1. 2 loss history loss trends – type and frequency identify strains, tears and pulls number of...
TRANSCRIPT
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Loss History
• Loss Trends – type and frequency
• Identify Strains, Tears and Pulls
• Number of Lost Time Claims
• Large Loss analysis - % of total cost
• Compare OccuSure costs for similar claims
• Projected Losses going forward
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Safety Management
• Review current programs in place
• How many losses could have been prevented
• Ground Troops in place
• Owner Support
• Pre-inspection or Phone Survey
• Attitude is extremely important
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Claims Management
• Current claims procedures
• Physician Panels
• Return to Work
• Comparison of Client data to NCCI and OccuSure
• What impact could we have with client support
• OccuSure Commitment Forms
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NCCI Statistics
• Lost time account for 23% of the total claims but 94% of the cost
• Average Medical Only claim - $580
• Average Lost Time claim - $41,800
• Average NCCI Claim cost - $7,100
• The average WC claims has increased 112% over last 10 years
• WC costs 71% more than Group Health during the first 3 months
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Claims Management
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How are we DIFFERENT?
We MANAGEMANAGE CLAIMS
We do not “Adjust” Claims
Adjust –
To fine tune, regulate, tweak, administer
Manage –
To direct, supervise, control, accomplish
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Claims MANAGEMENT Cornerstones
•75 Claims Per Adjuster – Includes Med Only and Lost Time Claims
•Insured assigned to one adjuster to promote a good working relationship
•Regular Round Table Discussions on Claims & Accounts
•Adjuster Maintains File Control–Not Case Management or Legal
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PROACTIVE TEAM APPROACH
•Weekly Roundtable Claim Meetings–All claims <30 days reviewed at least monthly
•Weekly Office Meeting –Safety & claims discuss at risk accounts
•Monthly Meeting–Underwriting, Claims and Safety
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The Typical TPA Life of a ClaimClaim Called into
Claim intake Company
Claim Assigned toBasic Adjuster
Claim Assigned to Lost Time Adjuster
Claim Assigned to Case Mgr Clmt gets an Atty often
Claim assigned to Litigation Adjuster
Claim Assigned to an Attorney
Claim has SubroAssigned to subro firm or adj
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OccuSure Life of a Claim
Insured
Safety
Surveillance Attorneys
Case Management
Doctors
Claimant
CLAIMS MANAGER
FROI Fax or Email
distributed to Claims & Safety
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RESULTS
Industry Average
Case Loads Indemnity 150-200Claim Duration Med Only 150 DaysDuration Indemnity 4-6 YearsAverage Claim Cost $ 7,100% of Claims – LT 23 %Litigated Cases 13 %
Type of Injury Total Cost
Back $150,000 to
$375,000
Shoulder $ 30,000 to
$150,000
Knee $ 50,000 to
$175,000
OccuSure Average
Case Loads 75 (incl. Med Only)
Claim Duration Med Only 74 DaysDuration Indemnity 132 YearsAverage Claim Cost $ 3,606% of Claims – LT 11 %Litigated Cases 0.15 %
Type of Injury Total Cost
Back $ 16,244 75 (largest
$190K)
Shoulder $ 18,089 (largest $152K)
Knee $ 12,680 (largest $69K)
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Evaluating a New Risk
•Typical Claims (Strains, Slips, etc)–Evaluate to ensure nothing unusual regarding account or claims specifically to account for increased costs.
–If not and company has typical claims and frequency then we adjust to OccuSure typical results for that industry.
•Catastrophic Claims –Safety & Claims discuss the catastrophic risks vs controls
–Sometimes adjustment in claim cost can be made for OccuSure claims handling. Get specifics.
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Loss Control
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Pre-Inspection Assessments
•Corporate Culture’s Top Management Commitment to Safety and OccuSure Guidelines
•Hiring Practices
•Temporary Modified Duty Policy
•Management’s desire to change loss history
•Identify Risks and Controls
•Company Safety Expectations Communicated
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LOSS CONTROL RELATIONSHIP
•Establish a relationship based on trust and partnership
•Communicate support system of Loss Control function
•Offer High Quality Safety Systems
•Establish accountability for timely follow-up action on recommendations
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Behavioral Based Model
•Communicate the value of The M.O.S.T.® Safety System
•Customize to the individual company
•Train the trainer to maximize resources
•Train supervision on observation methods from The M.O.S.T.® System for Supervisors