“Your Complete Employers’ Outsourcing Solution” Claims Management is Cost Management A Claims Management Presentation By Tri-State’s Claim Management Department Tri-State Employer Services

Risk Management Mission Statement Risk Management Mission Statement Tri-State Employer Services, Inc. (and affiliated companies) Mission Statement for Risk Management (Loss Prevention, Underwriting & Claims Management) is to develop and maintain an integrated multi-disciplinary program to effectively manage and preserve Tri-State Employer Services, Inc. (and affiliated companies) and our client companies’ resources, assets and liabilities. Tri-State Claims Management

Vision Statement Vision Statement The vision of the Risk Management Department is to: The vision of the Risk Management Department is to: continually improve services to our organization and client companies,continually improve services to our organization and client companies, protect human, physical and financial assets and resources,protect human, physical and financial assets and resources, help maintain a safe and healthy work environment,help maintain a safe and healthy work environment, assist and educate others in meeting regulatory compliance-related responsibilities, andassist and educate others in meeting regulatory compliance-related responsibilities, and promote a risk-conscious climate in a manner consistent with the mission and vision of Tri-State Employer Services, Inc., its affiliated companies and our client companies.promote a risk-conscious climate in a manner consistent with the mission and vision of Tri-State Employer Services, Inc., its affiliated companies and our client companies.

Tri-State Claims Management Tri-State Claims Department Responsibilities: Tri-State Claims Department Responsibilities: –Professionally administer the workers’ compensation claims management function at Tri-State Employment Services and its affiliated companies. –Manage the processing and payment of workers’ compensation claims in a timely manner. –Oversee and manage the defense of litigation brought against Tri-State Employment Services and its affiliated companies. –Be proactive in the development, implementation and management of rehabilitation and injury management policy programs for injured employees.

Tri-State Claims Management What Benefits Does Workers’ Compensation Provide? What Benefits Does Workers’ Compensation Provide? – Workers’ Compensation benefits include payment for time off work due to total or partial impairment and reasonable medical expenses.

Tri-State Claims Management Direct Worker’s Compensation Costs Direct Worker’s Compensation Costs Medical expenses (Unlimited)Medical expenses (Unlimited) Disability / Indemnity (Statutory Limits)Disability / Indemnity (Statutory Limits) Temporary Total Temporary Total Permanent Total Permanent Total Temporary Partial Temporary Partial Permanent Partial Permanent Partial Death Benefits (Statutory Limits)Death Benefits (Statutory Limits) Rehabilitation Benefits (Statutory Limits)Rehabilitation Benefits (Statutory Limits) Benefit AdministrationBenefit Administration Legal costs (Coverage “B”)Legal costs (Coverage “B”) Defense Costs Defense Costs

Tri-State Claims Management Tri State’s “Best Practices” Philosophy: Tri State’s “Best Practices” Philosophy: –Educate our clients on their roles and responsibilities. –Claims Administrator maintains weekly contact with disabled employees. –Client plans for employee’s “return to work.” –Claims Administrator stays informed about claimant’s medical and restricted duty status.

Tri-State Claims Management Tri State’s “Best Practices” Philosophy (continued): Tri State’s “Best Practices” Philosophy (continued): –Claims Administrator constantly questions DOL (date of loss). –Client maintains a safe and healthful workplace.  Participates in Safety Assessments and hazard identification.  Reports all unsafe conditions to help prevent incidents.  Communicates, educate and dedicate.

Tri-State Claims Management Tri-States’ Partners (Clients) “Best Practice” Philosophy: Tri-States’ Partners (Clients) “Best Practice” Philosophy: –Training  Supervisors train new employees in proper procedures, equipment usage, reporting “near misses.”  New employees receive training when hired.  Employees receive training when equipment, procedures or work assignments change. –Pre-Placement Physicals  ADA approved job descriptions are prepared.  Medical clinics have copies of approved job descriptions.

Tri-State Claims Management Tri State’s Partners (Clients) Best Practices ( Continued) Tri State’s Partners (Clients) Best Practices ( Continued) –Medical Control – select a clinic that:  Treats your injured workers promptly and respectfully  Is mindful of your return to work program.  Addresses work restrictions. –Transitional Duty Program:  Establish a return to work policy that is accepted by the bargaining units.  Establish a published version of modified positions.  Consider a time limit for modified duty.

Tri-State Claims Management Tri State’s Partners (Clients) Best Practices ( Continued) Tri State’s Partners (Clients) Best Practices ( Continued) –Litigation Avoidance:  Be responsive to the injured workers needs.  Start injured worker on the correct path by referring him / her to a qualified occupational medical practitioner.  Keep lines of communication open.

Tri-State Claims Management Tri-State’s “Best Practice” Philosophy Tri-State’s “Best Practice” Philosophy –Return to Work Programs  Workplace Injury Management is about returning employees to productive employment quickly and as safely as possible following a workplace injury.  The object of a workplace Injury Management Program is to establish a system that achieves optimum results in terms of a timely, safe and durable return to work for employees following workplace injury

Tri-State Claims Management Insurer Quarterly Claims Review: Insurer Quarterly Claims Review: –Claimant (Injured Worker) revaluation should include:  Employee Profile  Date of Birth  Current Age  Hire Date  Job Position  Compensation Rate  Accident Investigation & Compensability  Accident Date  Date Reported to Employer  Date Reported to Carrier  Accident Description

Tri-State Claims Management Insurer Quarterly Claims Review (Continued): Insurer Quarterly Claims Review (Continued):  Medical & Disability Management  Injury Description  Attending Physician  Estimated Future Disability  Comments  Litigation Management  Employee Attorney  Defense Attorney  Status  Comments

Tri-State Claims Management Insurer Quarterly Claims Review (Continued): Insurer Quarterly Claims Review (Continued):  Recovery Management  Recovery Potential: Y/N  2 nd Injfury Fund / Other: Y/N  Comments  Action Plan and Resolution Strategy  Comments  Time Tables  Follow-ups

Tri-State Claims Management Insurer Quarterly Claims Review (Continued): Insurer Quarterly Claims Review (Continued):  Financial Information  Indemnity  Medical  Expense  Total  Incurred  Paid to Date  Outstanding Reserve

Tri-State Claims Management We need this type of service ! Let’s contact Tri-State now! Let’s contact Tri-State now! Claims Management is Cost Management !

Tri-State Claims Management Contact Us Contact Us –Phone: –Fax: Phillip Bok, CPCU, CWCP, CFSA, CIPA, APA, ARMPhillip Bok, CPCU, CWCP, CFSA, CIPA, APA, ARM Vice President of Risk Management & Insurance Operations Vice President of Risk Management & Insurance Operations “Your Complete Employers’ Outsourcing Solution”