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Risk Management User Group. Wednesday, January 28, 2004. Welcome. Michael L. Hay, CGFM, CPPM. Please hold questions until the end of all presentations. Meeting Agenda. 8:30-8:40 – Welcome 8:40-8:55 – Short Term Special Events, General Liability 8:55-9:10 – Review of SORM 200 Data

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risk management user group

Risk ManagementUser Group

Wednesday, January 28, 2004

welcome

Welcome

Michael L. Hay, CGFM, CPPM

meeting agenda
Meeting Agenda
  • 8:30-8:40 – Welcome
  • 8:40-8:55 – Short Term Special Events, General Liability
  • 8:55-9:10 – Review of SORM 200 Data
  • 9:10-9:40 – Claims
  • 9:40-10:00– Trend Analysis & Accident Investigation
meeting agenda1
Meeting Agenda
  • 10:00-10:15 – Break
  • 10:15-11:00 – Life Safety Code 101, 2003 Update
  • 11:00-11:15 – SORM Fraud Team
  • 11:15-11:30 – Loss, Damage, & Destroyed Property
  • 11:30-12:00 – Questions & Comments
short term special events general liability

Short Term Special Events, General Liability

Steven E. Haynes, ARM

GRS Insurance Services, LLC

state office of risk management master short term general liability insurance program
State Office of Risk ManagementMaster Short Term General Liability Insurance Program
  • Background and Purpose
  • Key Elements of Program
    • Outside Users of State Owned Facilities
    • State Employees Using Third Party Facilities
  • Program Highlights
    • Types of Events Available
    • Underwriting Guidelines
    • Coverages, Limits, and Pricing
slide8
Application Process
  • Key Contacts
  • Marketing Material
  • Summary and Questions
sorm 200 loss data summary

SORM 200 Loss Data Summary

Sally Becker CPCU ARM

history
History
  • Annual Report to SORM
  • FY02 – change in data collected
    • Loss type
    • Loss cause
    • Retain from year to year
    • Update previously entered data
  • February, 2003 – availability to enter all year long
important
Important
  • UPDATE INFORMATION
512 936 1573 fax 512 370 9037 sally becker@sorm state tx us
512-936-1573

Fax: 512-370-9037

Sally.Becker@sorm.state.tx.us

terry g myers director of claims operations
Terry G. Myers

Director of Claims Operations

claims cost
Claims Cost

Cost to the Claims Fund

vs

Per Claim Costs

1 st qtr fy04 update
1st Qtr FY04 Update
  • Medical and Indemnity costs through the end of the 1st Qtr FY04
    • Fewer open claims
    • Significantly lower costs
1 st qtr fy04 update1
1st Qtr FY04 Update
  • WCRI
    • Cost of WC Claims in Texas
    • Future Comparison with SORM Claims Costs
claims operations reorganization
Claims Operations Reorganization
  • Realignment of State Agencies

HHSC

  • Three Indemnity Claims Teams

HHSC, TDCJ, ALL OTHERS

combined medical management with medical only claims team
Combined Medical Management with Medical Only Claims Team
  • Medical staff and senior adjusters
  • Eight (8) medical only adjusters
overview
OVERVIEW
  • INVESTIGATION PROCESS
      • OBJECTIVE
      • WHAT
  • ROOT CAUSE ANALYSIS
  • TREND ANALYSIS
slide43

Accident Causation Theories

There are a variety of theories on accident causation that can be grouped into the following categories:

  • Domino Theories which view accidents in three phases: pre-contact, contact and post-contact.
  • Multiple Causation Theories which view causes based on a variety of factors such as man, machine and the environment.
  • Psychological/Behavioral Causation Theories which focus on human behavior as the major cause of accidents
  • Energy Related Causation Theories which view accidents as a result of energy that is out of control.
root cause analysis
ROOT CAUSE ANALYSIS
  • SCIENTIFIC PROBLEM SOLVING METHODS
    • Fault Tree Analysis
    • http://reliability.sandia.gov/Reliability/Fault_Tree_Analysis/fault_tree_analysis.html
    • Fish Bone Diagram
    • http://www.pathmaker.com/resources/tools/cause.asp
slide47

Lamp

Won’t

Work

slide48

Power

Bulb

Lamp

Won’t

Work

Lamp

Plug/Cord

slide49

Power

Bulb

Loose

Burned

Lamp

out

Won’t

Work

Plug/Cord

Lamp

slide50

Power

Bulb

Loose

Burned

Lamp

out

Won’t

Work

Corroded

Missing

Switch

Broken

Switch

Plug/Cord

Lamp

slide51

Power

Bulb

Unpaid Bills

Loose

Switches

Burned

Lamp

Storm

out

Won’t

Work

Corroded

Missing

Switch

Broken

Switch

Plug/Cord

Lamp

slide52

Power

Bulb

Unpaid Bills

Loose

Switches

Burned

Lamp

Storm

out

Won’t

Work

Corroded

Dogchewed

Missing

Switch

Unplugged

Broken

Switch

Plug/Cord

Lamp

trend analysis
TREND ANALYSIS
  • IDENTIFY BASIC FACTS
  • SHOW POSSIBLE PATTERNS/TRENDS
  • ESTABLISH PRIORITIES FOR SAFETY ACTIVITIES
slide56

ASWG CODES

Effective June 1, 1997 the Commission adopted revised Advisory Statistical Work Group (ASWG) codes for Nature of Injury, Part of Body, and Cause of Injury. These code changes aligned the Commission's reporting requirements with the International Association of Industrial Accident Boards and Commissions (IAIABC) Electronic Data Interchange (EDI) reporting standards.

The ASWG codes are available to EDI participants through the IAIABC. If a carrier or trading partner has previously purchased an IAIABC Implementation Guide, the IAIABC will provide a list of all the ASWG codes as an update to the Guide. If you are interested in purchasing an Implementation Guide, you can contact the IAIABC directly at 1201 Wakarusa Drive C-3, Lawrence, Kansas, 66049 or by phone (785) 840-9103. The IAIABC has also made the codes available via their website at www.iaiabc.org. Once you have reached their web page, choose the EDI folder and available options will be listed.

slide57

Examples of categories to include in the analysis should at least be the following:

A. Department:

B. Job Title:

C. Agent Involved: (ironing press, material cutter, fabric rolls, sewing machine, and clothing bundles)

D. Experience: (1-5 years, 6-10 years, etc.)

E. Body Part: (hand/fingers, back, leg, head/neck, arm and foot)

F. Accident Type: (caught between, struck-by, struck-against, lift/lower, push/pull, etc.)

slide59

CAUSE OF INJURY BY DEPARTMENT FY 01 & FY 00

As of August 31, 2001

AGGRESSION

break time

Break Time!

See you at 10:15!

slide62
Fraud Investigations

Gary Ingram

Julie Herrera

workers comp fraud
Workers’ Comp. Fraud

Workers’ Compensation Fraud is committed when a person(s) knowingly or intentionally misrepresents, conceals, or omits a material fact to either obtain or deny workers’ comp benefits.

workers comp fraud cont d
Workers’ Comp. Fraud (cont’d)

Fraud is committed if a person knowingly or intentionally:

  • Makes a false or misleading statement.
  • Misrepresents or conceals a material fact.
  • Fabricates, alters, conceals, or destroys a document
  • Conspires to commit an act described by the events above.
fraud investigative unit
Fraud Investigative Unit
  • Investigate allegations of fraud
  • Validate SIBS, TIBS, and Death Benefits info
  • Validate suspect travel and prescription reimbursements
  • Assist DA’s and TWCC in prosecution of fraudulent claims
  • Assist the claims adjusters, agencies, and claimants
  • Assist SORM in obtaining information that is utilized at BRC’s and CCH’s
useful tool
Useful Tool

EMPLOYEE’S RIGHTS AND

RESPONSIBILITIES FORM

what to do when you suspect fraud or abuse
What to do when you suspect fraud or abuse.
  • Call SORM’s Investigators
    • Gary Ingram – (512) 936-1450
    • Julie Herrera – (512) 936-1521
  • Call your SORM adjuster or our main #
    • (512) 475-1440
lost damaged destroyed property
Lost, Damaged, & Destroyed Property

Patricia O’Hara

Systems Analyst

(512) 936-1500

peo1@sorm.state.tx.us

benchmarks
Benchmarks
  • The State Auditor’s Office (SAO) recommended that SORM create benchmarks for LDD property.
  • Benchmarks will be based on the Class Code of assets, and an overall agency percentage.
  • An agency should have procedures for safeguarding assets. Risk Managers can contact their agency’s property manager.
  • We should have the benchmarks in place this spring.
appropriation reduction
Appropriation Reduction
  • The Comptroller was charged by the 77th legislature to reduce an agency’s appropriations by 50% of the value of lost property, if the percentages are in excess of the American Society for Testing and Materials (ASTM) standards. This was implemented at the end of FY02 and was continued by the 78th Legislature in Article IX, Sec. 11.03 of the General Appropriations Act.

*Implementation Guidelines for General Appropriations Act, Art. IX, §9.03, 77th Leg., R.S. -- Appropriation Reductions for Lost Property http://www.window.state.tx.us/comptrol/san/fm.notices.date.html/fm02/fm02-47.html

ldd definitions
LDD Definitions
  • Class Codes
  • Disposal Methods
  • Lost Damage & Destroyed Property
  • Historical Cost vs Depreciated Value
  • Property level vs. Component level
ldd process
LDD Process
  • Missing Property
  • Stolen Property
  • Damaged/Destroyed Property
  • Negligence
useful websites
Useful Websites

SPA Class Codes and Annual Financial Report (AFR) Categories:

http://www.window.state.tx.us/comptrol/san/spa/spa_class_codes-afr_cats.html

SPA Disposal Methods for Fixed Assets:

http://www.window.state.tx.us/comptrol/san/fm_manuals/spa_man/spa_user2000/spauser_appd1.html

Missing, Damaged or Stolen Property Report:

http://www.window.state.tx.us/taxinfo/taxforms/74-194.pdf

useful websites cont d
Useful Websites (cont’d)

State Agency’s Property Managers

http://www.window.state.tx.us/comptrol/san/agency_contact_list/spa/st_agy_spa_contacts.html

State Auditor’s Office Report

http://www.sao.state.tx.us/Reports/report.cfm/report/01-032

risk management user group1

Risk ManagementUser Group

Thank you for attending.

See you on April 28th, right here!