Consider stewardship program to evaluate your claims and get best outcomes
"Basically, it's a way to evaluate your current claims program, evaluate how your claims are trending, and identify key opportunities for improvement," said Shannon Gardner, senior manager for Risk Management at Chick-Fil-A. "Really it is a way to highlight things that are going well and to tweak others to get better results."
Minimally, a stewardship program includes an annual meeting, typically between the employer, claims administrator, and often the insurance broker to carefully examine the company's claim and program trends from the previous year and often benchmarks against years past.
In the session, Sheila Clark of the TPA Sedgwick CMS and Cindy Larson, representing the broker Marsh USA, will join Gardner to demonstrate what she says is a unique, collaborative approach to the stewardship process.
"The problem in the past has been that the claims administrator provided you with information based on their standard stewardship template which may or may not be truly relevant to your claims program or provide insightful analysis of how your claims are trending," Gardner said. "We've put it in a language that makes sense to our organization."
As Gardner explains, the fact that claims went up during a particular year does not necessarily signal a problem. Measuring the claims against payroll or revenue to incorporate the company's growth into the trend may paint a different picture.
By the same token, she says it's important not to gloss over potential problem areas. That means taking out the false indicators, or things that could be false indicators.
"A lot of TPAs and carriers only want to highlight the really, really good trends and not focus on areas where there is opportunity for improvement because they feel it will be interpreted as their failure," she said. "But it could be something internally we are not doing to help the process."
Honing in on the key metrics involves more than the stewardship meeting itself. It should be a process, where the employer, claims administrator and even the broker meet in advance to define what is going to be included in the report.
"They define what's going to be analyzed. They're setting the parameters before the report is released," she said.
"Many times TPAs and carriers push a button and just show you what they want you to see," she said. "This process involves a lot more input from the client and the broker. It moves from the standardized to the customized."
Most workplace accidents and injuries have more than one cause, says Julie Sfurm, corporate risk operations manager for Elkay Manufacturing in Oak Brook, Ill. By identifying all the causes of workplace incidents employers can reduce their workers' comp claims.
Root cause analysis goes further than the typical claims investigation. It delves into the who, what, when, where and why of a worksite injury.
Sfurm says it's like unpeeling the layers of an onion. People involved in the investigation brainstorm possible causes.
She gave an example of a worker who lacerated his arm while polishing a bowl and required stitches. A typical investigation would include talking to the employee, his supervisor and any witnesses and likely concluding the employee was not wearing the proper sleeve guard for protection.
In root cause analysis, the supervisor asks more questions to uncover more information. "The bowl slipped while the person was trying to polish it and when he tried to catch it, he ended up cutting his arm," she said. "You ask, 'why did the bowl slip if it was properly placed?' That should lead to the question, 'why was the bowl not properly placed on the table?' Then you find out it may have been placed properly but maybe the table was damaged."
By continuing to ask more questions in this instance, Sfurm says you discover the table had been struck by a forklift on a Saturday, when there were many contractors in the plant. That leads to questions about whether the forklift operator was properly trained. In this case, he was not.
"Then you find out the [forklift] training is conducted on a Monday each month, and this occurred on the Saturday before," Sfurm said. "So you go from an employee not having the proper protective equipment, which is one of the root causes, but you also get into the root cause of the employee failing to report damaged equipment and an untrained driver. You end up finding there is a deficiency in new employee safety training."
Doing such an investigation need not be difficult. During the session, Sfurm will demonstrate a technique she uses -- the Fishbone Diagram.
"Think of it as a skeleton of a fish," she said. "The nose is the problem, in this case, the laceration . . . at the bottom of the fish is the machine he was using or the materials."
Sfurm says the safety team in her company blows up the fishbone diagram into large pieces of paper to investigate claims, and writes on them. "They're able to see what they had missed," she said. "It's like being a detective."
For complete information and to register, visit www.wcconference.com.
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August 15, 2011
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