HomeMy WebLinkAbout07 WORKERS COMP. 10-15-01AGENDA REPORT
MEETING DATE'
OCTOBER 15, 2001
TO:
WILLIAM A. HUSTON, CITY MANAGER
FROM'
HUMAN RESOURCES DEPARTMENT
520-90
NO. 7
10-15-01
SUBJECT:
WORKERS' COMPENSATION SELF INSURERS ANNUAL REPORT
RECOMMENDATION' RECEIVE AND FILE
FISCAL IMPACT: NONE
BACKGROUND AND DISCUSSION'
Each year the City is required to file an annual report with the State of California
Department of Industrial Relations Self Insurance Plans Division because we are self
insured for purposes of Workers' Compensation,. The report provides information on the
number of claims opened and closed, the incurred liability, amounts paid to date and
anticipated future liability. The report also provides information on our third party
administrator (Hazelrigg Risk Management Services, Inc), records storage, excess
insurance cover.age, and the methodology for funding of our program.
Pursuant to Labor Code Section 3702.6 (b) each public self insurer is required to advise its
governing board within 90 days after submission of the Self Insurers Annual Report of the
total liabilities reported and that the current funding of such liabilities is in compliance with
the requirements of Government Accounting Standards Board (GASB) Publication 10.
In compliance with this requirement, attached is a copy of the annual report (absent
confidential individual claim detail) filed with .the State on September 27, 2001. Further, as
required, the funding of the liabilities is in compliance with GASB requirements.
Arlene Marks, SPHR
Director of Human Resources
Attachment:
Public Self Insurer's Annual Report for Non-JPA Member Fiscal Year
Ending June 30, 2'001
S:\City Council Agenda Items\Staff Report Workers' Compensation self ins.doc
of Tustin No: 95-6000804
300 Centennial Way
~DRES~ OF MAIN HEADQUARTERS
Tustin, CA '~:~:." 92.780
-~i-~~+~ ---=
4. TYPE OF PUBLIC AGENCY: CITY
'.
~o
~o
~o
6 .. ~ THE~ ~ AG~CY EMPLOYEES ~ INCLUDED IN YOUR WOOERS' COMP~SATION
SELF INSU~CE PREGO?
....
~ ~'HESE E~4PLOYEES COVERED BY AN INSURANCE POLICY? ~ Yes ~ No
~ THESE EMPLOYES CO~D BY ~OTHER SELF ZNSU~CE CERT. OR JPA? ~ Yes ~ No
7. TO ~OM ~ YOU ~ CO~SPO~~E ~D~SSED?
.
Tustln, CA'~
TELEPHONE (714) 573-3040 FASCIMILE (F~) ~ER .(~1.4) 832-6382
-- {,~ .
.
8. CERTIF-IC~TION BY AG~CY OFFICIO:
I declare ~er ~he penalty of p~rju~ that I have ex~ined ~His Self InsUrer's
~ual Report '~ to the best of my ~owledge ~d belief it is t~e, correct and
complete. ~ ~
Signature: ~.. Date: 9/27/01
Typed Name:
Agency Name:
Street 'Address:
Tustin
City:
...... c~i~m Si~,ituro
Arlene Marks
City of Tustin
300' Centenni al Way
CA 92780
Telephone: ( 714)_ 573
3052
State' ZIP+4:
Fax: (_714__)
832
6382
Annual Report is Due October 1, 2001
Form A4-40b (4~92)
Page 2
Fiscal Year lending: June 30, 2001
II.CONSOLIDATED LIABILITES
.... ' ~L ' L t L ...... ' .' ..... -- ' - --- -- ____ - .... ' J ...... ILl _ -- , .........__~1 ........... -' '___ _'-'-' ' ' _ .... '
·
Certificate Number: ~- ! 7 I 1 [ ~-I ~1- L!_L!J - I' x'l 6'1 4"'1
Name of Master Certificate Holder: City of Tusfin
Type of Report:
[~] Original Report (Due October 1 each year)
O Inte~Amended Report for the Period of.'
I 0.1 ?'10 [-x ! 0 ['0"! lol6-1310lol~[
Month Day Year to Month Day Year
-A. CASES AND BENEFITS"(t°'nearest dollar)' '~ ] ......
....... incurred Li'/ibility ...... Paid to-Date --' .F. uture...Liabiij/y
Number. $Indemnity .... $ Medi~ai' $ Indemnity "' $ Medical $ Indemnity $'Medical
l.'"Cases open .....................
as of 6/30/2001
reported prior 11 253,039 548,312 248,422 406,006 4,617 142,306
to FY 1996-97
'2. Opei~'& Ciosed'-~ases: ~ . '
Total cases 54 157,039 57,913 157,039 57,913
reported 0 0
es"FY1'996-97 · , ..............
open 0 . 0 0 0 0~~
b. FY 1997-98
Total cases 43 261,714 107,205 252,309 106,121
reported__. _ 9,405 1,084
I'VYi!~9~'98 ' e. w cases ~ 998-99 open I 77,377 66,200 67,972 65,116 ~~ .
Total cases 51 159,957 151,094 I39,642 125,105
reported I' .. 20,315 25,989
FY 1998-99 4 85,865 105,519 65,550 77,530 ll
d. FY 1999-2000
Total cases 38 104,368 103,919 91,271 45,748
reported ~. . ....... 13,097 58,171
FY 6 103,650 86,500 90,553 28,329
1999-2ooo
Cases open , l
e. FY 2000-200-1'----
Total cases 31 38,690 52,876 28,789 24,067
reported 9,901 28,809
I FY 2ooo-9-om 12 38,690 ....... 44,250 28,789 15,441
Cases open .
$ Medical
SUBTOTAL .- ......... 57,3'35 256,359
3. ESTIMATED FUTURE LIABILITY (Indemnity plus Medical) TOTAL .... 3 13,694
$ Indemni~.... I $ Medical
100,741
4. Total Benefits paid during FY 2000-2001 (include all case expenditures): ........................
.....
5. Number of Medical-ONLY cases reported in FY 2000;2001: ....................................
6. Number of INDEMNITY cases report in FY 2000-2001: .......................................
26
7. TOTAL of 5 and 6 (also enter in 2e above):; ............................................ ' ..... 31
8. TOTAL number of open indemnity cases (ali years): ........................................... 25
9. Number of Fatality cases reported in FY 2000-2001: .......................................... 0
10. (a) Number of FY 2000-2001 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 200-2001: ............... 1
(b) Number of non-FY 2000-2001 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 2000-2001: .............. 0
B. TOTAL EMPLOYMENT AND WAGES PAID IN FISCAL YEAR 2000-2001 FOR THIS' SELF INSURER:
(a) NUMBER. OF EMPLOYEES 3'25
(Number of individual employees listed on Form DE-6 for year ending June 30, 2001)
Co) TOTAL WAGES AND sALARIES PAID $ 15.754..O0.q..Oa ..
(As reported on EDD Form DE-6 Line M for all fou~ quarters)
Claims ~dminlztrntor l~lsonl ¥oar ~ndlns Juno
OR
for
Pod~
o[~
incur~d Llat~lllt~ Paid to l~ata
' ..'--.---'-'-- _ __ .. _ ._ _ : .... . .... :~,~ ........ ,, , ,,
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~o~ 1~ .......... . .......... . ............... . ...........
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SHBTOT~ ..... ~ ,,. -
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3. ~~TED ~TU~ L~B~ITY ~nde~ plus M~mD TOT~
!
4. Total Benefits paid during ,[ ....
5. Number of MEDICAL-ONLY cases reported in FY 2000-2001: ..................... - -
6. Number of INDEMNITY cases reported in FY 2000-2001: ........................
7. TOTAL of 5 and 6 (also enter in 2e above): ...................... ' ....................
8. TOTAL number of open indemnity cases (all years): ...............................
9. Number of Fatality cases reported in FY ,2000-2001': ........................
10. (a) Number of FY 2000-2001 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 2000-2001: ....
(b) Number of non-FY 2000-2001 claims for which the employer or administrator was
notified of representation by an attorney or legal representative in FY 2000-2001: ....
Addt~..
.
.
~hone ...... .......... _ :---_.:__, : .......
Agency
.
Add.ss ~ _
CI~ ._- .......................... S~ ~~p~ ..... .
Phone ~---_.. _. __- :) .............. __._-_ _ ...................
City ::--: :-::___. _. :..:: _.:.:..=_...::.. State ___ ZIp+4 .
Phone _& ....... ~ ....
..... --- :-:: :-- -'=----' ---,,_, ,,.,._,._.__.__.. , :: -- _ ~,_,,,_,r.~,
D. Agency Nome =~.-~ ......... .. :_:___ ...... _.- =_-- _ _-_
Address .-_. ..... __. , _, ___. .... _ ................
Cie7 =---'-- - ............... .__..-__-- State .---.Zip+4
:Phone :_ .... ) ......: ......
...... ~. INSURANCE COVERAGE
___--~ ..... , _, __, _,,_ ..... ._ .... _._._ ......... _ : . .~ _ ._ .... =.=:-.._ __. _ ..,_,,... : . . .._ _ __. .............. . _,_- ..... .~.,__.
A~ any Of your workern' compensation liabilities in Cnitt~t*nla during tho r~porting period .....
covered by. a standard Workers' compensation Insurance policy?
1. Name of Insurance Company: ~ . ' ..... _ ........ _ .........................
Policy Number: ..... _ __._ ......
-,,'- .............. Policy Issue Dat~:
2. Name of Immurance Company: ................
...... : . - , .......
Policy Number: -- : ............... Policy Issue Date:
Are any of your workers' compemntton HnbHltles in California during the reporting period
covered by a spedfie excess workers' compensation Insurance policy?
1. Name of Carrier: _ Employer's Reinsurance
Policy Number: 0631197
- Policy Issue Date: __ .May 1 ~ 1999
, ,
Retention Limit: $27F;: flQt') .....
,,
2. Name of Carrier:
Policy Number: .......
Retention Limit: ,
,
Policy Issue Date:
3. Do you carry an aggregate (stop loss) workers' compensation insurance policy?
1. Name of Carrier: .
Policy Number: ... ~. Policy Issue Date:
Retention Limit: , ,
2. Name of Carrier:
,
Policy Number:
, . Policy Issue Date:
Retention Limit: __
VI. OPEN INDEMNITY CLAIMS
] IJILII I I _ I Illllll - . I · .. Il , ,mi Il I __
A. List of ALL Open Indemnity Claims bY reoorting location and bv year repo~t,e~ and with claims ~o~alohab.cticai
order is attached immediately following page 6'of this report.
(You may use the form attached or a computer-prepared printout organized in thesame format.)
Page 5
. - Fiscal Year l~udlng June 30, 2001
.
..
.......................... -'--- --ff .... ' .... /ur-' c-- - _/- y_ _-w_"~___- - :__ :--y_.,: ~: _- ,-.-. -, ._- "_'_'n_~""m-~ '~u _ .'_--,,,-_ · f_ - ._._ ..... .__'.---.
Name of Certificate Holder: C i tyo f Tus t i n ·
...... :u.: - h-_--. --_ .... _-: ...... '-.~--~- ......... L ...... -~-- m ,._,., ,-_- ,: ,.:,_ ............ ' ...... -_. .... : .......... __., _. _ .... z..: _._ _._
1. Which of the following bos[describos tho method your agency uses to fund the outstanding workers' compensation liabilities?
~] Actuarial Basis
,
D Cash Fqow B~is '
,
D Plxmd Amount i~ ~mnoy Dud~o~ount 1~I $ .-_: ..... .~...- -.~_- _-- -_-_ . . ~-- __ _'_ _..:._ ........ :~., .._..__ .__ ~..~.. :; :. .... ..~ .......
D Pore~ntngt~ Above Lemt ~/'ear's Lonnos,-,Porconm~e i~t ' ...:_. -.:. ~-=.~_=__::_ :1._..._._..._._.=~.:.._ __.._._._.__. ..... _~,
· ,,,,Total Amount Available is; $ ........ __:__ :. ...... _ .... _~_._ ........ _... ...... , ._. ~._
[~] Al~emoy Doea 1~o~ Pund W'ork~rn' Compensation Llablllttea
.-.:_ ~--_. ,,._,_~,~._...: .... __-:__ . :_..~. _._._.. _~ .--:u~ .... ?_.~...:: ..._ _._.._... :...._.._.. _,.____,_ ....
Does your asency fund for lnourred but not reported work~r~' compensation claims In addition to known or
reported olatms?
[~] Yes [~ N'c/ Ifyes, Amount: $ '_551 ,.5..99'. ............. . ........ _ .....
·
3, Is the workers' compensation funding res, tricted or set aside solely to pay the agency's' workers' compensation liabilities?
[~] Yes . [~]No ' ,
If yes, what was the amount set aside as of ,uno 30, 20017 $
·
4. ~)oes your agency have an outside, independent claims auditor review your case reserve practices and general
· claims management?
['~ Yes [~] No
If yes, what was the date of the last such audit?
As part of JPA
5. Does your agency have an outside, independent actuary to review future liability funding?
,
[]No
Ifyes, what was the date of the last such review? Apri 1,, 18, 2001