1. A WORKERS’ COMP DISCUSSION By Brad Scofield & Sandi Kuritzky National Interstate Insurance December 14, 2005

2. TYPE OF W.C. CLAIMS Medical only Lost time- TTD or TPD Permanent Partial Disability (PPD) Communication Is Key

3. MEDICAL ONLY Facts : School bus rear ended by a truck Driver had neck injury Emergency Room and 1 follow up with doctor Missed 2 days of work

4. Actions : 3 point contact : * ER- details, RTW date, direct medical tx EE- details of MVA, injury claimed, tx, prior injuries Dr- Diagnosis, tx plan, disability, reports/bills Subro investigation : Police report & witness Determine liability Notify third party carrier

5. Actions : Wages due? Waiting period? Determine compensability Bill review- fee schedule & PPO discounts Pay bills Contact ER/EE- verify no further tx Close file Pursue recovery via subrogation

6. LOST TIME CLAIM Facts : Mechanic slipped on ice on ER premises Severe ankle sprain EMS to Em Rm, referred to ortho No RTW

7. Actions: Repeat prior steps Calculate AWW- pay TTD Issue state regulatory forms Hire nurse case manager Reserves- evaluate exposure Encourage ER to maintain contact with EE

8. 2 wks later- released to modified duty Consult with ER- modified duty is available Obtain job description ER offers modified duty to EE Specifics - verbal & written Date/time, tasks, pay rate, report to whom, doctor approved

9. RTW - modified duty Confirm w/ ER the RTW date & wages Pay TPD Update regulatory forms Nurse pushes for full duty release

10. Modified Duty PROS Cost savings Avoid long disability Fulfill a function Establish protocol for others CONS Re-injury Morale issues Disgruntled employee EE likes modified duty too much

11. 4 wks - released to full duty Communicate to ER Pay remaining TPD due Suspend TPD Issue regulatory forms Finalize bills Close

12. LOST TIME WITH COMPLICATIONS Facts: Motor coach operator claimed a right knee injury while unloading luggage No report to ER for 2 weeks Stopped working when report was filed No treatment for 1 wk; with family doctor Family doctor opines injury is work related MRI found meniscus tear Surgery recommended

13. Actions: Repeat prior steps Investigate: R/S EE, witnesses, grapevine info Obtain personnel file, DOT physical Obtain current & past medical records Research prior injuries & claims Refer for Peer Review/ UR Issue delay or denial Refuse treatment requests

14. 4 wks- EE filed Claim Petition Refer to defense counsel Schedule Independent Medcial Exam (IME) Causation Medical tx Determine ER’s witnesses Reserve worksheet- evaluate exposure Medical ● Vocational Rehab Wage loss ● Expenses PPD rating

15. 6 wks- status IME opined etiology unknown. Surgery needed. Surgery done Receive health insurance lien No RTW

16. 10 wks - EE able to RTW modified duty ER has no modified duty EE won’t return ER’s calls TTD exposure continues Medical bills denied Consider surveillance Prepare for litigation EE & ER testimony Expert witnesses (doctors) Decision Appeal

17. 13 wks- released full duty ER doesn’t want EE back Doctor opines 10% impairment rating Surveillance was not helpful EE remains off work

18. Analysis of facts- How strong is our case? PROS: Reported late to ER Continued to work No witnesses Prior history Delayed tx IME doctor has good rep CONS: Family doctor opines work related IME inconclusive Undesirable venue EE appears credible ER won’t offer RTW Defense will be costly

19. VALUATION FOR SETTLEMENT Medical costs & liens 13 weeks TTD 10% Permanent Partial disability impairment rating Voc Rehab Future medical Letter of resignation

20. WHAT CAN ER DO TO ASSIST? Good hiring practices Direct med tx when permitted Develop a process to report claim Use internal forms Communicate process & person to file report Use posters Train supervisors to ask questions & ID witnesses Refer EE for med treatment

21. Report claims promptly to insurer Offer modified duty Adhere to modified duty restrictions Have job descriptions for full & modified duty jobs Maintain contact w/ EE & insurer Document! Document! Document! WHAT CAN ER DO TO ASSIST?

22. FACT OR FICTION? If a third party is responsible for injury, no W.C. claim needs to be filed. Iowa has the highest TTD rate in the nation. The lowest max TTD rate in the nation is $351. ER has no right to select the medical provider EE must see. Average cost of a lost time claim that exceeds 30 days in CA is $30,000. EE cannot sue ER or co-worker for negligence.

23. QUESTIONS?? Thank you and Happy Holidays!