Control of Risk

Commonly abused substances

Alcohol, marijuana, pain relievers, cocaine, depressants, heroin, hallucinogens, inhalants.

Segregation

an isolation of an exposure from other exposures, perils, or hazards; a risk control technique in which the goal is to reduce overall severity.

Root cause analysis

lays the foundation for preventing future accidents and injuries. Most unsafe behaviors and conditions happen one or more times before resulting in an accident or injury.

Reduction

pre-loss and post-loss activities that reduce the severity of financial impact from losses.

Avoidance

precludes or discontinues an activity to avoid the chance of loss, eliminating both positive and negative outcomes.

Transfer

reduces frequency and severity of losses by transferring some or all of the risk to another party, either through a physical transfer or contractual transfer.

Prevention

reduces the frequency of losses; an action taken to break the sequence of events that leads to a loss or that makes the event less likely.

Ergonomics

the applied science of designing and arranging equipment and the workplace to maximize productivity by reducing operator fatigue and discomfort. "The laws of work".

4: Claims Management Learning Objectives: 1a. Define Claims Mgmt

the prompt resolution of an organization's losses subject to insurance or an active retention program including claims by other entities to which it may be legally bound or ethically responsible. A loss is a reduction in value. A claim is a demand or obligation for payment as a result of a loss. The primary goal of claims mgmt is to resolve claims promptly and effectively to save money and relationships and potentially reduces litigation by 70%.

Separation

the spread of exposures or activities over several locations; a risk control technique in which the goal is to reduce overall severity.

Major considerations when selecting a TPA.

#Accessibility - 1. availability for physical inspections, meetings. 2. Assigned account manager and claims team. 3. Inside/outside adjusters; portion of investigation that will be outsourced. 4. Ease of claims reporting, communication and access to claims management system. 5. Frequency of file reviews and reports. #Systems compatibility - 1. Are the RMIS and the CMS compatible? to support meaningful risk mgmt analysis. (Revenue codes, divisions, depts, locations, special client specific coding, support statutory reporting for NCCI, NAICS or OSHA codes). 2. Ability to import existing data into the CMS. 3. What is the ease of extracting data and internet access. Systems capability. #Flexibility in account handling - claims handling instructions, particularly within SIR or deductible. #Staffing - Bios of all expected claims team members (Yrs of experience in industry, experience handling lines of coverage similar to the organization's business for past and present accounts). #Best Practices and quality control - Is there a written policy for claim standards? Does it reflect industry standards? Can it be modified to fit organization's needs? Audits to measure performance/QC. Is there an internal audit process? Who Audits? frequency? will TPA provide audit results? - Independent/outside audits. What is TPAs position on independent audit? Establish expectations that you or your rep will audit. #Industry experience and reputation - obtain TPA recommendations from broker, trade orgs, insurance carrier. Research website and promotional materials. Contact client and carrier references with specific questions in mind. Review financial solvency based on independent audit. #Additional services - Does the TPA allow you to select only the services you want/need? Will the TPA work with your existing svc providers? Can TPA provide services beyond your current program eg. loss control, medical case mgmt, PPO, MCOs? Identify subcontractors who may be doing work for the TPA - obtain certificates of insurance and addl insured endorsement naming the TPA and the organization. #Pricing and contract - 1. compare services and selection criteria, remembering the lowest price is not always the best price. Pricing structure to budgetary needs (Annual flat fee for all claims, Per claim fee - Does the fee cover the life of the claim? Sunset clause - states time period after which the billing structure will change, Reconciliation with billing (charged hourly)), Management fees.

Identify the common types of fleet exposures and hazards.

#Drivers: 1. Driving history and experience. 2. Physical condition and ability to operation a vehicle. #Impaired driving: 1. Distracted driving - cell phone use, operating navigation systems/maps/sound systems, climate controls. 2. Under influence of drugs/alcohol. 3. Fatigue. #Vehicle - 1. Size and value. Number of vehicles. , cargo exposures, routes and traffic, unsafe road conditions.

L Obj 2: Know the 5 reasons why organizations should focus on risk control.

1-Business: Its good business. 2-Cost: to reduce insurance costs and TCOR. Generally, prevention measures cost less than paying for a loss. 3-Compliance: It's the law (OSHA, DOT, WC statutes). 4-Care/Concern of employees/public's health/well being. 5-Reputation/brand name protection.

Explain the Quality Control (Evaluation of Program Effectiveness) element of a health and safety program.

1. Affirm the program is effective and appropriate with a formal process and using internal/external resources. 2. Measurements such as insurance and information (credits/debits, experience modifiers, loss-rates, and frequency/severity). 3. OSHA and BLS incidence rates (Total recordable injury rate (TRIR) & Days away and risk transfer rate). 4. Accident and injury trends and benchmarks (Frequency, severity, internal & external comparison). 5. National Safety Council statistics. 6. Behavioral Observations with documentation. 7. OSHA citations and fines.

Describe the benefits and possible legal problems associated with a workplace substance abuse program.

1. Benefits: a. Increased attendance and productivity. b. Fewer accidents and reduced WC costs. c. Reduced number of EE related crimes. d. Insurance premium credits and lower healthcare costs. 2. Possible legal problems: a. inadequate chain of custody of specimens or results of testing. b. Discrimination in testing or application of provisions. c. Slander and defamation. d. Breach of confidentiality and breach of privacy. e. Failure to act (reasonable suspicion). f. Inadequate recordkeeping. g. Illegal procedures.

Types of damages in tort

1. Common law damages: a. Economic - wages, medical, lost wages. b. Non-economic - pain & suffering, disfigurement, loss of consortium. More difficult to quantify. 2. Statutory damages. Attorney's fees, fines or penalties - not covered by insurance. 3. Punitive or exemplary damages. Awarded to a plaintiff in excess of compensatory damages.

Possible exposures to workplace violence

1. Contact with public. 2. Cash handling activities. 3. Certain goods and services. 4. Working alone late at night, working outside of normal business hours, working in areas with poor visibility or in high-crime areas. 5. Emerging risks such as cyberbullying, political unrest, active shooter, and open carry and concealed weapon laws.

Name the risk factors/flags used to prevent or reduce workplace violence.

1. Drug and alcohol abuse. 2. Fixation with weapons, frequent or graphic talk of violence, or violent acts. 3. Social media activity - negative or threatening posts, pages followed, etc. 4. Instability (mental, financial, medical, familial, behavioral). 5. Insubordination. 6. Employment issues: long gaps btw employment, inability to obtain references, or negative responses received.

L Obj 5: Identify the six basic steps of accident prevention.

1. Eliminate the hazard - similar to the risk control technique of avoidance. 2. Substitute a less hazardous substance or process. 3. Apply engineering controls - physical modifications designed to reduce the potential for injury. 4. Utilize administrative controls - rules or procedures that management undertakes to reduce the degree of or the potential for injury, i.e. safety meetings, job rotation, supervision, or safety rules. 5. Provide effective Personal Protective Equipment. 6. Train Employees - health and safety.

7. List the components of a claims audit and describe possible findings

1. Ensure proper handling, reserving, compliance with regulatory requirements & internal policies, combat fraud, etc. 2. Includes closed files: Reviewed for trends, reserve surplus or reserve inadequacy at the time of closing. Require regular & ongoing verification of the status of all outstanding claims. 3. Conducted by an audit team - needs claim handling experience & cannot be auditing their own files or cases. 4. Audit process may vary due to types of claims management plan (insured, TPA, self-insured). 5. Possible audit findings.

Sec 2-Obj 2: Identify and describe risk control measures to treat common sources of employment practices liability exposures.

1. Establish policies and procedures. 2. Hiring Practices. 3. Manage employee turnover 4. The Risk Manager's Role 5. Employment Practices Insurance Considerations

4. List the considerations when selecting a claims mgmt plan

1. Loss sensitivity 2. Loss runs 3. Loss reserves 4. Staffing 5. Settlement 6. Litigation Management 7. Bundling vs unbundling 8. Claims Audits

L Obj 6a. Identify the elements of a health and safety program.

1. Management leadership. 2. Accountability, responsibility and authority. 3. Employee participation and involvement. 4. Hazard assessment and control. 5. Employee information and training. 6. Accident reporting, investigation and analysis. 7. Post injury management. 8. Quality control - effectiveness of program effectiveness.

3. Discuss the four types of Alternative Dispute Resolution (ADR) methods

1. Mediation 2. Arbitration 3. Mini-trials 4. Summary Jury Trials (SJT). Mediation a. Informal process; no evidence. b. Neutral 3rd party acts as a facilitator to explore settlement. c. Mediator has no power to impose a decision. Arbitration a. Semi-formal process; summary/documentary evidence only. b. A neutral 3rd party or panel with a neutral umpire's oversight c. Arbitrator's decision usually final. Mini-trials

Why is lack of communication and training a root cause of accidents.

1. Never told, no reminders, no feedback. 2. Lack of training, insufficient training, and unaware behavior was unsafe.

Explain the Post-Injury Management element of a health and safety program.

1. Participants in the process includes supervisor/managers, HR, EE, Medical provider and claims adjuster. 2. Written policies and procedures includes (a). ongoing EE training incl. accident reporting, medical provider, and modified duty procedures. (b). prompt reporting procedures to claim administrator/WC carrier. (c). Use of established medical providers who may be impacted by WC system, are familiar with ops, engage in directing or soft channeling, and whose treatment and RTW philosophy is compatible. (d). RTW - restricted duty and job modification, e.g. light/limited duty, alternate duty - job transfer that meets medical restrictions, resources available.

Resolution

1. Payment in full. 2. Negotiated settlement: Steps of negotiation process: preparation, exploration, exchange of offers and counteroffers, settlement agreement, structured settlement. 3. Denial - unpleasant for both adjuster and claimant. Requires higher standard of investigation. Possible litigation. 4. Litigation/ADR.

Identify the risk control measures associated with manual material handling and lifting.

1. Plan before the move or lift. 2. Limit both frequency of move or lift and range of motion. 3. Adhere to recommended max weight limits using NIOSH equation. 4. Use mechanical aids - conveyors, hand trucks, robotics, etc. 5. Redesign job. 6. Implement job rotation. 7. Consider additional risk control techniques - elimination, engineering, administration, substitution, training, PPE (back belts).

Discuss the risk factors associated with ergonomics.

1. Repetitive tasks. a. Use automation/robotics when feasible. b. Job rotation - moving through different tasks). c. Job enlargement - extension of job duties/responsibilities. d. Work breaks - shorter, frequent breaks better than one long break. 2. Excessive force/load. a. use mechanical aids. b. use large muscle groups when muscular force required. 3. Awkward or deviated posture. a. Workstation assessment. b. Design office workstation for proper posture. c. avoid vertical reach below knees or above shoulders. 4. Static load. a. use fixtures for holding instead of hands. b. proper posture and workstation design. 5. Personal risk factors. a. stretching and strengthening exercises. Stress reduction measures and relaxation techniques. 6. Environmental risk factors. a. education. b. monitoring. c. shock absorption to eliminate vibration. d. noise control.

Issues caused by drugs and alcohol in the workplace.

1. Safety issues - increased number of accidents and injuries, others placed at risk. 2. Productivity and job performance - absenteeism, increased errors and reduced output. 3. Morale - damaged relationships with coworkers. 4. Theft and violence. 5. Legal Liability.

8. Explain the role of a TPA and the major considerations of the selection process

1. TPA represents and reports to the organization. 2. TPA should advise the organization when a claim is not covered and seek direction on handling; however, TPAs do not typically involve themselves in coverage issues or disputes btw the insured and the carrier. 3. TPA should advise organization when claims should be paid or denied; ie. acceptance of non-covered claims in excess of SIR will not be reimbursed.

Implementing a substance abuse program requires:

1. Testing 2. Prevention 3. Disciplinary and corrective actions.

Describe unsafe acts or behaviors. Give an example.

1. Unsafe work is faster, more convenient, more comfortable. 2. Unsafe behavior rarely results in injury on any single occasion. 3. People may take risks when rewards are quick and certain, and risk of accident is low. Example: an employee attempts to change a light bulb while using a swivel chair instead of a ladder.

How does the claims mgmt process support the risk control program

1. Utilizing claims data to improve performance. What types of claims are you having? Can transfer to risk control to modify or provide training to reduce losses. Are claims happening at night or during a certain shift, or in a particular place? 2. Enforcing contractual obligations. After being notified of a claim, look at the contract in relation to what happened. Who is responsible? Do you have to indemnify another party? Do you have to hold someone harmless? 3. Mitigation damages after a loss event. You are obligated by insurance to mitigate claims. Injured EEs should get immediate medical attention. Send someone with the injured person to the hospital for support. Reduce chances of litigation by making arrangement for family to accompany injured EE. 4. Promoting equitable compromise of claims. If you can get rid of a claim at the start-do that. 5. Identifying and combatting fraud. Make sure the claim is reasonable and fight fraudulent claims. i.e. Asbestosis normally occurs years after asbestos exposure. Fight rather than settle those that could grow in frequency over time because word get around that an org. is settling claims quickly. 6. Loss forecasting. What is the likely outcome? Reserve based on that. 7. Advising and consulting with all stakeholders. Make sure everybody, all stakeholders internally (HR, Ops) and externally (U/W, insureds).

Sec 2-Obj 1: List the common sources of employment practices liability exposures.

1. Violation of statutes. 2. Discrimination. 3. Wrongful termination. 4. Sexual harassment. 5. Retaliation. 6. Invasion of privacy.

9. List the considerations when selecting defense counsel for an organization.

1. What does the firm's mgmt profile look like. 2. Workloads - how many files or cases, and what types are they working on simultaneously. 3. Size of firm - Is it large enough and do they have the depth of experience to handle your claims. 4. Attorney's or firm's current client base - do they work for, what types of industries - potential conflicts of interest? 5. Experience level, education and training of the individuals related to the industry of the organization - do they require ongoing training in relevant fields? 6. Attorney's reputation in the insurance/business community - are they known for litigating or settling cases? Goals per claim may influence decision. 7. Fee structure - a. Types of billing agreements (hrly, negotiated discount rate, negotiated hrly limit, Flat fee per claim, Flat fee for all claims (virtual in house counsel), contingent fee. b. Other litigation costs (Reporter fee, photocopying, overnight mailing and couriers, research (LexisNexis)). Potential billing problems/issues - differentiated rates for varying levels of employees, including senior partners, investigators, paralegals, administrative asst. At what level are activities assigned? Activity reviews - match billings to activity reports. Incremental charges - meals, mileage.

Give example of uncontrollable events.

A bridge collapses during an earthquake causing multiple injured drivers and damaged vehicles.

Apply the 6 basics steps of accident prevention

A natl landscaping co. is having increases in frequency of work related accidents. They have recorded back injuries, workers falling out of trees, limbs falling on EEs and vehicles, and chipper accidents resulting in 2 fatalities from tree trimming operation accidents. Make 2 suggestions under each step to prevent accidents. Eliminating the hazard: 1. 2. Substituting the Hazard: 1. 2. Engineering Controls: 1. 2. Administrative Controls: 1. 2. Personal Protective Equipment: 1. 2. Training: 1. 2.

Explain the Accountability, responsibility, and authority elements of a health and safety program.

Activity oriented (training meetings, newsletters, etc.) Results-oriented (reduction in frequency and/or severity). Safety goals and objectives - should be addressed in performance reviews. Authority - includes responsibility for safety issues for each position. Individual accountability - for actions, behaviors, and conditions.

Risk control measures to reduce ergonomic related injuries.

Adjust chair, desk height, computer screen height, location of keyboard and mouse, etc. Take mini breaks, rest your eyes, stretch and take a short walk. Set time limits for screen time. Avoid additional computer time outside of office hours.

IBNR - Incurred but not reported

Arises from the natural delay btw the loss or claim and the discovery and or report. Represents the liability for unpaid claims not reflected in the case reserve estimated for individual losses. Pure IBNR - claims that have occurred but have not been reported as of the evaluation date. Broad IBNR includes pure IBNR plus the additional development on known claims. Casualty exposures have greater IBNR than first party property exposures.

Risk control techniques for workplace substance abuse

Avoidance - using drug testing and work sample tests as part of pre-hire employee screenings. Prevention - having a written and implemented policy for operation as a drug-free workplace. Reduction - providing wellness programs, EAPs, and other education on substance abuse. Segregation/Separation/Duplication - storing hazardous chemicals or medications in a secured location with limited access allowed. Transfer - hosting an employee function, where alcohol is going to be served, off site as a restaurant.

Risk control techniques and sample risk risk controls for ergonomics

Avoidance: avoid additional computer time outside of ofc hours. Reduction: set time limits for screen time. Segregation/Separation/Duplication: use of robotics for certain tasks when feasible. Prevention: take mini breaks, rest your eyes, stretch and short walks.

6. Distinguish between bundled and unbundled plans

Bundling: 1. The following services are bundled into the traditional/standard package. a. Loss control. b. Claims services. c. Policy issuance. d. State filings (WC, DOI). e. Statistical filings (NCCI). 2. The insurer retains control of claims services and loss citrik as oart if the insurance package. Unbundling: 1. Removes loss control and/or claims administration services from the package, leaving only the risk financing function of the insurance contract. 2. Annual premium (per line of coverage) must be large enough to justify the insurer's willingness to unbundle services. 3. Requires the willingness and ability of insured to assume a larger portion of the risk, compared to traditional "bundled" insurance programs. 4. Insured's financial ability must support the anticipated cost of risk, including increased service costs. 5. Unbundling with a large SIR us a valuable substitute for self insurance.

Explain the Hazard Assessment and Control element of a health and safety program.

Causes of accidents - unsafe acts or behaviors, unsafe conditions, or uncontrollable events; Existence of unsafe behavior and conditions - supervisors may have time to correct unsafe behaviors and conditions before an accident occurs; Systematic identification and assessment of workplace hazards - Audits identify weak management practices; Inspections identify unsafe conditions and behaviors; Job Safety Analysis or Job Hazard Analysis identifies unsafe work methods.

Describe the Occupational Safety and Health Administration (OSHA)

Created by the US Dept of Labor. 1. Develops industry standards including the OSHA Employer's General Duty Clause and the OSHA Employee Responsibility. 2. OSHA jurisdictions - covers private sector employees, excludes self-employed, family farm-workers and government workers, approve and monitor 28 state plans which cover private and public-sector employees, and assist federal agency programs. 3. OSHA enforcement - inspections, inspection priorities, citations and penalties. 4. Record-keeping and reporting - required by OSHA to affirm compliance. 5. OSHA Consultation - resource for safety program development. OSHCON offers free services. SHARP - Safety & Health Achievement Recognition Program for small businesses. Voluntary Protection Program (VPP) exempts employers who have implemented effective safety and health management systems. Outreach training program - offers resources and grants.

L. Obj 1: Risk Control (Definition-Purpose-Scope)

Definition: Any conscious action or inaction to minimize, at the optimal cost, the probability, frequency, severity, or unpredictability of loss. Purpose: To take action by focusing on solutions that will prevent, mitigate, avoid, or eliminate risk. Scope: It is a people process in which individuals within the organization must be involved in all aspects of an effective risk control program.

Explain the Management Leadership elements of a health and safety program.

Establishes a written health and safety policy statement signed by CEO/President. Provides top management leadership and involvement - management must walk the walk and integrate safety into business practices. Establishes goals and objectives - written program showing realistic and attainable safety policies and goals.. Assigns responsibilities and defines accountabilities - of all levels of management, supervisors and employees. Provides adequate authority, information, training, and resources - to fulfill responsibilities. Evaluates the effectiveness of the program.

Name five Human Resources exposures.

Health & Safety Programs, Ergonomic Risk Factors, Material Handling & Lifting, Substance Abuse, and Workplace Violence.

Methods of estimating IBNR reserves

Historical - relationship of previously reported & unreported claims. Look at % btw the two to determine future claims. Number of reported claims weighted by average severity. Based on organization's revenues (non suggested). Based on a reliable activity indicator.

Give example of unsafe conditions.

Inadequate scaffolding for high-rise window washing collapses and causes the worker to fall multiple stories to his death.

Sources of workplace violence

Internal - EE against EE; or EE against non-EE. External - non-EE against non-EE; or non-EE against EE.

Explain the Accident Report, Investigation and Analysis element of a health and safety program.

Investigate all accidents and incidents. Reasons for investigation accidents and incidents. Conducting the investigation - as soon as possible after the event, investigators, interviewing. Report back to management. Benefits of a well-performed investigation. Post-injury Management (Participants in the process - supervisor, managers, HR, employee, medical provider, claims adjuster). Written policy and procedure - ongoing employee training. Prompt reporting procedures to claim administrator/WC carrier. Use of established medical providers. Return to work - restricted duty and job modifications. Alternative duty. Resources available.

2b-1. Explain the Investigation key steps of the claims mgmt process

Investigation - reporting, responding, gathering info, documentation. Evaluation - coverage, liability, damage, reserving. Resolution - payment in full, negotiated settlement, denial, litigation/ADR, subrogation. #Investigation: --Reporting - Claims mgmt begins with a report of an event (accident, incident, occurrence, claim or loss). One person should be the point of contact for all reports. That report must be report to adjuster and regulatory bodies (OSHA, WC administration) asap. If first notice of an accident is via summons or complaint, defense counsel must be ntfd. asap. --Responding - initiate contact within 24 hours and maintain contact with EE/claimant. This is very important. Initiate medical case mgmt., if appropriate. Fill out consent forms - HIPAA compliant (except WC). Once contact is established, maintain the triangle of communication (btw Adjuster, claimant & medical provider). Once attorney gets involved communication is shut down. HIPAA ltr will be withdrawn. Medical info will be blocked. --Gathering info - prompt and thorough investigation is critical. Who, where, what, when, how - facts needed will vary based on specific claim. - Weather, physical conditions, official reports, media. - Witness issues: identification, reliability, bias(father/son are EEs), fading memory, reluctance. - Evidence collection and preservation. -Outside support: appraisers, engineers, accountants. - Claims history - Anticipate future litigation - File documentation (Claim notes) --Documentation: Phone calls, field notes, witness statements, requests for relevant documentation. #Evaluation --Determination of coverage a. Identify potential insurance coverages and place all potential insures on notice. b. Insurer will send notification of coverage issues. c. Reservation of rights (ROR) ltr. d. Non waiver agreement (bilateral-requires both parties to agree). Permits adjuster to continue processing claim. e. Resolving coverage disputes. 1. Declaratory judgment action. 2. Arbitration or mediation. 3. Assignment - assign to someone else. Concerns: 1. Funding costs of resolution. 2. Continued relationship - business reasons.

Why organizations should focus on risk control?

Its good business, reduces cost (insurance/TCOR-prevention measures cost less than loss payments), protects reputation & brand name, out of care & concern for employees & public's health & well being, and to comply with OSHA, DOT, & WC statutes.

Identify the risk factors associated with manual material handling and lifting.

Manual material handling and lifting causes CTD and injuries from single events such as low back strains and sprains, shoulder strains and sprains, increased WC costs such as medical and lost wages. Risk factors are 1. frequency of lift ormove. 2. Load weight. 3. Awkward posture. 4. Improper lifting techniques - NIOSH lifting equation: Frequency, horizontal distance, vertical distance, travel distance, asymmetry, coupling strength. 5. Personal risk factors - age, physical condition, mental condition, and physiology.

Name some Risk Control measures for workplace violence.

Physical controls- devices and construction techniques that prevent or reduce the likelihood of incidents. Hiring practices - thorough interview process including background checks. Administrative measures - written program including a statement of management commitment and EE involvement. Purchase workplace violence insurance policies. Training - emergency response procedures and ways to diffuse violent behavior. Program evaluation - to identify program deficiencies and to ensure compliance (OSHA).

Which Risk Control technique reduces frequency of losses; Give an example.

Prevention. i.e. Bread mfg'ing plant installs sprinkler system in all bdgs or requiring ee's to wear PPE's during shift (goggles, hard hats, etc.)

Describe the 5 risk control techniques with examples

Prevention: reduces frequency of losses. Bread mfg'ing plant installs sprinkler system in all bdgs or requiring ee's to wear PPE's during shift (goggles, hard hats, etc.) Avoidance: (passive) discontinues an activity; (proactive) avoids or eliminates the chance of loss. (Resort closes beach due to seasonal shark infestation endangering guests or toy store discontinuing wooden dollhouse painted with lead paint). Reduction: reduces the severity of financial impact of losses. Pre-loss - retail strip center installs firewalls throughout bldgs to reduce spread of fire or candy wholesale distributor installing fire suppression equipment in their warehouses. Post-loss - claims admin. program initiated to provide prompt response to accidents/incidents, for early intervention, or rapid claim closure or initiating a crisis mgmt policy Transfer: reduces frequency and/or severity by transfer of some or all of the risk to another party. Physical transfer - organization leasing ee's rather than hiring ee's or using a common carrier to distribute mfg'd goods rather than buying trucks to transport products. Contractual transfer - hold harmless agreements or waivers of subrogation. Segregation(separation/duplication): reduces overall severity of losses.

Explain the Employee Participation and Involvement element of a health and safety program.

Program success requires: The establishment, implementation, and evaluation of the program; Safety Committees; Safety Inspections; Communication; Reward and discipline.

5. Compare the three types of claims mgmt plans

See Learning Objective 5; page 26

Explain the Employee Information and Training element of a health and safety program.

Specific training for each exposure. When and how to train. When - at hire, before initial job assignment. Periodically to maintain awareness and competency. Change job assignment. Change in workplace injury exposure (new equipment, technology, arrangement of facility or equipment).

2a. List the key steps of the claims mgmt process

Step 1: Investigation. Step 2: Evaluation Step 3: Resolution.

Risk Control(In my own words)

Steps taken or not taken to minimize whether losses occur, how often they occur, how severe they are, and their unpredictability in a cost effective manner. These steps focus on solutions to prevent/avoid/remove and reduce(mitigate) risk. To be effective, everyone in the organization must be involved.

L Obj 3: Identify the five primary types of risk control techniques

The five primary types of risk control techniques are (PARTS): Prevention, Avoidance, Reduction, Transfer, and Segregation(separation/duplication).

Govt. agencies tasked with investigation, evaluation, and adjudication of complaints regarding employment practices and the protection of rights.

US Equal Employment Opportunity Commission (EEOC) - federal agency that administers and enforces civil rights laws against workplace discrimination. US Dept of Labor (DOL) - federal agency that fosters, promotes, and develops the welfare of wage earners, job seekers and retirees. Fair Employment Practices Agencies (FEPA) - state and local agencies who work with the US and state EEOC to enforce federal requirements. Civil Rights Act of 1964 - prohibits discrimination in employment based on race, color, religion, sex or natural origin. Family and Medical Leave Act of 1993 (FMLA) - entitles eligible EEs to take unpaid, job-protected leave for specified family and medical reasons with continued health benefits. Amercans with Disabilities Act of 1990 (ADA) - prohibits employment discrimination on the basis of disability in hiring, including all terms, conditions and privileges of employment. It guarantees that people with disabilities enjoy equal employment opportunities.

L Obj 4: List the root causes of accidents and injuries.

Unsafe Acts or behaviors, unsafe conditions, uncontrollable events, lack of communication and training.

Investigation questions we might ask about allegation that terminated EE was injured while on journey back to shore on a skiff.

What does the lawsuit say about the circumstances surrounding the alleged incident (when, where, how, why)? Was there an incident report/ investigation completed? Did anyone witness the alleged event? Did the claimant tell anyone about the alleged incident? What type of EE was he? What medical treatment has he had? What was the diagnosis and prognosis for recovery? Were there any photos taken of the vessel? Are there any records of repairs to the vessel?

DART rate

a BLS measure of injury and illness cases involving days away, restricted duties, or transfer to other duties during a return-to-work phase.

Subrogation/recovery

reduces the effect of losses on premiums and retained losses and therefore reduces the TCOR. Subrogation - the legal right of one who had paid another's obligation to collect from the party originally owing the obligation. ie the insurers right to recover from another the amt that the insurer paid to its insured for a covered loss.

Duplication

the use of back-ups for critical systems or operations; a risk control technique in which the goal is to reduce overall severity.

Setting reserves too high vs too low

too high can result in understating an organization's assets and create problems with tax reporting and stockholders. Too low can result in overstating an organization's asset or insolvency and bankruptcy in the future. Problems with AM Best.

Violation of statutes (statutory liability)

widely ranging federal, state, and local laws protecting rights of individuals.

Impairments caused by drug and alcohol use

altered judgment, reduced perception, lack of attention, loss of physical control, drowsiness, agitation, nervousness, hallucinations.