DEFER Overview

Quarterbacking the Process Scott Risk Performance Specialist AdjusterEmployer Injured Worker Behavior Compensability Medical Provider Return-to-WorkPADM Referral Advise, Advocate, Coach and Develop Resolution Strategy Facilitating Monuments Legal Maneuverings Settlement Positioning Monitoring Medical Suitable Employment Assignments Compliance Prior History Seven Day Window Physician Selection

Monuments & Action Items Resolution Strategy Information Development Directing, Evaluating, Facilitating & Expediting Resolution The DEFER Flow Process Determine Compensability Assess Medical Issues Assess Disability Issues Evaluate Behavioral Factors Quality of Information Questions that need answers Facts that Need Gathering Determine Compensability Assess Medical Issues Assess Disability Issues Evaluate Behavioral Factors Quality of Information Questions that need answers Facts that Need Gathering Formulation of Executable Strategy Identification of Resources Treatment Path Return to Work Date PADM Referral? Formulation of Executable Strategy Identification of Resources Treatment Path Return to Work Date PADM Referral? Assign Responsibilities Facilitate, Monitor & Evaluate Adjust Strategy as Needed Countermeasures Assign Responsibilities Facilitate, Monitor & Evaluate Adjust Strategy as Needed Countermeasures

Basic Expectations: Active Communication with all stakeholders Establishing/Building strong client relationships Being quick and responsive customer questions and issues Creation of action plan/resolution strategy Risk Performance Specialist Expectations

Always… Establish a resolution strategy as soon as possible which covers the key monuments, action items, obstacles and responsibilities Look for the opportunities to take action or get things accomplished Approach claims from the standpoint they involve your money Feel confident in coaching the client to play their role in getting things done Contact with the producer if account is not participating or making poor decisions Enlist the help of other specialist if you cannot find answers or angles Resist the urge to let things work themselves out...they won’t Keep the client well informed Recognize our livelihood is dependent on the outcomes we achieve for our clients Find new ways to be creative and differentiate your contribution Be working one step ahead Risk Performance Specialist Expectations

Never… Take the attitude the claim is in good hands with someone else Wait to obtain or resolve that which can be achieved today Leave yourself in a position where you are not fully versed on the facts, strategy, plan or developments of a claim Rely on traditional channels to problem solve Blame claims problems on others, the problems are the essence of your job... your responsibility to provide solutions Accept the status quo of traditional claims management Risk Performance Specialist Expectations

Impacts… Preventing lost time through action/effort Mitigating lost time through action/effort Developing information contributive to or supporting of denial Coaching the client on how to deal with injured worker Facilitation of medical care...appropriate provider Actions/efforts that expedite resolution Strategy or tactics that leads to successful defense Prevention of unnecessary medical care or treatment Obtaining the proper medical care or treatment Preventing lost time through action/effort Mitigating lost time through action/effort Developing information contributive to or supporting of denial Coaching the client on how to deal with injured worker Facilitation of medical care...appropriate provider Actions/efforts that expedite resolution Strategy or tactics that leads to successful defense Prevention of unnecessary medical care or treatment Obtaining the proper medical care or treatment Identifying and facilitating subrogation Coaching the client on best bets germane to a specific case Influencing or leading the adjuster to take action, where their action/inaction is detrimental to the case Tasking or collaborating with PADM to address pertinent medical or disability management issues Alternatives to costly or non-beneficial practices (2nd opinion, IME, Voc Rehab, FCE, etc.) Actions to prevent delays Assures all options have been undertaken Interventions that address behavioral issues of the injured worker Identifying and facilitating subrogation Coaching the client on best bets germane to a specific case Influencing or leading the adjuster to take action, where their action/inaction is detrimental to the case Tasking or collaborating with PADM to address pertinent medical or disability management issues Alternatives to costly or non-beneficial practices (2nd opinion, IME, Voc Rehab, FCE, etc.) Actions to prevent delays Assures all options have been undertaken Interventions that address behavioral issues of the injured worker Risk Performance Specialist Expectations

Non-Impacts… Reporting to the Carrier Passing along information to the adjuster After the fact coaching Providing the client with a status report Staying on diary Answering question Adjuster follow-up to identify actions Lowering of reserves not connected to specific actions Suggesting CRISIS training or use of PADM Client Meeting Risk Performance Specialist Expectations

Physician Assisted Decision Management: Overview Physician based medical advisory firm that deals directly with the treating MD on behalf of the employer under the direction of a Risk Performance Specialist. PADM addresses the following issues: Work-Relatedness (causality) Appropriateness of: ‒ Diagnosis ‒ Treatment Plan ‒ Work Restrictions (RTW)

Why You Need PADM…17:1 ROI Physician decision-making and practice patterns often drive claims outcomes. Nurses may improve communication but rarely influence decision-making: diagnosis, treatment, return-to-work Doctor/treatment shopping is widespread in lost time claims. Insurer panels are rarely more than a list of providers willing to accept a fixed reimbursement. At 12 weeks an injured worker only has a 50% chance of ever returning to work. Reserves for claims with uncertain/non-specific diagnosis are 43% higher than average. Medical causality is seldom pursued by claims handler. The treatment of work comp patients is 3-4 times longer than general trauma patients with the same injury. 2nd Opinions typically add 3-4 week of indemnity payments and rarely result in a change of course. Physician to Physician...not IME, File Review, etc.

PADM’s Findings 10% of claims are either not related to the workplace from the beginning or are worsened by an intervening incident that is not work related (see CRT) 25% of cases involve inappropriate or unnecessary medical care such as: ‒ Unnecessary surgery ‒ Non-thorough surgery ‒ Poorly performed procedures ‒ Iatrogenic illness ‒ PT/work hardening after MMI ‒ Chronic pain treatment w/o adequate diagnosis ‒ Experimental treatments ‒ Continued physician/medical visits w/o improvement In 50% of cases the diagnosis and/or treatment plan is changed or adjusted

Changing Performance Diet/Intervention Desire & Motivation Recognition & Awareness Measurement Least Important Step Non-Essential Yet 95% of Loss Control Efforts take place here Things that Truly Matter!!!

TRIAGE Overview Built by Scott RPG after years of studying the primary cost-drivers in workers comp claims. By assigning weights to various data points, we are able to accurately identify the 10-20% of claims that account for 80-90% of our client’s cost. Once a TRIAGE claim is identified we step into action in real-time with our full arsenal of talent, tools and resources. While it sounds complicated, implementing our TRIAGE is a simple four step process: ‒ Step 1 Calibrate based on past experience and demographics ‒ Step 2 Implement the data collection system ‒ Step 3 Provide training to the client ‒ Step 4 Monitor efficiency and fine tune as needed

TRIAGE: Predictive Modeling Tool Why?...Time is of the essence, waiting to take control and deploy claims management resources is a mistake, but one most cannot avoid because they have no way of determining, from day one, the claims where the stakes are high. After-all, there is little correlation between injury severity and total claims cost. Who?...Your claims administrator, supervisor, and other involved personnel will be trained on the TRIAGE process so they can recognize the characteristics of a claim that triggers us into action. Our Risk Performance Specialist will immediately begin to take control and quarterback the process all the way to resolution. When?...Ideally the same day the injury occurs so the claim can be managed and accountability brought to the process in real-time, as things are developing so we can direct, evaluate, and facilitate a resolution strategy, help drive decision making and anticipate the inevitable roadblocks…not simple react to them one month, two months, three months later.