California Coalition on Workers Compensation 2018 Annual Conference

Wednesday The Play Process: A July 11, 2018 Blueprint for Cost Effective Barry D. Bloom Closure of Complex High Cathey Jackson Exposure Claims Joanne Thomas Negar Matian Double Play

A double play in requires a number of players to coordinate their actions to obtain a quick and effective resolution

We use the term Double Play in Workers Compensation to describe a multi-disciplinary strategic process to resolving complex exposure (or high value) workers compensation claims Benefits from the Double Play Process • Brain Trust • Closed cases (at the appropriate cost) • Consistent reserving practices • Quality control for claims office and processes • Builds a positive culture for closing cases within claim departments • Determines the quality and effectiveness of vendor/partners • Consistent application of laws, rules and regulations Benefits from the Double Play Process (2)

• Consistent adherence to internal procedures • Helps train examiners to resolve large difficult claims (unlocking “Frozen” claims) • Helps management understand current claims administration issues and challenges • Adequate (appropriate) settlement authority for the defense counsel • Injury prevention opportunities for the Employer/Client Defining The Team (as appropriate per claim)

• Claims Examiner – team captain • Claims Supervisor • Claims Manager • Defense Attorney • VP Claims • Investigator (AOE/COE or Subrosa) • Excess Carrier • Structured Settlement Partner • MSA Partner © Copyrighted Material: Property of The bdb Group 2018 File Selection Criteria (Selection will vary….not necessarily all of these claims)

• All claims set for trial conference hearing or litigation event

• All claims with a defined level of opioid use • High reserves w/issues • If there is subrosa video evidence

• Serious medical conditions (not just catastrophic claims) • Employees with multiple claims or multiple body parts and other analytics/AI • Suspected fraud (vendor & injured worker) • The first claims after implementing new processes or procedures within the claim office

• High exposure denied claims • Claims w/potential serious legal issues The Claims Examiner is The Team Captain

• They drive the bus • They are accountable for ultimate outcome of the claim • Are supported by the team • Have to prepare the claim for presentation • Must make sure that every team member has the appropriate information in advance and are prepared for the Double Play © Copyrighted Material: Property of The bdb Group 2018 When To Schedule Double Play

The timing for Double Play depends upon the individual case exposure

• Most litigated events will need a Double Play several weeks prior to the scheduled hearing/deposition, etc. • Opioid cases should be scheduled as soon as the first prescription for opioids is filled at a pharmacy • Subrosa cases should be scheduled as soon as subrosa evidence depicting questionable or confirming activity is received • When large settlement authority is needed • When intractable cases have no forward momentum © Copyrighted Material: Property of The bdb Group 2018 Rules of Engagement

Use a standardized form and standardized process for all Double Plays

• Determine who will participate in that particular Double Play

• Develop your own form – specific to your needs based on reserves and paids as well as the facts of the case

• The Double Play form should be forwarded to all participants in advance © Copyrighted Material: Property of The bdb Group 2018

Rules of Engagement (continued)

Each participant must prepare for the meeting focusing on their own specialty

• MSA provider must be prepared to discuss MSA issues (including clinical factors impacting the MSA) • Subrosa team member must bring film/video • DA prepares a case and exposure analysis for the examiner in advance of the Double Play • Defense attorney must be able to talk (in-depth) about the key legal issues (strategies, tactics and case law), venue, applicant’s attorney skills and the proclivities of the projected judge • Every participant should have read the synopsis of the case prior to the Double Play Rules of Engagement (continued)

• It is highly recommended that all Double Plays be done in person. (You may create some exceptions for calling in due to conflicts in schedules or geographic issues) • The length of time spent on the Double Play process will vary greatly depending upon the file facts, the complexity of the claim and issues needing to be resolved (do not shortchange the process by time limits) • During the session access to the Internet and the Payers claims management system is important • It is nice to have coffee and appropriate refreshments available Rules of Engagement (continued)

• Civil polite interaction should be a primary rule of engagement within the team • The goal is to create an effective plan of action to resolve the claim • All participants are equal during the double play sessions • Double Play is not the time to go through the battle field and bayonet the wounded….look forward • Participants should not focus or make a comment on how the file “…got into such an awful mess…” © Copyrighted Material: Property of The bdb Group 2018

Rules of Engagement (continued)

• Share & distribute the Double Play results (Plan of Action - POA) to all parties within 24 hours • Convey the settlement authority and negotiations tactics to the defense counsel • Provide feedback to Employer/Client concerning injury prevention (if applicable) • Schedule follow up with the Defense team to determine if the efforts were a success and/or if an additional Double Play is required (it’s common to require multiple Double Plays Turning the Double Play Issues to review during a Double Play

• Defend vs. settle (be realistic!!) • Release of the video evidence • Reserves adequacy review • Anticipate potential issues and determine strategy to proactively address • Strategize the issues to develop the most appropriate POA given an honest assessment of the facts and the multiple perspectives and the experience of the team members • Ensure that the Excess Carrier is informed and fully on board © Copyrighted Material: Property of The bdb Group 2018 How to Keep Score Measure Your Efforts, the Costs & Your Success

• Case closure • Financial impact (salvage and changes in reserving, IBNR, TCOR & Expense control) • Impact on litigation • Quality control of the team • Ability to extend the learning from one claim to another (knowledge transfer and analytics) • Keep an eye on post-Double Play events that impact case strategy and tactics © Copyrighted Material: Property of The bdb Group 2018

The Team Dynamic How did the Team perform?

• Did they know the case? • Was everyone engaged? • Were they prepared? • Team in sync & collaborative? • Were work habits and work product efficient? • Did everyone know their roles and contribute? • Collect feedback from all Team members Re: Team performance © Copyrighted Material: Property of The bdb Group 2018 The Injured Worker

The Double Play Can……

Provide a fair and adequate assessment of issues to break down barriers to case resolution from multiple perspectives

Speed up the process to provide resolution to outstanding issues and avoid unnecessary benefit or litigation delays Post Game Analyses

• Issues addressed holistically • Accelerated claim closure • Attorneys get to “lawyer” • Claims Examiner recognized & empowered • Reserve consistency and adequacy • Produce better results for all parties (injured workers, employers, payers & partners) • Learning experiences to apply to future cases & circumstances • Claims Payer can enhance relationship with the Employer/Client and other constituents © Copyrighted Material: Property of The bdb Group 2018

Thank You !! Questions & Comments ?