Transcript - CPCU Society - Central Jersey Chapter

I Day 2016
New Jersey and Central Jersey
Chapters
Friday September 30, 2016
‘They Break It, You Buy It’
Risk Management of Slips, Trips, Falls,
Sprains & Strains
Panel Presenters
Veronica George
Inservco Insurance Services
Senior Claims Representative - experienced in all aspects of workers’
compensation claims, including temporary disability, formal and informal
petitions, medical management judgment, and second injury fund cases.
She started at Penn National Insurance, Inservco’s parent company,
before joining Inservco in assisting its self-insured customers in managing
their claims. Veronica has been with the company for over 30 years. She
enjoys a longstanding relationship with her clients as she participates in
regular client meetings assisting them in managing and reducing their
exposures. She continues to enhance her knowledge by regular
participation in courses on claim handling, and regulatory updates.
3150 Brunswick Pike, Suite 200
Lawrenceville, NJ 08648
800-334-1348– Direct
866-334-1348 – Fax
[email protected]
http://www.pennnationalinsurance.com/INSERVCO
Panel Presenters
Mike Pierson, AIC
MPierson Consulting, LLC
9 Seward Drive, Suite 201
Ocean, NJ 07712
732-918-8873– Direct
201-508-3384 – Fax
[email protected]
www.mpiersonconsulting.com
Executive Consultant to Inservco - has long been recognized in the
insurance industry for his knowledge in overseeing various types of selfinsurance programs including, but not limited to, workers’ compensation
and liability coverages. Mike has been associated with Inservco since
1988 and has over 30 years of insurance experience. Mike has been a
featured speaker at numerous industry functions throughout New Jersey
and has conducted educational seminars for many of Inservco’s selfinsured customers. Mike is considered as a valued resource by Inservco
customers, the broker community, attorneys, legislators, as well as the
entire claims community throughout New Jersey. He has also authored
several articles related to managing risk. Mike possesses a Bachelor of
Science from Monmouth University and earned an Associate in Claims
(AIC) designation).
Panel Presenters
Sanford Brown
Verisk Insurance Solutions
Sanford Brown is the Assistant Vice President of Product Development
for Verisk Insurance Solutions. Sanford is responsible for both the
development and ongoing management of commercial underwriting
products and services that have helped carriers improve profitability and
minimize future risk. Sanford has a significant experience in financial
services B2B product development. He has a BA from Syracuse
University and an MBA from the Columbia Business School
201-469-2570– Direct
[email protected]
www.verisk.com
Panel Presenters
Matthew Struck, CPCU, ARM, MBA
Brown & Brown Public Risk Advisors of New Jersey
Mr. Struck joined Brown & Brown in 2009. Prior to joining our
firm Mr. Struck worked in the personal finance and risk
management departments at Prudential Financial, Inc. and
TD Banknorth, NA. Mr. Struck has 10 years of experience in
risk management.
56 Livingston Avenue
Roseland, NJ 07068
973-549-1893– Direct
973-549-1000 – Fax
[email protected]
www.bbpra.com
Mr. Struck received his Bachelor’s Degree in 2003 from Tulane
University in New Orleans, LA where he majored in
Biomedical Engineering. Mr. Struck then received his MBA in
2007 from Fairleigh Dickinson University in Florham Park, NJ
with a concentration in Finance and Investment.
Risk Management of Slips, Trips, Falls, Sprains & Strains
Overview
 Overview of Industry Statistics
 Common Exposures
 Treating Exposures
 Third Party Administrator (TPA) Best
Practices
 Combatting Opioid Addiction
 WC Case Studies
 Using Data to improve WC Underwriting
Results
 Resources
 Q&A
Overview of Industry Statistics
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USDoL reports that Slips, Trips & Falls make up the majority of
general industry accidents
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15% of all accidental deaths
2nd leading cause behind motor vehicles (~12,000 per year)
~25% of reported claims each year
Over 17% of all disabling occupational injuries result from falls
Total Annual Cost of Americans’ Low Back Pain = $50 billion (Liberty
Mutual Research Institute for Safety)
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Average cost of a lower back injury is over $38,000
Indirect costs
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30% less productive replacement workers
Higher stress levels
Disruption of other employees’ work
MOST COULD HAVE BEEN PREVENTED!
There’s a Meme for Everything
The Perils of Being a Runway Model
 Video
Costs – Slips, Trips, & Falls
 Cost to the Worker
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Lost Wages & Out-of-pocket Expenses
Pain
Temporary or Permanent Disability
Reduced Quality of Life
Depression
 Cost to the Employer
– Loss of Productivity & Business
– Increased Total Cost of Risk (Premiums, Loss
Control, Out-of-Pocket, Expense)
– Train Replacement or Temporary Workers
(and/or OT for Current Workforce)
Common Exposures – Slips, Trips, & Falls
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Happen Anywhere
Minor to Fatal Injuries
‘Hiding in Plain Sight’
Not Difficult to Prevent
Common Exposures – Slips, Trips, & Falls (continued)
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Spills (or Present on Footwear)
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Grease
Oil
Food
Dust & Powder
Cleaning Fluid
Wax
Weather Hazards
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Rain
Mud
Snow & Ice
Debris
Potholes, Broken Sidewalks, Raised/Depressed Steps
Common Exposures – Slips, Trips, & Falls (continued)
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Improper Housekeeping
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Facility Maintenance & Condition
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Cables & Cords
Loose Floor Coverings
Poor Lighting
Improper or Irregular Steps
Changes in Walking Surface Type or Level
Unguarded/Secured Openings
Missing/Improper Signage
Inattentiveness
Mounting/Dismounting Vehicles & Equipment
Worn Shoe Soles
Improper Ladder Use
Treating Exposures – Slips, Trips, & Falls
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Good Housekeeping Practices
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Proper Facility Maintenance & Condition
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Proper Lighting
Re-route Cables
Contain Leak or Spill
Report Uneven Walking Surfaces
Proper Signage
Industrial/Ergonomic Design Consultation/Planning
Routine Walkthroughs & Inspections
Ladders
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Use the Correct Type
Proper Setup
Inspect the Ladder
Tie Off or Hold
Don’t Reach Too Far
Treating Exposures – Slips, Trips, & Falls (continued)
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Behavioral Loss Control
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Slow Down
Pay Attention
Proper Footwear
‘Three Points of Contact’
‘Penguin Walk’
Learn to Fall Properly
Holland – Work This Way
 Video
Seems Safe Enough
The Perils of Weight Lifting
 Video
Common Exposures – Lifting Sprains & Strains
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Damage Over Time
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Lifting
Standing
Sitting
Bending
Twisting
Vibration
Bad Posture
Improper Lifting Technique
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Rushing
Frustration
Fatigue
Complacency
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Lifting Too Much Weight
Jarring Movements
Insufficient Recovery/Rest
Treating Exposures – Lifting Sprains & Strains
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Health/Strength
Proper Rest/Recovery
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American Medical
Assocation
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Warm Up
Stretch
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Proper Lifting Technique
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Habits – 21 to 60 Days
Constant Reminders – Tool
Box Talks
Safety Training
Lift Slowly and Smoothly
Carry Close to the Body
Lift with Legs and Not Back
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Cooperative Lifting
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Back Belts – Journal of the
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No link between using back
belts and reduced injury
Could mislead workers into
thinking they can lift more
weight
Lifting Aids
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Dollies
Hand Trucks
Mobile Tables
Bins
Star – Safe Lifting
 Video
TPA Best Practices – Picking a TPA
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Identify Your Needs
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What is Important to You and Your Operation?
What Kind of Administrative Tasks do You Want to Handle?
Transfer of Responsibility
Pricing vs. Bottom Line (Value)
Services Provided
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Claims Management
IT/MIS
Managed Care Programs
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Telephonic/Case Management
Medical Bill Review/Re-Pricing
Pharmacy Management
Judging Program Performance & TPA Value
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Decrease in Lost Time Claims?
Decrease in Total Claims?
Decrease in Severity?
Decrease in Cost Per Claim?
Decrease in Experience Rating?
Strength of Communication Between You and Your TPA/Carrier?
TPA Best Practices – Methods & Practices
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Proactive Approach
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Compensability Determination
Team Effort
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Communications
Collaboration
Process Implementation
CIB
Return to Work
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Early Claims Reporting
Primary Physician Assigned is Critical
Consistently Evaluate Progress
Full Return
Modified Duty
MMI Determination
Litigation Support
Combatting Opioid Abuse
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Facts
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Over 16,000 Americans died from prescription painkiller overdoses in
2013
In a 2014 study, the Workers’ Compensation Research Institute
reviewed 264,000 claims from 25 states and found 65-85% of injured
workers in most states received narcotic painkillers
Opioids are used to relieve pain and include oxycodone, hydrocodone,
& morphine
What can these drugs do besides relieve pain?
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Addiction
Can affect safety, health, productivity
Increase workers’ compensation costs
Cause confusion
Drowsiness
Nausea
People on Opioids should not be doing any safety sensitive work
because of its impairment potential
Combatting Opioid Abuse (continued)
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Team Approach to Reduce Opioid Use
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Educate Workers about the risks and hazards of opioid use
Injured employees should be their own advocate by asking the
doctors for prescriptions that may relieve pain without these
harmful side effects
Use Non- steroidal anti-inflammatory drugs like Ibuprofen and
naproxen
Employee should advise employer when on opioid medication if
they work in a sensitive position (Required by DOT if a CDL
driver)
Implementation
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Employer commitment to establish and monitor a drug policy
Drugs are prohibited and consequences of using them
Communication should be done at orientation, safety and training
sessions
Combatting Opioid Abuse (continued)
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If non-steroidal meds do not help or are
contraindicated, and consideration is being given for
opioid then consider both long and short acting
prescriptions
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Do Urine testing for use of methadone, cocaine,
benzodiazepines, opiates, oxycodone, amphetamines and
tetrahydrocannabinol for all visits if opioids are to be considered
Check State RX data base. R/O doctor and pharmacy shopping
If system is clean of these drugs above and only choice is for an
opioid, ONLY GIVE up to a 7 day supply
NOT 30 to relieve intense pain
Reduce dosage to lowest dosage possible
Make sure patient is not selling/distributing medications
Discuss lowest pain tolerance patient can live with (1-10)
Tolerance vs. Addication
Consider suboxone for addiction
Combatting WC Fraud – Case Study
 Facts
– Employee is a 47 year old teacher who
alleged he sustained an injury to his right
leg, right shoulder, back and teeth when
he fell over a chair during a black-out at
the school on November 11, 2010.
– Based on the claim submission, it
appeared that the claim was not
suspicious.
– The employee reported the injuries to his
right leg and right shoulder in a timely
manner and completed the accident
report.
Combatting WC Fraud – Case Study (continued)
– On November 11, he was interviewed by the case manager who asked the
following questions:
• Injured area?
• Answered- right knee and right shoulder
• Any prior injury to this body part?
• Answer NO
– Treatment for these injuries commenced.
– A few weeks later, the employee stated he forgot to mention that he struck his
face and knocked out a tooth
Combatting WC Fraud – Case Study (continued)
– The claim for his teeth was inconsistent with what he originally stated. He had no
visible signs of facial injury
– On December 29, 2010 the employee had an MRI of the right knee. The report
indicated “that there was no significant change from the prior examination”.
– The case manager called the MRI facility and had the prior MRI report faxed over
for review
– The employee had an MRI of the right knee on October 22, 2010, three weeks
prior to the work accident
Combatting WC Fraud – Case Study (continued)
– We subpoenaed the records from the doctor who ordered the MRI. The records
revealed the employee was treating with his personal doctor for several months
prior to the work accident for the same identical complaints and pathology
– The injury to the right knee was denied, but treatment to the shoulder was
authorized
– The authorized treating doctor was seeking authorization for surgery for the
right shoulder and both knees. The doctor was informed no additional
treatment would be authorized for the right knee and we do not accept the left
knee claim
Combatting WC Fraud – Case Study (continued)
– We instructed our defense attorney to file a fraud motion with the
compensation court because of the lies and omissions of material facts by the
employee
– At the hearing the judge believed the seriousness of the claim of fraud under
the statute and suggested a section 20 dismissal
– If the claim was considered totally compensable, the value would be around
$150,000 (the need for three surgeries and permanent partial award) with
reopening rights in two years from date of last compensation payment
– After extensive discussions between the employee and his attorney, they finally
agreed to accept a nominal settlement of $5,000 under a section 20 dismissal;
otherwise a trial would ensue for fraud and would have severe employment
consequences for the employee
WC Case Study
Switch to Inservco Case Study Presentation
Using Data to Improve WC Underwriting Results
Switch to Verisk Date to Improve WC
Underwriting Results Presentation
We Can’t Let This Happen
Q&A
Questions