to to reduce educe the e the exposur xposure to e to of Workers - - PowerPoint PPT Presentation

Wha hat the t the Emplo Employer can do er can do to to reduce educe the e the exposur xposure to e to

• f Workers’ Compensation

cost costs s bef befor

• re and

e and aft after er a a claim. laim.

Present esented ed by R by Robe

• bert

t Ri Rice ce Sar Sarge gean ant Insu t Insuran ance ce Age Agenc ncy, L , LLC.

State Compensation Insurance Fund

 This presentation is intended to provide some

techniques to reduce the exposure and cost

• f Workers’ Compensation.

 This discussion is not intended to be legal

advice but a sharing of information from personal experience and the experience of

• thers.

 Consult an attorney or insurance professional

regarding any specific issue confronting your business.

State Compensation Insurance Fund

 35+ years as an insurance professional  35+ years appearing before the WCAB  25+ years as a licensed private investigator  25+ years as a certified self-insurance

administrator

 4 years as a licensed property casualty agent  30+ years as a small business owner

State Compensation Insurance Fund

 Saf

afet ety !!! !!!

 Medica

cal Provid vider r Network

• rk

 Re

Return n to work-modi modifi fied d or alternate ate duty

 Inve

nvestig stigatio tion

 Communi

mmunica cate te with insuranc ance ca carrier

 Documentati

cumentation

• n

State Compensation Insurance Fund

 Have

ve a written ten and enforced forced safety y program ram intended ended to provide ide employees loyees a DIRECT ECT FINAN ANCIAL CIAL INCENTI ENTIVE VE

 Measure

asure the emplo loyees yees succe cess s or lack k of succ cces ess s in con

• ntr

trollin

• lling

g inju juries/a ies/acciden ccidents

 Lead

ad by example mple

 Instill

still a positive itive healt alth h and safety cult lture ure

 Ensu

sure e that emplo loyees yees are involved

• lved in the decisio

sion makin ing g proc

• ces

ess

Safety !!!

State Compensation Insurance Fund

 1. Employees s become more focused ed on their work  2. Parti tici cipat pation ion mo moti tivates ates em employ

• yee

ees to to con

• ntribut

tribute e mo more.  3. Participa ticipati tion n in dec ecision n ma making ng can hel elp em employ

• yee

ees to to become e more accou

• untabl

ntable  4. Demons nstrat trates s that you care about them

State Compensation Insurance Fund

 Near misses and resulting inspections

may help prevent an injury or even a fatality, but an investigation cannot take place if the near miss is not reported accurately.

 Therefore, setting up a successful safety

management program to ensure near misses are reported and investigated is an important step in reducing

• ccurrences of serious incidents

State Compensation Insurance Fund

State Compensation Insurance Fund

 Gives the employer/insurance carrier

unlimited medical control.

 Doctors are trained in reporting requirements  Doctors are usually more accessible to the

employer’s input

 Better opportunity for prompt return to work  Significantly reduces medical costs in a

litigated case.

State Compensation Insurance Fund

 At the time the employee

• yee is hired or when a ne

new insur uranc ance ca carrier r is obtained ined the employe yee(s) (s) must t be notified of the employer’s MPN.

 In English

sh and in Spanish sh (required) red)

 Incl

clude ude a Predesi esignation gnation Form, , in English sh and Span anish. ish.

 Have

ve the employe yee sign the ack cknowl

• wledgemen

edgement t form m which ch should ld also be in English sh and Spanish sh an and signed ed in thei eir nat ative ve lan anguage uage

 Ta

Take a p photogra

• graph

ph of the employe

• yee holding

ng the MPN N pack cket. et.

State Compensation Insurance Fund

State Compensation Insurance Fund

State Compensation Insurance Fund

State Compensation Insurance Fund

State Compensation Insurance Fund

 Faci

cili litate tate returning ning injured ed workers rs to work

 Of

Offer er modifie fied d or al alter ernate ate work

• Does not have to be enjoyab

yable le or pe permanent nent

• Shoul

uld have to ha have some benefit it to t the employer yer

 Create

e modifi ified ed or alterna nate te work job bank and written ten job des escr cription iption for ea each ch

 Always

s co communicate municate with your employee

• yee and the

doct ctor(

• r(s)

s) in writing ng that alterna nate te or modifi fied d work is available able.

 Keep

p your insura ranc nce e adjuster ter informed rmed of modifi fied d

• r alternat

nate e work availabi ability lity

State Compensation Insurance Fund

 Prompt

mpt interna ternal l inve vest stig igatio ations s are cruc ucia ial

 Disputed

puted claim ims need ed an aoe/coe coe inves vesti tigat gatio ion

• This starts with the Employer investigation and documentation

 Recomm

ecommen end d Surveil veillan lance ce inve vest stiga igatio ion early in the claim ims proc

• ces

ess

• The insurance carrier far too often waits to undertake sub-rosa
• investigation. Provide them a reason, in writing, as to why

surveillance would be beneficial…FRAUD ?

State Compensation Insurance Fund

 Monitor the claims activity  Push disputed cases to a prompt disposition

including Trial

 Monitor reserves and claim closure  DO NOT DEPEND ON THE INSURANCE

COMPANY TO ALWAYS PUT THE EMPLOYER’S INTEREST FIRST

State Compensation Insurance Fund

 The common HR rule is to document

everything

 Serves you very well in Workers’ Comp

• Employer can seek relief from the insurance carrier

for improper claims handling Should a case go to Trial, you as the employer are prepared to influence the Judge

State Compensation Insurance Fund

Th Thank nk you for your r atten enti tion!!

• n!!

 Rob

• ber

ert Ric t Rice

 Sar

Sarge gean ant t Insu Insuran ance ce Age Agenc ncy, , LL LLC.