Report to the San Francisco Workers Compensation Council Peggy - - PowerPoint PPT Presentation
Report to the San Francisco Workers Compensation Council Peggy Sugarman Workers Compensation Director December 2, 2019 Agenda Accomplishments, Initiatives & Challenges Performance Quick Facts Claim Analytics
Peggy Sugarman Workers’ Compensation Director
December 2, 2019
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Banking Modernization Phase II:
Implemented Phase II of the Banking Modernization Project, activating direct deposit of Workers’ Compensation benefit payments to injured employees (8/6/19) and vendors (7/15/19).
From implementation through 11/22/2019, 13,022 EFT transactions have been processed and 2,215 claims are enrolled in direct deposit for benefit payment
Received Environmental Service Award from the Commission on the Environment on September 24
Finance/Technology:
Successful launch of EK Health managed care services program for the SFMTA, including Utilization Review and Bill Review services
Staff Training:
All-staff Mastering Emotional Intelligence training completed in early September
Medicare Reporting:
Training scheduled for January, 2020
Alternative Dispute Resolution Program:
324 claims now in the ADR Program, including 147 Fire Department and 177 Police Department claims, as well as 5 claims opted-in to the ADR Program as of 11/22/2019 Experiencing significantly lower rates of legal representation on ADR claims (Fire – 10%, Police – 12%) compared to all claims (Fire – 49%, Police – 50%)
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beginning 7/1/2020
development in Q3
cancelled outstanding checks to be re-issued on December 2
release of iVOS Claims Enterprise
– Visual interface re-design – Complete overhaul of user security profiles and access – Reconfiguration for all existing interfaces (State of California, Medicare, Medical Bill Review, Optum Pharmacy Program, US Bank, Employee Portal/FSP, ISO Claim Research, and all local network interfaces for document imaging, faxes, etc.) and scheduler job activities – Development enhancements to improve workflows requiring the 5.0 release to be launched in tandem
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first responders with PTSD, sunsets 2025 – Shortage of psychologists and psychiatrists
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FY20 Q1 Performance Quick Facts
FY20 Q1 98.27%
Benchmark: 95%
476 Indemnity Claims 289 Medical Claims
Benchmark: 402 Indemnity Claims/Quarter 281 Medical Claims/Quarter
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 Claim Cost in Period
Notes: All benchmarks based on rolling four-year averages (FY16-19.) Fiscal health metric includes overhead and claim expenditures and is based on revised budget, excluding any carryforward. Duration excludes disability retirement and future medical claims.
Indemnity Benchmark CCSF $15,699 $15,266 SFMTA $4,739 $9,756 Medical Benchmark $580 $685 $192 $463
233 Days
Benchmark: 277 Days
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FY16-19 FY20 Q1 FY20 Q1 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 Public Health 82 115 197 73 146 219
31 or 27% 22 or 11% Police 83 43 126 100 40 140 17 or 21%
14 or 11% Fire 62 18 79 74 18 92 12 or 20% 0 or 2% 13 or 16% Sheriff 37 9 46 46 4 50 9 or 24%
4 or 9% Recreation & Parks 17 20 37 42 4 46 25 or 143%
9 or 25% Human Services 23 11 35 33 5 38 10 or 42%
3 or 10% Airport 18 14 32 19 19 38 1 or 3% 5 or 40% 6 or 19% Public Works 15 16 31 12 24 36
8 or 51% 5 or 15% Water Pollution Control 7 4 11 8 4 12 1 or 15% 0 or 5% 1 or 12% PUC-Water 8 7 15 7 2 9
Citywide 402 281 683 476 289 765 74 or 18% 8 or 3% 82 or 12%
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Department 2016 2017 2018 2019 2020 Est. Fire 19 19 23 21 20 Police 23 23 21 20 20 Sheriff 23 20 20 22 20 Public Health 12 11 13 12 12 Citywide 11 11 12 11 11 Recreation & Parks 9 9 9 8 11 Public Works 11 9 10 11 10 Airport 10 10 10 8 9 Human Services 6 6 8 7 7 Water Pollution Control 2 2 3 2 2 PUC-Water 3 3 4 3 2
Notes:
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Notes:
5 10 15 20 25 2016 2017 2018 2019 2020 Est.
Top 10 Departments
Fire Police Sheriff Public Health Citywide Recreation & Parks Public Works Airport Human Services Water Pollution Control PUC-Water
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Notes:
50 100 150 200 250 Bodily Motion Exposure Cumulative Trauma Fall, Slip or Trip Physical Assault Caught In, Under, Between Struck By/Against Misc Stress Abrasion
Top 10 Claim Cause Groups by Frequency - New Claims in FY2020 Q1
Recreation & Parks Sheriff Fire Police All Other Departments Public Health
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Notes:
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 Over 1M Recreation & Parks 11 11 3 5 1 2 1 1 1 1 2 Public Health 67 48 15 11 9 6 4 1 3 1 5 1 1 4 Sheriff 69 48 30 12 4 4 3 2 1 1 2 Fire 87 74 48 19 15 9 5 1 1 1 2 All Other Departments 119 69 34 28 12 3 7 7 4 2 2 1 2 1 3 1 4 Police 132 95 70 40 19 17 6 12 1 2 1 1 2 2 1 11 50 100 150 200 250 300 350 400 450 500 Workers' Compensation Council Meeting December 2, 2019 14
1,364 Claims >=$100k $324 Million
Data as of 11/14/2019
Note: Dollar figures in millions
$106.5, 33% $56.5, 17% $41.9, 13% $36.3, 11% $10.4, 3% $72.9, 23%
Police Fire Public Health Sheriff Recreation & Parks All Other Departments
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Department Open Indemnity Claims Added from FY16-FY20 Q1 Represented Claims Represented % Litigated Claims Litigated %
Police 420 208 50% 174 41% Fire 284 138 49% 122 43% Public Health 284 95 33% 87 31% Sheriff 208 91 44% 87 42% Human Services 99 50 51% 41 41% Airport 98 29 30% 25 26% Public Works 86 35 41% 32 37% Recreation & Parks 82 29 35% 25 30% Water Pollution Control 38 16 42% 16 42% PUC-Water 37 12 32% 8 22% Citywide 1871 800 43% 703 38%
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Department FY19 Orig. Budget FY19 Actuals FY20 Orig. Budget FY20 Proj. Actuals FY20 Surplus/ (Deficit) YOY Decrease / (Increase)
Police 17,270,551 20,892,230 22,188,448 21,422,691 765,757
Fire 12,001,726 12,083,145 11,464,315 9,930,834 1,533,481 2,152,311 Public Health 9,154,940 10,624,054 12,275,372 12,201,064 74,308
Sheriff 5,630,186 5,425,734 5,746,567 6,855,029
Public Works 3,709,007 3,744,779 3,700,035 4,531,805
Recreation & Parks 3,569,246 3,216,084 3,269,246 2,556,845 712,401 659,239 Human Services 2,876,364 3,341,850 3,179,556 3,361,979
PUC-Water 2,580,723 2,236,215 2,406,452 2,633,622
Airport 2,570,798 2,759,569 2,975,768 3,321,565
PUC-Wastewater 1,547,720 1,813,882 1,767,076 2,082,098
Total Top Ten Departments 60,911,261 66,137,542 68,972,835 69,497,533
3,359,991 Total of All City Departments 71,188,844 74,848,476 78,248,879 77,261,129 987,750 2,412,653
Notes:
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FY18-19 Actuals FY19-20 Actuals YTD FY20 Est. YE Actuals YOY Change (%)
INDEMNITY Temporary Disability 8,687,912 2,395,432 9,581,727 9.3% Permanent Disability 16,377,105 3,824,357 15,297,429
INDEMNITY SUBTOTAL 25,065,017 6,219,789 24,879,156
VOCATIONAL REHABILITATION 157,416 73,210 292,840 46.2% MEDICAL 30,218,761 7,786,581 31,146,323 3.0% EXPENSE 3,290,825 882,437 3,529,747 6.8% RECOVERY (433,706) (225,672) (902,686) 52.0% GRAND TOTAL 58,298,314 14,736,345 58,945,380 1.1%
Notes:
benefits.
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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 – e.g. 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
Cancer, heart trouble, internal injuries or exposure to poison oak, MRSA, or heat stroke. Also may include foreign substance into eyes or body, or blood borne 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,
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 non-occupational 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
piece of furniture.
Orthopedic or head injuries
Suffocated Injuries sustained due to suffocation, such as during a fire.
Respiratory injuries, smoke inhalation. May
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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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 December 2, 2019 23
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 December 2, 2019 24
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 December 2, 2019 25
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 December 2, 2019 26
Municipal Transportation Agency
NEW CLAIMS BY TYPE CLAIM TYPE FY 19-20 July August September October November December January February March April May June FY Total Monthly Average INDEMNITY # 54 55 51 160 53 MEDICAL ONLY # 12 9 4 25 8 OTHER # 1 3 4 1 INDEMNITY % 81.81% 84.62% 87.93% 84.66% 84.13% MEDICAL ONLY % 18.18% 13.85% 6.90% 13.23% 12.70% OTHER % 0.01% 1.54% 5.17% 2.12% 3.18% CLAIM TYPE FY 18-19 July August September October November December January February March April May June FY Total Monthly Average INDEMNITY # 39 38 46 62 44 54 50 39 42 40 45 49 548 46 MEDICAL ONLY # 4 7 6 9 4 4 1 6 13 15 9 6 84 7 OTHER # 1 4 2 8 11 2 5 2 5 10 3 1 54 5 INDEMNITY % 88.64% 77.55% 85.19% 78.48% 74.58% 90.00% 89.29% 82.98% 70.00% 61.54% 78.95% 87.50% 79.88% 80.70% MEDICAL ONLY % 9.09% 14.29% 11.11% 11.39% 6.78% 6.67% 1.79% 12.77% 21.67% 23.08% 15.79% 10.71% 12.24% 12.28% OTHER % 2.27% 8.16% 3.70% 10.13% 18.64% 3.33% 8.93% 4.26% 8.33% 15.39% 5.26% 1.79% 7.87% 7.02% CLAIM TYPE FY 17-18 July August September October November December January February March April May June FY Total Monthly Average INDEMNITY # 51 54 40 45 57 32 44 52 40 44 45 41 545 45 MEDICAL ONLY # 3 6 5 11 13 7 12 10 6 13 9 2 97 8 OTHER # 2 1 3 3 3 3 2 1 5 3 7 2 35 3 INDEMNITY % 91.07% 88.52% 83.33% 76.27% 78.08% 76.19% 75.86% 82.53% 78.43% 73.33% 73.77% 91.11% 79.75% 80.70% MEDICAL ONLY % 5.35% 9.83% 10.41% 18.64% 17.80% 16.66% 20.68% 15.87% 11.76% 21.66% 14.75% 4.44% 15.03% 15.79% OTHER % 3.58% 1.65% 6.26% 5.09% 4.12% 7.15% 3.46% 1.60% 9.81% 5.01% 11.48% 4.45% 5.22% 3.51% CLAIM TYPE FY 16-17 July August September October November December January February March April May June FY Total Monthly Average INDEMNITY # 46 41 38 46 36 41 40 36 47 53 60 63 547 46 MEDICAL ONLY # 6 9 8 4 5 4 4 8 13 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% 78% 84% 86% 87% 83% 85% MEDICAL ONLY % 11.54% 16.36% 15.68% 7.84% 11.90% 8.89% 9.10% 17.77% 22% 14% 7% 8% 14% 13% OTHER % 0.00% 9.10% 9.82% 1.97% 2.39% 0.00% 0.00% 2.33% 0% 2% 7% 5% 3% 2% CLAIM TYPE FY 15-16 July August September October November December January February March April May June FY Total Monthly Average INDEMNITY # 40 51 44 56 32 58 45 52 59 50 39 39 565 47 MEDICAL ONLY # 6 9 3 7 8 7 2 12 6 9 7 8 84 7 OTHER # 3 2 1 2 1 2 1 2 3 17 1 INDEMNITY % 81.63% 85.00% 93.62% 86.15% 80% 87.87% 91.84% 80% 88% 83% 81% 78% 85% 84% MEDICAL ONLY % 12.24% 15.00% 6.38% 10.77% 20% 10.60% 4.08% 18.46% 9% 15% 15% 16% 13% 12% OTHER % 6.12% 0.00% 0.00% 3.08% 0.00% 1.53% 4.08% 1.54% 3% 2% 4% 6% 2% 4% 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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CLAIMS REOPENED FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2019-2020 9 7 5 21 7 FY 2018-2019 2 12 6 11 6 3 5 3 6 4 10 10 78 7 FY 2017-2018 3 3 8 7 11 4 9 6 13 3 7 6 80 7 FY 2016-2017 11 12 8 3 6 7 2 8 4 9 13 9 92 8 FY 2015-2016 8 7 4 7 4 6 6 6 18 8 7 11 92 8 CLAIMS CLOSED FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2019-2020 57 68 62 187 62 FY 2018-2019 45 60 56 71 34 68 74 50 67 58 78 91 752 63 FY 2017-2018 52 69 51 53 50 98 58 70 70 69 42 73 755 63 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 CLOSING RATIO FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2019-2020 76% 94% 98% 110% 89% FY 2018-2019 98% 98% 93% 79% 52% 108% 121% 100% 102% 84% 116% 138% 170% 99% FY 2017-2018 88% 108% 91% 80% 60% 213% 87% 101% 109% 110% 62% 140% 166% 101% 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% CLAIMS PENDING EOM FISCAL YEAR July August September October November December January February March April May June FY Total Monthly Average FY 2019-2020 1,645 1,649 1,650 1,650 1,648 FY 2018-2019 1,616 1,617 1,621 1,640 1,671 1,666 1,653 1,653 1,652 1,663 1,652 1,627 1,627 1,644 FY 2017-2018 1,620 1,615 1,620 1,633 1,667 1,615 1,624 1,623 1,617 1,611 1,637 1,615 1,615 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 1,649 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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FY 2018/2019 Three Month Expenditures FY 2019/2020 Three Month Expenditures Increase/Decrease % of Change
INDEMNITY Temporary Disability $2,240,115 $2,775,840 $535,725 23.92% Permanent Disability $1,301,292 $1,456,035 $154,743 11.89% Total Indemnity $3,541,408 $4,231,875 $690,468 19.50% Vocational Rehabilitation Total Vocational Rehabilitation $26,126 $9,886 ($16,240)
MEDICAL Total Medical $2,408,121 $2,482,128 $74,008 3.07% EXPENSE Total Expense $386,354 $417,140 $30,786 7.97% RECOVERY Total Recovery Processed ($125,338) ($35,277) $90,061
GRAND TOTAL $6,236,670 $7,105,752 $869,082 13.94% Workers' Compensation Council Meeting December 2, 2019 30
Open Claims Stratification: $100K+ Total Incurred = 663
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 213 137 122 54 35 16 18 13 8 3 1 4 8 3 4 1 4 3 16 213 137 122 54 35 16 18 13 8 3 1 4 8 3 4 1 4 3 16
Open Claims Stratification by Severity All Policy Years $100K+ Incurred Claims
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LITIGATION RATIO FISCAL YEAR 2019-2020 July August September October November December January February March April May June Open Litigated Claims* 430 428 432 Open Indemnity Claims* 1,114 1,117 1,119 Litigated Ratio 38.60% 38.32% 38.61% FISCAL YEAR 2018-2019 July August September October November December January February March April May June Open Litigated Claims* 412 418 411 410 417 415 421 421 412 423 427 431 Open Indemnity Claims* 1,075 1,076 1,076 1,098 1,120 1,119 1,128 1,138 1,115 1,106 1,111 1,103 Litigated Ratio 38.33% 38.85% 38.20% 37.34% 37.23% 37.09% 37.32% 36.99% 36.95% 38.25% 38.43% 39.08% FISCAL YEAR 2017-2018 July August September October November December January February March April May June Open Litigated Claims* 399 409 429 429 428 418 423 423 429 428 433 417 Open Indemnity Claims* 1,077 1,085 1,081 1,094 1,117 1,082 1,079 1,084 1,073 1,079 1,098 1,075 Litigated Ratio 37.05% 37.70% 39.69% 39.21% 38.32% 38.63% 39.20% 39.02% 39.98% 39.67% 39.44% 38.79% 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% *Does not include Future Medical Claims Data prior to March 2013 is unreliable and is excluded
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CLAIM CAUSE ANALYSIS
BY FREQUENCY
10 20 30 40 50 60 70 80 90 100 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 62 91 61 32 9 46 19 27 37 20 62 91 61 32 9 46 19 27 37 20
Top 10 Claim Causes by Frequency Rolling 12 Reporting Months
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CLAIM CAUSE ANALYSIS
BY SEVERITY
$0 $500,000 $1,000,000 $1,500,000 $2,000,000 $2,500,000 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 $1,187,952 $2,171,681 $1,392,172 $660,054 $274,144 $855,932 $365,621 $663,264 $906,428 $350,278 $1,187,952 $2,171,681 $1,392,172 $660,054 $274,144 $855,932 $365,621 $663,264 $906,428 $350,278
Top 10 Claim Causes by Severity Rolling 12 Reporting Months
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CLAIMS CLOSED - ROLLING 12 REPORTING MONTHS ENDING 9/30/2019 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 Abraision/Rubbed 6 $13,451 $2,242 3.23 $186.82 Faulty Roadway 1 $0 $0 1.52 $0.00 Adverse Reaction 11 $855,444 $77,768 129.08 $6,480.64 Foreign Substance 13 $48,190 $3,707 8.92 $308.91 Assault, Mental Verbal 16 $265,421 $16,589 13.78 $1,382.40 Ingestion $0 $0 0.00 $0.00 Assault, Physical 82 $2,788,344 $34,004 27.82 $2,833.68 Inhalation 14 $218,243 $15,589 32.92 $1,299.07 Bending, Stooping 7 $329,463 $47,066 54.98 $3,922.18 Lifting 20 $1,201,495 $60,075 52.76 $5,006.23 Bodily Reaction 16 $593,296 $37,081 69.64 $3,090.08 Personal Injury/Illness 7 $432 $62 2.43 $5.14 Caught In, Under, Between 26 $122,012 $4,693 7.99 $391.06 Pulling/Pushing 69 $4,534,373 $65,716 44.57 $5,476.30 Collision 17 $236,863 $13,933 15.19 $1,161.09 Reaching 11 $219,226 $19,930 21.96 $1,660.80 Contact Infectous Agent 1 $655 $655 4.95 $54.58 Relational Conflict 1 $1,447 $1,447 6.29 $120.58 Contact w/Temp Extremes 1 $5,184 $5,184 2.72 $432.00 Repeated Motion 52 $2,142,905 $41,210 26.76 $3,434.14 Contact with Chemicals 5 $281,204 $56,241 10.82 $4,686.73 Running/Walking 26 $169,691 $6,527 8.80 $543.88 Contact with Electricity 2 $2,219 $1,110 2.33 $92.46 Slip/Trip 37 $2,233,626 $60,368 72.82 $5,030.69 Continous Trauma 51 $2,227,515 $43,677 57.91 $3,639.73 Splashed 1 $0 $0 1.68 $0.00 Dermal 2 $154 $77 1.92 $6.42 Stress 16 $381,479 $23,842 19.86 $1,986.87 Event Type (NEC) 28 $363,796 $12,993 18.75 $1,082.73 Struck By Falling Object 9 $162,817 $18,091 21.84 $1,507.56 Explosion 1 $3,879 $3,879 4.52 $323.25 Struck By Moving Object 27 $1,193,639 $44,209 45.75 $3,684.07 Fall From Chair 7 $71,477 $10,211 21.67 $850.92 Throwing/Wielding 2 $137,134 $68,567 114.03 $5,713.92 Fall From Elevation 3 $88,646 $29,549 19.94 $2,462.39 Twisting/Turning 25 $336,799 $13,472 9.91 $1,122.66 Fall From Ladder 2 $11,096 $5,548 19.10 $462.33 Unassigned 15 $152,840 $10,189 22.98 $849.11 Fall From Stairs 6 $169,243 $28,207 24.67 $2,350.60 Vehicle Accident 69 $3,644,360 $52,817 55.35 $4,401.40 Fall Onto/Against Objects 2 $108,843 $54,422 23.65 $4,535.13 Vehicle Off Roadway 1 $1,607 $1,607 3.75 $0.00 Fall Same Level 17 $593,101 $34,888 19.99 $2,907.36 Vehicle Overturned 2 $45,901 $22,951 9.56 $1,912.54 Fall/Scaffold, Walkway $0 $0 0.00 $0.00 Vehicle Sudden Start/Stop 15 $245,424 $16,362 15.56 $1,363.47 Fall From Vehicle 8 $73,838 $9,230 5.04 $769.15 Vibation 2 $1,152 $576 8.76 $48.00 Faulty Equipment $0 $0 0.00 $0.00 TOTAL CLAIMS, TOTAL COST, AVERAGE COST 752 $26,277,925 $34,944 34.89 $2,912.00
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5,638 5,985 5,962 5,953 5,918 5,934 562 606 665 679 9.97 10.17 10.69 11.07 11.06 4,400 4,600 4,800 5,000 5,200 5,400 5,600 5,800 6,000 100 200 300 400 500 600 700 800
Agency Injury Rate Claims Incurred During Prior 12 Months per 100 Employees
Active Employees Rolling 12 Month Aggregate Injury Rate per 100 Employees
11.96
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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 1414 15 16 12 14 21 17 10 9 12 18 14 19 15 10 16 11 18 14 18 20 13 5 10 15 20 25 30 35 Workers' Compensation Council Meeting December 2, 2019 37
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. 5 0.69% $226,654 1.67% ADMINISTRATION 8 1.10% $169,679 1.25% ADMINISTRATION & FINANCE 0.00% $0 0.00% CABLE CAR & RAIL SYSTEMS 11 1.51% $271,703 2.00% CHIEF MECHANICAL OFFICER (BUS SECTION) 2 0.27% $60,001 0.44% CHIEF MECHANICAL OFFICER (RAIL SECTION) 3 0.41% $4,343 0.03% CITATION DIVISION 1 0.14% $17,000 0.13% COMMUNICATIONS MAINTENANCE SECTION 2 0.27% $6,494 0.05% DIESEL MAINTENANCE 4 0.55% $32,910 0.24% DIRECTOR OF TRANSIT 2 22.22% $0 0.00% DIVISION OF SUSTAINABLE STREETS 4 0.55% $37,320 0.28% ELECTRICAL MAINTENANCE 12 1.65% $192,993 1.42% ENFORCEMENT SERVICES 29 3.98% $643,839 4.75% EXECUTIVE DIRECTOR/CEO 1 0.14% $0 0.00% FINANCE, ADMIN., INFORMATION TECH. 4 0.55% $48,357 0.36% ISLAIS CREEK 5 0.69% $87,029 0.64% LEGISLATIVE AFFAIRS 0.00% $0 0.00% MAINTENANCE / UNASSIGNED 2 0.27% $1,375 0.01% MAINTENANCE DIVISION 20 2.75% $388,328 2.86% MUNI METRO EAST 6 0.82% $20,917 0.15% OPERATIONS / UNASSIGNED 5 0.69% $69,756 0.51% PARKING AUTHORITY 2 0.27% $34,000 0.25% SAFETY, SECURITY & ENFORCEMENT 51 7.01% $830,619 6.12% STRUCTURE & WAYS 3 0.41% $97,902 0.72% TAXI COMMISSION 0.00% $0 0.00% TECHNICAL SERVICES 1 0.14% $445 0.00% TRANSPORTATION DIVISION (TRAN) 535 73.49% $10,136,340 74.72% TRANSPORTATION PLANNING & DEVELOPMENT 1 0.14% $17,000 0.13% NOT YET ASSIGNED 9 1.24% $170,348 1.26% Grand Total 728 100.00% $13,565,351 100.00%
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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 62 11.59% $1,235,799 12.19% CABLE CAR CABLE TRANSPORTATION UNIT 56 10.47% $1,317,056 12.99% CENTRAL CONTROL 1 0.19% $3,000 0.00% DATA COLLECTION UNIT 1 0.19% $41,000 0.40% DISPATCH UNIT RAIL & BUS 1 0.19% $17,000 0.17% DIVISION OPERATIONS 0.00% $0 0.00% FLYNN MOTOR COACH TRANSPORTATION UNIT 38 7.10% $999,937 9.86% GREEN METRO RAIL TRANSPORTATION UNIT 39 7.29% $825,681 8.15% KIRKLAND MOTOR COACH TRANSPORTATION UNIT 33 6.17% $718,966 7.09% METRO RAIL TRANSPORTATION UNIT 8 1.50% $115,486 1.14% POTRERO ELECTRIC TROLLEY TRANSPORTATION 56 10.47% $741,383 7.31% PRESIDIO 0.00% $0 0.00% PRESIDIO ELECTRIC TROLLEY TRANSPORTATION 14 2.62% $282,406 2.79% PRESIDIO TROLLEY COACH 21 3.93% $561,207 5.54% RAIL TRANSPORTATION SECTION 1 0.19% $353 0.00% SAFETY/TRAINING 1 0.19% $17,000 0.17% SCHEDULES SECTION 0.00% $0 0.00% STATION OPERATIONS 3 0.56% $126,881 1.25% STREET SUPERVISION 16 2.99% $325,202 3.21% TRANSPORTATION DIVISION II (TRAN) 111 20.75% $1,860,454 18.35% WOODS MOTOR COACH TRANSPORTATION UNIT 65 12.15% $887,439 8.76% NULL 8 1.50% $60,091 0.59% Grand Total 535 100.00% $10,136,340 100.00%
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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
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Includes Hydrochloric Acid, Sulfuric Acid, Battery Acid, Methanol, Antifreeze
Non-Impact Injuries Resulting in a Burn Due to Hot or Cold Temperature Extremes, includes Freezing or Frostbite
Includes Inhalation of Carbon Dioxide, Carbon Monoxide, Propane, Methane, Silica (Quartz), Asbestos Dust and Smoke
Includes Welder’s Flash (Burns to Skin or Eyes as a Result of Exposure to Intense Light from Welding
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
Includes Electric Shock, Electrocution and Lightning
Not Otherwise Classified in Any Other Code. Includes Cleaning Agents and Fertilizers
Running or Meshing Objects, a Moving and a Stationary Object, Two or More Moving Objects
Includes Medical Hospital Bed and Parts, Wheelchair, Clothespin Vise
Slides of Earth
Either Man-Made or Natural, Not Otherwise Classified in Any Other Code
Includes Needle, Pencil, Knife, Hammer, Saw, Axe, Screwdriver
Includes Being Cut, Punctured or Scraped by a Person or Object Being Lifted or Handled
Includes Drill, Grinder, Sander, Iron, Blender, Welding Tools, Nail Gun
Not Otherwise Classified in Any Other Code. Includes Power Actuated Tools
Includes Collapsing Chairs, Falling from Piled Materials, Off Wall, Catwalk, Bridge
Includes Mining Shafts, Excavations, Floor Openings, Elevator Shafts
Slip or Trip and Did Not Come in Contact with the Floor or Ground
Not Otherwise Classified in Any Other Code. Includes Tripping Over Object, Slipping or Organic Materials
Vehicle Collision, Both Vehicles in Motion
Collision Occurring with Standing Vehicle or Stationary Object
Includes Overturned or Jackknifed
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
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52. Continual Noise: Injury to Ears or Hearing Due to the Cumulative Effects of Constant or Repetitive Noise 53. Noise:
: 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
Applies to Objects or People. Includes Restraining a Person
Includes Objects or People
Includes Objects or People
Physical Effort or Overexertion from Attempts to Resist a Force Applied by an Object Being Handled
Cumulative Injury or Condition Caused by Continual, Repeated Motions; Strain by Excessive Use, Carpel Tunnel
Not Otherwise Classified in Any Other Code
NOTE: Applies to Cases in Which the Injury Was Produced by the Impact Created by the Person, Rather than by the Source
Includes Scratches or Abrasions Caused by Sanding, Scraping, Cleaning Operations, Not Otherwise Classified in Any Other Code
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
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
Applies When a Person is Struck by a Motor Vehicle, Including Rail Vehicles, Water Vehicles, Airplanes
Includes Dropping Object on Body Part
Includes Another Person Dropping Object on Injured Person’s Body Part
Includes Bite, Sting or Allergic Reaction
Rapid Expansion, Outbreak, Bursting, or Upheaval. Includes Explosion of Cars, Bottles, Aerosol Cans, or Buildings. “Flare back” Involves Superheated Air and Combustible Gases
Not Otherwise Classified in Any Other Code. Includes Kicked, Stabbed, Bitten
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.
Not Otherwise Classified in Any Other Code. Includes Foreign Body in Ears
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
Injury to Eyes Resulting from Foreign Matter That is Not Otherwise Classified in Any Other Code
Injury Resulting from Natural Disaster. Includes Hurricane, Earthquake, Tornado, Flood, Forest Fire
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