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Medical Care Benefits & Cus-
tomizing Services
Oct.13, 2010
Commitments to Society
Passion for the World’s
BestDedication to Customers
Il-Joon Jo / ManagerCompensation Department
Suwon Branch Office
Ⅰ Introduction
Ⅱ
Ⅲ Customizing Services
Ⅳ Main Accomplishment
Medical Care Benefits
I Introduction
1. Why? Customizing services
2. Customizing Service of Samsung Life Insurance
3. New Mission & Vision
4. CEO Management Polices
1. Why? Customizing services
Global vision
Medium level of competitivenessMedium level of competitiveness
Ranking as the 3rd of pension fund
institutions
Ranking as the 3rd of pension fund
institutions
Top service provider of public
organizations
Top service provider of public
organizations
No.1 Strategy
Toward a global level of social security service provider most re-liable from workers that would enable the successful achieve-
ment of vision
Top service provider in Asia
Top service provider in Asia
Initiative strategies
ü
All-Touch Activities
CS HQ.
Holograph DM
Call Ctr. OB Call
FC
Holograph DM
Thanksgiv-ing
Executive
Holograph DM
Branch
TA Asst.
Contrac-tor
Guide
Family
Booklet
Field
Visit Support
Event
SMS
CustomerTouch ratio&
CSI Improvement
2. Customizing Service of Samsung Life Insurance
“World’s best workers’ compensation & la-bor insurance service provider
MissionMission
VisionVision
Key ValuesKey Values
Dedication to customers
Passion for the world’s best service provider
Commitments to society
3. New Mission & Vision
“World’s best workers’ compensation & la-bor insurance service provider"
Dedication to Customers
Passion for the World’s Best
Service Provider
Commitments to Society
Management PoliciesManagement Policies
Creative Management
Creative Management
Open Management
Open Management
Serving Management
Serving Management
Creating a higher value of existence
Organization opened for sharing and
communication
Serving attitudes & their practices
4. CEO Management Policies
II Medical Care Benefits
1. Overview
2. Process and Scope
3. Work-related Accident
Work-related AccidentWork-related Accident
WCI Medical InstitutionWCI Medical Institution
Medical Care BenefitsMedical Care Benefits
Recovery from InjuryRecovery from Injury
Disability BenefitsDisability Benefits
COMWELCOMWEL
Vocational RehabilitationVocational Rehabilitation
Non-WCI Medical InstitutionNon-WCI Medical Institution
Return to workReturn to work
Claim for Medical Care Expenses
Transfer following a first-aid treatment
If an injured worker can’t receive medical treatment from an authorized Institution, ….
Flow Diagram
1. Overview
Process of Claiming for Benefits
Injured Worker
COMWEL
employer
Medical Institution
2. Process and Scope
Process of Claiming for Benefits
There happens a work-related accident
Transfer to a medical institution
2. Process and Scope
Process of claiming for benefits
Is the medical institution designated by COMWEL?
Non designated? Transfer to WCI institution
2. Process and Scope
Process of Claiming for Benefits
Make an application for medical care benefits(WCI medical institutions can act on behalf of workers.)
Specify the details(including his/her workplace, theBackground of the accident, and medical opinions)!
2. Process and Scope
Process of Claiming for Benefits
Sign on the application.
Submit it to the medical institution.(To get a medical opinion)
2. Process and Scope
Process of Claiming for Benefits
Submit a copy of it to our branch office
A notice of determination within 7 days
2. Process and Scope
Process of Claiming for Benefits
It may take longer…(for concrete verification)
If denied, He/she has a right to appeal for a review
2. Process and Scope
Scope of Medical Care Benefits
Examination& Test
Hospitalization
Treatment& Operation
Medications
Nursing andPatient caring
Transfers
2. Process and Scope
Occupational Accidents
a significant causal relationship but the injuries caused by his/her willfulness or crimi-
nal acts are not covered
arise out of and in the course of employment
3. Work-related Accident
Accidents While Performing Duties
Act of performingHis/her duties
Physiologically necessary deeds
Act of preparing for work
Acts expectedAs a social normSuch as acts ofemergencyrefuge
3. Work-related Accident
Accidents Due to Defect, etc, in Facilities, etc.
If caused in violation of specific instructions from the employer
Not covered
due to defect in, or the careless mgmt. by theemployment
3. Work-related Accident
Commuting Accident
While using a means of Transport provided by the employer or can be regardedas being provided by the employer
Not have entire and exclusiveResponsibility to manage oruse the means of transport
3. Work-related Accident
Accident during Recess Hours
VIolating regulations, self injury, criminal offenses
Not covered
Due to an act that can be seen under the control of the employer
3. Work-related Accident
Business or official trip
Private action, self injury, violation of instructions
Not covered
outside working place
3. Work-related Accident
Accidents During Events (deemed necessary for labor managment)
Where the employerorders the worker toparticipate in the event
Other cases wherethe employer hasusually and customarilyrecognized the worker’sparticipation in the event
After obtaining Approval from theEmployer in advance
When the employerrecognizes his/herhours to participatein the event ashours worked
3. Work-related Accident
Work-Related Diseases
Exposed to hazardous materials
to require a medical care
When occurs as a result of a work-relatedinjury
a specific clinical symptoms
3. Work-related Accident
Diseases Arising from Work-related Injuries
The causal relationship Between the injury and diseases should bemedically recognized
Taking into accountthe worker’s sex, age,health, physicalconstitutions, etc.
Not caused by a naturally happeningsyndrome
3. Work-related Accident
III Customizing Services
1. Customers
2. Flow Chart
5. Integrated VOC System
3. Operating System
4. Customer-Serving Mgt. System
Our customers include workers, employers, unemployed workers, etc., occupying 62.3% of economically active population
Eligible workers
“13 millions”“13 millions”
Insured employers
“1.95 millions”“1.95 millions”
Workers’ CompensationEmployment Insurance
Supports for Becoming a Member & Paying Premiums
Workers’ Compensation Employment Insurance
Supports for Becoming a Member & Paying Premiums
Workers unemployed for 6 months or longer
“80 thousand”“80 thousand”
Unemployed WorkersBusiness Launching & Financial Supports
Unemployed WorkersBusiness Launching & Financial Supports
Low-income workers
“7.3 millions”“7.3 millions”
Low Income WorkersCredit Guarantee & Financial Supports
Low Income WorkersCredit Guarantee & Financial Supports
1. Customers
Workers’ CompensationCompensation, Care, Rehabilitation
Workers’ CompensationCompensation, Care, Rehabilitation
2. Flow Chart
Construction of Infrastructure At the Point of Customer Contact without Time & Space Limit
Electronic Fax
BSC System
OLAP
IFI System
Labor Insur-ance System
Internet Prep. Screening
Elastic Working
hours
Internet Total Service
Internet Con-tribution Rate
Search
ICSI Review Search
E-ComwelSpace Factor
Time Fa
ctor
Next GenerationComputation System SMS Service
Electronic Seizure En-
trustingIFM System
Go-To-See Service(VPN)
Welco-in (KMS) Welfare Por-
tal
Internet Return of Payment in Excess
U-Comwel
TeleCommuting
Business Policy
Execution &Maintenance
Business Goal
Internal Inspection
Management Review
Quality Management Manual/Laws and Enforcement Decrees
ProcedureDocument
GuidelineDocument
Regulation
DetailedRegulation
Pro
cess
MAICPDCA
3. Operating System
Quality Management Cycle(PDCA·MAIC)
Plan Measure
Do
Check
Action
Analyze
Improve
Control
Occurrence of non-confirmity
Investigation ofthe Cause
CorrectionAction
4. Customer-Serving Mgt. SystemServing customers has been el-
evated as a core value of our
management
Leadership
Strategy
Feedback
Goal : Seeking the Ultimate in CS
CS Tasks Selected & Checked
CS Team / CS Leader
CS Mgt. Committee
CS Instructor / CoP
Organization
Integrated VOC System
In/outbound Call (Call Ctr.)
On/Off line Customer Opinion
Customer Panel
VOC
PCSI / Regular CSI Survey
Customer Monitoring
COI Survey
ICSI / EI Survey
Call Ctr. CSI Survey
5. Integrated VOC System
Call Ctr.
Customer Moni-toring
VOC Distribution(Support Dept.)
·Classification by the Cause·Improvement Activities
DB Accumulation & Analysis
Customer Information
No Yes
Person in Charge(215 Dept. Mgr.)
Dept. /Staff Evaluation
·VOC BP Pick up·Improvement in Service
Efficient Strategy Set-up
Internet Q&A
Other Websites
Visit / Call
Customer Panel
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1. Findings on CSI Survey
2. Period for Return to Society
IV Main Accomplishment
3. Innovation in Medical Care
82.1
2008
84.2
2009
Improved in PCSI for 5 consecutive years in the Social Security Category in the Public CSI
2005 2006 2007 2008
71.0 73.6
78.4 79.7
12.3
1. Findings on CSI Survey
2009
83.3
Decrease in the period of Injured Workers’ Return to Society
산재근로자 사회복귀 소요비용 절감
Cost Cutting
2006
252 days
2008
191 days
2009
184 days
Period for Return to Society
60.7 BillionKRW
41 days
20 days
2007
211 days7
days
352.9Billion KRW
187.4BillionKRW
2. Period for Return to Society
Intimacy
산재요양 · 보상서비스 혁신
Financial Consulting('09.12)
Concentration Support('09.1)
'09New Service
Diversification of Application Route('09.1)
(Internet & Telephone 38Thousands/100Thousands)
Rainbow System('09.6)
Customizing Service('09.4)
Case Manager('09.1)
Differentiation
Compete
nce
3. Innovation in Medical Care
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