• 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

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

District Goals:
Reduce injury frequency and severity
Actual results achieved

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

$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

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

• 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

• 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

• 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
• 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

Reducing Lost Days and Temporary Disability costs

• 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

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 www.executivesm.com

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

Proactive Claims Management reduces the cost of injuries

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

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

• 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

Expert advocates that get your District results

• 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

www.executivesm.com