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1. 2 Loss History Loss Trends – type and frequency Identify Strains, Tears and Pulls Number of Lost Time Claims Large Loss analysis - % of total cost.

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Presentation on theme: "1. 2 Loss History Loss Trends – type and frequency Identify Strains, Tears and Pulls Number of Lost Time Claims Large Loss analysis - % of total cost."— Presentation transcript:

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2 2 Loss History Loss Trends – type and frequency Identify Strains, Tears and Pulls Number of Lost Time Claims Large Loss analysis - % of total cost Compare OccuSure costs for similar claims Projected Losses going forward

3 3 Safety Management Review current programs in place How many losses could have been prevented Ground Troops in place Owner Support Pre-inspection or Phone Survey Attitude is extremely important

4 4 Claims Management Current claims procedures Physician Panels Return to Work Comparison of Client data to NCCI and OccuSure What impact could we have with client support OccuSure Commitment Forms

5 5 NCCI Statistics Lost time account for 23% of the total claims but 94% of the cost Average Medical Only claim - $580 Average Lost Time claim - $41,800 Average NCCI Claim cost - $7,100 The average WC claims has increased 112% over last 10 years WC costs 71% more than Group Health during the first 3 months

6 6 Claims Management

7 7 How are we DIFFERENT? MANAGE We MANAGE CLAIMS We do not “Adjust” Claims Adjust – To fine tune, regulate, tweak, administer Manage – To direct, supervise, control, accomplish

8 8 Claims MANAGEMENT Cornerstones 75 Claims Per Adjuster – Includes Med Only and Lost Time Claims Insured assigned to one adjuster to promote a good working relationship Regular Round Table Discussions on Claims & Accounts Adjuster Maintains File Control –Not Case Management or Legal

9 9 PROACTIVE TEAM APPROACH Weekly Roundtable Claim Meetings –All claims <30 days reviewed at least monthly Weekly Office Meeting –Safety & claims discuss at risk accounts Monthly Meeting –Underwriting, Claims and Safety

10 10 The Typical TPA Life of a Claim Claim Called into Claim intake Company Claim Assigned to Basic Adjuster Claim Assigned to Lost Time Adjuster Claim Assigned to Case Mgr Clmt gets an Atty often Claim assigned to Litigation Adjuster Claim Assigned to an Attorney Claim has Subro Assigned to subro firm or adj

11 11 OccuSure Life of a Claim Insured Safety Surveillance Attorneys Case Management Doctors Claimant CLAIMS MANAGER FROI Fax or Email distributed to Claims & Safety

12 12 RESULTS Industry Average Case Loads Indemnity150-200 Claim Duration Med Only150 Days Duration Indemnity4-6 Years Average Claim Cost$ 7,100 % of Claims – LT23 % Litigated Cases 13 % Type of Injury Total Cost Back$150,000 to $375,000 Shoulder$ 30,000 to $150,000 Knee$ 50,000 to $175,000 OccuSure Average Case Loads 75 (incl. Med Only) Claim Duration Med Only74 Days Duration Indemnity132 Years Average Claim Cost$ 3,606 % of Claims – LT11 % Litigated Cases 0.15 % Type of Injury Total Cost Back$ 16,244 75 (largest $190K) Shoulder$ 18,089 (largest $152K) Knee$ 12,680 (largest $69K)

13 13 Evaluating a New Risk Typical Claims (Strains, Slips, etc) –Evaluate to ensure nothing unusual regarding account or claims specifically to account for increased costs. –If not and company has typical claims and frequency then we adjust to OccuSure typical results for that industry. Catastrophic Claims –Safety & Claims discuss the catastrophic risks vs controls –Sometimes adjustment in claim cost can be made for OccuSure claims handling. Get specifics.

14 14 Loss Control

15 15 Pre-Inspection Assessments Corporate Culture’s Top Management Commitment to Safety and OccuSure Guidelines Hiring Practices Temporary Modified Duty Policy Management’s desire to change loss history Identify Risks and Controls Company Safety Expectations Communicated

16 16 LOSS CONTROL RELATIONSHIP Establish a relationship based on trust and partnership Communicate support system of Loss Control function Offer High Quality Safety Systems Establish accountability for timely follow-up action on recommendations

17 17 Behavioral Based Model Communicate the value of The M.O.S.T. ® Safety System Customize to the individual company Train the trainer to maximize resources Train supervision on observation methods from The M.O.S.T. ® System for Supervisors


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