial Client List Air Liquide Baker Hughes, Inc. BJ Services BP Cactus Drilling Chevron ConocoPhillips Cudd Energy Encana Exterran Flint Energy FMC GDF Suez Energy NA Grey Wolf Precision Drilling Halliburton Honeywell Key Energy Marathon Oil Mirant Services, LLC PHI Schlumberger TEPPCO Team Industrial Services, Inc. Universal Ensco, Inc. Weatherford

Injury Case Management Topics Who Are We Injury Management Process Two Case Examples Stats on Immediate Intervention Closing

Who We Are Full Service Medical Department Physicals – OSHA, DOT Drug Testing - DOT, non-DOT Wellness Case Management

Axiom Different From a TPA We are NOT a Third Party Administrator (TPA) We do not process Workers’ Comp claims We do not negotiate or pay work comp bills Case Managers, not Case Trackers

How TPA Different From Axiom We are 24/7 - We don’t close at 5 We understand OSHA and its importance to our clients All Case Managers (CM) are medically licensed (minimum of RNs) Our CMs carry a case load of less than 15 – 20 cases (compared to 100 – 200)

Medical Staff Our staff consists of: Board Certified Physicians (MD) Occupational and Environmental Medicine Internal Medicine Family Practice Medical Review Officers (MRO) Qualified Medical Examiners (QME) Masters in Public Health (MPH) Board Certified Physician Assistants (PA-C)

Medical Staff Continued . . . Psychologists (Ph.D.) Registered Nurses (RN) with Bachelor or Masters of Science - Nursing (BSN / MS) Certified Case Managers (CCM) Certified Disability Management Specialists (CDMS)

Medical Staff Continued . . . Certified Occupational Health Nurses (COHN) Certified Occupational Health Nurses-Specialist (COHN-S) Certified Occupational Health Nurses-Specialist/Case Manager (COHN-S/CM)

Injury Management Process If the injury is critical or life threatening call 911 and then contact Axiom Never delay treatment in the event of an emergency If the injury is not an emergency contact Axiom before you transport the employee to a medical facility – this is important and will be explained

Injury Management Process Call comes into Call Center and received by our Intake Specialists Basic info taken and case is assigned to Case Manager (CM) CM calls injured employee within 5 – 10 minutes

Injury Management Process CM discusses incident and injury with employee CM gather critical medical info Supervisor is removed from treatment decisions Determines if employee requires evaluation at medical facility

Injury Management Process If a medical facility is indicated, CM directs employee to appropriate medical facility and provides initial info on case to health care provider Speak with medical facility before employee leaves Assist in getting post-accident drug and alcohol test –per company policy

Injury Management Process If a medical facility is not indicated, CM will provide 1st aid recommendations and monitor employee’s condition 50% of cases never require clinic visit CMs do NOT diagnose, nor do they need to in order to provide 1st aid measures

Injury Management Process Employee and person calling in case (i.e., HSE, supervisor) must be in agreement with CM’s 1st aid recommendations) If not, employee will be sent to medical facility for evaluation

Injury Management Process CM provides a direct number to employee and supervisor to call with any questions, problems or changes First e-mail goes out within 2 hours after treatment is completed First follow-up call is usually made within first 4 hours; then 24 hours

Injury Management Process This may mean calls in the evenings or weekends Keep mgmt and HSE updated via phone and e-mail during entire process Follow employee until able to perform regular duties or until adjuster assigned – depends on client’s preference

Injury Management Process Ongoing dialog with employee, supervisor and treating doctor Transitional duties (light duty) Will assist with return to work exam, FCE, etc. if indicated Important to determine if employee can safely perform all aspects of their job

Medical Case Management Case #1 Tuesday 3:30 PM - Employee (EE) holding a bolt and was struck in the hand by a sledge hammer by co-worker 4:00 PM - EE taken to local hospital 4:30 PM - Axiom called to intervene Called ER and spoke with charge nurse EE in x-ray

Medical Case Management Case #1 Tuesday 5:45 PM - Spoke with ER doc X-rays negative Diagnosis - hematoma Plan to give prescription if infection occurs Told doc we would follow case & look for infection. Prescription not written Return to work (RTW) - full duty

Medical Case Management Case #1 Wednesday 8:45 AM - Spoke with Supervisor (Supv) and EE. EE doing well. Regular duties. Reviewed importance of OTC NSAIDs and ice Friday Spoke with EE and Supv. EE still doing well. No sign of infection. Case closed

Medical Case Management Case #2 Friday 8:25 AM - Pipe rolled off truck bed and struck EE in thigh yesterday EE was Spanish-speaking only EE had continued swelling and discomfort today, but was able to work

Medical Case Management Case #2 Friday Had Spanish-speaking Case Manager speak with EE Determined injury was soft tissue only After getting thorough medical history EE was instructed on ice, heat, NSAIDs Gave direct number to EE

Medical Case Management Case #2 Saturday EE off work, but called him at home Reviewed treatment plan and discussed starting heat on Sunday Spoke with EE on Monday at work Significant improvement. Told to continue treatment plan Closed case on Tuesday

Outcomes of Injuries Without Case Mgmt Non-Work Related . . . . . . 0 First-Aid . . . . 44 Recordable . . 33 Restricted . . . 42 Lost Time . . . 33 TOTAL . . . . .152 With Case Mgmt Non-Work Related . . . . . . 16 First-Aid . . . . . 85 Recordable . . . 16 Restricted . . . . 29 Lost Time . . . . . 6 TOTAL . . . . . .152

Immediate Intervention 75% of cases - notified same day 14% of cases - the following day 11% of cases - notified 2 days or greater 40% of these were over 1 week 80% of those were placed on OSHA 300 All 6 lost times fell into this category

Immediate Intervention If case received within 24 hrs of injury the average time to close was 7 days If case received within 2 days of injury the average time to close was 14 days If case received on 3rd day or greater following the injury the average time to close was 32 days

Benefits To Employees Immediate access to Medical Professional 24/7 for injuries Employee can call CM at any time should medical condition change or if question comes up Axiom Case Manager is not a “Company Doctor”

Benefits To Employer Immediate access to Medical Professional 24/7 for injuries Supervisor removed from treatment / medical decisions Communication Lower Claims Frequency/Severity Reduction in Incident Rate, Reduction in Costs, Reduction in Modifier

Closing It’s important to report injuries immediately – no matter how minor A delay of reporting and treating injury by 1 day increases recordability by 60% 24 / 7 /365 coverage - (this is crucial) Have only one number to call (877) 502-9466 (877-50-AXIOM)