The TNSIA is partnering with the Tennessee Chapter and we want to get the word out since scholarship applicants are needed! Attached are the forms containing the Criteria as well as the Application. Kathy Kirby-Smithson is the President and any questions should be directed to her.

Criteria for Scholarship pdf
Scholarship Application pdf

TENNESSEE
Kathy Kirby-Smithson
809 North Hampton Cove
Franklin, TN 37064
(615) 336-1956

This year’s winners were chosen for their loss control, return to work programs, employee advocacy, performance, and leadership. The award program is sponsored by the National Council on Compensation Insurance and each year spotlights three organizations for their outstanding approach to workers’ compensation risk mitigation.

Bruce Jones, Director of Insurance for Community Health Systems (TNSIA’s newest member), was named one of the two finalists for the award. Community Health Systems, headquartered in Franklin, TN, has more than 94,000 employees.

Bruce identified one particular hospital that was having problems and after investigating, found that musculoskeletal injuries were the most frequent cause of claims. These injuries resulted from people hurting themselves when they had to move extremely obese patients.

The hospital purchased patient lifting equipment and established procedures and policies for the use of that equipment.

By the end of the third year, the hospitals using the patient lifting equipment reduced their losses by more than $11 million.

Michael Murphy, Manager of Global Property & Casualty Insurance with Kennametal, located in Latrobe, PA, was also one of the finalists for the award.

Michael, along with Kennametal’s risk management team, announced a goal in 2007 of reducing the workers’ compensation costs by 50% in three years while enhancing service to employees. The goal was realized and surpassed a year early by June 30, 2009. The two areas targeted for generating savings were: (1) enhanced loss prevention; and (2) improved claims handling. Significant loss prevention efforts coupled with improved claims management resulted in workers’ compensation costs being reduced by 59% in a three-year time period.

Congratulations are also in order for Gary Eastes, President of the Tennessee Self-Insurers’ Association, and this year’s winner of the National Underwriter Award for Excellence in Workers’ Compensation Risk Management programs. Gary is the Risk and Benefits Manager for the City of Knoxville, TN.

The City, which offers on-site occupational medical services, is both self-funded and self-administered for workers’ compensation. Claims administration, legal support, and safety are all done in house with these services interacting with all levels of supervision and management.

The City of Knoxville’s top injury category is orthopaedic, with the incidents of these types of injuries exacerbated by the physical demands of many of the city’s jobs. One way the City addresses orthopaedic risk is with an in-house physical therapist and fitness specialist, as well as an ergonomic specialist working with departments to reduce injuries.

Part of Gary’s success involved a philosophical shift from keeping occupational and personal health problems totally separate to a more holistic approach in which the employer makes the health and safety of the employee their business as opposed to having the employee’s personal health problems being considered “their own problem.”

TNSIA is proud of the recognition received for all three of its members above, and congratulates them on a job well done.

Terry L. Hill
Executive Director, TNSIA

The bill passed the Senate on Saturday, May 21st by a vote of 27-1, and passed the House that same evening by a vote of 79-13.

Workers’ Compensation Reform Bill

Terry L. Hill – Director, TNSIA

Judgment -The court of Federal Judge Paul Borman has dismissed the case of Brown v. Cassens Transport Company, stating that the exclusive remedy for the claim falls within the exclusive administrative scheme set forth in the Michigan Workers’ Disability Compensation Act. The dismissal forecloses the employees claim under the Racketeer Influenced and Corrupt Organizations Act (RICO).

The National Council of Self-Insurers, along with the Michiganand Illinois Self-Insurers Associations, filed an Amicus brief with the U.S. Supreme Court in support of Cassens.

History – In October 2008, the U.S. Court of Appeals (Sixth Circuit) ruled that six employees of Cassens Transport could proceed with their RICO suit, alleging that Cassens, its TPA and a doctor, engaged in an illegal scheme to deny the employees benefits for workplace injuries. Cassens subsequently petitioned the U.S. Supreme Court to review the decision of the Court of Appeals.

The National Council of Self-Insurers, Michiganand Illinois Self-Insurers Associations filed their amicus brief, stating to the Supreme Court that if the Appellate decision holds, employees, who say they are injured at work, will be able to prosecute RICO actions in state and federal courts as well as actions in workers’ compensation courts.

In September 2009, the Supreme Court denied Cassens’ Certiori Petition., allowing the case to resume.

The case was assigned to the court of Federal Judge Paul Borman, who had the responsibility to determine if certain medical evidence had relevance in his Court in the denial of workers’ compensation benefits.

On September 27, 2010, Judge Borman ruled that that the Plaintiffs’ exclusive remedy for their claim, that they were fraudulently denied benefits under the Michigan Workers’ Disability Compensation Act (WDCA), lies within the exclusive administrative scheme set forth in the WDCA. The judge further concluded that even assuming such a claim could be raised outside of the WDCA’s exclusive administration, the plaintiffs failed to allege an “injury to business or property” as that term is defined under RICO. The claims of the plaintiffs thus failed for this separate and independent reason.

Related Case – In Jacksonv Sedgwick Claims Management Services et al., a similar case has been instituted. It alleges that a self-insured employer, its third party administrator (TPA) and a physician conspired to deprive injured employees of their workers’ compensation benefits in violation of the RICO Act.

The National Council of Self-Insurers has filed an amicus brief in support of the employer, TPA and doctor.

Larry Holt
Executive Director

The National Council of Self-Insurers has contributed $15,000 toward an amicus brief, being coordinated by the American Insurance Association, in the case of Jackson et al v Sedgwick Claims Management Services, Inc. et al. The Council?s purpose is to preserve the exclusive remedy of workers? compensation.

In Jackson, the plaintiffs allege the same type of RICO claims against Coca Cola and its, TPA, Sedgwick, as six employees of Cassens Transport alleged against Cassens and its TPA.

In October 2008, the U.S. Court of Appeals (Sixth Circuit) ruled that the six employees, who work in Michigan, could proceed with their Racketeer Influenced and Corrupt Organizations Act (RICO) suit, alleging that Cassens, its TPA for workers? compensation; and a doctor, engaged in an illegal scheme to deny the employees benefits for workplace injuries. Cassens subsequently filed a Certeori Petition with the U.S. Supreme Court, requesting a review of the Court of Appeals? decision.

The National Council, with the Michigan and Illinois Self-Insurers Associations, filed an Amicus brief with the Supreme Court in support of Cassens. The brief stated that if the appellate decision holds, employees, who say they are injured at work, will be able to prosecute RICO actions in state and federal courts as well as actions in workers? compensation courts.

In December 2009, the Supreme Court denied Cassens? Certeori Petition.

In Jackson v Sedgwick, Judge Edmunds of the U.S. Court of Appeals (Sixth Circuit), in March 2010, granted the motions of Coca Cola and Sedgwick to dismiss. She said that the exclusive remedy provision in Michigan?s workers? compensation law barred RICO and other remedies.

Jackson et al, however, are appealing Judge Edmund?s decision, arguing it is inconsistent with Cassens. If upheld, Judge Edmund?s decision will have the effect of nullifying the Sixth Circuit?s decision on Cassens. For this reason, the National Council has joined the amicus in a significant way.

Larry Holt
Executive Director

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Contact: Steve Heckle – steve.heckle@lkqcorp.com

“Gary Eastes has achieved significant milestones for the City of Knoxville through his innovative health and wellness programs,” said Regis Coccia, the Chicago-based editor of Business Insurance. “We are proud to honor him and his colleagues for doing what great benefit managers do: improving the lives of plan members and helping his employer to achieve its goals.”

Business Insurance has sponsored the Benefit Manager of the Year competition annually since 2005. Business Insurance created the program to recognize excellence and innovation in employee benefits management. In 2010, the publication launched the Benefit Management Honor Roll, to recognize outstanding employee benefit managers in organizational categories not represented by the Benefit Manager of the Year.

“Mr. Eastes is a shining example of a benefit professional whose leadership sets him apart from his peers. His efforts not only have helped the City of Knoxville to gain control over health care costs, but he and his team are making a difference in the lives of the city’s employees and their dependents,” Mr. Coccia said.

Any full-time employee of a corporation, nonprofit organization or government entity who oversees or manages employee benefit functions is eligible for the awards. Benefit managers anywhere in the world are eligible for consideration. The value or generosity of specific benefits is not judged; the award is intended to honor excellence in managing and administering benefit programs overall.

An independent panel of judges, representing prior honorees and benefits industry executives, selects the Benefit Manager of the Year and Benefit Management Honor Roll members from nominations submitted to Business Insurance.