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HomeMy WebLinkAboutCOM 0888.000 1998-2000 MiY•Or M Stephen K. Yamashiro Dixie Kaetsu Mayor Duector S. K. Schutte ~Ta Or •Mr'' Deputy Countp of J~aWait DEPARTMENT OF FINANCE 25 Aupum Street, Room 118 • Hilo, Hawaii 96720-4252 (808) 961-8234 . Fax(808)961-8248 August 10, 2000 Honorable James Arakaki, Chairperson and Members of the County Council Hawaii County Council 25 Aupuni Street Hilo, Hawaii 96720 Re: Resolution Creating Positions Attached for council action is a resolution creating two positions for the Workers' Compensation Unit of the Division of Industrial Safety. Also attached are a memorandum from Lester Ishado, Deputy Corporation Counsel, presenting justification for the additional staff, and the results of a review of operations by the Department of Civil Service. We expect that the savings to the County in workers' compensation claims payments will exceed the cost of the additional positions. Therefore, the funding for the positions are coming from the amount budgeted for workers' compensation claims. The proposed $79,092 transfer into the salaries and wages account includes nine months funding for the two new positions, as well as twelve months funding for the present Workers Compensation Specialist III position, which was filled on April 18, 2000 and funded in part by the Council for fiscal year 2000 in Resolution No. 258-00 on June 2, 2000. However, due to an oversight, funding for this position was not included in the current year's budget. If you have any questions, please feel free to call Lester Ishado at 961-8344. G~ Dixie Kaetsu Director of Finance APPROVED: phen K. ashiro Mayor Enc. ZeB. 31..-00 Comm. No. 888 File No. T Ref. To FC Ref. DateAU6 14 2000 Stephen K. Yamashiro - Mapor Jay A. Saran Sa(ery Ceury,~,ar Count of clafnttii DIVISION OF INDUSTRIAL SAFETY Workers' Compensation Unit 75 Waduku Dnve . Hilo, Hawaii 96720 • (808) 961-8344 Fax (808) 961 8416 MEMORANDUM TO: James Y. Arakaki Chairman, Hawaii County Council FROM: Lester Ishado Deputy Corporation Counsel ?j RE: Workers' Compensation Unit Staffing Recommendations DATE: August 10, 2000 Staff On November 2, 1999, after a study of the situation and a review of other jurisdiction's programs, the Department of Civil Service recommended that the County of Hawaii Workers' Compensation Unit (herein, "WCU") staff be increased to include: 1. Two (2) Workers' Compensation Claims Specialists III, SR-22. 2. Two (2) Personnel Clerks ll, SR-15. 3. One (1) Clerk III, SR-10. Mr. Arakaki Chairman, Hawaii County Council August 10, 2000 Page Two Prior to June, 2000, the WCU staff consisted of two workers' compensation claims clerks, SR-12. Cases were assigned by alphabet (A-L and M-Z) to each claims clerk. The WCU also has one deputy corporation counsel (on assignment from the Office of the Corporation Counsel). Two temporary part-time clerks from Senior Employment and Cooperative Vocational Education also assist with light clerical duties (copying and filing). Long- term use of temporary, part-time file clerks, however, creates problems in rehiring and retraining, and the temporary clerks cannot handle the complexities of adjusting claims or assisting in the adjustment of claims. The Department of Civil Service recommended that the WCU be organized based on the alpha team concept, with each team (consisting of one workers' compensation claims specialist and one personnel clerk) to handle one-half of the cases. This is important because the workload cannot be handled with the current staff, and the workers' compensation program and the claimants suffer as a result. When a workers' compensation claims clerks is absent, that clerk's share of the cases is left largely unattended. This is understandable when you consider that expertise and familiarity with the cases are needed to make informed decisions. There is no back-up when there is only one claims clerk. The Department of Civil Service also recommended that the rating of the claims clerks (SR-12) be changed to SR-22. Pursuant to the recommendations of the Department of Civil Service, the WCU added one new position (Clerk III), resulting in a staff increase from two to three workers. The staff now consists of one workers' compensation claims specialist, SR-22 (formerly the workers' compensation claims clerk, SR-12), one workers' compensation claims clerk, SR-12, and one clerk III, SR-10. Mr. Arakaki Chairman, Hawaii County Council August 10, 2000 Page Three Caseload and Duties As of March 29, 2000, the WC Office had 722 open cases. Some open cases are very active and require constant processing and monitoring. For instance, the claimant may be receiving steady medical treatment and be off from work. Other open cases require less processing and monitoring. For instance, claimant may be back at work but receiving occasional medical treatment. Other open cases are inactive and require little or no attention. For instance, the claimant could be back at work and not be receiving any medical treatment. In such cases, the cases require little work until the claimant seeks further medical attention or takes off from work. The WCU is responsible for handling workers' compensation claims on behalf of the County of Hawaii. Handling claims involve much more than processing forms. Decisions have to be made which could cost the County thousands of dollars. The following summary describes the workload of the WCU: 1. Filing WC-1 forms (Employer's Report. of Industrial Injury). Upon notice of a work injury, the department prepares an incident/accident report and sends a WC-1 form to WCU. The WCU reviews, processes, and accepts or denies the claim, and files the WC-1 form with the Department of Labor and Industrial Relations (herein, "Department'). Workload-Review and process approximately three to five WC-1's per week or 200 WC-1's per year. Problem-The Department could fine the County up to $5,000.00 for failure to file the WC-1 within seven days after the County has knowledge of the injury. Mr. Arakaki Chairperson, Hawaii County Council August 10, 2000 Page Four 2. Filing WC-3 forms (Carrier's Case Report). The WCU must file WC-3 reports summarizing payments made within 30 days after the final payment, or for ongoing cases, by January 31 of the next year or when closing a case. Workload-Review and process approximately 722 WC-3's per year (one for each open case). Problem--The Department could fine the County up to $5,000.00 for failure to file WC-3 when due. 3. Filing WC-14 forms (Employee's Wage Report). The departments submit this form to the WCU, which files this form in conjunction with WC-1. The WCU and the Department use this form to calculate the average weekly wage and the compensable weekly wage. Workload-Review and process approximately four WC-14's per week or 200 WC-14's per year. Problem--checking calculations under workers' compensation law. 4. Reviewing WC-2 forms (Physician's Reports). The Claimant's treating physician prepares and files WC-2 forms to provide periodic reports on the diagnosis, prognosis, and treatment of the Claimant. The WC-2 form is also used to certify the periods of disability (and to pay temporary total disability benefits on that basis). Mr. Arakaki Chairman, Hawaii County Council August 10, 2000 Page Five Workload-Review and process approximately 200 to 300 WC- 2's per week or 15,000 WC-2's per year. Problem. Careful analysis of WC-2's is essential because the reports indicate whether continued treatment is reasonable and necessary and whether disability should be paid. The lack of adequate analysis may allow unnecessary or unreasonable treatment to take place or unnecessary disability to be paid. 5. Reviewing and approving or denying treatment plans and requests for consultation or surgery. The Claimant's treating physician prepares and files treatment plans, e.g. chiropractic care, and requests for consultation or surgery with the WCU. The plans must give the commencement and termination dates of treatment, specific diagnosis, time schedule of measurable objectives, number and frequency of treatments, modalities and procedures, and estimated total cost. Sometimes, additional information or a medical opinion is needed before approving or denying treatment plans. This process is very time consuming and requires expertise and careful scrutiny. Numerous letters and phone calls are made to follow up on each plan. Treatment plans have a limited duration of 120 days and have to be resubmitted for continued treatment. In addition, one injury may require different types of treatment. Workload-Process, review, and approve approximately 100 treatment plans per week or 5,000 treatment plans per year. Mr. Arakaki Chairman, Hawaii County Council August 10, 2000 Page Six Problem-The WCU only has seven calendar days, including weekends and holidays, to approve or deny a treatment plan. If the WCU fails to deny a treatment plan on time, the treatment is deemed approved and allowed by law to proceed. Failure to properly review the treatment plans may result in unreasonable or unnecessary treatment, and it is sometimes difficult to reverse or stop said treatment, especially after several years. 6. Reviewing and processing medical bills for payment. The WCU is assisted by an independent auditor, ADP. This similar to the process for treatment plans, but involve the payment of medical bills for which treatment has been approved. Workload-Review, process, and approve or deny approximately 280 medical bills per week or 14,500 bills per year. Problem-Delays in bill payment result in frustration by medical providers and additional work for WCU in checking on bill payment. 7. Providing clerical services and producing records upon request. For example, the production of documents is mandated by Department rules and under discovery rules, but has been hampered by lack of an adequate staff. Workload-Typing, filing, photocopying 260,000 copies per year, taking approximately 150 to 200 phone calls per week or 9,000 calls per year, and responding to approximately 250 to 300 letters per week or 14,000 letters per year. Mr. Arakaki Chairman, Hawaii County Council August 10, 2000 Page Seven Problem--The deputy corporation counsel and the specialist have been doing their own typing, copying, delivery, etc., taking time away from the areas requiring their expertise. 8. Approving and processing indemnity payments to claimants. Payments to claimants are sometimes delayed pending review of certifications of disability, further information, and/or medical review, etc. Sometimes, the information needed to make these decisions is not yet available. At other times, the WCU cannot handle the workload to get the work done promptly. Workload-The work involves the review of WC-2 forms certifying disability and other medical documents. Problem-Delays in making payments may result in frustration for the claimants or penalties. On the other hand, if inappropriate payments are allowed due to lack of adequate review, e.g. of disability, the County will have a difficult time in attempting to stop the payments, especially after making the payments for a long period. 9. Preparing for and attending hearings at the Disability Compensation Division level, Labor Appeals Board level, and if necessary, at the appellate court level. Workload-The number of hearings may vary. In May, 2000, there were 18 hearings scheduled. In June, 2000, there were 13 hearings scheduled. There are 12 cases on appeal before the Labor and Industrial Relations Appeals Board. Mr. Arakaki Chairman, Hawaii County Council August 10, 2000 Page Eight Problem-Sometimes, the deputy corporation counsel has to fill in for an absent clerk, taking time away from preparation. 10. Ordering independent medical examinations. The WCU needs the additional positions (one workers' compensation claims specialist III (SR-22) and one personnel clerk III (SR-15)) being discussed by the Council. Without this additional help, the WCU will work on an as needed basis covering the basic processing, but without going into the detail necessary to handle complex and long, ongoing cases. This is bare minimum efficiency at best, and inefficient and costly at worst. Open cases have to be kept open for eight (8) years after the last payment is made, or until the claimant passes away, or a full settlement is reached. Thus, the number of open cases alone may not be an accurate barometer of how well the program is doing. For example, the WCU managed to concentrate on and close/settle five long pending cases within the past four months, and the results show the advantage in hiring additional staff to scrutinize and process claims more efficiently. The typical case was from two to six years old, and the County had already paid total benefits exceeding $100,000.00 in some of these cases. At the time of closing, the typical claimant had pending claims for ongoing medical treatment ($3,000.00 and up per year) and for indemnity benefits ($14,000.00 and up per year). At an estimated cost of $17,000.00 per year, if allowed to continue unchecked, these five cases would have the cost the County about $85,000.00 per year. Unfortunately, without the additional staff, the WCU will not be able to continue these efforts on a systematic basis. Please call if you have any questions or comments. cm" ofMawad -DePaTmat ofakcservics 4 Interoffice .Zemo RE9;--,V AC 'Sf]: Mr. Tid N. A Hong, Assistant Corporation Counsel 1 ui~ DAB .7:'AON. hOchael L Ben, Director of personnelI DAIM NovemberZ 1999 SUMM- Expansion of Worker' ComliensaHon Ural We have concluded our review of yourdeparhnent's staffing rec«nmendation for the Workers' Compensation Unit. Based on a col- orative review offhe other Jurisdictions' programs and the duties being assigned to your current staff, our recommendaflans are: I . Ongoniitationai si uckm. (1) Deputy Corpo rafton Counsel (2) Workers' Compensation adffnSpedallst Ill. SR-22 (2) Personnel Clerk H, SR-i 5 (1) CWrkM SR•10 • The proposal is based on the assumption that the Deputy Corporation Counsel will continue to manage the Waters' Compensation Un t implement policy and procedures handle the mars di ficult upped cases: and provide advice and direction on the most difficult workers' compensation cases to staff and Itne depoftenis. • The orlpantratlon is based on an alpha team concept. This will ensure continuity in the handling of cases during leaves or absences. There will be two tearns comprised of one speda:'st and one personnel clerk- The WC,= Claims Spedakt ill will serve as team Wader, eroonsine and prepare the tyiP range and vastety of claims, indudng the rncd dMICOlt and compisx cases: and.provds managern ant advisory sarvk a to The department& rv • The Personnel Clerk h will examine and prccsss the full range and var?-Zf worKaro' compensation claims under general supervision: may paticlpAO In the more dittieuff and comple><casetr and provide advisory service to Ifpe departments. The Clerk tll wAl 00 ton, o variety of responsible clerical and administrative support services for the Deputy Corporation Counsel and team members: prepare and maintain ad statistical data and reports; set up and maintain Ming and re crd systems: and provide phone or counter service to clientele. 9Trf T96 50433 TT;60 nn y: .0 SI~.1 AiO~ ~SOa -CDO'C00fJ • Although, your rocommwKkdbn included a 1 tZ Imrosfigator pr+sition to iivesfigate suspected fraudulent and abuse cases we did not include this pastibn. Investigation is part of the WC specialist duties. Further, the duties and responsibility of the kwestlgatarwould overlap those of Yaw full-time - Chins Investpator6Adjustorwhose dutiesincinde workers' compensafbn - case l"vedootions. 2 Nov positions: (1) Workers' Compensation Claims Spsdaist 14 SR 22 (1) Clerk III. SIM 0 3. Reallocations: a. Position no. 2995 Workers' Compwaation Claim Specialist N, SR-24, to Workers' Compensation Clams Specialist IL SR-22. • vacant pos(rton to be mdocaled downward. The responsibity for the day-today aclM6es of the urNt is a primary funcom WC Spe lobt N. SR-24, class. Mowww, with this respomt Aty being assumed by the Deputy Corporation Counsel, that dassAtcation level is not warranted. The journey level WC Specidbt Ill, SR 22, ciatsiticahiort is more appropriate. b. Position nos. 188S and 3506 Workers' Compensation C1artn Clerk. SR-12 to Personnel Clerk V. SR-15. • The duties of the Personnel Clerk 11 doss of work represent the higher technical level of work that Is required for the WC unit. The current WC Claims Clerk dent reooprtbrt assignments that are "routine" workers' =rnpensailon dairm • If recommendation Is approved. the work experience of the current Incumbents of position nos. 1885 and 3506 will be screened to verify that they meet the minimum qualification requirements for the Personnel Clerk I; class of work. If there are any questions, please. cog Joney Nitaharo at cut. 8361. If not. submit your request for approval to the Mayor pursuant to the Directive on Orgon¢ationat Changes and Position Actions, dated March 10. 1993. C00 rCCti S:\1 a03 YHO.n git5 196 405$ TT:80 00 gz -