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Lunch Learn Roundtable No. 1 Workers Compensation Fundamentals

AGENDA. Introductions

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Lunch Learn Roundtable No. 1 Workers Compensation Fundamentals

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    1. Lunch & Learn Roundtable No. 1 Workers’ Compensation Fundamentals September 29, 2009 11:00 to 1:00 Westin Hotel, Waltham, Massachusetts

    2. AGENDA Introductions & Overview of the MCPSA Insurance Excellence Group John Tarvin & Mike Lucas Surprise Quiz Jeff Burke & Paul Marino A Primer on Workers’ Compensation & Claims Management Janice Moquin & Mark Hickox

    3. AGENDA Independent School Claims Data Mike Lucas & Deanna Bullock A True Life Case Study Jeff Burke, Paul Marino & Mark Hickox Risk Management Resources Available to You Jeff Burke

    4. AGENDA Everything is on the Table Roundtable - Your Questions Closing Comments John Tarvin and Mike Lucas

    5. Introductions & Overview The MCPSA Insurance Excellence Group Association Massachusetts Center for Charter Public School Excellence : John Tarvin - Executive Director Brian Anderson – Program Manager Insurance Agent Fred C. Church Team serving MCPSA Member Clients: Mike Lucas - Vice President & Account Executive Carol Bailey - Account Executive Jeanne Pitts - Account Manager Deanna Bullock - Manager, Claims Department Jeff Burke - Vice President & Risk Management Consultant Paul S. Marino - Risk Management Consultant

    6. Introductions & Overview The MCPSA Insurance Excellence Group Insurance Companies Property, General Liability, Educators Legal Liability, Auto, Umbrella & Builders Risk Hanover, (A.M. Best Rated A, Excellent) Crime & Fiduciary Liability Chubb Insurance, (A.M. Best Rated A++, Superior) International Travel ACE, (A.M. Best Rated A+, Superior) Student Accident Markel (A.M. Best Rated A, Excellent)

    7. Introductions & Overview The MCPSA Insurance Excellence Group Insurance Companies Workers Compensation Atlantic Charter Insurance (A.M. Best Rated A, Excellent) Team serving MCPSA Member Clients: Gina Wong - Underwriting Manager Janice M. Moquin - Assistant Claims Manager Neal Freedman - Safety and Health Manager Jacquie Willett - Marketing Manager Mark Hickox - Safety and Health Consultant Janeen Ackerson - Claims Specialist, Loss Control Consultant

    8. SURPRISE QUIZ ? You have ten minutes...good luck! Pass out questions and either have them work in small groups of 2 – 4 or individually. Then go over each question on screen.Pass out questions and either have them work in small groups of 2 – 4 or individually. Then go over each question on screen.

    9. Surprise Quiz!   Your school is required by the state of Massachusetts to provide workers’ compensation insurance coverage? True or False   Who is covered under a workers compensation policy? A) Employees B) Volunteers C) Students D) Anyone injured on school property Your school is required to report any worker’s compensation claim to the Department of Industrial Accidents when ____ of incapacity to earn full wages has been reached? A) 1 day B) 3 days C) 5 days D) 7 days Massachusetts requires schools to have a safety committee? True or False   Employees injured at work can go to any medical provider for treatment? True or False  

    10. Surprise Quiz! An employee who is out of work on a WC claim can continue working elsewhere? True or False   Employees who are injured as a result of their own negligence are not covered by WC? True or False   When should you report a work related injury to your insurer? What types of injuries should you report to your insurer?  What is “light duty”? A) Work that requires no lifting B) Work that requires no lifting over 10 pounds C) Work that requires no lifting over 30 pounds D) Work that is within the restrictions set by the treating physician  

    11. Surprise Quiz!   BONUS QUESTION: What does OSHA stand for and do you have to abide by their standards?

    12. A Primer on Workers Compensation What is the Purpose of WC Insurance? Worker’s Comp serves as virtually the exclusive remedy for employees who have sustained a work related injury/illness.

    13. Workers Compensation Primer Short History Lesson 1911 – Massachusetts enacts first WC act (voluntary) 1943 – WC becomes compulsory law 1991 – Most recent reformation of law The Massachusetts WC Marketplace – Insurers, Safety Groups, SIGs and the Pool

    14. Workers Compensation Primer Massachusetts Regulatory Structure Department of Industrial Accidents (DIA) Worker’s Compensation Rating and Insurance Bureau (WCRIB) Legal Obligations and Consequences Premium & Rate Calculation – Payrolls, Experience Modification Factor (the “Mod”), All Risk Adjustment Program (ARAP), Credits, Deviations, Dividends and Assessments

    15. Workers Compensation Primer When is an employee covered? ---------------No Fault Insurance--------------- Requirement Criteria for an employee to be covered: 1. Liability – arose in scope/course of employment Disability – medical treatment and incapacitated from earning full wage Causal Relationship – injury/illness is the result of work incident

    16. Workers Compensation Primer A Real Benefit to Your Employees ------------------Benefits--------------------- Medical Coverage – treatment related to work related condition Wage Replacement – Total and/or Partial Disability Loss of Function/Scarring Vocational Assistance – Job Placement and/or Training

    17. Workers Compensation Primer The Claims Process Injury Response Injury Treatment Claim Reporting Accident Investigation Corrective Actions Post Injury Management Follow-up with Adjuster Follow-up with Employee Follow-up on Corrective Actions

    18. A True Life Case Study Salvatore Marino, the custodian employed by North End Charter School was working during the school day cleaning tar stains off the stairs with a heavy duty cleaning solution. He slipped and fell down 2 steps causing his bucket to spill splashing cleaning solution on his face and right arm. Salvatore, feeling no pain from the fall or the cleaning solution got up, dried off and continued working, never saying anything to his supervisor prior to leaving work. His uncle picked him up from work and before arriving home Salvatore began to experience slight burning sensations. When he got home he rinsed the affected areas....but it was too late. His uncle drove him to the emergency room of the local hospital.

    19. A True Life Case Study (cont.) After sitting for 1 hour in the emergency room, he was finally seen and diagnosed with 2nd degree burns on his face, shoulder, arm and lower back. By this time it had been over 7 hours since the accident occurred. Salvatore was transferred to the burn unit of a city hospital. Treatment was intense and required extensive surgery including skin grafting from his thigh. Over a year later Salvatore continues to require pain management, therapy and is out of work.

    20. Injury Management Let’s assume he immediately reported the accident to you. He dried himself off and came right to your office to report. He tells you that he fell down the stairs and was splashed with cleaning solution but feels fine. What would you have done? Would you respond differently if you had witnessed the accident? WC Claim Handling Salvatore reported the incident to you. He did not go to the ER or to the school’s Occupational Health Provider. Would you report this incident to your workers compensation insurer? What is your procedure for gathering all of the facts?

    21. Injury Management Salvatore, does not want to see a doctor, but you insist that he must. Where will you send him and how will you get him there? Loss Prevention Just as in the case study, Salvatore does not go to the hospital immediately but waits. Within 24 hours you know the terrible burns that Salvatore has suffered. What do you do back at your school to understand how this could have happened and to prevent it from happening again? What if instead, Salvatore got immediate treatment and the doctor indicated that Salvatore had suffered only minor chemical burns from the cleaning solution but thanks to getting him treatment everything is fine. What would you do now to prevent this accident from happening again?

    22. Loss Prevention How would you find out what the chemical was...what the potential hazards were...what personal protective equipment was necessary...what first aid level response might be needed. What safety compliance programs and protocols are you required to have that relate to this type of incident? Claim Handling Salvatore is in the hospital. What is your follow-up with him...his wife...the claims adjustor? Salvatore is home recovering, it will be a long time before he can return to work. What is your follow-up with him...his wife...the claims adjustor...your agent?

    23. Root Causes What were the root causes of Salvatore’s injuries? Was this injury really preventable? Who was responsible?

    24. What if..... What if the cleaning solution also had splashed on several first graders as their class was ascending the stairs?...How would you handle Injury management?...Claim Reporting?...Loss Prevention? What if Salvatore was an independent contractor?...what would be your response? What if he were similarly injured...could the school be sued, found negligent and liable?

    25. Case Study Results Direct Claim Costs Total Incurred Loss to Date: $240,584 Medical Paid: $85,914.40 Medical Reserve: $102,537 Indemnity Paid: $3,662.64 Indemnity Reserve: $48,470 What are the indirect short and long term costs to the school?

    26. MCPSA Insurance Excellence Group Risk Management Resources If you have a question or a request for service on anything even remotely related to risk and insurance....ask us! We will either have the answer or we will find the answer and a way whenever possible to serve your needs.

    27. MCPSA Insurance Excellence Group Risk Management Resources Online Demonstration of Insight Risk Management Resource

    28. Roundtable – Q&A The Questions You Submitted to Us Overview of what I should know as someone fairly new; how to prevent claims How does the school communicate discomfort or doubt about a claim without prejudicing the process or going afoul of the laws? How many days does an employee need to be out for Workers Comp to pay them for their lost time? WC Coverage for sub-contractors and 1099 employees

    29. Closing Remarks Thank you for joining us today!! Lunch & Learn Roundtable No. 2 With Hanover Insurance Company In Worcester January or February 2010 On School Liability Details to Follow…

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