Pinnacol Assurance
Alumni Newsletter
November 2009
Most Food, Most Countries Represented at Around the World Food Festival
Employees and alumni enjoyed a cultural smorgasbord at Pinnacol's 2009 Around the World Food Festival. Nearly 30 countries were represented, ranging from Mexico to Slovakia. In fact, this year's festival had the most food prepared by employees and the most countries represented since the first festival in 2006."The employee-made food was absolutely wonderful this year!" said Telly Weddon, application services team. "I'm not the only one who thinks so, my entire team agrees the food was just excellent!"
The Around the World Food Festival is an opportunity to celebrate diversity in the workplace and learn more about the different countries and cultures represented at Pinnacol. This event was sponsored by the Diversity Task Force and Employee Activities Committee.
Pinnacol Transitions to New Claims Model
During the last several months, Pinnacol Assurance has been evaluating the way we service claims. In recent years, we’ve moved from a non-specialized claims model -- in which claims representatives (CRs) handled claims from start to finish -- to a specialized model -- in which one CR would investigate and then admit or deny the claim, and another would take the claim from admission through resolution. After a comprehensive evaluation process, Pinnacol has decided that a single model makes the most sense for the company. Beginning in early 2010, we will transition all of our business teams to a non-specialized claims model that incorporates some of the best practices from our specialized model.
The change is expected to provide policyholders with a consistent experience as they interact across teams. Having only a single model to support will also allow for staffing flexibility and align resources more precisely across the organization. The move is part of Pinnacol’s continued commitment to operating efficiently, effectively, and with a focus on the needs of our policyholders and injured workers.
Alumni Employee Referral Program
Our company’s employee referral program is highly successful at attracting candidates who otherwise remain unaware of openings at Pinnacol. Based on the premise of “who better knows what it takes to be a good employee than an alumni or current employee,” you will receive a $200 alumni referral award for each candidate we hire that you referred to Pinnacol!
If you know someone you think would be a strong addition to Pinnacol team, have the candidate complete an expression of interest via the "Careers" section of www.pinnacol.com. The system will allow the candidate to attach (or copy and paste) a cover letter and resume as well as gather additional information we will need to fully review the candidate’s qualifications regarding currently open positions. The system will ask how the candidate heard about Pinnacol, so remind the candidate to mention you by name when completing the form.
Free Covered Parking
Our Colorado weather has definitely been unpredictable lately! As a reminder, alumni who are working temporary assignments at Pinnacol receive free covered parking. We appreciate your help in coming back to cover desks while people are on leave or while positions are being filled, so be sure that you participate in this benefit!
Pinnacol Recognized by AARP as a National Top Employer
For the fifth consecutive year, Pinnacol has been recognized nationally as one of America’s “Best Employers for Workers Over 50.” Pinnacol placed 15th on the list of 50 companies nationwide and is the only Colorado company to receive the distinction.
“We are honored that AARP has once again recognized Pinnacol for the work environment we have created for our mature employees,” said Ken Ross, president and CEO of Pinnacol Assurance. “We strive to create the very best working environment at Pinnacol — one that is based on dignity and mutual respect. These values not only to apply to our employees, but also reflect how we treat our policyholders, injured workers and their families.”
AARP, the nation’s largest non-profit membership organization for people age 50 and over, recognized Pinnacol as an employer that offers progressive workplace policies and benefits to meet the needs of an increasingly older workforce. Pinnacol — along with the other recipients of this distinction — has demonstrated exemplary practices with regard to recruitment, retention and promotion of older workers.
A generous paid-time-off bank, flexible scheduling options — including compressed workweeks and telecommuting — and a variety of on-site training and certification programs are among the benefits that appeal to Pinnacol’s mature employees. Additionally, the company matches a portion of employees’ contributions to its 401(k) plan, allowing older workers to accelerate their retirement savings. Pinnacol pays the major portion of medical, dental and vision insurance premiums for eligible employees and contributes a portion of the premium cost for dependent coverage as well.
“Mature workers bring vital experience and knowledge to our workforce. This demographic makes up more than 25 percent of our staff and their average tenure is nine years,” said Carole Sumption, Pinnacol’s vice president of human resources and corporate services. “In 2008, 16 percent of our new employees were 50 or older. Pinnacol is committed to creating an environment that attracts and retains those who want to remain in the labor force longer.”
Alumni Event in 2010
We were very pleased to see so many alumni in attendance at Pinnacol’s first-ever alumni event in late September 2008. We are planning to hold another alumni event in 2010. If you have any suggestions or if you would like to help plan this event, please send an e-mail to: cecelia.muir@pinacol.com.
Legislative Update
The Interim Committee to Study Issues Related to Pinnacol Assurance recommended seven bills for introduction during the 2010 legislative session, which begins on January 13.
The Pinnacol Assurance Board of Directors has voted to support two and oppose five of the bills recommended by the Interim Committee Studying Issues Related to Pinnacol Assurance. The announcement was made by Gary Johnson, Pinnacol’s board chair.
The board will support the Workers’ Compensation Accountability bill (Bill A) from Sen. Mary Hodge (D-Brighton) and the Workers’ Compensation Claims Process Brochure bill (Bill G) from Rep. Joe Miklosi (D - Denver). The board is opposed to the remaining five bills on substantive grounds and noted that many are beyond the scope of the legal limitations imposed by SB281 because they impact the entire workers’ compensation industry.
Johnson said, “The board believes bills B, C, D, E and F present significant roadblocks to Pinnacol’s future success. These bills have the potential to drive up workers’ compensation costs in Colorado and others are redundant, as well as an inappropriate intrusion of the legislature into the operations of a company that, by statute, is directed to operate as a mutual insurance company.”
Johnson noted that the Pinnacol board is especially concerned about Rep. Su Ryden’s (D-Aurora) bill, the Workers’ Compensation Policyholder Protection Act of 2010 and a bill from Rep. Miklosi concerning the Pinnacol Board of Directors.
The provisions in Ryden’s bill that limit Pinnacol’s surplus to 800 percent of risk-based capital (RBC) and require the company to issue dividends hinder Pinnacol’s ability to be effective in the marketplace. The percentage of RBC written in the bill is arbitrary and there is no such RBC standard in the workers’ compensation industry.
“This bill is dangerous,” said Johnson. “The board, which is appointed by the governor and confirmed by the senate, is charged with making decisions regarding rates, surplus levels and dividends and this bill inappropriately limits our authority. It also limits our ability to market conditions. Pinnacol has issued a general dividend for the past five years, returning nearly $350 million to Colorado businesses.”
Johnson stated that Miklosi’s bill is not needed because the current board structure is working well. The board is concerned with language that adds two non-management employees to the group. Pinnacol is a multi-billion dollar company and board members need experience and expertise in order to make critical business decisions. The board is also concerned that adding the Executive Director of the Colorado Department of Labor and Employment (CDLE) creates a potential conflict of interest as the CDLE oversees workers’ compensation.
“The bill is a back door attempt to make Pinnacol a state agency by imposing a public testimony provision,” added Johnson. “Stakeholders with concerns have access to Pinnacol board members and to management through other means and Pinnacol is already subject to open meeting laws. This bill does nothing to further the transparency of Pinnacol’s operations. The company already has more oversight by state regulators and legislators than any other insurance company in Colorado.”
*Note: For the full text of the proposed bills, please go to www.pinnacol.com/2009-legislation and click on “2010 Legislation.” In addition, Pinnacol has developed the Legislative Action Network (LAN), an easy and convenient way to contact your state representatives. LAN members will receive regular e-mail alerts about legislative issues, and the LAN makes it easy for members to e-mail lawmakers about bills regarding Pinnacol and the workers' compensation system. To register for the LAN, go to www.pinnacol.com and click on the “Join Now” link under Legislative Action Network.
Thank You, Alumni!
We would like to thank the many Pinnacol alumni who have come back to work temporary assignments and/or returned to fill regular full-time or part-time positions. In 2009, the following 16 alumni worked temporary assignments for us:
• Charlotte Artman
• Sharon Barath
• Ross Bensman
• John Blood
• Joan Bruxvoort
• Sandra Dills
• Charlie Doggett
• Francine Gingrich
Our alumni are professionals who are trained in Pinnacol’s business standards and technology. They’ve been a great resource to us by covering desks while employees are on leave or by helping out while new employees get up to speed. In addition, alumni have worked on special projects such as the dividend check project.
Team leaders are often very flexible with alumni work schedules, as they prefer having an alumni help them with an assignment to working with a temporary agency. If you are a retired alumni working for Pinnacol, the company will pay into PERA on your behalf, but you will not pay into PERA. In addition, all returning alumni who are working temporary assignments receive free covered parking.
Please contact Lucinda Flores at 303-361-4966 if you are interested in returning to work at Pinnacol on a temporary or regular basis.
SIU Corner
Plumber Found Working While Receiving Benefits
In this case, the injured worker was employed as a plumber for a Pinnacol policyholder (a plumbing and heating company). The injured worker fell off a ladder at work and suffered a knee injury. The examining physician stated that the injured worker was unable to return to work, and the worker began receiving temporary total disability (TTD) benefits.
Later medical examinations revealed that the injured worker had also sustained a hip injury in the accident. He received surgery for this injury and was unable to return to work; subsequently, TTD benefits continued.
The Investigation
The Pinnacol claims representative on the claim became concerned that the injured worker was missing medical appointments and that mail sent to him was being returned. The claims representative contacted Pinnacol's special investigations unit (SIU) to request surveillance be performed on the injured worker. An outside surveillance firm was hired; surveillance showed the injured worker being picked up in the afternoon outside a hot water heat service company.
An SIU investigator then interviewed the injured worker, who denied working while receiving benefits. The injured worker completed two forms at the investigator's request:
• A return-to-work form, which asks injured workers to declare whether or not they have been working or earned income. On the form, the injured worker declared he had not been working.
• An employment records release form, which authorizes Pinnacol to obtain any records pertaining to an injured worker's possible employment or income.
The following day, the investigator visited the hot water heat service company in question and found the injured worker sitting in an office chair next to a desk. The injured worker said that he was answering the phone for the owner of the company – a "friend" – who was out of town.
Four days later, the investigator interviewed the company owner, who stated that the injured worker did work for the company as a subcontractor. The owner also produced records showing that the injured worker had received 13 checks from the company – totaling more than $6,000 – while receiving TTD benefits from Pinnacol.
The Outcome
Charges were filed against the injured worker, who eventually pled guilty to theft. He was sentenced to four years in a community-based intensive supervision program and ordered to pay more than $9,500 in restitution to Pinnacol.
Taken from Inside Pinnacol, September 2009
Case Law Update
COMPENSABILITY; UNEXPLAINED FALL; SPECIAL HAZARD
Almeda v. La Farge Construction, Inc., W.C. No. 4-774-216 (ICAO, 9/14/09) (Mottram): Claimant was a machinery operator for employer. October 1, 2008, claimant was found by a co-worker on his back on the ground next to a roller that he had been operating. While operating the roller claimant was at least five feet off the ground. Claimant sustained a concussion as a result of hitting his head against the ground. The ALJ found that although claimant’s initial loss of consciousness was not related to his employment, the roller constituted a special hazard of employment, and claimant’s unwitnessed fall and injury were compensable.
ICAO affirmed. ICAO acknowledged that there is no presumption that an employee found injured on the employer’s premises is injured from something arising out of the employment. Where a preexisting idiopathic condition causes a claimant to fall, the injury does not arise out of the employment unless the claimant proves a causal connection between the employment and the fall. A completely unexplained fall is not compensable. Where a claimant’s fall at work is precipitated by a preexisting physical infirmity which is unrelated to the employment, the resulting injury is not compensable unless a special hazard of employment elevates the risk of injury or increases the seriousness of the injury sustained. ICAO held that substantial evidence in the record supported the ALJ’s findings that claimant fell from the roller and that the roller constituted a special hazard of employment.
TEMPORARY DISABILITY BENEFITS; ECONOMIC CONDITIONS
Gaitan v. Pita Subway, W.C. No. 4-726-194 (lCAO, 8/26/09) (Henk): Claimant sustained an admitted left shoulder injury in a slip and fall on April 21, 2007. Claimant received temporary total disability (TTD) benefits from April 22, 2007 through May 1, 2007. Claimant continued to have restrictions, but returned to work on May 2, 2007. Due to economic circumstances, claimant only worked 1-2 days per week. Prior to her injury she worked 4-5 days per week. At hearing, respondents asserted that claimant's temporary wage loss after May 2, 2007 was caused by economic conditions unrelated to her employment. The ALJ rejected this argument and awarded temporary partial disability (TPD) benefits from May 2, 2007 through the present.
ICAO affirmed. ICAO held that a claimant is not required to mitigate economic losses, such as by seeking new employment. Loss of employment because of economic circumstances is not the responsibility of the employee, and does not sever the causal connection between an injury and any subsequent wage loss. ICAO concluded that because claimant continued to have work restrictions following her return to work, a causal link between the industrial injury and the subsequent wage loss was maintained and TPD benefits were properly awarded. Also, ICAO held the fact that claimant did not treat with the ATP during the period of time the ALJ awarded TPD benefits did not preclude such award. TPD benefits must continue until occurrence of one of the events listed in C.R.S. § 8-42-106(2).
Note: The information contained in this Case Law Update does not convey legal advice of any kind. Please consult with an attorney for application of the law to the specific facts of the case.
