Workers’ Compensation

Reducing risk and cost

Building a successful partnership

Presented by ESM Solutions, Inc.

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

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)

ESM Engagement Strategy

INTRODUCTION Work Comp Policy written WC service needed – ESM introduced

REFERRAL Broker completes “Referral Form” sends to ESM

ESM / Broker/ Client develop a POA for client

SERVICE ESM Service plan initiated Carrier/Broker/Client maintain presence in service stream

OBJECTIVES Assist insured with mitigating Work Comp risk and cost

Client and Broker results & satisfaction

Training & Education

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

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

Safety Management

Ongoing, structured Safety

Committee Meetings

Ongoing, scheduled Safety

Inspections & Trending

Relevant and compliant

Safety Training

Standardization of Processes for scalability and sustainability

Risk Assessmen

t

Define prioritized scope of

work

Prepare Corporate

S&H Policy

Develop Injury & Illness

Prevention Program

Develop Safety & Health Manual

Building a Safety program

Safety Foundation

Safety Application

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/

Insured

Safety

Compliance

Claims Managem

ent

Return-To-Work

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/

Optional training

programs:•IIPP Overview•Bloodborne Pathogens•Distracted Driving•Ergonomics•Fire Extinguisher•Hearing Conservation•Heat Illness Prevention•Housekeeping, Slip –Trip-Fall•Material handling/back safety•Industrial Truck / Forklift

Customer Engagement

Collect BackgroundInformation

Current Injury & Illness Prevention PlanOSHA 300 log (past three years) Training records (samples)Inspection reports (samples)Loss runs if available (most current)

Complete IIPP

Evaluation Questionnai

re

Phase 1 – IIPP Review

Program Introduction

Phase 2 – IIPP Revision

Review client’s current IIPP

Analyze supporting

documentation

Prepare revised IIPP

Outline

Revise and reformat

IIPP

Ensure IIPP meets Cal-

OSHA standards

Phase 3 – IIPP Roll out

Revise / develop custom

checklists for implementation and compliance

Provide revised IIPP, action

items and Bi-monthly safety

training modules to

client

Collaborate on revised program

Ensure procedures reflect organizational practices

Adopt revised IIPP

Provide IIPP training to

Supervisors / Managers

JointClient ESM

Multiple drafts may be required

Provide bi-monthly

safety training to employees

Coordinate with client regarding questions, or additional information needed

Identify missing Cal-OSHA

compliance requirements

Provide ongoing consultation and

support, including annual refresher to

IIPP

Safety training modules include: PPT Presentation, Learner’s Guide, Quiz and Answers

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/

Return-To-Work

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/

Return-To-Work Implementation

Foundation Assessment Launch

Write a management plan and policy statement

Build a support team and assign roles and responsibilities

Establish process and procedures

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

Phase 1 Phase 2 Phase 3

Evaluate Business Benefit ROI

ProgramEngagement

Collect BackgroundInformation

Current RTW Plan and/or PolicyRecent work status report from designated Medical ProviderJob descriptions Alternative dutiesLoss RunsX-Mod Worksheet/WCIRB

RTW Evaluation

Questionnaire

Phase 1 - Foundation

Program Introduction

Phase 2 - Assessment

Write Management

Plan and Policy Statement

Assign Roles and Responsibilitie

s

Planning Checklist

Review & Revise Job Descriptions

to include Essential Functions

EstablishProcess and Procedures

IdentifyTemporary Alternative

Duties (TADs)

Phase 3 - Launch

Build Support

Team

DocumentPhysical

Requirements

Coordinate Communicatio

n

Coordinate with Employee

Coordinate with Medical Provider

Coordinate with Claims Administrator

Train Supervisors/Manage

rs

Roll out to all

Employees

Assign RTW Coordinator

Return To Work Development Process

Member

ESM Support

FlyerPPTLetter to employees

Claims Management

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

Analyze reserves Litigation Management

Ongoing management of open indemnity

claims

Advisor to Employer/ Agency

Referral Form

Letter of Auth from client

Q1Summary Report

Claims Review

Q2 Unit Stat

Report

X-Mod Forecast

Q4 Renewal Report

Claims Management Schedule

Policy Year Application

Policy Year Milestones

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/

Disputed Claims

Claim is classified as MO or IND

MO claim processed, closed in 90

days

Begin RTW coordination

with medical provider and client

If ACCEPTED, manage claim

to conclusionClaim is delayed and investigated

for 90 day compensability determination

Large Loss Claims ( >$25,000 )

Continue 30 day ongoing

oversight and direction

IND claim: 3 point contact, provide benefits

Monitors Carrier for investigation process and strategizes

decision

Determination is made to accept or

denyIf DENIED and UNDISPUTED

Close in 30 daysIf DENIED and DISPUTED

Develop litigation strategy

for resolution

Develop a POA for resolution

Strategize best practices for

resolution

Monitor strategy for effectiveness

and accountability

ESM analyze at 90 days

for potential problems

Monitor settlement and any future medical

award

Claims Management

Oversees resolution strategy

Begin RTW coordinationwith medical provider

and client

Carrier processes

claim

CarrierESM Client

Claims Management Reporting & Oversight Process

The ESM Commitment

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.

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

Injury Prevention and Workers’ Compensation Claims

Management

Where there are risks, there are Solutions

www.executivesm.com