California Workers’ Compensation Make California WC Great Again Jerry Ferris, ARM Ferris Risk Solutions, LLC (940) 489-2040 jerry@ferrisrisk.com Lesley Feldman, ESQ Lesley Feldman Law (818) 995-3200 lesley@lesleyfeldmanlaw.com Paige Newbold, CWCP LivHOME, Inc. (800) 807-5854 pnewbold@livhome.com

Agenda California WC - Fun Facts Pre-Claim Steps Claims Management & Legal Environment Questions

California WC - Fun Facts More than 220 insurance companies provide workers compensation insurance coverage to nearly 700,000 employers and deliver medical and wage replacement benefits to almost 800,000 injured workers. CA continues to average the highest workers compensation insurance rates in the country CA rates are largely driven by the greatest frequency of permanent disability claims in the country, high medical costs per claim and higher than average costs of handling claims and delivering benefits

The Tangled Web

Cost Distributions Distribution of Total Insured System Costs 2014 & 2015 WCIRB of California – Cost Distributions publication 2016

Cost Distributions Distribution of Medical Benefits Paid 2014 & 2015 WCIRB of California – Cost Distributions publication 2016

Statistics Body Part most injured: Back 23% Shoulders/arms 13% Knees 9% Fingers 7% Percentage of Claims by date of hire: 0 – 90 days = 10% 91 – 180 days = 17% 181 + days = 73%

Pre-Claim Steps Establish a protocol for claims reporting internally Set-up Clinic protocols Return-to-Work Program Establish Claims Management Guidelines with Carrier/TPA Medical Provider Network (MPN) Participation Identify WC Defense Counsel by Territory Annual training for all staff Communicate with adjuster, counsel & injured worker

After an Injury - Forms Workers Compensation checklist (optional) Accident Investigation Report (AIR) – (optional) Employee Claim form (DWC1) - (required) Report of Illness or Injury (Form 5020) - (required) Authorization for medical treatment & clinic locations (required) Modified Duty Offer letter – template (required, only if offered) Facts about Workers Compensation – Division of WC (required) Medical Provider Network (MPN) handbook (required) http://www.dir.ca.gov/dwc/forms

After an Injury - Investigation The supervisor should visit the employee & accident location/site as soon as possible, no later than 24 hours, to review the site of the injury The Accident Investigation Report (AIR) should be used to collect pertinent details about the claim Photos should be taken of site and injured worker to ensure accident matches environment & injury matches investigation The Safety/HR department and the supervisor will work together to determine the cause of the injury and how to prevent future occurrences The employee/injured worker and any other witnesses should be interviewed Potential hazards should be removed and retraining provided wherever & whenever possible Document re-training on AIR

Return-to-Work – Transitional Work Program Objective Return injured employees (who might otherwise be out on disability) to productive employment as soon as possible Benefits Reduces the high cost of Temporary Disability (Indemnity) payments Reduces potential for litigation of claim Litigation adds to the overall cost of a claim Disability periods are typically extended as a result of litigation Speeds the recovery of the injured worker Allows for flexible work schedule to accommodate physician appointments, therapy, etc. Assist the injured worker and their families by staying active and providing them with meaningful work during their recovery. Studies confirm that the longer an injured worker is restricted from work, the harder it is to get him or her back to regular employment

Return-to-Work – Transitional Work Program How to get started: Referral sent to Transitional Work Program provider. Current work status/restrictions provided to assist provider in locating appropriate position. Current Job Descriptions / duties, rate of pay, etc. Date & time of next physician appointment, update after each appt. If litigated, the petitioner’s attorney & defense information. Provider will canvas area within 5-10 mile radius of employee’s residence to minimize transportation issues. Once position is found, then employer will send out Offer of Modified Duty letter to employee. If they accept, schedule & pay employee as you would if working normal duties.

Return-to-Work – Transitional Work Program WCIRB of California – Cost Distributions publication 2016

Return-to-Work – Transitional Work Program

Why Have Claim Reviews? Monitor the claims process – keeps claim active Provide a forum to exchange information and ideas Generate collaborative solutions Reduce claims costs

Components of a Claims Review Working as a Team Employer Carrier/Adjuster Defense Counsel Broker Other Experts

Track Progress After a Claim Review Review Plans of Actions Document progress and challenges Discuss challenges with carrier/adjuster Revise Plans of Actions as needed

Claims Management & Legal Environment Whether to ACCEPT OR DENY a claim? Case by case basis Take the full 90-days to evaluate and determine validity and compensability of claim Take deposition of applicant Get witness statement Subpoena medical records Have to pay up to $10,000 in medical treatment Deny claim you lose your MPN management and lose the UR process A denial based on NO medical evidence is NOT a strong denial If you went to trial on the issue of AOE/COE tomorrow would you prevail

Claims Management & Legal Environment A Company’s best defense is PREPARATION Additional body parts Was the added body part pled as part of original injury Did the applicant testify to these complaints at time of deposition Does the applicant have non industrial treatment in regards to additional body parts? Has the applicant in fact sought treatment for additional body parts or did AA just add them in hopes of getting more money? Did Panel QME or AME comment on additional body parts Cut off discovery before they receive treatment for additional body parts Know the difference between underlying condition and additional body parts

Liens – Preparation for Lien Trial How to be prepared for a Lien Trial at a Lien Conference: When the case resolves via C&R or Stip serving all medicals onto physician lien claimants Send a letter to all non-physician lien claimants and request they file a petition for medicals Serving exhibits 30-days prior to the Lien Conference date

Liens – Preparing Exhibits “Accepted Claim” When preparing exhibits on a an accepted claim, list the following: Medical Provider Network (MPN) Notices Delay Notices Acceptance Notices Benefit Notices Benefit Printouts Explanation of Reviews Utilization Reviews (UR) Bill Review Expert

Liens – Preparing Exhibits “Denied Claim” When preparing exhibits on a an denied claim, list the following: Delay Notice (if one was sent) Denial Notice Objection Letters Witnesses It becomes the lien claimant’s burden to prove AOE/COE for denied claims

Liens – Statue of Limitations An entity has 3 years to file a lien with the WCAB if their last DOS is prior to July 1, 2013 An entity has 18 months to file a lien with the WCAB if their last DOS is after July 1, 2013 All entities that file a lien are subject to pay a lien filing fee of $150.00

2 Year and Older Analysis

Questions?

Thank You! Jerry Ferris, ARM Ferris Risk Solutions, LLC (940) 489-2040 jerry@ferrisrisk.com Lesley Feldman, ESQ Lesley Feldman Law (818) 995-3200 lesley@lesleyfeldmanlaw.com Paige Newbold, CWCP LivHOME, Inc. (800) 807-5854 pnewbold@livhome.com