T h e F u t u r e O f W o r k e r s C o m p e n s a t i o n

Transcription

1 T h e F u t u r e O f W o r k e r s C o m p e n s a t i o n

2 Self Insured Solutions The Future Of Workers Comp Group Self Insurance Programs Providing workers compensation coverage has become more of a challenge than ever there are higher costs, stricter guidelines, and severe penalties for employers who do not comply with a long list of rules and regulations. Employers need to know their options, and weigh them carefully to find the solution that best fits their needs. Self Insured Solutions is a leading provider of enlightened workers comp alternatives that exceed standard insurance plans in all regards. Combining the ease of a fully insured plan, the low cost of a high deductible plan, and the strong employer-based control of self insurance, there is a new option that has become the method of choice for smart employers nationwide. That option is joining a Self Insured Group. A strong SIG combines the best elements of those plans mentioned above, and it is truly the best of all since it allows the employer to be in control while sharing the risk. What Is A Self Insured Group And How Does It Work? A Self Insured Group (SIG) is an group of employers in a common industry who have joined together to provide mandatory workers compensation benefits. A SIG is a California Non-Profit Mutual Benefit Corporation that only exists to benefit the members. Furthermore, the members own the SIG. The way it works is simple, yet amazingly effective. Group members make contributions to the SIG, and the SIG pays all expenses, provides safety & loss control services, and pays claims for injured workers. The funds left over are called surplus (this would usually be an insurance company s profit.) In a SIG, however, the members own the surplus and it can be used for dividends, rate reductions, or invested. What Is Self Insured Solutions Role? Self Insured Solutions (SIS) is a Group Administrator, and responsible for underwriting, administration and loss control that is provided directly to each member. In addition to these services, SIS oversees independent accounting, actuarial services, yearly audits and the purchase of A-Rated Excess Insurance to protect the fund. All Self Insured Groups are approved, monitored and regulated by the California Department of Industrial Relations and the Office of Self Insurance Plans. Underwriting The first step toward success is strict underwriting guidelines. SIS takes pride in performing detailed underwriting of all prospective members, including a hands-on inspection of the employer s place of business. Our underwriters are in constant contact with the field force, communicating daily with our loss control staff and agency partners to ensure that each prospective member gets a fair, competitively priced quote that will help maintain profitability for the SIG as a whole. Our Underwriting Team works hard to ensure that: Each application is thoroughly reviewed Every account is individually underwritten Every prospective member will have a Safety Evaluation Each prospective member will be assisted to meet regulatory compliance Each SIG maintains A rated Excess Insurance to protect the fund Member Services SIS s experienced Member Services department is dedicated to making group membership an important asset to member s companies. Our Member Services team helps your company by: Issuing Certificates of Insurance (with a 24-hour turnaround) Verifying or adjusting class codes Coordinating year-end premium audits When you call us you will reach a real person

3 11 Layers Of Protection For SIG Members 1. State Worker s Compensation Regulators SIS complies with applicable state requirements including: Excess insurance Members financial statement reviews Annual financial audits Claim reserve audits Deposit requirements Investment income placed in appropriate portfolio 2. The SIG s Board Of Directors SIS works with each SIGs Board of Directors to keep them informed through: Monthly board meetings Monthly financial, loss control, marketing, and claims reports 3. Independent Accountant And Actuaries SIS uses independent third-party experts for: Financial reports & auditing Actuarial reports & studies 4. Agents And Brokers SIS utilizes select agents and brokers to: Pre-screen prospective members Present membership proposals 5. Underwriting SIS has experienced underwriters who oversee SIG Members each prospective member application and Self Insurers Security Fund performs: Surety Bonds Detailed examination of the initial Group & Member Deposits application Excess Insurance Careful rating of each risk Claims Management 6. Safety And Loss Control Safety & Loss Control SIS has contracted with Loss Underwriting Prevention Specialists to perform: Agents & Brokers Safety evaluation of each risk Independent Accountant & Actuaries prior to SIG acceptance The SIG s Board of Directors Job site and classroom training sessions State Workers Compensation Regulators Accident investigations 7. Claims Management SIS works with the finest TPAs in the state and ensures that: Each legitimate claim is paid promptly Every case of suspected fraud is investigated thoroughly 8. Excess Insurance SIS meets and exceeds regulatory excess insurance requirements: Occurrence Coverage protects against catastrophic injuries Aggregate Coverage protects against high frequency Excess coverage is provided by an A rated admitted carrier 9. Group And Member Deposits Each SIG posts a deposit with state regulators Each member posts a deposit with the SIG 10. Surety Bonds SIS secures surety bond coverage that: Meets regulatory levels Uses A rated bonds 11. Self Insurers Security Fund (SISF) SIS protects each SIG with SISF: Funded by contributions of all self insured entities Has approximately $200M in assets

4 Covered Industries SIS has successfully created Self Insured Groups in industries that have typically challenged standard insurance markets, and is continuously seeking quality employers for each group and additional industries in which to expand. The following is a list of those industries currently covered by SIS. If you are interested in learning more about forming a Self Insured Group, please contact us. Construction Farm Labor Agriculture Processing Livestock & Dairy Loss Control Our SIGs have full-time, dedicated safety and loss control professionals throughout California, including Cal/OSHA Certified Safety Professionals and Industrial Hygienists. All SIS safety & loss control staff are fluently bi-lingual so they can effectively communicate with workers on the job site. A hands-on, effective safety program is essential for a Self Insured Group. Controlling losses is vital to keep costs down and ensure that the SIG is building a healthy surplus that benefits the members. We work with Loss Prevention Specialists (LPS) to provide safety & loss control for the groups. SIS has dedicated full time Loss Control consultants throughout California. Whether it s a job site training session for two supervisors, or seminar for 500 field workers, LPS will help train your workers, supervisors, foremen and leadmen to implement safety programs that will keep your employees as safe as possible. Our dedicated loss control team offers: An on-site analysis of your IIPP and Safety Program Comprehensive Action Plans to help improve your program CPR and First Aid Certification Cal/OSHA regulatory assistance Train the Trainer programs On-site training programs, including tail-gate safety trainings, OSHA 10-Hour certification and pesticide safety certification A dedicated safety consultant to help you with your entire program

5 Claims Self Insured Solutions believes that injury claims must be handled promptly, professionally, and aggressively. Aggressive claims management starts the minute a claim occurs. It entails gathering information from supervisors and witnesses, getting a drug test performed, and verifying that the claim occurred legitimately and that the worker is due benefits. It also means working with the medical providers to ensure proper, complete and adequate care while avoiding over-treatment and unnecessary procedures. SIS works only with the finest Third Party Administrators in the state. Maintaining a low ratio between claim adjusters and claim files allows each case to be handled aggressively, with active communication between physicians, injured workers and employers. The goal of our claims adjusters is to get each injured worker treated as quickly as possible and returned to work in a timely manner. Aggressive Anti-Fraud Measures Saves Money SIS believes that all legitimately injured workers should get the benefits they deserve, and do so quickly and without unnecessary delays. On the other hand, all fraudulent claims should be investigated, shut down, and fraud perpetrators referred for prosecution. Unprecedented Access Unlike traditional insurance plans in which any number of claims adjusters may work your account, a Self Insured Group offers the employer control and access to information about their losses. Our claims adjusters are given far less case files per industry average, allowing them to devote the time and energy needed to truly manage and understand each case under their care. It is typical for members to become familiar with the claims adjuster assigned to their company, and likewise promoting ease of use and a speedy process for all concerned. Furthermore, our claims adjusters are instructed to answer all member questions about the history and status of claims, in effect, to treat you as the client. After all, the SIG belongs to the members the claims people work for you! We offer our members superior and comprehensive claims services, including: A State-of-the-art claims system that allows you to monitor active claims online Dedicated field support staff to resolve claim issues and promote return-to-work Clandestine surveillance on all suspected cases of fraud Clandestine Surveillance SIS aggressive claims managers perform secret surveillance on all suspected fraudulent claims. We insist that all TPAs with which we work investigate any and all suspicious claims, perform clandestine surveillance on suspected fraud practitioners, and shut these claims down and seek reimbursement, or even send those folks to jail, whenever possible. It s All About You Dedication to you is what makes a Self Insured Solutions SIG superior to the standard insurance market. Our programs help make workers comp more understandable and accessible and take the mystery out of the process. A SIG only exists to benefit the members - we never forget that, and neither should you. What Are The Benefits Of Joining A Self Insured Group? Enjoy significant savings over the standard insurance market 100% of surplus is owned by the members, including interest income Each member receives comprehensive safety and loss control services Sophisticated claims management including aggressive fraud prevention All SIGs are carefully formed Each member is individually underwritten and approved Safety net provided through A rated excess insurance All programs are approved, regulated and monitored by the California Department of Industrial Relations, Office of Self Insurance Plans

6 The Self Insured Solutions Mission It is the mission of Self Insured Solutions to provide employers with cost-effective solutions to better manage their workers compensation obligations, to protect the health and safety of their employees, ensure effective medical care for injured workers, and build a sound financial future. To that end, Self Insured Solutions staff and management are devoted to creating value and innovation for employers seeking alternatives to the standard insurance market, and spare no effort to maintain the highest level of trust, integrity, and dedication. We ve built this company on a single, powerful premise that workers compensation coverage should be an asset, not an expense. I feel that by creating programs based on that premise, we have created success for our members and ourselves. -Tom Wheeler, President, Self Insured Solutions 2151 Convention Center Way Suite 203 Ontario, California p f