Report to the San Francisco Workers Compensation Council Peggy - - PowerPoint PPT Presentation

Peggy Sugarman Workers’ Compensation Director

Report to the San Francisco Workers’ Compensation Council

June 4, 2018

Agenda

• Accomplishments & Initiatives

– Banking Modernization Project

• Performance Quick Facts
• Claim Analytics
• Financials

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Accomplishments & Initiatives

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Accomplishments & Initiatives

 Pharmacy Benefit Management Program: 2,396 Cards Issued (approximately 33% of open claims)  >140 Monthly Department Chargeback and Loss Run Reports automated in early May, reducing ongoing manual report processing  Implementation of Batch Payment Processing functionality in iVOS claims system to significantly reduce manual processing effort  Successfully integrated DSW employee ID into iVOS claims system, enhancing reporting

• ptions that preserve confidentiality and minimize use of SSNs

 Overhauled employee import from eMerge HRIS database to improve the quality of data fed into claim records at claim setup, and update outdated job classifications  Set up an interdepartmental networking group to discuss best WC practices

• Section 111 Medicare reporting compliance audit schedule in progress
• On-line office ergonomic training in partnership with DPH, Workforce Development, HSS

and WCD scheduled to launch July 1, 2018

• Data reporting dashboard for departments to advise of claim costs, frequency, and
• pportunities for enhancing safety nearing completion
• Request for Qualifications for Document Retrieval/Copy Services closed on June 1
• Banking modernization program is on track for phase one implementation on July 1

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Banking Modernization

• Phase One: Account Migration to US Bank is on schedule for July 1, 2018
• Phase One improvements focus on improving operations, and include:

– Automation of Positive Pay; FSP integration for automated bank reconciliation; elimination of a complex manual process for daily funding of benefit payments; automated accounting entries for disbursed benefit payments – Positive Pay service is expanded to include payee name, enhancing fraud controls – Account formation transforms to a Master Zero Balance Account and subsidiary disbursement accounts, reducing administrative risk of accounting errors that cause WC administrative penalties and bank fees; and maximizing City funds in higher yielding accounts for as long as possible prior to disbursement

• Phase Two (expected Q2) and Phase Three (expected Q3) activate electronic

payments for vendors/injured workers, and medical providers (respectively). These phases will deliver further improvements and lower processing costs for the 295,000 annual payments and 80,000 checks issued annually by the Division.

• The overall project is anticipated to lower direct costs by more than $100,000 per

year, significantly reduce paper waste for remittance and explanation of review mailings, offer greater flexibility and convenience to all participants in the system, and significantly enhance the use of technology and automation to reduce manual effort in all financial processing activities.

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Performance Quick Facts

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FY18 Q3 Performance Quick Facts

FY18: 92% (estimate) FY17: 94%

Benchmark: 95%

472 Indemnity Claims 351 Medical Claims

Benchmark: 404 Indemnity Claims/Quarter 267 Medical Claims/Quarter

Indemnity: $14,597 Medical: $500

Benchmark: Indemnity: $15,818 Medical: $600

234 Days

Benchmark: 377 Days

Fiscal Health Ratio of Actuals to Budget Claim Volume Count of New Claims in Period Duration

Average Days Open of Claims Closed in Period

Claim Cost

Average Cost of Claims Closed in Period

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Claim Analytics

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Claim Filing Frequency

FY15-17 FY18Q3 FY18Q3 Increase / Decrease Department Average Indemnity Claims Per Quarter Average Medical Claims Per Quarter Average Indemnity + Medical Claims Per Quarter Total Indemnity Claims Total Medical Claims Total Indemnity + Medical Claims Indemnity Medical Indemnity + Medical Department of Public Health 90 100 190 88 133 221

• 2 or -3%

33 or 33% 31 or 16% Police 81 45 126 102 45 147 21 or 25% 0.5 or 1% 21 or 17% Fire 70 16 77 84 20 104 23 or 38% 4 or 26% 27 or 35% Sheriff 37 8 45 38 19 57 1 or 2% 11 or 138% 12 or 26% Human Services 20 14 34 20 13 33 0 or 0%

• 0.8 or -5% -0.8 or -2%

Recreation & Parks 19 21 39 19 22 41 0.3 or 1% 2 or 7% 2 or 4% SF Airport 19 14 32 34 21 55 15 or 83% 7 or 52% 23 or 70% Department of Public Works 14 15 29 11 18 29

• 3 or -22%

3 or 23% 0.3 or 1% PUC-Water 8 7 14 11 10 21 3 or 43% 3 or 50% 7 or 47% Water Pollution Control 6 4 10 5 7 12

• 1 or -21%

3 or 96% 2 or 21% Citywide 405 267 672 471 352 823 66 or 16% 85 or 32% 151 or 22%

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Claims Incurred Per 100 FTE

5 10 15 20 25 2014 2015 2016 2017 2018 (Est.)

Top 10 Departments

Police Sheriff Fire Department of Public Health Citywide SF Airport Department of Public Works Recreation & Parks Human Services Agency Water Pollution Control PUC-Water

Notes:

• 1. 2018 (Est.) reflects a straight line of Q1-Q3 claim volume for four quarters

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Claims Incurred Per 100 FTE

Department 2014 2015 2016 2017 2018 (Est.) Police 23 20 23 23 21 Sheriff 22 21 23 20 21 Fire 22 21 19 19 22 Department of Public Health 12 12 12 11 13 Citywide 12 11 11 11 12 SF Airport 9 10 10 10 11 Department of Public Works 9 10 11 9 9 Recreation & Parks 9 9 9 9 10 Human Services Agency 9 7 6 6 7 PUC-Water 4 3 3 3 4 Water Pollution Control 3 2 2 2 1

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Claim Cause Distribution

50 100 150 200 250 Bodily Motion Exposure Fall, Slip or Trip Cumulative Trauma Struck By/Against Physcial Assault Abrasion Caught In, Under, Between Misc Vehicle Accident

Top 10 Claim Cause Groups by Frequency – New Claims in Q3 2017-18

Recreation & Parks Public Health Sheriff Fire All Other Departments Police

Notes:

• 1. Claim cause group definitions are listed in Appendix 1

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50 100 150 200 250 300 350 400 450 500

Recreation & Parks Public Health Sheriff Fire All Other Departments Police

Notes:

• 1. $100K+ Total Incurred = $305.4 Million
• 2. All policy years for which incurred costs >$100k/claim

Open Claim Stratification

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Open Claim Stratification

1,294 Claims >$100k $305.4 Million

Data as of 5/10/2018 $98.4M, 32% $52.8M, 17% $39M, 13% $31M, 10% $11.8M, 4% $72.3M, 24%

Note: Dollar figures in millions

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Litigation Statistics

Open Indemnity Claims Added from FY14- FY18Q3 Represented Claims Represented % Litigated Claims Litigated % Police 392 179 46% 210 54%

Review of open, litigated claims is underway to ensure litigation variable is applied correctly. More data will be available in the Q4 presentation.

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Financials

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Department Expenditure Trends

Department FY17 Budget FY17 Actuals FY18 Budget FY18 Estimated YE Actuals FY18 Variance Surplus/(Deficit)

Police $14,668,764 $16,743,129 $15,691,689 $21,866,069 ($6,174,380) Department of Public Health $12,904,369 $10,292,642 $12,026,726 $11,247,093 $779,633 Fire $9,384,808 $8,755,681 $9,354,940 $7,888,373 $1,466,567 Sheriff $4,886,461 $6,454,201 $5,630,186 $5,464,563 $165,623 Department of Public Works $4,287,435 $2,951,404 $3,598,881 $1,644,558 $1,954,323 Recreation & Parks $3,341,363 $3,206,124 $3,569,246 $1,871,793 $1,697,453 Human Services $2,999,490 $2,263,476 $2,901,364 $2,675,118 $226,246 PUC-Water $2,277,709 $2,258,236 $2,504,098 $1,664,538 $839,560 San Francisco Airport $2,114,957 $2,325,591 $2,494,467 $2,166,143 $328,324 Juvenile Probation $1,192,594 $1,024,725 $1,079,467 $729,156 $350,311 Total Top Ten Departments $58,057,950 $56,275,209 $58,851,064 $57,217,404 $1,633,660 Total of All City Departments $68,653,840 $64,635,152 $69,378,135 $63,851,421 $5,526,714

Notes:

• 1. Expenditures exclude LC 4850 salary continuation benefits, and include program admin/overhead
• 2. All budget figures are Original Budget and do not include carry forwards

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Costs by Expenditure Category

FY17 Actuals FY18 Actuals YTD FY18 Est. YE Actuals YOY Change (%)

INDEMNITY Temporary Disability $8,354,164 $7,348,775 $8,093,719

• 3%

Permanent Disability $16,086,996 $14,412,190 $16,323,151 1% TOTAL INDEMNITY $24,441,160 $21,760,964 $23,966,870

• 2%

MEDICAL Hospitalization $6,601,290 $8,496,643 $9,357,946 42% TOTAL MEDICAL $22,282,032 $23,353,744 $25,721,109 15% VOCATIONAL REHABILITATION $257,602 $214,344 $236,072

• 8%

EXPENSE $3,862,338 $2,703,208 $3,127,232

• 19%

RECOVERY

• $881,443
• $646,565
• $712,107
• 19%

GRAND TOTAL $49,961,688 $47,385,695 $52,103,104 4%

Notes:

• 1. Expenditures exclude LC 4850 salary continuation benefits and program administration (overhead)
• 2. Expenditures reflect benefit payments and do not include overhead, as is represented in totals on the previous slide

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Appendix

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Appendix 1: Claim Cause Group Definitions

Claim Cause Group Definition Type(s) of Injury

Abrasion

Injuries sustained as a result of rubbing against a rough surface/wall Skin

Bodily Motion Injuries sustained due to physical motion, such as bending, lifting, reaching, pulling/pulling, twisting/turning, etc.

Primarily orthopedic injuries.

Caught In, Under, Between Injuries that have occurred due to being pinned by, under or between objects, furniture, or equipment. This includes injuries occurring as a result of a cave-in.

Orthopedic injuries, lacerations, crush injuries.

Cumulative Trauma Use for repetitive stress injuries due to repeated exposure over time.

Single or multiple body parts used in repeated exposure over a period of time – eg. carpal tunnel, prolonged standing, psyche stress.

Explosion Used for injuries sustained as a result of an explosion.

Orthopedic, burns, internal, catastrophic injuries, etc.

Exposure Used for various internal injuries, such as repeated exposure to carcinogens, stressful work situation, or hard physical work leading to a negative bodily

• reaction. This can also include reactions to poisonous
• r toxic substances.

Cancer, heart trouble, internal injuries or exposure to poison oak, MRSA, or heat stroke. Also may include foreign substance into eyes or body, or bloodborne pathogen exposure.

Fall, Slip or Trip Injuries sustained from a slip and fall, or trips and slips. This includes falls from elevation, from stairs, ladders,

• nto walkways, etc.

Single or multiple body parts, resulting in sprains, strains, contusions, lacerations, fractures, etc.

Ingestion Injury sustained due to ingesting harmful substance.

Internal/exposure.

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Appendix 1: Claim Cause Group Definitions, Cont.

Claim Cause Group Definition Type(s) of Injury

Misc Miscellaneous injury not covered in other areas or rarely filed

Misc

Personal Injury/Illness Injury that is nonoccupational in nature, but aggravated or exacerbated by work.

Personal injury of a orthopedic or internal nature.

Physical Assault Injuries sustained due to physical altercations (being struck or striking person or people).

Single or multiple body parts involved. Results in lacerations, sprains, strains, fractures, abrasions, even internal injuries.

Stress Injuries sustained due to work related stress.

Primarily psychological/psychiatric injuries, including any resulting physical symptoms.

Struck By/Against Injuries when objects are thrown at employees, when an employee is hit by a random moving machine part

• r object; or collides with an object such as a door or

piece of furniture.

Orthopedic or head injuries

Suffocated Injuries sustained due to suffocation, such as during a fire.

Respiratory injuries, smoke inhalation. May

• verlap with Exposure.

Vehicle Accident Injuries sustained due to a vehicle, including vehicle/pedestrian accident or incident. This may be car or truck, motorcycle, bicycle, scooter, etc.

Orthopedic, single or multiple body parts, head, internal

Vibration Injuries sustained due to vibration or seismic event, such as an earthquake.

Orthopedic, internal, head, etc.

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Appendix 2: Claim Cause Definitions

Claim Cause Group Claim Cause When Used

Abrasion ABRASION/RUBBED Injuries sustained as a result of rubbing against a rough surface/wall Bodily Motion BENDING/STOOPING Bending down to tie shoes, etc. Bodily Motion LIFTING Injuries from lifting weights, desks, tables, equipment, etc. Bodily Motion PUSHING/PULLING Pushing or pulling of furniture, equipment or patients. Bodily Motion REACHING Reaching for equipment resulting in hyperextension of extremities, etc. Bodily Motion RUNNING/WALKING Injuries while running (during exercise or running after suspects), stepping off a curb the wrong way, injuries while walking. Bodily Motion THROWING/WIELDING Injury sustained during baton-use exercise or other use of equipment in a throwing or maneuvering type motion. Bodily Motion TWISTING/TURNING Injuries resulting from exiting vehicle, maneuvering in small spaces, etc. Caught In, Under, Between CAUGHT IN, UNDER, BETWEEN Injuries as a result of being pinned under, or between objects, furniture, or equipment. Caught In, Under, Between CAVE IN Injuries sustained due to being crushed by collapsing debris, such as in a tunnel or collapsing building in a fire. Cumulative Trauma CONTINUOUS TRAUMA For repetitive stress injury due to repeated exposure over time. Cumulative Trauma REPEATED MOTION Repetitive stress injury due to continued motion (typing, etc.). May be used interchangeably with CONTINUOUS TRAUMA Cumulative Trauma REPEATED TRAUMA same as CONTINUOUS TRAUMA Explosion EXPLOSION Injuries when bombs are set off during demonstrations and protest or fireworks during celebrations. Also may be a gas/fire explosion. Workers' Compensation Council Meeting June 4, 2018 22

Appendix 2: Claim Cause Definitions, Cont.

Claim Cause Group Claim Cause When Used

Exposure ADVERSE REACTION Dizziness/Fatigue/Headaches due to heat exposure, intense exercise, dehydration, etc. Also could be an allergic reaction or exposure to poisonous substance. Exposure BODILY REACTION The body's reaction to repeated exposures to carcinogens, stressful work situations, hard physical work. This could also be an allergic reaction to a poisonous substance or toxic substance. Exposure CONTACT INFECTIOUS AGENT Needle Sticks, Exposure to blood borne pathogens (blood, saliva, urine, etc.) Exposure CONTACT WITH CHEMICALS Exposure to Toxin, chemicals Exposure CONTACT WITH ELECTRICITY Electrocution Exposure CONTACT WITH EXTREME TEMPERATURE Injuries sustained during firefighting or working in extreme heat. Exposure Contact with Radiation Exposure DERMAL Dermatitis due to contact with poison oak, poison ivy, etc. Exposure FOREIGN SUBSTANCE Object/s getting into the eyes Exposure INHALATION Injuries from smoke inhalation during firefighting, or inhaling chemical vapors Exposure SPLASHED Refers to when liquid splashes onto eyes or body. Overlaps with CONTACT INFECTIOUS AGENT. Fall, Slip or Trip FALL FROM CHAIR Sitting and falling off chair. Chair might have slid from underneath claimant. Fall, Slip or Trip FALL FROM ELEVATION Fall from a height, such as from a roof. Fall, Slip or Trip FALL FROM LADDER Injuries while falling off ladder. Workers' Compensation Council Meeting June 4, 2018 23

Appendix 2: Claim Cause Definitions, Cont.

Claim Cause Group Claim Cause When Used

Fall, Slip or Trip FALL FROM STAIRS Injuries resulting from falling down stairs or steps. Fall, Slip or Trip FALL FROM VEHICLE Injuries due to an officer falling off a police motorcycle or bicycle. Fall, Slip or Trip FALL ONTO AGAINST OBJECTS Filed if someone fell onto a certain object or machine, or against an object or machine such as gurneys and side tables Fall, Slip or Trip FALL SAME LEVEL Slip and Fall due to wet floor,slippery floo. Also used for an employee falling onto the ground (similar to Slip/Trip) Fall, Slip or Trip FALL SCAFFOLD/WALKWAY Fall from scaffolding/walkway Fall, Slip or Trip SLIP / TRIP Slipping on wet surface or tripping over object on the floor. Ingestion INGESTION Sustained due to drinking/eating harmful substance such as chemicals Misc EVENT TYPE (NEC) Misc FAULTY EQUIPMENT Injuries from defective chairs, tables and other equipment Misc FAULTY ROADWAY MTA Injury sustained due to road/street defect such as sinkhole or large pothole. Track/Track issues Misc UNASSIGNED Personal Injury/Illness PERSONAL INJURY/ILLNESS Injury or illness of a nonindustrial nature but filed as EE was at work (or aggravated by work). Physical Assault ASSAULT, PHYSICAL Used for physical assaults by the public, by patients/detainees, or between employees in a Workplace Violence setting Stress ASSAULT, MENTAL/VERBAL Altercation between co-workers, with the public, patients, etc. Overlaps with STRESS, RELATIONAL CONFLICT Workers' Compensation Council Meeting June 4, 2018 24

Appendix 2: Claim Cause Definitions, Cont.

Claim Cause Group Claim Cause When Used

Stress RELATIONAL CONFLICT Stress as a result of interpersonal conflicts at work (with Supervisor and/or co-workers) Stress STRESS MTA MTA uses this for all stress claims Struck By/Against COLLISION Running into another person at the office, striking a body part (e.g., nose) against another object, Hallway and door collisions Struck By/Against STRUCK BY FALLING OBJECT Injuries resulting from fighting fires or being hit by an object. Struck By/Against STRUCK BY MOVING OBJECT Injuries when objects are thrown at employees. May overlap with PHYSICAL ASSAULT. Also if EE is hit by a random moving machine part or object. Suffocated SUFFOCATED Fighting fires Vehicle Accident VEHICLE ACCIDENT Motor Vehicle Accidents (City Vehicles, motorcycles), rear-enders, collision with other vehicles Vehicle Accident VEHICLE OVERTURNED Use VEHICLE ACCIDENT Vehicle Accident VEHICLE RAN OFF ROADWAY Use VEHICLE ACCIDENT Vehicle Accident VEHICLE SUDDEN START/STOP Use VEHICLE ACCIDENT Vibration VIBRATION Earthquake Workers' Compensation Council Meeting June 4, 2018 25

Workers’ Compensation Council

Workers’ Compensation Loss Summary June 4, 2018

Claim Volumes

NEW CLAIMS BY TYPE CLAIM TYPE FY 17- 18 July August September October November December January February April May June FY Total Monthly Average INDEMNITY # 51 54 40 45 57 32 44 52 44 459 46 MEDICAL ONLY # 3 6 5 11 13 7 12 10 13 86 9 OTHER # 2 1 3 3 3 3 2 1 3 26 3 INDEMNITY % 91.07% 88.52% 83.33% 76.27% 78.08% 76.19% 75.86% 82.53% 73.33% 81.36% 80.70% MEDICAL ONLY % 5.35% 9.83% 10.41% 18.64% 17.80% 16.66% 20.68% 15.87% 21.66% 14.35% 15.78% OTHER % 3.58% 1.65% 6.26% 5.09% 4.12% 7.15% 3.46% 1.60% 5.01% 4.29% 3.52% CLAIM TYPE FY 16- 17 July August September October November December January February April May June FY Total Monthly Average INDEMNITY # 46 41 38 46 36 41 40 36 53 60 63 547 46 MEDICAL ONLY # 6 9 8 4 5 4 4 8 9 5 6 81 7 OTHER # 5 5 1 1 1 1 5 3 22 2 INDEMNITY % 88.46% 74.54% 74.50% 90.19% 85.71% 91.11% 90.90% 80% 84% 86% 87% 83% 85% MEDICAL ONLY % 11.54% 16.36% 15.68% 7.84% 11.90% 8.89% 9.10% 17.77% 14% 7% 8% 14% 13% OTHER % 0.00% 9.10% 9.82% 1.97% 2.39% 0.00% 0.00% 2.33% 2% 7% 5% 3% 2% CLAIM TYPE FY 15- 16 July August September October November December January February April May June FY Total Monthly Average INDEMNITY # 40 51 44 56 32 58 45 52 50 39 39 565 47 MEDICAL ONLY # 6 9 3 7 8 7 2 12 9 7 8 84 7 OTHER # 3 2 1 2 1 1 2 3 17 1 INDEMNITY % 81.63% 85.00% 93.62% 86.15% 80% 87.87% 91.84% 80% 83% 81% 78% 85% 84% MEDICAL ONLY % 12.24% 15.00% 6.38% 10.77% 20% 10.60% 4.08% 18.46% 15% 15% 16% 13% 12% OTHER % 6.12% 0.00% 0.00% 3.08% 0.00% 1.53% 4.08% 1.54% 2% 4% 6% 2% 4% CLAIM TYPE FY 14- 15 July August September October November December January February April May June FY Total Monthly Average INDEMNITY # 31 32 43 42 35 42 40 34 36 32 45 443 36.92 MEDICAL ONLY # 3 4 5 9 4 6 7 5 7 8 7 74 6.17 OTHER # 1 1 3 1 3 1 2 2 1 16 1.33 INDEMNITY % 91.18% 86.49% 87.76% 77.78% 89.74% 85.71% 80.00% 85.00% 80.00% 76.19% 84.91% n/a 83.36% MEDICAL ONLY % 8.82% 10.81% 10.20% 16.67% 10.26% 12.24% 14.00% 12.50% 15.56% 19.05% 13.21% n/a 13.77% OTHER % 0.00% 2.70% 2.04% 5.56% 0.00% 2.04% 6.00% 2.50% 4.44% 4.76% 1.89% n/a 2.86% CLAIM TYPE FY 13- 14 July August September October November December January February April May June FY Total Monthly Average INDEMNITY # 40 50 35 42 43 27 32 27 47 35 41 451 37.58 MEDICAL ONLY # 10 13 8 2 3 6 3 6 9 6 4 77 6.42 OTHER # 2 4 1 4 1 3 1 1 18 1.5 INDEMNITY % 76.92% 74.63% 79.55% 87.50% 91.49% 81.82% 91.43% 75.00% 82.46% 85.37% 89.13% n/a 82.94% MEDICAL ONLY % 19.23% 19.40% 18.18% 4.17% 6.38% 18.18% 8.57% 16.67% 15.79% 14.63% 8.70% n/a 13.95% OTHER % 3.85% 5.97% 2.27% 8.33% 2.13% 0.00% 0.00% 8.33% 1.75% 0.00% 2.17% n/a 3.11% Data prior to March 2013 is drawn from Sedgwick data as reported in HR Monthly Reports Other # = First Aid, Future Medical, Reported

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Claim Volumes

CLAIMS REOPENED FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2017-2018 3 3 8 7 11 4 9 6 13 3 67 7 FY 2016-2017 11 12 8 3 6 7 2 8 4 9 13 9 92 3 FY 2015-2016 8 7 4 7 4 6 6 6 18 8 7 11 92 8 FY 2014-2015 8 14 5 15 5 3 10 12 7 6 5 7 97 8 FY 2013-2014 8 15 13 13 10 10 16 12 6 7 9 4 123 10 FY 2012-2013 6 14 10 17 11 9 13 11 18 16 10 135 11 CLAIMS CLOSED FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2017-2018 52 69 51 53 50 98 58 70 70 69 640 64 FY 2016-2017 48 67 59 61 68 75 47 60 67 70 62 73 757 63 FY 2015-2016 46 53 45 82 41 99 35 62 72 82 75 69 761 63 FY 2014-2015 41 57 54 69 67 81 54 47 46 54 57 44 671 56 FY 2013-2014 110 88 61 254 74 71 50 52 41 64 57 48 970 81 FY 2012-2013 66 39 17 60 31 36 2 6 52 120 68 497 41 CLOSING RATIO FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2017-2018 88% 108% 91% 80% 60% 213% 87% 101% 109% 110% 100% 105% FY 2016-2017 76% 100% 100% 113% 136% 144% 102% 113% 105% 97% 75% 90% 102% 104% FY 2015-2016 80.70% 79.10% 88.24% 113.89% 93.18% 137.50% 63.63% 87.32% 84.70% 120.58% 136.36% 113.11% 100% 100% FY 2014-2015 97.62% 111.76% 100.00% 100.00% 152.27% 155.77% 90.00% 90.38% 95.83% 105.88% 121.28% 73.33% 107% 108% FY 2013-2014 183.33% 107.32% 107.02% 416.39% 129.82% 165.12% 98.04% 108.33% 89.13% 100.00% 114.00% 96.00% 145% 143% FY 2012-2013 106.45% 49.37% 32.08% 81.08% 43.06% 64.29% 3.17% 0.00% 11.32% 82.54% 173.91% 133.33% n/a 65% CLAIMS PENDING EOM FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2017-2018 1,620 1,615 1,620 1,633 1,667 1,615 1,624 1,623 1,617 1,611 1,611 1,625 FY 2016-2017 1,643 1,643 1,643 1,636 1,616 1,593 1,592 1,585 1,582 1,584 1,605 1,613 1,613 1,611 FY 2015-2016 1,642 1,656 1,662 1,652 1,655 1,628 1,648 1,657 1,670 1,656 1,636 1,628 n/a 1,514 FY 2014-2015 1,673 1,667 1,667 1,667 1,644 1,615 1,621 1,626 1,628 1,625 1,615 1,631 n/a 1,640 FY 2013-2014 1,923 1,917 1,913 1,720 1,703 1,675 1,676 1,672 1,677 1,677 1,670 1,672 n/a 1,741 FY 2012-2013 1,729 1,769 1,805 1,819 1,860 1,880 1,941 1,983 2,030 2,041 1,990 1,973 n/a 1,902 Data prior to March 2013 is drawn from Sedgwick data as reported in HR Monthly Reports Other # = First Aid, Future Medical, Reported

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Lag Time Report

ROLLING 12 REPORTING MONTHS - INJURIES BY DIVISION

DIVISION NAME CLAIM FREQUENCY Days Between Employer Knowledge and Reported to TPA Days Between DOI and Received by TPA ADMIN., TAXIS & ACCESIBLE SERV. 4 1.25 1.25 ADMINISTRATION 8 20.92 44.00 Administration & Finance 2 0.71 1.79 CABLE CAR & RAIL SYSTEMS 12 135.08 135.12 CHIEF MECHANICAL OFFICER (BUS SECTION) 4 39.83 39.83 CHIEF MECHANICAL OFFICER (RAIL SECTION) 2 0.38 0.38 CITATION DIVISION 1 0.24 0.24 COMMUNICATIONS MAINTENANCE SECTION 1 0.21 0.21 DIESEL MAINTENANCE 20 8.76 10.09 DIRECTOR OF TRANSIT OPS 2 0.05 0.05 DIVISION OF SUSTAINABLE STREETS 29 1.25 2.45 ELECTRICAL MAINTENANCE 29 19.32 19.57 ENFORCEMENT SERVICES 53 1.25 2.71 EXECUTIVE DIRECTOR/CEO 2 0.05 0.05 FINANCE, ADMIN., INFORMATION TECH. 7 0.28 0.32 Islais Creek 2 0.06 0.06 LEGISLATIVE AFFAIRS 0.00 0.00 MAINTENANCE / UNASSIGNED 3 0.01 0.08 MAINTENANCE DIVISION 17 1.36 6.83 Muni Metro East 16 2.15 2.18 OPERATIONS / UNASSIGNED 31 6.67 7.17 Parking Authority 8 0.31 0.37 SAFETY, SECURITY & ENFORCEMENT 29 2.79 6.89 STRUCTURE & WAYS 6 0.06 0.06 TAXI COMMISSION 2 0.13 0.18 TECHNICAL SERVICES 0.00 0.00 TRANSPORTATION DIVISION (TRAN) 389 12.70 16.06 Not yet assigned 34 1.97 1.97 Grand Total 713 29.98 37.61

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Financials

FY 2016/2017 Ten Month Expenditures FY 2017/2018 Ten Month Expenditures Increase/Decrease % of Change

INDEMNITY Temporary Disability $9,052,428 $9,603,850 $551,422 6.09% Permanent Disability $2,589,227 $2,813,060 $223,833 8.64% Total Indemnity $11,641,655 $12,416,910 $775,255 6.66% Vocational Rehabilitation Total Vocational Rehabilitation $102,406 $87,214 ($15,192)

• 14.84%

MEDICAL Total Medical $6,359,908 $5,935,277 ($424,631)

• 6.68%

EXPENSE Total Expense $1,305,435 $1,135,791 ($169,644)

• 13.00%

RECOVERY Total Recovery Processed ($586,910) ($114,913) $471,997

• 80.42%

GRAND TOTAL $18,822,494 $19,460,279 $637,785 3.39%

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Financials

Open Claims Stratification: $100K+ Total Incurred = 637

50 100 150 200 250 100k- 150K 150k- 200K 200k- 250K 250k- 300K 300K- 350K 350K- 400K 400k- 450K 450k- 500K 500k- 550K 550k- 600K 600k- 650K 650k- 700K 700k- 750K 750k- 800K 800k- 850K 850k- 900K 900k- 950K 950K- 1M 1M+ Total 215 132 106 43 37 16 16 15 6 1 5 6 9 2 3 1 3 3 18 215 132 106 43 37 16 16 15 6 1 5 6 9 2 3 1 3 3 18

Open Claims Stratification by Severity All Policy Years $100K+ Incurred Claims

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Litigation Statistics

Confidential Information- 4-30-18

LITIGATION RATIO FISCAL YEAR 2017-2018 July August September October November December January February March April May June Open Litigated Claims* 399 409 429 429 428 418 423 423 429 428 Open Indemnity Claims* 1,077 1,085 1,081 1,094 1,117 1,082 1,079 1,084 1,073 1,079 Litigated Ratio 37.05% 37.70% 39.69% 39.21% 38.32% 38.63% 39.20% 39.02% 39.98% 39.67% #DIV/0! #DIV/0! FISCAL YEAR 2016-2017 July August September October November December January February March April May June Open Litigated Claims* 358 393 383 387 388 386 385 389 391 377 389 391 Open Indemnity Claims* 1080 1129 1106 1096 1076 1058 1045 1042 1037 1038 1,052 1,065 Litigated Ratio 33.15% 34.81% 34.63% 35.31% 36.06% 36.48% 36.84% 37.33% 37.70% 36.32% 36.98% 36.71% FISCAL YEAR 2015-2016 July August September October November December January February March April May June Open Litigated Claims* 412 406 403 397 384 385 384 378 371 366 377 364 Open Indemnity Claims* 1113 1121 1128 1129 1046 1098 1127 1130 1135 1114 1105 1076 Litigated Ratio 37.02% 36.22% 35.73% 35.16% 36.71% 35.06% 34.07% 33.45% 32.69% 32.85% 34.12% 33.83% FISCAL YEAR 2014-2015 July August September October November December January February March April May June Open Litigated Claims* 490 477 468 464 460 455 445 440 441 437 427 422 Open Indemnity Claims* 1116 1100 1112 1119 1127 1108 1119 1122 1113 1122 1106 1121 Litigated Ratio 43.91% 43.36% 42.09% 41.47% 40.82% 41.06% 39.77% 39.22% 39.62% 38.95% 38.61% 37.64% FISCAL YEAR 2013-2014 July August September October November December January February March April May June Open Litigated Claims* 653 636 619 612 607 600 592 571 559 525 514 507 Open Indemnity Claims* 1250 1219 1194 1190 1209 1176 1162 1149 1138 1110 1108 1126 Litigated Ratio 52.24% 52.17% 51.84% 51.43% 50.21% 51.02% 50.95% 49.70% 49.12% 47.30% 46.39% 45.03% FISCAL YEAR 2012-2013 July August September October November December January February March April May June Open Litigated Claims* 760 736 686 681 Open Indemnity Claims* 1427 1403 1320 1304 Litigated Ratio 53.26% 52.46% 51.97% 52.22% *Does not include Future Medical Claims Data prior to March 2013 is unreliable and is excluded

Workers' Compensation Council Meeting June 4, 2018 32

Cause Analysis

CLAIM CAUSE ANALYSIS

BY FREQUENCY

10 20 30 40 50 60 70 80 90 Repeated Motion Assault/ Physical Vehicle Accident Twisting/ Turning Collision Pulling/ Pushing Fall Same Level (NEC) Stress-MTA Continuous Trauma Struck By Moving Object Total 44 82 47 40 35 51 32 32 45 23 44 82 47 40 35 51 32 32 45 23

Top 10 Claim Causes by Frequency Rolling 12 Reporting Months

Workers' Compensation Council Meeting June 4, 2018 33

Cause Analysis

CLAIM CAUSE ANALYSIS

BY SEVERITY

$0 $200,000 $400,000 $600,000 $800,000 $1,000,000 $1,200,000 $1,400,000 $1,600,000 $1,800,000 $2,000,000 Repeated Motion Assault/ Physical Vehicle Accident Twisting/ Turning Collision Pulling/ Pushing Fall Same Level (NEC) Stress- MTA Continuou s Trauma Struck By Moving Object Total $764,803 $1,838,598 $1,079,001 $704,134 $743,595 $1,047,044 $379,070 $324,693 $762,947 $1,278,141 $764,803 $1,838,598 $1,079,001 $704,134 $743,595 $1,047,044 $379,070 $324,693 $762,947 $1,278,141

Top 10 Claim Causes by Severity Rolling 12 Reporting Months

Workers' Compensation Council Meeting June 4, 2018 34

Cost Analysis

CLAIMS CLOSED - ROLLING 12 REPORTING MONTHS ENDING 4/30/2018 CLAIM CAUSE DESCRIPTION CLOSED CLAIMS TOTAL COST OF CLOSED CLAIMS AVERAGE TOTAL COST PER CLAIM AVERAGE DURATION OF CLAIM (MONTHS) AVERAGE COST PER CLAIM PER MONTH CLAIM CAUSE DESCRIPTION CLOSED CLAIMS TOTAL COST OF CLOSED CLAIMS AVERAGE TOTAL COST PER CLAIM AVERAGE DURATION OF CLAIM (MONTHS) AVERAGE COST PER CLAIM PER MONTH ABRASION/RUBBED 11 $114,184 $10,380 8.87 $865.03 FAULTY ROADWAY-MTA $0 $0 $0.00 ADVERSE REACTION 13 $574,207 $44,170 51.45 $3,680.81 Foreign Substance 13 $23,475 $1,806 2.73 $150.48 ASSAULT, MENTAL/VERBAL 9 $130,744 $14,527 10.54 $1,210.59 INGESTION 1 $781 $0 1.15 $0.00 ASSAULT, PHYSICAL 69 $1,721,812 $24,954 19.37 $2,079.48 INHALATION 8 $7,299 $912 2.85 $76.03 BENDING, STOOPING 10 $56,351 $5,635 12.26 $469.59 LIFTING 14 $211,826 $15,130 16.54 $1,260.87 BODILY REACTION 28 $2,357,268 $84,188 50.8 $7,015.68 Personal Injury/Illness 4 $428 $107 1.55 $8.92 CAUGHT IN, UNDER, BETWEEN 22 $228,240 $10,375 18.02 $864.55 PULLING/PUSHING 51 $1,936,935 $37,979 36.52 $3,164.93 COLLISION 24 $373,066 $15,544 12.25 $1,295.37 REACHING 16 $890,361 $55,648 26.23 $4,637.30 CONTACT INFECTIOUS AGENT 1 $1,873 $1,873 1.19 $156.08 REPEATED MOTION 46 $1,777,849 $38,649 23.76 $3,220.74 Contact W/temp Extremes 2 $6,378 $3,189 1.19 $265.75 RUNNING/WALKING 12 $125,494 $10,458 17.52 $871.49 CONTACT WITH CHEMICALS 2 $1,796 $898 2.28 $74.83 SLIP/TRIP 45 $3,214,042 $71,423 92.69 $5,951.93 Contact With Electricity 3 $829 $276 3.16 $23.03 Splashed 1 $0 $0 1.19 $0.00 CONTINUOUS TRAUMA 71 $3,241,024 $45,648 60.31 $3,804.02 STRESS - MTA 37 $384,865 $10,402 10.7 $866.81 Dermal 2 $4,573 $2,287 3.94 $190.54 STRUCK BY FALLING OBJECT 13 $174,984 $13,460 8.4 $1,121.69 EVENT TYPE (NEC) 3 $50,044 $16,681 119.62 $1,390.11 STRUCK BY MOVING OBJECT 40 $1,866,275 $46,657 49.79 $3,888.07 Explosion 2 $13,330 $6,665 7.03 $555.42 Throwing/Wielding 2 $3,256 $1,628 7 $135.67 FALL FROM CHAIR 1 $506 $506 3.72 $42.17 TWISTING/TURNING 32 $351,056 $5,785 10.62 $482.08 FALL FROM ELEVATION (NEC) 2 $3,890 $1,904 13.09 $158.67 Unassigned 20 $494,088 $24,704 30.82 $2,058.70 Fall From Ladder 3 $35,530 $11,843 32.09 $986.94 Vehicle Accident 45 $1,581,270 $35,139 42.25 $2,928.28 FALL FROM STAIRS 8 $30,404 $3,801 4.29 $316.71 Vehicle Off Roadway $0 $0 $0.00 FALL ONTO AGAINST OBJECTS 4 $166,870 $41,718 13.14 $3,476.46 Vehicle Overturned 1 $134,565 $134,565 29.25 $11,213.75 FALL SAME LEVEL (NEC) 36 $479,662 $13,324 10.55 $1,110.33 VEHICLE SUDDEN STOP/START 16 $372,653 $23,291 23.07 $1,940.90 Fall/Scaffold,Walkway 1 $155 $155 3.15 $12.92 VIBRATION 3 $3,984 $1,328 3.76 $110.67 Fall From Vehicle $0 $0 $0.00 TOTAL CLAIMS, TOTAL COST, AVERAGE COST 749 $23,373,821 $31,207 31.77 $2,600.56 FAULTY EQUIPMENT - MTA 2 $216,600 $108,300 125.55 $9,025.00

Workers' Compensation Council Meeting June 4, 2018 35

4698 4668 5,243 5,264 5,437 5,885 5,913 5,956 5,932 5,749 5,955 674 500 654 635 601 587 628 654 665 716 679 14.35 10.37 10.64 11.33 11.29 11.40 4400 4600 4800 5000 5200 5400 5600 5800 6000 100 200 300 400 500 600 700 800 Feb-13 Mar-13 Apr-13 May-13 Jun-13 Jul-13 Aug-13 Sep-13 Oct-13 Nov-13 Dec-13 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18

Agency Injury Rate Claims Incurred During Prior 12 Months per 100 Employees

Active Employees Rolling 12 Month Aggregate Injury Rate per 100 Employees

Workers' Compensation Council Meeting June 4, 2018 36

Claims Denied

17 11 13 9 7 7 14 9 9 26 8 17 12 12 17 9 15 9 11 18 9 17 12 17 8 8 6 18 10 17 6 14 20 12 10 15 10 14 6 12 20 31 13 15 17 25 14 14 15 16 12 14 5 10 15 20 25 30 35 Jan-14 Feb-14 Mar-14 Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15 Mar-15 Apr-15 May-15 Jun-15 Jul-15 Aug-15 Sep-15 Oct-15 Nov-15 Dec-15 Jan-16 Feb-16 Mar-16 Apr-16 May-16 Jun-16 Jul-16 Aug-16 Sep-16 Oct-16 Nov-16 Dec-16 Jan-17 Feb-17 Mar-17 Apr-17 May-17 Jun-17 Jul-17 Aug-17 Sep-17 Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18 Apr-18

Workers' Compensation Council Meeting June 4, 2018 37

Division Statistics

ROLLING 12 REPORTING MONTHS - INJURIES BY DIVISION DIVISION NAME CLAIM FREQUENCY PERCENT OF ALL CLAIMS IN PERIOD CLAIM SEVERITY PERCENT OF TOTAL INCURRED FOR PERIOD ADMIN., TAXIS & ACCESIBLE SERV. 4 0.56% $99,150 0.75% ADMINISTRATION 8 1.12% $69,412 0.52% ADMINISTRATION & FINANCE 2 5.88% $17,183 1.15% CABLE CAR & RAIL SYSTEMS 12 1.68% $93,116 0.70% CHIEF MECHANICAL OFFICER (BUS SECTION) 4 0.56% $45,421 0.34% CHIEF MECHANICAL OFFICER (RAIL SECTION) 2 0.28% $926 0.01% CITATION DIVISION 1 0.14% $0 0.00% COMMUNICATIONS MAINTENANCE SECTION 1 0.14% $2,032 0.02% DIESEL MAINTENANCE 20 2.81% $460,241 3.47% Director of Transit 2 5.88% $155 0.01% DIVISION OF SUSTAINABLE STREETS 29 4.07% $394,398 2.97% ELECTRICAL MAINTENANCE 29 4.07% $298,041 2.25% ENFORCEMENT SERVICES 53 7.43% $1,027,968 7.75% EXECUTIVE DIRECTOR/CEO 2 0.28% $1,213 0.01% FINANCE, ADMIN., INFORMATION TECH. 7 0.98% $46,393 0.35% Islais Creek 2 0.28% $21,280 0.16% LEGISLATIVE AFFAIRS 0.00% $0 0.00% MAINTENANCE / UNASSIGNED 3 0.42% $0 0.00% MAINTENANCE DIVISION 17 2.38% $274,978 2.07% Muni Metro East 16 2.24% $274,387 2.07% OPERATIONS / UNASSIGNED 31 4.35% $629,910 4.75% Parking Authority 8 1.12% $71,624 0.54% SAFETY, SECURITY & ENFORCEMENT 29 4.07% $407,012 3.07% STRUCTURE & WAYS 6 0.84% $24,157 0.18% TAXI COMMISSION 2 0.28% $34,000 0.26% TECHNICAL SERVICES 0.00% $0 0.00% TRANSPORTATION DIVISION (TRAN) 389 54.56% $7,479,124 56.37% Not yet assigned 34 4.77% $1,495,500 11.27% Grand Total 713 100.00% $13,267,620 100.00%

Workers' Compensation Council Meeting June 4, 2018 38

Division Statistics

ROLLING 12 REPORTING MONTHS - INJURIES BY LOCATION FOR TRANSPORTATION DIVISION TRANSPORTATION DIVISION - LOCATION NAME CLAIM FREQUENCY PERCENT OF ALL CLAIMS IN PERIOD CLAIM SEVERITY PERCENT OF TOTAL INCURRED FOR PERIOD BUS TRANSPORATION SECTION 20 5.14% $445,684 5.96% CABLE CAR CABLE TRANSPORTATION UNIT 32 8.23% $731,873 9.79% CENTRAL CONTROL 0.00% $0 0.00% DATA COLLECTION UNIT 0.00% $0 0.00% DISPATCH UNIT RAIL & BUS 0.00% $0 0.00% DIVISION OPERATIONS 3 0.77% $43,226 0.58% FLYNN MOTOR COACH TRANSPORTATION UNIT 49 12.60% $901,087 12.05% GREEN METRO RAIL TRANSPORTATION UNIT 53 13.62% $1,015,187 13.57% KIRKLAND MOTOR COACH TRANSPORTATION UNIT 28 7.20% $461,235 6.17% METRO RAIL TRANSPORTATION UNIT 6 1.54% $134,724 1.80% POTRERO ELECTRIC TROLLEY TRANSPORTATION 64 16.45% $1,040,937 13.92% PRESIDIO 0.00% $0 0.00% PRESIDIO ELECTRIC TROLLEY TRANSPORTATION 15 3.86% $211,970 2.83% PRESIDIO TROLLEY COACH 13 3.34% $118,337 1.58% RAIL TRANSPORTATION SECTION 0.00% $0 0.00% SAFETY/TRAINING 0.00% $0 0.00% SCHEDULES SECTION 0.00% $0 0.00% STATION OPERATIONS 12 3.08% $212,276 2.84% STREET SUPERVISION 3 0.77% $65,071 0.87% TRANSPORTATION DIVISION II (TRAN) 13 3.34% $273,764 3.66% WOODS MOTOR COACH TRANSPORTATION UNIT 75 19.28% $1,705,072 22.80% Null 3 0.77% $118,682 1.59% Grand Total 389 100.00% $7,479,124 100.00%

Workers' Compensation Council Meeting June 4, 2018 39

Claim Cause Frequency 2018 v. 2017

Analysis

• Note that Assaults continue to

be the most frequent type of

• injury. However note a trend
• f a significant drop in

cumulative trauma claims, when compared to the same report from 12 months

• ago. This reduction is

attributed to the ongoing benefits of the ergonomic program as well as increasing participation in the Wellness Programs, Road to Fitness, revenue vehicle fleet upgrades and replacements, employee advocacy.

Workers' Compensation Council Meeting June 4, 2018 40

Program Recommendations

Assaults and combined MVA’s continue to be the main cost drivers. Accordingly, the focus is on:

• Continue to fund and expand the Ergonomic Program;
• Expand utilization of the 24 Hour Injury Reporting

Hotline;

• Continue to support wellness and employee advocacy;
• Continue to develop and implement recommendations

from the Assault Committee to reduce assaults;

• Consider and evaluate additional driver safety training.

Workers' Compensation Council Meeting June 4, 2018 41

Report Definitions

CLAIM VOLUMES Category Method Notes Claims Opened iVOS - Claim_Log (Main) Add Date (claim) = each month; Format = PDF; data prior to March 2013 is unreliable in iVOS, and is drawn from Sedgwick data as reported in HR Monthly Report New Claims by Type iVOS - Claim_Log (Main) Add Date (claim) = each month; Format = PDF Claims Re-Opened iVOS - SFMTAClaimStatusMain (Main) Reporting History Period by each month; Format = PDF; data prior to March 2013 is unreliable in iVOS, and is drawn from Sedgwick data as reported in HR Monthly Report Claims Closed iVOS - SFMTAClaimStatusMain (Main) Reporting History Period by each month; Format = PDF; data prior to March 2013 is unreliable in iVOS, and is drawn from Sedgwick data as reported in HR Monthly Report Closing Ratio Calculation % "Claims Closed"/("Claims Opened" + "Claims Reopened") Claims Pending EOM iVOS - SFMTAClaimStatusMain (Main) Reporting History Period by month; Format = PDF; data prior to March 2013 is based on formula calculated backwards from March 2013 FINANCIALS Category Method Notes Payments Issued iVOS - LossRunMTA (Main) Reporting History Period by each month; Format = PDF; Reporting History Period = FY2013-2014; Reporting History Period = FY2012-2013 Open Claims Financials iVOS - LossRunMTA (Main) Reporting History Period = Last Month; Period Claimant Status = Open; Format = PDF; Data from Paid, Outstanding and Incurred columns Open Claims Stratification iVOS - LossRunMTA (Main) Reporting History Period = Last Month; Format = Excel Data Only; Pivot table filtered for "Open" and grouped by $50K LITIGATION STATISTICS Category Method Notes Open Litigated iVOS - SFMTAClaimStatusMain (Main) Reporting History Period by each month; Litigated (claimant) = checked; Format = PDF; Data from Ending Open column (Indemnity row); data prior to March 2013 is unreliable in iVOS and is excluded Open Indemnity iVOS - SFMTAClaimStatusMain (Main) Reporting History Period by each month; Format = PDF; Data from Ending Open column (Indemnity row); data prior to March 2013 is unreliable in iVOS and is excluded CAUSE ANALYSIS Category Method Notes Cause by Frequency iVOS - LossRunMTA (Main) Reporting History Period = Last Month; Add Date (Claim) = last 12-month period; Format = Excel Data Only; Pivot Table filtered for top-10 Causes by count of Claim Numbers Cause by Severity iVOS - LossRunMTA (Main) Reporting History Period = Last Month; Add Date (Claim) = last 12-month period; Format = Excel Data Only; Pivot Table filtered for top-10 Causes by sum Payment Amounts Closed Claims iVOS - LossRunMTA (Main) Reporting History Period = Last Month; Closed Date (claimant) = last 12-month period; Period Claimant Type (claimant_reporting_history) = First Aid, Medical, Indemnity, Future Medical, Disability Retirement (excludes Reported, Pending); Format = Excel Data Only, calculate Duration (Months), calculate Average Monthly Cost; Pivot Table with Totals and Averages, calculate Average Cost per Claim per Month Cause Determination Department and Adjuster Verification Cause codes are provided utilizing the NCCI mandated codes for State reporting purposes. The cause is determined by the department reporting the claim within SFMTA, our new set-up staff importing the claim to the system and the final review by the claims adjuster when managing the claim. DIVISION STATISTICS Category Method Notes Injuries by Division iVOS - LossRunMTA (Main) Reporting History Period = Last Month; Incident Date = last 12-month period; Format = Excel Data Only; Pivot Table filtered for top-10 Divisions by count of Claim Numbers and sum of Payment Amounts INJURY RATE Category Method Notes Injury Rate Per Month iVOS - LossRunMTA (Main) Reporting History Period = Last Month; Incident Date = last 12-month period; Format = PDF No Detail/ FTE # from SFMTA LAG TIME REPORT Category Method Notes Lag Time Information iVOS- LagTime Report Reporting History Period = Last Month; Add Date =last 12-month period; Sort by Division, Format = PDF No Detail

Workers' Compensation Council Meeting June 4, 2018 42

Claim Cause Definitions

• I. Burn or Scald — Heat or Cold Exposures — Contact With
• 01. Chemicals:

Includes Hydrochloric Acid, Sulfuric Acid, Battery Acid, Methanol, Antifreeze

• 02. Hot Objects or Substances:
• 11. Cold Objects or Substances:
• 03. Temperature Extremes:

Non-Impact Injuries Resulting in a Burn Due to Hot or Cold Temperature Extremes, includes Freezing or Frostbite

• 04. Fire or Flame:
• 05. Steam or Hot Fluids:
• 06. Dusts, Gases, Fumes or Vapors:

Includes Inhalation of Carbon Dioxide, Carbon Monoxide, Propane, Methane, Silica (Quartz), Asbestos Dust and Smoke

• 07. Welding Operations:

Includes Welder’s Flash (Burns to Skin or Eyes as a Result of Exposure to Intense Light from Welding

• 08. Radiation:

Includes Effects of Ionizing Radiation Found in X-Rays, Microwaves, Nuclear Reactor Waste, and Radiating Substances and Equipment. Includes Non-Ionizing Radiation Such as Sunburn

• 14. Abnormal Air Pressure:
• 84. Electrical Current:

Includes Electric Shock, Electrocution and Lightning

• 09. Contact With, NOC:

Not Otherwise Classified in Any Other Code. Includes Cleaning Agents and Fertilizers

• II. Caught In, Under or Between
• 10. Machine or Machinery:

Running or Meshing Objects, a Moving and a Stationary Object, Two or More Moving Objects

• 12. Object Handled:

Includes Medical Hospital Bed and Parts, Wheelchair, Clothespin Vise

• 20. Collapsing Materials:

Slides of Earth

• 13. Caught In, Under or Between, NOC:

Either Man-Made or Natural, Not Otherwise Classified in Any Other Code

• III. Cut, Puncture, Scrape Injured by
• 15. Broken Glass:
• 16. Hand Tool, Utensils; Not Powered:

Includes Needle, Pencil, Knife, Hammer, Saw, Axe, Screwdriver

• 17. Object Being Lifted or Handled:

Includes Being Cut, Punctured or Scraped by a Person or Object Being Lifted or Handled

• 18. Powered Hand Tool, Appliance:

Includes Drill, Grinder, Sander, Iron, Blender, Welding Tools, Nail Gun

• 19. Cut, Puncture, Scrape, NOC:

Not Otherwise Classified in Any Other Code. Includes Power Actuated Tools

• IV. Fall, Slip or Trip Injury
• 25. From Different Level (Elevation):

Includes Collapsing Chairs, Falling from Piled Materials, Off Wall, Catwalk, Bridge

• 26. From Ladder or Scaffolding:
• 27. From Liquid or Grease Spills:
• 28. Into Openings:

Includes Mining Shafts, Excavations, Floor Openings, Elevator Shafts

• 29. On Same Level:
• 30. Slip, or Trip, Did Not Fall:

Slip or Trip and Did Not Come in Contact with the Floor or Ground

• 32. On Ice or Snow:
• 33. On Stairs:
• 31. Fall, Slip or Trip, NOC:

Not Otherwise Classified in Any Other Code. Includes Tripping Over Object, Slipping or Organic Materials

• V. Motor Vehicle
• 40. Crash of Water Vehicle:
• 41. Crash of Rail Vehicle:
• 45. Collision or Sideswipe with Another Vehicle,:

Vehicle Collision, Both Vehicles in Motion

• 46. Collision with a Fixed Object::

Collision Occurring with Standing Vehicle or Stationary Object

• 47. Crash of Airplane:
• 48. Vehicle Upset:

Includes Overturned or Jackknifed

• 50. Motor Vehicle, NOC:

Not Otherwise Classified in Any Other Code. Includes Injuries Due to Sudden Stop or Start, Being Thrown against Interior Parts of the Vehicle and Vehicle Contents Being Thrown against

Workers' Compensation Council Meeting June 4, 2018 43

Claim Cause Definitions, Con’t

• VI. Strain or Injury by

52. Continual Noise: Injury to Ears or Hearing Due to the Cumulative Effects of Constant or Repetitive Noise 53. Noise:

• 53. Twisting :

Free Bodily Motion That Imposes Stress or Strain on Some Part of Body. Includes Assumption of Unnatural Position, Involuntary Motions Induced by Sudden Noise, Fright , loss of balance

• 54. Jumping or Leaping:
• 55. Holding or Carrying:

Applies to Objects or People. Includes Restraining a Person

• 56. Lifting:

Includes Objects or People

• 57. Pushing or Pulling:

Includes Objects or People

• 58. Reaching:
• 59. Using Tool or Machinery:
• 61. Wielding or Throwing:

Physical Effort or Overexertion from Attempts to Resist a Force Applied by an Object Being Handled

• 97. Repetitive Motion:

Cumulative Injury or Condition Caused by Continual, Repeated Motions; Strain by Excessive Use, Carpel Tunnel

• 60. Strain or Injury by, NOC:

Not Otherwise Classified in Any Other Code

• VII. Striking Against or Stepping on

NOTE: Applies to Cases in Which the Injury Was Produced by the Impact Created by the Person, Rather than by the Source

• 65. Moving Part of Machine:
• 66. Object Being Lifted or Handled:
• 67. Sanding, Scraping, Cleaning Operation:
• 68. Stationary Object:
• 69. Stepping on Sharp Object:
• 70. Striking Against or Stepping on, NOC:

Includes Scratches or Abrasions Caused by Sanding, Scraping, Cleaning Operations, Not Otherwise Classified in Any Other Code

• VIII. Struck or Injured by

NOTE: Applies to Cases in Which the Injury Was Produced by the Impact Created by the Source of Injury, Rather than by the Injured Person

• 74. Fellow Workers, Patient or Other Person:
• 75. Falling or Flying Object:
• 76. Hand Tool or Machine in Use:

Struck by Co-Worker, Either on Purpose or Accidentally. Includes Being Struck by a Patient While Lifting or Moving Them Not in Act of a Crime

• 77. Motor Vehicle:

Applies When a Person is Struck by a Motor Vehicle, Including Rail Vehicles, Water Vehicles, Airplanes

• 78. Moving Parts of Machine:
• 79. Object Being Lifted or Handled:

Includes Dropping Object on Body Part

• 80. Object Handled by Others:

Includes Another Person Dropping Object on Injured Person’s Body Part

• 85. Animal or Insect:

Includes Bite, Sting or Allergic Reaction

• 86. Explosion or Flare Back:

Rapid Expansion, Outbreak, Bursting, or Upheaval. Includes Explosion of Cars, Bottles, Aerosol Cans, or Buildings. “Flare back” Involves Superheated Air and Combustible Gases

• 81. Struck or Injured, NOC:

Not Otherwise Classified in Any Other Code. Includes Kicked, Stabbed, Bitten

• IX. Rubbed or Abraded by
• 94. Repetitive Motion:

Caused by Repeated Rubbing or Abrading; Applies to Non-Impact Cases in Which the Injury Was Produced by Pressure, Vibration or Friction between the Person and the Source of Injury.

• 95. Rubbed or Abraded, NOC:

Not Otherwise Classified in Any Other Code. Includes Foreign Body in Ears

• X. Miscellaneous Causes
• 82. Absorption, Ingestion or Inhalation, NOC:

Not Otherwise Classified in Any Other Code. Applies Only to Non- Impact Cases in Which the Injury Resulted from Inhalation, Absorption (Skin Contact), or Ingestion of Harmful Substance

• 87. Foreign Matter (Body) in Eye(s):

Injury to Eyes Resulting from Foreign Matter That is Not Otherwise Classified in Any Other Code

• 88. Natural Disasters:

Injury Resulting from Natural Disaster. Includes Hurricane, Earthquake, Tornado, Flood, Forest Fire

Workers' Compensation Council Meeting June 4, 2018 44