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OSIA Annual Conference
Episode I – The Menace of Claims Presented by Earl Johnson, Director of Safety Sabrina Dierksen, Occupational Healthcare Provider Antonio Rodriguez, Safety Manager
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Episode I – The Menace of Claims
Key Factors…Why Reporting an Incident Injury Treatment Incident Investigation TPA Claim Submission
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Health and Safety Mission: The Health & Safety of each associate visitor and contract service provider of an AdvancePierre Foods facility is of primary importance. As such, the elimination of accidents and injuries is a strategic goal. It is our belief that every accident is preventable through a process of constantly evaluating and improving the process to foster an environment where continuous improvement is imbedded in our culture and safety management systems. Keys: Elimination of accidents and injuries is a strategic goal and all situations are preventable Vision: We are committed to providing a safe work environment by building and maintaining a Health & Safety program that is compliant with all Local, State and Federal Regulatory requirements and one that engages workers in the process of continuous improvement. Keys: Committed to providing a safe work environment and engage workers in the process of continuous improvement. Values: Our motto “ZERO IS POSSIBLE” demonstrates our commitment to reduce and eliminate all incidents that result in injury to workers, visitors and contract service providers. Keys: Goal vs. Target
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Top 5 - Key Attributes Train workers in safe work practices, beyond that of regulatory requirements, and in hazard recognition. Keys: Education Use Hazard Identification and Risk Analysis to determine engineering and administrative controls to reduce and eliminate risk. Keys: Hierarchy of Controls Provide systems to address corrective actions, recommendations, and preventative measures. Keys: Accountability Listed are 9 key areas but I’m going to speak on 4 of them today We conduct orientation with all New Hire workers covering regulatory and company specific requirements We have a focused approach on Root Cause Analysis using the Hierarchy of Controls process; Elimination Engineering Administrative Work Practices Personal Protective Equipment Our system holds everyone accountable; bottom up and top down. We have a variety of ways to engage our workers in the solutions from Safety Teams Behavior Based Safety Suggestion Boxes, Encourage worker engagement by fostering Grass Roots participation. Keys: Ownership Acknowledge and recognize outstanding performance, success and continuous improvement. Keys: Celebrate
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Leadership Commitment
We are morally obligated to provide a safe work environment to our associates, visitors and contract service providers. Maintaining a safe work environment is the responsibility of everyone in the organization. Keys: Morally Obligated As an employer, we accept the responsibility in assuming leadership for the safety and health programs, for evaluating its effectiveness, and assuring continuous improvement strategies. Keys: We accept the responsibility and continuous improvement Safety Manager Plant Manager Director of Safety VP of Operations SVP of Human Resource COO President and CEO
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Claim Frequency
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Recordable Rate (Severity)
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Net Incurred
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Payroll Incurred
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Cost Avoidance 2017 vs 2016
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Cost Avoidance 2017 vs 2015
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Rate Analysis 2017*2016*2015
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!Disclaimer! I am not a paid spokesperson for any of the products represented in this presentation, nor do I own the rights to any of the pictures used.
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When to Report OSHA’s Definition of an Injury or Illness:
An injury or illness is an abnormal conditions or disorder. Injuries include cases such as, but not limited to, a cut, fracture, sprain, or amputation. Illnesses included both acute and chronic illnesses, such as but not limited to, a skin disease, respiratory disorder, or poisoning.
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Report Incidents Immediately!
Reporting and Incident The worker is then evaluated by one of our Occupational Healthcare Providers Then it is determined if the worker is treated in-house or sent out to an Occupational Health clinic or Emergency Department Safety managers and supervisors start the investigation Report Incidents Immediately! The worker and the supervisor fill out the form and bring it to the Health Office and report it to the Safety Manager immediately Don’t let something minor become something major!
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Documenting the Facts Workers are to report ANY incident or over use injury to their supervisor IMMEDIATELY, regardless of how insignificant it may seem.
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Determining Work Relatedness
OSHA’s Definition of Work- Relatedness (29 CFR ): Work-relatedness is presumed for injuries and illnesses resulting from events or exposures occurring in the work environment unless an exception specifically applies. A case is presumed work- related if, and only if, an event or exposure in the work environment is a discernable cause of the injury or illness or of a significant aggravation to a pre-existing condition.
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Determining Work Relatedness
Ask open ended questions. Open ended questions require more than a one word answer. EXAMPLES How did you hurt your self? What do you think you are doing to cause your back to hurt? How long has this been going on? Begin questions with: Why How What Describe Tell me about What do you think
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Injury Treatment Worker is evaluated by the Occupational Healthcare Provider Injury is evaluated and the OHP will begin In-house treatment or the worker will be sent out for care Claim is entered into Health claims management system If injured worker is sent to outside facility, TPA is notified and Form2 is sent
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Recordable Injury Treatment
Rigid Splints/Immobilization The one exception is Stax finger splints Rehabilitation Stretching/Strengthening TENS unit/Ultrasound Work Restrictions Prescription Medications Radiologic testing that has a positive finding Physician Referral that includes any of the above treatments
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Recordable Claims Metrics
YTD Performance H
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Non-Recordable Treatment Options
Kinesiology Taping OTC medications-Ibuprofen, Aleve, Tylenol Industrial Athlete Functional Education Program-Counseling Hydration Nutrition Conditioning Stretching Basic 1st Aid [1904.7(b)(5)(ii)] Soft Splints/Ace Wraps Ice/Heat Modalities Massage/ Instrument Assisted Soft Tissue Massage (IASTM)
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Out of the Box Tools
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Non-Recordable Claims Metrics
YTD Performance H
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Restricted Work Solutions
Utilize outside source to accommodate light duty when it is unavailable at the facility Modified Work Program APF provides light duty for all work comp injuries when applicable internal and external
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Why Avoid Lost Time Cases
Studies have shown the longer the worker is out of work due to an injury, the less-likely they are to return to work. If an worker is out of work more than 6 months there is less than a 50% chance they will return. The RAND Institute for Civil Justice states that on average the injured workers absence is reduced by 3.6 weeks when a return to work program is utilized.
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Key Investigation Factors
Filling out the Incident report is crucial to the investigation Mitigate any immediate hazards Statement of the facts are reported to the TPA/Insurer Document any outside injuries that workers may bring to your attention Social Media often tells a different story….
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Pre-Existing Conditions
Document in pre-employment health assessment or physical Have candidates return to treating specialist or Primary Care Provider for a release Include the job description and physical demands to the treating physiciant any outside injuries that workers may bring to your attention Social Media often tells a different story…. This is important because of our aging workforce!
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Root Cause Analysis Conduct investigation immediately through questioning the injured worker, witnesses and document statement of facts Determine if containment actions are needed and eliminate any immediate hazards Take photograph of the injury, work area and preserve any video footage Assemble team to conduct 5 deep dive analysis using 5 WHYs, Fishbone Diagram or other tools Use 5 WHYs, Fishbone Diagram or other tools to conduct formal cause and effect analysis Identify action to mitigate reoccurrence Communicate Safety Alert Lesson Learned
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Share Safety Alert
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Root Cause Metrics YTD Performance H
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Root Cause Metrics YTD Performance H
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Industrial Athlete Program
Functional Education is NOT recordable All workers at every level are educated on the program at time of hire Additionally, we review with anyone when a report an injury is filed or over-use condition is alleged
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Other Prevention Measures
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TPA Claim Submission * And any applicable: Medical Records
Once an injured worker is sent to an outside medical provider, the claim is submitted with applicable documents: * And any applicable: Medical Records In-house treatments Urgent Care Visits Emergency Department Visits Occupational Health Clinic Visits Incident Report Form 2 Witness statements Authorizations for any medical treatments
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TPA Claim Submission Work with claims manager and nurse case manager on modified duty or return to work dates Keep claims manager up-to- date on employment status and other issues the worker may have Internal team will work closely with TPA representative (CBR) In some cases we still provide in-house treatment to the worker OHP attends appointments Send applicable notes, Form 5’s, and other pertinent documents to TPA (CBR)
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Does all claims have to be submitted to your TPA?
Questions What is the difference between Recordable and Non-Recordable Cases? What is the difference between Recordable and Non-Recordable Cases? Can you deny a claim because a supervisor said it did not happen? What are key elements of a good Root Cause Analysis plan? What are some benefits of avoiding a Lost Time Cases? Does all claims have to be submitted to your TPA?
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Workers’ Compensation
“Just the Basics”
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Title 85A established The Workers’ Compensation Commission
Commissioners Mr. Mark Liotta, Chairman Mr. Jordan K. Russell, Member Ms. Megan Tilly, Member Administrative Law Judges Judge T. Shane Curtin Judge Blair McMillan Judge Michael Eagan Judge Molly Lawyer Judge Tara Inhofe
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About the Commission Governing Documents Commissioner Biographies
Administrative Law Judge Biographies Related Links Contact us News and Events Publications Employment Application Business Office
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Governing Documents
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Administrative Law Judges
Judge T. Shane Judge Michael T. Egan Judge Tara A. Inhofe Judge P. Blair McMillin Judge Patricia Sommer
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Employers/Employees
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What is Workers’ Compensation?
Who is covered by the AWC Act? How to obtain coverage? Employers responsibilities prior to injury. What to do when a injury has occurred. Benefits owed to the injured worker Exceptions from the General Rule that coverage must be provided Who is an independent contractor? FAQs Guide for Employers
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Guide for Injured Workers
What is Workers’ Compensation? Is your injury covered? Your rights and responsibilities as an injured worker. Benefits Medical Treatment Temporary Disability TTD TPD Permanent Disability PPD PTD Vocational Rehabilitation Continuing Medical Maintenance Death Benefits The Claim Process Guide for Injured Workers
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Medical Official Disability Guidelines
Vocational Rehabilitation Counselors IME Specialty List Case Managers Directory Oklahoma Medical Data Report September 2013 Medical Fee Schedule Schedule II Drug Guidelines
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Legal PPD Rate Charts Death Benefit Rate Charts
Amputation & Permanent Total Loss of Use Chart Maximum Historical Comp Rate Chart List of Mediators Commission Governing Document Mileage Information Interest on Judgments
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Forms Listing by Form Number/Title Hyperlink PDF Format
Tab and Fill Forms Link to Court forms
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Insurance Certificate of Non- Coverage Instructions Listings
Group Self Insurance Associations Service Agents for WC Insurance Carriers Third Party Administrators Individual Own Risk Employers WC Insurance Coverage Lookup NAICS Assistance & Information Commission Rules
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WC Insurance Coverage Look Up
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Basic WC Terms TTD-Temporary Total Disability
PPD-Permanent Partial Disability PTD- Permanent Total Disability MMI- Maximum Medical Improvement RTW- Return to Work Light Duty- Doctor allows a modified return to work but places temporary restrictions such as no lifting more than 3 pounds, no stooping, etc.
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Best Practices
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‘No-Fault’ system Oklahoma is a no-fault system for workers’ compensation and a witness is not required. We cannot deny a claim based on the worker’s stupidity.
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The magic formula to prevent injuries is to train workers to work “safely”.
After the injury, your adjuster is in ”cost control”.
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File Claims Immediately – Same Day Reporting (24 Hour Notice)
Critical Fact: If the claims adjuster can talk to the injured worker within 24 hours of the incident, the claim cost is reduced significantly.
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Accident and Injury Program “Best Practices”
Be Proactive Train to “prevent” claims. Employees with unsafe work habits require repetitive training and supervision to train away the poor habits. Offer medical treatment the day of the incident. Do not try to decide if a injury is a Workers’ Compensation or a health claim-- Let the doctor and adjuster decide.
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Accident and Injury Program “Best Practices” (cont.)
Provide payroll/contact information with the Form 2. This will speed up getting TTD benefits started timely. Stay in touch with the injured worker. Let them know you care about them and their recovery and to expect a call from an adjuster.
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Accident and Injury Program “Best Practices” (cont.)
Develop a Modified (Light) Duty program. This is a win-win the Employer and the worker. You are the eyes and ears, so share any and all information you have on the injured worker and their activities with your adjuster.
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Accident and Injury Program “Best Practices” (cont.)
Double check Personal information for the injured workers on the Form 2 (SS#, correct spelling of name, DOB, address, cell phone number). If a worker sues the company, a representative at trial is critical. Not all trials require attendance so your attorney or adjuster will advise which ones to attend. Match name to SS Card
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Accident and Injury Program “Best Practices” (cont.)
If an injury involves a third party (vehicle accident, slip/fall on property not owned by the Employer) provide all information that you have regarding the third party and any contact information you may receive from the Third party’s insurance carrier.
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Accident and Injury Program “Best Practices” (cont.)
10. The Employer has the right to question the validity of a claim. Provide statements of why you are questioning the incident. What are the extenuating circumstances? Provide cell phone photographs of building/grounds where accident occurred. Review the premises security video and secure if available.
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Train your Employees on Your Process
Encourage employees to promptly report a workplace injury. Send them to a pre-designated doctor/clinic. Develop a Modified Duty Program to get employees back to work while they heal
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Workers’ Compensation - A New Day is Coming
Questions? OMCTFOA Conference - 10/25/12
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