ESM Solutions School District Service Overview

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Workers’ Compensation

Reducing risk and cost

What we Strive for

School District Service Objectives

Reduce costs by reducing the frequency and severity of workplace injury

Establish a customized safety and claims management plan

Maintain an open line of communication and trusted working relationships with school district personnel

Provide ongoing training to ensure a safe work environment www.executivesm.com

Services

Training &

Education

Develop educational content and delivery

Creating a competitive advantage by empowering district personnel to identify and control exposures

Online Services / Educational Portal

Return-to-Work

Solutions

Develop customized RTW

Program

Ensure communication with all stakeholders

Return employees back to work immediately

Mitigating legal exposures (FEHA)

Safety

Management

Claims

Management

Customized safety management plans

Focused on reducing injury exposures

Developing compliant

Cal/OSHA programs

Enhancing communication strategies and training programs

Conducting inspection to reduce hazards

Providing strategies for claim closure

Oversight on indemnity claims

Facilitating communication with all stakeholders

Supplement & compliment efforts

Reducing reserves and controlling the

X-mod www.executivesm.com

Solutions

that get

Results

District Goals:

Reduce injury frequency and severity

Actual results achieved

Reduction of claim frequency

70

60

50

40

30

20

10

0

49

19

30

2008

66

26

40

2009

41

11

29

2010

53

14

35

Total Number of Claims

Indemnity

Medical Only

Линейная (Total Number of

Claims)

28

22

2011

5

2012

www.executivesm.com

Reduction of claims severity

$500 000

$450 000

$400 000

$350 000

$300 000

$250 000

$200 000

$150 000

$100 000

$50 000

$-

$437 465

2009

$445 598

2010

$180 365

$145 004

2011 2012

www.executivesm.com

Training & Education

Principal Safety Committee

Principal Safety Committee Program:

Develop Principal Safety Committee Guide

Establish committee at each site

Consists of Principal and three – four other designees

Establish general policies and procedures for the safety committee meetings, timeline, expectations, attendance forms etc…

Prepare binder with monthly agenda and guidelines for Principals

Curriculum for school year, including:

• Hazard identification presentation based on inspection reports and leading exposures

Inspection checklist based on monthly presentation

Recorded webinar for principal review www.executivesm.com

Training solutions

Customized safety videos

E.g. Principal Safety Program Strategic Plan, IIPP

Overview, Slip, Trip, Fall

Legislative Updates

E.g. SB863

Customized Computer Based Training (CBT)

Modules

Develop and host CBTs

Utilize Learning Management System www.executivesm.com

Safety Management

Why Safety Management?

Ensure written Cal/OSHA compliance programs

E.g. HazCom, MSDS management, PPE

Provide training based on leading exposures and safety policies (SOPs in hazardous tasks)

Conduct inspections identifying exposure trends

Implement customized scorecard inspection program

Utilize dashboard analytics for management decisions on resource allocation

Optimize District wide safety understanding

Legislative changes including Assembly Bill 2774

Focus on reducing injuries and injury exposure www.executivesm.com

Interior & Exterior

Site Inspections

School Site Inspections

• Focused on safety, fire and property / liability exposures.

Conduct inspection program to satisfy IIPP

Development of inspection binder for corrective action

Present findings to District management

Inspections will include all buildings and grounds, which include (but not limited to):

Alternate each year between exterior and interior inspections

100% of school grounds:

• Gates, fences, parking lots, sidewalks /walkways, fields, buildings, classrooms, locker rooms, gymnasiums, bathrooms etc…

Hazard identification

Electrical hazards

Slip, trip and fall hazards

Structural hazards

School grounds hazards

Housekeeping hazards

Fire hazards/safety

“Fall on” hazards

Life safety hazards

Chemical hazards www.executivesm.com

Playground Inspections

Playground Inspections

Inspect all elementary playgrounds and middle school athletic grounds

Inspections include:

Identifying hazards on playground equipment and the playground

Ranking the hazards according to injury potential

Recommendations on removing/correcting the hazards

Utilize established playground inspection checklist, complying with IIPP & playground inspection requirements

Per the National Playground Safety Institute (NPSI)

Provide summary report to District management www.executivesm.com

Return To Work

Reducing Lost Days and Temporary Disability costs

Return To Work Benefits

Reduce or avoid temporary or permanent disability payments

Reduce medical costs as injured workers experience faster recoveries when they remain at work in a work environment that is congenial with their physical capacity

Reduce or avoid litigation

Discourage fraudulent claims

Improve productivity and morale among all employees

Eliminate disability discrimination and comply with

FEHA www.executivesm.com

Return To Work Implementation

Phase 1

Foundation

Write a management plan and policy statement

Build a support team and assign roles and responsibilities

Establish process and procedures

Phase 2

Assessment

Review and Revise

Job Descriptions

Identify Temporary

Alternative Duties

(TADs)

Document physical requirements

Phase 3

Launch

Coordinate communication

Train supervisors and managers

Launch RTW program to all employees

Evaluate

Business Benefit

ROI

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Return To Work Development Process

Program Introduction

Program

Engagement

RTW

Evaluation

Questionnaire

Collect

Background

Information

Current RTW Plan and/or Policy

Recent work status report from designated Medical Provider

Job descriptions

Alternative duties

Loss Runs

X-Mod Worksheet/WCIRB

Phase 1 - Foundation

Write

Management

Plan and Policy

Statement

Build

Support

Team

Assign RTW

Coordinator

Assign

Roles and

Responsibilities

Establish

Process and

Procedures

Planning

Checklist

Phase 2 - Assessment

Review & Revise

Job Descriptions to include

Essential Functions

Identify

Temporary

Alternative

Duties (TADs)

Document

Physical

Requirements

Phase 3 - Launch

Coordinate

Communication

Coordinate with Employee

Coordinate with Medical Provider

Coordinate with Claims Administrator

Train

Supervisors/

Managers

Flyer

PPT

Letter to employees

Roll out to all

Employees

ESM

Support

Member

Claims Advocacy

Proactive Claims Management reduces the cost of injuries

Why Claims Management?

Reform results continue to erode

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

Recent Result: $61,000 reserve reduction

on two claims for a District that is Self Insured! www.executivesm.com

Claims Mgmt Service Schedule

Policy Year Milestones

Referral

Form

Letter of

Auth from client

Q1

Summary

Report

Claims

Review

Q2

Unit Stat

Report

X-Mod

Forecast

Q4

Renewal

Report

Policy Year Application

Oversight of carrier

/ TPA

Troubleshoot challenging claims

Advisor to

Employer / Agency www.executivesm.com

Claims oversight and support

• Ongoing Communication

Phone call, email and webinar communication for District claims management staff

• Develop written claims handling procedures

Work in conjunction with CUSD Workers’ Compensation coordinator to develop written policies and procedures.

Ongoing claims Oversight & Direction

Ensure examiner has positioned claim for speedy, cost-effective resolution

• Analyze reserves for accuracy and negotiate potential reduction

Act as liaison on all delayed claims, ensuring denial decision is met timely

Obtain current status of claim including work status, medical prognosis and recommend a resolution strategy

Ensure appropriate California laws and regulations are applied

Recommend litigation strategies to resolve claims

Create vendor list (e.g. Defense Attorney, Nurse Case Management etc..)

Create First Aid policy www.executivesm.com

Claims Management Reporting & Oversight Process

Claims Management

Carrier processes claim

Claim is classified as MO or IND

MO claim processed, closed in 90 days

IND claim:

3 point contact, provide benefits

Begin RTW coordination with medical provider and client

Begin RTW coordination with medical provider and client

Continue 30 day ongoing oversight and direction

Disputed Claims

Claim is delayed and investigated for 90 day compensability determination

Monitors Carrier for investigation process and strategizes decision

Determination is made to accept or deny

If ACCEPTED, manage claim to conclusion

If DENIED and UNDISPUTED

Close in 30 days

If DENIED and DISPUTED

Develop litigation strategy for resolution

Large Loss Claims ( >$25,000 )

Develop a POA for resolution

Strategize best practices for resolution

Monitor strategy for effectiveness and accountability

Monitor settlement and any future medical award

ESM analyze at

90 days for potential problems

Oversees resolution strategy

District

ESM

Carrier

Your Service Team

Expert advocates that get your District results

ESM is YOUR Advocate

Expertise in school district risk management

Designations:

Associate in Risk Management – ARM

Worker’s Compensation Claims Professional - WCCP

Associate in Management - AIM

Certified Playground Safety Inspector – CPSI

Certified Professional Disability Manager – CPDM

Self-Insured Professional – SIP

ESM’s consultants are fingerprinted for criminal compliance per the educational code, sections: 45125.1 & 45125.2

Established relationships with school districts

Results driven

Always raising the BAR

B

enefits from

A

ctivities that get

R

esults www.executivesm.com

Where there are risks… there are

Solutions

www.executivesm.com

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