Bill Nevin - XtraCare, A Self-Insurance Unit for Queensland Employees of Glencore - The development & evolution of a successful risk based injury management

The development & evolution The development & evolution of of a successful risk a successful risk basedbasedinjury management system injury management system

for employers.for employers.

Informa – Return to work forumMelbourne 29-30 July 2014

Presented by Bill NevinManager XtraCare

Are there any Questions?

In Closing In Closing

Actuarial Assessment of Estimated Outstanding Liability

Copper - 47%

Coal - 64%

Reductions In Outstanding Liability Reductions In Outstanding Liability

2007 2008 2009 2010 2011 2012 2013

Coal - 64%

Our Company has developed an employer based injury management systemthat incorporates risk management principles

to promote early assessment and consistent allocation of injury management resources

Documented Intent Documented Intent

consistent allocation of injury management resources

to assist injured workers achieveearly and sustainable

return to work outcomes.

The primary goal of returning injured workers to pre-injury duties is critical

and any significant risks to achieving this goal are

escalated for management intervention

Clarified Intent Clarified Intent

escalated for management intervention and development of strategies

to resolve issues andachieve sustainable outcomes.

Web Based Web Based ––Injury Management SystemInjury Management System

On Line On Line -- Risk Assessment ProcessRisk Assessment Process

The development & evolution of a successful risk based injury

management system for employers.

Initial principals, philosophies and beliefs

Simple agreements to get you started

Developing a model with the future in mind

Topic on the Brochure Topic on the Brochure

Developing a model with the future in mind

Adopting a new paradigm to achieve better outcomes

Payment Profile in QLD

Claims Payments Claims Payments

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Paid to Date

Payment & Stat Est. Profile in QLD

Claims Payments & Stat EstimatesClaims Payments & Stat Estimates

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Paid to Date Stat Est.

Payment & Stat & C/Law Est. Profile in QLD

Payments + Stat & C/Law EstimatesPayments + Stat & C/Law Estimates

2005 2006 2007 2008 2009 2010 2011 2012 2013 2014

Paid to Date Stat Est. C/Law Est.

104

75

58 58

98

70

40

60

80

100

120

Overview of Stat Claims & Common Law Claims Lodged

Statutory & C/Law ClaimsStatutory & C/Law Claims

15

6 6 52 0

0

20

40

2008 2009 2010 2011 2012 2013

Stat Claims C/Law Claims

104

75

58 58

98

70

60

80

100

120

Overview of Stat Claims,High Risk & Common Law Claims Lodged

Introducing High Risk CasesIntroducing High Risk Cases

21

15 13 15

22

1215

6 6 52 0

0

20

40

2008 2009 2010 2011 2012 2013

Stat Claims High Risk C/Law Claims

20

40

60

80

100

120

21 15 13 15 2212

83

60

45 43

76

58

Claims by Current Risk AssessmentOperations 2008 to 2013

Total Incurred Cost by Risk Assessment Operations 2008 to 2013

Total Total Incurred Incurred –– Based Based on Risk on Risk

0

2008 2009 2010 2011 2012 2013

15 13 15 12

High Risk Low/Medim Risk

2008 2009 2010 2011 2012 2013

High Risk Low/Medium

Strategy - A plan designed to achieve a particular long term aim.

Are we Naturally Strategic? Are we Naturally Strategic?

Or are we more like the frog in slow boiling pot of water ?

Planning to achieve a particular long term aim ?

Where do you sit? Where do you sit?

Or are you following the process to see where it leads ?

Successful Employers Successful Employers –– The Evidence The Evidence

Christine Randall presentation 2008

What are the principals and philosophy

that provides the best strategy

for your business?

We chose risk based principals and adopted an employer based

Principals & Philosophy Principals & Philosophy

adopted an employer based injury management philosophy.

A risk based approach is an integral part of many safety systems that are heavily promoted by employers and

enforced through legislation.

First Aid Minor Moderate Major Serious

Injury Management Matrix

IMM

A

B 247 12 17 21

L

I

K

E

L

CONSEQUENCE

20 23 2511 16

Why a Risk a based approach? Why a Risk a based approach?

D

E

C

1 3 6 10 15

9 14 19

4 8 13 18L

I

H

O

O

D

2 5

22

The aim was to create an Injury Management/Rehabilitation process that mirrored what was already operationally accepted

Injury Management Review

AIM - To develop a system that provides a method for assessing andmanaging risks associated with workplace injuries.

The system should provide:-

A method for rating various levels of incapacity;

Appropriate control measures for each level of incapacity; Appropriate control measures for each level of incapacity;

A mechanism to assess potential escalation factors;

A rating process consistent with current risk management practices.

The Original Presentation The Original Presentation

Injury Consequence

Incapacity Type Max Period of

Incapacity Medical Treatment Injury (MTI)

Restricted Work Injury (RTI)

Loss Time Injury (LTI)

First Aid As Per TARP

Minor

Moderate

Up to 14 Days

Up to 14 Days on Normal Shift, no reduced hours

Building an Injury Consequence TableBuilding an Injury Consequence Table

* Major

# Serious

* To include all stress related conditions regardless of time frames

# To include all injuries requiring hospitalisation and immediate surgery following injury

Injury Consequence

Incapacity Type Max Period of Incapacity

Medical Treatment Injury (MTI)

Restricted Work Injury (RTI)

Loss Time Injury (LTI)

First Aid As Per TARP _ _ _

Minor Up to 14 DaysUp to 14 Days on Normal Shift, no reduced hours

_ 14 Days

Moderate> 14 Days -< 8 Weeks

> 14 Days -< 8 Weeks

1 to 14 days 8 Weeks

Injury Consequence Table Injury Consequence Table

* Major > 8 Weeks -< 20 Weeks

> 8 Weeks -< 20Weeks

> 2 Weeks -< 4 Weeks

20 Weeks

# Serious > 20 Weeks > 20 Weeks > 4 Weeks Unlimited

* To include all stress related conditions regardless of time frames

# To include all injuries requiring hospitalisation and immediate surgery following injury

20

30

40

50

60

70

5 7

119 16 13

15

914

1711 12

19 1316 13

14 1814

2229

38

17

27

2517

20

25

23 26

22

34

27

11

25

1521 22

5 4

4

3

2

6

3

2

1

32

12

2

2

4

3

3 2

Injury Management cases opened since 01/01/2012 by Consequence

Does this graph assist Management?Does this graph assist Management?

0

107

2 2 6 7 5 5 1 1 1 1 3 2 61 4 2 1 2

56 2

17

61

16 4 3

60

44

42 0

3

9 16 13 14

811 12

11

16 14 1814

Serious Major Moderate Minor Other

Injury Management & Resource Matrix

Injury Consequence

Treatment Provider Workers'

Compensation Cert Required?

Work Capacity Assessment

RequiredAppoint a RRTWC

Meetings with Manager

Referral Required to External Provider?

First Aid Occup. F/Aider, Nurse or Doctor

Minor Doctor

Moderate Doctor

Major Doctor

# Serious Doctor

Management & Resource MatrixManagement & Resource Matrix

# Serious Doctor

Responsible Party

AS Per TARP Injured

Employee

Work Capacity Assessment Required

Appoint a RRTWC Meetings with Manager

Injury Management & Resource Matrix

Injury Consequence

Treatment Provider Workers'

Compensation Cert Required?

Rehab File Required?

Registration in Injury Management

System

Risk Assessment Required?

Referral Required to External Provider?

Workers' Compensation

Claim Required?

Line Management Notification

First Aid Occup. F/Aider, Nurse or Doctor

No No No No Not Required No Supervisor

Minor Doctor Yes Short File Only Registered as

Short File No Not Required

Only if Worker Requests

Superintendent

Moderate Doctor Yes Yes Yes YesTo be reviewed

at 15 Days Claim Must be

Lodged Manager

Major Doctor Yes Yes Yes YesImmediate Claim Must be Operations

Here’s one completed earlierHere’s one completed earlier

Major Doctor Yes Yes Yes YesImmediate

Referral Claim Must be

LodgedOperations Manager

# Serious Doctor Yes Yes Yes YesImmediate

Referral Claim Must be

LodgedSenior Site Executive

Responsible Party

AS Per TARP Injured

Employee RRTWC RRTWC RRTWC RRTWC

Injured Employee

RRTWC to Advise

The Injury Consequence & Resource and Management Matrix should be discussed and

developed with Employees, Management, Rehab professionals and the Insurer.

By obtaining approval by Management and the Insurer to the Matrix; -RRTWCs are now empowered to:-• take action • incur costs

Seek & Obtain Approval Seek & Obtain Approval

• incur costs• engage providers and• engage management

It is important to ensure every early intervention strategy that might be required is listed in the matrix.

Injury Management Review

AIM - To develop a system that provides a method for assessing andmanaging risks associated with workplace injuries.

The system should provide:-

A method for rating various levels of incapacity;

Appropriate control measures for each level of incapacity; Appropriate control measures for each level of incapacity;

A mechanism to assess potential escalation factors;

A rating process consistent with current risk management practices.

Back to the Original Presentation Back to the Original Presentation

First Aid Minor Moderate Major Serious

Injury Management Matrix

IMM

A

B 247 12 17 21

L

I

K

E

L

CONSEQUENCE

20 23 2511 16

Step 1: Step 2:

Risk Assessment Components Risk Assessment Components

D

E

C

1 3 6 10 15

9 14 19

4 8 13 18L

I

H

O

O

D

2 5

22

LowMediu

mHigh

The risk assessment process should be designed to assess:-

the risk of a worker not returning tonormal pre-injury duties

following a work related injury.

Determine the Risk to be assessed.Determine the Risk to be assessed.

Note :- The primary rehabilitation goal of returning the worker to pre-injury duties does not change because of the risk assessment.

The next step is to determine:-

1. the likelihood of the worker returning to pre-injury duties &

2. other factors that may cause escalation in the risk of the worker not returning to pre-injury duties.

Likelihood & Escalation FactorsLikelihood & Escalation Factors

returning to pre-injury duties.

Note - whilst 2 workers may sustain the same injury and receive the same level of rehabilitation and treatment the likelihood of them returning to work may be vastly different.

On Line On Line -- Risk Assessment ProcessRisk Assessment Process

2

2

3

3

4

4

5

5

0

1

0

1

1

0 0

20

0 0

1

Single Site Injury Management cases opened since 01/01/2013 by Risk Assessment

Single Site Single Site

0

1

1

2

1

0 0

2

0

1

0 0 0

1

2

1

0

0 0 0

0

0 0 0

0

1

0 0

0

0 0 0

0 0

0 0

0

0 0 0

High Medium Low No Assess

2

3

4

5

6

7

8

33

3

2

1

2

1

2

2

2

2

1

1

1

1

0

0

0

1

1

0

0 0

0

Multi Site Injury Management cases opened since 01/01/2013 by Risk Assessment

Multiple Sites Multiple Sites 33

0

1

0 0 0

3

1 1

0 0 0 0 0 0 0 0 0 0 0

11

3

1

1

2

0 0

1

0

1

0

2

0

1

0

02

1

1

0

0

1 1

0

1

00

0

0 0 0 0 0 0

High Medium Low No Assess

Flow Chart Flow Chart

Model Presentations Model Presentations

Continuous Improvement Continuous Improvement

Create a list words, terms and phrases that:-◦ are consistent with the language used in your company

◦ provide a positive message

◦ reinforce the desired behaviours

◦ are business orientated

Choose a Language Choose a Language

◦ are business orientated

◦ limit expectations

◦ avoid insurance or medical terminology

◦ SIMPLIFY the message

Employer based injury management Striving for better outcomes Early intervention – early resolution Resource allocation Risk management Injury consequence Activity based rehabilitation

Some Suggestions Some Suggestions

Activity based rehabilitation Sustainable return to work Information gathering Stage management

XtraCare review conducted in 2007 in the face of rising costs and outstanding liabilities.

In QLD 90% of costs came from common law claims where the claim centred on no employment or that current employment was not sustainable.

Workers’ Compensation was a problem for the company in each state in Australia.

Solution had to be Employer based as being compliant in each state meant different things in different states. (Outside the QLD Insurance Silo Thinking.)

The XtraCare Evolution The XtraCare Evolution

the QLD Insurance Silo Thinking.) The holistic view became to develop a consistent employer

based injury management system based on risk principals that could operate any where in the world.

Focus on “Sustainable return to work Outcomes” and early resolution as these save costs in any Workers’ Compensation System.

Created a language that was consistent with the company’s strategic objectives and business terminology. (Sustainability & Risk)

Developed flow charts and diagrams that reflected the message, developed & promoted the system and demonstrated the thought process through new injury management models.

Defined management’s time as a valuable resource used for strategic decisions, created forums to engage management and health and

The XtraCare Evolution The XtraCare Evolution –– cont.cont.

forums to engage management and health and safety.

Most importantly moved the responsibility for Injury Management to the Employer through the promotion of employer based injury management.

Vision Holistic - All encompassing EMPLOYER view based on the knowledge of the nature, functions, and properties of the components, their interactions, and their relationship to the whole. Philosophy - can refer to "the most basic beliefs, concepts, and attitudes of an individual or group” Do you want an Employer or Insurer philosophyIntent - A readily grasped declaration of the course that the company needs to take into the future to

Vision, Philosophy & Documented intent Vision, Philosophy & Documented intent

that the company needs to take into the future to deliver better outcomes. The intent needs to be easily understood by every member of the company and be consistent with current strategic goals

How relevant is the term Injury Management to the CEO, the Board or Shareholders

People waiting on top down approach to People waiting on top down approach to Injury ManagementInjury Management