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Risk Management User Group

Risk Management User Group

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Risk Management User Group

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  1. Risk Management User Group November 29, 2006

  2. WELCOMEMichael L. Hay, CRM, CGFM, CPPM

  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. HEALTHCARE NETWORKS Jonathan Bow Executive Director

  5. CLAIMS UPDATE Gordon Leff Deputy Director Claims Operations

  6. Return to Work and Stay at Work Bona Fide Offers of Employement

  7. 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

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

  9. 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

  10. 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

  11. 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.

  12. Your front-line supervisors must be on board!

  13. 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

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

  15. to Work Programs • "Position Description” • DWC 73 "Return-to-Work Status" • SORM 85 Return To Work Policy • Bona-fide Job Offer of Employment Notification

  16. Bona-Fide Offer of Employment

  17. 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.

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

  19. 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.

  20. This is Critical

  21. 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 StatusReport 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.

  22. 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.

  23. 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.

  24. 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.

  25. 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 receivesthe 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)

  26. Important Concept Coming Up

  27. 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.

  28. Changes in the Designated Doctor and Required Medical Examination rulesAs of January 1, 2007Rule 126.7 (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.

  29. Sample RTW forms are provided on SORM’s website at •

  30. 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 residence6. Beginning date of the position _________ Ending date of the position________ Should you have any questions, please contact the undersigned below. Sincerely,

  31. Formore information about return to work, please go to SORM’s website at: •

  32. Travel Safety Officer Garry Parker Texas Department of Public Safety

  33. BREAK See you in 15 minutes

  34. SORM 200 DATA Mary Loza, ARM, AIC

  35. 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.

  36. 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.

  37. 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.

  38. Cost of RiskFY 03, 04, 05

  39. Expenditures vs COR%

  40. Loss Prevention Effect Ratios

  41. 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. ;

  42. 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).

  43. Auto Liability ClaimsFY 06

  44. Insured Auto Claims FY 06