Case Management Tips and Techniques Rick Hill - Brickstreet Mutual Insurance & Joe “Safety” Baumgardner

Case Management without a Plan

My Company’s Plan… “We have been in business 25 years and No One hurt” “We’ll just pay for all the small stuff anything under …..” “They (Insurance or OSHA) will never know if we pay for it and don’t record it” “Just run them to ER or Med Express” “I don’t want them back till they are 100%” (They watch Edgar Snyder all day)

Fundamentally a Plan Protects the Worker Where to Begin………. Develop Policies / Tools – Formal or Informal Early Return-To-Work Accident / Incident (Near Miss) Investigation Injury Kit Communicate expectations & hold folks accountable Supervisors are the Key Coordination – Routine & Consistent Employees & Injured Workers Workers’ Comp Provider Medical Providers

What’s an Injury Kit ? Supervisor Checklist Reporting Contacts – Names and Numbers Physician Statement of Physical Capabilities Medical Records Release Incident Report First Fill Form – Pharmacy BI-1 Form - WV Workers’ Compensation Report of Injury or Disease

Cost of Poor Case Management Medical Vs Indemnity

Indirect Costs Reduced expenses for Litigation Fraudulent claims New hire(s) Training Personnel

What is E-mod? E-mod stands for Experience Modification E-mod “modifies” your workers’ compensation premium by multiplying directly with your base rate For example, if your base rate is $3.00 per every $100 payroll, and your E-mod is 1.00, you will pay $3.00 per every $100 payroll E-mod is one of the primary factors in determining your modified workers’ compensation premium. STATES ARE Different but CLAIM MANGEMENT WORKS THE SAME!

Why is E-Mod Important ? Direct link to bottom line profitability (lower premiums) Deciding factor when bidding against competitors – YOU CAN’T EXPLAIN ON ISNETWORLD A high E-Mod may prohibit company from bidding on projects altogether A high E-Mod portrays that a company may be unsafe, and can be a red flag to potential customers, employees, the community, or regulatory agencies.

ABC Company Incorporated Current E-Mod = 1.50 Base Rate = $3.76 per $100 of Payroll Modified Rate = $5.64 per $100 of Payroll Example Payroll of $1M – (20 employees @ $50k Annual Salary) $1,000,000 / $100 x $5.64 = $56,400 ( Base Premium)

XYZ Company Incorporated Current E-Mod = 0.50 Base Rate = $3.76 per $100 of Payroll Modified Rate = $1.88 per $100 of Payroll Example Payroll of $1M $1,000,000 / $100 x $1.88 = $18,800 (Base Premium)

Measure Results – Continual Improvement Questions to routinely ask about your program: Have lost workdays decreased? Have reporting times improved? Have claims / costs decreased? Has production been maintained? Have relationships with local healthcare providers improved? Has the culture improved? How can the process be improved?

Summary It begins and ends with Culture – Either design it, or get one by default Timely Reporting – Internal & External Communication is Key – Internal & External Safety Committees are a good tool that PA gives discount for having in place A/I Investigation – Facts and Conclusions Early Return to Work –Keep IW Engaged Measure Results / Continual Improvement Bad claims management will show on Your OSHA logs

Questions?