csrma · mendoza, joey: carpinteria sanitary district 4/20/2010: mooney, stephen oro loma sanitary...

2013 agendas.xls 1 1/31/2013

CSRMA California Sanitation Risk Management Authority

c/o ALLIANT INSURANCE SERVICES Insurance License No.: 0C36861 100 Pine Street, 11th Floor, San Francisco, CA 94111 Tel: 415.403.1400 Fax: 415.402.0773

OFFICERS: PAST PRESIDENTS:Russ Baggerly, President Robert Reid805.646.5548 2006-2010Paul Bushee, Vice President Kevin Hardy760.753.0155 2003-2006

Date/Time: Thursday, February 7, 2013 LOCATION: Alliant Offices12:00 PM Lunch 100 Pine Street, 11th Floor1:00 PM Meeting San Francisco, CA 94111

A. CALL TO ORDER A=ActionI=Information

B. PUBLIC AND COMMITTEE MEMBER COMMENTS V=VerbalS=SeparateH = Handout

C. GENERAL ADMINISTRATION1. Meeting Minutes of October 25, 2012 A p. 42. Reporting and Ratification of Claims Settlements A/V

D. CLOSED SESSION TO DISCUSS PENDING CLAIMSAction may be taken per Government Code Section 54956.95. A

See Reverse for Full Listing of Claims to be Discussed

E. CLAIMS ADMINISTRATION1. Quarterly Claims Report as of December 31, 2012 I p. 102. Medical Provider Network Update I p. 113. Senate Bill 863 Update I p.124. Bill Review Savings Report for 2012 I p. 165. Claims Connect - Live Demo V p. 19

F. UNDERWRITING ISSUES1. Actuarial Study A p. 202. Program Year 24 Renewal Preliminary Expectations V

G. LOSS CONTROL1. Safety / Loss Control and Wellness Reimbursements I p. 272. FY 13/14 Risk Control Work Plan I p. 41

H. INFORMATION ITEMS1. Poem of the Day I p. 472. York - Listing of DWC Information and Assistance Offices I p. 483. York - Facts About Workers' Compensation (New Hire Pamphlet) I p. 494. Article - Return-To-Work Specialists - Doctors Not Providing Work Restrictions I p. 545. CSRMA 2013 Meeting Calendar I p. 566. CSRMA Organization Chart I p. 577. CSRMA Service Team I p. 58

I. ADJOURNMENT

WORKERS' COMPENSATION COMMITTEE AGENDA

Per Government Code section 54954.2, persons requesting disability-related modifications or accommodations, including auxiliary aids or services in

order to participate in the meeting, are requested to contact Alliant at (415) 403-1400 twenty-four hours in advance of the meeting. Entrance to the

meeting location requires routine provision of identification to building security. However, CSRMA does not require any member of the public to register

his or her name, or to provide other information, as a condition to attendance at any public meeting and will not inquire of building security concerning

information so provided. See Government Code section 54953.3.

The next meeting is scheduled for May 30, 2013

CSRMA - as of January 31, 2013INDEMNITY

Claimant Name Employer Date of InjuryBinder, Penny Central Contra Costa Sanitary 9/17/2007

Bitle, Shawn Central Contra Costa Sanitary 9/15/2006

Boede, Laurie Santa Margarita Water District 3/9/2011

Bouyett, Timothy Ventura Regional Sanitation Di 3/11/2010

Brown, Keith West Bay Sanitary District 11/10/2011

Canepa, Charles Vallejo Sanitation & Flood Con 3/15/2012

Godinez, Ignacio Ventura Regional Sanitation Di 9/6/2010

Herlihy, Thomas Union Sanitary District 12/14/2010

Ingemansson, Erik Novato Sanitary District 9/2/2010

Jones, Lorine South Bayside System Authority 10/5/2005

Kruger, Don Dublin San Ramon Services Dist 7/20/2011

McAbee, Curtis Novato Sanitary District 12/28/2007

Perez, Alvaro Montecito Sanitary District 8/3/2010

Roletto, Jeffrey Union Sanitary District 8/24/2011

Wood, Jean South Bayside System Authority 4/24/2006

FUTURE MEDICALClaimant Name Employer Date of Injury

Alsbury, Jay South Tahoe Public Utility Dis 5/5/2008

Armstrong, Albert West Valley Sanitation Distric 11/10/1998

Ayers, James Vallejo Sanitation & Flood Con 9/11/2002

Baker, Jacob Lake Arrowhead Community Servi 1/6/2005

Bamber, Gary West Valley Sanitation Distric 6/25/2004

Comito, Anthony Montecito Sanitary District 11/16/1995

Culbertson, Robert Union Sanitary District 3/15/2007

Diaz, Juan Union Sanitary District 4/17/2007

Dugan, Jodey Santa Margarita Water District 3/28/2007

Dvorak, Josef South Tahoe Public Utility Dis 10/11/2006

Grabowski, Mat Union Sanitary District 7/31/2008

Grubka, Steven Central Contra Costa Sanitary 9/18/2007

Hernandez, Ralph Delta Diablo Sanitation Distri 4/17/1997

Jenkins, David South East Regional Reclamatio 1/29/2001

Marin, James Union Sanitary District 11/1/1990

Mendoza, Joey Carpinteria Sanitary District 4/20/2010

Mooney, Stephen Oro Loma Sanitary District 12/14/1998

Moraida, Christopher South Tahoe Public Utility Dis 4/4/2005

Rigdon, Bud Union Sanitary District 8/3/1998

Rondoni, Michael South Tahoe Public Utility Dis 4/21/2004

Strickland, David South Tahoe Public Utility Dis 8/25/1998

Synsteby, Eric Monterey Regional Water Pollut 9/21/2000

Szabo, John Sewer Authority Mid-Coastside 4/16/2007

Thompson, Franklin Union Sanitary District 10/14/2000

Trapp, Gordon Pete Central Contra Costa Sanitary 11/19/2004

Wilhite, Randy Oro Loma Sanitary District 9/16/2002

Wood, Ron Lake Arrowhead Community Servi 5/13/1998

Youry, Timothy West County Wastewater Distric 5/21/2001

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G:\Share\CLIENT\jpa\CSRMA\Agenda\_Work Comp\2013\02.07.13\C.1 - WC Meeting Minutes of October 25 2012 - FINAL.doc

MINUTES OF THE WORKERS’ COMPENSATION COMMITTEE MEETING

OCTOBER 25, 2012 SAN FRANCISCO, CA

MEMBERS PRESENT Ms. Zoeanne Tafolla, Vallejo Sanitation and Flood Control District, Chair Mr. Jason Dow, Central Marin Sanitation Agency Mr. Dan Child, South Bayside System Authority Mr. Logan Olds, Victor Valley Wastewater Reclamation Authority Ms. Shari Deutsch, Central Contra Costa Sanitary District MEMBERS ABSENT Mr. Tom Selfridge, Truckee Sanitation District GUESTS AND CONSULTANTS PRESENT Mr. Seth Cole, Alliant Insurance Services, Inc. Mr. Dennis Mulqueeney, Alliant Insurance Services, Inc. Mr. P.J. Skarlanic, Alliant Insurance Services, Inc. Mr. David Patzer, Risk Management Solutions Ms. Heather Truro, HT Consulting Ms. Tamara Kneff, York Insurance Services, Inc. Ms. Tricia Kelley, York Insurance Services, Inc. Ms. Kelli Vitale-Carson, York Insurance Services, Inc. Ms. Sara Ramirez, York Insurance Services, Inc. Mr. Tim Farley, Farley Consulting Services [Via Teleconference] A. CALL TO ORDER The meeting was called to order by Chairperson Zoeanne Tafolla at 1:02 p.m. B. PUBLIC COMMENTS None. C. GENERAL ADMINISTRATION C.1. Meeting Minutes – May 31, 2012 The meeting minutes of May 31, 2012 were reviewed. A motion was made to accept the meeting minutes of May 31, 2012 as presented.

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C.1


MOTION: Logan Olds SECOND: Dan Child MOTION CARRIED C.2. Reporting and Ratification of Claims Settlements There were no claims needing ratification by the Committee at this time. C.3. Proposed 2013 Meeting Calendar The Committee reviewed the proposed 2013 Meeting Calendar. A motion was made to accept the 2013 Meeting Calendar as presented. MOTION: Logan Olds SECOND: Jason Dow MOTION CARRIED D. CLOSED SESSION TO DISCUSS PENDING CLAIMS The Committee entered Closed Session at 1:05 p.m. pursuant to Government Code Section 54956.95. The Committee left Closed Session at 1:24 p.m., at which time it was announced that the claims administrator was provided with direction concerning the disposition of certain claims; however, no final settlements were approved, nor was any action taken. E. CLAIMS ADMINISTRATION E.1. Quarterly Claims Report as of September 30, 2012 Seth Cole reviewed the Quarterly Claims Report with the Committee. This Report represents the first three months of the current program year. He reported that both frequency and severity are down, and that the program is performing well. E.2. Claims Audit – Time Certain Presentation 1:30 Tim Farley, from Farley Consulting Services, conducted a claims audit of York Insurance Services. He presented his audit findings to the Committee via teleconference. Tim reported that York Insurance Services claims administration performance exceeds industry averages. Tim discussed his observations and recommendations. Recommendations included more accurately setting case reserves on three specific claims, three separate claims lacked timely contact with the employee, and York failing to aggressively pursue the responsible party on one claim involving subrogation. York Insurance Services handed out a written response to address the recommendations made in the audit report and reviewed with the Committee. The Committee discussed York’s response and was satisfied that York had adequately addressed the recommendations made in the audit report.

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E.3. Policy & Procedure for Formatting Claims Summaries in Agendas Dennis Mulqueeney introduced this item to the Committee, and began by providing some background as outlined in the agenda item. He added that such a Policy & Procedure is desired as overtime, the format of the documents has changed based on the desires of Committee members at the time of their membership resulting in inconsistency of presentation, and therefore possible violation of rules governing transparency and privacy. A motion was made to approve the Draft Policy & Procedure, subject to the correct Government Codes being cited in the Draft, and recommend its approval by the Executive Board. MOTION: Logan Olds SECOND: Shari Deutsch MOTION CARRIED E.4. Discussion on SB 863 Heather Truro discussed this item with the Committee. She explained the nuances of SB 863, and the various ways in which it may, or may not, affect CSRMA. Many of the provisions will impact claims with dates of injury beginning 1/1/13 and some will be phased in at 7/1/13 and 1/1/2014. This legislation increases Permanent Disability benefits with the intent to offset these increases through decreases in other areas. The Permanent Disability benefits increases will impact CSRMA’s reserving, creating them to increase for 2013 claims. The cost offsets, on the other hand, may not have much of an impact on CSRMA’s claims. The Committee reviewed an e-mail written by Heather, with a more detailed interpretation of SB 863. The Committee was also provided with summary of the key provisions of bill prepared by York Insurance Services. The Committee discussed this issue, and more specifically, Heather’s concern regarding the potential increase in bureaucracy created by the new Independent Medical Review (IMR) system and increased regulation on MPNs. Heather believes this will mean more litigation over the next few years beginning in late 2013. Both Heather and York Insurance Services expressed their dedication to helping educate CSRMA as this issue develops. F. UNDERWRITING ISSUES F.1. WC Payroll Audit PY 22 P.J. Skarlanic reviewed the Policy Year 22 payroll audit with the Committee. Based on the audit results, members will either receive a return check or invoice for any additional deposit due. P.J. reported that $13,879 in additional deposits is due from the membership. Last year, $18,187 was due from the membership.

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G. LOSS CONTROL G.1. Safety/Loss Control and Wellness Reimbursements David Patzer reviewed this item with the Committee. The Committee reviewed the reimbursements to date for the current fiscal year, and felt that the reimbursements were legitimate and carried out the purpose of this program. G.2. Workers’ Compensation Excellence Awards David Patzer reviewed this item with the Committee. David reported that the CSRMA Workers’ Compensation Excellence Award program recognizes those members with the lowest frequency and severity rates, with an emphasis on severity, for the Program year ending June 30, 2012. David announced the winners: Small Agency: San Elijo Joint Powers Authority, Castro Valley Sanitary District, Sausalito-Marin City Sanitary District, Sanitary District #5 of Marin County and Stege Sanitary District. Medium Agency: Novato Sanitary District, Goleta Sanitary District, Central Marin Sanitation Agency and Napa Sanitation District. Large Agency: Tahoe Truckee Sanitary Agency and Fairfield Suisun Sewer District. The winners will be recognized at the January 2013 Board of Directors meeting. G.3. Annual Workers’ Compensation Loss Analysis Reports David Patzer reviewed an analysis of the prior years’ workers’ compensation claims with the Committee. David showed that claims incident rate has trended downward over the years, however CSRMA’s claims incident rate is still higher compared to most heavy labor industries such as construction, utility system construction, roofing contractors, etc. David used this comparison to illustrate that CSRMA has improved, but can still do better. Back injuries continue to be the most often injured body part across most worker classifications within CSRMA, and the most common nature of injury continues to be strain. The incident rates for back injuries and claims due to strain are trending downward. G.4. Fall/Winter Area Training Update David Patzer reviewed the upcoming area trainings for Fall/Winter with the Committee. The area trainings are included in the 2012/13 Risk Control training budget.

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G.5. Risk Control Work Plan 2013 David Patzer reviewed this item with the Committee. He reminded the Committee that last year the Risk Control Work Plan Sub-Committee was created at the suggestion of the Executive Board. The Sub-Committee was created to more efficiently shape the Risk Control Work Plan for the upcoming fiscal year. David explained that the role of the Risk Control Work Plan Sub-Committee is to suggest, discuss and review proposed risk control work plan items and make a recommendation to the Executive Board with the goal of gaining agreement on the Risk Control Work plan for the next fiscal year. David asked for volunteers for the Sub-Committee. Both Zoeanne Tafolla and Shari Deutsch expressed interest in volunteering. H. INFORMATION ITEMS H.1. Poem of the Day The Committee reviewed the poem. H.2. Notice – “York – Important Notice Regarding CA Electronic Billing” The Committee reviewed the notice. H.3. Article - “Studies find new evidence of obesity-related risk” The Committee reviewed the article. H.4. Article - “Reassignment – Is it required for Reasonable Accommodation?” The Committee reviewed the article. H.5. Article - “Breast Pumps and the Workplace – The Risks Employers Must Know” The Committee reviewed the article. H.6. Committee Member Comments No comments were made. H.7. CSRMA 2012 Meeting Calendar The Committee reviewed the meeting calendar. H.8. CSRMA Organizational Chart

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The Committee reviewed the organizational chart. H.9. CSRMA Service Team The Committee reviewed the service team chart. I. ADJOURNMENT The meeting was adjourned at 3:08 p.m.

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G:\Share\CLIENT\jpa\CSRMA\Workers Comp\lossrun\2012 12 31 Losss Reports - WC\wcqtr 12_31_12 - Draft

WORKERS' COMPENSATION PROGRAMQuarterly Claims Reportas of December 31, 2012

PY 1-15 PY 16 PY 17 PY 18 PY 19 PY 20 PY 21 PY 22 PY23 Program ProgramYears 2005/06 2006/07 2007/08 2008/09 2009/10 2010/11 2011/12 2012/13 Average Average

Program Year Prior 7/1/05-06 7/1/06-07 7/1/07-08 7/1/08-09 7/1/09-10 7/1/10-11 7/1/11-12 7/1/12-13 Over 5 yrs Over 23 yrs

Number of Members N/A 40 42 42 42 43 43 43 43 43 N/A

Total Number of Claims 2,654 142 160 143 168 168 161 140 67 141 173

Earned Premiums 30,206,721 3,995,000 2,814,000 2,118,530 2,458,322 2,650,774 2,814,041 2,841,462 1,547,902 2,462,500 2,338,489

Paid Indemnity, Medical, & Rehab 21,449,927 1,260,650 2,052,194 1,193,003 1,192,025 921,117 1,106,979 891,104 47,101 831,665 1,368,823

Paid Expenses 2,536,068 75,704 285,267 64,316 212,709 132,596 166,962 93,108 8,831 122,841 162,525

Reserved Indemnity, Medical, & Rehab 1,211,841 380,880 431,787 360,615 345,540 495,342 569,425 1,360,182 116,727 577,443 239,652

Reserved Expenses 186,681 30,324 66,033 62,097 55,533 102,481 108,846 232,924 37,949 107,547 40,130

Total Incurred 25,384,518 1,747,558 2,835,281 1,680,030 1,805,807 1,651,536 1,952,212 2,577,318 210,608 1,639,496 1,811,130

Total Incurred Less ALAE 22,661,769 1,641,530 2,483,981 1,553,618 1,537,565 1,416,459 1,676,404 2,251,287 163,828 1,409,109 1,608,475

CSRMA (Loss Ratio) Total Incurred Less ALAE / Earned Premium (%) 75 41 88 73 63 53 60 79 11 53 69

0

20

40

60

80

100

120

Prior 7/1/05-06 7/1/06-07 7/1/07-08 7/1/08-09 7/1/09-10 7/1/10-11 7/1/11-12 7/1/12-13

Percentages

Workers' Compensation Loss Ratios

CSRMA (Loss Ratio) Total Incurred Less ALAE / Earned Premium (%) Program Avg. Over Years

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Agenda Item No. E2 Workers’ Compensation Committee Meeting

Meeting Date: February 7, 2013

Medical Provider Network Update

ISSUE: Professional Dynamics, Inc. (PDI) manages the CSRMA Medical Provider Network (MPN). Recently, member agencies have experienced some minor difficulties with the MPN. The Program Administrators and Heather Truro are working with PDI to resolve these issues, however, felt it important to alert the Committee to some of the difficulties experienced. A verbal update with be provided at the meeting. RECOMMENDATION: None, information only. FISCAL IMPACT: Unknown. BACKGROUND: CSRMA created an MPN for members of the Worker’s Compensation Program. An MPN is an entity or group of health care providers set up by an insurer or self-insured employer and approved by DWC's administrative director to treat workers injured on the job. The MPN was launched on March 1, 2006. Participation is voluntary. Currently 18 member agencies participate in the MPN. The contract with Professional Dynamics Inc. to provide Medical Provider Network Management Services will expire on July 1, 2013. The contract with PDI contains a provision that it be renewed annually for one additional 12-month term, unless notice of intent not to renew is given in writing, by either party, thirty (30) days prior to the renewal date. ATTACHMENTS: None.

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Agenda Item No. E3

Workers’ Compensation Committee Meeting Meeting Date: February 7, 2013

Senate Bill 863 Update ISSUE: The Governor signed into law new workers’ compensation reforms (SB 863) effective January 1, 2013. A brief overview of SB 863 was provided to the Committee at its October 2012 meeting. Heather Truro, CSRMA’s Return to Work Coordinator and Claims Advocate, recently authored an article on SB 863 for the CSRMA Did You Know Newsletter, which is attached to this item for the Committee’s review. The article provides a brief summary of the changes in the Workers’ Compensation Laws. Heather will discuss in more detail at the meeting. RECOMMENDATION: None, information only. FISCAL IMPACT: Unknown. BACKGROUND: None. ATTACHMENTS: “Workers’ Compensation Reform Bigger and Better/Worse (?) Than Before!” Article by Heather Truro.

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Workers’ Compensation Reform Bigger and Better/Worse (?) Than Before! With workers’ compensation costs rising and benefits to injured workers decreasing the legislature had to take action in an attempt to correct this situation. SB863, the most substantial WC reform in decades, was passed on September 18, 2012.

This is complex package of laws with some portions going into effect now while others will take effect over the next year. Regulations have to be written in order to implement these new laws and procedures. Some emergency regulations went into effect on 1/1/13 while others will be drafted over the next year. Thus, you will see changes continuing to take place through out 2013 and beyond. Rest assured that your claims administrator and CSRMA will keep you abreast of the changes that will affect you, as they develop.

Here is a brief summary of the changes in the Workers’ Compensation Laws. Changes Effective 1/1/13 that Require Employer Action New Hires: Employers are required to provide information about WC to all new hires at the time of hire or by the first paycheck. Due to the changes in the law, this form has been revised as of 1/1/13. The form approved by the Administrative Director is called “The Facts About Workers’ Compensation”. Copies can be obtained from York Insurance Services at 1-866-221-2402. You should replace all old copies in your CSRMA New Hire Packets and CSRMA Initial Injury Packets with the newly revised 1/1/13 version. Reminders for Employers Posting Notices: CA requires employers to post a Workers’ Compensation Posting notice for all employees in each location. This poster is also known as the DWC7. It has not changed since 6/2010 but revisions are expected later this year. To obtain a copy you may access the DWC website at http://www.dir.ca.gov/dwc/NoticePoster.pdf. or you can request them from York Insurance services at 1-866-221-2402. Whether you use this one or a large “All-in-One” employment poster (such as is issued by CalChamber), be sure to read the poster because there are blanks that need to be filled in, including the contact information for the nearest CA State Information & Assistance (I&A) office. To find out which office is closest to your location you may contact 1-800-736-7401. MPN – Medical Provider Network: CSRMA provides its member agencies with the option of joining the CSRMA MPN as a way to control WC costs and improve efficiencies. The changes in the legislation effecting MPNs will take effect in 2014. We are currently waiting for regulations to be adopted by the State of

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http://www.dir.ca.gov/dwc/NoticePoster.pdf�

California. Please be reminded that if your agency participates in the CSRMA MPN, then you must keep a copy of your Initial Notification Letter to Employees posted next to the WC Posting Notice and complete the corresponding blanks on the Posting Notice pertaining to the MPN. If you have any questions regarding the MPN, please contact Heather Truro, CSRMA WC/Return to Work Advisor, at [email protected] or 925-922-0305. General Changes in Regulations Lien Filing regulations – Filing fees and more regulations are being put into place to limit frivolous liens which have been costly and slowed down the WC court system. Fee Schedule for Hospital Outpatient and Ambulatory Surgical Centers – Limits/controls costs which had not been covered in other fee schedules. Independent Bill Review (IBR) – A new system has been created to resolve billing disputes in an attempt to keep liens from being filed and clogging up the WC court system. Independent Medical Review (IMR) - A new system has been created to resolve treatment disputes in an attempt to keep medical decisions out of the courts an in a medical dispute resolution system and to avoid unnecessary liens from being filed and clogging up the WC court system. In-patient Hospital Fee Schedule – Further limits/controls costs which had not been covered in other fee schedules. Interpreter Certification Regulation - Limits/controls costs associated with interpreter fees. Changes in Permanent Disability – Increases the pay out to injured workers for Permanent Impairments on a graduated basis over 2013 – 2014. Changes to Supplemental Job Displacement Vouchers – The voucher has been changed from a sliding scale of $4,000 - $10,000 to a fixed $6,000, to be paid earlier in the claim, can not be settled for a cash value, and it will carry a two-year expiration date. Creation of "Return to Work Fund" - SB 863 - $120 million per year “Return-to-Work Fund,” will be established and administered by the Dept. of Industrial Relations (DIR) for injured workers whose permanent disability ratings are disproportionately low in comparison to their wage loss. Eligibility for the benefits and the specifics of how the fund will be administered are yet to be developed by the DIR. Changes for Self-Insured Employers – This mostly affects private self-insurers. However, Self-insured public entities’ annual reporting requirements have been strengthened, and the CHSWC is now required to perform a study of the self-insured public entity program and make preliminary recommendations to improve the program by Oct. 1, 2013.

An excellent summary of these changes can be found at the DWC website at: http://www.dir.ca.gov/dwc/SB863/SB863_Overview.htm.

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mailto:[email protected]�

http://www.dir.ca.gov/dwc/SB863/SB863_Overview.htm#1�



http://www.leginfo.ca.gov/pub/11-12/bill/sen/sb_0851-0900/sb_863_bill_20120919_chaptered.html�


http://www.dir.ca.gov/dwc/SB863/SB863_Overview.htm�

The full effect of this legislation remains to be seen. As changes and corresponding regulations unfold, we will start to see the impact on claims handling, litigation strategy, and workers compensation costs. If the intent is fulfilled the overall cost of workers’ compensation will not rise and the legitimately injured workers will receive a greater part of each workers’ compensation dollar. We remain cautiously optimistic.

By Heather E. Truro 1/2013

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Bill Review Savings Report for 2012

ISSUE: The Program Administrators directed York Insurance Services to provide yearly reports on the savings realized by CSRMA through the Bill Review process. The Bill Review Savings Report for 2012 is attached to this item for the Committee’s review. York has also provided a litigation report, the summary of which is attached for the Committee’s review. RECOMMENDATION: None. FISCAL IMPACT: None. BACKGROUND: None. ATTACHMENTS: 1) 2012 Bill Review Report 2) 2012 Litigation Report Summary

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York Insurance ServicesP.O. Box 619058 Roseville, CA 95661-9058

Client Performance

1/28/2013 9:35:01 AM 1 of 1

3883 $4,207,624.74 $3,260,897.86 77.49 % 2349 60.49 % $37,741.15 3.98 % $3,298,639.01 $37,705.50 $5,661.59 $43,367.09 $3,255,271.92

78.39 % 77.36 %

C.S.R.M.A. W/C

Date Range: 1/1/2012 - 12/31/2012

Client # Bill(s) Billed Charges B. R. Savings %BR Savings

PPO Hits % PPO Hits

PPO Savings % PPO Savings

Total Savings BR Fees PPO Fees Total Fees Total Net Savings

Gross %Savings

Net % Savings

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CSRMA Workers Compensation Program2012 Litigaton Report Summary

Valued as of 6/30 of Each Fiscal Year

G:\Share\CLIENT\jpa\CSRMA\Agenda\_Work Comp\2013\02.07.13\E.4.b - Litigation Report Summary.xls

Total Reported

Claims

Total Litigated Claims

Annual Litigation

Rate2004 - 05 157 14 9%2005 - 06 139 9 6%2006 - 07 150 15 10%2007 - 08 139 11 8%2008 - 09 167 13 8%2009 - 10 160 6 4%2010 - 11 163 13 8%2011 - 12 143 12 8%

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G:\Share\CLIENT\jpa\CSRMA\Agenda\_Work Comp\2013\02.07.13\E.5 - Claims Connect - Live Demo.doc



Claims Connect – Live Demonstration

ISSUE: At their last meeting, the Committee requested that York Insurance Services provide a live demonstration of their Claims Management program, “Claims Connect”. York will be providing a demonstration at the meeting to provide the Committee with insight and a better understanding of how the claims management process is documented and maintained on Claims Connect. RECOMMENDATION: None. FISCAL IMPACT: None. BACKGROUND: None. ATTACHMENTS: None.

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G:\Share\CLIENT\jpa\CSRMA\Agenda\_Work Comp\2013\02.07.13\F.1 - Actuarial Study 2013.doc

Agenda Item No. F1 Workers’ Compensation Committee Meeting


Actuarial Study ISSUE: The actuarial study for the workers’ compensation program will be performed prior to the 7/1/13 renewal of the program. The actuarial report is used to re-evaluate past projections with current loss data and to project future payment patterns to determine rates. Towers Watson has provided a proposal to perform this year’s actuarial study. Included in the study the actuary will provide an overview of California’s workers’ compensation environment and examine CSRMA’s experience in relation to the industry’s experience as part of their presentation with additional commentary this year on sanitation-specific industry insured experience and loss costs. RECOMMENDATION: The Program Administrators are recommending that the Workers’ Compensation Committee engage Towers Watson to perform the 2013 Actuarial Study at a cost of $31,800. FISCAL IMPACT: $32,754 is budgeted for FY 2012/13. The cost of the actuarial study as proposed is $31,800. There is no increase in fee this year. BACKGROUND: The actuarial study assists the workers’ compensation program in the following areas:

1. Analyzing whether prior pool deposits are sufficient to cover known and unknown liabilities for expired program years.

2. Setting adequate rates for future years in order to fund for future unknown loss

amounts.

3. Calculating retrospective returns/assessments, updating the matrix, completing the financial audit and determining potential for dividend declaration.

Major components of workers’ compensation funding for each Program Year is as follows:

1. Ultimate Net Loss Value – Actuarial projection of the amount necessary to fund claim payments arising out of program years. If prior program years are being analyzed, claims paid and reserved are subtracted from Ultimate Net Loss to determine “Incurred But Not Reported” (IBNR) claims for that year. If it is an upcoming Program Year being analyzed, the entire Ultimate Net Loss is considered IBNR until such time that claims begin occurring.

2. Administrative Expense – The figure includes costs for the Excess Workers’

Compensation policy, the Annual Fee, and the Pool Deposit Fee.

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CSRMA attempts to fund the Workers’ Compensation Program to a 70% confidence level, which the actuarial study accounts for. In theory, a program funded to this confidence level will be adequately funded 7 years out of 10 years. Towers Watson conducted the last actuarial study in 2012. ATTACHMENTS: Towers Watson Proposal.

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Agenda Item: G1

Workers’ Compensation Committee Meeting Meeting Date: February 7, 2013

Safety/Loss Control and Wellness Reimbursements ISSUE: In order to help expedite processing of reimbursement requests, the CSRMA Executive Board gave staff direction to review and appropriately process reimbursement requests and then present a summary of the reimbursement requests and action taken to the Workers’ Compensation Committee at each meeting. RECOMMENDATION: Review the attached reimbursement request summary and discuss. FISCAL IMPACT: Both reimbursement programs have been included in the current fiscal years’ risk control budget. BACKGROUND: CSRMA has a history of wishing to reward those members who invest in controlling their risk. In the Workers’ Compensation Pool, CSRMA rewards top performers with the Safety Superstar Award and CSRMA recognizes top performers in both the Workers’ Compensation and Liability pools with the Loss Control Program of the Year award. The 2012/13 Risk Control Budget was approved with funding for two risk control incentive programs similar to what other pools offer their membership. The two incentive programs are described on the next page. ATTACHMENTS: 1. Current Risk Control Reimbursement Program Summary 2. Current Employee Health Promotion Reimbursement Program Summary

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Summary of Approved Wellness Requests 2009-To Date Category Description

Training CPR training session: Based on recent changes in emergency procedures adopted by AHA; certs good for 2yrs; provides staff knowledge/skills to administer first aid.

Service Hearing tests: Tests establish baseline data that will be used to determine any hearing loss induced by excessive industrial noise in the future. Consulting/ Equipment

Ergo Evaluations: After recent remodel, staff voiced concerns about work environment. Based on CSRMA recommendation, consultant hired for ergo eval. Based on ergo eval, various equipment purchased.

Equipment/ Consulting

HVAC enhancements: After recent remodel, staff voiced concerns about work environment. Based on CSRMA recommendation, consultant hired for ergo eval. Based on ergo eval, modification of new staff space was made.

Prog Mgt District Wellness Program (one monthly fee 12/09): provides an annual health fitness appraisal, health screening, & health education to promote a healthier lifestyle for EEs.

Prog Mgt District Wellness Program (one monthly fee 11/09): provides an annual health fitness appraisal, health screening, & health education to promote a healthier lifestyle for EEs.

Equipment Ergonomic Aids (arms/boards): Ergonomic aids for employees based on ergo evaluation; to minimize exposure employee to ergo hazards. Equipment Ergonomic Aids (fatigue mat): Ergonomic aids for employees based on ergo evaluation; to minimize exposure employee to ergo hazards. Equipment Elliptical exercise machine: allows staff to tone and strengthen muscles and improve endurance. Equipment Waterproof parkas/pants: Previous items were not durable & replaced on regular basis, tearing easily & possibly causing slip/trip hazard. New gear

is much more durable, lasts longer. Equipment Worker Trike: To aid District personnel by providing on-the-job low impact aerobic activity.

Service Fitness Professional Services: Implement customized stretch and fitness program for employees. Service Fitness Professional Services: Implement customized stretch and fitness program for employees. Service Fitness Professional Services: Implement customized stretch and fitness program for employees.

Equipment Exercise equipment: Improves employee movement, flexibility, reduces impacts on joints, minimizes fatigue, cardio effects. Service Physical Fitness Program reimbursement: District financially contributes to employee health club membership to encourage physical fitness,

addresses contributing factors of injuries. Consulting/ Prog

Mgt Updating wellness guidelines requirements: Ensuring that wellness requirements are current with current medical recommendations & ensuring cost effectiveness of the plan.

Other Healthy lunch snacks for Wellness Workshops: Shows employees healthy foods can still taste good! Prog Mgt Walk Fit Campaign: Misc prizes, drinks, food items to support Walk Fit Campaign for district.

Equipment Strengthening Machine and Free Weights: Increases full body strength and flexibility/stamina of employees Consulting Ergonomic Evaluation: Help reduce work injuries, makes District employees more aware of work environment. Training/ Service/

Consulting

EAP Program: provides brown bag trainings for employees and phone consultation for health&wellness topics.

Prog Dev Development of Wellness Program: Plan involves Dr. assisting EE with establishing & maintaining a Disease Mgt Program; designed for weight/loss mgt, controlling cholesterol, BP control, preventing/controlling diabetes.

Service/ Training

Ergo training/consulting: Work stations evaluated to make sure everyone was ergonomically correct. Monitors were adjusted and chairs ordered.

28

Summary of Approved Wellness Requests 2009-To Date Category Description

Service/ Training

Injury Prevention Classes: Class on proper lifting, pushing and pulling body mechanics; to prevent common injuries.

Service Employee Assistance Program: helps employees cope with a variety of problems (emotional, work-life stress), provides periodic wellness workshops.

Equipment Treadmill: encourages District's wellness program. Equipment Bicycles: for "Ride Don't Drive" program; for employee use to provide opportunities for exercise that staff may not have during a typical work day.

Consulting/Prog. Mgt.

Program: Provide wellness program and Health Fair for employees

Equipment Exercise Equipment: improves employee movement, flexibility, cardio, reduces joint impact, minimizes fatigue Equipment Treadmill

Service Wellness Program consulting services Consulting Consultant: staff work station ergonomic evaluations to prevent injuries due to posture Equipment Equipment: items recommended from ergo evaluations, including footrests, risers, doc holders, etc. to improved posture and prevent injuries.

Other Safety incentive pay to employees for accident free time. Prog Mgt/ Equipment

Equipment/Prog Mgt: Free weights and P90X workout video for employee use; preventive evaluations conducted for employees.

Service Service: Hired Fitness Professional Services to manage and monitor district flexibility and strengthening program that employee’s participate in daily.

Other Reimbursement of gym membership for participating employees. Other Reimbursement of gym membership for employees.

Equipment Equipment: bicycle rack, canopy for bicycles, pedometers to encourage employees to ride bikes to work and participate in district fitness program. Equipment Equipment: dumbbell set, exercise mats, resistance bands to enhance district's current workout routine and encourage those who prefer to use flor

exercise and lighter workout regimens. Equipment Equipment: Noise Dosimeter to give district noise exposure date to help protect the hearing health of staff, test new equipment and monitor existing

equipment for noise exposure limits to staff. Prog Mgt Prog Mgt: Incentive-based wellness program which records total hours/week that each participating employee does recreational activities; awards

are monetary prices spent on wellness related gifts. Equipment Equipment: chairs and office workstation equipment based on ergo assessment; allows employees to properly adjust their workstations based on

ergo assessment, reducing potential for MSDs. Equipment Equip: Pedometers to help incentivize healthy exercises by sponsoring pedometer races, challenges employees to walk a predetermined distance,

introduces a safe and economical means of exercise. Training Training: Onsite workshop/seminar for employees; to bring awareness to employees on nutrition and fitness.

Equipment Equip: misc exercise equipment(jump ropes, yoga accessories, bands, dvds) to help employees improve their overall health (movement, flexibility, cardio, reduce joint impact, minimize fatigue); help in fight against obesity.

Prog Mgt Prog Mgt: Health Screening as an incentive-based program; health screen benchmarks helps employees understand their current health status and set goals to achieve better health; incentives are gift cards from pre-approved vendors.

Prog Mgt Prog Mgt: Reimburse unrepresented employee expense on fitness club fees; club membership encourages employees to be fit and healthy. Prog Mgt Prog Mgt: On-site employee flu shots; having shots available on-site increase likelihood that employees will get these inoculations that are

important to the health.

29

Summary of Approved Wellness Requests 2009-To Date Category Description Prog Mgt Prog Mgt: Health Fair; 1/2 day fair sponsored by District, all employees attend, included 1hr mandatory training, 11 outside health vendors,

evaluations and health info distributed. Service/Other Service: Ergonomic evaluations for employees. NOTE: Item received after CSRMA 2011 Audit so reimbursement approved for FY2012.

Equipment Equipment: ergo equipment for employees as recommended by the ergo evaluations. NOTE: Item received after CSRMA 2011 Audit so reimbursement approved for FY2012.

Equipment Equipment: elliptical machine for employee use in fitness training to improve full body strength, flexibility and stamina. NOTE: Item received after CSRMA 2011 Audit so reimbursement approved for FY2012.

Equipment Equipment: ergonomic adjustable desk chair for safety specialist, per ergonomic evaluation Equipment Equipment: ergonomic chairs for employees to improve health and prevent MSD while sitting and working as desk.

Other Reimbursement for employee gym membership; provides an incentive for the employee to live a healthy lifestyle outside of work. Equipment Equipment/Training: Pedometers and upper arm blood pressure monitors; encourages employees to walk and monitor their daily steps and blood

pressures. Equipment Equipment: ergonomic adjustable desk chair for safety specialist, per ergonomic evaluation Prog Mgnt/ Equipment

Prog Mgt/Equipment: John Muir Health provides ongoing education, testing and programs to benefit employees and encourage health/fitness; pedometers encourage employees to participatein a step-walking program.

Prog Mgnt Prog Mgt: Speaker/trainer for District's Health Improvement Program Equip/ Training Equipment/Training: 32" LED TV and DVD player to replace old TV/VHS equipment to watch CSRMA training dvds.

2010-2011 Wellness Reimbursement Requests AGENCY/ ATTN:

PY Form Submittal

Date

Amount Approve/ Reject -

Date

Approved Total $$

Category Description

Napa Sanitation District 2011 7/28/10 $1,200.00 8/11/10 $1,200.00 Prog Mgt Fitness Program - NSD reimburses employee's fitness club fees in accordance with NSD policy.

Valley Sanitary District 2011 9/20/10 $1,200.00 9/30/10 $1,200.00 Prog Dev Development of Wellness Program: Plan involves Dr. assisting EE with establishing & maintaining a Disease Mgt Program; designed for weight/loss mgt, controlling cholesterol, BP control, preventing/controlling diabetes.

Oro Lomo Sanitary District ATTN: Anna Turon

2011 11/19/10 $2,732.03 Approved 12/30/10

$1,200.00 Equipment Exercise Equipment: improves employee movement, flexibility, cardio, reduces joint impact, minimizes fatigue

Ross Valley Sanitary District ATTN: Danielle McPherson

2011 12/9/10 $8,700.00 12/9/10 Denied

(not applicable

to Wellness)

$0.00 Consulting Consultant: assistance with LOTO program, Equipment SOPs for pump stations

30


PY Form Submittal

Date


Date

Approved Total $$


Delta Diablo Saniation District ATTN: Steve Laren

2011 11/27/10 $1,312.50 Approved 12/30/10

$1,200.00 Prog Mgt Program: Provide wellness program and Health Fair for employees

South Bayside System Authority ATTN: Donna Allen

2011 11/30/10 $3,793.91 Approved 12/30/10

$1,200.00 Prog Dev Bicycles: for "Ride Don't Drive" program; for employee use to provide opportunities for exercise that staff may not have during a typical work day.

South Taho PUD ATTN: Nancy Hussman

2011 3/22/11 $605.98 Approved 4/13/11

$605.98 Prog Dev Program: breakfast items and consultant fee for STPUD's monthly Wellness Class (June was nutrition and stress management), part of their Wellness Program

Ironhouse Sanitary District ATTN: Dave Smith

2011 3/14/11 $1,065.17 Approved 4/13/11

$1,065.17 Equipment Exercise Equipment: treadmill for employees

Encina Wastewater Authorty ATTN: Jimmy Kearns

2011 4/25/11 $300.00 Approved 6/16/11

$300.00 Consulting Consultant: staff work station ergonomic evaluations to prevent injuries due to posture

Encina Wastewater Authorty ATTN: Jimmy Kearns

2011 4/27/11 $1,033.24 Approved 6/16/11

$900.00 Equipment Equipment: items recommended from ergo evaluations, including footrests, risers, doc holders, etc. to improved posture and prevent injuries.

Napa Sanitation District ATTN: Cheryl Schuh

2011 4/25/11 $2,717.94 Approved 6/16/11

$1,200.00 Other Safety incentive payto employees for accident free time.

Fairfield Suisun Sewer District ATTN: Rich Sponholz

2011 6/8/11 $1,178.51 Approved 6/16/11

$1,178.51 Prog Mgt/ Equipment

Equipment/Prog Mgt: Free weights and P90X workout video for employee use; preventive evaluations conducted for employees.

Ojai Valley Sanitary District ATTN: Brenda Krout

2011 5/26/11 $1,214.25 Approved 6/16/11

$1,200.00 Service Service: Hired Fitness Professional Services to manage and monitor district flexibility and strengthening program that employees participte in daily.


2011 5/19/11 $1,180.00 Approved 6/16/11

$1,180.00 Other Reimbursement of gym membership for participating employees.

Sewer Authority Mid-Coastside ATTN: Jeannette Tracy

2011 6/14/11 $1,200.00 Approved 6/16/11

$1,200.00 Other Reimbursement of gym membership for employees.

Novato Sanitary District ATTN: Julie Borda

2011 6/2/11 $1,333.29 Approved 6/16/11

$1,200.00 Equipment Equipment: bicycle rack, canopy for bicycles, pedometers to encourage employees to ride bikes to work and participate in district fitness program.

West Valley Sanitation District ATTN: Ed Oyama

2011 5/18/11 $1,294.75 Approved 6/16/11

$1,200.00 Equipment Equipment: dumbbell set, exercise mats, resistance bands to enhance district's current workout routine and encourage those who prefer to use flor exercise and lighter workout regimens.

31


PY Form Submittal

Date


Date

Approved Total $$


Truckee Sanitary District ATTN: Denny Anderson

2011 6/21/11 $2,946.16 Approved 6/22/11

$1,200.00 Equipment Equipment: Noise Dosimeter to give district noise exposure date to help protect the hearing health of staff, test new equipment and monitor existing equipment for noise exposure limits to staff.

Carmel Area Wastwater District ATTN: Richard Mellinger

2011 6/28/11 $550.00 Approved 6/29/11

$550.00 Prog Mgt Prog Mgt: Incentive-based wellness program which records total hours/week that each participating employee does recreational activities; awards are monetary prices spent on wellness related gifts.

Central Marin Sanitation Agency ATTN: Dale Thrasher

2011 6/28/11 $1,200.00 Approved 7/5/11

$1,200.00 Equipment Equipment: chairs and office workstation equipment based on ergo assessment; allows employees to properly adjust their workstations based on ergo assessment, reducing potential for MSDs.

San Eljo JPA ATTN: Marisa Buckles

2011 6/28/11 $429.80 Approved 7/5/11

$429.80 Equipment Equip: Pedometers to help incentivize healthy exercises by sponsoring pedometer races, challenges employees to walk a predetermined distance, introduces a safe and economical means of exercise.


2011 6/28/11 $275.00 Approved 7/5/11

$275.00 Training Training: Onsite workshop/seminar for employees; to bring awareness to employees on nutrition and fitness.


2011 6/28/11 $260.10 Approved 7/5/11

$260.10 Equipment Equip: misc exercise equipment(jump ropes, yoga accessories, bands, dvds) to help employees improve their overall health (movement, flexibility, cardio, reduce joint impact, minimize fatigue); help in fight against obesity.


2011 6/28/11 $75.00 Approved 7/5/11

$75.00 Prog Mgt Prog Mgt: Health Screening as an incentive-based program; health screen benchmarks helps employees understand their current health status and set goals to achieve better health; incentives are gift cards from pre-approved vendors.

West County Wastewater District ATTN: Lisa Adamson

2011 6/27/11 $684.99 Partial Approved

7/5/11 (max $

reached)

$450.00 Prog Mgt Prog Mgt: Reimburse unrepresented employee expense on fitness club fees; club membership encourages employees to be fit and healthy.


2011 6/27/11 $750.00 Approved 7/5/11

$750.00 Prog Mgt Prog Mgt: On-site employee flu shots; having shots available on-site increase likelihood that employees will get these inoculations that are important to the health.

Vallejo Sanitation and Flood CD ATTN: Zoeanne Tafolla

2011 6/28/11 $1,212.95 Approved 7/5/11

$1,200.00 Prog Mgt Prog Mgt: Health Fair; 1/2 day fair sponsored by District, all employees attend, included 1hr mandatory training, 11 outside health vendors, evaluations and health info distributed.

Dublin San Ramon SD ATTN: Jessica

2012 7/18/11 $1,080.00 Approved 8/15/11

$1,080.00 Service/Other Service: Ergonomic evaluations for employees. NOTE: Item received after CSRMA 2011 Audit so reimbursement

32


PY Form Submittal

Date


Date

Approved Total $$


Rodriguez approved for FY2012.

Dublin San Ramon SD ATTN: Jessica Rodriguez

2012 7/18/11 $543.29 Approved 8/15/11

$120.00 Equipment Equipment: ergo equipment for employees as recommended by the ergo evaluations. NOTE: Item received after CSRMA 2011 Audit so reimbursement approved for FY2012.

Stege Sanitary District ATTN: Kary Richardson

2012 7/21/11 $941.58 Approved 8/15/11

$941.58 Equipment Equipment: elliptical machine for employee use in fitness training to improve full body strength, flexibility and stamina. NOTE: Item received after CSRMA 2011 Audit so reimbursement approved for FY2012.

Carpinteria Sanitary District ATTN: Jan Deering

2012 12/21/11 $453.47 Approved 1/9/12

$453.47 Equipment Equipment: ergonomic adjustable desk chair for safety specialist, per ergonomic evaluation

Oro Loma Sanitary District ATTN: Larry Olivan

2012 12/9/11 $1,544.25 Approved 1/9/12

$1,200.00 Equipment Equipment: ergonomic chairs for employees to improve health and prevent MSD while sitting and working as desk.


2012 12/20/11 $1,200.00 Approved 1/9/12

$1,200.00 Other Reimbursement for employee gym membership; provides an incentive for the employee to live a healthy lifestyle outside of work.

Sewer Authority Mid-Coastside ATTN: Jeanette Tracy

2012 11/8/11 $1,196.94 Approved 11/18/11

$1,196.94 Equipment/ Training/Prog

Equipment/Training: Pedometers and upper arm blood pressure monitors; encourages employees to walk and monitor their daily steps and blood pressures.

Goleta West Sanitary District ATTN: Diane Powers

2012 12/21/11 $463.30 Approved 1/13/12

$463.30 Equipment Equipment: ergonomic adjustable desk chair for safety specialist, per ergonomic evaluation

Delta Diablo Sanitation District ATTN: Steve Laren

2012 Q3

2/7/12 $1,807.50 Approved 2/7/12

$1,200.00 Prog Mgnt/ Equipment

Prog Mgt/Equipment: John Muir Health provides ongoing education, testing and programs to benefit employees and encourage health/fitness; pedometers encourage employees to participatein a step-walking program.

South Tahoe PUD ATTN: Nancy Hussman

2012 Q3

2/6/12 $370.61 Approved 2/7/12

$370.61 Prog Mgnt Prog Mgt: Speaker/trainer for District's Health Improvement Program

Montecito Sanitary District ATTN: Brett Walker

2012 Q3

4/11/12 $638.30 Approved 4/11/12

$638.30 Equip/ Training

Equipment/Training: 32" LED TV and DVD player to replace old TV/VHS equipment to watch CSRMA training dvds.

33

Summary of Approved Safety/Loss Control Requests 2009-To Date Category Description Software LOTO Software Training Program: Improve the LOTO procedures, providing a safer working environment for employees.

Other Cards/material for support of Safety Incentive Program: Safety incentive program encourages safety awareness with employees using point-system cards and scratch-offs for prizes .

Equipment Evaluation & installation of electrically operated air supply damper and relay: For safety prevention, will shut damper and shut off exhaust fan if chlorine gas is detected.

Training Front-End Loader Operator Certification for all Ops Staff: Training on safe & hands-on operation of equipment to demonstrate employee familiarization of its functions/devices.

Training Fire Prevention/Extinguisher Use safety training kit: Comprehensive video covering fire science, prevention, evac and extinguisher use; for all staff

Equipment First Aid Station Kits: Upgraded and replaced old first aid kits with new fresh products to OSHA standards. Training CPR/AED/First Aid Workbooks & Cards: Workbooks to compliment refresher training in AED/CPR/First Aid. 66 employees certified. Training 8-hr haz material technician training: Employee attending this training are first to respond to incident/accident at facility, training refreshes their skills. Software Brady Lockout Pro 3.1: Make our LOTO Program comply with CalOSHA guidelines

Equipment Ansi certified safety vests: Previous vests not ansi-certified; new vests will improve visibility day and night. Prog

Dev&Mgt/ Consulting/ Training/ Service

My Safety Officer: To effectively & efficiently manage our safety program; helps save time & resources with hands-on person-based safety mgt system, customized web-based safety training, training tools for in-person training, regulatory compliance, and a training/program maintenance calendar.

Equipment Worker trike: To aid EE in transporting small payloads around district facilities, reduce exposure to soft tissue injury.

Training *Quote Only* Traffic control & flagger safety training: Provide standards and guidelines and effective methods of creating a safe and workable traffic control zone. Training is scheduled for 6/23/10.

Equipment MiraCool cooling scarves/hard hat cooling pads: For field employees to reduce the potential for heat illness; to address heat prevention standards. Equipment Stretcher & helmets w/ lights: Equipment for the confined space rescue van.

Training Safety training/consulting: Provides safety training to field employees in water/wastewater & solid waste, helps employees perform their jobs safely & caution for the hazards they may encounter.

Training Fitness Training: Fitness training program for employees provided by outside fitness trainer

Prog Mgt/ Dev

Safety Incentive Program: rewards employees with monetary incentives to achieve one month without a lost time or recordable accident.

Equipment Noise Dosimeter: personal noise dosimetry for employees

Training Fitness Training: Fitness training program for employees provided by outside fitness trainer Prog Mgt/

Dev Safety Incentive Program: rewards employees with monetary incentives to achieve one month without a lost time or recordable accident.

Equipment Noise Dosimeter: personal noise dosimetry for employees

34

Summary of Approved Safety/Loss Control Requests 2009-To Date Category Description

Training/Dev Training Equipment: Improvements required to build a confined space training room Equipment Equipment: ergonomic assessment, workplace modifications and equipment

Service Analysis: Professional job analysis/evaluation to better evaluate readiness to return to work and modify the physical requirements of job classification to better reflect actual conditions.

Equipment Equipment: safety lights to improve flagger and worker safety on roadways Equipment Equipment: traffic control signs for blind corner at warehouse; improve safety of pedestrian employees.

Training Training Video: for new employee safety orientation and non-safety sensitive refresher. Prog Dev Safety Program: Consultant assistance with LOTO program and Equipment SOPs for pump stations.

Equipment Arc Flash PPE Training Conflict Resolution training

Equipment Equipment: multi-media projector enables use of CSRMA RCO online training resources. Equipment Equipment: manhole cover removal system reduces potential for injuries while removing manhole covers for industrial compliance sampling. Equipment Equipment: hats and cooling scarves - offers sun protection/cooling effects to mitigate sun and heat exposure. Equipment Equipment: Confined space rescue and recover system; improves fall protection for entry into alternate confined space. Equipment Material for support of safety incentive program. Equipment Equipment: TV and DVD player to enhance safety program and safety trainings, plant process trainings, equipment training. Prog Mgt Safety Program Mgt: subscription to My Safety Officer is an excellent services for agencies who don't have the resources to hire a safety professional

to plan, schedule, and track safety training for staff. Equipment Equipment: Noise Dosimeter to give district noise exposure date to help protect the hearing health of staff, test new equipment and monitor existing

equipment for noise exposure limits to staff. Equipment Equipment: Emergency Response Trailer will allow district personnel to have all the pumps, hoses and other items in one place to respond to an

overflow or emergency bypass, allowing for a faster response time. Equipment Equipment: hatch nets to provide additional fall protection during inspections or non-entry to space. Equipment Equipment: Grab-n-Go Emergency Kits for employees to be prepared for an emergency; accessible at all times at work, home or car. Equip/Trng Equip: Additional respirators for confined space rescue van; Training: monthly safety newsletters for employees.

Prog Mgt/Software

Software: Lockout Pro Software allows District to easily update and standardize its LOTO Program and be compliant with current OSHA regs; software improves in-house written procedures, enhance staff safety and training.

Equipment Equipment: icemaker for employees, encourage employees sto use their district-owned coolers and keep potable water at cool temperatures while employees are working in the field. NOTE: Item received after CSRMA 2011 Audit so reimbursement approved for FY2012.

Equipment Equipment: additional equipment (air supply masks, rescue stokes basket) to enhance and facilitate confined space rescue and training; dosimeter for more accurate noise exposure determination throughout facility.

Equipment Equipment: vehicle hitch mounted davit base provides greater visibility for confined space entry and rescue retrieval in remote locations. Equipment Equipment: deluxe portable label maker kit

35

2010-2011 Safety and Loss Control Reimbursement Requests AGENCY/ ATTN:

PY Form Submittal

Date


Date

Approved Total $$


Stege Sanitary District ATTN: Doug Humphrey

2011 8/19/10 $600.00 Approved 9/30/10

$600.00 Training Fitness Training: Fitness training program for employees provided by outside fitness trainer

South Bayside System Authority ATTN: Donna Allen

2011 9/2/10 $1,000.00 Approved 9/30/10

$1,000.00 Prog Mgt/ Dev

Safety Incentive Program: rewards employees with monetary incentives to achieve one month without a lost time or recordable accident.

Carpinteria Sanitary District ATTN: Jan Deering

2011 9/16/10 $999.00 Approved 9/30/10

$999.00 Equipment Noise Dosimeter: personal noise dosimetry for employees

Oro Loma Sanitary District ATTN: Anna Turon

2011 12/20/10 $1,329.20 Approved 12/30/10

$1,000.00 Training/Dev Training Equipment: Improvements required to build a confined space training room

Las Gallinas Valley SD ATTN: Tymber Carlson

2011 11/22/10 $1,567.91 Approved 12/30/10

$1,000.00 Equipment Equipment: ergonomic assessment, workplace modifications and equipment

Ventura Regional Sanitation District ATTN: Sandy Warren

2011 11/15/10 $1,993.76 Approved 12/30/10

$1,000.00 Service Analysis: Professional job analysis/evaluation to better evaluate readiness to return to work and modify the physical requirements of job classification to better reflect actual conditions.


2011 10/23/10 $518.40 Approved 12/30/10

$518.40 Equipment Equipment: safety lights to improve flagger and worker safety on roadways


2011 10/23/10 $222.76 Approved 12/30/10

$186.60 Equipment Equipment: traffic control signs for blind corner at warehouse; improve safety of pedestrian employees.


2011 10/23/10 $295.00 Approved 12/30/10

$295.00 Training Training Video: for new employee safety orientation and non-safety sensitive refresher.

36


PY Form Submittal

Date


Date

Approved Total $$



2011 12/9/10 $8,700.00 Approved 12/30/10

$1,000.00 Prog Dev Safety Program: Consultant assistance with LOTO program and Equipment SOPs for pump stations.

Lake Arrowhead CSD ATTN: Rick Dever

2011 3/2/11 $993.59 Approved 3/10/11

$993.59 Equip Equipment: Arc flash personal protection equipment

Fairfield-Suisun Sewer District ATTN: Rich Sponholz

2011 1/31/11 $850.00 Approved 3/10/11

$850.00 Training Training: on-site workplace violence/conflict resolution training

Carmel Area Wastewater District ATTN: Richard Mellinger

2011 6/13/11 $598.11 Approved 6/16/11

$598.11 Equipment Equipment: multi-media projector enables use of CSRMA RCO online training resources.

Encina Wastewater Authority ATTN: Jimmy Kearns

2011 4/25/11 $1,000.00 Approved 6/16/11

$1,000.00 Equipment Equipment: manole cover removal system reduces potential for injuries while removing manhole covers for industrial compliance sampling.

Novato Sanitary District ATTN: Julie Borda

2011 6/2/11 $537.69 Approved 6/16/11

$537.69 Equipment Equipment: hats and cooling scarves - offers sun protection/cooling effects to mitigate sun and heat exposure.


2011 5/26/11 $1,884.66 Approved 6/16/11

$1,000.00 Equipment Equipment: Confined space rescue and recover system; improves fall protection for entry into alternate confined space.


2011 5/26/11 $708.00 Denied 6/16/11 (Max $

reached)

$0.00 Equipment Material for support of safety incentive program.

Sanitary District #5 ATTN: Tony Rubio

2011 5/18/11 $976.50 Approved 6/16/11

$976.50 Equipment Equipment: TV and DVD player to enhance safety program and safety trainings, plant process trainings, equipment training.

West Valley SD ATTN: Ed Oyama

2011 5/18/11 $1,000.00 Approved 6/16/11

$1,000.00 Prog Mgt Safety Program Mgt: subscription to My Safety Officer is an excellent services fo ragencie who don't have the reources to hire a safety professional to plan, schedule, and track safety training for staff.

37


PY Form Submittal

Date


Date

Approved Total $$


Truckee Sanitary District ATTN: Denny Anderson

2011 6/21/11 $2,946.16 Approved 6/22/11

$1,000.00 Equipment Equipment: Noise Dosimeter to give district noise exposure date to help protect the hearing health of staff, test new equipment and monitor existing equipment for noise exposure limits to staff.


2011 6/27/11 $1,000.00 Approved 7/5/11

$1,000.00 Equipment Equipment: Emergency Response Trailer will allow district personnel to have all the pumps, hoses and other items in one place to respond to an overflow or emergency bypass, allowing for a faster response time.

Central Marin Sanitation Agency ATTN: Dale Thrasher

2011 6/28/11 $1,000.00 Approved 7/5/11

$1,000.00 Equipment Equipment: hatch nets to provide additional fall protection during inspections or non-entry to space.

San Eljio JPA ATTN: Marisa Buckles

2011 6/28/11 $893.97 Approved 7/5/11

$893.97 Equipment Equipment: Grab-n-Go Emergency Kits for employees to be prepared for an emergency; accessible at all times at work, home or car.

Vallejo Sanitation & Flood CD ATTN: Zoeanne Tafolla

2011 6/28/11 $1,000.00 Approved 7/5/11

$1,000.00 Equip/Trng Equip: Additional respirators for confined space rescue van; Training: monthly safety newsletters for employees.

Golta West SD ATTN: Brian McCarthy

2011 6/28/11 $870.56 Approved 7/5/11

$870.56 Prog Mgt/Software

Software: Lockout Pro Software allows District to easily update and standardize its LOTO Program and be compliant with current OSHA regs; software improves in-house written procedures, enhance staff safety and training.

Dublin San Ramon SD ATTN: Jessica Rodriguez

2012 7/18/11 $1,000.00 Approved 8/17/11

$1,000.00 Equipment Equipment: icemaker for employees, encourage employees sto use their district-owned coolers and keep potable water at cool temperatures while employees are working in the field. NOTE: Item received after CSRMA 2011 Audit so reimbursement approved for FY2012.

Oro Loma Sanitary District ATTN: Larry Olivan

2012 12/9/12 $1,249.99 Approved 1/9/12

$1,000.00 Equipment Equipment: additional equipment (air supply masks, rescue stokes basket) to enhance and facilitate confined space rescue and training; dosimeter for more accurate noise exposure determination throughout facility.

Delta Diablo Sanitation ATTN: Steve Laren

2012 Q3

2/7/12 $1,001.09 Approved 2/7/12

$1,000.00 Equipment Equipment: vehicle hitch mounted davit base provides greater visibility for confined space entry and rescue retrieval in remote locations.

Montecito Sanitary ATTN: Brett Walker

2012 Q3

4/6/12 $1,810.64 Approved 4/11

$1,000.00 Equipment Equipment: deluxe portable label maker kit

38

1/28/13 Page 1 of 1

CSRMA Safety Risk Control Reimbursement Program (Members in both PL and WC Pool)TOTAL REIMBURSEMENT REQUESTS Limit: $1,000.00 per FY start of program

Limit: $2,000.00 per FY starting in PY2013

PYAGENCY/ ATTN:

Approved Total $$ Category Description

Program 2012-20132013 Q1 Sausalito-Marin City SD

ATTN: Craig Justice$2,000.00 Prog Mgt/

Training/ Consulting

Prog Mgt/Consulting: development and implementation of District PS Emergency Response Plans and field training; will improve District's ability to respond and reduce the possibility of SSO; undertaken with City of Sausalito to improve response coordination, includes field training exercise and online training module.

2013 Q1 South Tahoe PUD ATTN: Nancy Hussman

$82.99 Equipment Equipment: hand sanitizers and dispensers; to reduce infectious diseases entering admin building

2013 Q2 Novato Sanitary District ATTN: Beverly James

$482.17 Equipment Equipment: specialty flashlights with intrinsically safe feature ensure that the user of device will be safe in atmospheric conditions that may cause a regular flashlight to spark/ignite.

39

1/28/13 Page 1 of 1

CSRMA Wellness Reimbursement Program (WC members only)TOTAL REIMBURSEMENT REQUESTS Limit: $1,200.00 per FY (7/1-6/30)

PY AGENCYApproved Total $$ Category Description

Program 2012-20132013 Q1 Central Marin Sanitation Agency

ATTN: Chris Finton$956.65 Equipment Equipment: Re-usable drinking water bottles w/ carbon filters; to move away from drinking sodas and drink more

water, carbon filters limit complaints about drinking water from tap.2013 Q1 Napa Sanitation District

ATTN: Cheryl Schuh$1,200.00 Prog Dev Prog Dev: Wellness Program Reimbursement; program encourages employees to stay fit, therefore reducing

injuries; additionally, the program promotes and helps maintain employees' health.2013 Q1 Ross Valley SD

ATTN: Danielle McPherson$1,200.00 Prog Dev Prog Dev: employee gym membership reimbursements; provides an incentive for the employee to live a health

lifestyle outside of work.2013 Q1 South Tahoe PUD

ATTN: Nancy Hussman$325.78 Prog Dev Prog Dev: Walk Fit 2012 Program; exercise prizes for participating in the Walk Fit Program, about 30 employees

participated.2013Q2 Sewer authority Mid-Coastside

ATN: Jeannette Tracy$1,047.91 Equipment Equipment: FitBit Ultra Wireless Activity tracker, pedometers to encourage staff to ge more active, take more interest

in their exercise regimes.

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Agenda Item: G2 Workers’ Compensation Committee Meeting


FY 13/14 CSRMA Risk Control Work Plan ISSUE: Each March, CSRMA Risk Control prepares an outline of the proposed initiatives to be undertaken in the coming year to address ongoing and new exposures. This work plan is then presented to the Executive Board at the annual Long Range Planning Session. At the 2011 Long Range Planning Session, the Executive Board thought it would be helpful and more efficient to form a Sub-Committee to review the Work Plan ahead of time. The Chairs of the Workers’ Compensation and Liability Committees, along with Al Miller and Shari Deutsch, formed the Risk Control Work Plan Sub-Committee, to develop proposed risk control work plan items for the upcoming program year. The recommendations of the Risk Control Work Plan Sub-Committee will be presented to the Executive Board at the next Long Range Planning session after review with each Committee. The proposed Risk Control Work Plan and Committee comments will then be presented to the Executive Board for review at their Long Range Planning Session in March. RECOMMENDATION: Review the attached Risk Control work plan and discuss. FISCAL IMPACT: The approved work plan components will be incorporated into the draft 13/14 budget as the Executive Board and Committees direct. Fiscal history: -FY 08/09 Outside Safety Consultant Budget: $225k -FY 09/10 Outside Safety Consultant Budget: $222k -FY 10/11 Outside Safety Consultant Budget: $205k -FY 11/12 Outside Safety Consultant Budget: $174k -FY 12/13 Outside Safety Consultant Budget: $188,600 -FY 13/14 draft Outside Safety Consultant Budget: $208,000 (Note: 10% increase over FY 12/13) BACKGROUND: Each March, CSRMA Risk Control prepares an outline of the initiatives to be undertaken in the coming year to address ongoing and new exposures. The Work Plan is composed of four sections:

1. Continuing Core Programs that CSRMA has contracted Alliant Insurance Services to provide. 2. Continuing risk control reimbursement incentive programs and Risk Control Online infrastructure

support/subscription services. 3. Recommended enhancements to Risk Control Online to improve member value and site marketability

to non-CSRMA members 4. Recommended new programs and initiatives designed to address new exposures, new technologies and

new legal environments.

Taken together, the Work Plan is designed to help members address risk exposures in a cost-effective and efficient manner. ATTACHMENTS: Draft 2013/14 CSRMA Risk Control Work Plan

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California Sanitation Risk Management Authority

~Proposed Risk Control Work P lan 2013/ 14~ Draft 1/14/13

Core Risk Control Services CSRMA Contracts Alliant to Provide

(Note: This scope of services if part of the CSRMA/Alliant contract and if changes are made, they must be negotiated between CSRMA and Alliant) Current Proposed Justification Notes

Perform a minimum of 15 loss control audits annually and issue the subsequent report within 45 days (15 remote survey/questionnaire based audits with follow up web meeting to review results and discuss work plan).

No change None

Write & distribute a minimum of 6 Bulletins annually No change None Update & distribute the CSRMA Member Contact Directory No change None Provide member hotline service via phone & email No change None Advertise and implement the CSRMA Risk Control and Wellness Reimbursement Programs

No change None

Provide annual workers' compensation loss analysis reports No change None Recommend expenditures from the CSRMA Safety Other budget to the Program Administrators that will benefit CSRMA's risk control efforts

No change None

Oversee the annual purchasing & ongoing maintenance of the CSRMA Video Library

No change None # of videos checked out: 7/1/11-present: 305 Number of members utilizing the video library: 26 Top 5 users: Carpinteria, Oro Loma, Ross Valley, West County, Union SD

Implement the CSRMA Workers’ Compensation Excellence award program No change None Implement the CSRMA SHELL Award program No change None Develop & distribute the Annual CSRMA Loss Control Calendar Delete this

item None The Risk Control Work Plan Sub

Committee believes this item has outlived its usefulness

Schedule, arrange & provide the following training seminars: a. CASA /CSRMA Risk Management Seminars 1. Summer = Succession Planning 2. Winter = Topics TBD 3. Spring = Topics TBD b. Fall Area Training - Topic = Electrical Safety for Wastewater Workers: Basic

Skills Building c. Winter Area Training – Topic = NFPA 820 c. Spring Area Training – Topic = Topic TBD d. 6 webinars on topics relevant to the pool e. CalOSHA training school annually in NCal and SCal

No change None

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Provide up to 6 training workshops at member locations on risk control topics, excluding CalOSHA & CalEPA regulatory compliance, affecting CSRMA

No change

Oversee the periodic update of the various CSRMA Risk Control manuals & training programs

No change

Prepare agenda items for the various CSRMA meetings, as needed No change Attend a minimum of 80% of the CSRMA meetings Delete This is not a work plan item. (As side

note, David intends to attend every regularly scheduled CSRMA meeting)

Oversee the distribution of the CSRMA Well Workplace monthly newsletter No change Assist CSRMA with the development of risk control programs, initiatives & trainings to address ongoing and new loss exposures as needed or directed

No change

Oversee the implementation of the CSRMA Workers' Compensation Claims Management Program

No change

Oversee and coordinate the efforts of the CSRMA Return to Work Consultant No change Provide CSRMA with research/analysis of various risk control topics affecting CSRMA as needed/directed

No change

Maintain a library of sample risk control materials for distribution to CSRMA as requested

No change

Communicate with the CSRMA Program Administrator’s to facilitate the delivery of risk control services

No change

Prepare an annual Risk Control Work Plan for presentation to the CSRMA Executive Board at their annual Long Range Planning meeting

No change

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Proposed Supplemental Risk Control Projects FY 13/14

Item Justification Projected Cost Notes Recommendations per Randy Musgraves’ report and Liability Committee Recommendations

1. Develop a comprehensive administrative and safety policy library in Word format, categorized by generic and detailed. Once compiled, place on Risk Control Online (RCO) in a searchable format: $10,000

2. Revise RCO interface to make finding resources easier and more intuitive: $30,000

3. Develop a summary document, “cheat sheet”, identifying the steps for accessing information and resources through the CSRMA website and a series on online tutorials (This would help staff due to the infrequent use of the website): $10,000

4. Develop an Administration Practices/Reference E-Manual for employees new to their role and responsibilities that identifies best practices, common areas of concern, links to additional CSRMA resources and references, and links to additional public resources and references on RCO: $16,000

5. Consider development of a program whereby a Committee or Executive Board member would visit any member agency with a new functional employee (i.e. WC Claims, Liability Claims, HR, finance, safety, General Manager, etc) and meet with them to review all of the resources CSRMA has available to assist them in their position, including Risk Control Online, Risk Control Advisor, Heather Truro, Alliant staff, York and Carl Warren).

$66,000 (Proposed Contractors: Randy Musgraves, Arclight, KBF Consulting, DKF Solutions Group and Alliant Insurance Services) Unknown and will likely vary, but will likely include: -Committee or EB Member staff time reimbursement -Travel costs -Alliant accounting time

TOTAL PROPOSED FOR 2013/14 $66,000 TOTAL FOR 2012/13 $64,000 PERCENT CHANGE FROM 2012/13 to 2013/14 +3%

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Continuing Risk Control Reimbursement and Infrastructure Services and NEW Proposed Risk Control Online Projects

What Why Projected Cost Notes This is for CSRMA’s subscription to SIPE’s web platform and additional programming for CSRMA-developed content in 2013/14.

The subscription fee is an annual fee for CSRMA members to have access to the CSRMA Risk Control web site, which is hosted by SIPE. The additional programming fees are necessary to account for minor programming issues that arise during the year (i.e. programming new reports suggested by members).

$25,000 (11/12= ~ $20,000)

Paid to SIPE (Arclight)

Update, manage and provide support for the CSRMA Risk Control Online. Also, provide up to six webinars on how to use the various features available on Risk control Online.

This service requires update, member training and oversight to remain useful to the membership.

$12,000 (12/13= $12,000)

Paid to ORS

Update the Contractor Safety Program Builder to address service contracts, new standard safety specifications and CalOSHA’s draft Affirmative Defense for Controlling Employers.

This will update the existing Contractor Safety Program Builder on RCO to reflect updated regulations, contracts other than construction and CalOSHA’s draft Affirmative Defense for Controlling Employers.

$10,000

(Proposed Contractors: $8k to DKF Solutions

Group and $2k in SIPE programming expense)

This feature was last updated in 2010.

Update Hazard Communication web based training module to new rules.

The new changes to the Occupational Safety and Health Administration's (OSHA) Hazard Communication Standard are designed to bring the United States into alignment with the Globally Harmonized System of Classification and Labeling of Chemicals (GHS).

$2,000 (Proposed Contractors:

Paid to DKF Solutions Group)

Monitor and, if safety guidelines recommended by the CDC, OSHA or NIOSH have been developed and publicly released, develop a new online training module titled: “Methicillin-resistant Staphylococcus aureus (MRSA) in municipal wastewater: an uncharted threat?” reflecting an 11/12 study by the University of Maryland.

Drug-resistant bacteria has made its way to wastewater treatment facilities, according to a new study from the University of Maryland. This study shows that MRSA survives in wastewater and that the WWTP may be a potential reservoir for MRSA. Published in the journal Environmental Health Perspectives, the findings show that methicillin-resistant Staphylococcus aureus (MRSA) is present at two water treatment facilities in the Midwest and two facilities in the mid-Atlantic region. "Our findings raise potential public health concerns for wastewater treatment plant workers and individuals exposed to reclaimed wastewater," study researcher Rachel Rosenberg Goldstein, a doctoral student in environmental health at the University of Maryland's School of Public Health, said in a statement. "Because of increasing use of reclaimed wastewater, further research is needed to evaluate the risk of exposure to antibiotic-resistant bacteria in treated wastewater."

$4,000

(Proposed Contractors: Paid to DKF Solutions

Group)

45

Fiscal history: -FY 08/09 Outside Safety Consultant Budget: $225k -FY 09/10 Outside Safety Consultant Budget: $222k -FY 10/11 Outside Safety Consultant Budget: $205k -FY 11/12 Outside Safety Consultant Budget: $174k -FY 12/13 Outside Safety Consultant Budget: $188,600 -FY 13/14 draft Outside Safety Consultant Budget: $208,000 (Note: this represents a 10% increase over FY 12/13)

MRSA is of particular importance in the public health realm because it is resistant to the usual antibiotics that are used to fight staph. It's particularly common in hospitals, what is known as hospital-acquired MRSA. This training module will present the findings of the study and control strategies as being developed by the Centers for Disease Control.

Update and refresh 10 online training modules.

CSRMA’s goal is to update and refresh the look and feel of 10 out ~110 CSRMA online training modules each year in order to keep them current and maintain interest of the members.

$15,000

(Proposed Contractors: Paid to DKF Solutions

Group

Risk Control Reimbursement Continuation of the incentive program created by the Workers’ Compensation Committee in 2009.

$44,000 (12/13= $43,000)

Usage: FY10/11: 21 members FY11/12: 16 members

Employee Health Promotion Reimbursement

Continuation of the incentive program created by the Workers’ Compensation Committee in 2009.

$30,000 (12/13= $54,000) Usage: FY10/11: 20 members FY11/12: 20 members

TOTAL PROPOSED FOR 2013/14 Up to $142,000 TOTAL FOR 2012/13 Up to $109,600 PERCENT CHANGE FROM 2010/11 to 2011/12 +30%

46

Paradise by Louis Jenkins

January finally drags into February and one fumbles with numb fingers at the ordinary knots and hooks of life. People are irritable, difficult. Some days you want to stay in bed with the covers over your head and dream of paradise. A place where the warm sea washes the white sand. There are a few palm trees on the higher ground, many brightly colored fish in the lagoon, waves breaking on the reef farther out. No one in sight. Occasionally an incredibly large, split-second shark darkens the clear water. Sea birds ride the wind currents, albatross, kittiwake, ... and pass on. Day after day, sea wind and perfect sky .... You make a big heap of driftwood on the beach.

"Paradise" by Louis Jenkins, from Just Above Water

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http://writersalmanac.publicradio.org/author.php?auth_id=1284�

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Revised 12/2012 Effective 1/2013

To: Members of CSRMA From: York Risk Services Group, Inc. Subject: INSTRUCTIONS REGARDING REGULATORY CHANGES RE: California Workers’ Compensation

Employer Action by January 1, 2013 Date: December 31, 2012 ____________________________________________________________________

Amendments of California Code of Regulations Effective January 1, 2013

Pursuant to Senate Bill 863

“Facts About Workers’ Compensation” AKA the New Hire Pamphlet Attached you will find an electronic version of what is known as the new hire pamphlet entitled “Facts About Workers’ Compensation.” This revised copy renders all other versions obsolete as of January 1, 2013. Please dispose of all revisions prior to January 1, 2013. EMPLOYER ACTION: All newly hired employees, on or after January 1, 2013, shall be

given the newly revised pamphlet. You are not required to provide the new pamphlet to your current employees, unless they request one. There are two blank fields on the back of the “Facts About Workers’ Compensation” that must be completed by the employer. The items that must be completed are:

• Where and to whom your employees should report work injuries. • You are also required to fill in the information regarding the nearest

Department of Workers’ Compensation Information and Assistance Office. A list of all offices is included at the bottom of this memorandum.

It is highly recommended you have your employees acknowledge receipt of this document and that you retain their acknowledgment. If you have Spanish speaking employees, you are required to provide the pamphlet in Spanish. In an effort to lessen paperwork, we are providing the “Facts About Workers’ Compensation” in electronic format. As a York customer, you may reproduce this document or use the electronic version on your website as a link. The pamphlet, as written, has been approved by the Department of Workers’ Compensation and the text may not be altered.

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Notice Of Personal Chiropractic Or Personal Acupuncturist

If your employer or your employer’s insurer does not have a Medical Provider Network (MPN), you may be able to change your treating physician to your personal chiropractor (D.C.) or acupuncturist (L.AC.) following a work-related injury/illness. In order to be eligible to make this change, you must give your employer the name and business address of a personal D.C. or L.AC. in writing prior to the injury/illness. York generally has the right to select your treating physician within the first 30 days after your employer knows of your inju-ry/illness. After your employer or York has initiated your treatment with another physician during this period, you may then, upon request, have your treatment transferred to your personal D.C. or L.AC. You may use this form to notify your employer of your personal D.C. or L.AC., or your employer may have their own form. The D.C. or L.AC. must be your regular D.C. or L.AC. who has directed your treatment and retains your chiropractic records and history. If your employer has an MPN, you may only switch to a D.C. or L.AC. within the MPN. A chiropractor cannot be your treating physician after 24 visits. If you still require medical treatment thereafter, you will have to select a physician who is not a chiropractor.

__________________________________________ ________ Name of chiropractor or acupuncturist (D.C., L.AC.)

__________________________________________________ (street address, city, state, zip code)

____________________________________________________ (telephone number)

Employee Name (Please Print):_____________________________

Employee’s Address:____________________________________

___________________________________________________

Employee’s Signature:___________________________________

Date:________________________________________________

Pre-designation Of Personal Physician

In the event you sustain an injury or illness related to your employment, you may be treated for such injury/illness by your personal medical doctor (M.D) or doctor of osteopathic medicine (D.O.) or medical group if: You have health care insurance for injuries/illness that are not work related, the doctor is your regular physician, who shall be either a physician who has limited his or her practice of medicine to general practice or who is a board-certified or board-eligible internist, pediatrician, obstetrician-gynecologist, or family practitioner, and has previously directed your medical treatment, and retains your medical records; your “personal physician” may be a medical group if it is a single corporation or partnership composed of licensed doctors of medicine or osteopathy, which operates an integrated multispecialty medical group provid-ing comprehensive medical services predominantly for non-occupational ill-nesses and injuries; prior to the injury your doctor agrees to treat you for work injuries or illnesses; prior to the injury you provided your employer the following in writing: (1) notice that you want your personal doctor to treat you for a work-related injury/illness, and (2) your personal doctor’s name and business address.

You may use this form, a form provided by your employer or provide all the information in writing to notify your employer if you wish to have your per-sonal medical doctor or a doctor osteopathic medicine treat you for a work-related injury/illness and the above requirements are met.

Notice Of Pre-designation Of Personal Physician

Employee: Complete this section

Employer ________________________________________________

If I have a work-related injury or illness, I choose to be treated by:

_______________________________________________________ (Name of doctor) (M.D., D.O., or medical group)

_______________________________________________________ (street address, city, state, zip)

_______________________________________________________ (telephone number)

Employee Name (please print): __________________________________

Employee’s Address:__________________________________________

Employee Signature:_______________________Date__________

Note to Employee: Unless you agree in writing, neither your employer or York may contact your personal physician to confirm a pre-designation. If your physician does not sign this form, other documentation that they agreed to be pre-designated prior to the injury will be required. If you agree, your employer or York may contact your personal physician to confirm this pre-designation, sign and date below:

Employee Signature__________________________________________

Employee #_________________________ Date_________________

Physician: I agree to this Pre-designation:

Signature:________________________________Date____________

(Physician or Designated Employee of the Physician)

The physician is not required to sign this form, however, if the physician or designated employee of the physician or medical group does not sign, other documentation of the physician’s agreement to be pre-designated will be required pursuant to Title 8, California Code of Regulations, section 9780.1(a)(3).

© 1/1/13 YORK. All rights reserved

WHEN A WORK INJURY OCCURS…

Quickly seek first aid.

Call 9-1-1 for help immediately if emergency medical care is

needed.

Immediately report injuries to your supervisor or employer representative at ____________________________________________

__________________________________________________________________

Information & Assistance Office:______________________________

__________________________________________________________

__________________________________________________________

Employer MUST complete this information

York Risk Services Group, Inc. P.O. Box 619079

Roseville, CA 95661 Phone (866) 221-2402

Fax (866) 548-2637 Approved by Division of Workers’ Compensation

The Facts About Workers’

Compensation For dates of injury on or after

January 1, 2013

50

State law limits certain medical services as of January 1, 2004. You should never receive a medical bill. If additional treatment is necessary, York will coordinate medical care that meets applicable treatment guidelines for the injury. The doctor may be a specialist for your specific type of injury, and he or she will be familiar with workers’ compensation requirements and will report promptly to York so your benefits can be paid.

The physician with overall responsibility for treating your injury/illness is your primary treating physician (PTP). The PTP decides what kind of medical care you need and if you have work restrictions. If necessary, the PTP will review your job description with you and your employer to define any limitation or restrictions that you may have. This doctor also is responsible for coordinating care between other medical providers and will write reports about any permanent impairment of bodily function(s) or the need for future medical care. Generally, your employ-er selects the PTP you will see for the first 30 days, but if you want to change doctors for any reason, ask your employer or York. They’re as interested as you are in your prompt recovery and return to work and will select a different doc-tor for you. If your employer has a Medical Provider Network (MPN) you will be directed to treat with a physician within the MPN and different rules apply re-garding changing your physician.

You can be treated by your personal physician or medical group immediately if you have health care insurance for injuries or illness that are not work related, and your physician agrees in advance to treat you for any work injuries/illnesses and has previously directed your treatment and retains your medical records and agrees, prior to your injury/illness, to treat you for workplace injuries/illnesses and you gave your employer your physician’s name and address in writing before the injury. You may use the form inside of this pamphlet or your employer may have a form for you to use.

If you give the name of your personal chiropractor or acupuncturist, different rules apply, and you may need to see an employer-selected physician first.

Temporary Disability Benefits: If you are not medically able to work for more than three days due to your work-related injury, counting weekends, you have a right to temporary disability (TD) payments to assist substituting your lost wages. After two weeks from reporting the injury, you will receive a check. If your employer has a salary continuation plan, your benefit may be included in your regular paycheck. TD is payable every 14 days until the doctor states you can return to work (Payments won’t be made for the first three days, though, unless you’re hospitalized as an inpatient or unable to work more than 14 days). The amount of the payments will be two-thirds of your average wage, subject to minimums and maximums set by the state legislature. Although the TD payment will not be the full amount of your regular paycheck, there are no deductions and the payments are tax-free. For injuries occurring on or after January 1, 2008, TD payments are limited to 104 compensable weeks within five years of date of injury. For a few long-term injuries such as chronic lung disease or severe burns, TD payments can last up to 240 weeks within five years from the date of injury. If you reach the maximum TD payment period before you can return to work or before your condition becomes permanent and stationary. See the “Other Bene-fits” section of this pamphlet for additional in information. A timely filing with Employment Development Department may result in additional State Disability benefits when TD benefits are delayed, denied, or terminated.

Permanent Disability: If your doctor says your injury will always leave you with some permanent impairment of bodily function(s), you may receive permanent disability (PD) payments. The amount depends on the doctor’s report, how much of the PD was directly caused by your work, and factors such as your age, occupation, type of injury, and date of injury. State law determines minimum and maximum amounts, and they vary by injury date. If you are entitled to PD, York will send you a letter explaining how the benefit was calculated. If the injury

What is workers’ compensation? Its purpose is to insure that an employee who is found to sustain an industrial injury or illness will be provided with benefits to medically cure or relieve them from the effects of the injury/illness, provide tem-porary compensation when they are medically unable to perform any occupational function, compensation for any residual handicap and/or impairment of bodily function, benefits for dependents if an employee dies as a result of an inju-ry/illness, protection from discrimination by his/her employer because of the injury/illness.

Am I Covered? Nearly every person employed in California is protected by workers’ compensation, however there are a few exceptions. People that are self-employed or volunteer workers may not be covered. Similar laws cover federal and maritime workers. York Risk Services Group (York) is your employer’s claims administrator. Your employer or York can answer any questions you might have about coverage.

What Does Workers’ Compensation Cover? If you have an injury/illness due to your job, it is covered. The cause can be a single event, like a fall or it can be due to repeated exposures, such as hearing loss due to constant loud noise. Injuries ranging from first-aid to serious accidents are covered. Even injuries related to a workplace crime, such as psychological or physical injuries, are covered under workers’ compensation. Some injuries that result from voluntary activity, such as off duty social or athletic activities may not be covered. Check with your employ-er or York if you have questions. Coverage begins the moment you start your job. There is no probationary period or wage rate.

Duty Of The Employee. Immediately notify your employer or York so you can get the medical help that you need without delay. If your injury is greater than a first-aid injury, your supervisor will give you a Claim Form (Form DWC-1) for you to describe where, when and how it happened. To submit a claim, fill out the “Employee” section of the DWC-1. Keep one copy of this form and give the remaining pages to your supervisor. Your employer will fill out the “Employer” section and return a signed and dated copy of the form to you. Your employer will keep a copy of this form and forward another to York. York is in charge of handling your claim and informing you about your eligibility for benefits.

Your claim benefits do not start until your employer knows about your injury, so report and file the DWC-1 as quickly as possible. California law requires your employer to authorize medical treatment within one working day of receipt of your Claim Form. Employers are liable for up to $10,000 in treatment pending a decision by York for a claim to be accepted or rejected. Waiting to report may delay workers’ compensation benefits. You may not receive benefits if you fail to file a claim within one year of the date of injury, the date you know the injury was work related, or the date benefits were last provided.

Duty of the Employer: Provide this form to every employee at the time of hire or by the end of their first pay period.

Within one working day, upon knowledge or notice from any source of a work injury/illness greater than first-aid, provide the employee with a Claim Form (DWC-1) and authorize medical treatment and report the claim to York Risk Services Group.

What are the benefits? You may be entitled to various kinds of benefits under California workers’ compensation law including:

Medical Care: Medical treatment that is reasonably required to cure or relieve the injured worker from the effects of the injury/illness. There is no deductible or co-payment. These medical benefits may include lab tests, physical therapy, hospi-tal services, medication and treatment by a doctor.

causes PD, the first payment of PD benefits is made within 14 days after the last payment of TD, unless your employer has offered you a position that pays at least 85% of your date of injury wages or if you are returned to a position that pays you 100% of the wages and, compensation paid to you on the date of injury, the PD would be paid after an Award issues.

Supplemental Job Displacement Benefit (SJDB): If you have a permanent whole person impairment, the eligibility for SJDB begins when your employer does not offer regular work, permanent, modified, or alternative work within 60 days of the receipt of a doctor’s Medical Maximum Improvement (MMI) report. This is a nontransferable voucher for education-related retraining and/or skill development at state-approved schools, tools, licensing, certifica-tion fees and other resources as possible benefits. If you qualify for the supple-mental job displacement benefit, York will provide a voucher up to a maximum of $6,000.

Death Benefits: If the injury/illness causes death, payments may be made to your dependents. State law sets these benefits and the total benefit depends on the number of dependents. The payments are made at the same rate as TD payments. In addition, workers’ compensation provides a burial allowance.

Discrimination: It a violation of Labor Code Section 132(a) and illegal for your employer to punish or fire you for having a workplace injury/illness, for filing a claim or for testifying in another person’s workers’ compensation case. If your employer is found guilty of discrimination, you would be entitled to increased benefits, reinstatement and reimbursement for lost wages and benefits.

Other Benefits: Sometimes people confuse workers’ compensation with State Disability Insurance (SDI). Workers’ compensation covers on-the-job injuries/ illnesses and is paid for by your employer or their insurance. On the other hand, SDI covers off-the-job injuries or sicknesses, and is paid for by deductions from your paycheck. If you are not getting workers’ compensation benefits, you may be able to get State Disability benefits. Contact the local office of the State Employment Development Department listed in the govern-ment pages of your phone book for more information.

You may be eligible to access the return-to-work fund, for the purposes of making supplemental payments to injured worker’s whose PD benefits are disproportionately low in comparison to their earnings loss. If you have ques-tions or think you qualify, contact the Information & Assistance office listed in this pamphlet or visit the DIR website at: www.dir.ca.gov.

If You Still Have Questions…ask your supervisor or employer representa-tive. Or contact York at the number indicated on workers’ compensation posters at work and on this brochure. You can also contact the State Division of Workers’ Compensation (DWC) and speak with an Information and Assis-tance Officer. These officers are available to review problems, answer ques-tions and provide additional written information about workers’ compensa-tion at no charge. The local office is listed below and posted at your work-place. You can also call 800-736-7401 or visit the DWC website at: http://www.dir.ca.gov/dwc.

WORKERS’ COMPENSATION FRAUD IS A FELONY

Anyone who makes or causes to be made any knowingly false or fraudu-lent material statement for the purpose of obtaining or denying workers’ compensation benefits or payments is guilty of a felony. Fines can be up

to $150,000 and imprisonment up to five years. 51

Designación previa del médico personal En el caso que usted sufra una lesión o enfermedad relacionada con su empleo, usted puede ser tratado por su lesión/enfermedad por su médico personal con grado de Doctor en Medicina (M.D.), Doctor en Osteopatía (D.O.) o grupo médico si: tiene seguro médico para lesiones/enfermedades que no están relacionadas al trabajo, el médico es su médico de cabecera, quien deberá ser un médico que ha limitado su práctica de medicina a la medicina general o que es un internista certificado por el consejo o internista, pediatra, gineco-obstetra , o médico de familia elegible por el consejo, y ha dirigido previamente su tratamiento médico, y conserva sus registros médicos; su "médico personal" puede ser un grupo médico si se trata de una corporación o asociación simple compuesta de médicos licenciados en medicina u osteopatía, que opera un grupo médico de múltiples especialidades integradas que presta servicios médicos integrales sobre todo para enfermedades y lesiones no ocupacionales; antes de la lesión su médico está de acuerdo en darle el tratamiento para lesiones o enfermedades ocupacionales; antes de la lesión usted proporcionó a su empleador por escrito lo siguiente: (1) notificación de que usted desea que su médico personal le trate por una lesión o enfermedad relacionada con el trabajo y (2) el nombre y dirección comerciales de su médico personal. Usted puede utilizar este formulario, proporcionado por su empleador o proporcionar toda la información por escrito para notificar a su empleador si desea que su médico personal con grado de Doctor en Medicina o Doctor en Osteopatía le trate por su lesión/enfermedad relacionada con el trabajo y se cumplen los requisitos mencionados anteriormente.

Aviso de Designación Previa de Médico Personal Empleado(a): Complete esta sección Empleador _____________________________________________________ Si tengo una enfermedad o lesión relacionada con el trabajo, elijo ser tratado(a) por: ______________________________________________________________ (Nombre del médico) (M.D., D.O., o grupo médico) ______________________________________________________________ (dirección calle, ciudad, estado, código postal) ______________________________________________________________ (número de teléfono) Nombre de empleado (por favor usar letra de imprenta): __________________ Dirección del empleado: ___________________________________________ Firma del empleado: _______________ Fecha __________ Nota para el Empleado: A menos que usted esté de acuerdo por escrito, ni su empleador ni York pueden comunicarse con su médico personal para confirmar una designación previa. Si su médico no firma este formulario, será necesaria otra documentación que confirme la aceptación en ser designado antes de la lesión. Si usted está de acuerdo, su empleador o York pueden comunicarse con su médico personal para confirmar esta designación previa, firme y coloque la fecha a continuación: Firma del empleado ___________________________________________ Empleado nº ________________ Fecha ____________ Médico: Acepto esta designación previa: Firma: ________________________ Fecha ___________ (Médico o Empleado Designado del Médico) No se exige que el médico firme este formulario; sin embargo, si el médico o empleado designado del médico o grupo médico no firma, se exigirá otro documento de la aceptación del médico de la designación previa en conformidad con el Título 8, Código de Normas de California, sección 9780.1(a)(3).

Aviso del Quiropráctico o Acupunturista Personal

Si su empleador o aseguradora de su empleador no tiene una Red de Proveedores Médicos (MPN por sus siglas en inglés), usted puede cambiar que su médico tratante sea su quiropráctico (D.C., por sus siglas en inglés) o acupunturista (L.AC., por sus siglas en inglés) personales luego de una lesión/enfermedad relacionada con el trabajo. A fin de ser elegible para hacer este cambio, usted debe dar a su empleador el nombre y dirección comercial de un quiropráctico o acupunturista personales por escrito antes de la lesión/enfermedad. York generalmente tiene el derecho de seleccionar a su médico tratante en el periodo de los primeros 30 días luego que su empleador se entere de su lesión/enfermedad. Después que su empleador o York hayan iniciado su tratamiento con otro médico durante este período, usted podrá, previa solicitud, hacer que su tratamiento sea transferido a su quiropráctico o acupunturista personales. Usted puede usar este formulario para notificar a su empleador acerca de su quiropráctico o acupunturista personales, o su empleador puede tener su propio formulario. El D.C. o L.AC. deben ser su D.C. o L.AC. habituales que han dirigido su tratamiento y conservan sus registros e historia de quiropraxia. Si su empleador tiene una red de proveedores médicos (MPN, por sus siglas en inglés), usted sólo puede cambiar a un D.C. o L.AC. dentro de la MPN. Si un quiropráctico no puede ser su médico tratante después de 24 visitas. Si aún requiere de tratamiento médico de ahí en adelante, tendrá que elegir un médico que no sea quiropráctico. _______________________________________________________ Nombre del quiropráctico o acupunturista (D.C., L.AC.) _______________________________________________________ (dirección calle, ciudad, estado, código postal) _______________________________________________________ (número de teléfono) Nombre de empleado (Por favor use letra de imprenta): __________________________________ Dirección del empleado: __________________________________________ _______________________________________________________ Firma del empleado: __________________________________________ Fecha: _______________________________________________________ CUANDO OCURRE UNA LESIÓN EN EL TRABAJO ... • Busque rápidamente primeros auxilios. • Llame al 9-1-1 para solicitar ayuda inmediata, si es una emergencia, se

requiere atención médica. • Informe inmediatamente las lesiones a su supervisor o representante del

empleador en ___________________________________________ ______________________________________________________________ Oficina de Información y Asistencia: _________________________________ _______________________________________________________ _______________________________________________________

El empleador DEBE completar esta información

© 01/ENE/2013 YORK. Todos los derechos reservados

Información Acerca de

Compensación del

Trabajador Para lesiones en fechas a partir del

1 de enero de 2013

York Risk Services Group, Inc. P.O. Box 619079

Roseville, CA 95661 Teléfono (866) 221-2402

Fax (866) 548-2637

Aprobado por la División de Compensación del Trabajador

52

¿Qué es la compensación del trabajador? Su propósito es asegurar que un empleado que sufre una lesión o enfermedad ocupacional reciba beneficios para curar o aliviar médicamente los efectos de la lesión/enfermedad, proporcionar compensación temporal, cuando el empleado sea médicamente incapaz de realizar cualquier función ocupacional, compensación por cualquier discapacidad residual y/o impedimento de la función corporal, beneficios para los dependientes si un empleado fallece como consecuencia de una lesión/enfermedad, protección contra la discriminación de su empleador debido a la lesión/enfermedad. ¿Tengo cobertura? Casi todas las personas empleadas en California están protegidas por la compensación del trabajador; sin embargo hay algunas excepciones. Las personas que trabajan de manera independiente o trabajadores voluntarios no pueden tener cobertura. Leyes similares cubren a los trabajadores federales y marítimos. Su empleador está lícitamente autoasegurado. York Risk Services Group (York) es el administrador de reclamaciones de su empleador. Su empleador o York pueden responder a cualquier pregunta que usted tenga acerca de la cobertura. ¿Qué cubre la Compensación del Trabajador? Si usted tiene una lesión/enfermedad debido a su trabajo, usted tiene cobertura. La causa puede ser un solo evento, como una caída, o puede ser debido a exposiciones repetidas, como la pérdida de audición debido al ruido fuerte y constante. Las lesiones que varían desde primeros auxilios a accidentes graves tienen cobertura. Incluso las lesiones relacionadas con un delito en el lugar de trabajo, tales como lesiones físicas o psicológicas, tienen cobertura de la compensación del trabajador. Algunas lesiones que resultan de actividades voluntarias, como actividades sociales o deportivas fuera del servicio, no pueden tener cobertura. Consulte con su empleador o York si usted tiene preguntas. La cobertura comienza en el momento de empezar su trabajo. No hay periodo de prueba o tarifa de salario. Deber del Empleado. Notifique inmediatamente a su empleador o York de manera que usted pueda conseguir la ayuda médica que usted necesita sin demora. Si su lesión es mayor que una lesión de primeros auxilios, su supervisor le dará un Formulario de Reclamación (Formulario DWC-I) para que usted describa dónde, cuándo y cómo sucedió. Para presentar una reclamación, complete la sección "Empleado" del DWC-I. Guarde una copia de este formulario y entregue las páginas restantes a su supervisor. Su empleador deberá completar la sección "Empleador" y entregarle una copia firmada y fechada. Su empleador conservará una copia de este formulario y enviará otra a York. York está a cargo de manejar su reclamación e informarle a usted acerca de su elegibilidad para recibir beneficios. Sus beneficios de reclamación no se inician hasta que su empleador se entere de su lesión, por ello informe y presente el DWC-I tan pronto como sea posible. Las leyes de California exigen que su empleador autorice el tratamiento médico en el plazo de un día hábil luego de haber recibido su Formulario de Reclamación. Los empleadores son responsables de un máximo de $10,000 por el tratamiento en espera de una decisión de York sobre la aceptación o rechazo de una reclamación. Esperar el informe puede retrasar los beneficios de indemnización del trabajador. Usted no puede recibir beneficios si no presenta una reclamación en el periodo de un año luego de la fecha de la lesión, la fecha en que usted se entera que su lesión era ocupacional, o la fecha en que se proporcionaron por última vez los beneficios. Deber del Empleador: Entregue este formulario a todos los empleados en el momento de la contratación o al final de su primer período de pago. En el periodo de un día hábil, al conocer o recibir aviso por parte de cualquier fuente de una lesión/enfermedad ocupacional mayor que primeros auxilios, entregue al empleado un formulario de reclamación (DWC-1) y autorice tratamiento médico e informe la reclamación a York Risk Services Group. ¿Cuáles son los beneficios? Usted puede tener derecho a diversos tipos de beneficios en virtud de la ley de compensación del trabajador de California, incluyendo: Atención médica: El tratamiento médico que sea razonablemente necesario para curar o aliviar al trabajador lesionado de los efectos de la lesión/enfermedad. No hay deducible ni copago. Estos beneficios médicos pueden incluir análisis de laboratorio, terapia física, servicios de hospital, medicamentos y tratamiento por un médico. La ley estatal limita ciertos servicios médicos a partir del 1 de enero de 2004. Usted nunca debe recibir una factura médica. Si el tratamiento adicional es necesario, York coordinará la atención médica que cumpla con las normas aplicables de tratamiento para la lesión. El médico puede ser un especialista para su

tipo específico de lesión, deberá conocer los requisitos de compensación del trabajador e informará con prontitud a York de manera que se paguen sus beneficios. El médico con la responsabilidad general del tratamiento de su lesión/enfermedad es el médico de atención primaria (PTP, por sus siglas en inglés). El PTP decide qué tipo de atención médica usted necesita y si usted tiene restricciones de trabajo. Si es necesario, el PTP revisará la descripción de su trabajo con usted y su empleador para definir cualquier limitación o restricción que usted pueda tener. Este médico también es responsable de coordinar la atención entre los demás proveedores de servicios médicos y, si es una lesión grave, escribirá los informes sobre cualquier discapacidad permanente de las funciones corporales o la necesidad de atención médica en el futuro. Generalmente, su empleador selecciona al PTP que usted verá durante los primeros 30 días, pero si usted desea cambiar de médico por cualquier motivo, pregunte a su empleador o York. A su empleador le interesa tanto como a usted su pronta recuperación y retorno al trabajo y seleccionará a un médico diferente para usted. Si su empleador tiene una Red de Proveedores Médicos (MPN, por sus siglas en inglés), usted será dirigido a tratarse con un médico dentro de la MPN y se aplican reglas diferentes sobre cómo cambiar a su médico. Usted puede ser tratado por su médico personal o grupo médico de inmediato si tiene seguro médico para lesiones o enfermedades que no estén relacionadas al trabajo, y si su médico estuvo de acuerdo por adelantado en darle el tratamiento para las lesiones o enfermedades ocupacionales y ha dirigido previamente su tratamiento y conserva sus registros médicos y está de acuerdo, antes de su lesión/enfermedad, en atenderle por sus lesiones o enfermedades ocupacionales, y usted entregó a su empleador el nombre de su médico y la dirección por escrito antes de la lesión. Usted puede utilizar el formulario dentro de este folleto o su empleador puede tener un formulario para que usted lo utilice. Si usted da el nombre de su quiropráctico o acupunturista personal, se aplican reglas diferentes, y usted puede necesitar ver primero a un médico seleccionado por el empleador. Beneficios de discapacidad temporal: Si usted no es médicamente capaz de trabajar durante más de tres días debido a su lesión relacionada con el trabajo, contando los fines de semana, usted tiene el derecho a pagos de discapacidad temporal (TD, por sus siglas en inglés) para ayudarle en la sustitución de sus salarios perdidos. Después de dos semanas a partir de la presentación del informe de la lesión, usted recibirá un cheque. Si su empleador tiene un plan de continuación de salario, sus beneficios pueden ser incluidos en su cheque de pago habitual. TD se paga cada 14 días hasta que el médico declare que usted puede retornar al trabajo (sin embargo los pagos no se hacen durante los primeros tres días, a menos que usted esté hospitalizado o no pueda trabajar más de 14 días). El monto de los pagos será dos tercios de su salario promedio sujetos a los mínimos y máximos establecidos por la legislatura estatal. Aunque el pago por discapacidad temporal no será el monto total de su cheque de pago habitual, no hay deducciones y los pagos están libres de impuestos. Para lesiones que ocurren a partir del 1 de enero de 2008, los pagos por discapacidad temporal se limitan a 104 semanas compensables en el periodo de cinco años luego de la fecha de la lesión. Para unas pocas lesiones a largo plazo, tales como enfermedad pulmonar crónica o quemaduras severas, los pagos por discapacidad temporal pueden durar hasta 240 semanas en el periodo de cinco años a partir de la fecha de la lesión. Si usted alcanza el máximo pago por discapacidad temporal antes que usted pueda retornar al trabajo, su condición se convierte en permanente y estacionaria. Vea la sección "Otros Beneficios" de este folleto para más en la información. La presentación oportuna al Departamento de Desarrollo de Empleo puede dar lugar a beneficios Estatales de Discapacidad adicionales cuando los beneficios por discapacidad temporal se retrasan, deniegan o cancelan. Discapacidad permanente: Si su médico dice que su lesión siempre le dejará con cierta discapacidad permanente de las funciones corporales, usted puede recibir pagos de discapacidad permanente (PD, por sus siglas en inglés). El monto depende del informe médico, la cantidad de discapacidad permanente que fue causada directamente por su trabajo, y factores como su edad, ocupación, tipo de lesión, y fecha de la lesión. La ley estatal determina los montos mínimos y máximos, y varían según la fecha de la lesión. Si usted tiene derecho a discapacidad permanente, York le enviará una carta explicando cómo se calculó el beneficio. Si la lesión causa discapacidad permanente, el primer pago vence en el periodo de 14 días a partir del pago final por discapacidad temporal, salvo que su empleador le haya ofrecido a usted un puesto de trabajo que pague un mínimo del 85% del salario de su fecha de lesión o si regresó a un puesto de trabajo que paga el 100% del salario y, las

prestaciones pagadas a usted en la fecha de la lesión, la discapacidad permanente se pagará después que se emita la adjudicación. Beneficio complementario por desplazamiento laboral(SJDB, por sus siglas en inglés): Si usted tiene una discapacidad permanente, la elegibilidad para el beneficio complementario por desplazamiento laboral comienza cuando su empleador no tiene trabajo regular, permanente, modificado o alternativo en un periodo de 60 días a partir del recibo de un informe de Mejoría Máxima Médica (MMI por sus siglas en inglés). Esto es un vale no transferible para cuotas de reentrenamiento y/o desarrollo de habilidades relacionadas con la educación en escuelas autorizadas por el estado, herramientas, autorización de licencias y certificación así como otros recursos como beneficios posibles. Si usted califica para el beneficio complementario por desplazamiento laboral, York ofrecerá un vale por un monto máximo de $6,000. Beneficios por defunción: Si la lesión/enfermedad causa la muerte, los pagos se pueden efectuar a sus dependientes. Las leyes estatales establecen estos beneficios y el beneficio total depende del número de dependientes. Los pagos se hacen a la misma tarifa que los pagos por discapacidad temporal. Además, la compensación del trabajador ofrece un monto asignado por concepto de sepelio. Discriminación: Es una infracción del Código Laboral, Sección 132(a) e ilegal que su empleador le castigue o despida por sufrir una lesión/enfermedad ocupacional, presentar una reclamación o atestiguar en el caso de compensación del trabajador de otra persona. Si su empleador es declarado culpable de discriminación, usted tendría derecho a un aumento de beneficios, restitución y reembolso de los salarios y beneficios perdidos. Otros beneficios: A veces se confunde la compensación del trabajador con el Seguro Estatal de Discapacidad (SDI, por sus siglas en inglés). La compensación del trabajador las lesiones/enfermedades ocupacionales, y es pagada por su empleador o su aseguradora. Por otro lado, el SDI cubre las lesiones o enfermedades ocurridas fuera del trabajo, y es pagado mediante deducciones de su cheque de pagos. Si usted no está recibiendo beneficios de compensación del trabajador, puede ser capaz de obtener los beneficios de Discapacidad del Estado. Póngase en contacto con la oficina local del Departamento de Desarrollo de Empleo del Estado que aparece en las páginas gubernamentales de su directorio telefónico para obtener más información. Puede ser elegible para acceder al fondo de regreso al trabajo, con el fin de hacer pagos complementarios a trabajadores lesionados cuyos beneficios de discapacidad permanente son desproporcionalmente bajos en comparación con su pérdida de ganancias. Si tiene alguna pregunta o cree que califica, póngase en contacto con la oficina de Información y asistencia indicada en este folleto o visite el sitio web de DIR en: www.dir.ca.gov. Si usted todavía tiene preguntas... pregunte a su supervisor o representante del empleador. O póngase en contacto con York llamando al número que se indica en los afiches de compensación del trabajador colocados en el trabajo y en este folleto. También puede comunicarse con la División Estatal de Compensación del Trabajador (DWC, por sus siglas en inglés) y hablar con un Funcionario de Información y Asistencia. Estos funcionarios están disponibles para examinar los problemas, responder preguntas y proporcionar información adicional escrita sobre la compensación del trabajador de manera gratuita. La oficina local se muestra a continuación y se publicará en su lugar de trabajo. Usted también puede llamar al 800-736-7401 o visitar el sitio web de DWC: http://www.dir.ca.gov/dwc

EL FRAUDE DE COMPENSACIÓN LABORAL ES UN DELITO GRAVE

Toda persona que haga o disponga que se haga una declaración material deliberadamente falsa o fraudulenta con el fin de

obtener o denegar los beneficios o pagos de la compensación laboral es culpable de un delito grave. Las multas pueden ser de hasta un máximo de $150,000 y el encarcelamiento de hasta un

máximo de cinco años.

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1/22/13 Problem Doctor Meeting Recap

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Below is a recap of the meeting with Department of Workers' Compensation to discuss the problem ofdoctors not providing work restrictions. On Tuesday, January 15, 2013, Jim Libien - attorney with Laughlin, Falbo, Levy & Moresi, Dr. KarlaRhay - Chief Administrative Officer for SCSRM, Debbie Ehsan - V.P. of Claims for JT2 IntegratedServices, Jack Blyskal - Chief Claims Officer with CSAC-EIA and myself met with Desty Overpeck,Chief Counsel, DWC and Dr. Rupali Das, Executive Medical Director from the Department of IndustrialRelations for the state of California. The goal of the meeting was to present the problem of physicians not giving physical capacities forinjured workers for both work and home and to discuss solutions to this problem. Ms. Overpeck andDr. Das were both very receptive to finding solutions to the challenge. We came up with five ideas:

1. Include the need to state restrictions in the physician treatment guidelines.2. Try on an experimental basis paying the doctors for documenting physical capacities to see if

increased compliance is worth the additional costs (we will be developing the researchguidelines).

3. If the experiment of paying doctors for documenting physical capacities is successful thenconsider having documentation become a requirement in the WC regulations.

4. Give presentations about the benefits of early return-to-work, the costs, research and theimportance of physician's participation in the RTW process at doctors' educational forums.

5. Develop legislative solutions (Jack will bring to CSAC.)

The tenor of the meeting was positive. I think over the long haul we will be able to affect thecompliance rate which will allow more injured workers to return to work in a modified capacity earlier. For those going to PARMA we invite you to find either Jack Blyskal or Dr. Rhay, while they arewandering around or Debbie Ehsan at booth #202 or me at booth #509 to discuss what happened orshare your ideas. Norm Norman Peterson & Associateswww.returntowork.comPh: 800-497-1368Fx: 541-488-5408

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1/22/13 Problem Doctor Meeting Recap

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CSRMA MEETING CALENDAR 2013JANUARY FEBRUARY MARCH APRIL

CSRMA OC - THUR - 12/20/2012 CSRMA WC - THUR - 7 CSRMA LRP - SUN - TUE - 17, 18 & 19 CSRMA OC - THUR - 4CSRMA EB - THUR - 17 CSRMA FIN - MON - 8CSRMA BD - FRI - 18 CSRMA EB - THUR - 25CSRMA LIAB (TC) - THUR - 31 CSRMA BD - FRI - 26

CASA January 16-18 Indian Wells CASA April 24-26 Newport Beach

MAY JUNE JULY AUGUSTCSRMA LIAB - THUR - 9 CSRMA EB - MON - 10 CSRMA OC - TUES - 16 CSRMA EB - THUR - 22CSRMA OC - TUES - 21 CSRMA BD - FRI - 23CSRMA WC - THUR - 30

CASA August 21-24 San Diego

SEPTEMBER OCTOBER NOVEMBER DECEMBERCSRMA OC - FRI - 20 CSRMA EB - FRI - 11 CSRMA FIN - MON - 4 CSRMA EB - MON - 9CSRMA LIAB - THUR - 26 CSRMA WC - THUR - 24 CSRMA LIAB - THUR - 7

CSRMA OC - FRI - 15

CAJPA September 17-20South Lake Tahoe

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CSRMA Board of Directors

60 Members

Executive Board Russ Baggerly, Ojai Valley Sanitary District (President)

Paul Bushee, Leucadia Wastewater District (Vice President)

Craig Murray, Carpinteria SD

Jason Warner, Oro Loma SD

Greg Baatrup, Fairfield-Suisun SD

Tom Rosales, SOCWA

Bert Michalczyk, Dublin San Ramon SD

Logan Olds, Victor Valley WRA (Alternate)

Officers Committee

Russ Baggerly

Paul Bushee

Secretary

George Emerson

Finance Committee

Kenneth Spray, Chair

Ed Oyama

Brenda Krout

Treasurer

Kenneth Spray

Program Management Alliant Insurance Services, Inc.

JPA Administration & Insurance

Dennis Mulqueeney

Seth Cole

Myron Leavell

Marilyn Schley

P.J. Skarlanic

Thary Ou

Tevea Him

Loss Control Services

David Patzer, Risk Management Solutions CSRMA Risk Control Advisor

Heather Truro, HT Consulting

Return to Work Consultant

Accounting

Tami Giovanni

Legal Counsel

Byrne Conley, Esq. Gibbons & Conley

Coverage Counsel

David J. Garthe, Esq. Boornazian, Jensen &

Garthe

Claims

Janice Yardley Carl Warren & Co.

Financial Auditor

David Becker James Marta & Company

Claims

Tamara Kneff York Insurance Services, Inc.

Pooled Liability Program Committee

Bert Michalczyk,

Dublin San Ramon SD, Chair

Al Miller, Stege SD

Richard Currie, Union SD

Jason Warner, Oro Loma SD

Jeff Moorhouse, Carpinteria SD

Workers’ Compensation Program Committee

Greg Baatrup,

Fairfield-Suisun Sewer District, Chair

Jason Dow, Central Marin SA

Dan Child, SBSA

Shari Deutsch, Central Contra Costa SD

Roland Williams, Castro Valley SD

Financial Advisor

Carlos Oblites PFM Asset Management

LLC

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CSRMA California Sanitation Risk Management Authority

Service Team

Dennis Mulqueeney Senior Vice President

JPA Manager (415) 403-1421

[email protected]

Seth Cole First Vice President

Assistant JPA Manager (415) 403-1419

[email protected]

Tami Giovanni Accounting

(925) 963-0951 [email protected]

Thary Ou Account Administrator

Account Support Services (415) 403-1433

[email protected]

Myron Leavell Unit Manager

JPA / Insurance Administration (415) 403-1404

[email protected]

Marilyn Schley Account Manager

Insurance Administration (415) 403-1432

[email protected]

David Patzer Risk Control Advisor

Risk Control Consulting Services

(707) 373-9709 [email protected]

Tevea Him Administrative Support

Services (415) 403-1416

[email protected]

P.J. Skarlanic Account Manager

JPA / Insurance Administration (415) 403-1455

[email protected]

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csrma · mendoza, joey: carpinteria sanitary district 4/20/2010: mooney, stephen oro loma sanitary...

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