Gary Jennings presented on improving workers' compensation defensibility. He discussed that defensibility relies on proper planning and efficient execution of claims handling procedures before and after incidents occur. Key factors in improving outcomes include maintaining consistency, clearly defining roles and responsibilities, investigating claims promptly and fully, and executing claims handling plans with discipline and urgency. Jennings emphasized having the right people and processes in place to properly manage claims from reporting through resolution.
The document provides information about a webinar on health and safety issues for restaurants. It includes an agenda with four expert speakers who will discuss topics like building a safety culture, controlling workers' compensation costs, common OSHA citations for restaurants, and safety and labor law. The document also provides details about the individual presentations, including speaker bios and presentation summaries. Attendees can participate by asking questions during the live Q&A session or accessing a recording of the webinar later.
Incentive programs aimed at safety performance can have unintended consequences if not carefully designed. Some programs may discourage reporting of injuries in order to receive rewards. Proper investigation of incidents is important to identify root causes such as fatigue, pressure to work quickly, or lack of training, rather than solely blaming individual worker error. A positive approach focusing on near miss reporting and proactive identification of hazards may better promote a strong safety culture.
The document discusses accident investigation and prevention. It defines an accident and outlines the objectives of investigating accidents which include understanding causes, identifying prevention methods, and determining how to be thorough. It also describes the accident investigation process including what should be investigated, who should investigate, and how to conduct interviews, analyze data, and write a report with findings and recommendations.
Behavioral based safety is a new approach to workplace safety that focuses on identifying and preventing unsafe behaviors rather than just injuries. It involves employees observing each other and providing feedback on safety behaviors. Data on unsafe behaviors is collected and analyzed to identify risks and recommend solutions like training or barrier removal. The goal is to change behaviors and attitudes to reduce injuries and incident rates over time. Peer observations are non-punitive and aim to have employees understand risks and voluntarily improve safety practices.
The document discusses business continuity and disaster recovery, distinguishing between proactive and reactive models. It emphasizes that business continuity is primarily a mindset and program that involves business impact analysis, dependency modeling, training, response, and recovery. An effective continuity program gathers information, makes recommendations, provides training, coordinates efforts, and develops documentation to act as an umbrella protecting the organization from hazards through mitigation. Gaps in planning include communication, documentation, roles and responsibilities, resources, and technology.
PREVENT WORK-RELATED INJURIES
Behavior-based safety is based on the theory that most accidents at workplaces can be prevented with the right behavioral analysis and training. Minor errors and oversights are often left unreported and thus can lead to major accidents if the causes for the incidents are not addressed.
Improve employee safety with our presentation on Behavior-Based Safety:
http://www.presentationload.com/behavior-based-safety-powerpoint-template.html
The BBS approach examines which behaviors and organizational circumstances led to accidents. By knowing this, you can inform employees about safe behavior at the workplace and implement Behavior-Based Safety in your company.
This template not only contains images with background information on occupational safety, but also a series of graphs with statistics and figures on the subject as well as a useful icons toolbox.
This document outlines best practices for responding to a water supply contamination event. It emphasizes the importance of advance crisis preparation, activating a crisis management team, and effectively communicating with the public, regulators, and media. The first few hours and days of the response set the tone, so priorities include protecting public safety, investigating the issue, and treating or shutting down the affected water supply. Managing the various legal, reputational, and investigative aspects that follow requires a coordinated, strategic response. Overall, being ready before a crisis occurs is key to a successful outcome.
This document discusses behavior-based safety (BBS) approaches. It begins by outlining the objectives of understanding the benefits of BBS, basic principles for motivating safe behavior, assessing organizational readiness, and comparing different BBS systems. It then discusses why traditional safety programs often do not work and explores common "fallacies" regarding safety. Core elements of successful safety programs are outlined, including safety culture and accountability. The rest of the document delves into BBS concepts like antecedents, behaviors, consequences and reinforcement. It examines models for understanding accident causation and human motivation. Benefits of BBS like significant injury reductions are presented. Key aspects of implementing BBS like roles, features, and assessing organizational readiness are covered
The document provides information about a webinar on health and safety issues for restaurants. It includes an agenda with four expert speakers who will discuss topics like building a safety culture, controlling workers' compensation costs, common OSHA citations for restaurants, and safety and labor law. The document also provides details about the individual presentations, including speaker bios and presentation summaries. Attendees can participate by asking questions during the live Q&A session or accessing a recording of the webinar later.
Incentive programs aimed at safety performance can have unintended consequences if not carefully designed. Some programs may discourage reporting of injuries in order to receive rewards. Proper investigation of incidents is important to identify root causes such as fatigue, pressure to work quickly, or lack of training, rather than solely blaming individual worker error. A positive approach focusing on near miss reporting and proactive identification of hazards may better promote a strong safety culture.
The document discusses accident investigation and prevention. It defines an accident and outlines the objectives of investigating accidents which include understanding causes, identifying prevention methods, and determining how to be thorough. It also describes the accident investigation process including what should be investigated, who should investigate, and how to conduct interviews, analyze data, and write a report with findings and recommendations.
Behavioral based safety is a new approach to workplace safety that focuses on identifying and preventing unsafe behaviors rather than just injuries. It involves employees observing each other and providing feedback on safety behaviors. Data on unsafe behaviors is collected and analyzed to identify risks and recommend solutions like training or barrier removal. The goal is to change behaviors and attitudes to reduce injuries and incident rates over time. Peer observations are non-punitive and aim to have employees understand risks and voluntarily improve safety practices.
The document discusses business continuity and disaster recovery, distinguishing between proactive and reactive models. It emphasizes that business continuity is primarily a mindset and program that involves business impact analysis, dependency modeling, training, response, and recovery. An effective continuity program gathers information, makes recommendations, provides training, coordinates efforts, and develops documentation to act as an umbrella protecting the organization from hazards through mitigation. Gaps in planning include communication, documentation, roles and responsibilities, resources, and technology.
PREVENT WORK-RELATED INJURIES
Behavior-based safety is based on the theory that most accidents at workplaces can be prevented with the right behavioral analysis and training. Minor errors and oversights are often left unreported and thus can lead to major accidents if the causes for the incidents are not addressed.
Improve employee safety with our presentation on Behavior-Based Safety:
http://www.presentationload.com/behavior-based-safety-powerpoint-template.html
The BBS approach examines which behaviors and organizational circumstances led to accidents. By knowing this, you can inform employees about safe behavior at the workplace and implement Behavior-Based Safety in your company.
This template not only contains images with background information on occupational safety, but also a series of graphs with statistics and figures on the subject as well as a useful icons toolbox.
This document outlines best practices for responding to a water supply contamination event. It emphasizes the importance of advance crisis preparation, activating a crisis management team, and effectively communicating with the public, regulators, and media. The first few hours and days of the response set the tone, so priorities include protecting public safety, investigating the issue, and treating or shutting down the affected water supply. Managing the various legal, reputational, and investigative aspects that follow requires a coordinated, strategic response. Overall, being ready before a crisis occurs is key to a successful outcome.
This document discusses behavior-based safety (BBS) approaches. It begins by outlining the objectives of understanding the benefits of BBS, basic principles for motivating safe behavior, assessing organizational readiness, and comparing different BBS systems. It then discusses why traditional safety programs often do not work and explores common "fallacies" regarding safety. Core elements of successful safety programs are outlined, including safety culture and accountability. The rest of the document delves into BBS concepts like antecedents, behaviors, consequences and reinforcement. It examines models for understanding accident causation and human motivation. Benefits of BBS like significant injury reductions are presented. Key aspects of implementing BBS like roles, features, and assessing organizational readiness are covered
This document provides an overview of a behavioral-based safety observation program. It describes the basics of such a program, which involves employees recording safety observations of each other, with a focus on stopping unsafe work. The core aspects of the program are outlined, including observing behaviors, analyzing for safe and unsafe acts, providing feedback, and reporting observations. A seven-step process for conducting observations is also detailed, covering approaching employees, discussing hazards, agreeing on safer work methods, and documenting the interaction. The goals of the program are to increase hazard awareness and develop safer practices among employees.
This document outlines four cornerstones of successful global supply chain risk management: 1) Identifying uncontrollable risks, 2) Having crisis plans to minimize impacts of uncontrollable incidents, 3) Identifying controllable risks that can be proactively mitigated, and 4) Effectively managing supply chains to prevent or lessen impacts of risks. It emphasizes that while some risks are outside a company's control, proper risk management can significantly reduce costs and impacts of incidents through prevention and preparedness.
The document discusses the importance of business continuity and resilience in order to avoid disruptions like natural disasters or pandemics that could threaten the business. It emphasizes having backup systems, communication strategies, and recovery plans in place for various scenarios to ensure the business can continue operating no matter what challenges occur. The key is considering all possible risks and vulnerabilities and having thorough, well-tested plans to address disruptions across business functions from IT to customer service to assets.
Your business faces risks on multiple fronts, so risk management should be a strategic priority. Identifying and addressing risks helps your business run smoothly, and keeps you focused on pursuing your business objectives. We discuss strategies to mitigate your IT threats, explore insurance options and assess your internal control needs.
This document discusses risk management in banking. It describes different types of risk including operational risk, credit risk, and reputational risk. Operational risk includes internal fraud, external fraud, risks related to employment practices, risks related to clients and products, risks of damage to physical assets, risks of business disruptions, and risks related to execution and processes. Credit risk refers to the uncertainty in a counterparty's ability to meet its obligations. The document provides checklists and guidelines for managing operational and credit risks, including establishing appropriate risk environments, credit granting processes, credit administration, and risk controls.
Learn From the Experts: Critical Elements of Effective Environmental PoliciesEDR
With scrutiny on lenders’ risk management policies intensifying, more and more community banks are writing their first policies or updating old ones. The OCC just raised the bar for the banks it regulates with the August release of expanded guidelines for environmental risk management that bring their policy requirements in line with those of the FDIC. What are the critical components that should be in every policy? What elements are common to most institution’s policies? How does your institution measure up to industry best practices? How is policy administered across organizations?
Join us for this webinar as seasoned insiders selected from the ranks of a mid-sized bank and small community lender share their experiences in writing and updating environmental policies. Learn what these experts are doing to protect their institutions from environmental risk exposure, and the dangers that lenders face by not have adequate policies in place to protect them from financial and legal liability.
Tuesday, October 29, 2013
2pm EST
75 minutes
Presented by:
Georgina Dannatt
VP, Environmental Risk Manager
Bank of the West
Brian A. Ginter, VP & CCIM
Appraisal/Environmental Group
Burke & Herbert Bank
Larry Schnapf, Attorney, Schnapf Law
This document provides an overview of topics related to human factors and safety culture for aviation maintenance instructors. It discusses key concepts like human performance, error management, the SHEL model, and performance shaping factors. It also outlines requirements from regulations like CAR 145 regarding developing a safety culture, providing human factors training, implementing error reporting procedures, and considering human factors in task planning and sign-off processes. The document emphasizes that procedures should be designed to help users perform tasks correctly and that training helps build competence but cannot change the human condition, only the working conditions.
This document discusses behavior-based safety (BBS) and why traditional safety programs often do not work. It explains that BBS focuses on observing and providing feedback on worker behaviors, rather than just training or rules. BBS is most effective when it involves workers in developing the process and focuses on positively reinforcing safe behaviors. For BBS to be successful, a company must establish a strong safety culture with management commitment and accountability. The document also outlines the key components of applying BBS, including defining important safety behaviors, observing behaviors, and using data to reinforce safe practices.
This document summarizes a presentation about fixing problems in workers' compensation programs through data, accountability, and reducing fraud. The presentation discusses measuring results through claims scorecards and detailed reporting, using data elements to drive analysis rather than being paralyzed by data, and identifying key performance indicators like lag time, adjuster turnover, and closing ratios to analyze programs. The presentation concludes that forming the right partnership with service instructions, program enhancements, and ongoing evaluation can lead to a healthy workers' compensation program.
Candace McIntosh has over 25 years of experience in sales and management roles. She has a proven track record of exceeding sales goals and building profitable customer relationships. Her background includes experience in industries such as healthcare software, home building supplies, security systems, and electronics retail. She has consistently been a top performer, earning numerous awards for her sales achievements.
ATLANTA RIMS Nov 2013 - Hazards of Best Practices and How to Avoid ThemGary Jennings
This document discusses best practices in claims management. It begins by defining best practices and describing where they are typically applied in claims processes like workers' compensation and casualty claims. The presenter then shares observations from claims audits that quality is slipping despite increased adherence to best practices. Scorecards that claims administrators use to measure best practices compliance are discussed, but the presenter notes that these may not reliably indicate desired outcomes. While best practices are still important to track, additional metrics are needed to truly measure performance and ensure quality claims management.
This document provides examples of usage for several of the author's photographs from Getty Images, including a sunshower photo licensed by HarperCollins and Gyldendal, a photo of people walking on the beach licensed by J'ai lu, and a winter wonderland photo licensed by Editura Trei. It also lists sales of an old fashioned light bulbs photo as a royalty free image to over a dozen companies and organizations.
Defensibility of Workers’ Compensation Claims GA PRIMA Apr2015Gary Jennings
This document discusses improving workers' compensation claim defensibility. It begins by defining defensibility as the ability to successfully defend, protect, and justify actions. Common issues with claim outcomes like mediation, hearings and trials are then examined. The document suggests that thorough pre-incident planning, clear roles and responsibilities, and disciplined claims handling processes can help improve defensibility. Specific areas like reporting, investigating, and managing claims are identified as ones that require assertive execution to achieve the best results.
Mike Osman is a chef and manager with over a decade of experience in fine dining restaurants and banqueting. He has strong management, financial, and social media marketing skills. His experience includes turning around businesses and maximizing profits. He is highly organized, motivated, and has excellent communication and man management abilities. In his spare time he enjoys traveling, sports, and ancient history.
PRIMA 2012 - The Three Ps of Effective Claims Management v2Gary Jennings
The document discusses the three Ps of effective claims management: plans, protocols, and partnerships. It emphasizes developing detailed plans that address who will manage claims, what types of claims will be handled, and how performance will be measured. It also stresses establishing standardized protocols for claims processes and documentation. Finally, it recommends clarifying roles and expectations with both internal and external partners to achieve program goals. Developing plans, protocols, and partnerships can help claims management attain leading industry practices and control claims costs.
ATLANTA RIMS Nov 2013 - Hazards of Best Practices and How to Avoid ThemGary Jennings
This document discusses best practices in claims management. It begins by defining best practices and where they are typically applied in claims processes like workers' compensation and casualty claims. The presenter then shares observations from claims audits that quality is slipping despite increased adherence to best practices. Scorecards that claims administrators use to measure best practices compliance are discussed, but the presenter notes that these may not reliably indicate desired outcomes. While best practices are still important to track, additional metrics are needed to truly measure performance and ensure quality claims management.
This short document promotes creating presentations using Haiku Deck on SlideShare. It encourages the reader to get started making their own Haiku Deck presentation by simply clicking the "GET STARTED" prompt. In just one sentence, it pitches presentation creation using Haiku Deck on SlideShare's platform.
Case Reserving Methodologies and Procedures (PwC)Gary Jennings
This document discusses case reserving methodologies and procedures. It begins with defining case reserves and the estimated costs for individual claims. It then covers differences between short-tail and long-tail liabilities, and the roles of actuaries, management reporting, and claims management. The document provides details on methodologies, monitoring reserves, and responsibilities of insurers, third party administrators, and self-administered employers. It emphasizes the importance of accurate reserving and outlines best practices such as prompt handling, regular reviews, and monitoring significant changes.
The document discusses the neurobiology of procrastination. It explains that the limbic system, which includes the amygdala and nucleus accumbens, controls reward and emotional reactions. The limbic system favors immediate rewards and avoids tasks without immediate positives. The prefrontal cortex is responsible for higher thinking and decision making but often defers to the limbic system. Procrastination occurs when the limbic system sees no immediate reward for a task and avoids it in favor of other activities.
The document describes 4 types of hearts according to Matthew 13: the calloused heart, which is not responsive and hardened; the soft heart, which is responsive and able to understand insights and secrets of God's kingdom; the shallow heart, which hears but does not develop deep convictions and falls away easily; and the good heart, which hears and understands, retains what is learned, and produces fruit.
Applying the Science of High Reliability to Improve Operations and Increase...Health Catalyst
Principles of high reliability have been a strategic focus for many hospitals and healthcare systems. Still, significant disruptions, such as the COVID-19 pandemic, often push strategic initiatives aside or categorize them as “not important right now.” However, high-reliability organizations (HROs) principles and practices are essential in uncertain times to support operations and organizational resilience.
Fran Griffin, an independent consultant with over 25 years of experience in healthcare—specializing in the areas of patient safety, quality improvement, and high reliability—discusses the characteristics of HROs and how to apply these principles in both expected and unexpected situations. Fran discusses approaches to process design and analysis, movement from “Safety 1 to Safety 2,” and the impact on organizational culture. She also shares strategies for self-assessing an organization’s progress on the high-reliability journey.
After this webinar, attendees will be able to:
-Describe how high-reliability practices support operations in both expected and unexpected situations.
-Summarize key concepts from Safety 2 approaches.
-Apply self-assessment methods to their organization.
-Identify opportunities for design and redesign using HRO principles.
This document provides an overview of a behavioral-based safety observation program. It describes the basics of such a program, which involves employees recording safety observations of each other, with a focus on stopping unsafe work. The core aspects of the program are outlined, including observing behaviors, analyzing for safe and unsafe acts, providing feedback, and reporting observations. A seven-step process for conducting observations is also detailed, covering approaching employees, discussing hazards, agreeing on safer work methods, and documenting the interaction. The goals of the program are to increase hazard awareness and develop safer practices among employees.
This document outlines four cornerstones of successful global supply chain risk management: 1) Identifying uncontrollable risks, 2) Having crisis plans to minimize impacts of uncontrollable incidents, 3) Identifying controllable risks that can be proactively mitigated, and 4) Effectively managing supply chains to prevent or lessen impacts of risks. It emphasizes that while some risks are outside a company's control, proper risk management can significantly reduce costs and impacts of incidents through prevention and preparedness.
The document discusses the importance of business continuity and resilience in order to avoid disruptions like natural disasters or pandemics that could threaten the business. It emphasizes having backup systems, communication strategies, and recovery plans in place for various scenarios to ensure the business can continue operating no matter what challenges occur. The key is considering all possible risks and vulnerabilities and having thorough, well-tested plans to address disruptions across business functions from IT to customer service to assets.
Your business faces risks on multiple fronts, so risk management should be a strategic priority. Identifying and addressing risks helps your business run smoothly, and keeps you focused on pursuing your business objectives. We discuss strategies to mitigate your IT threats, explore insurance options and assess your internal control needs.
This document discusses risk management in banking. It describes different types of risk including operational risk, credit risk, and reputational risk. Operational risk includes internal fraud, external fraud, risks related to employment practices, risks related to clients and products, risks of damage to physical assets, risks of business disruptions, and risks related to execution and processes. Credit risk refers to the uncertainty in a counterparty's ability to meet its obligations. The document provides checklists and guidelines for managing operational and credit risks, including establishing appropriate risk environments, credit granting processes, credit administration, and risk controls.
Learn From the Experts: Critical Elements of Effective Environmental PoliciesEDR
With scrutiny on lenders’ risk management policies intensifying, more and more community banks are writing their first policies or updating old ones. The OCC just raised the bar for the banks it regulates with the August release of expanded guidelines for environmental risk management that bring their policy requirements in line with those of the FDIC. What are the critical components that should be in every policy? What elements are common to most institution’s policies? How does your institution measure up to industry best practices? How is policy administered across organizations?
Join us for this webinar as seasoned insiders selected from the ranks of a mid-sized bank and small community lender share their experiences in writing and updating environmental policies. Learn what these experts are doing to protect their institutions from environmental risk exposure, and the dangers that lenders face by not have adequate policies in place to protect them from financial and legal liability.
Tuesday, October 29, 2013
2pm EST
75 minutes
Presented by:
Georgina Dannatt
VP, Environmental Risk Manager
Bank of the West
Brian A. Ginter, VP & CCIM
Appraisal/Environmental Group
Burke & Herbert Bank
Larry Schnapf, Attorney, Schnapf Law
This document provides an overview of topics related to human factors and safety culture for aviation maintenance instructors. It discusses key concepts like human performance, error management, the SHEL model, and performance shaping factors. It also outlines requirements from regulations like CAR 145 regarding developing a safety culture, providing human factors training, implementing error reporting procedures, and considering human factors in task planning and sign-off processes. The document emphasizes that procedures should be designed to help users perform tasks correctly and that training helps build competence but cannot change the human condition, only the working conditions.
This document discusses behavior-based safety (BBS) and why traditional safety programs often do not work. It explains that BBS focuses on observing and providing feedback on worker behaviors, rather than just training or rules. BBS is most effective when it involves workers in developing the process and focuses on positively reinforcing safe behaviors. For BBS to be successful, a company must establish a strong safety culture with management commitment and accountability. The document also outlines the key components of applying BBS, including defining important safety behaviors, observing behaviors, and using data to reinforce safe practices.
This document summarizes a presentation about fixing problems in workers' compensation programs through data, accountability, and reducing fraud. The presentation discusses measuring results through claims scorecards and detailed reporting, using data elements to drive analysis rather than being paralyzed by data, and identifying key performance indicators like lag time, adjuster turnover, and closing ratios to analyze programs. The presentation concludes that forming the right partnership with service instructions, program enhancements, and ongoing evaluation can lead to a healthy workers' compensation program.
Candace McIntosh has over 25 years of experience in sales and management roles. She has a proven track record of exceeding sales goals and building profitable customer relationships. Her background includes experience in industries such as healthcare software, home building supplies, security systems, and electronics retail. She has consistently been a top performer, earning numerous awards for her sales achievements.
ATLANTA RIMS Nov 2013 - Hazards of Best Practices and How to Avoid ThemGary Jennings
This document discusses best practices in claims management. It begins by defining best practices and describing where they are typically applied in claims processes like workers' compensation and casualty claims. The presenter then shares observations from claims audits that quality is slipping despite increased adherence to best practices. Scorecards that claims administrators use to measure best practices compliance are discussed, but the presenter notes that these may not reliably indicate desired outcomes. While best practices are still important to track, additional metrics are needed to truly measure performance and ensure quality claims management.
This document provides examples of usage for several of the author's photographs from Getty Images, including a sunshower photo licensed by HarperCollins and Gyldendal, a photo of people walking on the beach licensed by J'ai lu, and a winter wonderland photo licensed by Editura Trei. It also lists sales of an old fashioned light bulbs photo as a royalty free image to over a dozen companies and organizations.
Defensibility of Workers’ Compensation Claims GA PRIMA Apr2015Gary Jennings
This document discusses improving workers' compensation claim defensibility. It begins by defining defensibility as the ability to successfully defend, protect, and justify actions. Common issues with claim outcomes like mediation, hearings and trials are then examined. The document suggests that thorough pre-incident planning, clear roles and responsibilities, and disciplined claims handling processes can help improve defensibility. Specific areas like reporting, investigating, and managing claims are identified as ones that require assertive execution to achieve the best results.
Mike Osman is a chef and manager with over a decade of experience in fine dining restaurants and banqueting. He has strong management, financial, and social media marketing skills. His experience includes turning around businesses and maximizing profits. He is highly organized, motivated, and has excellent communication and man management abilities. In his spare time he enjoys traveling, sports, and ancient history.
PRIMA 2012 - The Three Ps of Effective Claims Management v2Gary Jennings
The document discusses the three Ps of effective claims management: plans, protocols, and partnerships. It emphasizes developing detailed plans that address who will manage claims, what types of claims will be handled, and how performance will be measured. It also stresses establishing standardized protocols for claims processes and documentation. Finally, it recommends clarifying roles and expectations with both internal and external partners to achieve program goals. Developing plans, protocols, and partnerships can help claims management attain leading industry practices and control claims costs.
ATLANTA RIMS Nov 2013 - Hazards of Best Practices and How to Avoid ThemGary Jennings
This document discusses best practices in claims management. It begins by defining best practices and where they are typically applied in claims processes like workers' compensation and casualty claims. The presenter then shares observations from claims audits that quality is slipping despite increased adherence to best practices. Scorecards that claims administrators use to measure best practices compliance are discussed, but the presenter notes that these may not reliably indicate desired outcomes. While best practices are still important to track, additional metrics are needed to truly measure performance and ensure quality claims management.
This short document promotes creating presentations using Haiku Deck on SlideShare. It encourages the reader to get started making their own Haiku Deck presentation by simply clicking the "GET STARTED" prompt. In just one sentence, it pitches presentation creation using Haiku Deck on SlideShare's platform.
Case Reserving Methodologies and Procedures (PwC)Gary Jennings
This document discusses case reserving methodologies and procedures. It begins with defining case reserves and the estimated costs for individual claims. It then covers differences between short-tail and long-tail liabilities, and the roles of actuaries, management reporting, and claims management. The document provides details on methodologies, monitoring reserves, and responsibilities of insurers, third party administrators, and self-administered employers. It emphasizes the importance of accurate reserving and outlines best practices such as prompt handling, regular reviews, and monitoring significant changes.
The document discusses the neurobiology of procrastination. It explains that the limbic system, which includes the amygdala and nucleus accumbens, controls reward and emotional reactions. The limbic system favors immediate rewards and avoids tasks without immediate positives. The prefrontal cortex is responsible for higher thinking and decision making but often defers to the limbic system. Procrastination occurs when the limbic system sees no immediate reward for a task and avoids it in favor of other activities.
The document describes 4 types of hearts according to Matthew 13: the calloused heart, which is not responsive and hardened; the soft heart, which is responsive and able to understand insights and secrets of God's kingdom; the shallow heart, which hears but does not develop deep convictions and falls away easily; and the good heart, which hears and understands, retains what is learned, and produces fruit.
Applying the Science of High Reliability to Improve Operations and Increase...Health Catalyst
Principles of high reliability have been a strategic focus for many hospitals and healthcare systems. Still, significant disruptions, such as the COVID-19 pandemic, often push strategic initiatives aside or categorize them as “not important right now.” However, high-reliability organizations (HROs) principles and practices are essential in uncertain times to support operations and organizational resilience.
Fran Griffin, an independent consultant with over 25 years of experience in healthcare—specializing in the areas of patient safety, quality improvement, and high reliability—discusses the characteristics of HROs and how to apply these principles in both expected and unexpected situations. Fran discusses approaches to process design and analysis, movement from “Safety 1 to Safety 2,” and the impact on organizational culture. She also shares strategies for self-assessing an organization’s progress on the high-reliability journey.
After this webinar, attendees will be able to:
-Describe how high-reliability practices support operations in both expected and unexpected situations.
-Summarize key concepts from Safety 2 approaches.
-Apply self-assessment methods to their organization.
-Identify opportunities for design and redesign using HRO principles.
This document outlines an organization's "Good Catch Program" which aims to promote safety and quality by recognizing employees who identify potential issues. It defines key terms like incidents, adverse events, and near misses. The program aims to create a safety-focused culture through employee-driven reporting of good catches, which are events that could have caused harm but did not due to intervention. Employees who report good catches will be recognized monthly to encourage participation and use learnings to implement improvements. FAQs provide examples of good catches and clarify what should be reported to strengthen communication and safety.
This document outlines an organization's "Good Catch Program" which aims to promote safety and quality by recognizing employees who identify potential issues. It defines key terms like incidents, adverse events, and near misses. The program aims to create a safety-focused culture through employee-driven reporting of good catches, which are events that could have caused harm but did not due to intervention. Employees who report good catches will be recognized monthly to encourage participation and continuous improvement based on learning from good catches. FAQs provide examples of good catches and clarify reporting procedures.
This document outlines an organization's "Good Catch Program" which aims to promote safety and quality by recognizing employees who identify potential issues. It defines key terms like incidents, adverse events, and near misses. The program aims to create a safety-focused culture through employee-driven reporting of good catches, which are events that could have caused harm but did not due to intervention. Employees who report good catches will be recognized monthly to encourage participation and drive improvement actions. The document provides examples of good catches and answers frequently asked questions to promote understanding of the program.
It's So Hard to Say Goodbye: Minimizing Risk When Terminating Employees (Seri...Financial Poise
Involuntary terminations are never pleasant, but they are an inevitable part of business. Whether an employee is being let go due to poor performance or serious misconduct, chances are that he or she may take issue with the company’s decision—either during the termination meeting or at some point down the road. In the event the terminated employee decides to visit the nearest Equal Employment Opportunity Commission Office or meet with a plaintiff’s attorney, you want to make sure that you have taken steps to minimize risk and give your organization its best chance to defend against claims of discrimination, retaliation and/or wrongful discharge. This webinar discusses the various issues you should consider not only when you are making the decision to terminate but also in the weeks and months that lead up to that point. Drawing on their experiences as an HR consultant and management-side employment lawyer, the panelists provide practical tips to minimize exposure and best practices for conducting an employee termination meeting.
To view the accompanying webinar, go to: https://www.financialpoise.com/financial-poise-webinars/minimizing-risk-when-terminating-employees-2020/
It’s So Hard To Say Goodbye: Minimizing Risk When Terminating EmployeesFinancial Poise
Part of the webinar series: PROTECTING YOUR EMPLOYEE ASSETS: THE LIFE CYCLE OF THE EMPLOYMENT RELATIONSHIP 2021
This webinar discusses the various issues you should consider not only when you are making the decision to terminate but also in the weeks and months that lead up to that point. Drawing on their experiences as an HR consultant and management-side employment lawyer, the panelists provide practical tips to minimize exposure and best practices for conducting an employee termination meeting.
Administrative Safeguards to Limit the Risk of Professional MisconductJohn Gavazzi
Administrative safeguards are needed to limit the risk of professional misconduct. Key areas to focus on include staff selection and hiring practices, written policies on boundaries and complaints, training staff on ethical issues, providing supervision, and handling complaints in a thoughtful manner. While legal and ethical issues can arise, the goal is to thoughtfully address problems and do right by clients and staff. Maintaining an open and learning environment can help prevent misconduct and promote best practices.
This document outlines strategies for controlling work compensation costs. It discusses setting a culture of safety, careful hiring practices to avoid high-risk employees, prompt injury reporting and medical care, identifying red flags in claims, designating an injury management coordinator, maintaining communication with injured employees, implementing a modified work program, and understanding an organization's experience modification rate. The overall message is that a multifaceted approach is needed to effectively manage work comp claims costs.
The document outlines the grievance process, including:
1) The purpose is to allow employees and management to resolve workplace problems through open communication.
2) Steps include an oral grievance, written grievance, appeal to Employee Relations, and possible arbitration.
3) Management should investigate complaints thoroughly, treat employees fairly, and respond to grievances in a timely manner to prevent issues from escalating.
It’s So Hard To Say Goodbye: Minimizing Risk When Terminating EmployeesFinancial Poise
Involuntary terminations are never pleasant, but they are an inevitable part of business. Whether an employee is being let go due to poor performance or serious misconduct, chances are that he or she may take issue with the company’s decision—either during the termination meeting or at some point down the road. In the event the terminated employee decides to visit the nearest Equal Employment Opportunity Commission Office or meet with a plaintiff’s attorney, you want to make sure that you have taken steps to minimize risk and give your organization its best chance to defend against claims of discrimination, retaliation and/or wrongful discharge. This webinar discusses the various issues you should consider not only when you are making the decision to terminate but also in the weeks and months that lead up to that point. Drawing on their experiences as an HR consultant and management-side employment lawyer, the panelists provide practical tips to minimize exposure and best practices for conducting an employee termination meeting.
Part of the webinar series: PROTECTING YOUR EMPLOYEE ASSETS: THE LIFE CYCLE OF THE EMPLOYMENT RELATIONSHIP 2022
See more at https://www.financialpoise.com/webinars/
Financial Aspects of Genetic Testing - 1/11/22CHC Connecticut
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The choice of a lawyer is an important decision and should not be based solely on this presentation. All rights are reserved and content may not be reproduced, disseminated or transferred, in any form or by means, except with the prior written consent of Armstrong Teasdale.
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Similar to Defensibility of Workers’ Compensation Claims GA PRIMA Apr2015 (20)
Defensibility of Workers’ Compensation Claims GA PRIMA Apr2015
1. Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA
Principal
Strategic Claims Direction LLC
(678) 520-3739 1
2. WC Defensibility
2
#1 topic requested by Georgia PRIMA members
State
Cities
Counties
Risk pools
School districts
Water & sewage authorities
Shared concern regardless of entity
3. WC Defensibility
3
Displeased with outcomes
Mediation
Hearings
Trials
Why are we not getting the desired results?
What can we do to improve the outcomes?
4. WC Defensibility
4
Different program types
Risk Managers, HR Managers, Safety Managers, Finance
Managers, and others
Self-administered or TPA-administered
Contractors and vendors used in different ways
In-house counsel or outside counsel
The issues are the same regardless of your program type,
structure, administration model, or size.
5. WC Defensibility
Why aren’t we getting the desired results?
Common refrains on why we aren’t winning more
cases:
The deck is stacked against us – employees always win
The unions work against us
We have too many employees with entitlement
mentalities
5
6. WC Defensibility
6
Why are we not getting the desired results?
Our supervisors don’t handle it properly
The claims administrator is doing a poor job of
managing the claims
Defense counsel dropped the ball
We will take a broad view of WC defensibility and what we
can do to improve it.
8. WC Defensibility
Defend – Successfully repel attackers
Protect – Maintain safe place for the people
and resources or assets that we value
Justify – Our actions are respected,
supportable, and affirmed
8
10. WC Defensibility
Inherent presumption in this definition is that we and
our employees are all:
Concerned about our employees
Acting in good faith
Following Georgia’s WC requirements
Seeking the most appropriate care for the injured
employee
Trying to eliminate or significantly reduce time off from
work
10
12. WC Fraud
“3 Most Common Types of Workers’ Comp Fraud” -
Claims magazine November 2014
1. Abusers
Outright fraud – injury did not occur at work
2. Opportunists
Injury occurred at work but employee has performance issues,
is uncooperative, and seems to extend time off
3. Forgotten and/or uninformed employees
Not fraudulent but frustrating and eventually may be viewed
unfavorably
12
13. WC Defensibility
13
We spend a lot of our
time on the fewer
claims from ABUSERS
& OPPORTUNISTS
The rest are the claims of
UNINFORMED or
FORGOTTEN EMPLOYEES
that can be reduced
through assertive and
disciplined claims handling
ALL OF THESE CLAIMS CAN GENERATE SIGNIFICANT CLAIMS COSTS
14. Forgotten and/or
Uninformed Employees
Regular people who have lost their way and we suspect
them of fraud / malingering
Unaware of or unclear about requirements
Hurt and in pain
May have other physical problems
Seeing medical providers they don’t know
Don’t understand medical and WC terminology and
procedures
Often get little information from informed sources
Are financially stressed, worried about their jobs/future
May get misleading information and advice from family &
friends
14
16. What do we do?
How do we handle these claims
from different types of employees?
Abusers
Opportunists
Forgotten employees
What can we do about these cases?
16
17. “How do I make time for this?”
17
“I’m already doing a balancing act!”
18. Maybe the better question is:
Will you have more time in
the future to spend on these
issues, and will you get better
results if you don’t change
anything?
18
21. Claims are Hard to Predict
Employers don’t know at the outset which claims will
become the most costly or most difficult to manage
Employers must be consistent
Prepare for assertive claims handling
Adhere strictly to the plans and procedures
Execute all steps with discipline
KNOW WHAT TO DO AT THE RIGHT TIME FOR THE
RIGHT RESULTS
21
22. To be efficient & effective -
Do it right the first time
Create a clear path for claims handling
Make sure the claims are being managed well
Act with a sense of urgency
Ensure that employees get the information they need
Investigate promptly and fully
Evaluate based on objective facts, not favoritism or
politics
Choose your battles
Manage expectations
22
24. Contributing Factors
24
Contributing factors to unsuccessful WC defensibility
Lack of “Leading Industry Practices” – unstated,
inadequate, and/or inefficient claims management
expectations, procedures, and activities
Unclear or undefined roles and responsibilities - roles
of the public entity representatives, the adjusters, the
nurse case managers, the defense attorneys, etc.
Poor execution or follow-through
25. WC Defensibility
Successful defensibility relies upon proper planning
and efficient execution before AND after an incident
occurs. Don’t have a procedural “goose egg” before the
incidents occur.
25
LIFE OF A CLAIMNO
PLANS
26. WC Defensibility
Case may start to unravel before the incident occurs
Lack of notification and knowledge regarding claims
reporting
Inadequate reporting procedures, uninformed or
uncooperative supervisors
Inefficient processes to manage claims once incidents
occur
26
27. WC Defensibility
DISCIPLINE
The difference between a successful defense and an
unsuccessful defense is often due to the difference in the
level of detail
Maintain a strong sense of urgency throughout the life
of a claim
Take decisive steps
Don’t let the claim languish
27
29. Theme: Keep Calm, Sail On
29
To have “happy sailing”
Have a steady captain
Experienced
Committed
Understand the seas ahead
Study & analyze
Learn from past mistakes
Prepare for the voyage
Identify the destination
Create detailed maps and directions
30. Theme: Keep Calm, Sail On
30
To have “happy sailing”
Get the right crew / define your duties
TPA or self-administer?
Qualified personnel
Continuing training
Clear expectations
Chart your course and check it regularly
Compare where you are against known guides
32. Discipline - Pre-Incident
Pre-incident planning and preparation
Hire “right” employees for the jobs
Discharge the “wrong” people
Promote “right” workers to supervisors and managers
Set up prompt reporting processes & methods
Select medical panel & post it
Inform employees of the medical panel
Develop special claims admin. service instructions
Inform employees of reporting responsibilities
32
33. Discipline – Pre-Incident
Pre-incident planning and preparation
Make the right decision – self-administer or use a TPA
Create a Stay at Work / Return to Work (SAW/RTW) program
Select “right” vendors
In-house counsel vs. outside counsel
Managed Care Organizations
Triage Nurses
Medical Bill Review / Re-pricing
Telephonic or Field Case Management
Utilization Review
Durable Medical Equipment
Pharmacy Benefit Management
33
34. Discipline – Pre-Incident
Pre-incident planning and preparation
Select “right” claims system or risk management
information system (RMIS)
Efficient claims operation
Capture key information
Create meaningful reports
Allocate claims costs back to departments
Set up performance measurements for claims
administrator and for departments / divisions
34
35. Discipline – Incident Response
35
Reporting
To the supervisor or designated person
Completing the Supervisor’s Report
Completing the First Report
Getting the report to the TPA
Setting up and assigning the claim
36. Discipline – Incident Response
36
Reporting, set-up, and contact “lag times”
Incident
date
Date EE
reported
to Supv.
Date
Supv.
compl.
invest.
Date
FROI
compl.
(WC-1)
Date sent
to Claims
Admin.
Date
Claims
Admin.
set up /
assigned
Fri.,
3/20
Mon.,
3/23
Tues.,
3/24
Wed.,
3/25
Thu.,
3/26
Fri.,
3/27
Cumulative Days Expired
0 3 4 5 6 7
Possible first contact with employee
37. Discipline – Incident Response
37
Reporting and Initial Contact – if not done promptly,
it may be several days before someone starts managing
the claim.
What are the dangers?
Employee sees unauthorized medical providers
Employee is uncertain and stressed – getting no
direction
Friends & family give misleading advice and information
Witnesses and co-workers may be unavailable / coached
Facts of the claim become murky
Employee may become represented
38. Discipline – Incident Response
38
Investigation
Often one of the biggest weaknesses
Slow to initiate – may be days or weeks after claim occurred
and was reported
Cursory - Adjuster asks “Do you have any reason to doubt this
claim?”
Sometimes performed by unqualified persons – public entity
representatives
Lacks timely follow-up - What’s next?
Sometimes based solely on medical provider’s opinion
Requests medical information late
39. Discipline – Incident Response
39
Investigation - 2 layers
1. Did it happen on the job?
Supervisor
Often more of a cursory effort
Loss Control
What can be done to prevent this in the future?
Claims Administrator
Compensability – Did it arise out of and in the course of
employment (AOE/COE)?
Employer’s simple lack of doubt that the injury occurred is not
the only compensability determinant
Layer 1
Layer 2
40. Discipline – Incident Response
Investigation – some possible questions
Where did it happen? Did it happen at another
company’s site?
Was there evidence at the site?
Was the employee where s/he should have been?
What caused the employee to slip / fall ……?
Does the employee have health conditions that might
have caused this?
Did another employee or contractor play a part?
Did the employee tell others about his/her complaint?
40
41. Discipline – Incident Response
41
Investigation – 2 layers
2. What do we need to know to manage this claim well?
What is the injury, the diagnosis, the prognosis, the
treatment plan, expected time off from work (if any)?
What is the employee’s usual job and can the employee
perform that job – continue to work?
Is this a motivated employee who will do what s/he can to
get appropriate treatment and get back to work?
Layer 1
Layer 2
42. Discipline – Incident Response
42
Investigation – 2 layers
2. What do we need to know to manage this claim well?
Does the employee have any other conditions, injuries,
illnesses, or other circumstances that might delay recovery?
Did the incident occur at another site or in a way that makes
a third party potentially responsible for payment?
Layer 1
Layer 2
43. Compensability Decision
43
Questions to ask yourself
Have you been able to complete the investigation before
the first indemnity payment is due?
Have you investigated the claim fully and promptly?
Are the facts and details clear?
Is the compensability decision clear, or is there room for
interpretation?
When required, can you replicate the information and
facts on which you based the decision?
44. Compensability Decision
Are we accepting and denying the right claims?
If we suspect a claim is not legitimate, how do we
manage the claim until we have the proof?
What do we do if we can’t prove it?
44
45. If Some Aspect of Claim
is Being Contested
45
Should the claim be at this stage in the first place?
Has the claims administrator maintained ongoing
contact?
Has the employee been properly informed throughout
the life of the claim?
If the employee is represented, has the claims
administrator had an ongoing discussion with the
employee’s attorney?
What are the issues?
Should they have been resolved?
If so, why haven’t they been resolved?
46. Defense Counsel Considerations
46
In-house or outside counsel?
Advantages and disadvantages of each?
Managing litigation
Litigation management guidelines
Regular meetings and discussions
Evaluate “success”
Compare return on investment (ROI)
“Success” versus costs
47. Preparing Defense
47
Proper Description of Respective Duties
Claims Administrator Responsibilities
Investigation and Compensability issues should be resolved
Employee’s condition should be well known
Action plan / resolution goals should be well defined
Keep claim moving
Keep defense counsel accountable
48. Preparing Defense
48
Proper Description of Respective Duties
Defense Counsel Responsibilities
Legal advice
Under Claims Administrator’s direction
Perform directed discovery
Inform Claims Administrator of all important developments
Discuss action plans / resolution strategies with Claims
Administrator
“Try” case
49. Make an Early Decision
49
Resolve or Contest?
If Contest
Complete discovery
Obtain needed information
Get it to the hearing quickly
50. Summary - WC Defensibility
50
Better outcomes based on
Consistency
Defining your pre-incident and post-incident
procedures
Clarifying roles and responsibilities
Maintaining a sense of urgency
Executing your plans
51. Questions / Comments?
51
CONTACT INFORMATION
Gary Jennings, CPCU, ARM, ALCM, AIC, ARe, SCLA
(678) 520-3739
Gary.Jennings@StrategicClaimsDirection.com