day of injury study 2005-2006 schools insurance authority
TRANSCRIPT
Day of Injury StudyDay of Injury Study2005-20062005-2006
Schools Insurance Authority
Co-Presenters:Co-Presenters:Martin Brady, Director, SIADennis Chandler, DAY-1 SystemsDebra Russell, WC Manager, SIA
SIA BackgroundSIA Background
Joint Powers Authority (JPA) Self Insured-Self Administered Administers workers’ compensation,
property & liability & prevention services
Staff CA Comp
Study of Schools Insurance Authority (SIA) workers’ compensation program.
Nurse “First Call”/Structured Return to Work Program implemented in 2000.
SIA represents 34 school districts, 19,500 employees in several counties in northern California.
Day of Injury StudyDay of Injury StudyPERI Funded Research PERI Funded Research
Comparative data analysis within industry and similar programs in CA.
National data on RN “first call’ telephonic reporting.
Develop a best practices manual for injury reporting, medical management and return to work
Day of Injury StudyDay of Injury Study
Day of Injury Day of Injury
““Controlling the workers’ Controlling the workers’ comp line of scrimmage”comp line of scrimmage”
Comp & FootballComp & Football
Team SportTeam Sport
Involves strategiesInvolves strategies
Employer is always plays defense.Employer is always plays defense.
Focus on controlling the line of Focus on controlling the line of scrimmage, day of injury.scrimmage, day of injury.
Holding the offense to no gain or short Holding the offense to no gain or short gain plays.gain plays.
RE-THINK YOUR CURRENT SCHEMERE-THINK YOUR CURRENT SCHEME
It’s All About Xs & OsIt’s All About Xs & Os
High Tech… High TouchHigh Tech… High TouchGame PlanGame Plan
What is the impact of using a nurse “first call” process to :
Employees?Supervisors?Claims management,
frequency/severity?Litigation?Medical Providers?Return to Work?
DAY of INJURYDAY of INJURY
The most important The most important play to execute.play to execute.
The employer’s response on the day of injury
significantly determines the nature, duration, cost and
eventual outcome of a claim.
Three Distinct Processes:
injury reporting & notification
assessing & managing the medical treatment process
return to work.
Day of Injury Day of Injury
Time is MoneyTime is Money
18%
30%
45%
Increased Claim Cost
COST OF LATE REPORTINGThe Hartford Study, 2000
3-D Column 1 1-2 weeks 3-4 weeks >4 weeks
Medical-Legal Event
Notification process
Data collection of facts to determine cause and claim compensability.
Medical situation/triage assessment.
Shared information to all primary stakeholders.
Injury ReportingInjury Reporting
Injury Reporting- NotificationInjury Reporting- Notification
“Invite the call” philosophy. TLC approach by intake RN. Comprehensive data gathered on the day of
injury by RN. Better claims decisions on compensability.
Effective medical channeling to occupational providers in spite of employee’s right to pre-designate treating physician.
Nurse “First Call’Nurse “First Call’
Telephonic ReportTelephonic Report
Injury report telephonically to Occupational RN.
Medical triage to preferred providers. Immediate return to work in modified duty
with pre-identified tasks (>100 modified duty options)
Ongoing RTW case management integrated with claims management.
Nurse “First Call”Nurse “First Call”
Structured Return to Work ProgramStructured Return to Work Program
Claims examiners & RN assigned to district.
Balance/interface of claim & medical goals.
RN–RTW Coordinator continually develops provider relationships, attends significant medical appointments with employee.
SIA’s Utilization Review (UR) program.
Claims Management Claims Management
Promotes communication at the onset of an incident between all parties. Litigation dropped 65%.
RN viewed as an employee advocate. Claims data: how, when, where, is more
complete & detailed. Within minutes the simultaneous processes
of claims management, medical treatment and return to work are engaged.
Nurse “First Call”Nurse “First Call”
Study FindingsStudy Findings
Telephone reports-averages 1450 incidents
(calls) annually. 40% of reports are RN self-care or report
only, not resulting in a claim. 30% of claims are classified medical
only/restricted duty due to immediate return to work in modified duty within 3 days in CA.
42% of claims are medical only. 28% of claims result in lost time/indemnity.
SIA 5 Year ResultsSIA 5 Year Results
1589 15771526
15001403
594562
662600
564
995 1015
864908
839
184174210
254
163
811 841
654654
676
303
215
235231 247
Incidents RO/RN Claims Indemnity MO MO-RD
W.C. Incidents & Claims / Types Comparison
3-D Column 1 2001 2002 2003 2004 2005
During the last 3 years, 1826 injury reports
were handled as RN Self-care/Report Only. 94 % of those incidents remained as RN
Self-care/Report Only (no further medical treatment) after 90 days.
Top three nature of injury categories were: strain/sprain, bruise/contusion, & laceration.
RN First Call ResultsRN First Call Results
26% of all calls were classified as Medical
Only/Restricted Duty. i.e. Claims with medical restrictions, back to
work within 3 calendar days. In a review of the past 3 years of MO/RD
claims, 92 % of those claims remained as a Medical Only claim after 90 days.
RN First Call ResultsRN First Call Results
First Year PerformanceFirst Year Performance Schools Insurance Authority, SacramentoSchools Insurance Authority, Sacramento
First Year Evaluation, 2000 vs. 1999 34% decrease in all claims. 44% decrease in indemnity claims. 46% decrease in total paid. 37% decrease in incurred costs. 1,589 incidents reported, 995 claims filed,
37% of all incidents did not result in opening a claim.
First Year PerformanceFirst Year PerformanceRedwood Empire Schools Insurance Group, Redwood Empire Schools Insurance Group,
WindsorWindsor
First Year Evaluation, 2004 vs. 2003 Total Incurred costs decreased 42%. Total paid costs decreased 20%. 871 incidents reported, 503 claims filed,
42% of all incidents did not result in opening a claim.
148 claims were placed in modified duty within the first 3 days to avoid an indemnity lost time claim.
RN “FIRST CALL”
Systematic return-to-work decision process.
Immediate response to employee disability using RTW Coordinator.
Utilizes planned or pre-identified RTW options .
Structured Return to Work
Structured Return to WorkStructured Return to Work
Formal mod. duty program at all districts. Goal: Fully engage RTW within 3 calendar
days to avoid indemnity claim. RTW Coordinator case manage all mod duty
claims until RTW full duty resolved. Program requires ongoing efforts to keep
program viable at site levels.
Employer’s RoleEmployer’s Role
Prompt reporting using Nurse Line Set a return to work expectation through
policy and training. Develop RTW options (plan) in all major job
classifications subject to injury claims. Maintain close contact with employee, RTW
Coordinator and claims examiner.
Temporary Work AssignmentTemporary Work Assignment
Tasks might be . . . Part of existing job Supervisor assistance Administrative; special projects Maintenance/p.m., benchwork,
cleaning Inventory/sorting/labeling/ordering Quality; visual tasks Safety/hazard inspection Training Ongoing or periodic/seasonal
Temporary Work Assignment
JOB TITLE: Shop Tasks
SUMMARY: Performs a variety of light tasks within maintenance/electrical shop. task can include sorting parts, labeling, bin straightening, filing paperwork, painting, cleaning/painting light fixtures, assisting regularly assigned personnel in benchwork tasks as available.
HOURS AVAILABLE: 8 daily
Unified School District.
Essential Job Function Essential Job Function AnalysisAnalysis
Equipment & Tool Repair TechnicianJob DescriptionJob Title: CustodianDistrict: The Best USD
Return-to-Work ProcessReturn-to-Work Process
Work Injury
Employee/Supervisor Call Nurse
Report InjuryTriage MedicalComplete ReportImmediate notification/reports to all parties
Nurse Directs/channels Employee to
Medical Treatment
Physician completes work status reportEmployee returns work status report to employer.
Employee/Supervisor & RTW Coordinator
Review work status reportAssign modified duty/TWAComplete RTW agreement
Monitor Employee’s Progress to Full Duty