session title: speaker name · workers’ comp from the trenches tales of frustration and how to...

Workers’ Comp from the TrenchesTales of Frustration and How to Overcome

Alethea Leandro-FarrSafety & Loss Control ManagerJG Parker Insurance Associates

Carlos LunaVice President of Marketing and Business DevelopmentRisico Total Managed Care, Inc.

Amy Wolfe, MPPA, CFREPresident & CEOAgSafe

Welcome

2020 AgSafe Conference Emergency Plan

If an emergency occurs during the 2020 AgSafe Conference, participants are asked to follow this process:

After hearing 3 long horn blasts, walk – DO NOT RUN – out the conference center or hotel towards the courtyard fountain on K Street.

AgSafe and Hotel staff will provide further instruction following building evacuation.

Participants should not use elevators to exit buildings; DO NOT leave the site in your vehicle – all participants should stay on the DoubleTree property.

When it is safe to return to all buildings, another series of 3 long horn blasts will occur.

• Ag Workers’ Compensation Trends

• 5 Essentials to Managing Workers’ Comp

• Lessons Learned: The Employer’s Perspective

Ag Workers’ Compensation Trends

• The California Workers’ Compensation Institute (CWCI) conducted 11-year study detailing data on claims from California’s Central Valley Farm Belt.

– Study analyzed nearly 344,000 Central Valley claims for 2005 - 2015 for injuries that resulted in more than $4.4 billion in medical and indemnity payments.

– Study found that workers in California’s Central Valley have a distinctly different workers' comp claims experience.


• Differences captured in the data included:

– Regional claim and payment distribution;

– Distribution by industry sector;

– Nature of injuries;

– Average claim duration; and much more.

Ag Aging Workforce

In 2006, the average age of farm workers was 36 years old. In 2017, the average age for farm workers was 42 years old.

Ag Aging Workforce

Ag Aging Workforce and Workers’ Compensation

• Workers’ Compensation claim costs increase with age.

– Pre-existing conditions (e.g., joint pain from arthritis, decreased range of motion and loss of muscle strength and flexibility) are more prevalent in older workers.

– Older workers can be at higher exposure of injuries common in the Ag work environment (e.g., Strains and Sprains).

– Older workers may take longer to heal physiologically heal and return to the workforce.


As the workforce ages, the data suggests that claims will become more complex (mixing compensable and pre-existing conditions, delayed recovery) presenting new challenges for employers and claims administrators.

5 Essentials to Managing Workers’ Comp

Employees• Time of hire pamphlet (DWC website)

• Posters are completed and posted – Where they are located

• Safety training completed

• What to do should an incident occur – To whom he/she should report the incident


Claims Kit

Your claims kit should include:

• Your Policy Number and Effective Date

• How to report a Claim

• Claim reporting Phone Numbers and Email addresses

• Payroll and Online Reporting

• Medical Panel Network Provider and MPN Coordinator

• Medical Authorization Form

• Risk Management and Safety Services


Medical Panel Network – Why is this important?

• You must use it to determine the Clinic that you will use.

• Develop a relationship with Clinic.– Who is the Clinic/Employer Liaison?– Who is the Company Contact?– Do you provide modified/alternative duty?

• This is EXTREMELY important in order to limit time loss claims.– How will you receive a Work Status?– Do you need to call in when you’re bringing in a worker?


Medical Panel Network – Why is this important?

• Report the claim within 5 days of knowledge of incident– If you don’t know all the facts, at least report the employee’s

name and date of the incident.

• Carrier only has 90 days to accept or deny the claim– If not determined before 90 days, they MUST accept the claim

• Include a Wage Statement for 1 year prior to date of injury– Used to determine Average Weekly Wage


Supervisors/Foremen

• Supervisors link management and the workforce.

－ The Supervisor is the first line of defense in managing safety issues.

－ Supervisors are expected to know the elements of the IIPP and to enforce safety regulations


Supervisors/Foremen

• When an injury/illness occurs:

－Provide Employee Claim Form (DWC1) to the injured employee within 1 working day of knowledge.

－Must arrange for treatment.

－ If treatment is refused, have employee complete Refusal of Medical Treatment form.

－Report the injury to the office.


Investigate the incident

– Ask questions

– Take photographs

– Interview witnesses

– Document all findings


Injured Worker

I was injured at work, what do I do now?

A quick overview of what will happen next:

1. Report your injury.

2. Complete the Employee Claim form.

3. The Insurance Carrier will contact you.

4. Go to in-network Medical Provider near you.

5. For life threatening emergencies call 911 or go to an emergency room immediately.


Adjuster

Communication is the best way to manage claims.

Contact your Claims Adjuster if:

– An injured worker’s job status changes.

– The availability of modified work changes.

– The injured worker is terminated.

– The injured worker’s rate of pay has changed.

– You believe they’re working elsewhere or are involved in recreational activities.

– You suspect fraud.

Lessons Learned: The Employer’s Perspective

Employee Job Description

• Ensure there is a job description for the position

• Provide to the adjuster early in the process

• Ensure a copy has been provided to the medical provider

• During later phases in the medical review, confirm receipt of the description


Medical Resources

• Ask about all resources available for both the patient and the company

• If you feel you are not receiving sufficient care, ask about options to change medical providers

• Trust your judgement


Employer Representative Always Present

• Attend all medical appointments

• Request copies of all documentation

• After each medical appointment, follow-up with your adjuster

• Make the time and energy to be engaged


Communication is Key

• Ensure you are in communication with all parties all the time

• Communicate with the employee separate from medical appointments about their medical experience

• Always ask for information in writing

Thank you for being a great audienceAlethea Leandro-Farr, Safety & Loss Control ManagerJG Parker Insurance Associates(831) [email protected]

Carlos Luna, Vice President of Marketing and Business DevelopmentRisico Total Managed Care, Inc.(303) [email protected]

Amy Wolfe, MPPA, CFRE, President & [email protected]

session title: speaker name · workers’ comp from the trenches tales of frustration and how to...

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