Costs for outsourced private investigation by special investigation's unit (SIU) increased significantly. Reducing payments to external investigators would cause stakeholder pressure and increase internal investigators' expectations.
Increased criteria level to secure external investigators. Restricted surveillance time to determine whether or not activity was deemed fraudulent. Standardized reporting requirements.
Reduced investigation costs from $800,000 to $150,000 while only increasing operating expenses 7%. Boosted overpayment restitution from $19,000 to $203,000.

Severe claim rates per 100 covered workers were increasing. Severe claims take a human toll, interrupt workplace productivity, and cost an average of $40,000 per claim.
Implemented safety intervention programs. Revised safety consultants' roles and requirements.
Reduced severe claims per 100 workers from .81 to .67, well below national average of 1.1.

Claim filing system was complicated, and customer was forced to choose from one of eight forms. Multiple teams in an eight-year period attempted to consolidate forms into one with no success.
Assembled cross-functional team. Developed 180-day plan to create and roll out single claim reporting form to be used statewide.
Minimized reporting delays 52%. Saved $25 million in process reduction costs. Named as finalist in national competition. Awarded award.

Organization faced $1.9 billion funding deficit with fluctuating premium rates. Challenged with creating solvency without reducing benefit or service levels.
Created new business model for claims and safety management. Targeted fraud reduction. Implemented private, managed care for medical management. Implemented healthcare cost containment strategies.
Reduced premium rates 34%. Created positive fund balance. Dividend credits returned were more than $10 billion. Reduced medical costs more than $4 million. No benefits to injured workers were reduced.

Recruited to prepare plan to transition Ohio’s unemployment system to 100% filing for benefits by phone or Internet. Challenged with transitioning 60 locations into 25 and redesigning local service delivery system into a claims filing and processing system.
Testified before state legislature on a plan to transition unemployment system to 22 facilities and purchase new telecommunications system.
Plan saved $17 million annually in facility and personnel costs.

Claim determinations were more than twice the national average for permanent total disability (PTD). State laws were insufficient and did not define PTD with clear, objective definitions.
Negotiated and facilitated new state law defining conditions necessary to determine injury as permanent.
Actuarially estimated decrease of PTD determinations 20%. Law change and cap for temporary benefits reduced costs $2.5 to $3.3 million annually.

Information systems that supported business operations were outdated and failing. Challenged with securing board and legislative approval for more than $14 million to replace system.
Hired consulting company to evaluate information technology systems and establish business case. Leveraged business case to secure staff, stakeholder, board, and legislative support.
Gained authorization for $14 million to replace system. Will save $2.7 million annually. Company is projected to recoup investment within four to five years.

Claim allowances were stagnant at 93% and were not based on objective medical evidence. Medical providers and customers would be resistant to requiring medical evidence prior to allowing claim.
Implemented ODG's nationally recognized evidence-based treatment and disability guidelines to evaluate medical care's effectiveness or necessity. Instituted a proactive claim allowance/management model.
Decreased claim allowance rate from 93% to 90%. Proactively managed claim to ensure better outcome and customer service.

Reduced workforce by 1,450 employees, resulting in excessive office space. Workforce was located in 21 field offices. Challenged with workforce consolidation and expense planning.
Launched consolidation plan to reduce field operations to 16 offices.
Saved $7 million annually in administration costs, increased operational efficiencies, and allowed organization to improve product and service offerings for customer.

Just 10% of claims were filed within one business day from date of injury. Policyholders had no incentive for early reporting because they paid $250 for each claim regardless of date of filing. Company had no early reporting program in place.
Developed incentive program whereby company paid first $250 of claim if reported within one business day from date of injury.
Increased claims reported within one business day from 10% to 45%, a direct savings of more than $5.4 million to policyholders.

Claims per 100 workers filed increased 3% annually while providing $5 million in non-performance discounts. Company lacked performance-based discount program for policyholders.
Spearheaded creation of a discount program based on actual reductions in claim frequency and severity. Policyholders were automatically eligible for up to 15% discount with no paperwork required.
Claim filings per 100 workers dropped 3.7%. Discounts awarded tripled to $15 million and quintupled the number of policyholders receiving discounts.

Premium rates were unstable and number of claims filed was high. No adequate programs or procedures were in place to reduce policyholders’ claims.
Implemented cutting-edge safety, matching-grant, and training programs for policyholders.
Reduced medical-only claims 13% and lost-time claims 42%, which reduced premium rates an average of 34% and assisted in providing $10 billion in premium dividend credits to policyholders.