WORKERS COMPENSATION: THE 2010 MODEL April 29, 2015 IASBO CONFERENCE

MIKE NUGENT ●Worked for two large insurance brokers from 1981 – 1993 ●Specialized in public entity insurance and pooling ●Created Nugent Consulting LLC in 1993 ●Oversee, manage or consult to 30+ Illinois governmental agency self-insurance plans ●Manage 3 educational pools and 4 municipal pools

Diane Salomon ●Safety Director for the Secondary School Cooperative Risk Management Program (SSCRMP). (16 High Schools and 6 Alternative Schools) ●Primary responsibilities include; program implementation, incident investigation, facility inspections, claim analyses and safety recommendations to reduce work related injuries. ●Previously worked with Learning Care Group as the National Safety Specialist and Weber Stephen Products Company as a Safety Coordinator.

WC COVERAGE OPTIONS ●Pools ●Self-insurance ●Traditional Coverage

THE 2010 WC MODEL ●Front End Safety ●Nurse Triage ●Accident Investigation ●Dedicated Adjuster with Controlled Case Load ●Return to Work

FREQUENT MODEL ● Safety Audits / Inspections ● Safety Committees ● Policy Manuals ● Limited Accident Investigation ● Adjuster Case Load = ● Fax or Form 45 ● Initial Medical Triage by Supervisor ● Hyper PPO ● Limited RTW

NEW MODEL: FRONT END SAFETY ●Dedicated Safety Professional ●Accident Investigation ●Facility Inspections ●Training ●Safety Committees ●Resource

NURSE TRIAGE ●The Medcor Approach ●1-800-NURSE ●Injured Employee calls the 800 number right after the injury ●The Nurse triages the claim over the phone ●Employee is sent for care to a designated medical provider or given self-care instructions

NURSE TRIAGE ●Calls are recorded and stored ●Translation in 200+ languages ●Triage report ed minutes after the call ●Accident investigation is initiated minutes after the call ●Adjuster notified minutes after the call (No more form 45!)

NURSE TRIAGE RESULTS ●Provided an opportunity to commence accident investigation ●Provided a risk management tool ●Reduced lag time ●Improved adjuster / employee communication ●Reduced medical costs / per claim costs ●Employees have gone to designated provider 90% of the time

Claim Reporting- Average Lag Days Secondary School Cooperative Risk Management Program

New Model: Dedicated Adjuster ●Hired a full time dedicated adjuster ●Capped case load at 60 ●Contact with injured employees weekly ●Oversight of medical care ●Responsible for transition to RTW

New Model: RTW ●Previous resistance ●New Model / New Day ●Flexibility ●Everyone can work

Results ●SSCRMP Members WC claims volume decreased 4% from the three years after implementatin of the model, compared to three years prior. ●This reduction occurred even after the Nurse Triage system drew more claims into our system than before ●Total costs savings over the three-year period = $485,000 (after adjusting for medical inflation)

Additional Savings ●The number of auto accident cut in half, saving $700,000 over three years ●The number of student / visitor injury claims cut in half, saving $415,000 over three years ●Total Savings on non-WC claims = $1,115,000

Total Savings $1,600,000

Q&A ●Q&A