Lunch

1
Lunch Learn Roundtable No. 1Workers
Compensation Fundamentals

• September 29, 2009 1100 to 100
• Westin Hotel, Waltham, Massachusetts

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AGENDA

• Introductions Overview of the MCPSA Insurance
  Excellence Group
• John Tarvin Mike Lucas
• Surprise Quiz
• Jeff Burke Paul Marino
• A Primer on Workers Compensation
• Claims Management
• Janice Moquin Mark Hickox

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AGENDA

• Independent School Claims Data
• Mike Lucas Deanna Bullock
• A True Life Case Study
• Jeff Burke, Paul Marino Mark Hickox
• Risk Management Resources Available to You
• Jeff Burke

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AGENDA

• Everything is on the Table Roundtable -
• Your Questions
• Closing Comments
• John Tarvin and Mike Lucas

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Introductions OverviewThe MCPSA Insurance
Excellence Group

• Association
• Massachusetts Center for Charter Public School
  Excellence
• John Tarvin - Executive Director
• Brian Anderson Program Manager
• Insurance Agent
• Fred C. Church Team serving MCPSA Member Clients
• Mike Lucas - Vice President Account Executive
• Carol Bailey - Account Executive
• Jeanne Pitts - Account Manager
• Deanna Bullock - Manager, Claims Department
• Jeff Burke - Vice President Risk Management
  Consultant
• Paul S. Marino - Risk Management Consultant

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Introductions Overview The MCPSA Insurance
Excellence Group

• Insurance Companies
• Property, General Liability, Educators Legal
  Liability, Auto, Umbrella Builders Risk
• Hanover, (A.M. Best Rated A, Excellent)
• Crime Fiduciary Liability
• Chubb Insurance, (A.M. Best Rated A, Superior)
• International Travel
• ACE, (A.M. Best Rated A, Superior)
• Student Accident
• Markel (A.M. Best Rated A, Excellent)

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Introductions OverviewThe MCPSA Insurance
Excellence Group

• Insurance Companies
• Workers Compensation
• Atlantic Charter Insurance (A.M. Best Rated A,
  Excellent)
• Team serving MCPSA Member Clients
• Gina Wong - Underwriting Manager
• Janice M. Moquin - Assistant Claims Manager
• Neal Freedman - Safety and Health Manager
• Jacquie Willett - Marketing Manager
• Mark Hickox - Safety and Health Consultant
• Janeen Ackerson - Claims Specialist, Loss Control
  Consultant

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SURPRISE QUIZ ?

• You have ten minutes...good luck!

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Surprise Quiz!

•  
• Your school is required by the state of
  Massachusetts to provide workers compensation
  insurance coverage? True or False
•  
• Who is covered under a workers compensation
  policy?
• A) Employees B) Volunteers C) Students
  D) Anyone injured on school property
• Your school is required to report any workers
  compensation claim to the Department of
  Industrial Accidents when ____ of incapacity to
  earn full wages has been reached? A)
  1 day B) 3 days C) 5 days D) 7
  days
• Massachusetts requires schools to have a safety
  committee? True or False
•  
• Employees injured at work can go to any medical
  provider for treatment? True or False
•  

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Surprise Quiz!

• An employee who is out of work on a WC claim can
  continue working elsewhere?
• True or False
•  
• Employees who are injured as a result of their
  own negligence are not covered by WC?
• True or False
•  
• When should you report a work related injury to
  your insurer?
• What types of injuries should you report to your
  insurer?
•  What is light duty? A) Work that requires no
  lifting B) Work that requires no lifting over 10
  pounds C) Work that requires no lifting over 30
  pounds D) Work that is within the restrictions
  set by the treating physician
•  

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Surprise Quiz!

•  
• BONUS QUESTION
• What does OSHA stand for and do you have to
  abide by their standards?

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A Primer on Workers CompensationWhat is the
Purpose of WC Insurance?

• Workers Comp serves as virtually the exclusive
  remedy for employees who have sustained a work
  related injury/illness.

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Workers Compensation PrimerShort History Lesson

• 1911 Massachusetts enacts first WC act
  (voluntary)
• 1943 WC becomes compulsory law
• 1991 Most recent reformation of law
• The Massachusetts WC Marketplace Insurers,
  Safety Groups, SIGs and the Pool

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Workers Compensation PrimerMassachusetts
Regulatory Structure

• Department of Industrial Accidents (DIA)
• Workers Compensation Rating and Insurance Bureau
  (WCRIB)
• Legal Obligations and Consequences
• Premium Rate Calculation Payrolls, Experience
  Modification Factor (the Mod), All Risk
  Adjustment Program (ARAP), Credits, Deviations,
  Dividends and Assessments

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Workers Compensation PrimerWhen is an employee
covered?

• ---------------No Fault Insurance---------------
• Requirement Criteria for an employee to be
  covered
• 1. Liability arose in scope/course of
  employment
• Disability medical treatment and incapacitated
  from earning full wage
• Causal Relationship injury/illness is the
  result of work incident

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Workers Compensation PrimerA Real Benefit to
Your Employees

• ------------------Benefits---------------------
• Medical Coverage treatment related to work
  related condition
• Wage Replacement Total and/or Partial
  Disability
• Loss of Function/Scarring
• Vocational Assistance Job Placement and/or
  Training

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Workers Compensation PrimerThe Claims Process

• Injury Response
• Injury Treatment
• Claim Reporting
• Accident Investigation
• Corrective Actions
• Post Injury Management
• Follow-up with Adjuster
• Follow-up with Employee
• Follow-up on Corrective Actions

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A True Life Case Study

• Salvatore Marino, the custodian employed by North
  End Charter School was
• working during the school day cleaning tar stains
  off the stairs with a heavy
• duty cleaning solution. He slipped and fell down
  2 steps causing his bucket to
• spill splashing cleaning solution on his face
  and right arm. Salvatore, feeling
• no pain from the fall or the cleaning solution
  got up, dried off and continued
• working, never saying anything to his supervisor
  prior to leaving work.
• His uncle picked him up from work and before
  arriving home Salvatore
• began to experience slight burning sensations.
  When he got home he rinsed
• the affected areas....but it was too late. His
  uncle drove him to the
• emergency room of the local hospital.

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A True Life Case Study (cont.)

• After sitting for 1 hour in the emergency room,
  he was finally seen and
• diagnosed with 2nd degree burns on his face,
  shoulder, arm and lower back.
• By this time it had been over 7 hours since the
  accident occurred.
• Salvatore was transferred to the burn unit of a
  city hospital. Treatment was
• intense and required extensive surgery including
  skin grafting from his thigh.
• Over a year later Salvatore continues to require
  pain management, therapy
• and is out of work.

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A True Life Case Study (cont.)

• Injury Management
• Lets assume he immediately reported the accident
  to you. He dried himself
• off and came right to your office to report. He
  tells you that he fell down the
• stairs and was splashed with cleaning solution
  but feels fine. What would you
• have done?
• Would you respond differently if you had
  witnessed the accident?
• WC Claim Handling
• Salvatore reported the incident to you. He did
  not go to the ER or to the
• schools Occupational Health Provider. Would you
  report this incident to your
• workers compensation insurer? What is your
  procedure for gathering all of
• the facts?

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A True Life Case Study (cont.)

• Injury Management
• Salvatore, does not want to see a doctor, but you
  insist that he must. Where
• will you send him and how will you get him
  there?
• Loss Prevention
• Just as in the case study, Salvatore does not go
  to the hospital immediately
• but waits. Within 24 hours you know the terrible
  burns that Salvatore has
• suffered. What do you do back at your school to
  understand how this could
• have happened and to prevent it from happening
  again?
• What if instead, Salvatore got immediate
  treatment and the doctor indicated
• that Salvatore had suffered only minor chemical
  burns from the cleaning
• solution but thanks to getting him treatment
  everything is fine. What would
• you do now to prevent this accident from
  happening again?

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A True Life Case Study (cont.)

• Loss Prevention
• How would you find out what the chemical
  was...what the potential hazards
• were...what personal protective equipment was
  necessary...what first aid
• level response might be needed.
• What safety compliance programs and protocols
  are you required to have
• that relate to this type of incident?
• Claim Handling
• Salvatore is in the hospital. What is your
  follow-up with him...his wife...the
• claims adjustor?
• Salvatore is home recovering, it will be a long
  time before he can return to
• work. What is your follow-up with him...his
  wife...the claims adjustor...your
• agent?

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A True Life Case Study (cont.)

• Root Causes
• What were the root causes of Salvatores
  injuries?
• Was this injury really preventable?
• Who was responsible?

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A True Life Case Study (cont.)

• What if.....
• What if the cleaning solution also had splashed
  on several first graders as
• their class was ascending the stairs?...How
  would you handle Injury
• management?...Claim Reporting?...Loss Prevention?
• What if Salvatore was an independent
  contractor?...what would be your
• response? What if he were similarly
  injured...could the school be sued,
• found negligent and liable?

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Case Study Results

• Direct Claim Costs
• Total Incurred Loss to Date 240,584
• Medical Paid 85,914.40 Medical Reserve
  102,537
• Indemnity Paid 3,662.64 Indemnity
  Reserve 48,470
• What are the indirect short and long term costs
  to the school?

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MCPSA Insurance Excellence GroupRisk Management
Resources

• If you have a question or a request for service
  on anything even remotely related to risk and
  insurance....ask us!
• We will either have the answer or we will find
  the answer and a way whenever possible to serve
  your needs.

• On Call Risk Management Advice Customized
  Service
• Consultants from Fred C. Church, Atlantic Charter
  Hanover
• Employee Handbook Development Human Resources
• Safety Policy and Program Development and
  Training
• Safety Training Materials
• Regulatory Compliance Assistance (OSHA, DOT)
• Risk Management Evaluations and Assessments
• Special Project Assistance

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MCPSA Insurance Excellence GroupRisk Management
Resources

• Online Demonstration of
• Insight Risk Management Resource

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Roundtable QA

• The Questions You Submitted to Us
• Overview of what I should know as someone fairly
  new how to prevent claims
• How does the school communicate discomfort or
  doubt about a claim without prejudicing the
  process or going afoul of the laws?
• How many days does an employee need to be out for
  Workers Comp to pay them for their lost time?
• WC Coverage for sub-contractors and 1099
  employees

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Closing Remarks

• Thank you for joining us today!!
• Lunch Learn Roundtable No. 2
• With Hanover Insurance Company
• In Worcester
• January or February 2010
• On School Liability
• Details to Follow