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Risk ManagementClaims Reportingand HandlingPresentation
County AdministrationRisk Management DivisionJ o h n P e t r e lliR is k M a n a g e r(4 0 7 ) 8 3 6 - 9 6 3 6Margot KizerA d m in is tr a tiv e A s s is ta n t( 4 0 7 ) 8 3 6 -9 6 4 5S u s a n M a r t inF is c a l A d v is o r(4 0 7 ) 8 3 6 -9 6 3 9L an ce San d ersS a f e ty & L o s s P r e v e n tio n A d m in .(4 0 7 ) 8 3 6 - 9 6 3 2Gina PolitakisA d m in is tr a tiv e S p e c ia lis t(4 0 7 ) 8 3 6 -9 6 3 5C in d y G a r c ia -E a s t lic kR is k M a n a g e m e n t A d m in is tr a to r(4 0 7 ) 8 3 6 -9 6 3 7Joann GiardielloS e n io r R is k M a n a g e m e n t A n a ly s t(4 0 7 ) 8 3 6 -9 6 4 4B e c k y R e in e r tR is k M a n a g e m e n t A n a ly s t(4 0 7 ) 8 3 6 -9 6 4 8T im T y n d a llE n v . L o s s P r e v e n tio n A n a ly s t(4 0 7 ) 8 3 6 - 9 6 3 8E n e id a R o s a r ioS e n io r R is k M a n a g e m e n t A n a ly s t(4 0 7 ) 8 3 6 -9 6 3 4C hannon B akerR is k M a n a g e m e n t A n a ly s t(4 0 7 ) 8 3 6 -9 6 3 3W a y n e A r g u inS a fe ty & L o s s P r e v e n tio n A n a ly s t(4 0 7 ) 8 3 6 - 9 6 4 7B e v e r ly S c a r la t aC la im s S p e c ia lis t(4 0 7 ) 8 3 6 -9 6 4 9M ic h a e l S tillm a nS a fe ty P r o g r a m D e v . S p e c ia lis t(4 0 7 ) 8 3 6 - 9 6 4 6F red d S appS a fe ty & L o s s P r e v e n tio n A n a ly s t(4 0 7 ) 8 3 6 - 9 6 4 1
Workers’ CompensationDefinition:A statutory benefit paid by the employer to an employee who hasbeen injured in the course and scope of his employment duties.Benefits:MEDICAL BENEFITS – Payment of medical expenses for an on-the-job injury orsicknessINDEMNITY BENEFITS – Partial replacement of lost wages due to an on-the-job injuryafter a statutory waiting period.
Rights of Orange CountyOrange County is protected from a civil lawsuit (unless special circumstances exist) if anemployee is injured or becomes ill because of conditions that exist in the workplace.Orange County can deny Workers’ Compensation benefits to employees who are injuredoutside the scope of their employment, willfully intended to injure themselves oranother, and is intoxicated or under the influence of drugs.Orange County can deny Workers’ Compensation indemnity benefits to the employee, ifthe employee refuses the employers light or restricted duty work.Orange County or our third party administrator for Worker’s Compensation (Crawfordand Company) give authorization to the medical provider for reasonable and necessarytreatment of the injured employee, except in cases of emergency treatment. OrangeCounty has a physicians provider list and we request the employee be treated by theseauthorized medical providers. If the employee goes to an unauthorized medical providerhis medical bills could be denied.
Responsibilities of Orange CountyReport the injury to the 1-866-8ORANGE telereporting number immediately. IfOrange County does not timely report claims to the State, the State may fine OrangeCounty.Welcome the injured employee when he/she is able to return to work.Do not terminate an employee on Worker’s Compensation without first contacting theRisk Management Division.Contractors/Subcontractors: Employers that hire contractors who do not have Workers’Compensation coverage are liable for the contractors’ employees workplace injuries.Hence, Orange County’s contractors should be required to purchase a Workers’Compensation policy for their exposure.
Claims Coordinator orSupervisor’s ResponsibilitiesContact injured employee within 48 hours of accident notification and at least weeklyuntil the employee returns to work1. Express Concern2. Obtain and initial a written copy of the work restrictions.3. Discuss light duty work restrictions, if applicable. Plan immediately forinjured employee’s return to work, if applicable.Fax a copy of the work restrictions to Crawford & Company at (407) 895-4500Call Crawford and Company Claims’ Examiner on the next business day of theinjured employee returning to full or light duty. Make sure the employee doesnot exceed his/her restrictions.Call Crawford and Company Claims Examiner at (407) 894-1011 with anyinformation that could affect the handling of the claim i.e., employee has alawyer, employee is unhappy with medical treatment, notice of hearing or contactby a lawyer, etc.
Rights of the EmployeeEmployees are to be provided Workers’ Compensation benefits for work injuries atthe employer’s expense via a third party administrator. Benefits such as:1.Reasonable and necessary medical care that is pre-approved by theemployer’s third party administrator.2.Portion of lost wages (between 60-80%) resulting from a work injuryDoctor’s verification required via written work release documentation7-Day Waiting period before Workers’ Compensation lost wages begins.In Orange County it can be supplemented with Personal or Term Leave.If employee loses 21 total days, the waiting period is paid.
Responsibilities of the EmployeeFAILURE TO TAKE THESE MEASURES MAY RESULTIN REDUCED OR DELAYED BENEFITS.Utilize available safety equipment to avoid work injury.Report work related injuries to supervisor as soon as possible.Go to the doctor authorized by Orange County and keep all doctor appointments.Obtain all necessary authorizations prior to treatment, except in the case of anemergency.Report all earnings received after the injury to the employer.Provide to your supervisor your return to work slip after every visit.Return to work as soon as doctor approval is given.Maintain records for your future reference.
First HealthNotice to EmployeesIN THE CASE OF AN ON-THE-JOB INJURYSTEPS:1. CONTACT YOUR SUPERVISOR IMMEDIATELY!2. IF MEDICAL ATTENTION IS NEEDED, OBTAIN A PROVIDER INITIALTREATMENT LETTER TO RECEIVE MEDICAL TREATMENT INACCORDANCE WITH THE PROVISIONS OF THE WORKERS’COMPENSATION LAW TO PRESENT TO THE NETWORK PROVIDER.The nearest Managed Care Network Providers are listed below:URGENT CARE CLINICS*Lee Road Centra Care2540 Lee RoadWinter Park, FL 32879Phone: 407/629-9281Fax: 407/629-5739Weekdays: 7 am - 11 pmSat/Sun: 8 am - 5 pm*Vineland Road Centra Care6001 Vineland Rd, Ste. 108Orlando, FL 32819Phone: 407/351-6682Fax: 407/345-0533Weekdays: 7 am - 7 pmSat/Sun: 8 am - 6 pm*Azalea Park Centra Care509 S. Semoran Blvd.Orlando, FL 32807Phone: 407/277-0550Fax: 407/381-4237Weekdays: 7 am - 7 pmSat/Sun: 8 am - 6 pm*Airport Center Centra Care5810 S. Semoran Blvd.Orlando, FL 32822Phone: 407/207-0601Fax: 407/207-2118Weekdays: 8 am - 8 pmSat: 8 am - 1 pmWest Colonial Centra Care9580 W. Colonial DriveOcoee, FL 34761407/296-9096Weekdays: 8 am - 8 pmSat/Sun: 8 am - 5 pm*Sand Lake Road CentraCare/ D.O.T.STOP(Near Chancellor Drive)2301 Sand Lake RoadOrlando, FL 32809Centra Care 407/851-6478D.OT.STOP 407/857-5573Weekdays: 8 am – 8 pmSat/Sun: 9 am – 5pmURGENT CARE CLINICS(Continued)ORTHOPEDIC SURGEONS(Continued)Lake Buena Vista Centra Care12139 S. Apopka Vineland RdOrlando, FL 32836407/239-7777Weekdays: 8 am - 8 pmSat/Sun: 9 am - 9 pmMacksoud, Wadih407/345-1646Westergan, Robert407/345-16467300 Sandlake Common Blvd #127Orlando, FL 32819Regency Family MedicalCenter9815 S. Orange Blossom TrailOrlando, FL 32837407/851-0883Weekdays: 8 am - 8 pmSat: 8:30 am - 3 pmMumby, Robert7300 Sandlake Common Blvd.#2212Orlando, FL 32819407/354-3700Pine Castle Clinic5636 Hansel AvenueOrlando, FL 32809407/850-0056Weekdays: 8:30 am - 8 pmSat: 8:30 am - 5 pmSun: 8:30 am - 1:30 pm33rd Street Medical Center4382 LB McLeod RoadOrlando, FL 32811407/648-0076Weekdays: 8 am - 5 pmMain Street Physicians8324 International DriveOrlando, FL 32819407/370-4881Weekdays: 8 am - 8 pmSat/Sun: 8 am - 5 pmORTHOPEDICSURGEONS(By appointment only)Beckner, Mark8701 Maitland Summit BlvdOrlando, FL 32810407/916-4120Chase, JohnKrumins, KennethTall, Reginald1285 Orange AvenueWinter Park, FL 32789407/647-2287Macksoud, Wadih (HAND)1700 Lucerne TerraceOrlando, FL 32806407/236-0404Konsens, Richard3403 Technological Ave. #4Orlando, FL 32817407/380-8705Palumbo, Robert615 E. Princeton St., #510Orlando, FL 32803407/303-4270White, George825 N Garland Ave. #300Orlando, FL 32801407/841-2100Schellhammer, Mark10000 W. Colonial Dr. #496Orlando, FL 32741407/292-2156HOSPITALSFOR EMERGENCIES ONLY(AN EMERGENCY IS A LIFETHREATENIG SITUATION)i ALL FLORIDA HOSPITALLOCATIONSWinter Park Memorial Hospital200 N. Lakemont AvenueWinter Park, FL 32792(407) 646-7000Health Central10000 W. Colonial DriveOcoee, FL 32741(407) 296-1000Osceola Regional Medical Center700 W. Oak StreetKissimmee, FL 34741407/518-3600Halifax Behavioral Health North841 Jimmy Ann DriveDaytona Beach, FL 32117386/274-5333Memorial Hospital Ormond Beach875 Sterthaus AveOrmond Beach, FL 32174386/676-6000Memorial Hospital Peninsula264 S. Atlantic AvenueOrmond Beach, FL 32176386/672-4161Cox, William10000 W. Colonial Dr. #1262Orlando, FL 32761407/292-6011Roberts, Robert453 N. Kirkman Rd. #201Orlando, FL 32811407/292-8992Davenport, William9430 Turkey Lake Rd. #116Orlando, FL 32819407/345-1234* Fast Track of medical attention for injured employees is available at these clinics. STEPS: (1) CallCenter to alert them of employee’s visit; (2) Complete Provider Initial Treatment Letter and Fax to Center.
First HealthPROVIDER INITIAL TREATMENT LETTERINJURED EMPLOYEE INFORMATION:Name (Please Print):Date of Birth: Social Security #Home Address: Phone Number:The injured employee named above is coming to you for an initial visit as an employee of OrangeCounty Government, who is a participant in the Crawford & Company / First Health Workers’Compensation Managed Care Arrangement. Please note that this letter does not confirm that the injuryor condition is covered by Workers’ Compensation Insurance. That determination will be made assoon as an investigation is completed by our claims examiner.We are working closely with Crawford & Company / First Health and the involved medical providersto ensure that our employees receive access to timely and medically necessary treatment of theirindustrial injuries. In the best interest of our employees, we will have modified work availablewhich will allow the employee to return to work at the earliest possible date. Please keep this inmind as you treat our employee.WHEN ONE OF THE FOLLOWING OCCURS 1. New injury with disability 7 days & No Release to Return-to-Work2. Hospitalization3. Anticipated surgery4. Physical Therapy or Chiropractic Treatment Recommended5. Referral to another Provider6. Assistance to Required to Return Injured Employees to Work7. Repeat Major Diagnostic Studies PLEASE CONTACT OUR CRAWFORD & COMPANY / CLAIMS EXAMINER OR NURSECASE MANAGER FOR PRE-CERTIFICATION AT:(407) 893-7116All claims for treatment must be submitted to the address below, on a form HCFA 1500, form UB92 orthe appropriate form required by the state. Please submit all medical reports within the time framerequired by applicable state law to:Crawford & CompanyP.O. Box 140175Orlando, FL 32814Fax (407) 896-1407Sincerely,Orange County Supervisor/Claims Coordinator:Printed Name: Work Phone Number:Signature:
Experience ModificationAn Experience Modification Rate (EMR) is an employer’s specific multiplier thatmeasures the employer’s loss experience relative to that of other employers inthe same industry. The EMR is compromised of job classifications, payrolls andincurred losses for a three year period.An EMR equal to 1 indicates average loss experience: An EMR greater than 1indicates higher than average loss experience versus an EMR less than 1 equalsa lower than average loss experience. An EMR greater than 1 will increase anemployer’s Workers’ Compensation premium.
General Liability ClaimsDEFINITION:Claims associated with bodily injury and propertydamage arising out of premises, operations, products,completed operations and advertising and personalinjury liability, alleged to be caused by OrangeCounty against a third party.
Examples of General Liability Claims Pot Holes Slip & falls by citizens Sewer back-ups Accidents on Orange County owned playgrounds Death of an inmate Damage to citizens property by Orange County Improper medical care Damage to utility cables
Auto ClaimsDEFINITION:Claims associated with Orange County owned vehiclesthat includes both damage to other people’s property anddamage to the vehicles themselves.Departments that cause damage/loss to Orange Countyvehicles will have a 2,500 deductible charged to thedepartment for the total amount of the loss.
Examples of Auto Claims Vehicle accidents with County vehicles Stolen County vehicles Objects coming or falling from County vehicles Fire truck damages/losses* An auto accident claim kit should be providedfor each County Vehicle *
Property ClaimsDEFINITION:First party claims Orange County suffers that compensatesOrange County for its property loss when caused by acovered peril such as fire, explosion or windstorm.Departments that caused the damage/loss to Orange Countyproperty have a 2,500 deductible which will be charged tothe department for the total amount of the loss.
Examples of Property Claims Missing or stolen County property (tools,computers, etc.) Damage to County property (by lightning, waterdamage, fire, etc.) Falling objects unto County property
Environmental ClaimsDEFINITION:Claims that cover liability and cleanup costsassociated with pollution
Examples of Environmental Claims Underground and aboveground County storage tanks(leaking, explosion, etc.) Contaminated County water Contaminated County land Erosion Landfill clean-up Asbestos and lead base paint air releases
Crime / Theft ClaimsDEFINITION:Claims covering property losses from criminalactivity and employee dishonesty.Crime/Theft Claim Example County employee dishonesty/theft of cash or property
Employment Law ClaimsDEFINITION:Claims covering wrongful acts arising from theemployment process
Examples of Employment Law Claims Wrongful termination Sexual Harassment to County employee Discrimination to County Employee American with Disabilities’ Act (ADA) Claims
REPORTING CLAIMSImmediately Report all Claims to1-866-8ORANGECrawford and Company is the Third PartyAdministrator, the adjusting company for OrangeCounty, who is handling and paying the claims.
IN THE CASE OF AN ON-THE JOB INJURY,GENERAL LIABILITY, AUTO, PROPERTY,ENVIRONMENTAL, CRIME ANDEMPLOYMENT LAW CLAIMSPLEASE CALL OUR CLAIMREPORTING HOTLINEXPRESSLINK TO REPORT CLAIM1-866-8ORANGE(1-866-867-2643)
W o r k e r ’ s C o m p e n s a t i o n R e p o r t i n g In s t r u c t i o n s1 -8 6 6 -8 O R A N G EX P R E S S L IN K R E P O R T IN GPrior to reporting the accident, please review your records to ensure thefollowing information is available:9 Reported by:9 Name:9 Job Title:9 Phone Number:9 Date and time of injury or onset of illness9 Injured employee’s name, address, telephone number (home &business) and date of hire9 Is employee male or female?9 Date of birth9 Social Security number9 Employee Job Title9 Employee’s work schedule (Regular Work Hours)9 Employment Status-Full-Time, Part-Time or other (temp. seasonal,casual labor)9 Is employee hourly or salaried?9 Date of Hire9 Occupation when injured9 Salary information*o Average weekly wage, overtime, bonuses9 Description of accidento How did the loss/injury occur?9 Did employee knowingly refused to use safety appliances providedby employer?9 If other people were involved (Name, Address and Phone #)9 Equipment, material or substance involved.9 Contribution Factors (drugs, alcohol, horseplay, weather)9 Type of injury/illnesso Nature of injury/illness9 Description of injury/illnesso Extent of injury/illness9 Body part injured9 Location of accident (location code)o Street address, city, state9 First aid received?9 Did employee die? Y/N9 If yes, date and time of death.9 Medical attention received, extent9 Name, address, and telephone number of all providers9 Will employer continue to payemployee’s salary?9 Last day paid through9 Lost time information, if availableo Has the employee lost anytime fromwork?o Has the employee returned to work?9 Return-to-work informationo What is available?9 Name, address, and telephone number of any witnesses9 Supervisor’s Name:9 Supervisor’s Phone #:9 Best Hour to Contact:*Salaryinformationrequirements vary by state. Depending onthe jurisdiction, wemay need to knowthe average weeklywage, wage rate, wage period, weekly wage,hourly, daily, monthly rate, returnto workrate, or other compensation.Reasons for Early Reporting of Claims: Studies and experience showthat the timelyreporting of accidents and other losses saves moneyreduces litigation, and benefitsall primaryparties involved.
Property R eporting Instructions1-866-8O R AN GEXPR ESSLIN K R EPOR TIN GPrior to reporting the accident, please review your records to ensure thefollowing information is available:9 State9 Location9 Injured’s Name9 Sex9 Social Security Number9 Date of Birth9 Date of Accident9 Time of Accident9 Claimant Death?9 Death Date9 Reported by (Your Name)o Job Titleo Phone Number9 Accident Description9 Location Numbero Nameo Addresso City, State, Zipo Countyo Phone Number9 Mailing Information (if different from above)o Nameo Addresso City, State, Zipo County9 Date of Loss9 Time of Loss9 Previously Reported9 Contact Nameo Addresso City, State, Zipo Where to Contact (H/W/O)* *(H)ome(W)ork(Other)o Contact Home Phoneo Contact Business Phone9 Location of Losso Addresso City, State9 Police/Fire Dept. to which reported9 Kind of Losso *(F)ire (T)heft (L)ighning (H)ail (D)flood (W)ind(O)thero Other Explain:9 Probable Amount of Entire Loss9 Description of Loss and Damage
G e n e ra l L ia b ility ; E n v ir o n m e n ta l; C r im e a n d E m p lo y m e n t L a wR e p o r t i n g In s t r u c t i o n s1 -8 6 6 -8 O R A N G EX P R E S S L IN K R E P O R T IN GP r io r t o r e p o r t in g t h e a c c id e n t , p le a s e r e v ie w y o u r r e c o r d s t o e n s u r e t h e fo llo w in g in fo r m a t io n is a v a i la b le :G e n e r a l L ia b i l it y9 R e p o r t e d b y :N am e:xJ o b T it le :xP ho ne N u m b er:x9 N a m e , a d d r e s s , t e le p h o n e n u m b e r , a n d S o c ia l S e c u r it y n u m b e r o f a n y o n e in ju r e dD a t e o f B ir t hxM a le o r F e m a le ?x9 D a t e o f in c id e n t9 D e p a r t m e n t , D iv is io n , S t a t io n in v o lv e d ?9 D e s c r ip t io n o f in c id e n tx E v e n t s le a d in g u p t o I n c id e n tx C a u s e o f I n c id e n tx C o n d it io n sx W e r e s t a n d a r d o p e r a t in g p r o c e d u r e s fo llo w e d ? Y / N9 W h e r e d id a c c id e n t o c c u r ?x S p e c if ic lo c a t io nx C it y , s t a t e9 D id a n y o n e r e c e iv e m e d ic a l a t t e n t io n ?x O n - s it e ?x P r o v id e r n a m e9 W a s t h e r e d a m a g e t o s o m e o n e ’ s p r o p e r t y ?x D e s c r ip t io n o f d a m a g ex W here ca n the d a m ag e be se e n ?9 N a m e , a d d r e s s , a n d t e le p h o n e n u m b e r o f a n y w it n e s s e s9 D a t e r e p o r t e d t o lo c a t io n / e m p lo y e rR e a s o n s fo r E a r ly R e p o r t in g o f C la im s : S t u d ie s a n d e x p e r ie n c e s h o w t h a t t h e t im e l y r e p o r t in g o f a c c id e n t s a n do t h e r lo s s e s s a v e s m o n e y r e d u c e s lit ig a t io n , a n d b e n e f it s a l l p r im a r y p a r t ie s in v o lv e d .
A u to L ia b ility R e p o r tin g In s tr u c t io n s1 -8 6 6 -8 O R A N G EX P R E S S L IN K R E P O R T IN GPrior to reporting the accident, please reviewyour recordsto ensure the followinginformationis available:9 Date andtime of accident9 Department, Division, Stationinvolved?9 Accident locationx Intersection, highway, etc.x City, state9 Description of accidentx Road conditionx Weather conditionsx Brief description of eventsx Were Standard Operating Procedures followed? Y/Nx Were seat belts worn? Y/Nx Purpose of use?x Used with Permission? Y/N9 Descriptionofeach vehicle involved, includingregistration informationx License plate number and stateregistered inx Make, color, model, andyear of vehiclex Vehicle Identification Number (VIN)x Where and when can the vehicles be seenx Estimate amount of damage9 Company and driver’s name, vehicle owner’s address, daytime and after hourstelephone number9 Other drivers’ names, addresses, telephone numbers, and insurance information9 Driver’s license number for all drivers9 Name, address, and telephone number of anyone injuredx Age of injuredx Was the injured a pedestrian, Employee, Other vehicle occupant?9 Medical attention received, extentx Did anyone receive medical attention at the scene?x Medical provider information9 Property damage informationx Was there damage to someone’s property?x Estimate amount of damagex Description of damagex Where and when can damage be seen9 Was a police report filedx Report number and city, county, and/.or state of jurisdictionx Did the authorities show? Y/N If authorities can not show get a case or reportnumber9 Witnesses’ or passengers’: name, address, and telephone numberReasons for Early Reporting of Claims: Studies and experience show that the timelyreporting of accidents and other losses saves money reduces litigation, and benefits allprimary parties involved.
HANDLING CLAIMS
Responsibilities of the RiskManagement DivisionContacts the supervisor/claims coordinator and/or injuredemployee within 48 hours of accident notificationCoordinates the efforts between Crawford and Company,claimant, supervisor and/or claims coordinator, and doctorin getting the injured employee back to work or resolvingclaimant’s issuesOversees the claim adjusting efforts of Crawford andCompanyThe Safety and Loss Prevention section of Risk Managementwill conduct loss investigations and sit with variousdepartment/divisions to discuss proactive measures inminimizing loss exposures. Welcome their expertise.
Responsibilities of the ClaimsCoordinator or SupervisorPostings: Post the following information in a place visible toall employeesState Workers’ Compensation Poster (This has already beendistributed, please let us know at the end of training if your unitneeds another copy)“Supervisors and Coordinators” Claims Reporting Poster
Claims Reporting Contact Listing byBusiness Unit3-Page, double-side listing has been provided in your packetwith the following information:1.Orange County Department/Divisions2.Orange County Department/Division Coordinator’s Name, Phone and FaxNumbers3.Orange County Risk Management Contact Name, Phone and Fax Numbers4.Crawford and Company’s Adjusters Names by Type of Claim5.Crawford and Company’s Nurse Case Managers (NCM) Names, Phone andFax NumbersKeep this listing readily available. It should assist in streamliningthe lines of communication in claims handling.Section 12
Orlando, FL 32819 407/354-3700 Macksoud, Wadih (HAND) 1700 Lucerne Terrace Orlando, FL 32806 407/236-0404 Konsens, Richard 3403 Technological Ave. #4 Orlando, FL 32817 407/380-8705 Palumbo, Robert 615 E. Princeton St., #510 Orlando, FL 32803 407/303-4270 White, George 825 N Garland Ave. #300 Orlando, FL 32801 407/841-2100 Schellhammer, Mark .
