C L A I M S M A N A G E M E N T & M I T I G A T I O N - W O R - - PowerPoint PPT Presentation

C L A I M S M A N A G E M E N T & M I T I G A T I O N - W O R K I N J U R I E S I N T H E T R U C K I N G I N D U S T R Y M a y 6 , 2 0 1 5

T R A N S P O R T A T I O N

T R A N S P O R T A T I O N

THE DEADLI EST JOBS

T R A N S P O R T A T I O N

STAGGERING NUMBERS

• 475,000 large trucks with a gross vehicle weight rating of more than 10,000 pounds are

involved in crashes each year

• 5,360 fatalities and 142,000 injuries each year
• Of the 5,360 fatalities

– 74% were occupants of other vehicles – 3% were pedestrians – 23% were occupants of trucks.

• The unsafe actions of automobile drivers are a contributing factor in about 70 percent of

the fatal crashes involving trucks.

• Exceeding the speed limit was a factor in 22 percent of the fatal crashes.

https://www.osha.gov/SLTC/trucking_industry/safetyinfo.html

AVE RAG E ACCI DE NTS AN D I N JURI E S E ACH Y E AR

T R A N S P O R T A T I O N

• Traffic accidents
• Climbing in and out of the cab or trailer
• Loading or unloading the trailer
• Slips and falls on loading docks
• Roadway vibrations and/or poorly adjusted seating
• Improper maintenance of equipment
• Musculoskeletal disorders of the neck, back and upper extremity

– Truck drivers have a disproportionate number of musculoskeletal injuries compared to other industries

• Wrist & leg fractures
• Internal derangement of the neck and back

PRI MARY CAUSE S MOST COMMON I N JURI E S

T R A N S P O R T A T I O N

EXACERBATI NG FACTORS

• Comorbidities

– Obesity (53.3% with BMI > 30) – Morbidly Obese (26.6% with BMI > 35) – Heart Disease – Hypertension – Diabetes – Chronic Low Back Pain – Drug Abuse

• Mental Health Issues

– Loneliness (27.9%) – Depression (26.9%) – Chronic sleep distubances(20.6%) – Anxiety (14.5%) – Emotional problems (13%)

• Due to the nature of work, involving many hours of seating, following by brief periods of strenuous

labor loading/unloading, drivers are more prone to injury.

OTHE R CON TRI B UTI NG FACTORS

T R A N S P O R T A T I O N

COMPENSABI LI TY

• Generally Yes if occurred within course and scope of business
• Exacerbation/Aggravation of a preexisting injury
• Increased Symptoms vs. Actual Injury

– Temporary exacerbation vs. permanent aggravation (varies by jurisdiction)

• Sequelae of Injuries
• Occupational Disease

– Person is exposed to work-related hazard over extended period of time – Hazardous conditions must be more prevalent during employment when compared to everyday life

• Idiopathic injuries

– Heart attack, stroke, syncopal event, etc. – May need medical opinion to determine if compensable injury

WA S THE RE A COMPE N SAB LE I N JURY ?

T R A N S P O R T A T I O N

MEDI CAL BENEFI TS

• Physician
• Emergency Room Visit
• Hospitalization
• Therapies
• Work Hardening
• Prescriptions
• Nurse Case Managers
• All medical treatment deemed to be reasonable and necessary related to the work injury or

illness I N S U R A N C E C O M P A N Y W I L L P A Y F O R :

T R A N S P O R T A T I O N

I NDEMNI TY BENEFITS

• Waiting Period – Usually 7 days
• Temporary Total Disability Benefit (TTD)

– Pays up to a maximum dollar amount per week and usually up to 104 weeks

• Continuous Total Disability Benefit (CTD)

– Begins after TTD benefits cease, provided you apply for and receive a Social Security Disability Award for the covered injury – Payable up to a certain age

• Accidental Death & Dismemberment Insurance
• Non-Occupational Accident Coverage

– Accidental Death & Dismemberment Insurance – Accidental Medical Expense – TTD benefits – 14 day waiting period and 10 week duration – No CTD benefits

OCCUPATI ON AL ACCI DENT

T R A N S P O R T A T I O N

I NDEMNI TY BENEFITS

WORK E RS’ COMPE N SATI ON

• Waiting & Retroactive Periods – Range from 3 – 14 days
• Temporary Total Disability Benefit (TTD)

– Benefits are paid until the employee has reached Maximum Medical Improvement (MMI)

• Permanent Partial Disability Benefit (PPD)

– Calculation varies based on jurisdiction

• Permanent Total Disability Benefit (PTD)

– 100% permanently and totally disabled – Industrial disability

• Death Benefits

– Funeral Expenses – Benefits paid at TTD weekly rate – Benefits for surviving spouse, children and other dependents

• Other dependents may include elderly parents, adult children with physical or mental handicaps

– Benefits payable until spouse has passed away and children reach adulthood (varies)

T R A N S P O R T A T I O N

MODI FIED DUTY

I MPORTAN T TO AVOI D N E G ATI VE CON SE QUE N CES

• Increased level of physical deconditioning
• Loss of marketable employment skills
• Driver’s routine changes to no longer include a regular daily work routine
• Multiple studies conclude lack of active employment can lead to depression
• Ongoing indemnity payments increase the cost of the claim
• Attorney involvement
• Fear of re-injury
• Higher PPD/PTD rating

T R A N S P O R T A T I O N

• Transportation Company

– Reduces the cost of indemnity benefits – There is a direct correlation between RTW and the Experience Rating Modification Factor – Reduction in OSHA lost time days – Maintaining the services and skills of a trained employee – Improving employee retention

• Injured Worker Benefits

– Maintains wage-earning power – Facilitates a quicker recovery and transition back to work – Promotes emotional health – Helps reduce deconditioning

B E N E FI TS

MODI FIED DUTY

T R A N S P O R T A T I O N

• Have you considered a Modified Duty Offsite(MDOS) program?

– MDOS provides volunteers to non-profit organizations – Physician must release injured worker with documented temporary restrictions – Placement is usually up to 90 days but can be extended – Placement is based on the temporary restrictions and skills of the injured workers – Case Manager can facilitate ongoing communication between all parties

• Employers may be eligible for tax benefits secondary to contributing to a non-profit
• rganization. We recommend you consult with your legal team and accountants for eligibility.
• Multiple vendors across the country

WHAT I F MODI FI E D DUTY I SN ’ T AVAI LABLE ?

MODI FIED DUTY

T R A N S P O R T A T I O N

E X P E R I E N C E R A TI N G M O D I F I C A TI O N F A C TO R

• Method for tailoring the cost of insurance to the characteristics of an employer or risk
• It gives the employer the incentive to manage its own costs
• Predicts whether an employer is likely to develop loss experience that is better or worse than

the average risk in a particular classification

• Modifies premium by a factor that is designed to more accurately price insurance
• Uses the employer’s past experience to project future losses

WHAT DOE S THE E X PE RI ENCE RATI N G DO?

https://www.ncci.com/documents/abc_Exp_Rating.pdf

T R A N S P O R T A T I O N

E X P E R I E N C E R A TI N G M O D I F I C A TI O N F A C TO R

• Employer A

– 1 loss totaling $50,000

• Employer B

– 10 losses totaling $50,000

• Which employer would you expect to incur the higher workers’ compensation costs in the future?

E X AMPLE APPLI CATI ON

T R A N S P O R T A T I O N

CONTI NGENT LI ABI LI TY

• This coverage provides a layer of protection by providing defense to the Motor Carrier when a

qualified Independent Contractor attempts to collect Workers' Compensation benefits as an

• employee. If the Independent Contractor is deemed an employee, benefits will be paid

equivalent to those payable under the Workers' Compensation statutes and Employer's Liability law that apply.

DE FI N I TI ON

http://www.greatamericaninsurancegroup.com/Insurance/Trucking/Products/Pages/Contingent-Liability.aspx

I MPORTAN T STE PS

• Notify TrueNorth or your agent as soon as possible!
• TrueNorth will engage with the OA/CL and Motor Carrier WC adjuster to seek dismissal of

the WC claim

• TrueNorth will see the claim through dismissal to ensure the Motor Carrier is protected from

any WC claim

T R A N S P O R T A T I O N

SUBROGATI ON

• Subrogation is defined as a legal right that allows one party (e.g., your insurance company) to

make a payment that is actually owed by another party (e.g., the other driver’s insurance company) and then pursue reimbursement from the responsible third party.

DE FI N I TI ON WHY SUBROG ATE ?

• When a claim is filed with your insurance company and another party is at fault, your

insurance company will generally:

1. Pay the claim in order to indemnify you (cover your damages and injuries) 2. Seek to recover the money they paid – or at least a part of it – from the at-fault party

WHE N I S SUBROG ATI ON USE D?

• Cost savings for the employer/insured

T R A N S P O R T A T I O N

• 1 0 0 VE HI CLE PI LE UP ON

I N TE RSTATE 8 4 I N ORE G ON

• SAN DWI CHE D BE TWE E N

TWO TRUCK S

• SURVI VE D WI TH TWO

BAN D -AI DS