WORKERS’ COMPENSATION & RETURN TO WORK PROGRAMS: 3 REASONS FOR FAILURE AND HOW TO OVERCOME THEM (PART 1)

Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA
Principal of Strategic Claims Direction, LLC
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Running a successful Return to Work Program (RTW) is hard work. However, it is critical to reduce workers’ compensation claims costs. I have worked with public entities with superior RTW programs while simultaneously working with other public entities who said they couldn’t set them up. These were sometimes public entities with similar operations and employee characteristics with widely varying attitudes and outcomes.

If RTW programs are beneficial, then why aren’t more public entities using them? There are three primary reasons why many Return to Work programs are not successful, the first of which will be discussed in this blog. The three reasons are:

  1. The leaders who can make it happen are not willing to lead,
  2. The program lacks incentives and rewards for the people most responsible for its success, and
  3. It is treated as a “shiny object” program rather than a behavior change.

REASON # 1: THE LEADERS WHO CAN MAKE IT HAPPEN ARE NOT WILLING TO LEAD

To avoid RTW program failures, leaders must be willing to make the hard decisions and require the hard work needed.

Why wouldn't they make the hard decisions? Some will say:

  • “We won’t save that much.”
  • “Our jobs or circumstances are different / too strenuous.”
  • “Our supervisors don’t have time for this.”
  • “The doctors won’t go along with it.”
  • “Human Resources doesn’t think we can do it.”
  • “The unions won’t allow it.”
  • “We don’t have the people or expertise required.”
  • “Our claims people/TPA should already be doing this.”

While it is safe to say that a Return to Work program cannot eliminate all lost time (LT) claims payments, the Pareto principal, also sometimes referred to as the 80/20 rule, applies in workers’ compensation also. In my experience, 15 to 25% of the claims will generate 80%, 85%, 90% or even more of the claims costs. The following pie charts display this data:

If you sort your claims by highest total incurred cost, you will probably see that the most costly claims are not those that had the most severe injuries, although these obviously can be very costly, but those in which the employees’ time off from work has continued on and on. If these costs are allowed to linger, then the current and subsequent budget years will have a growing layer of costs on top of new claims costs that must be budgeted and funded into the future.

This data will clearly show that you need a RTW program. When this is understood, senior management must work on understanding and overcoming the typical objections mentioned earlier and utilize creativity to unearth solutions. Senior management, once it is willing to lead, will then realize that many of these objections are simply barriers erected by people who do not understand the importance of addressing this issue or who are reluctant to change the status quo.

We all work hardest on the things that will benefit us, so Part 2 will focus on the benefits to different people and departments that will help drive success.

By: Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA
Principal of Strategic Claims Direction, LLC

Summary of Qualifications

Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLE, is a property/casualty claims consultant with over 40 years of claims experience. He has worked over 20 years as a claims consultant and has served many public entity clients. Since forming Strategic Claims Direction (SCD) over 7 years ago, most of his clients have been in the public entity sector. Prior to forming SCD, Gary worked for insurers, third party administrators, corporations, independent adjusters, and two of the "Big 4" consulting firms (PwC LLP and KPMG LLP). His employment experience allows him to bring a wide range of expertise to his clients to help them develop their claims programs. Gary is a frequent speaker at professional conferences and has authored numerous articles, some of them being included in PUBLIC Risk magazine. His next PUBLIC RISK article is scheduled for October 2016.

Reponsibilities

SCD performs a wide variety of claims-related engagements. Gary leads and performs all engagements. He works throughout the United States performing:

1. Claims audits, to compare the program to leading industry practices and/or contract requirements, These audits may be to meet statutory requirements, to meet AGRiP certification, or to meet requirements set out by the board of directors or commissioners.
2. Reserve reviews to evaluate the reasonableness of reserving procedures and the estimates. This may be needed when public entity risk management programs merge, when a concern arises about reserving by a TPA or self-administered program, or to support a casualty actuarial evaluation.
3. Claims efficiency studies, which include an analysis of the claims processes to identify redundant or unnecessary steps, to determine if the claims personnel should be realigned to optimize Return on Investment (ROI), to determine if system enhancements are necessary to improve efficiency, or if other steps are needed.
4. Assistance in TPA selection, including development of the claims-related requirements, creation of a grading methodology, identifying TPAs that meet the clients' needs regarding expertise and geographic spread, evaluating proposals as received, and working throughout the TPA selection process to select the TPA that best meets the clients' needs.
5. Developing claims manuals or other procedural documentation to provide direction for public entity risk management staff, TPAs, medical management organizations, and others.
6. Provide expert testimony relative to claims handling, reserving, and excess insurance reporting.

Business Experience

Prior to forming SCD Gary worked for the following firms:
Crawford & Company - Director Technology & Process Management
KPMG LLP - Manager, Claims Consulting
PwC LLP - Director, Claims Consulting
International Paper - Supervisor, Workers' Compensation Claims
Travelers Insurance - Claims Supervisor

This broad experience from several different perspectives provides Gary with the ability to provide his clients with "real world" answers to improve their programs.

Professional Affliliations

CPCU
Georgia PRIMA

Education

BS BA - University of Tennessee, Knoxville

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THE “SCHOOL CLIMATE SOLUTION” TO REDUCING K-12 WORKERS’ COMP COSTS

William Grace Frost
Director of Strategic Relations, Community Matters
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The physical and emotional well-being of employees is of vital importance to the success of K-12 schools, but the challenge of keeping school staff safe from harm is becoming more and more complex. As a result of rising grievances, the costs of Workers’ Compensation (WC) claims are sky rocketing. Rising claims and rising costs are the curse of school administrators who continually look for ways to reduce the probability of injuries happening on their campuses, and it’s also why risk managers embrace the saying – “the best Workers’ Comp claims are the ones that never happen.”

Making sure that claims never happen depends on any number of factors ranging from reducing hazards to surveillance videos to effective training and, according to the AMAXX Workers’ Comp Resource Center, “unsafe acts” contribute significantly to WC claims. In K-12 schools, those unsafe acts most often involve teachers intervening in student altercations or student attacks directly against teachers.

In a July 2015 U.S. Department of Education report addressing teacher victimization by students, the department cited more than $2 billion lost annually and lost work days approaching one million.

In a recent Risk & Insurance article, author David Godkin noted that “physical contact between students and teachers in one Minnesota school district had tripled over the past five years… and that 8 of 10 teachers nationwide report being victimized by students at least once in a school year.”

After nearly 20 years working with schools on climate improvement, Community Matters knows unequivocally that the most effective way to reduce school violence, including staff injuries, is by creating a culture of respect where the nurturing of positive staff-student relationships is of paramount focus, therefore minimizing unsafe acts.

The good news is that there is increased recognition among administrators nation-wide of the value, benefits and effectiveness of implementing school climate improvement plans. The current trends, research and legislation all highlight and promote the importance of school climate as a primary cornerstone and driver for improving safety and discipline resulting in the reduction of undesirable student behaviors that can lead to injuries.

So Where to Begin?

We know we can’t legislate civility nor can we punish children into being less violent. The only viable solution to the spread of students’ aggression towards teachers and peers is to change the social norms that allow it to occur. When school norms change from meanness and indifference to kindness, compassion and respect, that’s when vandalism, altercations, retaliations and other risk-related incidents go down.

Given our experience in providing support, training and consultation to more than 1,600 schools across the country, Community Matters has found the following to be the best practices leading to successful climate improvement and risk reduction:

  • Successful teachers and staff are those who put relationships first – taking the extra time to greet students by name, offering a kind word or smile, being “hall-friendly” and cultivating authentic connections with students. These actions pay off in students developing a stronger sense of belonging, less negative reactivity towards teachers, reduction in staff time spent on discipline and more time for teaching and learning.
  • Increasing student voice and utilizing a peer to peer role-modeling approach is the quickest, most cost efficient and effective way to change the social norms on campus and reduce bullying, fights and resultant teacher injuries. By identifying and training the socially-influential leaders in each of the campus cliques to set an example of courage and compassion in their words and actions towards others, over time the social acceptability of such negative behaviors can be eradicated.
  • Discipline needs to be focused on restoration rather than punishment – restorative practices include powerful tools and strategies that maintain connection, restore relationships, repair hurt and ultimately reduce altercations; disagreements can also be diffused well before they get to the point of a physical exchange when restorative practices are used effectively.
  • It takes strong organizational leadership to change the culture and climate of a school. Discipline procedures and practices are effective when all key stakeholders, from the administration and school board to the students, parents and staff, are included in the development and implementation of behavioral policies. If we want our students to be compassionate, respectful of differences and courageous enough to intervene, we must find our own courage first – the shift starts at the top.
  • Educational leaders, from school boards and superintendents to building administrators, must be willing to make an honest and comprehensive climate assessment of their school’s strengths, weaknesses, gaps and opportunities for improvement. Starting with a “deep dive” analysis will go a long way in ensuring that school climate improvement planning is built on accurate data and leads to measureable and sustainable results.

In the end, transforming school climate is the only real solution to engendering employee risk reduction and stemming the tide of spiraling claims. We take heart in knowing that shifts are taking place and that many schools are committed to school climate transformation. While there is still much work to be done, more and more schools are taking positive actions to ensure that students can attend schools where they feel welcome, safe, connected, and where the consequences and costs of Workers’ Comp claims are vastly reduced.

By: William Grace Frost
Director of Strategic Relations, Community Matters

Summary of Qualifications

For nearly three decades William Grace Frost has lead leadership and creativity trainings with a wide variety of multi-national corporations, non-profit groups, community organizations, MBA students, charter schools and even schoolchildren in South Africa. As director of strategic relations for Community Matters, William works to build collaborations with joint pool associations (JPAs), insurance pools, risk managers and other corporate sponsors. Community Matters is a national thought-leading non-profit organization that assists schools and districts with its wide variety of school climate improving programs including its evidence-based Safe School Ambassadors program, Whole School Climate 360 Degree Assessment, restorative practices trainings, peer-to-peer alcohol, tobacco and other drugs prevention programs.

Responsibilities

As director of strategic relations for Community Matters, William works to build collaborations with JPAs, insurance pools, risk managers and other corporate sponsors.

Business Experience

William Grace Frost has lead leadership and creativity trainings with a wide variety of multi-national corporations, non-profit groups, community organizations, MBA students, charter schools and even schoolchildren in South Africa. He has also been a restaurateur, landscape architect and professional soccer player.

Education

B.A. in Economics, Brown University
MLA in Landscape Architecture & Educational Psychology, University of Minnesota

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STAY AT WORK: A PRACTICAL SOLUTION FOR WORKERS’ COMPENSATION

Myra Keleher, DNP, RN, NEA-BC, CDMS, CHCQM, LHRM
Branch Manager, Genex Services, LLC
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In workers’ compensation claims, the main objective for an employer is to return injured employees to work as quickly and safely as possible within their functional limitations through transitional work. Stay at Work (SAW) programs allow this to happen.

For the employer, states offer financial incentives to facilitate transitional duty by reimbursing part of the employee’s salary. For the employee, SAW programs enhance self-esteem and promote healing. These medical best practice programs help workers with on-the-job injuries recover faster and for employers to maintain skilled, injured workers in a difficult job market and reduce workers’ comp premium costs.

Offering a physician-approved transitional duty position can improve the employee’s life as well as the company’s bottom line along with enhancing employee morale in the workplace. SAW programs allow the employer to retain a valued employee, thereby, not incurring recruitment and new-hire training costs. Such initiatives are designed to keep the injured worker connected to the workplace, allowing him to maintain a productive mindset as well as avoiding dependence on a disability system. SAW programs provide a sense of security and stability for the employee and the employer.

Getting Everyone On Board

Transitional duty can consist of any temporary change in work tasks or functions. Modified workstations and equipment allow injured workers to perform work functions while recovering from an injury, and reduced time/work schedules and providing different jobs are examples of actions employers may take to facilitate the return of an injured worker to the workplace. Successful SAW programs significantly reduce the duration of injury absences from 15 weeks to 3-4 weeks.

Of course, to be successful, these initiatives require “buy in” from all parties. An SAW program benefits the employer financially by:

  • anticipating and controlling hidden costs
  • reducing financial impact of workplace injuries
  • providing a proactive approach to cost containment
  • improving the company’s ability to manage an injury claim and any restrictions
  • getting experienced employees back to work, resulting in less time and money spent on recruiting and hiring

Research tells us that SAW programs result in a significant early return to work, helping to prevent long-term disability and improve the likelihood of the employee continuing to work once released to full duty (also known as sustainable RTW).

It should be no surprise that a simple workers’ compensation case may result in expensive litigation if not handled correctly. Well-executed SAW programs will provide clear expectations and guidelines for employees injured on the job and have proven to reduce litigation. Employees feel valued, and providing a well-documented program shows prospective insurance companies that the employer takes risk management seriously.

Easy to Establish

Establishing a SAW policy is not difficult. Clear guidelines and specific, consistent policies must be established in writing. A payroll gatekeeper is a must if the injured worker will receive partial compensation for hours worked. There is usually a cap on the SAW eligibility of 90 days. This typically gives the injured employee ample time to be released to full duty. All parties involved in the program need to be educated as to how it works and why it is important to adhere to the guidelines.

Statistics show employers who make these programs available are highly effective at reducing the duration of absence associated with work-related injuries, with an average 3.6-week reduction in the median time away from work. For workers with a permanent disability, SAW programs reduce the median number of weeks out of work by 12.6 weeks.

By: Dr. Myra P. Keleher
Branch Manager, Genex Services, LLC

Summary of Qualifications

Dr. Keleher is a branch manager for case management for Genex Services, a Disability & Case Management Company. She is a highly experienced nurse case manager, has lectured on nurse case management, and has worked in the past for AonHewitt, Publix Supermarkets, Inc., Sedgwick, and CorVel. Dr. Keleher received her BSN & MSN from the University of Central Florida and her Doctor of Nursing Practice from The University of Alabama. As an adjunct professor, she has taught classes in Leadership and Management, Nursing Theory, and Business of Health Care in Complex Systems. She is an industry leader in utilization management/telephonic case management for workers’ compensation.

Responsibilities

In her role as branch manager at Genex Services, LLC, Dr. Myra Keleher's responsibilities include operational management for the Lake Mary branch for telephonic nurse case management for multiple regional and national clients.

Professional Affiliations

American Nurses Association, Florida Nurses Association, American Organization of Nurse Executives, Central Florida Organization of Nurse Executives, Association of Rehabilitation Nurses, and Case Management Society of America

Education

The University of Alabama, Doctor of Nursing Program, Emphasis in Executive Leadership, 2015

University of Central Florida, Master of Science in Nursing, Leadership and Management, 2011

LA in Landscape Architecture & Educational Psychology, University of Minnesota

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CYBER RISKS, CYBER SECURITY AND PUBLIC RISK MANAGEMENT

Sarah Perry, ARM-P
Risk Manager, City of Columbia, Missouri
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The topics of cyber risk and cyber security have been around for a while, but wrapping our heads around these topics seems to be something with which many of us public risk management professionals struggle. As chair of PRIMA’s External Affairs Committee, cyber risks and security are topics that we have been discussing for more than a year, and still strive to define.

While the following may not provide answers to the bigger questions regarding cyber security, hopefully, it will help us to wrap our collective heads around the potential exposures. First, let’s look at some definitions.

Cyber Risk – any risk of financial loss, disruption, or damage to the reputation of an organization from some sort of failure of its information technology system. (1)
Cyber Security – protection of computers, networks, programs and data from unintended or unauthorized access, change, or destruction.

Next, what are some of the risks to our cyber security? Again, the list is evolving, but below are some of the more common exposures that may pose a threat.

  • Loss of hardware through theft or accidental loss – think of this as the physical loss of any device with sensitive information, including laptops, tablets, cell phones, and hard drives.
  • Misuse of data by employees or other insiders – could be anyone with access to data who might use or exploit private information for personal gain.
  • Web application attacks – a category which may include defacing a website, additions of spam or a malicious code, theft of account and database information, and access to classified content.
  • Phishing – any activity that attempts to gain sensitive information by posing as a legitimate site. Phishing efforts may ask for specific information or may contain links to malicious software (which is often referred to as pharming).
  • Dedicated Denial of Service (DDOS) attacks – an activity where multiple systems, sometimes hundreds or thousands, target a website or system causing a slowing or complete shutdown of the website or system.
  • Cyber extortion – any kind of attack where a ransom is demanded before the assault is disengaged.
    Point-of-sale (POS) attacks – an effort to gain credit card data through data skimming (installation of hardware to a point of sale terminal), malware (exploits the gap(s) in security while credit card data is being processed), and even the cloning of cards or their data.
  • Payment card skimming – a form of POS attack method where a small device is installed on a credit card reader to scan and store data from the magnetic strip.
  • Viruses – programs from other infected computers, data medium (CD, DVD, etc.) or through a network which replicates itself and can infect other computers or device in a network.
  • Worms – programs which copy themselves across a network or computer program

Recognizing and identifying the various types of cyber risks that threaten the security of our entities is just the beginning of the process. From here, the risk management process of assessment, development and evaluation of a plan, implementation of risk management actions, and monitoring the results is crucial.

By: Sarah Perry, ARM-P
Risk Manager, City of Columbia, Missouri

Summary of Qualifications

Sarah Perry began her insurance and risk management career in the early 1980’s with a major insurance broker. She worked in risk management for an Iowa hospital and for a workers’ compensation trust in Missouri prior to joining the City of Columbia, Missouri in 1997 as the risk manager. Sarah is active in the Missouri chapter of PRIMA, was involved in PRIMA’s Core Competencies Initiative and has participated in PRIMA’s Conference Planning Committees 2004 through 2010. Sarah served on the PRIMA Board of Directors 2003 – 2010, and as president of the Board July 2008 - 2009. Currently Sarah is serving as the chair of PRIMA’s External Affairs committee.

Responsibilities

Administers City of Columbia’s self insurance for workers’ compensation, liability, and property coverages, as well as straight insurance for risks as specified by city administration. Works with representatives from all city departments to identify potential problems. Develops and assists in implementation of city-wide strategies to prevent and minimize losses. Plans and conducts loss prevention, safety and health, and other training for city employees. Applies for, and administers brokered insurance coverage. Coordinates selection of the city’s insurance brokers and third party claim administrator. Monitors performance of broker, TPA, medical providers. Coordinates legal activities regarding city claims. Responds to and resolves difficult and sensitive inquiries and complaints from citizens, employees, or employee bargaining units. Prepares annual budget for the risk management division. Assists the city’s budgeting division in allocation of insurance costs to city departments and divisions. Serves as a liaison for the risk management division with other city departments/divisions and outside agencies. Supervises risk management staff.

Education

Masters in Strategic Leadership (2011) - Stephens College, Columbia, Missouri

Bachelor of Arts in Business Administration (2001) - Stephens College, Columbia, Missouri

Associate in Risk Management for Public Entities (ARM-P)

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CONSIDERATIONS FOR DRONE USE IN LAW ENFORCEMENT AND OTHER DEPARTMENTS WITHIN A PUBLIC ENTITY

James A. Robb
Acting Risk and Benefits Manager, City of Wilmington, DE
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You get a call from the chief of police about using a drone in his department. They are excited about the many uses in law enforcement, such as surveillance on rooftops where snipers may be or have been, traffic accident investigations where there is a big traffic jam, and various other things. He asks what they need to do to start operating; they can buy one online with fancy cameras for only a few hundred dollars.

Naturally you contact your legal department about this. It is doubtful whether any of the attorneys within the department are involved with aviation law, but they can search on Google and the Federal Aviation Authority (FAA) website (www.faa.gov) to find information. The attorney shares that since this drone (classified by the FAA as a “small unmanned aircraft system (sUAS)” is considered a public aircraft, the new FAA Part 107 regulations that have been publicized in the media do not apply to your city or any government. Therefore, you have to seek what is known as a Certificate of Waiver or Authorization (COW) to operate the drone, which exempts you from the Federal Aviation Regulations (FAR) for operation of an aircraft. Note that the drone is defined as an “aircraft” under recent interpretations by the National Transportation Safety Board (NTSB) and FAA.

The application process begins with a “declaration letter” from your solicitor, which certifies that you are in fact a public entity, as defined by federal law. This is sent to the FAA, and you must be accepted by the FAA as a public entity before proceeding further. The letter must highlight that the drone will not be used for commercial purposes, such as monitoring a public works construction project.

Next, you must register the drone with the FAA, with the necessary application, purchase documentation, and manufacturer, model and serial number information. This can be done online or by mail to the FAA. After this is complete, there is an online process of applying for the COA with the FAA. Details are required concerning the maintenance of the sUAS, its area of operations, its mission, safety and risk control details, such as recovery due to battery failure or communication failures.

Additionally, the person who will serve as pilot of the drone needs training and certification as a remote pilot, which involves classroom or online training and completion of a test. If the individual is already a private pilot, recreational pilot or sport pilot that will suffice. In a later blog, I will explore the tort liability and insurance issues associated with operation of a drone.

By: James A. Robb
Acting Risk and Benefits Manager, City of Wilmington, DE

Responsiblities

James handles evaluation of funding and insurance needs for the city, acquisition of insurance, approvals or denials of all liability claims and budgeting for the risk and benefits divisions. He also work with brokers for property, casualty, life and health insurance, as well as actuaries and several other vendors. Additionally, James supervises a staff of three, provides education of staff and employees in areas of liability and medical coverages, and handles applications for FAA waivers for drone program.

Business Experience

Government Lawyer and Risk Manager (2007-Present)

City of Wilmington, DE 2013-Present

New Castle County, DE 2007-13

Private practice of law-Aviation Emphasis (1979-Present)

Chief Deputy Insurance Commissioner of DE (1989-92)

Professional pilot/flight/jet simulator instructor-part and full time (1970-present)

Adjunct Professor-Aviation Law-Widener Univ. School of Law (1979-86)

U.S. Army- Vietnam service (1967-70)

Professional Affiliations

Member of Delaware Bar and Delaware Bar Association, Lawyer Pilots Bar Association, Aircraft Owners and Pilots Association and Veterans of Foreign Wars (VFW)

Education

B.B.A., Wilmington College - 1974 [Aviation Management, Cum Laude]

J.D., Widener University School of Law - 1978

Airline Transport Pilot - 1972

Certified Flight Instructor - 1969

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WORKERS’ COMPENSATION SELF-INSURANCE: AVOIDING THE PRICING PITFALLS (PART 2 OF 2)

Glenn Backus
President, Alternative Service Concepts
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In last week’s PRIMA Blog, we explored unallocated expenses. In this blog, we will discuss allocated expenses. According to IRMI, allocated expenses (ALAE) are defined as loss adjustment expenses that are assignable or allocable to specific claims. Fees paid to outside attorneys, experts, and investigators used to defend claims are examples of ALAE. Municipalities typically entrust their TPAs to select vendors as needed to administer the claims. One common example of an allocated expense is bill review, which is used to reprice medical bills to fee schedule. Many TPAs use bill review as an additional source of revenue.

Example: Bill Review (ALAE)

Assumptions

  • 1000 claims: 250 LT; 750 MO
  • 10 invoices per LT claim; 3 invoices per MO claim
  • 45% savings
  • Average fee per bill: LT = $600; MO = $300

TPA 1                         TPA 2

Rates                                                      20% savings                $8.50/bill

Invoices                                                N/A                            4,750

Medical Paid                                         $2,175,000                N/A

Bill Review Fee                                        $195,750                   $40,375

Total Fee                                                $542,000                   $652,375

Now comparing the two TPAs, TPA 1 still has an advantage (albeit much smaller); but that is not all. Many TPAs have also hired their own nurses to perform telephonic case management and utilization review. This has also become an important source of revenue for TPAs. While some TPAs do a very good job in the managed care sector, oftentimes the emphasis is on the revenue leading to an overutilization of managed care services.

Example: Telephonic Case Management (ALAE)

   TPA 1                         TPA2

Counts                                                  1,000                         1,000

 Lost Time                                           250                            440

 Medical Only                                      750                            560

Rates                                                     $ 85/hr                      $200/mo

 Utilization (LT)                                   50%                            25%

 Utilization (MO)                                  5%                             5%

 Duration

LT                                                      8 hrs/mo (3 mos)       3 months

MO                                                     2 hrs/mo (1 mo)        1 month

 Total Telephonic Case Management  $261,460                   $71,600

Total Fees                                             $803,460                   $723,975

Once all costs have been identified and defined, TPA2 has become the best choice for the municipality. The entity must remain ever diligent in making sure that all business partners comply with established service and financial standards. Reporting mechanisms must be in place until a level of trust has been established. Even then, as President Reagan stated so succinctly, “trust, but verify”.

What Can You Do About It?  

Demand full disclosure. Insist that all pricing – allocated and unallocated – remain fully transparent.  Retain the opportunity to contract with vendors directly. Make sure allocated expenses as a percent of total paid fall below 10% (typically 5-8%). Pay your TPA a fair fee up front, preferably a flat, fixed fee. Audit all business partners frequently by a disinterested third party. And, most importantly, develop a relationship with your business partners. These are integral factors that will determine the success of your workers’ compensation program. All are entrusted with the care of a very valuable asset – your employees.

When a self-insured entity hires a TPA to manage their claims program, the entity, in essence, hands their checkbook (and a high degree of trust) over to the TPA. The TPA is also given the authority to hire other vendors necessary to administer the claim. Make sure they have your best interests at heart and do not forget to “trust but verify”.

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By: Glenn Backus
President, Alternative Service Concepts

Summary of Qualifications

Mr. Backus started his career in the insurance industry in the 1990's. Before he was appointed president in 2013, Mr. Backus served 12 years in sales as an account executive and senior vice president for the company. Mr. Backus has extensive industry experience in systems and claims, including a wide variety of clients across the industry.

Responsibilities

As company president, Mr. Backus is responsible for long and short-term service strategies, including, revenue planning, performance management, and public relations. Mr. Backus sits on the board of directors.

Business Experience

Mr. Backus offers 20 years’ experience in the insurance industry, primarily from a technology and claims aspect. Mr. Backus started his career at Corporate Systems where he worked with Fortune 1000 employers, insurance carriers and third party administrators to automate processes and deliver risk information to employers enabling them to better manage their risk. Prior to joining ASC, Mr. Backus worked for Marsh, developing claims management and reporting solutions for TPA’s, insurance carriers, brokers, pools and associations.

Professional Affiliations

The CPCU Society

Association of Government Risk Pools (AGRIP)

Public Risk Management Association (PRIMA)

The Risk Management Society (RIMS)

Education

BBA in Management, West Texas State University

MBA in Financial Services, The University of Dallas

Chartered Property Casualty Underwriter (CPCU)

Associate in Risk Management for Public Entities (ARM-P)

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WORKERS’ COMPENSATION SELF-INSURANCE: AVOIDING THE PRICING PITFALLS (PART 1 OF 2)

Glenn Backus
President, Alternative Service Concepts
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You have just concluded a rigorous request for proposal (RFP) process and selected a third party administrator (TPA) at a very good price, or so you thought. At the end of the three-year agreement, your average cost per claim is still increasing at a steady rate. But you have just negotiated a hefty reduction in the fee per claim you are paying. The medical network, utilization review and pharmacy vendors are all showing much-improved savings. At the end of the day, your experience modification (e-mod) has not improved and still remains at an unacceptable level. Average costs per claim are actually increasing. Does this sound familiar?

The industry, using the RFP and spreadsheets, has done a good job of holding unallocated expenses steady over the past 15 years. As a result, the claims fee now covers approximately 60% of a TPA’s expenses, such as investments in technology, and the overall rise in expenses (e.g. benefits) facing businesses today. Therefore, it might make financial sense for your entity to self-insure and hire a TPA. The first step towards getting a good deal is developing an understanding of allocated vs. unallocated expenses. Unallocated expenses (according to IRMI) are defined as all external, internal, and administrative claims handling expenses, including determination of coverage, that are not included in allocated loss adjustment expenses (ALAE). In a typical TPA contract, the most common unallocated expenses are claim fees, though administration and system fees are common as well.

Example: In a typical TPA contract, ULAE =

  • TPA 1 WC Claim Fee
    • Indemnity = $995
    • Medical Only = $130
  • TPA 2 WC Claim Fee
    • Indemnity = $1200
    • Medical Only = $150

As you can see, there is a big difference between the fee charged for an indemnity claim versus a medical only claim. Therefore, to make sure that you are paying the proper fee, entities need to ensure that the TPA follows the industry definition of indemnity and medical only claims. Many TPAs will use a liberal definition to classify a higher portion of claims as indemnity, resulting in a higher overall fee. For example, the statutory definition of an indemnity claim is a claim that has incurred or paid (on closed claims) indemnity or legal costs; the file will be charged as a lost time claim. All other claims should be charged as medical only. However, some TPAs will classify a medical claim as an indemnity claim if, indemnity is paid or incurred, or if a claim incurs only medical charges but remains open for more than 90 days, or if medical charges exceed a certain dollar amount (e.g. $2500).

When reviewing RFP responses, looking at two TPAs, one that follows the statutory definition (TPA 1) and another that follows the more liberal definition (TPA 2), how might this impact the bottom line?

         TPA 1            Rate              TPA 2             Rate

Claim Counts                1,000                                 1,000

 Indemnity                              250                $995            440                $1,200

 Medical Only                         750                $130            560                 $150

         Cost

 Indemnity                             $248,750                            $528,000

 Medical Only                         $97,500                             $84,000

         Total                               $346,250                           $612,000

As you can see, the results can be dramatic. The savvy consultant you hired to lead the RFP selection process has done a good job of pointing out the potential pitfalls. Your spreadsheet will clearly indicate that TPA 1 is your best choice. We will peel back the onion by looking at allocated expenses in my next blog post.

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By: Glenn Backus
President, Alternative Service Concepts

Summary of Qualifications

Mr. Backus started his career in the insurance industry in the 1990's. Before he was appointed president in 2013, Mr. Backus served 12 years in sales as an account executive and senior vice president for the company. Mr. Backus has extensive industry experience in systems and claims, including a wide variety of clients across the industry.

Responsibilities

As company president, Mr. Backus is responsible for long and short-term service strategies, including, revenue planning, performance management, and public relations. Mr. Backus sits on the board of directors.

Business Experience

Mr. Backus offers 20 years’ experience in the insurance industry, primarily from a technology and claims aspect. Mr. Backus started his career at Corporate Systems where he worked with Fortune 1000 employers, insurance carriers and third party administrators to automate processes and deliver risk information to employers enabling them to better manage their risk. Prior to joining ASC, Mr. Backus worked for Marsh, developing claims management and reporting solutions for TPA’s, insurance carriers, brokers, pools and associations.

Professional Affiliations

The CPCU Society

Association of Government Risk Pools (AGRIP)

Public Risk Management Association (PRIMA)

The Risk Management Society (RIMS)

Education

BBA in Management, West Texas State University

MBA in Financial Services, The University of Dallas

Chartered Property Casualty Underwriter (CPCU)

Associate in Risk Management for Public Entities (ARM-P)

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TWO MAJOR RISKS IN TODAY’S WORKPLACE AND THREE STRATEGIES FOR OVERCOMING THEM

Randy Anderson, CSP
Certified Speaking Professional/Independent Training Consultant, E3 Professional Trainers, LLC
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Communication problems and unresolved conflict in the workplace may be two of your biggest risks. Whether you are trying to convey policies, proper methodologies, expectations, or coaching, the ability to communicate effectively often proves to be a limiting factor for many people – especially managers and supervisors. If you are a great communicator, then you can develop broad influence and deep impact. If you struggle to be engaging, compelling and memorable, then you will likely experience and cause a lot of frustration for yourself and the people with whom you work.

If there is unresolved conflict within your team or between one or more of your team members, or between one or more of your external customers – whoever that may be – this too can cause a significant loss of productivity, create a hostile environment, and in some cases, result in various kinds of elevated risks.

Here are some tips to help you become a better communicator. First, be a better listener. If you do not listen, you should not consider yourself a great communicator, regardless of how prolific you may be at presenting your ideas. Moreover, when I say listen, I do not simply mean to be physically present, and hear another person talking. Listening is active. It requires you to be patient, and give your best energy to understanding their perspective. It means remaining in receiving mode until they are completely finished with their statement, without trying to interrupt them with your response. You have to process what the other person is saying, evaluate whether you understand and/or agree with them, and consider how you are going to apply the information you got from them.

Secondly, stop being a “teller of information” and become a “seller of ideas”. Many people get frustrated in the communication process because they believe they have done an adequate job of explaining “the facts”, when the reality is no one was listening. Though others may have heard what they said, they were not really listening and grabbing the pertinent information. Consider what the information will mean to your audience and how they will use it. Why do they need the information and what difference is it going to make. Present it in a way that engages them first, informs them second, and directs them appropriately.

Third and final tip: If conflict exists, whether you are directly involved with it or not, you have to realize that it will not resolve itself. Figure out who is involved, and eliminate the cheerleaders. Focus on the point of conflict, listen to both sides, and determine your strategy. Make sure you do not confuse personality or personal preference with the facts. When it is time to “sit down and talk it out”, make sure you maintain a professional tone and a conversational volume level. Once it is over, try to get everyone to move on. A running scoreboard is not good for anyone.

By increasing your communication effectiveness and resolving conflict when it arises, your team members will be more engaged in their work. They will learn more from the training/coaching that is provided to them and they will be much more likely to work together as a team. As a result, productivity and customer retention will both increase, and accidents and problems that arise from disengagement will dramatically decrease.

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By: Randy Anderson, CSP
Certified Speaking Professional/Independent Training Consultant, E3 Professional Trainers, LLC

Summary of Qualifications

Before starting E3 in 2005, Randy spent 20 years in sales and sales management. Most of that time was spent in media sales, which gave him the opportunity to work with virtually every type of business and in every industry. His clients included small, mom-and-pop businesses to large corporations, and were spread all across the United States. It is from that experience that he draws the ideas and strategies to help his clients improve their performance in the workplace and to achieve their maximum potential in life. Over the last 25 years, he has spoken to tens of thousands of people, helping them to become more engaged in their work, better equipped to do it, and to feel empowered to have greater influence personally and professionally. His areas of expertise include: time management, organizational skills, communication, sales, and leadership/management. Randy’s clients include organizations in manufacturing, construction, health & financial services, public service and retail.

Responsibilities

Randy provides customized training, keynote presentations, and personal coaching to help people work with greater effectiveness and efficiency, to help leaders develop greater impact, and to help clients at any level better understand how important they are in servicing customers...regardless of whether the customers are internal (co-workers) or external.

Business Experience

In addition to managing operations and teams within large and small companies, Randy has run his own small business for 11 years. Through his career, Randy has overseen sales staffs as well as support teams, giving him the opportunity to work with a wide variety of personality types, education levels, and generations. His career is deeply rooted in developing and practicing excellence in product development and delivery, coupled with great customer service.

Professional Affiliations

Randy is a member of the National Speaker Association, where he earned the Certified Speaking Professional designation. He is also a member of the Society for Human Resource Management.

Education

In 1990, Randy earned a Bachelors of Science in Agricultural Communications from Texas Tech University. Since that time, he has participated in and completed numerous training courses including; Your Leadership Legacy (Ken Blanchard Co.), Changing the Picture (Ziglar Corp.), Ethics 101 (Cox Enterprises, Inc.), LifeNet Time Management Training (Life Net Inc.), Basic Selling Skills (AVI International), Top Selling (Ziglar Corp.), Professional Selling Skills (Learning International), System 21 Selling (Executive Decision Systems), and Fast Track Media Sales (Cox Media, Inc.).

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RISK DISRUPTED

Christopher Mandel, RF, CPCU, ARM-E

SVP, Strategic Solutions, Sedgwick

Director, The Sedgwick Institute

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With increasing frequency, the world of risk and insurance is facing challenges that are leading to disruptive interventions from a variety of sources, the aggregate of which portends some significant shifts in an industry often viewed as being stuck in a lower gear. Well-known and understood among underwriters is the challenge of the investment environment, which has been disrupted continuously since the recession beginning 2008 with returns being artificially suppressed by the federal government’s economic strategy. This fact only exacerbates the reality of the conservative investment limitations already imposed on the industry by regulators.

In the healthcare world, the Affordable Care Act (ACA), aka Obamacare, has surely disrupted medical benefit plans. Most Americans have been accustomed to leveraging their benefits to protect their assets from catastrophic health events and perhaps to an even greater degree, manage their day-to-day medical costs. While one of the few clear benefits of the ACA is the catastrophe protection enabled by the removal of aggregate expense caps (previously the lifetime maximum was $1 million in many plans), many other changes brought about by the ACA have been at a minimum, disruptive. You cannot expand an exposure and constrain an underwriter’s ability to charge the appropriate premium for risk underwritten, without a significant negative impact on premiums. Underwriting disrupted.

Further, we find ourselves inexplicably surprised that the $2,500 average savings promised by the administration has been anything but the reality. In fact, just the opposite is emerging for many who are not eligible for subsidies (estimated by the CBO to be over $300B in 2016). Corporate medical/benefits budgets and planning continue to be disrupted while benefit levels are reduced and/or premium increases are increasingly common.

In the property casualty world, two new exposures in particular are fanning the flames of the unknown for underwriters. First, cyber risk continues to expand its profile as “social media” risk emerges as a potentially more damaging source of loss than even more well-known and better understood exposure to hacking. The latest example is hot off the press with Kalobios filing for chapter 11 after its CEO used both regular and social media to trumpet his decision to exploit the pricing of a newly deregulated drug to the detriment of the customer. This rapidly led to disclosures of alleged criminal (yet unrelated) conduct, leading to the CEO’s firing and now the demise of another potentially great company. Total elapsed time from first negative media to bankruptcy – three months. Another emerging exposure of growing concern is “domestic” terrorism. Since Ft. Hood, San Bernardino, the Boston Marathon and other assorted instances of targeted violence in recent years, domestic terrorism is becoming more “expected” than one would have hoped, yet the industry’s ability to predict the impact or severity remains limited.

Assessing and pricing exposures accurately where there is insufficient historical data to support conclusions is a challenge for an industry so heavily reliant on data to accurately price risk. Disruption looks to be evolving into a more frequent and accelerating characteristic of this industry. While challenging, disruption nevertheless has the potential to drive innovation and improve the industry for the better as players are forced to respond to new entrants with ideas and solutions that are often outside the typical considerations of an industry constrained by regulation and the vagaries of new and often poorly understood exposures. Accordingly, I see disruption as a necessary sign of likely progress ahead.

1 Wall Street Journal, “The Biggest PR Headaches of 2015,” December 29, 2015.

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By: Christopher Mandel, RF, CPCU, ARM-E

SVP, Strategic Solutions, Sedgwick

Director, The Sedgwick Institute

Summary of Qualifications

Highly skilled risk and insurance professional with more than 30 years of experience designing, developing and implementing large, global corporate risk management programs for Fortune 500 firms. Thought leader in enterprise risk management, insurance and the alignment of risk stakeholder interests among internal audit, compliance, legal, control, planning, crisis management and business performance functionaries. Designed and implemented numerous risk and insurance programs for large, global corporates. Led and aligned small to mid-size teams toward successful delivery of multi-million dollar expense saving programs and captive insurance company profit centers solving unique risk financing problems and delivering tens of millions in net income.

Responsibilities

As SVP Strategic Solutions, Chris works collaboratively with senior management and ownership to “Tell the Sedgwick story” and represent Sedgwick as an “ambassador” within the broader risk and insurance industry space. Primarily responsible for developing, evolving and ensuring the execution of the company’s strategy for influencing the industry in an effective and cost efficient manner as well as identifying opportunities and people that can contribute to the success of Sedgwick and its subsidiaries.

As director of Sedgwick Institute, Chris is responsible for providing strategic and tactical leadership to internal and external resources used to deliver the Institute's mission and goals.

Business Experience

27 years of senior risk management leadership roles in large, often global enterprise

Has led staff from 4 to 35 executing the risk and insurance functions

Has held and currently hold numerous board positions for industry entities

Has provided consulting and advice to numerous firms as both a sr consultant for Marsh and by starting and running my own ERM consulting firm

ERM Experience

Designed, implemented and managed the ERM strategy for a Fortune 125 diversified financial services company whose program was rated "excellent" by S&P (its highest rating) from 2006-2010. Same program was recognized by receipt of the Alexander Hamilton Award for "excellence in ERM" in 2007.

Has taught four level of ERM and SRM for RIMS over the last 6 years.

Consulted through my own ERM consulting firm and a separate ERM partnership firm, for more than ten years.

Regular speaker across the globe, on ERM, SRM and related subjects.

Professional Affiliations

Member and RIMS Fellow (RF) of the Risk Management Society

Former president (2003) and board member of RIMS (1998-2004)

Member, Society of CPCU (the Institutes)

Member and Board Director of the Association of Responsible Alternatives to Workers Compensation (ARAWC)

Member, Associated Industries of Florida (AIF)

Member and Board Director for Captive Insurance Group of NJ

Faculty, International Center for Captive Insurance Education

Education

MBA - Finance, George Mason University
BS - Business Administration (Mgmt); Virginia Polytechnic Institute & State University
RF - RIMS Fellow, Risk Management Society
ARM-E - Insurance Institute of America
CPCU - American Institute of Property/Liability Underwriters
AIC - Insurance Institute of America
CCSA – Institute of Internal Auditors

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THOUGHTS ON REDUCING LAW ENFORCEMENT AUTO LOSSES

Wendell Bosen, MBA, CPCU, RF

Senior Account Executive, Moreton & Company

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I recently had the opportunity to mingle with public entity risk managers from across the country at the national PRIMA conference in Atlanta. I took the opportunity to ask those I met (as often as I could, while trying not to be too annoying), “How can we reduce law enforcement auto accidents?” And while my data collection would not stand up to scientific scrutiny, I am confident it is a fair reflection of the situation. Two conclusions are clear:

  • Law enforcement officers have a lot of auto accidents; and
  • Law enforcement officers generally are immune from receiving traffic citations.

I found the answers to be very diverse, but all of them included some type of accountability, such as rewards or punishments for the officers. The most controversial suggestion was to enforce giving traffic tickets to law enforcement officers when appropriate (meaning that a citation would be given to officers, in any situation where a citation would be given to a citizen).

A few agencies I discussed this idea with claimed that their officers receive the same tickets as anyone else for breaking a traffic law. Most claimed just the opposite, saying even with other agencies investigating law enforcement officers’ accidents, citations are seldom issued. A recently retired deputy admitted that the risk of a traffic citation for law enforcement officers was remote. He believed that citations would not have any effect on the number of accidents involving officers, but rather indirect personnel incentives (e.g. promotions and pay raises) would have the best chance of affecting behavior changes, which would in turn reduce accidents.

A survey done by PoliceOne.com asking if officers would ticket an off-duty officer had these results:

  • 3% said yes
  • 38% said no
  • 59% said it depended on the severity.[i]

Risk managers as a group held the belief that the threat of citations, would over time, change behavior and reduce accidents. The minority of agencies that give traffic citations to their law enforcement officers also claimed to have good accident records; this gives further credence to the idea that officers being “at-risk” for citations can help reduce accidents.

The group as a whole was very empathetic towards law enforcement officers and agreed that the two main causes of their poor vehicle accident records are, first, constant driving and, second, all the distractions inherent to the job (computers, radios, etc.).

Using an enterprise-wide risk management (ERM) approach may help bring a broader perspective. With the current misgivings in the news about law enforcement, whether justified or not, it is important to protect the agency’s reputation. If known by the public, police immunity from citations may do more damage to the agency’s objectives than the vehicle accidents.

My conclusion – all public entities with law enforcement should be providing some measure of accountability for officers’ vehicle accidents to help inculcate safe driving. I recommend officers receive citations when merited, especially if the violation causes an accident.

[i] PoliceOne.com. 2009 “Ticketing off duty officers: P1 Members speak out”

(https://www.policeone.com/patrol-issues/articles/1839312-Ticketing-off-d...)

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By: Wendell Bosen, MBA, CPCU, RF

Senior Account Executive, Moreton & Company

Summary of Qualifications

Wendell is a senior account executive for Moreton & Company, based in Salt Lake City, Utah where he is responsible for providing a variety of risk management services for public entities and other clients. He has more than 25 years of risk management experience. His previous experience includes serving as the director of risk management for Management & Training Corporation (MTC) where he had risk management responsibility for more than 10,000 employees operating local, state and federal prisons and department of labor job corps centers in twenty three states. While working for MTC, Wendell developed partial ERM programs that underscored risk management as vital to the organization’s mission and every employee as a risk manager.

Business Experience

Has extensive experience in dealing with commercial insurance loss control, local government pools, corporate risk management, and risk management consulting, and is frequent instructor of risk management classes.

ERM Experience

A member of PRIMA's ERM Training Faculty.

Professional Affiliations

Public RIsk Management Association (PRIMA)

Risk and Insurance Management Society (RIMS)

American Society of Safety Engineers (ASSE)

Chartered Property Casualty Underwriter Society

Education

M.B.A., Westminster College

B.A. in Economics, Brigham Young University

A.S. in Chemical Engineering, Brigham Young University

Professional Designations

Rims Fellow (RF)

Associate in Risk Management for Public Entitites and Enterprise Risk Management designations (ARM-P/E)

Chartered Property Casualty Underwriter (CPCU)

Associate in Loss Control Management (ALCM)

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