Solutions
Scholarship recipient builds better future
Sammy Joe Parsley was a 59-year-old roofing contractor with a wife and four children. One day, his truck swerved off of State Highway 60 near Pampa and struck a tree. He died instantly.
His daughter, Sammie Jo, had just turned 14 years old. Faced with the challenge of forging ahead without a loved one and the primary breadwinner, the family turned to Texas Mutual Insurance Company. The monthly benefit checks helped cover essentials. They fell short, however, when Sammie Jo decided to go to college in 2002.
Fortunately, Texas Mutual Insurance Company has a scholarship program for people in Sammie Jo’s situation. The program provides up to $4,000 for tuition and fees per individual per semester. Assistance is also available for course-related books and supplies. Sammie Jo qualified for a scholarship every year of her college career.
“This takes so much weight off my family and me,” wrote Sammie Jo in one of many thank-you notes. “Though I will never be able to say it enough, thank you again for your help. College has been an exciting and maturing experience.”
Sammie Jo put her money and her mind to work at West Texas A&M University in Canyon. She graduated this spring with an accounting degree. Not long after, she married her high school sweetheart and accepted a job as an accountant back home in Pampa. She has her sights set on the certified public accountant and certified management accountant exams.
The scholarship program is open to qualifying family members of policyholders’ employees who die from compensable injuries. Injured employees who receive lifetime income benefits from Texas Mutual Insurance Company, as well as their family members, are also eligible.
Campaign teaches safety
first, second and third
You probably have car insurance to protect you in the event of an auto accident. Wouldn’t it be nice if your insurance carrier taught you how to prevent accidents in the first place?
This fall, our loss prevention professionals boiled the safety process down to three core steps for our policyholders. The result was an exciting new concept: Safety First, Second and Third.
Step one is the planning stage. That is when employers get management buy-in, write a safety policy statement and designate a point person. In step two, they train their employees how to implement the safety plan. Finally, in step three, they analyze their results and adjust their plan.
We launched a multimedia educational campaign to spread the word about this three-step approach to a better safety plan. The campaign included podcasts, radio spots, print ads and a dedicated website. We hope that these tools helped our policyholders put safety first, second and third.
Specialized teams control injury costs
In business, it makes sense to identify your employees’ strengths and put them in positions to better serve your customers. That is what Texas Mutual Insurance Company did when we organized our claim professionals into specialized teams.
Working closely with nurse case managers, the teams determine compensability promptly and identify return-to-work opportunities early. By resolving claims efficiently, they help control the human and monetary costs of workplace injuries. That can require extra care in the case of catastrophic injuries.
Our catastrophic (CAT) injury team includes insurance professionals who have a passion for helping injured workers get their lives back on track.
“It takes a special person to do this job,” said Sally McGraw, CAT team leader. “Dealing with this level of human devastation every day is difficult. We do it because we care, and we want to make a difference.”
CAT team members coordinate temporary lodging for injured workers who need to stay close to their medical facility. They arrange home modifications that help injured workers function outside the medical facility. Sometimes, they simply provide a supportive shoulder to lean on.
Because of the specialized nature of CAT claims, McGraw and her co-workers handle their claims along every step of the process. That is a comforting thought to workers and their families who are coping with life-altering injuries.
Network offers premium discount, return-to-work focus
There’s an old adage that says, “Use it or lose it.” That is good advice for employees who are sidelined by work-related injuries. Many get bored, stressed and depressed. Their job skills often suffer, along with their income.
The longer they are off work, the more likely they are to develop a disability mindset: “I’m injured, and I cannot work.”
After six months of being idle, injured workers have only a 50 percent chance of returning to full employment. Meanwhile, their employers must find a way to make up for lost production.
Texas Mutual Insurance Company created its workers’ compensation health care network to help employers reduce the costs of accidents and help employees get appropriate care.
Participating doctors understand the complexities of treating workplace injuries. Certified network case managers coordinate with doctors to identify return-to-work opportunities as soon as medically appropriate.
Bob Hays, Goodwill Industries
“The doctors in the network do everything in the best interest of the team member and focus on getting them back on the job,” said Bob Hays, treasurer/chief financial officer of Goodwill Industries of San Antonio. “With faster return-to-work times, we’re getting back a productive employee. That’s a cost savings for us, as well.”
Hays knows that direct costs, which include medical and income benefits paid by the insurance carrier, are only one part of the injury cost equation. Indirect costs, which include lost production, come out of the employer’s pocket.
Ultimately, the cost of replacing an injured worker can be 50 percent to 150 percent of the employee’s salary.
In 2007, we expanded our network service area to include less-populated counties. Approximately 97 percent of our policyholders are eligible to take advantage of the network.
“We’re in a rural area, so access to care is critical,” said Sally Casas of San Miguel Electric Cooperative Inc. in Christine. “Our people get appointments quickly, and network doctors help them get back to work efficiently.”
Some injured workers cannot perform all of their job duties immediately. Most, however, can contribute to productivity. Casas works closely with network doctors to monitor injured workers’ medical restrictions. Whenever possible, she provides alternative work that employees can do while they recover.
“Network doctors are great about partnering with us,” added Casas. “We’re all working toward the same goal. We’ve found that once injured workers are back on the job in some capacity, they’re more motivated to return to full duty.”
Most eligible policyholders who choose the network get a 12 percent annual premium discount. Goodwill Industries of San Antonio used its $100,000 premium savings to help serve more than 30,000 people in 2007, a record for the nonprofit organization.
Customers get ahead with group discount programs
State law allows employers in similar industries to purchase their coverage as a group. Members get a premium discount, an industry-specific safety plan, and potential individual and group dividends. Their agents get renewal stability, increased market share and higher premium volumes.
In 2007, we partnered with agents to form three new group discount programs: Hospitals of Texas, Texas Medical Group and Texas Automotive Purchasing Group.
We are a leading writer of group discount programs in Texas. We offer group opportunities for a range of industries, including oil and gas, manufacturing, construction and restaurants. Any licensed Texas agent can submit clients for consideration.
Businesses grow with dividends
Texas Mutual Insurance Company is on a mission to make Texas a safe place to work. Dividends help us reward policyholders who share our commitment.
“They’ve returned more than $55,000 to our company over the past five years,” said Paul Workman of Workman Commercial Construction. “That’s money we’ve used to grow our safety programs, train our people, upgrade our equipment and improve our bottom line.”
Paul Workman, Workman Commercial Construction
Workman was one of more than 37,000 employers who qualified for a share of nearly $125 million in individual policyholder dividends this year. The dividend distribution was the largest in our company’s history. Policyholders who controlled workplace accidents improved their chances of qualifying.
Pete Snider of Alco Glass has earned more than $28,000 in individual dividends over the past six years.
“That return on our premium was a huge help,” said Snider. “One year, we put it toward another truck, which was something we needed for our company.”
Snider and other policyholders who qualify for dividends are more likely to stay with Texas Mutual Insurance Company and, more importantly, their agents.
To help our agent partners retain valuable customers during the vulnerable first-year renewal, we added an early-qualifier component to our individual dividend plan. The early-qualifier component shortened the time that first-year policyholders must wait for a dividend.
Our individual dividend plan is separate from dividends we pay to our group discount programs. Group dividends are based largely on each group’s overall loss ratio.
In 2007, we distributed more than $13.6 million in group dividends.
“With their dividend program, safety resources and health care network, we’re seeing a tremendous reduction in our workers’ compensation costs,” added Workman. “We have a great relationship with Texas Mutual, and we look forward to being with them for a long time to come.”
Workman is not alone. Eighty-two percent of our policyholders chose to renew with us in 2007.
Fraud investigators level playing field
Some people think that workers’ compensation fraud only hurts insurance carriers. Tim Riley, manager of special investigations at Texas Mutual Insurance Company, offers a different perspective.
“Fraud creates an unlevel playing field,” said Riley. “When people cheat the system, premiums increase systemwide. When premiums increase, everyone pays, including honest employers.”
Riley leads three teams of experienced, in-house investigators. Some come from the federal and state law enforcement world. Others are former parole officers, private investigators and insurance adjustors. All share Riley’s commitment to stamping out fraud.
In 2007, our investigators identified more than $8 million in fraud. Their diligence resulted in:
- • Eighteen indictments and 17 convictions in our favor
- • Claimant fraud future savings of $4,224,191
- • Restitution of $88,610 from claimants
- • Health care provider fraud in the amount of $1,336,379 prevented
- • Restitution of $1,104,021 in premium fraud
Online tools streamline business
Eight seconds: That is all the time it takes to pour a cup of coffee, tie your shoes or lose a customer.
Smart business owners know that consumers want to do more of their business online. They also know that their customers are busy. If a website is difficult to use, they will quickly abandon it. Most will never return.
In 2007, our e-business team unveiled a new look for the password-protected areas at www.texasmutual.com. The redesign makes it even easier for our customers to access the Texas Mutual® online services they count on.
In just a few mouse clicks, policyholders can report injuries, access claim details, analyze their losses, use interactive safety tools and learn how to launch a return-to-work process.
Agents can get a quick quote, manage their book of business and review their clients’ dividend histories.