Description
In England and Wales, a claims management company is a business that offers claims management services to the public. Claims management services consist of advice or services in respect of claims for compensation, restitution, repayment or any other remedy for loss or damage, or in respect of some other obligation.
4
Study Design for Evaluating Workers’ Compensation Claims Management
Briefing Report
Stephanie Hoffman, JLARC Staff
December 5, 2012
2011 Legislation Directs Workers’ Compensation Claims Management Audit by June 2015
? 1st briefing in June 2012
? Reported that we hired a consultant to assist with study design
? Today’s briefing will include:
? Overview of Washington’s workers’ compensation claims management system ? JLARC’s study design plan ? Study cost and timeline for full evaluation
Study Design for Evaluating Workers’ Compensation Claims Management
December 5, 2012
2
1
I. Overview of Workers’ Compensation Claims Management
Workers’ Compensation Insurance Seeks to Protect Workers and Employers
? Pays for eligible medical expenses, portion of lost wages, permanent disability awards, and vocational retraining ? In return, workers cannot sue their employers for work?related injuries or illnesses ? Workers in WA are covered by the state insurance plan (“State Fund”) administered by Labor and Industries (L&I) or self?insured employers
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 1
December 5, 2012
4
2
Over 146,000 Workers’ Compensation Claims Were Filed in Fiscal Year 2012
Fiscal Year 2012: Workers Employers New Claims Filed Benefits Paid State Fund 2.4 million (74%) 167,000 101,500 $1.5 Billion Self?Insured Employers 850,000 (26%) 2,300 45,000 $419 Million
December 5, 2012 5
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 1
What Is Claims Management?
Series of decisions L&I and others make to:
? Help a worker recover from a work?related injury or illness ? Mitigate the economic impacts of that injury or illness ? Assist the worker in returning to work
Decisions include:
? ? ? ? Has injury/illness created a disability from work? Is worker eligible for portion of lost wages? When is medical treatment no longer necessary? When to close a claim?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 1 December 5, 2012 6
3
II. JLARC’s Study Design Plan
Research Questions Focus on Timeliness, Fairness, and Efficiency of Claims Management
? Audit will assess whether changes are warranted in six areas of claims management
1 Decision?making:
? How long does it take for benefits to be paid to injured workers and providers? ? Are key decisions made consistent with statutes, rules, and L&I policies?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 2
December 5, 2012
8
4
Research Questions (cont.)
2 Complaint and Dispute Resolution:
? How long does it take for Department to respond to a protest on a claim decision? ? Are the complaint and dispute resolution processes applied consistently for State Fund and self?insured claims? ? Is the content of L&I’s forms, publications, and website usable and easy to understand? ? Do workers and employers believe they receive information (such as appeal rights) in a timely manner?
Study Design for Evaluating Workers’ Compensation Claims Management Report pp. 2?3 December 5, 2012 9
3 Communications:
Research Questions (cont.)
4 Organizational Structure and Service Delivery
Models:
? Do L&I’s organizational structure and delivery systems support prompt payments? ? Are they focused on encouraging rapid and sufficient physical recovery and returning workers to work?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 3
December 5, 2012
10
5
Research Questions (cont.)
5 Service Delivery for Retrospective Rating Plan
Participants versus Non?Plan Participants:
What is the retrospective rating plan? A voluntary program for State Fund employers that promotes safe workplaces and provides partial refunds on insurance premiums to employers who reduce injuries and lower claim costs.
? Is L&I organized differently for the handling of claims from retrospective rating plan participants? ? If so, can one determine whether those differences impact rating plan refunds for plan participants?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 3 December 5, 2012 11
Research Questions (cont.)
6 Current Department Initiatives:
? Do current initiatives improve service delivery and provide new opportunities for education about how best to return workers to work? ? Is the Department measuring the impact of new initiatives?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 3
December 5, 2012
12
6
JLARC Will Compare Performance in These Six Areas Across Claim Programs
State Fund
Non? Retrospective retrospective rating plan rating plan
Self?Insured Claims
To the extent information is available, compare performance to workers’ compensation programs outside of Washington and industry practice
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 5 December 5, 2012 13
Study Will Require Multiple Evaluation Tools and Interdisciplinary Team of Experts
Evaluation Tool Consultant Expertise Required
Statistical analysis Labor economics/statistics; of claims data data programming Claim file reviews Claims management; workers’ compensation law
Surveys of workers Survey implementation & employers Interviews JLARC staff and consulting team
December 5, 2012 14
Study Design for Evaluating Workers’ Compensation Claims Management Report pp. 4?5
7
III. Study Cost and Timeline
Cost for Expert Consultants
? Estimated cost for consultants is $664,000 ? Estimate developed with workers’ compensation expert and reviewed by four independent professionals ? Appropriation in 2013?15 Budget is needed to carry out this study
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 6
December 5, 2012
16
8
Full Evaluation to be Completed by June 2015
?
Phase 1 Dec 2012 Briefing report on study design plan Phase 2
Dec 2013 Report on progress of audit June 2015 Present audit results to Legislature
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 6
December 5, 2012
17
Contact Information
Stephanie Hoffman, Project Lead [email protected] 360?786?5297 Valerie Whitener, Project Supervisor [email protected] 360?786?5191
www.jlarc.leg.wa.gov
9
doc_540451421.pdf
In England and Wales, a claims management company is a business that offers claims management services to the public. Claims management services consist of advice or services in respect of claims for compensation, restitution, repayment or any other remedy for loss or damage, or in respect of some other obligation.
4
Study Design for Evaluating Workers’ Compensation Claims Management
Briefing Report
Stephanie Hoffman, JLARC Staff
December 5, 2012
2011 Legislation Directs Workers’ Compensation Claims Management Audit by June 2015
? 1st briefing in June 2012
? Reported that we hired a consultant to assist with study design
? Today’s briefing will include:
? Overview of Washington’s workers’ compensation claims management system ? JLARC’s study design plan ? Study cost and timeline for full evaluation
Study Design for Evaluating Workers’ Compensation Claims Management
December 5, 2012
2
1
I. Overview of Workers’ Compensation Claims Management
Workers’ Compensation Insurance Seeks to Protect Workers and Employers
? Pays for eligible medical expenses, portion of lost wages, permanent disability awards, and vocational retraining ? In return, workers cannot sue their employers for work?related injuries or illnesses ? Workers in WA are covered by the state insurance plan (“State Fund”) administered by Labor and Industries (L&I) or self?insured employers
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 1
December 5, 2012
4
2
Over 146,000 Workers’ Compensation Claims Were Filed in Fiscal Year 2012
Fiscal Year 2012: Workers Employers New Claims Filed Benefits Paid State Fund 2.4 million (74%) 167,000 101,500 $1.5 Billion Self?Insured Employers 850,000 (26%) 2,300 45,000 $419 Million
December 5, 2012 5
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 1
What Is Claims Management?
Series of decisions L&I and others make to:
? Help a worker recover from a work?related injury or illness ? Mitigate the economic impacts of that injury or illness ? Assist the worker in returning to work
Decisions include:
? ? ? ? Has injury/illness created a disability from work? Is worker eligible for portion of lost wages? When is medical treatment no longer necessary? When to close a claim?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 1 December 5, 2012 6
3
II. JLARC’s Study Design Plan
Research Questions Focus on Timeliness, Fairness, and Efficiency of Claims Management
? Audit will assess whether changes are warranted in six areas of claims management
1 Decision?making:
? How long does it take for benefits to be paid to injured workers and providers? ? Are key decisions made consistent with statutes, rules, and L&I policies?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 2
December 5, 2012
8
4
Research Questions (cont.)
2 Complaint and Dispute Resolution:
? How long does it take for Department to respond to a protest on a claim decision? ? Are the complaint and dispute resolution processes applied consistently for State Fund and self?insured claims? ? Is the content of L&I’s forms, publications, and website usable and easy to understand? ? Do workers and employers believe they receive information (such as appeal rights) in a timely manner?
Study Design for Evaluating Workers’ Compensation Claims Management Report pp. 2?3 December 5, 2012 9
3 Communications:
Research Questions (cont.)
4 Organizational Structure and Service Delivery
Models:
? Do L&I’s organizational structure and delivery systems support prompt payments? ? Are they focused on encouraging rapid and sufficient physical recovery and returning workers to work?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 3
December 5, 2012
10
5
Research Questions (cont.)
5 Service Delivery for Retrospective Rating Plan
Participants versus Non?Plan Participants:
What is the retrospective rating plan? A voluntary program for State Fund employers that promotes safe workplaces and provides partial refunds on insurance premiums to employers who reduce injuries and lower claim costs.
? Is L&I organized differently for the handling of claims from retrospective rating plan participants? ? If so, can one determine whether those differences impact rating plan refunds for plan participants?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 3 December 5, 2012 11
Research Questions (cont.)
6 Current Department Initiatives:
? Do current initiatives improve service delivery and provide new opportunities for education about how best to return workers to work? ? Is the Department measuring the impact of new initiatives?
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 3
December 5, 2012
12
6
JLARC Will Compare Performance in These Six Areas Across Claim Programs
State Fund
Non? Retrospective retrospective rating plan rating plan
Self?Insured Claims
To the extent information is available, compare performance to workers’ compensation programs outside of Washington and industry practice
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 5 December 5, 2012 13
Study Will Require Multiple Evaluation Tools and Interdisciplinary Team of Experts
Evaluation Tool Consultant Expertise Required
Statistical analysis Labor economics/statistics; of claims data data programming Claim file reviews Claims management; workers’ compensation law
Surveys of workers Survey implementation & employers Interviews JLARC staff and consulting team
December 5, 2012 14
Study Design for Evaluating Workers’ Compensation Claims Management Report pp. 4?5
7
III. Study Cost and Timeline
Cost for Expert Consultants
? Estimated cost for consultants is $664,000 ? Estimate developed with workers’ compensation expert and reviewed by four independent professionals ? Appropriation in 2013?15 Budget is needed to carry out this study
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 6
December 5, 2012
16
8
Full Evaluation to be Completed by June 2015
?
Phase 1 Dec 2012 Briefing report on study design plan Phase 2
Dec 2013 Report on progress of audit June 2015 Present audit results to Legislature
Study Design for Evaluating Workers’ Compensation Claims Management Report p. 6
December 5, 2012
17
Contact Information
Stephanie Hoffman, Project Lead [email protected] 360?786?5297 Valerie Whitener, Project Supervisor [email protected] 360?786?5191
www.jlarc.leg.wa.gov
9
doc_540451421.pdf