June 30, 2014
1:30 p.m. - 3:30 p.m.
Heartland Payment Systems is the Lead
Sponsor of all RES events.
The ORA Restaurant Education Series (RES) provides
members free access to educational events that help them
sustain and grow their businesses and are developed based on
member feedback. RES events support a key ORA initiative:
the education of our members.
 Brad Hunt, RiskControl360° Moderator of the conversation
 Developing a Culture of Safety: Strategies to Support Safe
Work Practices: Doug Wiegand, National Institute for
Occupational Safety & Health
 Controlling the Cost of Injuries - Third-Party Administrator
Perspective: Jim Wirth, CareWorks Consultants, Inc. (CCI) &
RiskControl360°
 Controlling the Cost of Injuries - Managed Care Organization
Perspective: Derek Stern, CareWorks
 Safety & Labor Law - Top OSHA Citations for Restaurants:
Keith Pryatel, Kastner, Westman & Wilkins, LLP
Expert Speakers
• Open and close your Panel
• View, Select, and Test your audio
• Submit text questions
• Q&A addressed at the end of today’s
session
• Everyone will receive an email with a
link to view a recorded version of
today’s session
• Your feedback is important! You will
receive a prompt to complete a
survey at the end of the session
When a 1,000 things pile up, it’s easy to overlook the importance of
health & safety issues - that’s dangerous!
The Health & Safety section of the ORA’s website helps you stay on
top of concerns, offering solutions to today’s restaurant, food, and
alcohol safety issues.
www.ohiorestaurant.org/healthandsafety
Health and Safety
 Restaurant Safety &
Training
 Information Resources
 Policies & Guides
 Videos & Multimedia
 Restaurant Safety
Consultants
 Food Safety
 Alcohol Safety
Douglas Wiegand, Ph.D.
National Institute for Occupational Safety
and Health
Disclaimer: The findings and conclusions in this
presentation have not been formally disseminated by
the National Institute for Occupational Safety and
Health and should not be construed to represent any
agency determination or policy.
 The safety culture of an organization is the
product of individual and group values, attitudes,
perceptions, competencies, and patterns of
behavior that determine the commitment to, and
the style and proficiency of, an organization’s
health and safety management (HSC, 1993).
 Or, the way we do things around here.
 John’s manager sees that John is chopping
vegetables at an amazing speed…
 Should the manager:
A: Nod in approval; the food will be prepped on time
B: Say nothing
C: Tell John “Be Careful”; we don’t want him to cut
himself and stop working
D: Ask John why he is working so fast; try to understand
why John feels like he needs to rush
 Attitude vs. behavior change
 Behavior is easier to see, and easier to change
 Change the behavior and attitude may follow
Attribution of the causes of injuries
 Chance vs. “person” causes vs. latent causes
 Look at the whole picture
 Injury logs can help identify trends and problem areas.
 Exploring and documenting near-misses
Thorough walk-through
 Identify trip/slip/fall hazards
 Employee involvement for continuous improvement
What types of controls can be implemented?
 Ongoing monitoring and review to ensure controls are
effective
 How can we be preventive rather than reactive?
Most Effective /
Protective
Elimination
Substitution
Engineering Controls
Administrative Controls
Personal Protective Equipment
Coworker
reminder to
use
protective
glove
Employee
safely cuts
food
Employee
receives
appreciative
comment from
manager
Restaurant
owner attends
ORA training
event on
safety culture
Restaurant
owner provides
safety training
and equipment
to employees
Restaurant
owner
experiences
lower
probability of
worker injury
 Safety does not end with training
 Must check for employee understanding
 Have employees demonstrate safe behaviors
 Practice with feedback as part of training
 Integrate behavior-based safety coaching into the culture
 Management commitment and employee involvement
 Peer observation and feedback
 Ongoing monitoring and review
Behavior Safe At-Risk
Load appropriate?
Back straight?
Use legs?
Hold load close to body?
Shoulders and hips aligned?
TOTAL
Total Safe Behaviors / Total Safe + At-Risk Behaviors
X 100 = % Safe
 Consult managers and employees to get their
impressions of the problem areas and ideas / areas for
improvement
e.g. Have them help to develop checklists
 When people contribute to a safety effort, their
ownership and commitment to safety increases.
Employees communicate about safety
 Perception of management / owner’s total buy-in for
safety practices and procedures increases employees’
participation
 Unsafe behavior is a symptom, not the disease
Unhealthy safety culture is a system problem
Email: dwiegand@cdc.gov
Phone: 513.841.4240
The Third Party Administrator Perspective
Jim Wirth,
CareWorks Consultants / RiskControl 360
Introduction - What is the best way to control
workers’ compensation costs?
 Maintain a healthy, cooperative relationship with your
associates where communication is open and encouraged
 Safety/Prevention:
Make safety a priority for your organization
Create and promote a safety process that reduces the
occurrence of incidents/accidents…and claims
Involve all associates in your safety efforts
Claims
 Medical Only Claims:
Usually a minor injury
Claims with seven or fewer days of disability usually results in a
small reserve for a limited period of time
 Lost Time Claims:
Claims with eight or more calendar days of disability
Reserves can occur in lost-time claims
 Occupational Disease Claims:
Claims where an employee contracts a disease in the course of
employment.
These claims often develop over time
Cost Control Tools
 Safety
 Accident Investigation
 Communication
 Salary / Wage Continuation
 Deductible
 Vocational Rehabilitation
 Transitional Work
 Lump Sum Settlements
 Handicap Reimbursement
 Subrogation
 BWC/Employer
Sponsored IME
 Surveillance
 Work with Third Party
Administrator (TPA) /
Managed Care
Organization (MCO)
Accident Investigation
 Communicate with your CareWorks Consultants
claims examiner as soon as the injury occurs
 Report to the MCO
 Thoroughly investigate the circumstances of the
incident / accident
 Document evidence in writing
 Utilize accident report and photographs
 Obtain witness statements
 Utilize classes at BWC Training Centers
 Important for PREVENTION…and hearings
Salary Continuation
 Should be considered for any claim if eight or
more calendar days of work will be missed, even if
claim is not certified by employer
 CareWorks Consultants can provide the employer
with a premium impact study to help make a
decision on whether salary continuation should
occur
Transitional Work
 Reduces cost of hiring and training replacements
 Helps prevent injured worker’s adjustment to disability
lifestyle
 No break or loss in income
 Gradually returns employee to full duty work
 Lower costs contribute to reduced premiums
 Works in conjunction with salary continuation
 Consists of short term and temporary tasks
Vocational Rehabilitation
 Surplus charge for most services
 Return-to-work focused
 Closely monitored, individualized programs
 Case management professional assigned to each case.
 Participation is voluntary…but make it an interesting and
positive experience.
Lump Sum Settlements
 CareWorks Consultants helps identify claims appropriate
for Lump Sum Settlements (LSS) and determine settlement
amount.
 Employer directs CareWorks Consultants to offer
settlement.
 Employer, injured worker and BWC must agree to LSS.
 BWC pays settlement.
 Settlement will eliminate the reserve portion of the claim
and prevent future payments.
 Claim will remain in employer’s experience for four years.
Handicap Reimbursement
 Epilepsy
 Diabetes
 Cardiac Disease
 Arthritis
 Loss of sight
 Poliomyelitis
 Cerebral palsy
 Multiple sclerosis
 Parkinson’s disease
 Cerebral vascular accident
 Tuberculosis
 Silicosis
 Psychoneurotic disability
 Hemophilia
 Amputation foot, leg, arm or hand
 Chronic osteomyelitis
 Ankylosis of joints
 Hyperinsulinism
 Muscular dystrophy
 Arteriosclerosis
 Thrombophlebitis
 Varicose veins
 Cardiovascular & pulmonary disease
(firefighters)
 Coal miner’s pneumoconiosis
 Completion of Industrial Commission or
similar rebab program
 Service related disability
Subrogation - A type of third party recovery
 Motor vehicle accident
 Medical malpractice
 Exposure to toxins
 Machinery malfunctions
 Animal bites
BWC generally pursues
Independent Medical Exams (IME)
 BWC Independent Medical Examination - used to determine
whether the injured worker is capable of returning to his/her
former position of employment, or if the allowed conditions
have become permanent.
 Employer-sponsored IME / IMR (Independent Medical
Review) - used to provide medical evidence in support of an
employer’s objection to the claim allowance or
compensation.
 Fee for this exam/file review is paid by the employer.
Surveillance
 Employer hires a private investigator if red flags exist
that may point to fraudulent activity.
 Employer contracts directly with the investigator.
 If fraud is identified, it can be reported by calling BWC at
1-800-OHIOBWC or logging on to www.ohiobwc.gov
 BWC generally does not allow a TPA to report fraud - it
must be reported by the employer.
Summary
 Contact CareWorks Consultants and your MCO
immediately when an accident occurs
 Thoroughly investigate the accident
 Document evidence in writing
 Understand how a claim impacts your rates
 Consider salary continuation on all lost-time claims
 Offer transitional work when worker is on restrictions
 Lump sum settlements / Handicap reimbursements
 Subrogation
BWC Prospective Premium Payment Transition
 The Ohio Bureau of Workers’ Compensation (BWC) is
transitioning to a prospective billing system.
 According to BWC, this change aligns them with
standard industry practices.
 Employers will see an overall base rate reduction of 2% as a
result of this change.
 The transition becomes effective July 1, 2015, for private
employers, and January 1, 2016, for public employers.
How it Will Work
 Earlier opportunities to sign up for incentive programs
Beginning in the fall of 2014, employers looking to
participate in programs such as group rating,
group-retrospective rating or other rating plans will
have the opportunity to make those selections sooner.
 A one-time credit in July 2015
 Employer will receive a one-time premium credit, as BWC will
cover their August premium payment (covering the January to
June 2015 premium) as well as the first two months of 2015
policy year (July and August) prospective premium.
How it Will Work (continued)
 A new payment schedule
Employers will receive their invoice in June 2015 and begin paying
premiums before July 1, 2015. While that is earlier than before, all
employers will be able to make quarterly or semi-annual payments,
and some employers will be able to pay up to as many as
12 installments.
 A true-up process
Because BWC is providing workers’ compensation insurance
coverage based on estimated payrolls, they will ask businesses to
report or “true-up” their actual payroll for the prior policy year. This
begins in August 2016.
What to Expect
 Industry TPAs will be contacting employers to inform them of the
changes. Be prepared to receive information from multiple TPAs.
 It is important for employers to make sure they do not
have a lapse in their workers’ compensation coverage.
 Be sure you are current on all BWC payments.
 June 2014 - BWC will mail letter to employers announcing
change in alternative rating plan sign-up deadlines.
 October 2014 - BWC will mail letters to employers to
explain the upcoming premium payment changes and
remind them about the new plan enrollment deadlines.
Timeline
 August 31, 2014 - Payroll reports/premium due for
1/1/14 - 6/30/14 period (as normal)
 November 24, 2014 - Group rating program filing
deadline (tentative deadline for the 2015 policy year)
 January 30, 2015 - Group retrospective rating program
filing deadline (tentative deadline for the 2015 policy
year)
Timeline (continued)
 February 28, 2015 - Payroll reports/premium due for
7/1/14 - 12/31/14 period (final retrospective premium
payment)
 May 2015 - BWC will mail Estimated Premium Notice for
2015 policy year
 Note: If the employer does not agree with estimation of payroll,
BWC says they will be able to have it adjusted.
Timeline (continued)
 June 2015 - BWC will mail payroll reports for 1/1/15 -
6/30/15 period. Employers will report payroll as normal,
but will not be required to pay premium for this period.
Payroll reports will be due as normal (8/31/15).
 August 1, 2015 - BWC will mail first prospective premium
invoice to employers for 7/1/15 - 6/30/16 policy year.
First payment due 8/31/15, for the 2015 policy year only.
Note: In August 2015, employers will send in their payroll report for 1/1/15 -
6/30/15 period along with their first prospective payment for the 2015 policy
year.
Timeline (continued)
 November 2015 - Group rating program filing
deadline (tentative deadline for the 2016 policy
year)
 January 2016 - Group retrospective rating
program filing deadline (tentative deadline for the
2016 policy year)
Jim Wirth, CPEA
jwirth@riskcontrol360.com
614-827-0370
Workers’ Compensation
Best Practices:
Managed Care Organization (MCO)
Perspective
Derek Stern, CareWorks
 Safety
 Flow Chart
 Role of the MCO
 4 “R”’s
 Transitional Work
Safety should always be in the forefront.
When there is a safety breakdown or the unforeseen occurs…injuries
happen.
 Try to anticipate ANYTHING
that could happen in the
workplace.
 If an injury does occur, have
a process in place to ensure
injured workers receive care
and claims are reported
immediately.
 Work with your MCO, TPA
and BWC.
 Claim intake and reporting to BWC.
 Ensure injured workers receive appropriate
medical care.
 Authorize or deny medical treatments requested
by physicians.
 Assist employers and injured workers with
successful return to work.
 Payment of medical bills (excluding prescriptions).
 The MCO is a neutral party to the claim.
Responsibilities of the MCO.
 Ensure injured workers and employers are
aware of the latest progress in the claim.
 Assist employer with the development of
programs to enhance their workers
compensation program (Transitional Work,
Injury Reporting Packets).
 Assist employer with identifying local initial
treating providers.
 Ensure medical documentation is transmitted to
BWC.
Responsibilities of the MCO
 Early Reporting is crucial.
 Early investigation is important.
 Collect facts and documentation.
If You Have a Workplace Injury:
 Early and effective medical management.
 Early return to work management.
 Lower claims costs.
Early Reporting Leads to:
 Your Managed Care Organization (MCO)
can help establish good reporting
practices.
 MCO can provide injury reporting packets
to assist with claims filing.
 No one can help with a claim they don’t
know about.
Early Reporting Strategies
Claim scenario: WITH early reporting (Part I)
 Date of Injury: 12-1-2011
 Claim reported: 12-1-2011.
 Employer, TPA and MCO discuss case. Determine if
the claim is compensable.
 Facts reveal claim not legit, employer decides to reject
claim.
 Claim goes to hearing and employer has claim denied
by IC.
 No impact on employer’s EM or premiums.
Claim scenario: WITH early reporting (Part II)
 Date of Injury: 12-1-2011
 Claim reported: 12-1-2011.
 Employer, TPA and MCO discuss case. Determine if the
claim is compensable.
 Facts reveal claim IS compensable. Can we mitigate the
claims cost?
 TPA advises employer to continue salary. MCO and TPA
discuss transition work options with employer.
 Result: Compensable claim, but costs significantly
reduced due to early intervention.
Witness Statements are important
 Identifying an initial treating provider.
 Communication.
 Set expectations.
 Introduce the provider to the workplace.
 Employers have the right to recommend a
treatment facility to an injured worker.
 Injured workers have right to select any
provider.
 Keep in touch with the Injured Worker.
 Contact your MCO/TPA/BWC claims
rep if you have claim updates.
 No such thing as too much
information.
 Communication is vital to
the success of your
program.
 If you are in doubt about
anything, call your MCO
Account Executive.
 Don’t “assume” anything.
Communication is Key.
 Defining Transitional Work
 How is it best used?
 Transitional Work Best Practices
 BWC’s Transitional WorkGrants
 A work site program that provides an individualized
step in the recovery of an injured associate with job
restrictions resulting from the allowed conditions in
their claim.
 A successful transitional work program provides
meaningful work which allows an injured worker to
increase strength and endurance while decreasing
restrictions.
 Transitional work is not LIGHT DUTY!
 Take advantage of BWC’s Transitional Work
Grants.
What is Transitional Work?
Return to Work
 Aggressive return to work program that assists
employers in the temporary “job placement” of
injured workers with temporary restrictions that
cannot be accommodated onsite.
 The goal of MDOS is to help facilitate a timely
and safe return to work while realizing cost
savings.
 Employer Benefits
 Employee Benefits
 Non-profit Benefits
Modified Duty Off Site (MDOS)
 MDOS program should have an established
positive outcome success rate.
 Placements are made by an MDOS
coordinator and managed by a Vocational
Case Manager.
 Programs are customized to each employer,
including policy and program
documentation.
MDOS (continued)
WITHOUT transitional work
 Medical = $2,500
 Compensation = $5,000
 Reserve = $25,000
 Total cost = $32,500
Why Transitional Work?
WITH transitional work
 Medical = $1,500 (vs. $2,500)
 Compensation = $0 (vs. 5,000)
 Reserve = $25,000*
 Total cost = $26,500
*In general, utilizing transitional work can
reduce the overall reserve in the claim
Why Transitional Work?
 Call your MCO and TPA immediately.
 You’re going to pay them, or you’re going
to pay them – it’s a matter of which pot it
will come from.
 Consider paying salary continuation (after
first discussing with TPA).
 Injured worker must not miss regular pay cycle.
 Injured worker should receive regular pay.
What to do if a Claim is Going to be Lost
Time.
An employer should
never feel like they
are alligator food.
Your MCO can help
you avoid the
workers
compensation “pit.”
Thank you
Derek Stern
Director of Customer Relations
(734) 944-2193 direct
(888) 627-7586 ext. 3554 toll free
derek.stern@careworks.com
www.careworksmco.com
Keith L. Pryatel, Esq.
Kastner Westman & Wilkins, LLC.
 National study on HR Practices and Employee
Turnover in the Restaurant Industry Jan. 15, 2014
Rockefeller & Ford Foundational Funding
Studies show 1 of 2 fast food workers turnover each
year; 40% turnover rate for “moderately priced”
restaurants; lower rates for “fine dining”, but higher per-
employee turnover costs
 Turnover costs -- $18,200/annual for 30
employees or less; $182,000 for 10 restaurant
chain; $1.8 million for 100 restaurant chain
 Most important HR practices that significantly
reduce turnover and lengthen job tenure
 high relative wages
 job security
 longer work hours
 more discretion at work
 policies for promotion from within
 Less than 20% of restaurant employers offer any level
of paid sick time or paid time off; only 33% offer
vacations or subsidized health insurance even “fine
dining” is low. 30% offer paid leave or PTO; 5% offer
paid vacations or subsidized health insurance.
 Employee discretion is low in all restaurant
establishment. Only 5% allow front-of-house
employee discretion in their communications with
customers without consulting managers; or in problem
solving.
 Annual pay for fast food employers:$13,257
($255/52 weeks); $18,720 (back-of-house / BOH)
and $24,123 (front-of-house / FOH) for
“moderately priced restaurants”; $20,902 (BOH)
and $34,990 (FOH) for fine dining.
 Restaurant industry traditionally offers few
employee benefits e.g. paid sick leave; paid time
off; paid vacation; subsidized health insurance
because: part-time; seasonal; student; immigrant
workers
High turnover is costly; Raises curb of
selecting, recruiting and training
replacements
New employees are less proficient until they catch up
on the learning curve (less knowledgeable about
menu - no customer relations)
Disruption of operations - manager attention to other
areas is shifted.
How investment in HR reduces turnover
Hourly wages and job security are two
most important factors.
Hours available to work and discretion
exercise are other important facts.
 PPE Survey
 Identifying workplace violence risks – cases / door
markers / drop sales / windows
 Disciplining for safety violations
 HazComm Program
 Lock Out / Tag out
 Voluntary OSHA Log (300 and 300A)
www.osha.gov
Thank you!
Keith L. Pryatel, Esq.
kpryatel@kwwlaborlaw.com
Kastner Westman & Wilkins, LLC.
3480 W. Market Street, Suite 300
Akron, OH 44333
Social Media Webinar Series sessions:
Every Tuesday at 2:00 p.m.
 July 1st Foursquare, Urban Spoon and Yelp - Time for a little R & R
(Revenue and Reviews)
 July 8th Instagram - Pics and Profits
 July 15th Pinterest - Pin to Win
 July 22nd Google + - Just Another Pretty Facebook?
 July 29th Mobile apps - So Many Apps. So Little Time.
Other RES events
 August 6th - "Is Franchising the Right Choice?" 2:00 p.m.
Go to www.ohiorestaurant.org/res NOW to register!
Heartland Payment Systems is the Lead
Sponsor of all RES events.

ORA RES The Relationship Between Human Resources and Safety Performance Webinar

  • 1.
    June 30, 2014 1:30p.m. - 3:30 p.m. Heartland Payment Systems is the Lead Sponsor of all RES events. The ORA Restaurant Education Series (RES) provides members free access to educational events that help them sustain and grow their businesses and are developed based on member feedback. RES events support a key ORA initiative: the education of our members.
  • 3.
     Brad Hunt,RiskControl360° Moderator of the conversation  Developing a Culture of Safety: Strategies to Support Safe Work Practices: Doug Wiegand, National Institute for Occupational Safety & Health  Controlling the Cost of Injuries - Third-Party Administrator Perspective: Jim Wirth, CareWorks Consultants, Inc. (CCI) & RiskControl360°  Controlling the Cost of Injuries - Managed Care Organization Perspective: Derek Stern, CareWorks  Safety & Labor Law - Top OSHA Citations for Restaurants: Keith Pryatel, Kastner, Westman & Wilkins, LLP Expert Speakers
  • 5.
    • Open andclose your Panel • View, Select, and Test your audio • Submit text questions • Q&A addressed at the end of today’s session • Everyone will receive an email with a link to view a recorded version of today’s session • Your feedback is important! You will receive a prompt to complete a survey at the end of the session
  • 6.
    When a 1,000things pile up, it’s easy to overlook the importance of health & safety issues - that’s dangerous! The Health & Safety section of the ORA’s website helps you stay on top of concerns, offering solutions to today’s restaurant, food, and alcohol safety issues. www.ohiorestaurant.org/healthandsafety Health and Safety  Restaurant Safety & Training  Information Resources  Policies & Guides  Videos & Multimedia  Restaurant Safety Consultants  Food Safety  Alcohol Safety
  • 8.
    Douglas Wiegand, Ph.D. NationalInstitute for Occupational Safety and Health Disclaimer: The findings and conclusions in this presentation have not been formally disseminated by the National Institute for Occupational Safety and Health and should not be construed to represent any agency determination or policy.
  • 9.
     The safetyculture of an organization is the product of individual and group values, attitudes, perceptions, competencies, and patterns of behavior that determine the commitment to, and the style and proficiency of, an organization’s health and safety management (HSC, 1993).  Or, the way we do things around here.
  • 10.
     John’s managersees that John is chopping vegetables at an amazing speed…  Should the manager: A: Nod in approval; the food will be prepped on time B: Say nothing C: Tell John “Be Careful”; we don’t want him to cut himself and stop working D: Ask John why he is working so fast; try to understand why John feels like he needs to rush
  • 11.
     Attitude vs.behavior change  Behavior is easier to see, and easier to change  Change the behavior and attitude may follow
  • 12.
    Attribution of thecauses of injuries  Chance vs. “person” causes vs. latent causes  Look at the whole picture  Injury logs can help identify trends and problem areas.  Exploring and documenting near-misses Thorough walk-through  Identify trip/slip/fall hazards  Employee involvement for continuous improvement What types of controls can be implemented?  Ongoing monitoring and review to ensure controls are effective  How can we be preventive rather than reactive?
  • 13.
    Most Effective / Protective Elimination Substitution EngineeringControls Administrative Controls Personal Protective Equipment
  • 15.
  • 16.
    Restaurant owner attends ORA training eventon safety culture Restaurant owner provides safety training and equipment to employees Restaurant owner experiences lower probability of worker injury
  • 17.
     Safety doesnot end with training  Must check for employee understanding  Have employees demonstrate safe behaviors  Practice with feedback as part of training  Integrate behavior-based safety coaching into the culture  Management commitment and employee involvement  Peer observation and feedback  Ongoing monitoring and review
  • 18.
    Behavior Safe At-Risk Loadappropriate? Back straight? Use legs? Hold load close to body? Shoulders and hips aligned? TOTAL Total Safe Behaviors / Total Safe + At-Risk Behaviors X 100 = % Safe
  • 19.
     Consult managersand employees to get their impressions of the problem areas and ideas / areas for improvement e.g. Have them help to develop checklists  When people contribute to a safety effort, their ownership and commitment to safety increases. Employees communicate about safety  Perception of management / owner’s total buy-in for safety practices and procedures increases employees’ participation  Unsafe behavior is a symptom, not the disease Unhealthy safety culture is a system problem
  • 20.
  • 21.
    The Third PartyAdministrator Perspective Jim Wirth, CareWorks Consultants / RiskControl 360
  • 22.
    Introduction - Whatis the best way to control workers’ compensation costs?  Maintain a healthy, cooperative relationship with your associates where communication is open and encouraged  Safety/Prevention: Make safety a priority for your organization Create and promote a safety process that reduces the occurrence of incidents/accidents…and claims Involve all associates in your safety efforts
  • 23.
    Claims  Medical OnlyClaims: Usually a minor injury Claims with seven or fewer days of disability usually results in a small reserve for a limited period of time  Lost Time Claims: Claims with eight or more calendar days of disability Reserves can occur in lost-time claims  Occupational Disease Claims: Claims where an employee contracts a disease in the course of employment. These claims often develop over time
  • 24.
    Cost Control Tools Safety  Accident Investigation  Communication  Salary / Wage Continuation  Deductible  Vocational Rehabilitation  Transitional Work  Lump Sum Settlements  Handicap Reimbursement  Subrogation  BWC/Employer Sponsored IME  Surveillance  Work with Third Party Administrator (TPA) / Managed Care Organization (MCO)
  • 25.
    Accident Investigation  Communicatewith your CareWorks Consultants claims examiner as soon as the injury occurs  Report to the MCO  Thoroughly investigate the circumstances of the incident / accident  Document evidence in writing  Utilize accident report and photographs  Obtain witness statements  Utilize classes at BWC Training Centers  Important for PREVENTION…and hearings
  • 26.
    Salary Continuation  Shouldbe considered for any claim if eight or more calendar days of work will be missed, even if claim is not certified by employer  CareWorks Consultants can provide the employer with a premium impact study to help make a decision on whether salary continuation should occur
  • 27.
    Transitional Work  Reducescost of hiring and training replacements  Helps prevent injured worker’s adjustment to disability lifestyle  No break or loss in income  Gradually returns employee to full duty work  Lower costs contribute to reduced premiums  Works in conjunction with salary continuation  Consists of short term and temporary tasks
  • 28.
    Vocational Rehabilitation  Surpluscharge for most services  Return-to-work focused  Closely monitored, individualized programs  Case management professional assigned to each case.  Participation is voluntary…but make it an interesting and positive experience.
  • 29.
    Lump Sum Settlements CareWorks Consultants helps identify claims appropriate for Lump Sum Settlements (LSS) and determine settlement amount.  Employer directs CareWorks Consultants to offer settlement.  Employer, injured worker and BWC must agree to LSS.  BWC pays settlement.  Settlement will eliminate the reserve portion of the claim and prevent future payments.  Claim will remain in employer’s experience for four years.
  • 30.
    Handicap Reimbursement  Epilepsy Diabetes  Cardiac Disease  Arthritis  Loss of sight  Poliomyelitis  Cerebral palsy  Multiple sclerosis  Parkinson’s disease  Cerebral vascular accident  Tuberculosis  Silicosis  Psychoneurotic disability  Hemophilia  Amputation foot, leg, arm or hand  Chronic osteomyelitis  Ankylosis of joints  Hyperinsulinism  Muscular dystrophy  Arteriosclerosis  Thrombophlebitis  Varicose veins  Cardiovascular & pulmonary disease (firefighters)  Coal miner’s pneumoconiosis  Completion of Industrial Commission or similar rebab program  Service related disability
  • 31.
    Subrogation - Atype of third party recovery  Motor vehicle accident  Medical malpractice  Exposure to toxins  Machinery malfunctions  Animal bites BWC generally pursues
  • 32.
    Independent Medical Exams(IME)  BWC Independent Medical Examination - used to determine whether the injured worker is capable of returning to his/her former position of employment, or if the allowed conditions have become permanent.  Employer-sponsored IME / IMR (Independent Medical Review) - used to provide medical evidence in support of an employer’s objection to the claim allowance or compensation.  Fee for this exam/file review is paid by the employer.
  • 33.
    Surveillance  Employer hiresa private investigator if red flags exist that may point to fraudulent activity.  Employer contracts directly with the investigator.  If fraud is identified, it can be reported by calling BWC at 1-800-OHIOBWC or logging on to www.ohiobwc.gov  BWC generally does not allow a TPA to report fraud - it must be reported by the employer.
  • 34.
    Summary  Contact CareWorksConsultants and your MCO immediately when an accident occurs  Thoroughly investigate the accident  Document evidence in writing  Understand how a claim impacts your rates  Consider salary continuation on all lost-time claims  Offer transitional work when worker is on restrictions  Lump sum settlements / Handicap reimbursements  Subrogation
  • 35.
    BWC Prospective PremiumPayment Transition  The Ohio Bureau of Workers’ Compensation (BWC) is transitioning to a prospective billing system.  According to BWC, this change aligns them with standard industry practices.  Employers will see an overall base rate reduction of 2% as a result of this change.  The transition becomes effective July 1, 2015, for private employers, and January 1, 2016, for public employers.
  • 36.
    How it WillWork  Earlier opportunities to sign up for incentive programs Beginning in the fall of 2014, employers looking to participate in programs such as group rating, group-retrospective rating or other rating plans will have the opportunity to make those selections sooner.  A one-time credit in July 2015  Employer will receive a one-time premium credit, as BWC will cover their August premium payment (covering the January to June 2015 premium) as well as the first two months of 2015 policy year (July and August) prospective premium.
  • 37.
    How it WillWork (continued)  A new payment schedule Employers will receive their invoice in June 2015 and begin paying premiums before July 1, 2015. While that is earlier than before, all employers will be able to make quarterly or semi-annual payments, and some employers will be able to pay up to as many as 12 installments.  A true-up process Because BWC is providing workers’ compensation insurance coverage based on estimated payrolls, they will ask businesses to report or “true-up” their actual payroll for the prior policy year. This begins in August 2016.
  • 38.
    What to Expect Industry TPAs will be contacting employers to inform them of the changes. Be prepared to receive information from multiple TPAs.  It is important for employers to make sure they do not have a lapse in their workers’ compensation coverage.  Be sure you are current on all BWC payments.  June 2014 - BWC will mail letter to employers announcing change in alternative rating plan sign-up deadlines.  October 2014 - BWC will mail letters to employers to explain the upcoming premium payment changes and remind them about the new plan enrollment deadlines.
  • 39.
    Timeline  August 31,2014 - Payroll reports/premium due for 1/1/14 - 6/30/14 period (as normal)  November 24, 2014 - Group rating program filing deadline (tentative deadline for the 2015 policy year)  January 30, 2015 - Group retrospective rating program filing deadline (tentative deadline for the 2015 policy year)
  • 40.
    Timeline (continued)  February28, 2015 - Payroll reports/premium due for 7/1/14 - 12/31/14 period (final retrospective premium payment)  May 2015 - BWC will mail Estimated Premium Notice for 2015 policy year  Note: If the employer does not agree with estimation of payroll, BWC says they will be able to have it adjusted.
  • 41.
    Timeline (continued)  June2015 - BWC will mail payroll reports for 1/1/15 - 6/30/15 period. Employers will report payroll as normal, but will not be required to pay premium for this period. Payroll reports will be due as normal (8/31/15).  August 1, 2015 - BWC will mail first prospective premium invoice to employers for 7/1/15 - 6/30/16 policy year. First payment due 8/31/15, for the 2015 policy year only. Note: In August 2015, employers will send in their payroll report for 1/1/15 - 6/30/15 period along with their first prospective payment for the 2015 policy year.
  • 42.
    Timeline (continued)  November2015 - Group rating program filing deadline (tentative deadline for the 2016 policy year)  January 2016 - Group retrospective rating program filing deadline (tentative deadline for the 2016 policy year)
  • 43.
  • 44.
    Workers’ Compensation Best Practices: ManagedCare Organization (MCO) Perspective Derek Stern, CareWorks
  • 45.
     Safety  FlowChart  Role of the MCO  4 “R”’s  Transitional Work
  • 46.
    Safety should alwaysbe in the forefront. When there is a safety breakdown or the unforeseen occurs…injuries happen.
  • 47.
     Try toanticipate ANYTHING that could happen in the workplace.  If an injury does occur, have a process in place to ensure injured workers receive care and claims are reported immediately.  Work with your MCO, TPA and BWC.
  • 49.
     Claim intakeand reporting to BWC.  Ensure injured workers receive appropriate medical care.  Authorize or deny medical treatments requested by physicians.  Assist employers and injured workers with successful return to work.  Payment of medical bills (excluding prescriptions).  The MCO is a neutral party to the claim. Responsibilities of the MCO.
  • 50.
     Ensure injuredworkers and employers are aware of the latest progress in the claim.  Assist employer with the development of programs to enhance their workers compensation program (Transitional Work, Injury Reporting Packets).  Assist employer with identifying local initial treating providers.  Ensure medical documentation is transmitted to BWC. Responsibilities of the MCO
  • 51.
     Early Reportingis crucial.  Early investigation is important.  Collect facts and documentation. If You Have a Workplace Injury:  Early and effective medical management.  Early return to work management.  Lower claims costs. Early Reporting Leads to:
  • 52.
     Your ManagedCare Organization (MCO) can help establish good reporting practices.  MCO can provide injury reporting packets to assist with claims filing.  No one can help with a claim they don’t know about. Early Reporting Strategies
  • 53.
    Claim scenario: WITHearly reporting (Part I)  Date of Injury: 12-1-2011  Claim reported: 12-1-2011.  Employer, TPA and MCO discuss case. Determine if the claim is compensable.  Facts reveal claim not legit, employer decides to reject claim.  Claim goes to hearing and employer has claim denied by IC.  No impact on employer’s EM or premiums.
  • 54.
    Claim scenario: WITHearly reporting (Part II)  Date of Injury: 12-1-2011  Claim reported: 12-1-2011.  Employer, TPA and MCO discuss case. Determine if the claim is compensable.  Facts reveal claim IS compensable. Can we mitigate the claims cost?  TPA advises employer to continue salary. MCO and TPA discuss transition work options with employer.  Result: Compensable claim, but costs significantly reduced due to early intervention.
  • 55.
  • 56.
     Identifying aninitial treating provider.  Communication.  Set expectations.  Introduce the provider to the workplace.  Employers have the right to recommend a treatment facility to an injured worker.  Injured workers have right to select any provider.
  • 57.
     Keep intouch with the Injured Worker.  Contact your MCO/TPA/BWC claims rep if you have claim updates.  No such thing as too much information.
  • 58.
     Communication isvital to the success of your program.  If you are in doubt about anything, call your MCO Account Executive.  Don’t “assume” anything. Communication is Key.
  • 59.
     Defining TransitionalWork  How is it best used?  Transitional Work Best Practices  BWC’s Transitional WorkGrants
  • 60.
     A worksite program that provides an individualized step in the recovery of an injured associate with job restrictions resulting from the allowed conditions in their claim.  A successful transitional work program provides meaningful work which allows an injured worker to increase strength and endurance while decreasing restrictions.  Transitional work is not LIGHT DUTY!  Take advantage of BWC’s Transitional Work Grants. What is Transitional Work? Return to Work
  • 61.
     Aggressive returnto work program that assists employers in the temporary “job placement” of injured workers with temporary restrictions that cannot be accommodated onsite.  The goal of MDOS is to help facilitate a timely and safe return to work while realizing cost savings.  Employer Benefits  Employee Benefits  Non-profit Benefits Modified Duty Off Site (MDOS)
  • 62.
     MDOS programshould have an established positive outcome success rate.  Placements are made by an MDOS coordinator and managed by a Vocational Case Manager.  Programs are customized to each employer, including policy and program documentation. MDOS (continued)
  • 63.
    WITHOUT transitional work Medical = $2,500  Compensation = $5,000  Reserve = $25,000  Total cost = $32,500 Why Transitional Work?
  • 64.
    WITH transitional work Medical = $1,500 (vs. $2,500)  Compensation = $0 (vs. 5,000)  Reserve = $25,000*  Total cost = $26,500 *In general, utilizing transitional work can reduce the overall reserve in the claim Why Transitional Work?
  • 65.
     Call yourMCO and TPA immediately.  You’re going to pay them, or you’re going to pay them – it’s a matter of which pot it will come from.  Consider paying salary continuation (after first discussing with TPA).  Injured worker must not miss regular pay cycle.  Injured worker should receive regular pay. What to do if a Claim is Going to be Lost Time.
  • 66.
    An employer should neverfeel like they are alligator food. Your MCO can help you avoid the workers compensation “pit.”
  • 67.
    Thank you Derek Stern Directorof Customer Relations (734) 944-2193 direct (888) 627-7586 ext. 3554 toll free derek.stern@careworks.com www.careworksmco.com
  • 68.
    Keith L. Pryatel,Esq. Kastner Westman & Wilkins, LLC.
  • 69.
     National studyon HR Practices and Employee Turnover in the Restaurant Industry Jan. 15, 2014 Rockefeller & Ford Foundational Funding Studies show 1 of 2 fast food workers turnover each year; 40% turnover rate for “moderately priced” restaurants; lower rates for “fine dining”, but higher per- employee turnover costs
  • 70.
     Turnover costs-- $18,200/annual for 30 employees or less; $182,000 for 10 restaurant chain; $1.8 million for 100 restaurant chain  Most important HR practices that significantly reduce turnover and lengthen job tenure  high relative wages  job security  longer work hours  more discretion at work  policies for promotion from within
  • 71.
     Less than20% of restaurant employers offer any level of paid sick time or paid time off; only 33% offer vacations or subsidized health insurance even “fine dining” is low. 30% offer paid leave or PTO; 5% offer paid vacations or subsidized health insurance.  Employee discretion is low in all restaurant establishment. Only 5% allow front-of-house employee discretion in their communications with customers without consulting managers; or in problem solving.
  • 72.
     Annual payfor fast food employers:$13,257 ($255/52 weeks); $18,720 (back-of-house / BOH) and $24,123 (front-of-house / FOH) for “moderately priced restaurants”; $20,902 (BOH) and $34,990 (FOH) for fine dining.  Restaurant industry traditionally offers few employee benefits e.g. paid sick leave; paid time off; paid vacation; subsidized health insurance because: part-time; seasonal; student; immigrant workers
  • 73.
    High turnover iscostly; Raises curb of selecting, recruiting and training replacements New employees are less proficient until they catch up on the learning curve (less knowledgeable about menu - no customer relations) Disruption of operations - manager attention to other areas is shifted. How investment in HR reduces turnover
  • 74.
    Hourly wages andjob security are two most important factors. Hours available to work and discretion exercise are other important facts.
  • 75.
     PPE Survey Identifying workplace violence risks – cases / door markers / drop sales / windows  Disciplining for safety violations  HazComm Program  Lock Out / Tag out  Voluntary OSHA Log (300 and 300A) www.osha.gov
  • 76.
    Thank you! Keith L.Pryatel, Esq. kpryatel@kwwlaborlaw.com Kastner Westman & Wilkins, LLC. 3480 W. Market Street, Suite 300 Akron, OH 44333
  • 78.
    Social Media WebinarSeries sessions: Every Tuesday at 2:00 p.m.  July 1st Foursquare, Urban Spoon and Yelp - Time for a little R & R (Revenue and Reviews)  July 8th Instagram - Pics and Profits  July 15th Pinterest - Pin to Win  July 22nd Google + - Just Another Pretty Facebook?  July 29th Mobile apps - So Many Apps. So Little Time. Other RES events  August 6th - "Is Franchising the Right Choice?" 2:00 p.m. Go to www.ohiorestaurant.org/res NOW to register! Heartland Payment Systems is the Lead Sponsor of all RES events.

Editor's Notes

  • #9 poll launch between slides 8 & 9 Poll Question: My workplace has a strong safety culture.
  • #25 poll launch Poll Question: Do you know your Claims Examiner?
  • #57 90% of the time, an injured worker will seek medical treatment where directed by the employer
  • #60  TW is progressive in nature and provides meaningful work If employer is in Group Retro, they cannot get 10% discount BWC determines discount based on number of claims where they feel that the employer accommodated TW – seems subjective