1. 2 NCCI Statistics Lost time account for 23% of the total claims but 94% of the cost Average Medical Only claim - $580 Average Lost Time claim - $41,800.

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Presentation transcript:

1

2 NCCI Statistics Lost time account for 23% of the total claims but 94% of the cost Average Medical Only claim - $580 Average Lost Time claim - $41,800 Average NCCI Claim cost - $8,200 The WC Industry has made money in only 1 of the last 20 years WC costs 71% more than Group Health during the first 3 months IF THE INDUSTRY IS BROKEN WHY DO IT THE SAME WAY? Updated: 01/25/12

33 How are we DIFFERENT We MANAGE Claims We don’t ADJUST Claims Adjust – (reactive) To fine tune, regulate, tweak, administer Manage – (proactive) To direct, supervise, control, accomplish

4 OccuSure Life of a Claim ASSIGNED CLAIMS MANAGER ClaimantDoctors Assigned RN Case Management AttorneysSurveillance Assigned Loss Control Representative Insured FROI Fax or distributed to Claims & Safety

5 OccuSure Case Loads75 (incl. Med Only) Claim Duration Med Only Days Duration Indemnity228 days Average Claim Cost$5,698 % of Claims – LT13% Litigated Cases 1% Injury Type Average Cost Back$ 15,189 (largest $230K) Shoulder$ 19,029 (largest $174K) Knee$ 17,954 (largest $162K) RESULTS Industry Average Case Loads Indemnity Claim Duration Med Only150 Days Duration Indemnity4-6 Years Average Claim Cost$ 8,200 % of Claims – LT21 % Litigated Cases 13 % Injury Type Average Cost Back$262,500 Shoulder$ 90,000 Knee$112,500 Updated: 03/29/12

6 Expectations Commitment from the top down Support Post Accident Investigations Complete loss control recommendations Claims Commitment form

7 Claims Commitment Form 24 hour lag time Use our panel of physicians Return to Work with modified duty To not fire an employee with an open/active claim without an OccuSure consultation

8 Loss Control Behavioral Based Model Communicate the value of The M.O.S.T. ® Safety System Customize to the individual company Train the trainer to maximize resources Train supervision on observation methods from The M.O.S.T. ® System for Supervisors

9 Transition 24 hours - Introduction phone call, claims kits delivered, gather key contacts information. 3 days - schedule WebEx to review all claims handling procedures and expectations and schedule initial loss control visit. 2 weeks - WebEx Training with key contacts (decision maker, claims and loss control 30 days – Complete onsite loss control assessment, identify causes of loss, and introduce the M.O.S.T. safety system