risk management user group wednesday, january 28, 2004
TRANSCRIPT
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Risk ManagementRisk ManagementUser GroupUser GroupWednesday, January 28, Wednesday, January 28,
20042004
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WelcomeWelcome
Michael L. Hay, CGFM, CPPMMichael L. Hay, CGFM, CPPM
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Please hold Please hold questions until the questions until the
end of all end of all presentations.presentations.
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Meeting AgendaMeeting Agenda 8:30-8:40 –8:30-8:40 – WelcomeWelcome 8:40-8:55 – 8:40-8:55 – Short Term Special Short Term Special
Events, General Events, General Liability Liability
8:55-9:10 – 8:55-9:10 – Review of SORM 200 Review of SORM 200 Data Data
9:10-9:40 –9:10-9:40 – ClaimsClaims 9:40-10:00– 9:40-10:00– Trend Analysis & Trend Analysis &
Accident Accident InvestigationInvestigation
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Meeting AgendaMeeting Agenda 10:00-10:15 10:00-10:15 – Break – Break 10:15-11:00 10:15-11:00 – Life Safety Code 101, – Life Safety Code 101,
2003 Update 2003 Update 11:00-11:15 11:00-11:15 – SORM Fraud Team– SORM Fraud Team 11:15-11:30 11:15-11:30 – Loss, Damage, & – Loss, Damage, &
Destroyed Destroyed Property Property
11:30-12:00 – Questions & Comments11:30-12:00 – Questions & Comments
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Short Term Special Events, Short Term Special Events, General LiabilityGeneral Liability
Steven E. Haynes, ARMSteven E. Haynes, ARM
GRS Insurance Services, LLCGRS Insurance Services, LLC
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State Office of Risk ManagementState Office of Risk ManagementMaster Short Term General Liability Master Short Term General Liability
Insurance ProgramInsurance Program
Background and PurposeBackground and Purpose
Key Elements of ProgramKey Elements of Program• Outside Users of State Owned FacilitiesOutside Users of State Owned Facilities• State Employees Using Third Party FacilitiesState Employees Using Third Party Facilities
Program HighlightsProgram Highlights• Types of Events AvailableTypes of Events Available• Underwriting GuidelinesUnderwriting Guidelines• Coverages, Limits, and PricingCoverages, Limits, and Pricing
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Application ProcessApplication ProcessKey ContactsKey ContactsMarketing MaterialMarketing MaterialSummary and Summary and QuestionsQuestions
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SORM 200 Loss Data SORM 200 Loss Data SummarySummary
Sally Becker CPCU ARMSally Becker CPCU ARM
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History History
Annual Report to SORMAnnual Report to SORM FY02 – change in data collectedFY02 – change in data collected
– Loss type Loss type – Loss causeLoss cause– Retain from year to year Retain from year to year – Update previously entered dataUpdate previously entered data
February, 2003 – availability to February, 2003 – availability to enter all year longenter all year long
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Data – FY02 vs. FY03Data – FY02 vs. FY03OverallOverall FY02FY02 FY03FY03 ChangChang
e %e %
No. of No. of LossesLosses
16361636 18391839 12%12%
OpenOpen 823823 852852
ClosedClosed 813813 987987
Amt. Pd.Amt. Pd. 5,665,1205,665,120 5,193,8335,193,833 -8%-8%
Res/DmdsRes/Dmds 615,379,6615,379,65353
1,048,355,91,048,355,94343
LawsuitsLawsuits 759759 636636 -16%-16%
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Automobile LiabilityAutomobile LiabilityFY02FY02 FY03FY03 Change Change
%%
No. of LossesNo. of Losses 382382 363363 -5%-5%
OpenOpen 165165 115115
ClosedClosed 217217 248248
Amount PaidAmount Paid 991,501991,501 524,462524,462 -47%-47%
Avg. Pd./Cld.Avg. Pd./Cld. 4,5694,569 2,1152,115 -54%-54%
Resr./Resr./DemandsDemands
3,255,913,255,9144
1,998,551,998,5511
LawsuitsLawsuits 159159 5959 -63%-63%
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InattentionInattention
FY02FY02 FY03FY03 Change Change %%
No. of LossesNo. of Losses 291291 260260 -11%-11%
OpenOpen 124124 8787
ClosedClosed 167167 173173
Amount PaidAmount Paid 799,050799,050 317,604317,604 -60%-60%
Avg. Pd./Cld.Avg. Pd./Cld. 4,7854,785 1,0851,085 -77%-77%
Resr./Resr./DemandsDemands
1,594,941,594,9488
886,693886,693
LawsuitsLawsuits 124124 4242 -66%-66%
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BackingBacking
FY02FY02 FY03FY03 Change Change %%
No. of LossesNo. of Losses 3636 3838 6%6%
Amount PaidAmount Paid 45,49745,497 37,96637,966 -17%-17%
Avg. Pd./Cld.Avg. Pd./Cld. 1,8191,819 1,0851,085 -40%-40%
Resr./Resr./DemandsDemands
509,372509,372 1,8251,825
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Automobile Physical Automobile Physical DamageDamage
FY02FY02 FY03FY03 Change Change %%
No. of LossesNo. of Losses 135135 290290 115%115%
OpenOpen 1010 6363
ClosedClosed 125125 227227
Amount PaidAmount Paid 227,140227,140 436,667436,667 92%92%
Avg. Pd./Cld.Avg. Pd./Cld. 1,8171,817 841841 -54%-54%
Resr./Resr./DemandsDemands
56,83456,834 216,332216,332
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CollisionCollisionFY02FY02 FY03FY03 Change Change
%%
No. of LossesNo. of Losses 104104 183183 76%76%
Amount PaidAmount Paid 187,114187,114 190,903190,903 2%2%
Avg. Pd./Cld.Avg. Pd./Cld. 1,9701,970 1,4141,414 -28%-28%
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General Liability (Third General Liability (Third Party)Party)
FY02FY02 FY03FY03 Change Change %%
No. of LossesNo. of Losses 610610 367367 -40%-40%
OpenOpen 380380 215215
ClosedClosed 230230 152152
Amount PaidAmount Paid 921,198921,198 406,325406,325 -56%-56%
Avg. Pd./Cld.Avg. Pd./Cld. 4,0054,005 2,6732,673 -33%-33%
Resr./DemandsResr./Demands 456,981,57456,981,5733
652,382,76652,382,7666
LawsuitsLawsuits 401401 197197 -52%-52%
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Employment PracticesEmployment PracticesFY02FY02 FY03FY03 Change %Change %
No. of LossesNo. of Losses 289289 308308 7%7%
OpenOpen 185185 200200
ClosedClosed 104104 108108
Amount PaidAmount Paid 1,232,2701,232,270 2,059,1772,059,177 67%67%
Avg. Pd./Cld.Avg. Pd./Cld. 11,84811,848 19,06619,066 61%61%
Resr./DemandsResr./Demands 114,687,70114,687,7044
8,248,0008,248,000
LawsuitsLawsuits 148148 181181 22%22%
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Discrimination - RaceDiscrimination - Race
FY02FY02 FY03FY03 Change Change %%
No. of LossesNo. of Losses 6666 8888 33%33%
Amount PaidAmount Paid 41,00041,000 206,700206,700 404%404%
Resr./Resr./DemandsDemands
00 1,106,751,106,7500
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RetaliationRetaliation
FY02FY02 FY03FY03 Change Change %%
No. of LossesNo. of Losses 2828 9898 250%250%
Amount PaidAmount Paid 16,03116,031 1,540,001,540,0000
9506%9506%
Resr./Resr./DemandsDemands
1,100,001,100,0000
4,630,004,630,0000
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PropertyProperty
FY02FY02 FY03FY03 Change Change %%
No. of LossesNo. of Losses 7878 118118 51%51%
OpenOpen 1515 2929
ClosedClosed 6262 8989
Amount PaidAmount Paid 720,967720,967 669,089669,089 -7%-7%
Avg. Pd./Cld.Avg. Pd./Cld. 11,62911,629 7,5187,518 -35%-35%
Resr./Resr./DemandsDemands
169,910169,910 212,852212,852
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Data by Date of LossData by Date of Loss# #
LossesLossesPaidPaid Resr./Resr./
DemandsDemands
FY98FY98 7171 1,320,1931,320,193 106,458,574106,458,574
FY99FY99 115115 743,620743,620 3,142,6023,142,602
FY00FY00 315315 2,545,9212,545,921 56,609,04656,609,046
FY01FY01 619619 3,011,9743,011,974 73,565,87573,565,875
FY02FY02 12461246 1,603,4451,603,445 542,820,186542,820,186
FY03FY03 10751075 1,354,7221,354,722 880,839,313880,839,313
Total:Total: 34413441 10,579,87510,579,875 1,663,435,591,663,435,5966
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Automobile LiabilityAutomobile Liability
# # LossesLosses
PaidPaid Resr/Resr/DemandsDemands
FY98FY98 1414 19,03519,035 8,5748,574
FY99FY99 1515 86,89786,897 00
FY00FY00 5151 140,434140,434 543,032543,032
FY01FY01 109109 398,482398,482 1,100,5941,100,594
FY02FY02 317317 591,728591,728 2,862,1512,862,151
FY03FY03 237237 249,387249,387 740,114740,114
Total:Total: 743743 1,485,9631,485,963 5,254,4655,254,465
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Auto Physical DamageAuto Physical Damage
# # LossesLosses
PaidPaid Resr/Resr/DemandsDemands
FY98FY98 11 125125 00
FY99FY99 22 284284 00
FY00FY00 22 1,1601,160 00
FY01FY01 3434 97,54497,544 00
FY02FY02 152152 222,626222,626 70,03670,036
FY03FY03 233233 151,165151,165 102,582102,582
Total:Total: 424424 472,904472,904 172,618172,618
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Employment PracticesEmployment Practices
# # LossesLosses
PaidPaid Resr/Resr/DemandsDemands
FY98FY98 1616 235,000235,000 105,750,000105,750,000
FY99FY99 1515 71,00071,000 100,000100,000
FY00FY00 4646 1,812,6221,812,622 00
FY01FY01 136136 416,700416,700 4,483,0004,483,000
FY02FY02 250250 471,817471,817 12,102,70412,102,704
FY03FY03 128128 82,75082,750 500,000500,000
Total:Total: 591591 3,098,8893,098,889 122,935,704122,935,704
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General Liability (Third General Liability (Third Party)Party)
# # LossesLosses
PaidPaid Resr/Resr/DemandsDemands
FY98FY98 1616 9,8509,850 700,000700,000
FY99FY99 4343 156,719156,719 3,042,6023,042,602
FY00FY00 139139 207,373207,373 15,821,01415,821,014
FY01FY01 242242 709,614709,614 61,511,78661,511,786
FY02FY02 343343 118,136118,136 517,112,291517,112,291
FY03FY03 180180 69,21169,211 531,919,146531,919,146
Total:Total: 963963 1,270,9031,270,903 1,130,106,831,130,106,8399
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PropertyProperty
# # LossesLosses
PaidPaid Resr/Resr/DemandsDemands
FY00FY00 88 10,33210,332 00
FY01FY01 88 578,259578,259 00
FY02FY02 7676 146,381146,381 170,010170,010
FY03FY03 104104 655,084655,084 212,752212,752
Total:Total: 196196 1,390,0561,390,056 382,762382,762
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ImportantImportant
UPDATE INFORMATIONUPDATE INFORMATION
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Terry G. MyersTerry G. Myers
Director of Claims Director of Claims OperationsOperations
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Claims CostClaims Cost
Cost to the Claims Cost to the Claims Fund Fund
vs vs
Per Claim CostsPer Claim Costs
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11stst Qtr FY04 Qtr FY04 UpdateUpdate
Medical and Indemnity Medical and Indemnity costs through the end of costs through the end of the 1the 1stst Qtr FY04 Qtr FY04
– Fewer open claimsFewer open claims
– Significantly lower costsSignificantly lower costs
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11stst Qtr FY04 Qtr FY04 UpdateUpdate
WCRIWCRI
– Cost of WC Claims in TexasCost of WC Claims in Texas
– Future Comparison with Future Comparison with SORM Claims CostsSORM Claims Costs
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Claims Operations Claims Operations ReorganizationReorganization
Realignment of State AgenciesRealignment of State AgenciesHHSCHHSC
Three Indemnity Claims TeamsThree Indemnity Claims Teams
HHSC, TDCJ, ALL OTHERSHHSC, TDCJ, ALL OTHERS
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Combined Medical Combined Medical Management with Management with
Medical Only Claims Medical Only Claims TeamTeam
Medical staff and senior adjustersMedical staff and senior adjusters
Eight (8) medical only adjustersEight (8) medical only adjusters
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ACCIDENT ACCIDENT INVESTIGATION/TREND INVESTIGATION/TREND
ANALYSISANALYSIS
ON-LINE TRAININGON-LINE TRAINING
Leonard ZolondekLeonard Zolondek
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Events & TrainingEvents & Training
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Safety PuzzleSafety Puzzle
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OVERVIEWOVERVIEW INVESTIGATION PROCESSINVESTIGATION PROCESS
OBJECTIVEOBJECTIVE
WHATWHAT
ROOT CAUSE ANALYSISROOT CAUSE ANALYSIS
TREND ANALYSISTREND ANALYSIS
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PROCESSPROCESS
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WHATWHAT
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Accident Causation Theories
There are a variety of theories on accident causation that can be grouped into the following categories: •Domino Theories which view accidents in three phases: pre-contact, contact and post-contact.
•Multiple Causation Theories which view causes based on a variety of factors such as man, machine and the environment.
•Psychological/Behavioral Causation Theories which focus on human behavior as the major cause of accidents
•Energy Related Causation Theories which view accidents as a result of energy that is out of control.
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ROOT CAUSE ANALYSISROOT CAUSE ANALYSIS
SCIENTIFIC PROBLEM SOLVING SCIENTIFIC PROBLEM SOLVING METHODSMETHODS– Fault Tree AnalysisFault Tree Analysis– http://reliability.sandia.gov/Reliability/http://reliability.sandia.gov/Reliability/
Fault_Tree_Analysis/fault_tree_analysiFault_Tree_Analysis/fault_tree_analysis.htmls.html
– Fish Bone DiagramFish Bone Diagram– http://www.pathmaker.com/resourceshttp://www.pathmaker.com/resources
/tools/cause.asp/tools/cause.asp
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ForkliftHits Ladder
Ladder inDoorway
ForkliftCouldn’t Stop
No BarrierSigns
ForkliftBrakes
Defective
Cooking Oil on Floor
ForkliftGoing Too
Fast
BrakeMaintenance
Delayed
HousekeepingInadequate
Speed LimitsNot Enforced
Or
Lack ofPersonnel
NoPolicy
NoEnforcement
NoEnforcement
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Fishbone Analysis
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LampWon’tWork
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Plug/Cord Lamp
LampWon’tWork
BulbPower
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Power
Plug/Cord Lamp
LampWon’tWork
Burnedout
Loose
Bulb
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Power
Plug/Cord Lamp
LampWon’tWork
BrokenSwitch
MissingSwitch
Corroded
Burnedout
Loose
Bulb
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Power
Plug/Cord Lamp
LampWon’tWork
Unpaid Bills
Switches
Storm
BrokenSwitch
MissingSwitch
Corroded
Burned out
Loose
Bulb
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Power
Plug/Cord Lamp
LampWon’tWork
Unpaid Bills
Switches
Storm
Dogchewed
UnpluggedBrokenSwitch
MissingSwitch
Corroded
Burnedout
Loose
Bulb
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TREND ANALYSISTREND ANALYSIS
IDENTIFY BASIC FACTSIDENTIFY BASIC FACTS
SHOW POSSIBLE SHOW POSSIBLE PATTERNS/TRENDSPATTERNS/TRENDS
ESTABLISH PRIORITIES FOR SAFETY ESTABLISH PRIORITIES FOR SAFETY ACTIVITIESACTIVITIES
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ASWG CODESEffective June 1, 1997 the Commission adopted revised Advisory
Statistical Work Group (ASWG) codes for Nature of Injury, Part of Body, and Cause of Injury. These code changes aligned the
Commission's reporting requirements with the International Association of Industrial Accident Boards and Commissions
(IAIABC) Electronic Data Interchange (EDI) reporting standards. The ASWG codes are available to EDI participants through the
IAIABC. If a carrier or trading partner has previously purchased an IAIABC Implementation Guide, the IAIABC will provide a list of all the ASWG codes as an update to the Guide. If you are interested in purchasing an Implementation Guide, you can contact the IAIABC directly at 1201 Wakarusa Drive C-3, Lawrence, Kansas, 66049 or
by phone (785) 840-9103. The IAIABC has also made the codes available via their website at www.iaiabc.org. Once you have
reached their web page, choose the EDI folder and available options will be listed.
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Examples of categories to include in the analysis should at least be the following:
A. Department:
B. Job Title:
C. Agent Involved: (ironing press, material cutter, fabric rolls, sewing machine, and clothing bundles)
D. Experience: (1-5 years, 6-10 years, etc.)
E. Body Part: (hand/fingers, back, leg, head/neck, arm and foot)
F. Accident Type: (caught between, struck-by, struck-against, lift/lower, push/pull, etc.)
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0
5
10
15
20
25
30
35
FY 01 11 3 2 0 3 2 2 1 2 1 1
FY 00 31 21 11 1 2 0 0 0 0 0 0
Aggr Slip/Fall Misc CutCghting/
BtwnRept
MotionJumping Vehicle Lifting Pushing Sports
CAUSE OF INJURY – FY 01 & FY 00As of August 31, 2001
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0
2
4
6
8
10
12
14
16
FY 01 2 1 1 2 1 4 0
FY 00 14 6 2 3 1 4 1
Acute IBP MIMR ITR Ger/Med CAU Extnd
CAUSE OF INJURY BY DEPARTMENT FY 01 & FY 00As of August 31, 2001
AGGRESSION
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0
1
2
3
4
5
6
FY 01 0 2 3 0 3 1 2 1
FY 00 5 2 1 1 1 0 0 0
Hskgf FdSvc ITR CSD Rehab Med Rec Acute Maint
CAUSE OF INJURY BY DEPARTMENT FY 01 & FY 00As of August 31, 2001
STRAINS
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Break Time!Break Time!
See you at 10:15!See you at 10:15!
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Fraud InvestigationsFraud Investigations
Gary Ingram Gary Ingram
Julie HerreraJulie Herrera
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Workers’ Comp. FraudWorkers’ Comp. Fraud
Workers’ Compensation Fraud is Workers’ Compensation Fraud is committed when a person(s) committed when a person(s) knowingly or intentionally knowingly or intentionally misrepresents, conceals, or omits misrepresents, conceals, or omits a material fact to either obtain or a material fact to either obtain or deny workers’ comp benefits.deny workers’ comp benefits.
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Workers’ Comp. Fraud Workers’ Comp. Fraud (cont’d)(cont’d)
Fraud is committed if a person Fraud is committed if a person knowingly or intentionally:knowingly or intentionally:
Makes a false or misleading statement.Makes a false or misleading statement. Misrepresents or conceals a material fact.Misrepresents or conceals a material fact. Fabricates, alters, conceals, or destroys a Fabricates, alters, conceals, or destroys a
documentdocument Conspires to commit an act described by Conspires to commit an act described by
the events above.the events above.
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Fraud Investigative UnitFraud Investigative Unit Investigate allegations of fraudInvestigate allegations of fraud Validate SIBS, TIBS, and Death Benefits infoValidate SIBS, TIBS, and Death Benefits info Validate suspect travel and prescription Validate suspect travel and prescription
reimbursementsreimbursements Assist DA’s and TWCC in prosecution of Assist DA’s and TWCC in prosecution of
fraudulent claimsfraudulent claims Assist the claims adjusters, agencies, and Assist the claims adjusters, agencies, and
claimantsclaimants Assist SORM in obtaining information that is Assist SORM in obtaining information that is
utilized at BRC’s and CCH’sutilized at BRC’s and CCH’s
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Useful ToolUseful Tool
EMPLOYEE’S RIGHTS ANDEMPLOYEE’S RIGHTS AND
RESPONSIBILITIES FORMRESPONSIBILITIES FORM
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Recent TrendsRecent Trends
MilitaryMilitary
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What to do when you What to do when you suspect fraud or abuse.suspect fraud or abuse.
Call SORM’s InvestigatorsCall SORM’s Investigators– Gary Ingram – (512) 936-1450Gary Ingram – (512) 936-1450– Julie Herrera – (512) 936-1521Julie Herrera – (512) 936-1521
Call your SORM adjuster or our main Call your SORM adjuster or our main ##– (512) 475-1440(512) 475-1440
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Lost, Damaged, & Lost, Damaged, & Destroyed PropertyDestroyed Property
Patricia O’HaraPatricia O’HaraSystems AnalystSystems Analyst(512) 936-1500(512) 936-1500
[email protected]@sorm.state.tx.us
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BenchmarksBenchmarks
The State Auditor’s Office (SAO) The State Auditor’s Office (SAO) recommended that SORM create benchmarks recommended that SORM create benchmarks for LDD property.for LDD property.
Benchmarks will be based on the Class Code Benchmarks will be based on the Class Code of assets, and an overall agency percentage.of assets, and an overall agency percentage.
An agency should have procedures for An agency should have procedures for safeguarding assets. Risk Managers can safeguarding assets. Risk Managers can contact their agency’s property manager.contact their agency’s property manager.
We should have the benchmarks in place this We should have the benchmarks in place this spring.spring.
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Appropriation ReductionAppropriation Reduction The Comptroller was charged by the 77The Comptroller was charged by the 77thth legislature legislature
to reduce an agency’s appropriations by 50% of the to reduce an agency’s appropriations by 50% of the value of lost property, if the percentages are in value of lost property, if the percentages are in excess of the American Society for Testing and excess of the American Society for Testing and Materials (ASTM) standards. This was implemented Materials (ASTM) standards. This was implemented at the end of FY02 and was continued by the 78at the end of FY02 and was continued by the 78thth Legislature in Article IX, Sec. 11.03 of the General Legislature in Article IX, Sec. 11.03 of the General Appropriations Act.Appropriations Act.
*Implementation Guidelines for General Appropriations Act, Art. IX, §9.03, *Implementation Guidelines for General Appropriations Act, Art. IX, §9.03, 77th Leg., R.S. -- Appropriation Reductions for Lost Property 77th Leg., R.S. -- Appropriation Reductions for Lost Property http://www.window.state.tx.us/comptrol/san/fm.notices.date.html/fm02/fhttp://www.window.state.tx.us/comptrol/san/fm.notices.date.html/fm02/fm02-47.htmlm02-47.html
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LDD DefinitionsLDD Definitions
Class CodesClass Codes
Disposal MethodsDisposal Methods
Lost Damage & Destroyed PropertyLost Damage & Destroyed Property
Historical Cost vs Depreciated ValueHistorical Cost vs Depreciated Value
Property level vs. Component levelProperty level vs. Component level
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LDD ProcessLDD Process
Missing PropertyMissing Property
Stolen PropertyStolen Property
Damaged/Destroyed PropertyDamaged/Destroyed Property
NegligenceNegligence
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Useful WebsitesUseful WebsitesSPA Class Codes and Annual Financial Report (AFR) SPA Class Codes and Annual Financial Report (AFR)
Categories:Categories:
http://www.window.state.http://www.window.state.txtx.us/.us/comptrolcomptrol/san/spa/spa_class_codes-/san/spa/spa_class_codes-afrafr_cats.html_cats.html
SPA Disposal Methods for Fixed Assets:SPA Disposal Methods for Fixed Assets:
http://www.window.state.tx.us/comptrol/san/fm_manuals/spa_man/shttp://www.window.state.tx.us/comptrol/san/fm_manuals/spa_man/spa_user2000/spauser_appd1.htmlpa_user2000/spauser_appd1.html
Missing, Damaged or Stolen Property Report:Missing, Damaged or Stolen Property Report:
http://www.window.state.http://www.window.state.txtx.us/.us/taxinfotaxinfo//taxformstaxforms/74-194./74-194.pdfpdf
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Useful Websites (cont’d)Useful Websites (cont’d)
State Agency’s Property ManagersState Agency’s Property Managers
http://www.window.state.http://www.window.state.txtx.us/.us/comptrolcomptrol/san/agency_contact_list/spa//san/agency_contact_list/spa/stst__agyagy_spa_contacts.html_spa_contacts.html
State Auditor’s Office ReportState Auditor’s Office Report
http://www.sao.state.tx.us/Reports/report.cfm/rehttp://www.sao.state.tx.us/Reports/report.cfm/report/01-032port/01-032
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Questions & Comments?Questions & Comments?
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Risk ManagementRisk ManagementUser GroupUser Group
Thank you for attending.Thank you for attending.
See you on April 28See you on April 28thth, right , right here!here!