Published by the Public Risk Management Association
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OCTOBER 2013
The Hidden Costs of Uninsured and Underinsured Motorist Insurance Coverage ZERO IN ON WORKERS’ COMPENSATION COST DRIVERS
CATCHING UP WITH PRIVATE EMPLOYERS
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Volume 29, No. 9 | October 2013 | www.primacentral.org
The Public Risk Management Association promotes effective risk management in the public interest as an essential component of public administration.
PRESIDENT Betty Coulter Director of Risk Management and Insurance University of North Carolina at Charlotte Charlotte, NC
CONTENTS
PAST PRESIDENT Cindy B. Mallett, AIC, CWCP, ARM-P Human Resources/Risk Manager City of Gainesville Gainesville, GA PRESIDENT-ELECT Regan Rychetsky, ABCP Director, HHS Enterprise Risk Management and Safety Texas Health and Human Services Commission Austin, TX
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11
6 THE HIDDEN COSTS OF UNINSURED AND UNDERINSURED MOTORIST INSURANCE COVERAGE
By Bradley York
Results of the Public Entity Workers’ Compensation Survey 2013 conducted by PMA Companies and PRIMA, with strategies to better manage workers’ compensation performance and costs
Amy Larson, Esq. Risk and Litigation Manager City of Bloomington Bloomington, MN Tracy Seiler Manager of Risk Finance The University of Texas System Austin, TX
EDITOR Jennifer Ackerman, CAE Deputy Executive Director 703.253.1267 • jackerman@primacentral.org ADVERTISING Donna Stigler 888.814.0022 • donna@ahi-services.com
Proactive Strategies to Contain Health Care Benefit Costs
Terri Evans Risk Manager City of Kingsport Kingsport, TN
EXECUTIVE DIRECTOR Marshall W. Davies, Ph.D.
By Frank X. Altiere, III, RF, CPCU, ARM, AU, IIA, AIS
17 CATCHING UP WITH PRIVATE EMPLOYERS
Dean Coughenour, ARM Risk Manager City of Goodyear Goodyear, AZ
Matt Hansen, MPA Director, Risk Management Division City & County of San Francisco San Francisco, CA
11 ZERO IN ON WORKERS’ COMPENSATION COST DRIVERS
DIRECTORS Ed Beecher Risk Manager City of Pompano Beach Pompano Beach, FL
By Gerald M. Gates
17
Public Risk is published 10 times per year by the Public Risk Management Association, 700 S. Washington St., #218, Alexandria, VA 22314 tel: 703.528.7701 • fax: 703.739.0200 email: info@primacentral.org • Web site: www.primacentral.org Opinions and ideas expressed are not necessarily representative of the policies of PRIMA. Subscription rate: $140 per year. Back issue copies for members available for $7 each ($13 each for non-PRIMA members). All back issues are subject to availability. Apply to the editor for permission to reprint any part of the magazine. POSTMASTER: Send address changes to PRIMA, 700 S. Washington St., #218, Alexandria, VA 22314.
IN EVERY ISSUE
Copyright 2013 Public Risk Management Association Reprints: Contact the Reprint Outsource at 717.394.7350.
4 News Briefs | 19 Advertiser Index | 20 Member Spotlight
OCTOBER 2013 | PUBLIC RISK
1
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Message from PRIMA President Betty Coulter
ASSEMBLE YOUR TEAM FOR EFFECTIVE WORKERS’ COMPENSATION MANAGEMENT
T
he football season has officially started. Coaches are chosen, teams are assembled, players are conditioned, trainers are prepared and the game plan is communicated. All components of the team are focused on the same outcome of preparing for an undefeated season with minor injuries—maybe with a championship, too. The 11 starters of each team assemble on the field. Offensive and defensive lines take their positions. Coaches, special teams and trainers are prepared to react. The center snaps the ball and the quarterback hands off to the running back and a run to the goal line is carried out. In opposition to a successful play, all types of obstacles may hinder the success of the plan. Circumstances may arise while trying to make it to the goal line. A player may fumble, a pass may be intercepted, the referee may call a penalty, the equipment may fail, or a security concern may arise. A successful workers’ compensation program also depends on a team to reach the goal of returning an employee to a healthy, productive state. Let’s examine eight best practices of managing a workers’ compensation program. Just as a football team requires the support of the athletic director and the front office, the workers' compensation program requires the support of the management team. Management must support programming and provide the necessary budget to meet the needs of the employee and employer. The workers’ compensation administrator acts as the quarterback to execute and manage the components and moving parts of the workers' compensation program. The workers' compensation administrator could be the director of human resources, the risk manager and/or the safety manager. Creation of the workers’ compensation policy and procedure serves as the communication plan for the employees, just as the playbook serves as the communication plan for the football team.
Executing a successful play is based on the effective communication between the coach, the quarterback and the receiver. Training, communication and medical management are essential components of a successful workers’ compensation program. Keeping everyone engaged in the process produces optimum results. An effective safety and wellness program serves as the defensive and offensive line for reducing exposures that may contribute to an employee injury. Returnto-work programs, job banks, transitional duty, work conditioning and work hardening are examples of offensive and defensive maneuvers in the workers’ compensation process. Immediate and proper claims handling is necessary. Just as trainers are able to immediately respond to player injuries, claim reporting and handling processes are essential for successful claim evaluation and mitigation. Special teams include human resources, nurse case management, claims management and legal. Special teams must collaborate to provide the best resources and options for the workers’ compensation process. How would a football team perform without referees? Just as a football team needs referees to keep the game moving forward by applying the rules, the employer must be knowledgeable of state laws and regulations. ADA and FMLA are considered elements within the regulatory environment of workers’ compensation management.
A successful workers’ compensation program also depends on a team to reach the goal of returning an employee to a healthy, productive state.
Evaluate your workers’ compensation program and plan. Assemble your team and have a winning game plan. Sincerely,
Betty P. Coulter 2013–2014 PRIMA President Director of Risk Management and Insurance UNC Charlotte
OCTOBER 2013 | PUBLIC RISK
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News Briefs
NEWS
BRIEFS OKLAHOMA’S WELFARE DRUG TESTING PROVES COSTLY Efforts to identify and prevent Oklahomans high on illegal drugs from receiving certain taxpayer-financed welfare benefits cost the state more than $82,700 in the first seven months after a new law took effect, reports News OK. The net result was 83 adults—about 4.4 percent of those applying—were denied benefits. Oklahoma's drug screening and testing program is more expensive—and arguably less reliable—than the one originally envisioned and proposed by then-state Rep. Guy Liebmann, R-Oklahoma City, back in Jan. 2012.
ILLINOIS TO POST NAMES ONLINE OF PEOPLE WHO FAIL TO PAY TOLLS, FINES Motorists who use the Illinois Tollway but refuse to pay tolls and fines may already have collection agents chasing them, but soon the names of the most egregious scofflaws could also be posted on the Tollway's Web site, reports the Chicago Tribune.
It all sounded so simple when the bill was introduced: Oklahoma adults seeking welfare assistance through the Temporary Assistance for Needy Families (TANF) program would be required to take a drug test.
The list will name those who have racked up more than $1,000 in tolls and fines, officials said. Until now, the Tollway had been reluctant to publicize the names. But Gov. Pat Quinn signed legislation allowing the Tollway to do so, along with the amount of fines and unpaid tolls owed by each violator.
The goal was to save the state money, Liebmann stated at the time. Liebmann's initial bill called for the welfare applicants to pay the costs of drug testing, but it was amended so that the state now pays those bills.
"We are working to compile this list now and hope to be able to publish it on the Tollway's Web site this week," agency spokeswoman Wendy Abrams said.
The proposed law encountered a roadblock when word spread that a federal judge in Florida had issued a temporary injunction months earlier blocking enforcement of a similar law there. The court's decision was based on Fourth Amendment concerns that requiring mandatory drug testing of all applicants represented an “unreasonable search” by the government without cause. A federal appeals court upheld the injunction in February.
The Tollway's action follows similar public shamings by agencies in Texas and on the East Coast. The North Texas Tollway Authority posts its list of "Top 100 Toll Violators" on its Web site.
Rather than risk a similar costly lawsuit in Oklahoma, state senators amended the bill here so that not all TANF applicants are required to submit to a urinalysis or similar chemical drug test. Instead, all Oklahoma applicants are required to go through a screening process called the Substance Abuse Subtle Screening Inventory (SASSI) where they are asked a series of indirect questions designed to detect whether they are likely illegal drug users.
Another agency that uses the tactic is the Port Authority of New York and New Jersey. Its "Wall of Shame" lists the "top egregious toll violators." Last year the Illinois Tollway estimated that deadbeats had racked up about $300 million in unpaid tolls and fines since 2001. The Tollway said it issues about 1.4 million first-violation notices every year. The agency collected more than $33 million in revenue from toll violations in 2011, according to a recent audit.
Individuals identified as likely drug abusers can be required to go through an additional screening evaluation called the Addiction Severity Index and pass a urinalysis test before being approved for benefits. The Addiction Severity Index evaluation is administered by a licensed alcohol and drug counselor and is much lengthier and more intensive than the SASSI screening, said Mark Beutler, communications manager for the Oklahoma Department of Human Services.
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NEW TRAFFIC SYSTEM IMPROVES MINNEAPOLIS’ FLOW A trip down Washington Avenue in downtown Minneapolis is now seven minutes faster for the average driver than it was a year ago. That’s because traffic lights have been re-timed in the first comprehensive rejiggering since 1991, reports the Minneapolis Star Tribune. The city this summer installed new technology to operate the lights on Washington Avenue and at 200 downtown intersections. Lights are timed so that successive traffic lights remain green, allowing for rush-hour traffic to get in and out of the city more efficiently, said Steve Kotke, director of the Minneapolis Public Works Department. “What’s irritating for any driver is to have that traffic light turn red and stop, then go to the next block and stop again,� said Mayor R.T. Rybak. “Over the past year we have done lots of work to make sure drivers can get through the city of Minneapolis easier.� The city used a federal grant along with city, county and state money to pay for the $11.2 million signal project, which will be expanded to the rest of the city by the end of summer 2014. In addition to making traffic flow smoother, the new signal system is expected to lower exhaust emissions, since vehicles will be idling less, and allow more time for pedestrians to cross the street. Some of the city’s traffic control boxes use technology that dates to the 1940s.
HALF OF STATES LACK DISASTER PLANS FOR SCHOOLS, DAY CARE More than half of the states and the District of Columbia do not require schools or day care centers to meet minimum standards to protect children during major emergencies, according to a new report. Save the Children, a non-governmental disaster relief organization focused on children, found that 17 states don't require evacuation plans in day care centers, reports USA Today. The report also found that numerous other states don't require specific plans  for reuniting children with their parents after an emergency. Other states don't require plans for helping children with special needs, which includes infants and toddlers. Four states—Iowa, Idaho, Kansas and Michigan— also do not require K-12 schools to have emergency plans for multiple hazards, such as school shootings or natural disasters, the report found.
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OCTOBER 2013 | PUBLIC RISK
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The Hidden Costs of UNINSURED and UNDERINSURED Motorist Insurance Coverage By Bradley York
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Public entities across America continue to keep a close eye on their budgets, reconciling revenue with long and short-term expenditures, while simultaneously searching for opportunities to reduce deficits or grow surplus. While insurance is a necessary and practical expense for public entities, some insurance components are considered elective and should be carefully considered when evaluating an entity’s risk management needs.
PUBLIC RISK | OCTOBER 2013
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Entity risk managers may elect to purchase one or multiples of these optional coverages with the intention of providing additional benefits to their employees. But in doing so, they may unwittingly and unnecessarily risk the entity’s claims experience. Uninsured and Underinsured Motorist Bodily Injury (UM/UIM BI) is an example of a coverage that many public entities purchase without fully understanding the potential ramifications. While risk managers may feel this coverage better protects their entity, it could, in fact, impact the entity’s loss experience for years to come, which translates to insurability and the costs of future renewals.
A BRIEF HISTORY OF UM/UIM BI COVERAGE The purpose of UM/UIM BI is to fill a void of inadequate or non-existent financial responsibility when an entity’s driver is involved in a not-at-fault accident with an uninsured or underinsured motorist. From an entity or employer’s perspective, the vast majority of these losses involve employees who are otherwise covered by workers’ compensation and who may have also purchased UM/UIM BI coverage through their own personal automobile policy. In such a case, a public entity whose vehicle was damaged and employee injured could be exposed to workers’ compensation liability for the injured employee but also may expose their automobile loss history by virtue of a UM/ UIM BI claim. A UM/UIM BI claim in turn often becomes a complex liability claim (remember, this coverage stands in the shoes of the third-party), frequently involving expensive litigation in an attempt to determine coverage eligibility, allocation of fault and the extent of injury or damages.
THE CONUNDRUM OF UM/UIM BI Obtaining UM/UIM BI coverage benefits an entity’s employees—it’s a nice protection to offer and, when costs
were low, a traditional purchase was a sound business decision. However, as UM/UIM BI costs continue to rise and approach that of direct liability insurance rates, this decision may not align with the goals to compensate injured employees while also managing the budget. This coverage offers no protection to the entity and, in fact, may only serve to drive up the costs of an insurance program.
Uninsured and
The vast majority of local government losses will involve individuals covered by workers’ compensation. Dependent upon state laws, uninsured or underinsured motorists may offer an additional recovery to an injured employee. However, when considering the significant premium costs involved, actual payment of UM/UIM BI benefits are the opposite of linear. In fact, a lengthy and daunting series of hurdles exists that might prevent payment altogether including overcoming workers’ compensation-exclusive remedies, workers’ compensation offsets and deciding if UM/UIM BI is even applicable. Furthermore, it is one of the few coverages where an insurance carrier is providing a third-party liability coverage for the benefit of an insured by stepping into the shoes of the at-fault party under a first-party coverage grant. Often, when disputes arise, employees become frustrated with their employer and their choice of insurance carrier.
many public entities
Entities should also consider whether UM/UIM BI coverage is a redundant benefit to workers’ compensation and potentially detrimental to the employer/employee relationship. As outlined above, the employee is a third-party beneficiary; he or she did not select the carrier or the limits. Instead, UM/UIM BI simply becomes a benefit that inures in the employee’s favor just by the employee’s status. And unlike the structure of workers’ compensation, there is no benefit schedule or arbiter to resolve the ongoing issue of lost wages, benefits and non-economic loss. Instead, all of these issues are resolved after a complete investigation and evaluation of fault,
Underinsured Motorist Bodily Injury (UM/ UIM BI) is an example of a coverage that
purchase without fully understanding the potential ramifications. While risk managers may feel this coverage better protects their entity, it could, in fact, impact the entity’s loss experience for years to come, which translates to insurability and the costs of future renewals.
OCTOBER 2013 | PUBLIC RISK
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The Hidden Costs of Uninsured and Underinsured Motorist Insurance Coverage
By carefully considering all options when it comes to elective coverages, public entity risk managers can help reduce their insurance costs and avoid making decisions that could negatively impact their entity for years to come.
extent of injury and consideration of available coverages, including any offsets and the ability of the at-fault party to compensate the injured employee. Additionally, your workers’ compensation carrier may seek recovery in those states where an offset is not allowed, which can significantly increase the costs of each claim and create yet another source of controversy. Such a scenario ultimately impacts two distinct coverages, both of which feed to the entity’s claim experience. And unlike workers’ compensation, there is no common goal of returning the injured employee back to work. Another consideration is that coverage is often sold with a focus on the policy limit, as if those would be quickly or readily paid. Workers’ compensation indemnity payment supplements funded through accident insurance may prove a far more direct, timely and cost effective method of providing added benefits to injured employees, volunteers or employee family members injured while riding in a local government owned vehicle.
MITIGATING THE RISK Risk managers should critically consider their entity’s needs and work with their insurance agent to review all options to reduce exposures and lower insurance costs. It is possible, in
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some states, to forego UM/UIM BI coverage entirely. In others, it is as simple as choosing a lower UM/UIM BI limit without affecting liability policy limits. Generally, insurance agents will sell UM/UIM BI limits equal to an entity’s auto liability limits because it has long been considered the appropriate method. However, requesting UM/UIM BI limits to be reduced can significantly decrease an entity’s exposure in the long run. Here is a real-world example to illustrate our discussion: A city worker assigned highway traffic-flagging duties, but not operating or riding in an automobile, is struck and killed by an underinsured motorist. The deceased employee’s estate receives workers’ compensation benefits. Because the entity purchased $1,000,000 of UM/UIM BI coverage, the estate also initiates a UM/UIM claim. The city’s insurance carrier responds to that claim, which is defended the same as any third-party claim. The $1,000,000 UM limit is not payable as a “benefit.” As with all third-party claims, coverage, liability, and damages must be determined by the insurance carrier and legal system. In this case, coverage is disputed as UM/UIM BI applies only when occupying a vehicle. Legal costs accrue but there is no added recovery to the estate since UM/UIM BI coverage has not been triggered as the employee was not occupying a vehicle at the time of the accident. However, the incurred legal expenses contributed to higher renewal premiums for the city. Public entities should always resist a status quo approach to its risk management and insurance needs. Coverage options vary by state, but in most cases, limits can be reduced. Considering the escalating costs of UM/UIM BI and the inefficient and litigious claims settlement process, purchasing such coverage may not be a cost-effective method of delivering employee benefits or the best allocation of an entity’s risk management funds. Ultimately, individuals and employees are arguably in the best position to purchase this cover at an appropriate limit via their personal automobile carrier to fit their needs. The availability of UM/UIM BI coverage for personal consumers makes this a simple and prudent decision for an employee. It also removes the entity from yet another source of conflict with an injured employee; instead addressing those needs through a well-established, regulated and structured workers’ compensation schedule. By carefully considering all options when it comes to elective coverages, public entity risk managers can help reduce their insurance costs and avoid making decisions that could negatively impact their entity for years to come. Bradley York is the vice president for business development for OneBeacon Government Risks.
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PUBLIC RISK | OCTOBER 2013
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Zero In on Workers’ Compensation Cost Drivers Results of the Public Entity Workers’ Compensation Survey 2013 conducted by PMA Companies and PRIMA, with strategies to better manage workers’ compensation performance and costs
By Frank X. Altiere, III, RF, CPCU, ARM, AU, IIA, AIS
A
Public entities are grappling with tight budgets, declining revenues, growing economic pressures, and a wide array of risks. At the same time, workers’ compensation costs continue to rise. Given this environment, PMA Companies partnered with PRIMA in February 2013 to conduct a survey of PRIMA members who are public entity risk managers, using an independent market research firm, J.P. Murphy and Company.
SURVEY RESULTS The following are among the key findings of the Public Entity Workers’ Compensation Survey 2013: Biggest Workers’ Compensation Concerns The biggest workers’ compensation concern cited by survey respondents was an aging workforce, selected by 42% of respondents. Controlling claims frequency, returning employees to work, and co-morbidity issues were the next biggest concerns.
BIGGEST WORKERS' COMPENSATION CONCERNS Please indicate your two biggest workers' compensation concerns (N=209) 42%
The Aging Workforce Controlling Claims Frequency
31%
Returning Employees to Work
31% 22%
Co-Morbidity Issues Impacting Claims 17%
Severity of Exposures and Risk Potential Resistance to Safety Culture
14%
Increasing WC Regulations
14% 10%
Ability to Benchmark Results Medical Costs (Write-In)
5%
Access to Critical Risk Management Info 2% 11%
Other 0%
10
Reducing Claims Through Loss Prevention
PUBLIC RISK | OCTOBER 2013
5%
10%
15%
20%
25%
30%
35%
40%
85%
45%
W W W.PRIMACENTRAL .ORG
Re
Resistance to Safety Culture
14%
Increasing WC Regulations
14% 10%
Ability to Benchmark Results 5%
Medical Costs (Write-In)
Managing Workers’ Compensation Performance Access to Critical Risk Management Info 2% When asked forAging the topWorkforce four ways they are managing workers’ compensation performance, 85% cited “reducing claims through loss 42% The 11% Other injury severity, and prevention.” Reducing costs per claim, reducing improving claims reporting time were the other top choices. Controlling Claims Frequency
0%
Returning Employees to Work
5%
10%
31% 20% 25% 31%
15%
30%
35%
40%
45%
MANAGING WORKERS' COMPENSATION PERFORMANCE 22%
Co-Morbidity Issues Impacting Claims
Indicate the top four ways you are managing your workers' compensation performance (N=208) 17%
Severity of Exposures and Risk Potential Reducing Claims Through Loss Prevention Resistance to Safety Culture
14%
Costs Per Claim Increasing WCReducing Regulations
14%
85% 56% 48%
Reducing Ability to Benchmark ResultsInjury Severity10% 5%Time Medical Costs Claims (Write-In) Improving Reporting
47%
Access to Critical Risk Management Info 2% Reducing Our Frequency Ratio 11% Other Claims Litigation Management 0% 5% 10%
44% 15%
35%
40%
45%
23%
Fraud Prevention
85%
10%
Other
Reducing Costs Per Claim
43% 25% 30%
25%
Benchmarking/Stewardship Reporting
educing Claims Through Loss Prevention
20%
0%
10%
20%
30% 56% 40%
50%
60%
70%
80%
90%
48%
Reducing Injury Severity
Increased 47% Medical Provider Costs
Improving Claims Reporting Time
RECENT COSTS TRENDS:
Reducing Our Frequency Ratio
78% 53%
Increased Pharmacy Costs 44%
When asked about workers’ compensation costs, 39% reported an increase, 27% reported a decrease, and 34% said they Aging Workforce stayed same during the prior three years. 43% Claimsthe Litigation Management Increased Claims Frequency
47% 35%
Decreased 25% Benchmarking/Stewardship Reporting Compensation 35% General Economic Conditions Top Reasons for 27% Workers’ Cost Increases 28% Costs ofcosts, Premiums and/or TPA costs, an aging workforce The top four reasons for higher costsIncreased were increased medical provider increased pharmacy 23% Fraud Prevention 39% and increased claims frequency. 25% Co-Morbidity Issues Impacting Claims 10% Other 18% Workers’Compensation Reform Remained About the Same 0% 10% 20% 30% 40% 50% 60% 70% 80% 16% 90% Increased Regulations RECENT COST TRENDS TOP REASONS FOR WORKERS' COMPENSATION 34% How workers' compensation costs Check the15% top four Insufficient RTW Programs
changed during the prior three years for survey respondents
Inadequate Safety Programs 5% Increased Medical Provider Costs Other Increased Pharmacy Costs 0% Aging Workforce
Remained About the Same 34%
Increased 39% Unsure 4%
No 66%
53% 20% 47% 30% 40%
10%
50%
60%
70%
80%
35% 35%
General Economic Conditions Decreased Revenue Available Costs of Premiums and/or TPA
79%
28%
25% Co-Morbidity Issues Impacting Claims Workforce Reduction 18% Workers’Compensation Reform Yes 30%
78%
22%
Increased Claims Frequency Decreased 27%
COST INCREASES
21%
16% Increased Regulations Consolidation of Services 15% Insufficient RTW Programs
20%
Inadequate Safety Programs 5% Other 0%
Other
22%
10% 20% Litigation 5%
16% 30%
40%
Pension Funding Issues 5% Decreased Revenue Available 0%
50%
60%
70%
80%
79%
OCTOBER 2013 | PUBLIC RISK
10%
20%
30%
40%
50%
60%
90%
11
70%
80%
23% Fraud Prevention Aging Workforce
Zero In Decreased 27%
47%
Other Increased Claims10% Frequency On Workers’ Compensation
General Economic 0% Conditions 10% 20% Increased 39%
30%
35% Cost Drivers 40%
35% 60% 50%
70%
80%
90%
28%
Costs of Premiums and/or TPA
25% Co-Morbidity Issues Impacting Claims RISK MANAGEMENT BUDGET REDUCTIONS
Increased Medical ProviderinCosts When asked if their risk management budgets have been18% reduced the past three years, 30% said it had been reduced, Workers’Compensation Reform 53% Increased Pharmacy Costs 66% said that they had not.
Remained About the Same 34%
16% 47% Aging Workforce 15% Reasons for Risk Management Budget Reductions 35% Increased Claims Frequency 5% Inadequate Programs The top reasons for budgetSafety reductions were less revenue available, workforce reduction, and consolidation of services. Decreased 35% General Economic Conditions 27% 22% Other Increased 28% Costs of Premiums and/or TPA 39% 0% 10% 20% 30% 40% 50% 60% 70% 80% 25% Co-Morbidity Issues Impacting Claims MANAGEMENT REASONS FOR RISK MANAGEMENT BUDGET REDUCTIONS Increased Regulations
Insufficient RTW Programs
RISK BUDGET REDUCTIONS Remained About
Select allReform that apply Workers’Compensation
Has your risk management budget the Same been reduced in the past three years? 34% Decreased Revenue Available
18% 16%
Increased Regulations
No 66%
0%
20%
Consolidation of Services
Yes 30%
79%
15%
Insufficient RTW Programs
Inadequate Safety Programs 5% 21% Workforce Reduction Other
Unsure 4%
90%
22% 10%
20%
30%
40%
50%
60%
70
16% Other Decreased Revenue Available Unsure 4%
Litigation 5%
Pension Funding Issues 5% Consolidation of Services Yes 30% 0% 10% 20% 30% Other
No 66%
21%
Workforce Reduction
20%
40%
50% 16%
60%
70%
80%
90%
Litigation 5%
Percent of Budget Allocated to Loss Prevention 3% When asked how much of their budget was allocated to loss prevention, only 4% said 20% or more, while 36% said 1–4% Said None Pension Funding Issues 5% and 32% said they were unsure. 32% Said Unsure PERCENT of Allocation
0%
10%
20%
30%
40%
50%
60%
OF BUDGET ALLOCATED TO LOSS PREVENTION 36%
What percent of your workers' compensation Said 1–4% budget do you allow for loss prevention (safety)? (N=207) Allocated 3% Said None
16% Said 5–9% Allocated
94% Said 20% or More Allocated 9% Said 10–19% Allocated
94% Said 20% or More Allocated
Medical Costs
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PUBLIC RISK | OCTOBER 2013
Increased Regulations
16% 65% Said 5–9% Allocated
30%
Liberal Definitions of WC Injuries
Budgetary Concerns
36% Said 1–4% Allocated
9% Said 10–19% 37% Allocated
Aging Workforce
Co-Morbidity Affecting Claims
32% Said Unsure of Allocation
21% Medical Costs 18% Aging Workforce 14%
65% 37% W W W.PRIMACENTRAL .ORG
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32% Said Unsure of Allocation
0%
10%
20%
30%
40%
50%
60%
70%
36% Said 1–4% Allocated
Two Most Significant Factors Risk Managers Anticipate Will Impact 3%Workers’ Compensation Costs During the Next Three Years Said None 16% 94% expect Said 20% or costs and an aging workforce During the next three years, public entities medical to be the most significant issues Said 5–9% More Allocated affecting their workers’ compensation costs. Allocated 9% Said 10–19% 32% Allocated Said Unsure of Allocation
36%
Said 1–4% TWO MOST SIGNIFICANT FACTORS RISK MANAGERS ANTICIPATE WILL IMPACT Allocated WORKERS COMPENSATION COSTS DURING THE NEXT THREE YEARS Medical Costs 94% Said 20% or More Allocated Aging Workforce 9% Said 10–19% Allocated Liberal Definitions of WC Injuries
65%
16% Said 5–9% 37% Allocated 30% 21%
Co-Morbidity Affecting Claims Medical Costs Budgetary Concerns
65%
18%
AgingRegulations Workforce Increased
37%
14%
Liberal Definitions of WC Reform Injuries Healthcare
30%
13%
Co-Morbidity Affecting Claims0%
10%
20% 21%
30%
40%
50%
60%
70%
18%
Budgetary Concerns
78%
Improved Safety Programs
Workers’ Compensation Cost Reduction Strategies—Attempted or Will Attempt 14% Increased Regulations 72%programs, Programs Risk managers saidReturn-to-Work they are attempting or will attempt to reduce costs in four primary ways: improved safety return-to-work programs,Wellness wellness programs, Programs and manager accountability/charge backs. 56% 13% Healthcare Reform 47% Manager Accountability/Charge-Backs 0% 10% 20% 30% 40% 50% 60% 30% Claims Settlements WORKERS' COMPENSATION COST REDUCTION STRATEGIES—
70%
Attempted or Will Attempt: Check the top four 29% Pre-Screening of Employees 27%
Nurse Case Management Improved Safety Programs 15%
Fraud Prevention Return-to-Work Programs Change Vendors (Insurance TPA) Wellness Programs Incentive Programs ManagerEmployee Accountability/Charge-Backs Other Claims Settlements Pre-Screening of Employees0%
Other 0%
56%
10%
47%
8%
30%
10%
20% 29% 30%
40%
50%
60%
70%
80%
90%
40%
50%
60%
70%
80%
90%
27% 15%
Fraud Prevention
Employee Incentive Programs
72%
11%
Nurse Case Management
Change Vendors (Insurance TPA)
78%
11% 10% 8% 10%
20%
30%
OCTOBER 2013 | PUBLIC RISK
13
80%
Zero In On Workers’ Compensation Cost Drivers
SELECTED WORKERS’ COMPENSATION SOLUTIONS FOR PUBLIC ENTITY RISK MANAGERS Public entity risk managers seeking to manage workers’ compensation costs can benefit from workplace safety programs. These programs should build a positive safety culture, foster employee involvement, promote management safety training, and reduce the frequency and severity of risk. Moreover, public entity risk managers should consider specific strategies to address issues raised in the survey results—the impact of an aging workforce, higher medical and pharmacy costs, employee health, and higher claims costs.
AGING WORKFORCE An aging workforce was cited in the survey as the top concern of public entity risk managers. Strategies to address an aging workforce must recognize that the issue is not the frequency of claims, but the severity. In fact, according to the National Council on Compensation Insurance, Inc. (NCCI), frequency rates are within approximately 5% of each other across all age groups. However, medical and indemnity severity rates were 51% and 56% higher, respectively, for workers ages 45 to 64 compared to younger workers. In addition, the Bureau of Labor Statistics reports that injuries and illnesses become more severe as workers age. Median days away from work due to injury and illness increase from five days for workers ages 20 to 24, to 12 days for workers ages 55 to 64. When addressing risk management concerns and older workers, consider the following: • Role of co-morbidities, e.g., obesity, hypertension, and diabetes, affecting the older workers and their impact on workers’ compensation claims
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PUBLIC RISK | OCTOBER 2013
• Workers aging in jobs, particularly older workers in physically demanding jobs who may find it difficult to continue handling their job responsibilities • Helping older workers stay healthy, with particular emphasis on key areas such as exercise, eye examinations, appropriate medication usage, and workplace accommodations/safety features
MEDICAL COSTS As identified in the survey, medical expenses significantly impact workers’ compensation costs. To manage these expenses, mitigate costs through a multi-faceted managed care and pharmacy benefit management program that provides quality healthcare to injured workers and manages medical and pharmacy costs. A successful managed care program should include: • Medical case management and clinical services • Nurse triage/early intervention • Pharmacy nurses • Complex bill review services • Pharmacy benefit management, including programs to monitor narcotic utilization • Out-of-network services • Quality and regulatory assurance programs
WORKPLACE SAFETY AND EMPLOYEE WELLNESS With public entities reporting rising medical and pharmacy costs as top cost drivers for their workers’ compensation programs, employee health and wellness needs to be addressed on several fronts. Strategies should address overall employee health. Obesity is a growing problem for workers’ compensation costs. As reported by the Insurance Information Institute (III), a study "Obesity and Workers’ Compensation”, Archives of Internal Medicine, April 23, 2007 by Ostbye, T., et al, found that the most obese workers file twice as many workers’ compensation claims and have 13 times more lost workdays than healthy weight workers. Workers’ compensation medical claims and indemnity costs are 5 to 10 times higher for the most obese workers. Traditionally, occupational health and safety sought to foster a safer work environment by focusing on injury and illness prevention, while wellness programs focused on enhancing the overall well-being of workers by addressing lifestyle behaviors inside and outside the workplace.
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By joining together occupational health and safety initiatives with workplace wellness programs, you can improve employee morale and health, reduce medical plan costs, increase productivity, and reduce the frequency and severity of workers’ compensation claims. To succeed, break down internal silos between the risk management and human resources departments, customize solutions and use incentives, actively engage workers and management, have adequate staff and resources, and evaluate and adapt as necessary.
CALENDAR OF EVENTS PRIMA’s calendar of events is current at time of publication. For the most up-to-date schedule, visit www.primacentral.org.
RETURN-TO-WORK PROGRAMS To manage claims costs, it is critical to facilitate return-to-work of injured workers as soon as is medically appropriate. Strategies include paying attention to injured workers in a timely way, following up consistently, and showing sincere concern. Risk management should also focus on transitional or modified-duty programs. To set up an effective modified-duty program, risk managers should: • Develop a written policy: Educate medical providers on the availability of modified jobs, the need for physical capacity information, and return-to-work philosophy • Educate the management team on why modified duty is important and expectations concerning use • Inventory potential modified-duty jobs • Track and manage employees on modified duty • Consider central budgeting of modified-duty expense
CHARGE-BACK STRATEGY Charge-backs, also called cost-allocation systems, can be an effective cost-reduction strategy for public entities looking to motivate and manage positive risk management behaviors, as well as promote accountability and transparency. While each cost-allocation system is different, these systems should be easy to understand and administer, and not subject to manipulation. After establishing the goals of your cost-allocation system, you should: • Assess your organization’s willingness and financial ability to budget and allocate costs at the operating-unit level • Define the risk management costs to be allocated • Determine an allocation approach—prospective or retrospective • Define allocation methods, including an exposure base, experience base, allocation limits, experience period, and valuation dates • Partner with others: Agents, consultants, actuaries, accounting, financial, senior management, information systems, etc. • Perform trial calculations As public entities grapple with workers’ compensation costs and declining revenues, effective workers’ compensation and workplace safety strategies are more important than ever. To address the key concerns identified in the study, public entities should implement strategies that promote a healthy and safe workforce and reduce costs, including an integrated occupational health and safety and wellness program, effective return-to-work programs that utilize transitional duty, and loss prevention initiatives tailored for public entities.
WEBINARS 2013 • November 13: Amendments to Americans With Disabilities Act—Implications for Human Resource Management
PRIMA ANNUAL CONFERENCES June 8–11, 2014 PRIMA 2014 Annual Conference Long Beach, CA Long Beach Convention Center June 7–10, 2015 PRIMA 2015 Annual Conference Houston, TX George R. Brown Convention Center June 5–8, 2016 PRIMA 2016 Annual Conference Atlanta, GA Hyatt Regency Atlanta
OTHER MEETINGS November 4–8 PRIMA Institute 2013 Milwaukee, WI
UPCOMING CHAPTER MEETINGS Chapter meetings are listed on a space-available basis. For a complete list of PRIMA chapter meetings, visit www.primacentral.org. For information on a specific meeting, please contact the chapter directly. Kansas Nov. 16 Tennessee Nov. 20–22 Texas Nov. 11–14 To have your chapter meeting listed on the PRIMA Web site, contact Bles Dones at bdones@primacentral.org.
Frank X. Altiere, III is president of PMA Management Corp., a member of PMA Companies. .
OCTOBER 2013 | PUBLIC RISK
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PRIMA 2013
WEBINAR SERIES FREE FOR PRIMA MEMBERS! Looking for a cost-effective way to train your staff while avoiding the frustration of budget cuts and travel expenses? The Public Risk Management Association’s Webinar series is designed to help risk management professionals like you excel in the field without leaving your office.
WEDNESDAY, NOVEMBER 13 | 12 PM – 1:30 PM EST
AMENDMENTS TO AMERICANS WITH DISABILITIES ACT— IMPLICATIONS FOR HUMAN RESOURCE MANAGEMENT PRESENTERS: Michael Otworth, CPCU, ASLI, Vice President, Claims Department, Genesis Management and Insurance Services Corporation Benjamin C. Eggert, Partner, Wiley Rein LLP This Webinar will examine recent statutory, regulatory and case law developments that bear on public entities’ human resource obligations under the amended American with Disabilities Act (ADA). Although the ADA originally was enacted more than two decades ago, Congress amended the ADA in 2008 in response to several U.S. Supreme Court decisions that narrowed the statute, and the implementing regulations promulgated by the EEOC went into effect in 2011. This Webinar will provide an overview of the practical implications of these changes, which present challenges to public employers that must predict their responsibilities under a recalibrated ADA. In addition, it will address actual claims against public employers, discussing the issues and exposure in such matters. Finally, because the amended ADA now shifts the focus to whether the public entity employer has provided reasonable accommodations to employees, the Webinar will discuss strategies to assist public human resource managers in meeting their evolving obligations in an atmosphere of fiscal uncertainty and legal ambiguity. During this Webinar, participants will learn how to: • Understand the evolving public entity human resource obligations under amended ADA • Develop strategies for predicting responsibilities under shifting ADA requirements • Learn how to survey recent claims under amended ADA Who should attend: • Human resource professionals • Risk management professionals • General counsel • City & county attorneys REGISTER TODAY!
PRIMA members receive complimentary registration and access to the Webinars! S E R I ES S P O N S O R :
For more information, or to register, visit www.primacentral.org.
Catching Up with Private Employers PROACTIVE STRATEGIES TO CONTAIN HEALTH CARE BENEFIT COSTS By Gerald M. Gates
Employers of all kinds have been contending with rising health benefit costs for years. Despite the variety of strategies that have been adopted across every sector to slow the increases, public employers have been much less successful than their private counterparts in containing costs. And with public budgets continuing to feel the aftershocks of the recession, health benefit spending on state and local government employees has by necessity become a target for those who want to save taxpayer dollars.
A sampling of statistics from the federal Bureau of Labor and the U.S. Census Bureau tells the story of how much more aggressive the private sector has been about addressing health benefit costs: • In March 2013, health insurance costs per hour worked were $2.26 for private employees—but were $5.10 for public employees. • In 2012, health benefits constituted 7.8 percent of compensation for the private workforce compared to 11.7 percent for the public sector. • In 2009, the gap between what public employers versus private employers paid for health care per worker had grown to 20.5 percent. The gap was only 7.5 percent in 2000. Public sector leaders, both elected and appointed, understand this trend is unsustainable and must be reversed. The question is, what tactics can they implement, quickly, that will have a near-term impact on budgets? They can start by transitioning to a self-funded model, and then begin to take advantage of four strategies that result in both improved health for employees and lower costs for employers.
SELF-FUNDING IS THE CORNERSTONE Traditionally, only larger employers, both public and private, chose self-funding over fully insured health benefits and enjoyed savings that would otherwise be “paid” to insurers. These big companies had the cash-flow and depth of resources to withstand the risk of fluctuating health care costs resulting from unpredictable, catastrophic claims.
Today, however, realizing they are paying for those claims and insurer profit one way or the other, even small employers are moving to self-funding, with stop-loss insurance giving them the backstop they need to address risk. By 2012, about 60 percent of all employees with health benefits across the country were covered by a self-insured employer. The rate for state and local government employees was even higher—66 percent—according to a 2010 Deloitte study. With the Affordable Care Act coming on line in 2014, the benefits of self-funding are becoming even more evident. A primary benefit being the profit margin and risk charge of an insurance carrier/HMO are eliminated for the bulk of the plan. Any strides an employer makes to reduce utilization has a direct impact on the group’s health care spending. Among other advantages, it allows employers to customize their health coverage strategies to fit the needs of their workforce and maximize their savings. Once a public employer opts to self-fund, there are a number of ways to create a robust health benefit that can do a better job of containing costs. The following are four strategies that are proving particularly effective for public employers. Engaging Employees to Make Smart Decisions. Popularly known as wellness initiatives, the concept of getting employees to make healthy choices—such as losing weight or quitting smoking—is attractive on the surface, but has proven only marginally effective in containing health care costs. Instead, employers need to
OCTOBER 2013 | PUBLIC RISK
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Catching Up with Private Employers
The Centers for Disease Control and Prevention reports that more than 75 percent of an employer’s health care costs and productivity losses are related to lifestyle choices made by the employees. Convincing them to make different choices can make a significant difference to the health benefit budgets of selffunded employers.
engage employees much more deeply. Financial incentives and disincentives can be used to encourage employees to manage chronic health conditions more effectively, to be wise shoppers for the best value in health care services, and to understand how health benefit spending impacts the resources available for other forms of compensation. The foundation for an effective wellness program is analytics. Public employers can partner with experts who can help them use data—both from claims and from employee health risk assessments—to understand their highest level of risks and the cost drivers that should be addressed. Securing this kind of data in the fully insured environment has proven very difficult because many insurance carriers believe they (not the employer) “own” the data. The Centers for Disease Control and Prevention reports that more than 75 percent of an employer’s health care costs and productivity losses are related to lifestyle choices made by the employees. Convincing them to make different choices can make a significant difference to the health benefit budgets of self-funded employers. Tailoring Benefits to Demographics. A self-funded health benefit program can be adjusted to cater to the needs of the public employer’s workforce. By analyzing demographic data, an employer may decide it is critical to emphasize chronic disease management (a workforce of older people) or offer family-oriented services (a workforce with younger employees). One example is providing specialized maternity management services. These programs focus on early identification of potential problems and appropriate early intervention with prevention or treatment services. They often result in significant savings by preventing pre-term births and other costly complications. Adding Specialty Programs to Address High-Cost Claims. Another strategy is to contract for special services that address high-cost claims so that treatment is delivered in the most effective and efficient setting. For example, dialysis management can be highly effective. Estimates show that more than 10 percent of adults in the United States age 20 and older have some level of chronic kidney disease, and there are 500,000 people with End Stage Renal Disease. Ongoing dialysis treatments for these conditions can often exceed $50,000 per month—a tremendous burden for self-funded employers. By partnering with specialists who can evaluate each dialysis claim, public employers can be sure that patients are getting
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PUBLIC RISK | OCTOBER 2013
the most effective service at the best negotiated price. The goal is to have high-quality care for the employee but with a balance between savings, flexibility and defensibility for the self-insured employer. Using Audits to Drive Cost Savings. When employers are fully insured, they typically lack access to the data that would tell them what is going on within their benefits program. The large insurers insist the data is proprietary and argue that they are already getting the employer the lowest costs possible through bargained rates. However, the insurers have very little incentive to analyze data to see if there are added costs from incorrect billings, out-of-coverage services and other anomalies. Higher claim costs help them build the case for the following year’s premium increase. Self-funded employers, however, have access to the data and can hold health care providers accountable for appropriate services and correct billing. They can contract for audits of pharmaceutical costs, claim settlements and other aspects of their benefit package. Often, these specialized audit firms will work on a “percentage of savings” basis (plus a small set-up fee), so there is little or no cost and potential for meaningful savings. In one case, a public school district used an external contractor to perform a benefits eligibility audit to identify dependents of employees who were not qualified to be included in their family health care coverage, because of age or other factors. The audit found 14 percent of the 1,500 dependents were ineligible and were dropped from coverage—for a savings of more than $1 million annually.
PROACTIVE BENEFIT STRATEGIES ARE CRITICAL The Affordable Care Act changes the health care environment in many ways that are yet to be determined – but the one thing that no one disputes is that there is no short-term relief in sight for employers who are already struggling with the high cost of health care benefits. For the past few years, private-sector employers have made a concerted effort to find strategies that will contain costs while still delivering a benefit that employees value. By embracing self-funding and adopting the customized strategies outlined above, public employers can make their benefit packages more affordable and begin to bring their spending into line with what private-sector employers have achieved. Gerald M. Gates is the president of Stop Loss Insurance Services, an AmWINS Group Company.
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Has your entity launched a successful program? An innovative solution to a common problem? A money-saving idea that kept a program under-budget? Each month, Public Risk features articles from practitioners like you. Share your successes with your colleagues by writing for Public Risk magazine! For more information, or to submit an article, contact Jennifer Ackerman at jackerman@primacentral.org or 703.253.1267. Reduce the device shape to the required size, then make a new clipping mask.
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OCTOBER 2013 | PUBLIC RISK
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Member Spotlight
CIRSA KEEPS ITS HEAD ABOVE WATER WITH AN AQUATIC SAFETY PROGRAM Each month, Public Risk features a member who has
T
he Colorado Intergovernmental Risk Sharing Agency (CIRSA) saw a need to protect its member entities from the risk associated with managing aquatic facilities.
gone above and beyond “Member Spotlight.” Do you know someone who deserves recognition, has made a contribution or excelled in their profession? If so, we’d like to hear from you for this exciting column, as PRIMA shines the spotlight on its members. To be considered for the Member Spotlight column, contact Jennifer Ackerman at jackerman@primacentral.org or 703.253.1267.
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“Many accidents and injuries, including drowning, occur due to employee inattention, poor housekeeping, not following established safety practices and inadequate training,” said Tim Greer, CIRSA executive director. “Our members felt there was a need for a video to assist them in establishing a formal aquatic risk management program.” The result is a video and resource guide, “Aquatic Risk Management: Keeping Your Head Above Water.” The key components of the program address personnel and supervision, lifeguard training, emergency action plans, patron communication and education, employee safety, facility design, inspection and maintenance.
Greer thinks that the CIRSA video is easily transferable to other entities. “Regardless of aquatic facility size or operation, similar exposures exist,” he said. “The video demonstrates the need for management commitment to safety, employee accountability and establishing procedures for emergencies.”
“Following good established practices can reduce these exposures and liability,” said Greer.
The CD resource guide contains aquatic inspection forms, checklists and surveys to identify and control potential hazards. These documents can be modified to meet the needs of individual aquatic facilities. The guide also contains the Colorado regulations, a city aquatics manual, sample emergency action plans, lifeguard rescue reports, documentation for patron injuries and links to useful Websites.
The CIRSA safety committee worked with the CIRSA staff to produce the video. The CIRSA staff prepared the
For more information on the CIRSA video and resource guide, contact Tim Greer at tim@cirsa.org.
Regardless of aquatic facility size or operation, similar exposures exist,” he said. “The video demonstrates the need for management commitment to safety, employee accountability and establishing procedures for emergencies.
PUBLIC RISK | OCTOBER 2013
“
in a feature column titled
script for the video and a video task force met with the production company to refine it. The video filming involved 96 employees and volunteers and seven days of filming at multiple locations in three entities. A professional actor was used for narration and on-camera scenes.
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