Download Firefighter Presumptions Issues and Solutions

Challenges and Changes in
Presumption Legislation
Presented October 4, 2016
Mike Rogers
President - Colorado Professional Fire Fighters
Don Lombardi
Chief - West Metro Fire Protection District
Joseph DePaepe
Senior Vice President – McGriff, Seibels & Williams, Inc.
Colorado Special Districts Property, Liability, and WC Pool Administrator
Colorado Firefighter Heart and Circulatory Benefits Trust Administrator
Overview of Presentation
• Relevance of Cancer and Cardiac
• Outline Cancer Presumption Status
• Call to Action
• Heart Incident Solution
• Heart Incident Benefits
• Heart Incident Structure
• How is it Working
• Background on Cancer
• Background on Cancer
Presumption
• Issues with Cancer Presumption
• Solution for Cancer Presumption
• Incident Structure for Cancer
Presumption
• Concerns
• Opportunities
Relevance of the Issues
• Cancer in the fire service
• Cardiac events in the fire service
• WC Presumption Legislation CO May 2007
– Not working well
– Management committed to being at the table in the
future involved in the process
Outline Current 2007
Colorado WC Presumption Legislation
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C.R.S. § 8-41-209 - Link to Legislation
16,000 firefighters in CO - 1/3 Paid; 2/3 Volunteer
Survey 8 years of data on 5,000 firefighters
Cancer within five systems: Genitourinary,
Digestive, Hematological, Skin, Brain
• Annual estimated cost of $6,400,000 statewide
• Pure estimated annual claims cost of $400 per FF
Call for Action
• Cancer presumption pitfalls for firefighters
• Heart was on the Professional FF Agenda in
2013
• Management enlists resources for ideas to
combat
• Listening sessions result in ideas and a give
and take partnership
Heart Incident Solution
• How did this come about
• Link to the Heart Legislation - CRS 29-5-302
• Cardiac bill signed by Governor June 5, 2014
• What are the benefits
• What is covered
• How is it structured
Benefits
• $4,000 cash award for out-of-pocket expenses upon diagnosis
of covered heart or circulatory malfunction other than
hypertension or angina
• $10,500 cash award where admitted to hospital for less than
48-hours
• $50,000 cash award where admitted to hospital for more than
48-hours
• $250,000 cash award where totally and permanently disabled
• Limited benefits apply for Retraining/Education and Cosmetic
Surgery
Structure or Heart Trust
• Multiple Employer Trust (MET) Used
• Legislation specifically enabled Heart Benefit to be
formed under MET rules
• Public entities in Colorado have a less regulated status
under MET
• Benefits defined in legislation pulled into CFH Trust
Coverage Document www.cfhtrust.com
• Administered by McGriff, Seibels & Williams, Inc.
• State funded due to objection of CML to an unfunded
mandate - labor found funding
How is it working
• Heart coverage left open to competition and self insurance
• 2,881 FF covered in the CFH Trust
• 2 other markets have entered the field – neither fully
complies with the statute
• 5 largest cities self insure
• 13 of 15 claims presented in first 2 years of CFH Trust have
been paid
• CFH Trust makes an initial $4,000 payment within 10 days of
completed claim form
• To date the pure loss cost is $100 per FF
Background Cancer Presumption
for Firefighters
• Presumptive legislation passed in May 2007
• Previously, cancer as a disease was excluded from WC
except where FF could show through a preponderance of
evidence that it was work-related
• New statute put the burden of the “Preponderance of
evidence” on the employer to prove it was not job-related
• Employer allowed to investigate and rebut presumption
• Exposure not consistently maintained by employer in the
past
Issues - Cancer Presumption
for Firefighters
• Investigations take minimum of 30 to 90 days
• WC claims filing rules require a determination within 20
days or a Tentative Notice of Denial, subject to
investigation, must be issued
• FF take the ‘tentative denial’ as a flat out denial and
involve attorneys
• FF report this as a WC claim and then health carrier
refuses to pay leaving employees without either party
paying bills or benefits
Issues - Cancer Presumption
for Firefighters (Continued)
• Bills from medical providers stack up
• Sick leave and vacation time run out
• FF and families are stressed and financially strapped
• WC Administrative Law Judges side with FF over the intent of
Presumption while employers disagree as rubutability is
suppose to be built into the statute
• Complicated cases spend 2-3 years in court
• FF pass away before indemnity or medical bills are paid and/or
compensability decided
• Three cases go to the Supreme Court
Solution for
Cancer Presumption
• Look at the successes within the Cardiac Program
• Look only to fix what is broken without duplication of
other benefits provided elsewhere
• Understanding that no funding would be available as it
was for the cardiac program which made the chances slim
• Management was still eager to close some unintended
consequences with cancer statute
• Gathered data from the CSD Pool and self-insured cities to
do a benefit analysis
Solution for
Cancer Presumption (Continued)
• Benefit analysis showed:
– Moderate cost reduction with anticipation of twice as many claims being accepted
– Limit the liability of employers to 10-years after employment
– Removes cancer from the current inefficient and ineffective WC process
• Employers agree to payout same incurred indemnity amounts as paid
since 2007 plus 50% of incurred legal to all future claimants as a group
• Indemnity and out-of-pocket expenses range from a minimum $4,000 to
a maximum cap of $250,000 with potential future increases
• 10 Cash Award levels upon diagnosis of one of five (5) types of cancer
and five (5) stages within each type
• Multiple Employer Trust owned by employers will administer the new
Program with representation from the professional FF
Solution for
Cancer Presumption (Continued)
• Employers save 50% of the litigation costs
• Employers limit their future liability from FF getting cancer to 10
years after employment
• FF get cash award upon diagnosis with no investigation, no directed
care, and no litigation
• Cash award contemplates the value of what is given up under WC
but does not replace it
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Lifetime medications
Lifetime medical
Permanent Partial Disability awards
Spouse dependent benefit
Death benefit
Incident Structure
for Cancer
• Incident Based Coverage Form developed to:
– Works like an Accident Policy with a cash award to cover a
window of deficiencies between an employer’s current
medical benefit, retirement, short and long term disability,
and post employment medical benefit programs
– Avoid WC directed care for FF
– Avoid invasive investigation
– Avoid time consuming and costly adjudication and
litigation
Concerns
• Many fire operations opt out of Social Security
so a plan for post employment healthcare is
needed
• ObamaCare provides the needed solution but
the program’s fate is not certain
• Provide appropriate value of the specific cancer
healthcare costs into the future
Opportunities
• Cancer Prevention in the Fire Service
• Lung incidents
• Can PTSD follow the same course
• Can solutions for other emergency responders
be included
• Can a new era of Labor and Management
collaboration be built and sustained
Weak Signal
• Entities that opt out of Social Security have a
variety of plans that may or may not have an
equivalent plan for post employment
healthcare
Questions
Thank you!
• Mike Rogers, President - Colorado Professional Fire Fighters
[email protected]
• Don Lombardi, Chief - West Metro Fire Protection District
[email protected]
• Joe DePaepe, Sr. VP - McGriff, Seibels & Williams, Inc.
[email protected]