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Wisconsin Safety Conference

April 2015

Discussion Topics

Important Personnel Policies & Procedures

Insurance Awareness

Supervisor Training

Investigating Questionable Claims

Work Related vs. Non-Work Related Claims

Camera Systems

Important Policies & Procedures

� Injury Reporting

� Associate Honesty / Conduct

� Return to Work

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Injury ReportingPolicy 501

“All accidents resulting in injury, damage to company or customer property must be reported immediately to the appropriate supervisor, regardless of how insignificant the injury or damage may appear. All injuries are fully investigated by the employer and the insurance carrier, and compensation is paid in accordance with all governing rules and regulations…”

Injury ReportingPolicy 501

“…Failure to report accidents in a timely manner may result in a delay of payments or denial of a worker’s compensation claim. Repeated failure to comply with these requirements will result in discipline up to and including discharge.”

Why is this type of policy important?

Injury Reporting Procedure� Notice of Claim Form

� OSHA 301

� Medical Release of Information

� Fitness for Duty Form

� Notice to Doctor

� Restricted Duty Job Agreement

All applicable documentation is located in electronic “claim packets” on company intranet.

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Associate ConductPolicy 701

“It is expected that you will honestly give the information requested on all forms or reports required by the company or its insurance carriers…

…Representation of an injury/illness or symptoms of an injury/illness as being work-related when, in fact, the injury/illness is not related to employment is dishonest and fraudulent and will not be tolerated. Such acts will be cause for immediate dismissal.”

HonestyPolicy 717

“Blain’s Farm and Fleet has a zero tolerance policy regarding dishonesty and misconduct in the workplace. Dishonesty and misconduct is described as, but not limited to: theft of product and/or monies, making false claims, statements, falsifying records/reports, theft of time and destruction of company property.”

Why are conduct and honesty policies important?

Return to WorkPolicy 309

“…It is important to understand that while participating in a Return to Work program, it is not acceptable to engage in conduct inconsistent with medical restrictions or that which may extend the period of the work related injury. Violation of this rule may lead to disciplinary action up to and including termination.”

Restricted Duty Agreement Form � Why?

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New Associate Orientation

Insurance Awareness� Know your WC policy

� Deductible amount

� Service Agreement

� Claim handling procedures

� Get to know your adjusters and their claim managers

� Utilize your broker when necessary

� Educational opportunities

� Conflict resolution

Supervisor TrainingNew Manager Orientation

� OSHA Recordkeeping

� Worker’s Compensation

� Injury Reporting

� Required documentation

� Investigating Questionable Claims

� DVR Review

� Associate statements

� How, when, where, pain level, witnesses, etc.

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When Should You Take a Closer Look?

“Red Flags”:

� Late reporting

� Report made immediately after time off

� Report made after denied vacation request

� Report made subsequent to disciplinary action

� Can’t give specific details how incident occurred

� Details that are provided change

� Injury claimed early into scheduled shift

� Refusal or excessive reluctance to work light duty

Using resources to your advantage.

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Case Study #1Associate reports to management she hurt her left shoulder and neck the previous day. Injury report states: “Checking out customer. Lifted a 50 pound bag of dog food and felt pull in neck and left shoulder.”

Work related injury?

Red flags?

Case Study #1Associate treated for a work related injury at local occupational health provider and was returned to work with restrictions.

Medical Support?

Compensable?

Case Study #1� Associate was not happy she was returned to work and

complained the light duty work was causing her pain.

� Associate went to another medical provider and claimed store management was making her do work outside of her restrictions – not true. Second provider took her off of work for seven days.

Red flags?

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Where do you go from here?

Verify the FactsOn three separate occasions to three separate people, including a recorded statement, associate stated she injured herself when lifting a 50# bag of dog food while checking out an older male.

Verify the FactsReview Digital Video Recorder (DVR) footage to verify

incident occurred.� When possible utilize methods to narrow down search

time:� Find out how many SKU numbers there are for 50# bags of

dog food

� Find out what register associate was working on

� Obtain sales history for those SKU numbers for the register the associate was assigned to operate

� Obtain transaction detail for those sales - includes time of sale

� Focus initial DVR review on those transactions

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What if the incident is not caught on camera?

Case Study #2On 7/19 at 7:59am, associate enters the building, punches in for the day and proceeds to walk back to her department.

At 8:04am the associate reports an injury to her right wrist.

There is no camera coverage in the area where the alleged injury occurred.

Red flags?

Associate Statement

“…I then reached for a box that was stacked on a shelf of Curt receiver hitches. The box was on an upper shelf above my eye level where there were two boxes stacked on top of each other. These boxes had receiver hitches in them. When I started to pull the top box off of the shelf I saw a loose receiver hitch on top of the box. By the time I saw the loose hitch it was already coming towards me. The loose hitch fell and hit the shelf, bounced off the shelf and struck me on the right wrist on its way to the floor.”

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Questions?

� Weight of the hitch?

� Type of shelf?

� Type of floor?

� Noise levels?

� Witnesses?

Case Study #2

� The hitch weighs 6 pounds.

� The shelf is made of metal.

� The floor is cement.

� At this time of day there is no music playing, no overhead pages, or forklift traffic.

� Two other associates were in the warehouse at the time of the incident. One associate was in an adjacent aisle approximately 18 feet away; the second associate was approximately 100 feet away - neither heard a thing.

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Witness StatementsStatement from associate standing 18 feet away:

“I was working on 07/19 and came to work at 8:00am. I was in the warehouse until I left about 8:08am. I did not hear any loud noises like something hitting the floor. I know Miss X, and if something hit her she would have been yelling and cussing a blue streak. I did not hear anything and I did not even know Miss X was in the warehouse. I used to be the department head of automotive and I know if a receiver was to fall and hit the floor it would make a lot of noise. It would even take a chunk out of the cement.”

Case Study #2DVR footage:

Although the event itself is not on camera, video footage from other cameras can sometimes be helpful.

Partnering with your claim specialist.

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Case Study #3On 1/4/12, associate, Joel, reported to Management he had

been having back pain for 2 – 3 weeks. He wasn’t exactly sure why his back hurt but felt it had to be work related. On the morning of 1/4 associate helped another associate lift a car battery out of a vehicle and claimed this caused his back to hurt worse.

“As I lifted the battery I felt a sharp pain - 9 out of 10 on the pain scale. It was hard to walk and I was limping.”

On this particular day Joel was more than a half-hour late for work and reported his injury within the first hour

Red flags?

Case Study #3Associate treated with medical provider , who felt the injury was work related, and was assigned the following restrictions:

� Light work

� No lifting over 15 pounds

� No bending

Medical support?

Excerpt from Incident Report…

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Check the CamerasReview DVR to verify incident occurred

� Look for behaviors that support or dispute claim

� 9 out of 10 on pain scale should illicit a response

� “It was hard to walk and I was limping.”

TeamworkProvided all statements and video to claim adjuster for review

Worked with claims adjuster to develop next steps in investigation

� Adjuster to contact claimant and obtain recorded statement

� Allow claimant to restate the story

� Questions specifically targeting bowling

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Case Study #3Interview structured the following way:

� Documented current version of the story:� Tell us again what happened

� What, where, when, how, pain level

- Document any new details – ER visit on 1/4/12

� Suspected areas of deceit – bowling

� Obtain a signed statement

� “Is there anything in your statement would like to change?”

� “Nope!”

� Confront associate with factual inconsistencies� Obtain new signed statement: “I lied…”

“Yeah, that’s the ticket”

Case Study #4On 6/22, associate reports an injury to her right hand. Associate statement:

“I was injured when a female customer with an oxygen tank was purchasing a car battery. During the purchase the customer tried to lift the battery from the cart and couldn’t. I leaned over the counter to assist the customer and put my right hand on the counter for support. With my left hand I helped the customer lift the battery. Before the battery was all the way on the counter the customer let go of the battery and the battery fell on the little finger of my right hand.”

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Case Study #4� Associate was taken to the emergency room for

treatment

� Per Fitness for Duty, associate was diagnosed with a hand contusion and given restrictions

Red flags?

Medical Support?

Case Study #4

As part of the incident investigation an assistant store manager reviewed the incident on video and was confused by what she saw.

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How would you handle?

Associate reports for work on Friday morning and immediately approaches management to report a sore back. The facts:

� Associate worked Tuesday, was scheduled off on Wednesday, and took vacation on Thursday

� Associated explains they woke up Thursday morning with a sore back

� When asked, associate cannot state what they did or when they did it, however, they feel its work related as they “don’t do anything outside of work”

� Associate cannot perform job duties and wishes to seek medical treatment

Return on Investment

Digital Video Recorder

A 16-camera system, with DVR unit, can be installed for $10K - $15 K

� Variables include:� DVR

� Memory, features, ease of use

� Quality of monitors

� Camera quality

� Digital vs. analog

� Type of lens

� Wide angle, zoom, auto irises for low light, infrared

� Size of the building/structure

� Labor cost to install wiring, rental equipment

� Indoor vs. outdoor installations

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Functional Uses

� Theft

� Property Damage

� Employee Incidents

� General Liability Claims

� Neighboring Property Events

� Law Enforcement Partnerships

� Freight Claims / Delivery Disputes

� Procedure Verification

Location Strategy

Where do you start?

� Parking lots

� Entrances / Exits

� Time clock

� Break rooms

� High traffic areas

� Areas with high claim stats