State Workers’ Compensation Program Advisory Board Meeting - September 26, 2019

The State Workers’ Compensation Program Advisory Board held its meeting September 26, 2019.  In attendance were Jack Engle (Chairperson), Teresa Flesch (Deputy Director, CMS Benefits), Kevin Richey (CMS Risk Management), Nicole Featherstone (CMS Risk Management), Ken Wertz (Senate Minority Leader Appointee), Greg Riddle (Attorney General), Deanna Bandy (DHS), Jim Sterr (DOT) and in attendance via video conference in Chicago, Michael Brennan (Workers’ Compensation Commission), Bob Bauer (DOI), and Brad Lucchini (DOI).

Jack Engle opened the meeting with the program overview and analysis of the last 3 fiscal years.  It basically states the responsibilities of the Workers’ Compensation Program and what Tristar (TPA) manages.  The overview indicates the agencies, boards, commissions and universities the Workers’ Compensation Program handles, excluding the Illinois Toll-Highway Authority and the University of Illinois. 

In FY17, FY18 and FY19 our claims received have decreased.  Claims closed have increased slightly, but the average costs have declined as we have gone through FY17, FY18 and FY19.  There was a savings of $2 million from the previous 2 fiscal years, and our average cost decreased $2,000 per claim over prior 2 years.  Our appropriations have decreased over the past 3 fiscal years but increased in FY20.

A claims analysis was distributed indicating the top 5 agencies for claims frequency, dollar spend in FY19 and injury type.  The Department of Human Services had the highest number of claims reported, but the highest dollar spend was with the Department of Corrections.

Workers’ Compensation Coordinator Training will be conducted October 16, and we will encourage communication between the workers’ compensation coordinators, CMS Risk Management and Tristar should they encounter any issues or any suspect claims.

On-site case reviews were handled at Juvenile Justice last month, and some are scheduled at DHS the end of October.  All open files and active litigated files will be reviewed, and hopefully create an action plan for better procedures to bring these claims to resolution.

Improvement is needed in our fraud referrals. Fraud training was conducted 2 months ago with the workers’ compensation coordinators.  The training consisted of supplying supporting evidence of fraud, indicating what part of the act was violated and documented.  Jack Engle implemented a procedure so that all fraud referrals must pass through him instead of being submitted to Tristar since there was no quality control in place.  Currently there is a permanent disability fraud claim that CMS is being worked with the Attorney General’s office.  

Teresa Flesch stated that CMS Acting Director, Janel Forde was the Chief Operating Officer for the City of Chicago, and the team she brought in from the city worked on all the property and risk management for the City of Chicago.  CMS Risk Management is meeting with her frequently to identify some opportunities for training agency employees how to avoid injuries that have been taking place.  

Improvement is needed on communication which will be addressed at the next worker’ compensation coordinator meeting scheduled in October.  New incoming claims can be reported weekly, monthly and quarterly.  As a failsafe, a weekly report will be run and communicated downward just in case the coordinator missed the opportunity to report upward.  If there is a property defect that needs fixed, it needs to be addressed timely to avoid that type of loss going forward.  CMS is meeting monthly with property management and many of the Director’s staff.

CMS has hired consultants, Managed Care Associates, who are engaging with our contracts unit and Tristar to identify opportunities for improvement relating to high pharmacy costs spent rather than more productive rehabilitation services for employees to return to work.  More discussions are planned with Managed Care Associates going forward to address these issues.

Michael Brennan indicated that there were several instances where the commissioners came and spoke about what expectations and evidence is needed in an adjudicated file at the workers’ compensation coordinators meeting.  Having someone from the Workers’ Compensation Commission be present at the workers’ compensation coordinators’ meetings could benefit the workers’ compensation coordinators with a better understanding.  It was agreed that having someone from the Workers’ Compensation Commission would be beneficial at future workers’ compensation coordinators meetings.

Future meetings for FY20 will be scheduled in January and May.  The annual report will be submitted to the Governor and Legislature by June 30, 2020.