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Los Angeles Unified School DistrictLos Angeles Unified School District

OOwner wner CControlled ontrolled IInsurance nsurance PProgram rogram ((OCIPOCIP))

Presented by:Presented by: Aristeo Aguilera, CRIS Aristeo Aguilera, CRIS

OCIP CoordinatorOCIP Coordinator

AgendaAgenda

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• LAUSD background / Overview• Traditional vs. OCIP Insurance• LAUSD OCIP Risk Management• OCIP Enrollment / Coverage's• OCIP Claims Reporting Protocols‘• OCIP Risk Management contacts• Q & A

LAUSD BackgroundLAUSD Background

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The Los Angeles Unified School District (District) is the second largest school district in the United States

The District will serve nearly 690,000 elementary, middle, and high school students

Over 1200 schools and centers, dispersed over an area of approximately 710 square miles

District buildings range in age from new or currently under construction, to buildings more than 60 years old

129 new K – 12 schools have been constructed since 1999 / opened 20 new schools this fiscal year

Finger Facts 2013-2014 LAUSD has eight local Districts / three regions: North, Central & South

Background continuedBackground continued The Bond Funded Construction Program includes both the repair, upgrade

and modernization of all schools and construction of new schools or additional classrooms at existing schools.

Work on existing school campuses includes the following projects:

– improve school safety

– upgrade communications, technology access and electrical service

– replace portable bungalow classrooms with permanent structures

– install or upgrade air conditioning and heating

– accomplish deferred maintenance work

– repair plumbing and paving

– adding gymnasiums, lunch facilities, libraries, and support structures

– solar panel installation program District wide04/19/23

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Traditional VS. OCIP InsuranceTraditional VS. OCIP InsuranceTraditional:

a) Contractors required by the District to purchase & maintain adequate insurance coverage’s naming the District as additional insured.

b) Passes through the cost of the insurance to the District

OCIP:

a) Purchase insurance that covers District, contractors and subcontractors working at the project site at no premium cost to contractors

b) Obtains insurance at a lower cost than most contractors / subcontractors

c) Administers uniform loss prevention & safety programs

d) Manages all LAUSD OCIP claims until claims are closed

e) Establishes centralized programs to monitor contract compliance

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Types of Insurance structuresTypes of Insurance structures

a) Guaranteed Costb) Retrospectivec) Large Deductible Program d) Excess Insurance e) Self Insured

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Reducing Your PremiumReducing Your PremiumThree factors go into the calculation of your workers’ compensation premium:

1)Rate assigned to each payroll classification in your business2)Total amount of your payroll for each classification3)And your experience modification factor.

The experience modification factor is also known as “mod” or “Ex-mod”.Your workers’ compensation premium is calculated:Payroll Classification X $100.00 of payroll X experience mod. = Premium.

The amount of risk assigned to each payroll classification is calculated by the National Council on Compensation Insurance (NCCI); California would be the Workers’ Compensation Insurance Rating Bureau (WCIRB).

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LAUSD’s Risk ManagementLAUSD’s Risk Management Oversees the day to day operations of LAUSD’s OCIP

functions, including contractor enrollment, WC, GL, contractors pollution liability, builder’s risk, marketing, loss prevention, claims management, construction values, contractor payroll, and all vested partner inquiries.

Partnering with the Facilities Services Division, Insurance Broker, Third Party Administrator, & Vested partners to achieve continuous success.

Provide courteous and expeditious customer service to all LAUSD OCIP inquiries from all sources.

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OCIP Risk Management ContinuedOCIP Risk Management Continued

Analyze and review LAUSD OCIP insurance exposure data (New / Modernization Construction) using several data sources and customized programs.

Initiate recommendations, evaluate and administer new policy and procedures relating to LAUSD’s OCIP for all participants and partnered organizations.

Perform quarterly claim reviews of all open OCIP insurance claims, imposing best developed strategies to resolve all litigated and non-litigated liability exposures.

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LAUSD’s OCIPLAUSD’s OCIPLAUSD’s Risk Managements’ department has arranged for the

Districts construction projects to be insured under an OCIP; a single insurance program that insures the District, the Board, all enrolled contractors and enrolled subcontractors, and other designated parties for work performed at the Enrolled Project Site(s). .

Coverage's under LAUSD’s OCIP include: Workers’ Compensation, Commercial General Liability, Excess Liability, Contractors Pollution liability, and Builder’s Risk for enrolled parties at the project site(s).

LAUSD’s OCIP is Bond funded through approved Measures:a) BB, K, R, & Yb) For both New & Existing projectsc) The shift from New Construction, to providing LAUSD

with comprehensive repair and modernization projects has begun; next responding bond: Measure Q.

LAUSD OCIP Insurance Coverage’sLAUSD OCIP Insurance Coverage’s(site specific) $500K SIR(site specific) $500K SIR

Workers’ Compensation (Statutory Coverage) for work related industrial injuries/accidents.

General Liability ($2 Million) bodily injuries / property damage

Excess Liability ($100 Million)

Contractor’s Pollution Liability ($50 Million) contamination / spills

Builder’s Risk ($10K Contractor deductible) property damaged during the course of construction /pending pending project valueproject value

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Enrollment ProcessEnrollment Process / Contracts / ContractsAll contractors and subcontractors must each complete and submit enrollment documents for each contract awarded, Broker triggers: NOIA / NTP & LAUSD communication. Upon completion of this process, Alliant will issue to the contractor and subcontractor, a certificate of insurance (COI) evidencing coverage in the OCIP. The completed COI and workers’ compensation insurance policy will be provided to each enrolled Contractor and Subcontractor.

•Alliant will provide a welcome letter confirming OCIP enrollment specific to the contract number awarded, referencing the workers’ compensation policy issued

•Insurance information required by Alliant: 1) workers’ compensation, general liability and automobile for any outside non – LAUSD work, providing waivers of Subrogation in favor of the District & Additional insured endorsement required.

•Master Job Order Contracts – Alliant will need Prime contractor award letter, including contract number, School name(s) and certificate of insurance(s).

Excluded ContractorsExcluded ContractorsExcluded contractors must meet the insurance requirements set forth in the OCIP Insurance Manual (GC), providing evidence of coverage to the District.

Hazardous material remediation

Architects, surveyors, engineers, soil testing engineers & consultants

Vendors, suppliers, fabricators, material dealers, pick up drivers…

Contractors & each of their respective subcontractors who do not perform any actual labor on the project site, during term of contract

All crane operators and crane operations

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Contracts with LAUSDContracts with LAUSDThe Facilities Services Division advertises projects for the following services:1)Best Value Procurement2)Job Order Contracts (JOC)3)Formal Construction Contracts4)Informal Construction Contracts5)Maintenance Material Advertisement6)Professional & Technical Services

General Conditions (GC) – Section 00700: An integral part of the Owner – Prime contractor agreement; the GC of the contract sets forth the responsibilities of the Owner, contractor and architect during construction

Insurance Manual – OCIP Contractors Insurance Procedures Manual

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OCIP Claims Reporting OCIP Claims Reporting ProtocolProtocol

Complete the claims report form / call the claim into the TPA, must provide the following details:

1) Project/School site name, 2) Project/School address, 3) Employer name, 4) Prime contractor’s LAUSD contract

number, 5) Employer’s OCIP insurance policy number.

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Reporting Process / SequenceReporting Process / SequenceImmediately notify your supervisor – Injury / near miss occurs Evaluate situation / conditions Follow established treating (protocol): First Aid / band aid / ice / eye drops MPN provider (protocol) (authorization slip) / Provider special instructions 911 Commence paperwork: Field level Investigation Claim form DWC-1 MPN information acknowledgment form B Complete carrier / site claim reporting paperwork call in report (procedures) 5020 Review claims / injury procedures: dot the “I’s” and cross the “T’s”

Types of claims (Policy)Types of claims (Policy)

Definition of a claim (legal): Definition of a claim (legal): To demand or assert as a right. Facts To demand or assert as a right. Facts that combine to give rise to a legally enforceable right or judicial that combine to give rise to a legally enforceable right or judicial action. Demand for relief.action. Demand for relief.

Workers’ Compensation – Record Only / Medical / Indemnity (Workers’ Compensation Claim form DWC-1)

Commercial General Liability – Coverage A, B & C

Property Multiple levels / Builders Risk (COC)

Professional Liability / Errors & Omissions

Auto Liability –

Pollution Liability –

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The Commercial General Liability policy has three general groups of coverage, as follows:

Coverage A of the CGL is specifically intended to pay compensation for bodily injury and property damage which the insured is held legally liable for. This means that if the insured's business operations cause bodily injury or property damage to a third party, coverage A will cover the damages awarded in a lawsuit up to the policy limits, as well as the contingent legal defense costs. Some noteworthy exclusions apply to Coverage A, including intended injury, liquor liability, contractual liability and pollution.

Coverage B of commercial general liability insurance provides protection against personal and advertising injury, such as libel, slander, malicious prosecution, and unlawful imprisonment, copyright and other intellectual property infringement, etc. If the offense is committed intentionally or before the policy comes into effect, it is usually not covered by commercial general liability policy.

Coverage C is intended to cover the medical payments of people who have suffered bodily injuries as a result of the business operations of the insured or on the commercial premises of the insured, regardless of legal liability. This means that the insured does not need to be taken to court for Coverage C to come into effect. The only requirement is that the medical bills are incurred within a year of the occurrence.

Property Insurance :Property Insurance :

Any type of commercial insurance that reimburses a party that has suffered a loss because Any type of commercial insurance that reimburses a party that has suffered a loss because property has been damaged or destroyed. “Property” is considered to be any item that has property has been damaged or destroyed. “Property” is considered to be any item that has value, and is classified as real property, such a building; or personal property, such as value, and is classified as real property, such a building; or personal property, such as someone’s computer. someone’s computer. Basic property insurance policies typically cover explosions, fire, lightning, windstorm, hail, Basic property insurance policies typically cover explosions, fire, lightning, windstorm, hail, smoke, aircraft or vehicle damage, vandalism, sprinkler leakage and sinkhole collapse. smoke, aircraft or vehicle damage, vandalism, sprinkler leakage and sinkhole collapse. Additional coverage can be added for water damage, damage from the weight of snow, ice or Additional coverage can be added for water damage, damage from the weight of snow, ice or sleet, breakage of glass and coverage for falling objects. sleet, breakage of glass and coverage for falling objects.

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Builder's risk insurance:

Is a special type of property insurance which indemnifies against damage to buildings while they are under construction. Builder's risk insurance is "coverage that protects a person's or organization's insurable interest in materials, fixtures and/or equipment being used in the construction or renovation of a building or structure should those items sustain physical loss or damage from a covered cause.

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Professional liability:

Insurance policies are generally set up based on a claims-made basis, meaning that the policy only covers claims made during the policy period. More specifically, a typical policy will provide indemnity to the insured against loss arising from any claim or claims made during the policy period by reason of any covered neglect, error or omission committed in the conduct of the insured's professional business during the policy period. Claims which may relate to incidents occurring before the coverage was active may not be covered, although some policies may have a retroactive date, such that claims made during the policy period but which relate to an incident after the retroactive date (where the retroactive date is earlier than the inception date of the policy) are covered.

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Pollution liability:

Insurance is for businesses and contractors who wish to protect against risks associated with construction and ongoing industrial operations, such as broken pipelines, fuel spills and release of toxic gases. It's a form of gap insurance, because most general liability policies exclude pollution risks. Different pollution insurance carriers offer different terms, and may exclude or charge more for risks they deem to be especially onerous.

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Overview of California claims systemOverview of California claims system

Commission on Health & Safety & Workers' Compensation (CHSWC): A state-appointed body that conducts studies and makes recommendations to improve the California workers' compensation and workplace health and safety systems.

Division of Workers' Compensation (DWC): A division within the state Department of Industrial Relations (DIR). The DWC administers workers' compensation laws, resolves disputes over workers' compensation benefits and provides information and assistance to injured workers and others about the workers' compensation system.

Workers' Compensation Appeals Board (WCAB): Consists of 24 local offices throughout the state where disagreements over workers' compensation benefits are initially heard by workers' compensation judges. The WCAB Reconsideration Unit in San Francisco is a seven-member, judicial body appointed by the governor and confirmed by the Senate that hears appeals of decisions issued by local workers' compensation judges.

Workers' Compensation Insurance Rating Bureau (WCIRB): An agent of the state Department of Insurance and funded by the insurance industry, this private entity provides statistical and rating information for workers' compensation insurance and employer's liability insurance, and collects and tabulates information to develop pure premium rates.

OCIP Risk Management ContactsOCIP Risk Management Contacts

All OCIP Insurance coverage question/concerns are to be directed to the Risk Management Unit.

Aristeo AguileraAristeo Aguilera, CRISCRIS – General Liability, Builders Risk, and Insurance Coverage questions.(213) 241-7994, aristeo.aguilera@lausd.net

Don Hughes, WCCP Don Hughes, WCCP – Claims Reporting Procedures, Medical Provider networks (MPN), Claims Kits,(213) 241-2210, donald.hughes@lausd.net

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Summary / Q & ASummary / Q & A LAUSD background

Types of Insurance

OCIP Risk Management

OCIP Enrollment / Contracts

OCIP Claims reporting procedures

OCIP Insurance / Coverage's contacts

Q&A04/19/23

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