Program A: Injured Workers' Benefit Protection

Program Authorization: R.S. 23:1021

PROGRAM DESCRIPTION

The mission of the Injured Workers' Benefit Protection Program is to establish standards of payment as well as utilization and review procedures of injured worker claims; receives processes, hear and resolve legal actions on compliance to state statutes; educate and influence employers and employees to adopt comprehensive safety and health policies, practices and procedures; and collect fees.

The goals of the Injured Workers' Benefit Protection Program are:

1. Maximize the quality of medical care received by workers injured on the job.

2. Administer the resolution of workers' compensation disputes in an efficient, timely and impartial manner.

The Injured Workers' Benefit Protection Program includes the following activities: Mediation and Adjudication of All Workers' Compensation Disputes, Collection of Statistical Data on Compensable Occupational Injuries and Illnesses, Determination of Minimum and Maximum Allowable Levels of Compensation, Development and Implementation of Medical Utilization Review Procedures, Development, Implementation and Administration of Loss Prevention Safety and Health Programs, Assistance to Louisiana Employers with Programs Pursuant to Code of Federal Regulations (OSHA Consultation), and Administration of the Louisiana Cost Containment Program.

OBJECTIVES AND PERFORMANCE INDICATORS

1. In FY 1998-99, the Office of Workers' Compensation, through its Administrative activity, will resolve or adjudicate workers compensation disputes (or law suits) in a fair manner within six months from filing, unless continued for good cause by a party(ies) to the claim.

2. In FY 1998-99, the Office of Workers' Compensation, through its Administrative activity, will continue to resolve 35% of the disputed claims before they reach the pre-trial stage.

1 Video conferencing may be implemented. Cost is difficult to estimate. The increased expense from implementing a video system will, in turn, result in savings by those parties (primarily insurers and self-insured employers) who will use the system resulting in overall savings for the total operation of workers' compensation insurance in Louisiana.

3. In FY 1998-99, the Office of Workers' Compensation, through its Injured Workers' Benefit Protection Program, will resolve 100% of the number of disputes filed and increase to 13% the number of disputes resolved.

1 This increase is compared to the number of disputes filed and resolved in the previous fiscal year.

4. In FY 1998-99, the Office of Workers' Compensation, through its Workers' Benefit Protection Program, will complete 95% of investigations initiated.

1 May not meet felony threshold or unable to prove intent.

5. In FY 1998-99, the Office of Workers' Compensation, through its Injured Workers' Benefit Program, will request and review 3% of the 14,000 employers required to maintain safety and health programs and shall conduct 100% compliance audits/inspections which should result in a 6% reduction of employers needing assistance.

1 Actual figures are submitted on a calendar year basis. Louisiana employer data are manually and/or electronically produced and maintained on a calendar year basis.

2 From 1993 through July 1996, the OWCA Safety and Health section was not allowed by its director to conduct employer on-site safety and safety plan verifications and facility inspections under R.S. 23:1291(B)(4) Safety and Health legislation. Since July 1996, inspections have since been allowed under R.S. 23:1291(B)(4)(13).

6. In FY 1998-99, the Office of Workers' Compensation, through its Injured Workers' Benefit Protection Program, will investigate 100% of all reported accidents and/or illnesses in an attempt to maintain a 3.0 or lower total recordable incidence rate for the 1,172 Louisiana Department of Labor employees.

1 These figures are based on fiscal year-to-date totals.

2 The incidence rate is the number of injuries and or illness or loss/restricted workdays per 100 F/T employees per year or 200,000 man-hours of exposure. The incidence rate may also be interpreted as the percentage of employees who will suffer the degree of injury for which the rate was calculated. That is, if the incidence rate of total recordable cases is 5.1 per 100 full-time workers, then about 5 percent of the establishment's employees incurred a recordable injury.

7. In FY 1998-99, the Office of Workers' Compensation, through its Record Management section, will collect and code case characteristics and cost data for 100% of the disputed and undisputed claims within six weeks of their receipt.

8. In FY 1998-99, the Office of Workers' Compensation, through its Records Management section, will retrieve 95% of records requested by its employees, attorneys, state and federal agencies, court officials, employers and insurance carriers within 7 days.

1 Numbers for this year are projected.

9. By June 30, 1999, the Office of Workers' Compensation, through its OSHA Consultation section, will respond to 80% of requests received from high hazard private employers, having fewer than 500 employees, requesting OSHA consultation services from Louisiana private employers.

1 These figures are based on Louisiana Department of Labor, Research and Statistics, Employment and Total Wages Paid by Employers September, 1997, potential for 106,831 employers to request on-site consultation services.

2 These figures are an approximation based on site surveys expected to be requested using past experiences as a base. The figures also reflect a staffing shortage for this fiscal year.

3 The Department of Labor estimates that they are surveying one hundred percent of the high hazard request. However, at this time, they are unable to capture this data on its federal system. This data should be available in the future.

10. By June 30, 1999, the Office of Workers' Compensation, through its OSHA section, will identify hazards at 100% of the facilities requesting on site services and will provide program assistance at 100% of the facilities requesting customized program assistance and training.

1 These figures are based on Louisiana Department of Labor, Research and Statistics, Employment and Total Wages Paid by Employers, September, 1997, potential for 106,831 employers to request on-site consultation services.

2 These figures are an approximation based on site surveys expected to be requested using past experiences as a base. The figures also reflect a staffing shortage for this fiscal year.

3 This number is an estimate. Actual data was not available.

4 This number is based on new federal software to be installed. This new software will enable us to capture a more accurate picture of these activities.

RESOURCE ALLOCATION FOR THE PROGRAM

SOURCE OF FUNDING

This program is funded with Statutory Dedications and Federal Funds. The Statutory Dedications are derived from the Worker Compensation Fund. (Per R.S. 39:32B. (8), see table below for a listing of expenditures out of each statutory dedicated fund). The Worker Compensation Fund receives revenues from an assessment on all insurance companies and self-insurer's writing worker's compensation insurance in Louisiana. Such assessments are a percentage of the amount reported in the annual reports. The Federal Funds are derived from an Occupational Safety Health Administration (OSHA) statistical grant. This grant requires a 10% match from the Worker's Compensation Fund.

ANALYSIS OF RECOMMENDATION

The total means of financing for this program is recommended at 99.7% of the existing operating budget. It represents 91.1% of the total request ($ 10,905,769) for this program. The decrease is primarily due to an attrition adjustment, retirement rate adjustments, Acquisitions/Major Repairs. This program does not have any positions that have been vacant for 1 year or more.

PROFESSIONAL SERVICES

OTHER CHARGES

ACQUISITIONS AND MAJOR REPAIRS