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1. NYS Workers Compensation
Mark V. O’Brien
Claim Manager
Lawley Insurance
716 849-1504
MOBrien@lawleyinsurance.com

2. Economics of Workers Compensation
 Inflation relative to WC Benefits
• Indemnity increasing @ 2% per year
• Medical increasing @ 6% per year
 The workforce is aging (average @ 49 years) resulting in
fewer but more costly injuries

3. NYS Workers Compensation
 NYS is the 5th
most expensive state for employers
 2007 Reform measures were attempts to level the playing
field between states but:
 Loss Costs in 2013 are actually higher than in 2007
 Increase in Average Weekly Wage
 Shift from lower cost claims to higher permanent partial
disability claims

4. NYS WC Cost/Benefits 2007 to Present
 Permanent Partial Disability claims, carriers required to
deposit present value of future stream of indemnity into
the ATF
 Medical Treatment Guidelines were enacted for multiple
body parts
 Elimination of “lifetime” permanent partial disabilities
 With increase in Average Weekly Wages, SLU’s
have doubled

5. Benefits: 2007 to Present
 2007 Law: The Changes
 Increase to maximum and minimum weekly benefits
 Minimum increased from $40 to $100 effective July 1, 2007
 Maximum increased according to following schedule
Effective Date Maximum Weekly Benefit
July 1, 2007 $500
July 1, 2008 $550
July 1, 2009 $600
July 1, 2010 2/3rds of AWW: $739.83
July 1, 2011 $772.96
July 1, 2012 $792.07
July 1, 2013 $803.21

6. Present and Future NYS WC Landscape
 3/1/14 WCB requires electronic reporting to go
paperless and become more efficient
 Requires carriers to invest in software and potentially
more staff
 Could result in increased caseloads and less focus
on quality
 ACA could result in higher reimbursements for WC
vs Medicare and Major Medical

7. Pre-Accident Risk Management Efforts
 Utilize your Loss Source Analysis (Trending Report)
to identify problem areas
 Implement post offer physical assessments to
determine if the potential hire can do the work
 Develop strong relationships with Occupational
Health Facilities

8. Craft Special Handling Instructions With The Carrier
 Where possible, require a dedicated WC adjuster
on your account
 Carrier system access during and after policy
 Reserve notifications above $25k
 Settlement Authority on settlements above $50k
 Nurse case management and pharmacy benefit
management

9. Accident Investigation And Claim Reporting
 Active participation in accident investigation
 Ask the employee to show you how/where the accident
occurred
 Designate a WC Coordinator for supervisors to
report claims
 Most effective WC Coordinators have an interest in the
fine details of each claim
 Once the claim is reported to the carrier, direct all
claimant questions to that carrier

10.  Per WC Section 110, you can self pay medical only claims
 Less than 3 Medical treatments
 No lost time past the date of injury and 1 day
 Prevents these claims from being factored into the
underwriting decision
 Eliminates the claim exposure on your experience
modification factor
Self Pay First Aid Claims

11.  Participate in claim reviews and focus on disposition
strategy and reserve analysis
 Invite department heads to participate in the claim reviews
for claims that impact their specific department and overall
organization
 Question the carrier on use of Nurse Case Managers and
Pharmacy Benefit Managers
 Identify mitigation practices that will help reduce the
overall claim incurred (Paid + Reserve= Incurred)
 Subrogation (Loss Transfer and Third Party)
 Look to apportion claims to prior carriers where possible (Outside
your effective rating period)
Claim Reviews

12.  Provide a RTW program that brings employees back to
work as soon as possible in either temporary alternative
work or their full time job
 Maintain a library of RTW jobs in electronic format that
can be sent to the claimant doctor or an Independent
Medical Exam
 Integrate the RTW program into your collective
bargaining agreement
Return To Work Program (RTW)

13.  Familiarize yourself with the effect of your claims on your
experience modification factor
 Benchmark yourself against industry competitors
experience mod factors
 Ask your broker to provide a Mod Master Analysis of your
experience mod including trending reports on cause of
loss, injury types and the impact of individual claims on
your mod
Experience Mod Analysis

14.  Demonstrate empathy for the claimant
 Maintain consistent dialog (Medical status and RTW options)
 Try to be cordial throughout the claimants period of disability.
 Encourage use of a Wellness Program
Maintain Communication With The Claimant

15.  In hiring process, consider what other transferrable skills
the potential employee may possess (Academic or
vocational)
 In application process, exercise your rights to contact the
prior employers relative to work performance etc.
 Consider “Kitchen Table Economics” of potential hires
who may be injured
Additional Observations And Ideas

16. Legacy Workers Compensation Claims
 Understand the impact on your current and future
experience mod factors
 Trust claims may not impact your experience mods but
have a profound financial impact via joint/several liability
and thus annual assessments
 Lawley has developed a legacy claim management
services to assist in mitigation

17. Thank you.