1 PREPARE! FOR YOUR SELF-INSURED PROGRAM COMPLIANCE AUDIT January 26, 2012 Noon 1:00 PM Suzanne Metz & Mike Lary WHWCP WEBCASTS 2 This webcast series is being recorded and will be available for viewing on our website at: www.whwcp.com For information on how to access these recordings after the webcast, please contact host, Julie Stowitschek at: julies@wsha.org Please hold your questions until the end of the presentation. Thank you! 3 Presenters Suzanne Metz WHWCP Program Safety Coordinator Mike Lary WHWCP Program Safety Coordinator 1
Overview 4 Every three or so years, the Department of Labor & Industries sends a specially trained compliance auditor to inspect self-insured employers. The purpose is to assure that self-insured employers are managing their workers compensation programs according to Washington state rules and regulations, and are reporting claim costs and worker hours accurately. Our last self-insured audit was in 2007. For our claims and payroll contacts: 5 1. Understand the L&I auditor s perspective. 2. Know what auditor will do, say and ask of you when she arrives at your facility. 3. March will be here soon! Take the time now to review your internal processes. Then relax! 4. Know that we will be with you at every step! Handouts for this webcast 6 Firm Interview Worksheet Quarterly Review Worksheet/Worker Hours Calculations Worksheet Preparing for your self-insured audit L&I PUBLICATION F207-110-000 [05-2011] 2
Think of this as a positive experience: 7 We know the auditor - She audited our program before. We think we know what to expect. Self-auditing your program will improve it and help you provide a more effective workplace! You will understand why we keep nagging you for policies, programs and updates! This is something employers should be doing as part of the employee health and safety program. Let s start from the beginning 8 Lynn Kuntz, the L&I auditor, will be in the Seattle office on February 16, 2012. She will review claim files. We expect her to choose 8 to 10 hospital site locations to inspect. We won t know who will be chosen until she tells us. That is why every hospital must be prepared. You have a 1-in-3 chance of being selected. From the auditor s perspective 9 We are you You are us. We are one big selfinsured employer with different locations throughout Washington state. Every location should be managing their site the same way In her opinion, the right way! It is her job to make sure you are doing your job correctly and taking care of your employees. 3
What will the auditor do on arrival? 10 On arrival, she will expect to meet with the designated claims contact, the payroll contact and their supervisor(s). Hold an opening conference, explain her purpose p and request documents. Request a conference room for interviews and for her review of documents and materials. She will complete the Firm Interview Worksheet during hospital staff interviews. Auditor will interview the claims contact 11 Review your OSHA Log and attachment logs. Interview the claims contact about internal processes. Physically inspect how internal claims files are managed, maintained and information is protected. Go through the claims filing process. Review how employees are informed about rights, benefits & obligations. (New hire orientation, claim filing processes, notifications and documentation.) 12 Firm Interview Worksheet - Item #1 Personal Service Labor Contracts Personal Service Labor Contacts: Have your policy ready. Be prepared to provide a AP (accounts payable) list for the last three years. Be prepared to demonstrate that individuals paid on the AP ledger are truly independent contractors and meet the L&I standard. Be prepared to provide copies of contracts with independent contractors. 4
Problems with Independent Contractors 13 Not vetted to determine if they are independent or not updated. (Things change!) No documentation to establish status. No central registry or controls on contracts. Policies in place, but not followed. No one in charge to ensure the system for management of personal services contracts works. 14 Firm Interview Worksheet Item #2 KOS* or Benefit Policy Have your sick leave policy ready for review. Is it the same one you submitted to WHWCP? Who is responsible for the policy? WHWCP sends your updated policy to L&I. Is your policy current? Has there been an annual review documented? *KOS means Kept on Salary 15 Firm Interview Worksheet Item #3 Rights and Obligations Newly hired filing information provided? In a form identical to the F207-155-000? A fillable form is available on line at http://www.lni.wa.gov/formpub/detail.asp?docid=15 23 Are you using the current L&I Pamphlet when a claim occurs? Check the edition date. These are provided by WHWCP F207-085-000 (05-2010) 5
16 Firm Interview Worksheet Item #4 Injury Procedure You need to know and be able to discuss your procedures for filing a claim. How is this information given to employees? Are current Self-Insured Posters in place? Both Spanish and English? How are claims reported if the employee goes to the ED? Are all visits to ED generating a claim? If not, do you have systems to maintain a log and advise employees of their right to file a claim? 17 Firm Interview Worksheet Item #4-contd. Injury Procedure Can you: Explain and show the procedures for filing a claim including the paperwork? Explain how you report wages and hours? See your claims training manual Tab 3 b (1) Which copy of the SIF-2 is given to the employee? NOTE: often your claims files will be examined physically to see if the employee copy (pink) has been provided to the employee or left in the file. MAKE SURE THEY ARE NOT IN THE FILE 18 Firm Interview Worksheet Item #5 Modified Work Program Do you have a modified work, transitional duty and Return to Work (RTW) program? Who is responsible for coordinating RTW offers? Do you have documentation for physician approval for each case? Does the employee and physician get the modified job description at the same time? Do both employees and supervisors sign the Job Assignment Agreement for modified work? 6
19 Firm Interview Worksheet Item #6 Date Stamp on PIR Do you have a date stamp? Do you date stamp all materials received, including the PIR (Physicians Initial Review), or other medical reports when you receive them? When received, how and when do you send them to the WHWCP? 20 Firm Interview Worksheet Item #7 Claims Log Trick Question! Beware! The master claims log is maintained by WHWCP. You maintain a claim register, similar to a check register, to document who has been provided a SIF-2 or alternative reporting form. The Claims Log is not maintained by your hospital. You may have to provide a copy of your OSHA 300 log for them to compare with the claims logs at WHWCP. 21 Firm Interview Worksheet Item #8 Self-Insured Poster Do you have the Self-Insured Notice to Employees (F207-037-909 (02/2009) *Used to be called pink posters; posted? A current poster must be posted at each location your hospital maintains i were employees work. Clinics Offices Warehouses, etc. Be prepared to provide a list of all your locations. 7
She will interview the payroll contact 22 Calculation and reporting of worker hours. Audit internal processes (like time records) to assure accuracy. How deductions for workers compensation are handled. If taken from employee paychecks, are all workers comp. deductions: (Including asbestos fund and supplemental pension fund) accurate? 23 Quarterly Report Review Worksheet Item #1 Supplemental Pension Fund Deduction Do you deduct from employees paychecks for the Supplemental Pension Fund Assessment? Yes or No? What amount is deducted? Is it correct?* Is that amount one-half of SPF(Supplemental Pension Fund) assessment? One-half of the Asbestos Fund Assessment? Is it deducted from all employees? Hourly only? Salaried only? *Each January the WHWCP sends out the rate set by L&I for the year. 24 Quarterly Report Review Worksheet Item #2 Worker Hours How are worker hours reported? Hourly workers on actual hours worked excluding vacation or sick leave? Salaried employees using: 160 hours per month No need to track hours, overtime, time off etc. Actual hours worked- includes overtime, vacation, personal time-off, and sick leave.* *It is highly recommended that you use the 160 hour method. 8
25 Quarterly Report Review Worksheet Item #2 Worker Hours How do you compile the total hours reported? How do you compile hourly employees? How do you compile salaried employees? Claims Cost: This is compiled in the Seattle office, the hospital does not need to be able to answer the methodology used. She ll walk through the entire program 26 Probably visit clinics (On and off campus). Look at your emergency room process and medical treatment log. Pull claim files randomly from file drawers and look through them for doctor notes. Meticulously go through all attachment logs: (sharps log, claim registry log, medical treatment log, and your workplace violence log). She ll inspect the- Safety Bulletin Board 27 Is it in a place where all shifts, all employees can see it? Required posters Including the Self-Insured poster and the name of the contact person to file claims. OSHA 300A summary log (It should remain posted, as of February 1, 2012). 9
Insider Tips #1 28 Complete the Firm Interview Worksheet & Quarterly Review Worksheet / Worker Hours Calculations Worksheet. Write out your internal processes and check against the rules and reality. This includes sharps injury procedures and R.N. Standing Orders! Have all typically-requested documents checked, ready for review and ready to copy, if needed, before the audit visit. Insider Tips #2 29 Ask Suzanne and Mike to help you with a mock audit. You cannot prepare the night before the auditor arrives. Prepare for contingencies. Auditor will not cancel if someone is sick or on vacation. She expects your location to handle it. Supervisors should be prepared to answer questions and provide explanations. Insider Tip #3 30 Do not attempt to cajole, joke your way out, get angry or pretend you do not know what is going on in your organization during the interviews. Make every attempt to assure accuracy and honestly comply with all information requests. Take this audit very seriously. The auditor is very, very serious about this process. She will take the time to be thorough maybe all day! 10
Summary: 31 You need to do your part now and not wait to see if she will choose your location. We will help you prepare in advance. It is not difficult. We have done this before. We will be at your location before the auditor arrives, during the audit and after the audit if your hospital is chosen as a location. What you should do now: 32 Call either Suzanne or Mike to schedule a mock inspection as soon as possible. This could take between 3 hours to a full-day. Provide updated information about your locations or any new locations where you have employees. Tell us if you are new, or if you will have a new designated contact in February or March 2012. Remember 33 You do the work now, to avoid the stress later. 11
Call Us! We are here to help! 34 Mike Lary (206) 953-9827 (Cellular) Suzanne Metz (206) 890-8169 (Cellular) Thank you for attending! 35 Please visit our website: www.whwcp.com for documents, resources & webcast recordings. *Contact Julie Stowitschek at: JulieS@wsha.org for more information on these webcasts, training dates, etc. 12