Function Based Prevention & Injury Management Programming WorkSTEPS ®

COMPANY HISTORY WorkSTEPS ®

Founded in 1986 by Larry Feeler, PT, CEAS, in response to soaring injury costs experienced by the oil industry. Designed with a mission to provide employers with a medically safe, scientific, objective and legally compliant assessment that could assist in appropriately matching employees to the essential functions of their jobs. WorkSTEPS ®

Founded in 1986 by Larry Feeler, PT, CEAS, in response to soaring injury costs experienced by the oil industry.

Designed with a mission to provide employers with a medically safe, scientific, objective and legally compliant assessment that could assist in appropriately matching employees to the essential functions of their jobs.

WorkSTEPS ® Post-Offer Testing was so successful in reducing injuries for the oil industry, it quickly was expanded into other physically demanding and repetitive motion industries such as manufacturing, transportation, mining, healthcare, hotel, retail, warehouse distribution, etc. WorkSTEPS ®

WorkSTEPS ® Post-Offer Testing was so successful in reducing injuries for the oil industry, it quickly was expanded into other physically demanding and repetitive motion industries such as manufacturing, transportation, mining, healthcare, hotel, retail, warehouse distribution, etc.

Today WorkSTEPS ® experiences national recognition as a premier provider of legally compliant functional employment testing AND is used in every sector of industry. WorkSTEPS ® provides functional testing and other ergonomic, prevention and rehabilitation services to 3,000+ employers nation wide through it’s trained, certified, and managed network of 650+ healthcare providers in 46 states. WorkSTEPS ®

Today WorkSTEPS ® experiences national recognition as a premier provider of legally compliant functional employment testing AND is used in every sector of industry.

WorkSTEPS ® provides functional testing and other ergonomic, prevention and rehabilitation services to 3,000+ employers nation wide through it’s trained, certified, and managed network of 650+ healthcare providers in 46 states.

WorkSTEPS ® surpassed over 1,000,000 functional employment evaluations in 2007 and continues to grow at a very rapid rate. WorkSTEPS ® has the largest pre-injury normative data base in the nation. WorkSTEPS ®

WorkSTEPS ® surpassed over 1,000,000 functional employment evaluations in 2007 and continues to grow at a very rapid rate.

WorkSTEPS ® has the largest pre-injury normative data base in the nation.

SERVICE OFFERING WorkSTEPS ®

Functional Employment Tests include: Post offer, Fitness for duty, Upper quadrant / carpal tunnel, and Functional capacity evaluation (post injury) Sincerity of Effort Tests (peer reviewed/published) WorkSTEPS ®

Functional Employment Tests include:

Post offer,

Fitness for duty,

Upper quadrant / carpal tunnel, and

Functional capacity evaluation (post injury)

Sincerity of Effort Tests (peer reviewed/published)

Post Offer/Pre-Employment Functional Evaluation Components A WorkSTEPS Functional Test is different from a physician’s physical in that the WorkSTEPS test is designed to assess function and detect common, pre-existing musculoskeletal injuries like: Torn rotator cuffs Neurological “back” problems Carpal Tunnel, Significant arthritic changes, and Other injury or disease processes that cost employers significant dollars the FIRST months or year of employment.

A WorkSTEPS Functional Test is different from a physician’s physical in that the WorkSTEPS test is designed to assess function and detect common, pre-existing musculoskeletal injuries like:

Torn rotator cuffs

Neurological “back” problems

Carpal Tunnel,

Significant arthritic changes, and

Other injury or disease processes that cost employers significant dollars the FIRST months or year of employment.

Post Offer/Pre-Employment Functional Evaluation Components Legal (Policies and Procedures) Job Analysis Medical History Questionnaire Medical Testing Heart Rate, Blood Pressure, 3-Minute Step Test Complete Musculoskeletal Evaluation (Posture, Reflexes, Manual Muscle Testing, Palpation of Spine, ROM, Joint Integrity, Investigate Damaged Parts)

Legal (Policies and Procedures)

Job Analysis

Medical History Questionnaire

Medical Testing

Heart Rate, Blood Pressure, 3-Minute Step Test

Complete Musculoskeletal Evaluation (Posture, Reflexes, Manual Muscle Testing, Palpation of Spine, ROM, Joint Integrity, Investigate Damaged Parts)

Post Offer/Pre-Employment Functional Evaluation Components (Continued) Static Grip and Pinch Strength Testing Dynamic Lifting (4 postures) Upper Quadrant / Carpal Tunnel (if required) Essential Function Simulation (Job Specific Tasks)

(Continued)

Static Grip and Pinch Strength Testing

Dynamic Lifting (4 postures)

Upper Quadrant / Carpal Tunnel (if required)

Essential Function Simulation (Job Specific Tasks)

Essential Function Testing

Essential Function Testing

Essential Function Testing

Post-Employment: aka “Fit for Duty” Testing “ Under ADA, medical information or medical exams may be required when an employee suffers an injury on the job. Such an exam may be required when an employee wishes to return to work after an injury or illness, if it is job related and consistent with business necessity.” TAM VI-13

“ Under ADA, medical information or medical exams may be required when an employee suffers an injury on the job.

Such an exam may be required when an employee wishes to return to work after an injury or illness, if it is job related and consistent with business necessity.” TAM VI-13

Fit for Duty Testing EEOC Enforcement Guidance: Disability Related Inquiries and Medical Examinations of Employees under the ADA Allows employer to test when an employer “has a reasonable belief, based on objective evidence, that an employee’s ability to perform essential job functions will be impaired by a medical condition” When an employer can reasonably attribute performance problems to a known medical condition

EEOC Enforcement Guidance: Disability Related Inquiries and Medical Examinations of Employees under the ADA

Allows employer to test

when an employer “has a reasonable belief, based on objective evidence, that an employee’s ability to perform essential job functions will be impaired by a medical condition”

When an employer can reasonably attribute performance problems to a known medical condition

Post Injury Test Compares baseline to current status Defines exact deficit caused by injury Utilizes latest technology to determine depth of symptoms compared to diagnosis Has proven consistency measures (Peer review published) to prove or disprove symptom exaggeration Creates accountability, accurate goals and transitional return to work

Compares baseline to current status

Defines exact deficit caused by injury

Utilizes latest technology to determine depth of symptoms compared to diagnosis

Has proven consistency measures (Peer review published) to prove or disprove symptom exaggeration

Creates accountability, accurate goals and transitional return to work

These tests allow employers to manage the function of employees from new hire through retirement. Use of functional tests by employer results in safer, more productive workforces with fewer injuries, reduced turnover and significant reductions in workers compensation costs. WorkSTEPS ®

These tests allow employers to manage the function of employees from new hire through retirement.

Use of functional tests by employer results in safer, more productive workforces with fewer injuries, reduced turnover and significant reductions in workers compensation costs.

The Case For Measuring Function Pre-Hire Through Retirement WorkSTEPS ®

Worker’s Comp Assumes Worker’s are perfect when hired Worker’s never grow old Whatever happens to the worker, the employer caused

Worker’s are perfect when hired

Worker’s never grow old

Whatever happens to the worker, the employer caused

Research Validates: of the American work force is physically incapable of performing the essential functions of their jobs safely of work related injuries occur among this same 10% 10% 75%

of the American work force is

physically incapable of performing the

essential functions of their jobs safely

of work

related injuries

occur among

this same

10%

WorkSTEPS ® Successfully: Identifies persons who have pre-existing cardiovascular, degenerative, or cumulative trauma disorders Identifies person who do not meet essential job specific requirements Provides employers with individualized assessments that appropriately match current and new employees to safe/appropriate job positions Collects baseline physical measurements post offer, for comparative analysis post injury or trauma

Identifies persons who have pre-existing cardiovascular, degenerative, or cumulative trauma disorders

Identifies person who do not meet essential job specific requirements

Provides employers with individualized assessments that appropriately match current and new employees to safe/appropriate job positions

Collects baseline physical measurements post offer, for comparative analysis post injury or trauma

5. Allows determination of objective physical/functional loss 6. Qualifies legitimate injuries and disqualifies fraudulent injuries (validated Sincerity of Effort) 7. Expedites rehabilitation and return-to-work post legitimate injury 8. Allows successful medical/legal intervention comparing an employee’s pre-injury and post-injury status WorkSTEPS ® Successfully:

WorkSTEPS ® Results: Reduced incidence and costs related to work injuries by an average of 50% (with some clients having achieved reductions as high as 86%) during first year implementation with increased reductions in second and third years!

Results:

Reduced incidence and costs related to work injuries by an average of 50% (with some clients having achieved reductions as high as 86%) during first year implementation with increased reductions in second and third years!

Legal Compliance WorkSTEPS ® has its protocols and procedures reviewed for by a national employment labor law firm for legal compliance with the Americans’ With Disabilities Act. The Program has already been reviewed for compliance with the new Americans’ With Disabilities Amendment Act (ADAAA). The WorkSTEPS ® White Paper is available for review upon the execution of a Confidentiality Non-Disclosure Agreement. WorkSTEPS ®

Legal Compliance

WorkSTEPS ® has its protocols and procedures reviewed for by a national employment labor law firm for legal compliance with the Americans’ With Disabilities Act. The Program has already been reviewed for compliance with the new Americans’ With Disabilities Amendment Act (ADAAA).

The WorkSTEPS ® White Paper is available for review upon the execution of a Confidentiality Non-Disclosure Agreement.

LEGAL (cont’d) WorkSTEPS ® data has been used in litigation on a number of occasions to reduce awards, provide case closure and negate fraudulent lawsuits. We believe we have the most comprehensive, legally compliant, competitively priced functional employment-testing program on the market today

WorkSTEPS ® data has been used in litigation on a number of occasions to reduce awards, provide case closure and negate fraudulent lawsuits.

We believe we have the most comprehensive, legally compliant, competitively priced functional employment-testing program on the market today

WorkSTEPS ® BENEFITS WorkSTEPS ® Providers are required to complete intensive certification training before being allowed to offer the WorkSTEPS ® Functional Employment Testing Program to employers. Providers are also required to participate in on-going bi-annual re-certification training. They receive ergonomic, medical, clinical and legal compliance training necessary in the delivery of our functional employment test programming.

WorkSTEPS ® Providers are required to complete intensive certification training before being allowed to offer the WorkSTEPS ® Functional Employment Testing Program to employers.

Providers are also required to participate in on-going bi-annual re-certification training. They receive ergonomic, medical, clinical and legal compliance training necessary in the delivery of our functional employment test programming.

BENEFITS (cont’d) In most instances, federal law allows the employer to withdraw the offer of employment if a test candidate: is belligerent, obnoxious, or demonstrates a poor attitude during the test, or with regard to undergoing a post offer test lies on the medical history can’t lift enough weight to qualify to attempt the essential functions

In most instances, federal law allows the employer to withdraw the offer of employment if a test candidate:

is belligerent, obnoxious, or demonstrates a poor attitude during the test, or with regard to undergoing a post offer test

lies on the medical history

can’t lift enough weight to qualify to attempt the essential functions

BENEFITS (cont’d) has significant medical condition (i.e. carpal tunnel, torn rotator cuff, etc.) that would pose a ‘direct threat’ to self or others isn’t capable of safely performing any of the essential functions The WorkSTEPS Testing has protocols ‘built-in’ to identify any of these scenarios that may be present.

has significant medical condition (i.e. carpal tunnel, torn rotator cuff, etc.) that would pose a ‘direct threat’ to self or others

isn’t capable of safely performing any of the essential functions

The WorkSTEPS Testing has protocols ‘built-in’ to identify any of these scenarios that may be present.

BENEFITS (cont’d) WorkSTEPS ® Tests have built in scientific consistency checks so that symptom exaggeration is easily detected post injury. It is also the only functional test that includes peer review published Sincerity of Effort protocols using distraction based physical measures that are irrefutable. Information gathered during our individualized functional assessments creates measured accountability for treating physicians and rehab service providers through its pre-established baseline and post injury diagnostic and consistency check parameters

WorkSTEPS ® Tests have built in scientific consistency checks so that symptom exaggeration is easily detected post injury. It is also the only functional test that includes peer review published Sincerity of Effort protocols using distraction based physical measures that are irrefutable.

Information gathered during our individualized functional assessments creates measured accountability for treating physicians and rehab service providers through its pre-established baseline and post injury diagnostic and consistency check parameters

BENEFITS (cont’d) Provides realistic recovery goals that show the exact difference of the individual before and after the injury Limits employer liability for pre-existing conditions (apportionment) due to the use of “individualized assessments” following AMA guidelines / recognized medical procedures. Also limits medical treatment to “return to previous status only” !!

Provides realistic recovery goals that show the exact difference of the individual before and after the injury

Limits employer liability for pre-existing conditions (apportionment) due to the use of “individualized assessments” following AMA guidelines / recognized medical procedures. Also limits medical treatment to “return to previous status only” !!

TECHNOLOGY & SYSTEMS WorkSTEPS ® forms and technology systems are HIPAA compliant Web based state of the art technology All data is stored in a secured data center (rackspace.com) Real time, automated reporting generated within seconds of data entry completion (virtually instantaneous) Full range of automated reports: Statistical Analysis (gender, age, task, etc.) ROI Reporting Disparate Impact Reporting

WorkSTEPS ® forms and technology systems are HIPAA compliant

Web based state of the art technology

All data is stored in a secured data center (rackspace.com)

Real time, automated reporting generated within seconds of data entry completion (virtually instantaneous)

Full range of automated reports:

Statistical Analysis (gender, age, task, etc.)

ROI Reporting

Disparate Impact Reporting

Actual Experience Employment testing database contains over 1M employment tests and shows “not capable” rates of 7-14% (10.2% average). Employers using employment testing are experiencing injury reductions and cost savings averaging between 50%- 86% !!! Functional testing will prevent one claim in every 10 employees with a minimal savings of $10,000 to $30,000 in an uncomplicated case.

Employment testing database contains over 1M employment tests and shows “not capable” rates of 7-14% (10.2% average).

Employers using employment testing are experiencing injury reductions and cost savings averaging between 50%- 86% !!!

Functional testing will prevent one claim in every 10 employees with a minimal savings of $10,000 to $30,000 in an uncomplicated case.

RESULTS Does Employment Testing Work?

Does Employment Testing Work?

Fleetwood Outcomes 10,000 Employees Nationwide Injury frequency was reduced from 32.4 (per hundred) in 1999 to 6.9 to date in 2006 Loss prevention and claims processes initiated in 1999, to lower exposure, have led to reductions in Letters of Credit of $10.1 Million (Reserves) The cost of risk for Texas injuries has been reduced from $2.2 million annually to $631,000 annually.

Injury frequency was reduced from 32.4 (per hundred) in 1999 to 6.9 to date in 2006

Loss prevention and claims processes initiated in 1999, to lower exposure, have led to reductions in Letters of Credit of $10.1 Million (Reserves)

The cost of risk for Texas injuries has been reduced from $2.2 million annually to $631,000 annually.

$670,309.03 $946,110.91 $1,400,000.00 $1,800,000.00 $649,807.32 $664,692.10 $0.00 $200,000.00 $400,000.00 $600,000.00 $800,000.00 $1,000,000.00 $1,200,000.00 $1,400,000.00 $1,600,000.00 $1,800,000.00 $2,000,000.00 Company W/C Cost 2002 Proj. Company W/C Costs Yr. 2003 2002 - 2003 2003 - 2004 2004 – 2005 188 Claims 158 Claims 157 Claims Total Incurred: $274,926.57 150 Claims Total Incurred: $333,715.20 2005 – 2006 Fleetwood Texas Locations

Company W/C Cost 6/00 – 6/01 Proj. Company W/C Costs 2002 2001 - 2002 2002 - 2003 2003 – 2004 2004 – 2005 $456,000.00 $547,200.00 $272,930.00 $199,427.00 $177,767.00 $92,698.68 $0.00 $100,000.00 $200,000.00 $300,000.00 $400,000.00 $500,000.00 $600,000.00 53 Claims Total Incurred $121,987.94 19 Claims Total Incurred $99,842.97 17 Claims Total Incurred $24,611.22 9 Claims Total Incurred $18,314.07 Small Manufacturing Company, 150 Employees, 1 Location

Knight Transportation “ Year to date, we have experienced a 70% reduction in the severity of claims as well as a 30% reduction in frequency of claims…translating into savings of several hundred thousand dollars.” Safety Manager

Knight Transportation A little over a year ago, I contacted you about providing Worksteps Screening for our new employees. At that time, we had three office employees moving to Tulsa, we were accepting delivery of our first seven trucks, and we were looking for some safe drivers to bring onto our team. Since then, we have sent every new driver through your program for evaluation. We now have 55 trucks, 58 drivers, and 7 office employees. Thanks largely due to your thorough process, we have had zero lost-time claims from anyone who completed the Worksteps Screening at your facility. We have ambitions to continue our growth in Tulsa and maintain our excellent safety record. Brad Hicks Director of Safety

Maverick Transportation 707 Post Offer Tests Performed 30 Individuals NOT Capable Post Offer 9 Did not return for testing (physician consent form for knee instability not completed): at $25,000 each 2 HBP or HR: at $20,000 each 18 Did not “pass” essential functions testing at $6,000 - $13,000 each 10 “medical weed-out” cumulative trauma at $20,000 each DIRECT COST SAVINGS 1 st YEAR $456,000

707 Post Offer Tests Performed

30 Individuals NOT Capable Post Offer

9 Did not return for testing (physician consent form for knee instability not completed): at $25,000 each

2 HBP or HR: at $20,000 each

18 Did not “pass” essential functions testing at $6,000 - $13,000 each

10 “medical weed-out” cumulative trauma at $20,000 each

DIRECT COST SAVINGS 1 st YEAR

$456,000

Missouri D.O.T. We began our statewide program in January of 2006. After our first year of using your program, we reduced our lost time incidents by 61% and our lost workdays by 69%. We were so thrilled with our results we began studying other physically demanding job titles and have just begun testing those applicants. In addition to the reduction in both lost time incidents and lost workdays, we are proud to say we saved the tax payers of Missouri $7,000,000.00 by reducing our workers' compensation costs! Another bit of good news is that during the first two quarters of 2007, we have reduced our lost workdays another 55% and our lost time incidents by an additional 36%. As you can tell, we are very pleased with the results of our program. We look forward to our continued partnership in the future. Jean Endsley, M.S. Employee Safety and Health Manager

WorkSTEPS ® Some Of Our Clients: Barnes Aerospace Knight Transportation SYSCO Waste Management COMAIR Kinetic Concepts, Inc. Chevron Conoco Phillips Nabors Drilling Trinity Industries Borden Republic Services Johnson Controls Embarq Autoliv AIMCO Proctor & Gamble Missouri DOT Chaparral Steel Southern California Edison And many more !

THANK YOU! WorkSTEPS ®