Workers' Compensation
Due Le Human Resources October 29, 2014
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Program Overview • Workers' Compensation is a mandated employee benefit and is regulated under California Labor Code. • District staff is responsible for monitoring and coordinating efforts with the District's defense attorneys and Sedgwick, the third party claims administrator. - Sedgwick is responsible for the administration of all workers' compensation claims, including: approving/denying claims, ensuring employees receive .A~ medical treatment and regulatory reporting.
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Open Inventory • As of September 30, 2014, there are 900 open claims. -Of the 900 claims, 20 are medical only. -The remaining 880 claims are indemnity, the liability for total temporary disability and permanent disability.
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Financial Impact • As of June 30, 2014 the workers' compensation actuarial study reported that the financial exposure for the program was approximately $45.4M. -This includes all liabilities, including the cost of future medical claims. -This reflects a $1.7M increase from the previous year.
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Settlement Authority • Revisions to Board Policy 108 were submitted on October 22, 2014. - Requested settlement authority for the Human Resources Manager responsible for workers' compensation to settle claims, with concurrence from the General Counsel for up to $SOK. - Requested settlement authority to settle claims above $SOK and up to $lOOK, with concurrence from the General Counsel and approval from the General Manager. - Board approval is required for settlements exceeding $lOOK. ~~ 5
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Requested Metrics
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Open/Closed Claims Workers' Compensation Claims Open/Closed By Claim Type 600 500 400 300 200 100 0
Closed Medical Only
Total - New
Total- Closed
63 53 65
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New Claims by Age Group • Claims by age Group
• ACT Demographics
Workers' Compensation - New Claims 9'o of Total Oaims and Year
50.0% . - - - - - - - - ---'---'--
---'--
-'---=--
--=-- - - - - - - -
Workers' Compensation - New Claims %of Total Employees by Age Group and Year 45.0% ....--- - - -- - - - -- - - - - - - - - - - - - 40.0% +--- -- -- - - - - - - - - 35.0% +--- - - -- - - -- - - -------, 30.0% +--- - - -- - -- - --== = =------' 25.0% +--- - - - - - - - 20.0% t -- - - - ----;::::::;;:::=;----; 15.0% +--- - - - 10.0% +--- - - --
S.O%
0.0%
t::::&iiiiB~
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New Claims by Service Years Workers' Compensation - New Claims %ofTotal OaimsbyTop FrequencyServiceYearsand Year
• New claims by years of serv~ce
Workers' Compensation - New Claims _ % ~~9'c -=:. o -=:. of~l=-= ota .=::... I .=: Em ..:;:.p !::..::l-=:. oy '-e__ e_s b _,y._Se _ nn _· c_e_Y,_ea _r_s _an_d_Y _e_ar_ _ _ _ _ __ 40 0 35.0% - - - - - - - - - 30.0% - - - - - - - - -25.0% - - - - - - - - - 20.0% - -----fo,.,.-J t-15.0% 10.0% 5.0% 0.0%
• ACT workforce demographics by years of services
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New Claims by Division . Workers• Compensation -New Claims 160 140 120 100 80 60 40 20
daim Count
~----------------------------------==~------------~· +-------~~~-----------.--~----
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Division and Year
Div 2 Transportation
Div 6 Transportation
Div 4 Transportation
All Other
88
87
115
101
11 2013
74
89
116
9:)
w 2014
104
99
87
136
40.5%
11.2%
·25.096
51.1%
%0\ange
Location
FY 2012
FY 2013
FY 2014
D2- T
388
464
412
D4-T
363
388
405
06-T
115
383
385
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New Claims by Injury Type Workers' Compensation - New Claims 175 150 125
Count
Cause of
and Year
100 75 50 25 0
Strain or Injury By
Mscell aneous Causes
Struck or Injured By
Motor Vehide
Fall or Sl ip Inju ry
All Other
8 2012
172
117
25
22
29
26
1i1 2013
136
104
34
35
30
30
w 2014
155
11 2
52
37
35
35
14.096
7.796
52.9%
5.796
16.796
16.796
96 Change
• Miscellaneous causes include: stress, cumulative trauma, acts of crime, foreign body in eye, etc. • "All Other" causes include: cuts, scrapes, burns, caught i~~ between, etc. 12
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New Claims by Day of Injury Workers• Compensation - New Claims %of Total Oaims by Day of Loss and Year
25.0% 20.0% 15.0% 10.0% 5.0% 0.0%
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
• 2012
15.196
19.996
16.196
17.696
17.696
6.496
7.LJ6
11 2013
16.8%
14.496
16.3%
17.196
19.8%
9.5%
6.LJ6
2014
14.396
18.596
20.2%
19.796
13.6%
7.5%
6.196
96 Pt Change
-2.596
4.196
3.9%
2696
-6.296
-2.0%
-0.196
• No identifiable trend
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Pending/Open Claims Workers• Compensation - Pending Claims Oairn Count by Claim Type and As of Year 1,000 800 600 400 200 0
Indemnity
Medical Only
Total
11 2012
823
15
838
11 2013
867
22
889
2014
842
21
863
-2.9"A>
-4.5%
-2.9"A>
%Change
• Pending/open claims at 2014 fiscal year end 26 claims lower than 2013; despite 15.4% increase in new ....,A4§claims
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Repeat Claimants • Of the existing 900 open claims: Number of Claims
Number of Employees
404 2 3, 4
.
s
126 45
."
11 4 4 3
..
6 7
..
..
A~ 15
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Ongoing Initiatives •
Research Alternative Dispute Resolution -
Mediation as option to resolve claims
• Aggressive legal defense -
Working with TPA and defense attorneys to aggressively defend claims
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Refer fraud activity to District Attorney's Office
• Strategic settlements Proactively identify opportunities to settle potentially high liability cases early. Resolve claims before employees feel need to retain legal representation.
• TPA contract expiration -
Research and identify opportunities to leverage TPA relationship
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