Tri-State Employer Services

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

2. Tri-State Claims Management • 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.

3. Tri-State Claims Management • Vision Statement The vision of the Risk Management Department is to: • continually improve services to our organization and client companies, • protect human, physical and financial assets and resources, • help maintain a safe and healthy work environment, • assist 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.

4. Tri-State Claims Management • 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.

5. Tri-State Claims Management • 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.

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

7. Tri-State Claims Management • 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.

8. Tri-State Claims Management • 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.

9. Tri-State Claims Management • 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.

10. Tri-State Claims Management • 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.

11. Tri-State Claims Management • 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.

12. Tri-State Claims Management • 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

13. Tri-State Claims Management • 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

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

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

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

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

18. Tri-State Claims Management • Contact Us • Phone: 212-619-0160 • Fax: 212-619-1611 • Phillip Bok, CPCU, CWCP, CFSA, CIPA, APA, ARM Vice President of Risk Management & Insurance Operations • pbok@tristatepeo.com “Your Complete Employers’ Outsourcing Solution”