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Workers’ Compensation Reducing risk and cost

Workers’ Compensation Reducing risk and cost. Building a successful partnership Presented by ESM Solutions, Inc. Executive Summary.

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Workers’ Compensation Reducing risk and cost

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  1. Workers’ Compensation Reducing risk and cost Building a successful partnership Presented by ESM Solutions, Inc.

  2. Executive Summary • Thank you for considering ESM Solutions, Inc. as a service provider to your company. This deck provides specific details as to the depth of service ESM can provide. • Our staff of trained professionals includes individuals who have the necessary professional designations needed to carry out the required risk management services. Designations that include: • Associate in Risk Management – ARM • Associate in Enterprise Risk Management – ARM-E • Associate in Management – AIM • Certified Safety Professional – CSP • Workers’ Compensation Claims Management Professional – WCCP • Workers’ Compensation Claims Management Associate – WCCA • Certified Professional Disability Manager – CPDM • Self Insured Professional – SIP • Project Management Professional - PMP • Masters in Project Management – MBA Please visit our website for more information: www.executivesm.com

  3. What we Strive for • Employer Service Objectives • Provide services focused on reducing the frequency and severity of workplace injury • Meet with key decision makers to create an effective safety and claims management plan • Establish and maintain good working relationships with employers • Provide Workers’ Compensation management training to the reduce the risk and cost of workplace injury exposure • Provide excellent value-added service • Ensure services goals are met • “Over the past seven years, ESM served an important role in helping VSP Vision Care decrease our workers' compensation claims and costs. ESM developed a deep understanding of our unique business and is a strategic partner.” • April Bettencourt, Manager, Benefits & Payroll, • Vision Service Plan (VSP)

  4. ESM Engagement Strategy

  5. Training & Education

  6. Training Solutions Only ESM offers: • Leading-edge Workers’ Compensation market intelligence and insight through: • Live Lunch & Learn • Onsite Safety Training • Webinars (live and recorded) • Development of Computer Based Training Modules (CBTs) • Private branding http://www.executivesm.com/education/ Check out our 90 second trailer! http://youtu.be/4uMtTY-QSUE

  7. Safety Video Development • Private Branded Safety Training Videos: • Safety Videos • E.g. IIPP Overview • Legislative Updates • E.g. SB863 • Informative Videos • E.g. New Hire Safety Orientation process • “Green Screen” productions available Check out our 30 second promotional video!http://youtu.be/d5x6qJTOycQ

  8. Safety Management

  9. Building a Safety program Safety Foundation Safety Application

  10. Risk Assessment • Comprehensive Risk Assessment for employers • Workers’ Comp / Safety Audit • Conduct an audit of written programs to ensure compliance and accuracy of organizational practices • Conduct a site inspection to identify leading exposures • Report • Summary of risk • SWOT analysis of Safety & Work Comp program • Recommendations • Acceptable or unacceptable risk • Roadmap for risk management improvement http://www.executivesm.com/products/risk-assestment-kit/

  11. Injury & Illness Prevention Plan • Injury & Illness Prevention Program Review and Revision • Ensure compliance with Cal-OSHA’s required 8 elements • Code of Safe Practices (COSP) 9th element required for Construction industry • Ensure written programs reflect field practices • Supporting forms and checklists include: • Accident investigation form • Inspection checklist by industry • Employee safety contact report • Employee warning record • Supervisor report of Injury • Optional: Provide Do-It-Yourself compliance based train-the-trainer programs • Includes training schedule, attendance forms, learner’s guide, PowerPoint Training, quizzes and answers • Private or co-branding available http://www.executivesm.com/products/iipp-kit/

  12. Program Introduction Collect Background Information Current Injury & Illness Prevention Plan OSHA 300 log (past three years) Training records (samples) Inspection reports (samples) Loss runs if available (most current) Customer Engagement Complete IIPP Evaluation Questionnaire Phase 1 – IIPP Review Review client’s current IIPP Analyze supporting documentation Identify missing Cal-OSHA compliance requirements Prepare revised IIPP Outline Coordinate with client regarding questions, or additional information needed Phase 2 – IIPP Revision Revise / develop custom checklists for implementation and compliance Ensure IIPP meets Cal-OSHA standards Revise and reformat IIPP Phase 3 – IIPP Roll out Collaborate on revised program Provide bi-monthly safety training to employees Provide IIPP training to Supervisors / Managers Adopt revised IIPP Provide revised IIPP, action items and Bi-monthly safety training modules to client Multiple drafts may be required Ensure procedures reflect organizational practices Safety training modules include: PPT Presentation, Learner’s Guide, Quiz and Answers Provide ongoing consultation and support, including annual refresher to IIPP ESM Client Joint

  13. Safety Management Program • Monthly or Quarterly Safety Management program • Assist with development of or attendance at insured’s Safety Committee meetings for the purpose of acting as a technical advisor. • Goals include assisting insured with effectively reviewing, revising and communicating the organizations safety initiatives. • Program includes the following functions: • Customized IIPP • Safety & Health Manual • Cal-OSHA compliance policies and training for leading exposures • E.g. Industrial truck, LOTO, Electrical safety etc. • Inspection checklist and schedule • Training matrix (including tailgate schedule and material) • Onsite quarterly safety committee meetings • Ongoing email/phone communication and support • http://www.executivesm.com/portfolio/safetymanagement/

  14. Return-To-Work

  15. Return-To-Work Program • Return To Work program • Program includes: • Written RTW management plan and policy statement • Establishing a support team • Assign roles and responsibilities (via committee) • Establish process and procedures for organization • Identify and develop written Temporary Alternative Duties (TADs) • Document physical requirement of job tasks (“Essential Functions”) • Develop communication tools to stakeholders • Carrier, Medical provider, Supervisors, Employees • Train supervisors and managers • Provide ongoing consultation regarding management and ensure compliance with the “Interactive Process” per FEHA regulations http://www.executivesm.com/portfolio/returntowork/

  16. Return-To-Work Implementation Phase 1 Phase 2 Phase 3 Foundation Assessment Launch Review and Revise Job Descriptions Identify Temporary Alternative Duties (TADs) Document physical requirements Coordinate communication Train supervisors and managers Launch RTW program to all employees Write a management plan and policy statement Build a support team and assign roles and responsibilities Establish process and procedures Evaluate Business Benefit ROI

  17. Return To Work Development Process Program Introduction Current RTW Plan and/or Policy Recent work status report from designated Medical Provider Job descriptions Alternative duties Loss Runs X-Mod Worksheet/WCIRB Collect Background Information Program Engagement RTW Evaluation Questionnaire Phase 1 - Foundation Write Management Plan and Policy Statement Assign Roles and Responsibilities Establish Process and Procedures Build Support Team Planning Checklist Assign RTW Coordinator Document Physical Requirements Identify Temporary Alternative Duties (TADs) Review & Revise Job Descriptions to include Essential Functions Phase 2 - Assessment Phase 3 - Launch Roll out to all Employees Coordinate with Employee Coordinate Communication Train Supervisors/Managers Coordinate with Medical Provider Coordinate with Claims Administrator Flyer PPT Letter to employees Support ESM Member

  18. Claims Management

  19. Why Claims Management? • SB899 Reform results continue to erode • SB863 legislative changes and impact • X-Mod analysis and control • Medical cost inflation • Increase in Medicare Set Aside • Abuse of medical lien process • Increase in cost containment factors • Legislative changes • New case law impact • Increasing litigation • Turnover in claims examiners "I have worked with Sharon Poston of ESM Solutions, Inc. for almost 7 years.  She is the most knowledgeable person I have met, in the ever changing arena of workers' compensation.  If you have a question, she has the answer.  Sharon is a most supportive ally for any company in need of an advocate.  I would not want to work without her valuable input. “ -Mary MacDonald, Safety Manager,  Robert Mondavi Winery

  20. Claims Management Schedule Policy Year Milestones Policy Year Application

  21. Why Claims Management? • Ongoing oversight and management of key claims • Ensure examiner has positioned claim for speedy, cost-effective resolution • Act as liaison for employer on all delayed claims, ensuring 90- day decision is met timely • Ensure current labor code and case law are applied • Recommend litigation strategies to resolve claims • Ensure X-Mod accuracy • Communication: Ongoing phone call and email communication for clients and staff • Audit of Third Party Administrators as needed • For more on our Claims Management process please visit our website: http://www.executivesm.com/portfolio/claimsmanagement/

  22. Claims Management Reporting & Oversight Process Carrier processes claim Claims Management MO claim processed, closed in 90 days Begin RTW coordination with medical provider and client ESM analyze at 90 days for potential problems Claim is classified as MO or IND Continue 30 day ongoing oversight and direction IND claim: 3 point contact, provide benefits Begin RTW coordination with medical provider and client Disputed Claims If ACCEPTED, manage claim to conclusion Claim is delayed and investigated for 90 day compensability determination Determination is made to accept or deny Monitors Carrier for investigation process and strategizes decision If DENIED and UNDISPUTED Close in 30 days Oversees resolution strategy If DENIED and DISPUTED Develop litigation strategy for resolution Large Loss Claims ( >$25,000 ) Strategize best practices for resolution Monitor strategy for effectiveness and accountability Monitor settlement and any future medical award Develop a POA for resolution Client ESM Carrier

  23. The ESM Commitment

  24. ESM’s Commitment • Results Driven • The ESM focus is to minimize risk and cost by reducing the frequency and severity of workplace injury and time off of work. • Our service team will provide a diversified portfolio of services that can assist your organization with your ongoing Workers’ Compensation needs and profitability. • Relationship Focused: • ESM is driven to establishing and maintaining superior working relationships with all stakeholders by meeting with key decision makers and designing a mutual plan for success.

  25. ESM is the Solution • Expertise in Safety & Workers’ Compensation • Established relationship and understanding of Safety and Workers’ Compensation needs • Results driven program plan of action • Successful partnership with strategic resources • Designations: • WCCA, WCCP, CPDM, ARM, AIM, SIP, PMP, CSP • Responsive and friendly • Raising the “BAR” • Benefits from Activities that get Results

  26. Injury Prevention and Workers’ Compensation Claims Management Where there are risks, there are Solutions www.executivesm.com

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