Nissan North America• Operations include Automotive styling, Engineering,

Manufacturing and distribution, consumer & corporate financing, sales and marketing.

• Primary risk: Manufacturing- High speed repetitive processes– Launched Safety One Program in 2002– Investment in Ergonomics: We understand the ROI

• Focus on Data Driven Analytics

Safety One

FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 as of Feb 29

REC GOAL 28.1 24 17.29 12.4 11.3 7.57 7.24 6.23 6.98 NaN NaN

Rec Rate 29.1 20.19 17.67 12.32 8.9 8.01 8.87 7.58 5.6 7.02 5.21

DART GOAL NaN NaN NaN NaN NaN NaN NaN NaN NaN 4.32 1.7

DART Rate NaN NaN NaN NaN NaN NaN NaN NaN NaN 2.27 1.77

LT GOAL 0 4.7 2.81 1.9 1.8 1.58 1.31 1.12 1.45 1.25 0.49

LT Rate 6.47 4.01 3.82 2.71 1.6 1.44 2.13 1.54 1.25 0.650000000000002

0.57

2.50

7.50

12.50

17.50

22.50

27.50

32.50

NNAS - Safety PerformanceFY2001 - FY2011 (as of 02/29/12)

Rec: -82%FY01-FY11LT: -91%

Since FY2001 Rec: -31%LT: -38%Since FY01

Rec: -12%

LT: -5%Since FY02

Rec: -30%

LT: -29%Since FY03

Rec: -10%

LT: -10%Since FY05

Rec: -28%

LT: -41%Since FY04

Rec: -26%

LT: -19%Since FY08

Rec: -15%

LT: -28%Since FY07

Rec: +11%LT:

+48%Since FY06

Rec: 25%LT: -48%

Since FY09

Rec: -26%

DART: -22% LT: -12%

• Aligned Safety performance as a Key Performance Indicator (KPI) . KPI performance drives Action & Accountability. DART is the primary KPI for Safety.

• Shared responsibility in all layers of line organization• Safety and Ergonomics focus on action driven by analytics

Monthly Tracking/Reporting

Critical Success Factors • Attitude that WC costs are controllable• Thorough assessment of current conditions (SWOT)

– Quantitative • Multivariable analysis of any adverse trends (severity, lost work days)

– Qualitative• Selected quantifiable targets/goal setting• Explored, selected and prioritized fast, free and quantifiable high

payoff solutions• Collaborative execution• Post implementation progress reporting• Continuous improvement mentality beyond incremental gains

Where Does the Money Go?Scripts

Surgery

Lost work days

Shoulders(impact/manage)

20% Conversions

Litigation expenses

Operations

Adjuster severity

Spend on Dr. Hayes?

(how soon are we seeing narcotics prescribed, who is prescribing them, duration?)

(How many workers out w/o surgery)

(Why/prevent?)

(Is there a more effective MD in the area?)

(Who is suing us, at what point, and why?)

(Body movement? Can we profile the costly claims and get in front of them?)

(Accountability practices)

(impact)

(reserve accuracy) Cormobidities

Current Severity TrendsAverage Cost Per Claim Comparison

2006 2007 2007 2008 2008 2009 2009 2010 2010 2011Average Incurred $13,344 $11,678 $10,889 $11,181 $10,797 $7,338 $7,130 $4,466 $3,255 $4,033% Change

Average Paid $12,384 $10,202 $9,769 $10,050 $9,392 $6,095 $4,709 $2,655 $1,413 $1,504% Change

3%

3%

59

-18%

-12%

11

24%

6%

47 35

-32%

23

-35%

-37%

-44%

-12%

3%

-32%-37%

24%

-18%

3%

-35%

-44%

6%

-60%

-40%

-20%

0%

20%

40%

59 Month Comparison 47 Month Comparison 35 Month Comparison 23 Month Comparison 11 Month Comparison

Incurred Paid

PY 2008 PY 2009 PY 2010PY 2007 PY 2011

 Project Charter

  Affiliate: NNA Date Prepared: 6/4/2010 Last Revision Date:

                   

  Project # Project Title Project Type

   Claims Management Strategy FY'10 Medical Management Initiative

   

  Upper-Level Goals:              

 

1. Establish measurable criteria for claim audits.2. Review criteria with stakeholders prior to the audit to ensure expectations are communicated and understood. 3. Complete semiannual file audits and quarterly claim reviews to assess file quality, adherence to claims best practices, progression of claims toward resolution and ultimately performance of Work Comp Third Party Administrator (ESIS).3. Assess areas of high, standard and low performance in handling of Work Comp claims.4. Provide feedback to stakeholders for continuous process improvement.5. Obtain feedback and action plans from stakeholders to improve deficient areas of performance.6. Assess audit tool annually to focus on areas that need improvement to encourage.

 

 

 

  Target (First Metrics)

  Definition Current Value (baseline) Target Value Gap

 

Cumulative audit score calculated after auditing appx 50 WC files

Will have after July audit 85%+ TBD

  Milestones

 

Due Date for Intensive Discussion (VF3) or End of Team Activity Date

(DECIDE I3)

Implementation Start Date(Estimated for DECIDE / Actual for V-FAST) Due Date for Target Achievement

(End of DECIDE Phase E or VF5)

  6/10/2010 10-Jun-10 1-Apr-11

  Preconditions (incl. Physical Scope , budget, 2nd metric etc.)

 

Second measurement will be obtaining a timely response and action plan from TPA 30 days post presentation of audit findings.Implementation of action plan and effectiveness will be gauged at the next 6 month review.

       

       

  Basis for Project Benefit Calculation Estimated Project Benefit   Benefit Categories:

1) Claim Costs2) TPA Service Fee

Period considered for the amount below:  

         

  Benefit Calculation Formula: 1) Claim costs measured by performance year in comparison to previous policy year at same point in time valuation. Values derived from monthly Beecher scorecard.2) Service Fee will be impacted in Yr 2 of contract contingent upon Yr 1 performance and audit scores.

       

         

  Project Approval  Role Company Department Name Signature Date

 Leader Nissan Treasury/Risk Mgmt Jason Bartlett JB  

  Team Members (Includes Financial Validator)

  Company Department Name Role Company Department Name Role

  ESIS   Kim MetzlerAcct Mgr

      

  ESIS   Miles TateManager

      

  CHS   Brad KoehlManager

      

  NNA Medical Mgmt Justin Rhodes

Med Mgmt(Mfg)      

 

  NNA Medical Mgmt Cheryl Shull

Med Mgmt(Non-Mfg)      

 

  Beecher Carlson Claims Janet Warrant

Director Claims

     

 

        

      

        

      

  © 2007 NISSAN MOTOR CO.,LTD. All rights reserved. Form 0701

NISSAN PROGRAM TASK LISTUpdated March 15, 2008

  Task   Task  initiated   completed

  Change to   Missed  task list   deadline

Task # Task Responsible Team

Member

Start Date Target Complete

Actual Complete

Comments

  Data Management Tasks          1 Analysis and Evaluation of Systems including KCRS and

RiskAdvantage, Justin 1/16/2009 4/1/2009   Justin is also in the process of doing a broader

analysis of systems. Although this task may assist him in that larger project, the goal of this analysis is to define current usage, needs, abilities and integration of the systems to ensure that the team is able to effectively utilize these tools now

2 Provide Wish List of system capabilities Carol       Carol will provide an outline of essential system capabilities based on needs and experience with other systems

3 Identify available medical cost containment reports from current systems

Justin        

4 Develop benchmarks and Dashboard Scorecard Janet 12/1/2008 3/2/2009 3/9/2009 To provide a benchmark to measure improvement and compliance with best practices as well as overall program management

5 Review with Nissan Janet 3/9/2009 3/23/2009   Get input from Nissan team for final metrics list6 Develop schedule for metrics reports with ESIS Janet 3/23/2009 4/1/2009    

             

  Communication and Teamwork Tasks          1 Process map both internal communication and external

communications with CHS, ESIS, Nissan and external providers including, roles and responsibilities including on-site and field case management, mail process and documentation

Cheryl S. 1/20/2009      

2 ESIS and CHS to host a "Meet & Greet" Miles & Cheryl F.

1/26/2009      

3 Develop report card and peer review process Janet 1/26/2009 3/23/2009    

4 Complete report card and peer review Janet 3/1/2009 3/28/2009    5            

6            

               Medical Case Management & Cost Containment Tasks          1 Review and revise the Care Management Status Report form Cheryl F.

with team1/26/2009      

2 Obtain access to appropriate protocols and guidelines Carol 2/2/2009      

3 Reconvene Provider Panel Committee to review and credential Providers

Kerry 1/29/2009 3/2/2009    

4 Define Second Opinion, Second Surgical Opinion and IME and develop process and protocols for all three

Cheryl S. 1/26/2009      

5 Provide a list of triggers (red flags) for catastrophic injury management and process for escalation of case for appropriate medical management

Janet 1/26/2009 2/2/2009    

6 Facilitate debrief on Ojomoji claim Janet 2/15/2009 3/2/2009 3/17/2009  

7 Develop audit tool for CHS Medical Management Janet 2/1/2009 2/15/2009 2/16/2009  8 Complete Audit of CHS Medical Management Janet 2/15/2009 3/2/2009 2/20/2009  9 Present Medical Update to team Carol        

10 Establish triggers and process for escalation of claims to and within Nissan and process for handling issues

Janet 2/2/2009 4/1/2009   This is rolled into VTP process map. Provided copies of escalation procedures developed for other clients 03/15/09

               Claims Management & Administration Tasks          1 Provide list of Nissan, CHS and ESIS users Kerry 1/28/2009 1/30/2009 2/6/2009  2 Provide access to Beecher Carlson Extranet David 2/2/2009 2/6/2009 2/11/2009  3 Review Transitional Duty Program with Recommendations Janet 2/2/2008 2/15/2009 2/17/2009  4 Set up Quarterly Claim Review Calendar Janet 2/2/2009 4/1/2009   March and June set up - need to set up

September and December5 Set up Date for follow-up audit Janet 2/2/2009 4/1/2009    

               Project Management Tasks          

Nissan North American, Inc.

2009 Open Items List

Claims - Loss ControlTuesday, January 05, 2010

        Target Completion

Date

Actual Completion

Date

 Subject Item Responsible Start Status / Comments

    Party Date  CLAIMS-LOSS CONTROL

           

2009-2010            

ESIS Dedicated Unit Staffing Update

  Warren, Dove, Bartlett

Ongoing Ongoing

 

ESIS will provide information on a monthly basis and a formal staffing analysis will be completed on a quarterly basis going forward. ESIS is preparing update with target completion 10/15/09.

Monthly Scorecard

 

Grady Ongoing Ongoing - Reports due on 10th of each month

  Closed item for Finalizing Scorecard. Will continue to provide monthly scorecard.

MMSEA - MEDICARE            

2009-2010            

MMSEA for Products Liability

 

Myers 8/3/2009  

 

TMCS has agreed in writing that they will perform work for current program using NGRe as reinsurer. TMCS is working on price for pre 2006 programs with NMIC (Hawaii captive) as insurer. As of 10-6-09 Nissan was waiting for new number. Sompo agreed to report on Products Liability and will have a price within first 2 weeks of January. Waiting to see regarding the Hawaiian captive.

ESIS CONTRACT RENEWAL            2009-2010            

ESIS Renewal Contract wording Barlett, Dove, Warren

1/5/2010 1/31/2010   Review of contract wording. Jason and Janet will discuss prior to negotiations with ESIS.

ESIS Renewal

Agree on renewal terms and Performance Guarantee to provide to Rhonda for Final Negotiation with ESIS

Bartlett, Dove, Warren 7/1/2009 2/15/2010

   

CLAIMS CLOSURE            2009-2010            

ESIS Open Claims   Warren TBD 3/1/2010   First phase of closure project completed during ESIS staffing Analysis. Kim Metzler updated open claims and will be updating on a quarterly basis. 12/01/09 update showed total decrease at $2.1 million

Partnership to Drive Results(strategy maps)

Progress Reporting

Program Period PY10(4/1/10 to 3/31/11)

valued as of

Base Period PY09(4/1/09 to 3/31/10)

valued as of

Base Period PY08(4/1/08 to 3/31/09)

valued as of

Goal % Goal $2/29/12

(23 Months)2/28/11

(23 Months)2/28/10

(23 Months)Variance to

goals2010 variance

to 20092010 variance

to 2008

1 Total claims frequency > $0 885 959 987 -8% -10%

Frequency rate per 100k man hours 3.2 3.4 3.5 -8% -9%

2 Avg employee lag

%of claims w/ employee lag < 1 day 100%

Avg employer lag 3.48 3.81 4.53 -9% -23%

%of claims w/ employer lag < 1 day 48% 32% 38%

3 Total incurred (all claims) $3,952,431 $6,837,944 $10,109,507 -42% -61%

Total paid $2,349,856 $4,515,804 $7,334,089 -48% -68%

4 Payroll per $1000 (payroll/$1000) $774,518 $823,998 $893,775 -6% -13%

Units produced - weighted NNA 1,403,123 1,160,655 1,027,534 21% 37%

Man hours 27,805,746 27,864,989 28,209,390 0% -1%

Incurred % $1000/payroll -10% $7.47 $5.10 $8.30 $11.31 -32% -39% -55%

Incurred /units produced - weighted NNA -10% $5.30 $2.82 $5.89 $9.84 -47% -52% -71%

Incurred / man hours -10% $0.22 $0.14 $0.25 $0.36 -36% -42% -60%

5. Average incurred - all claims 0% $7,130 $4,466 $7,130 $10,243 -37% -37% -56%

Average paid $2,655 $4,709 $7,431 -44% -64%

6 Closed claims 834 891 894 -6% -7%

Incurred closed claims $1,337,964 $2,661,070 $4,140,804 -50% -68%

Avg severity/closed claims $1,604 $2,987 $4,632 -46% -65%

All claims closing ratio 94% 93% 91%

7 Claims coded as indemnity

Lost Time Rate per Unit Produced 7.63 13.53 20.53 -44% -63%

Claims w/ indemnity incurred 159 107 157 211 -32% -49%

Total incurred indemnity $3,579,628 $6,447,904 $9,640,103 -44% -63%

Total paid indemnity $1,996,984 $4,150,919 $6,931,321 -52% -71%

Indemnity as a % of all claims 18% 12% 16% 21%

Average incurred indemnity $33,454 $41,069 $45,688 -19% -27%

Average paid indemnity $18,663 $26,439 $32,850 -29% -43%

8 Indemnity closed claims 61 94 131 -35% -53%

Indemnity closing ratio 62% 57% 60% 62%

Indemnity as a % of total incurred 91% 94% 95%

Open indemnity claims 46 63 80 -27% -43%

Nissan North America23 Month Goals Scorecard Focus On Outcomes for PY10

Knowing precisely where and how

to f ocus to lower y our cost of risk

Medical Management Process

Superior Outcomes

Investigation

Compensability

RTW & Medical ManagementResolution Plan

Case Closure

Establish Standardized Case Management Process

• Injury Reporting – Early employee reporting- day of injury event or within 2 weeks of

symptoms for cumulative trauma injuries– Rapid reporting to ESIS – within 24 hours of Nissan knowledge

• Standardized Investigation and Information – Employee Medical Manager Statement (EMMS)- completed by Nissan

and provided to ESIS and the treating physician prior to first medical examination

– Daily meeting to investigate &plan cases strategically and collaboratively– Incident investigation information package to ESIS & physician– Attending Physician Report – work collaboratively with medical

community to establish required feedback from physician. The goal is to secure standard/consistent medical information for determining work relatedness and to manage the injury and case effectively.

Tools of the Trade

• Process Map• Supervisor Incident Report• Employee/Manager Medical Statement• Daily Incident Reporting• Medical Management Care Map• Compensability Dashboard• Case Management Tracking

Injury Process MapNon-Urgent Work Related Injuries – Reporting Responsibilities Nissan Dallas

Com

pany

D

esig

nate

d

Med

ical

Clin

ic

Em

ploy

ee

Info

rmat

ion

Em

ploy

ee’s

Sup

ervi

sor

Employee reports a complaint of pain or incident/injury to

direct supervisor or other work group manager if direct

supervisor is not available *

Start

Does the employee specifically report the

problem to be work related? Ask!

Refer to their personal physician. Fees are the

responsibility of the employee

Go to WIN Nissan World/Safety and Medical/ Dallas or

WINHR and print Work Related Injury

Investigation form & instructions to

employee and manager

End No

Employee completes the front page (Employee Section) of the Work

Related Injury Investigation form.

Supervisor reviews to ensure form is fully

completed by employee Supervisor must sign for indicating they reviewed.

Yes

** Work Related Injury Investigation Form

Unless emergency care is required, no medical evaluation or care is authorized under workers

comp until the Employee Section is completed by employee and signed by Nissan management.

Send employee to company

designated Clinic with a copy of

completed Employee Section

of Injury Investigation Form & Job Description

Call report into ESIS within 1

business day 1-888-361-5807 24/7 service

*** The physician must identify tasks the

employee can safely perform, specific

restrictions and estimated duration of same (DWC73

Work Status Form)

Provide the employee with a

copy of Work Related Injury Instructions to

Employee

ESIS Adjustor

972.465.7552 / 800.937.7460

Fax #: 800-373-5156

Email: Becky.Clifton@esis.com

ESIS may call the supervisor for incident related and job related

information

Treatment or payment for care

may be negatively impacted if there is

a delay in reporting by employee or

Nissan

Provide Employee’s Job Description to

ESIS

* Employees are expected to report

an injury or complaint of pain the same shift it

occurs

Complete Investigation and email both pages of Injury Investigation Form Safety Mgr. & Medical Management Mgr. &

ESIS Adjustor

Attend assessment

appointment at company

designated clinic

Reviews Employee Section

of Injury Investigation form & job description

**

Assesses and provides initial

treatment if employee agrees

Completes Work Status Report

(DWC 73) Should include

specific restrictions ***

Provides completed DWC

73 copy to employee

Return DWC 73 to supervisor (in person if able)

Go to page 2 Return to

Work

Supervisor Incident Report

1st Step: On-line system designed to document facts• Supervisor completes by the end of the

shift the incident or injury is reported• Capture worker’s account of the event• Description of incident by Supervisor• Initiate investigation & determine root

cause of incident: 5 whys• Initiates interim safety countermeasures

Provides:• Notification to management, Safety and

Medical Management• Establishes accountability• Feeds reporting database

Employee/Manager Medical Statement

2nd Step: Designed to document & tie the incident & injury symptoms to medical management

• Capture worker’s account of the event in writing and signed by EE

• Identify manager’s concerns• Verify EMMS with recorded

statement (gap analysis)• Meet face to face with employee if

there are discrepancies

Daily Incident Reporting

On-site team of experts collaborate to review incidents in daily 11:00 meeting:• Safety – Safety & Ergonomics Job Review to determine root cause and help

with corrective measures on the floor with manufacturing• Medical Management : CHS– Medical Job Review, determine causation• ESIS – Compensability and defense issues addressed, plan strategically

Medical Management Care Map

• Establish evidence based medicine expectations at the outset with all stakeholders. Based on ODG guidelines. Establishes accountability !

• Focuses on worker’s functional capabilities and successful progression through treatment gateways.

• Weekly case management meetings to identify variances to care plan and develop action plans to mitigate the same, using the Case Management Dashboard.

Compensability Dashboard

• Facilitate timely exchange of information between Safety, Medical and TPA.• Vet compensability concerns from each perspective.• Make the correct decision at the outset.

Case Management Dashboard

• Used by Medical Management to track and report progress of cases• Presented in Case Management weekly meeting for discussion• Quick visual management, we only discuss yellow and red cases• Focuses on barriers to progression and solutions/actions to be taken

Physician Performance

102

51

121

0

27

101

16

83

122

52

35

64

0

68

11

0

2217

0

20

40

60

80

100

120

140

160

180

200

Sundaram, Mani Geissler, William Geissler, William Katz, Howard Vohra, Rahul Sundaram, Mani

HAND ELBOW SURGERY ORTHOPEDIC SURGERY ORTHOPEDICS PHYSIATRY PHYSIATRY PLASTIC SURGERY

Average LOA by Physican - Canton Plant2008 2009 2010

10295

134

144

130

145

137

76

92

78

103

91

151

105

0

61

11

0

14

0

27

0

20

40

60

80

100

120

140

160

180

200

Coogan, Philip Joyner, Kyle S Weikert, Doug Berkman, Richard Garside, Blake Kioschos, Michael Steinagle, Timothy J

HAND ELBOW SURGERY

HAND ELBOW SURGERY

HAND ELBOW SURGERY

NEURO SURGERY ORTHOPEDICS ORTHOPEDICS ORTHOPEDICS

Average LOA by Physican - Smyrna Plant2008 2009 2010

0

20

40

60

80

100

120

Fiscal Year Comparison - Canton Referrals

FY 2010 FY 2009 FY 2008

0

20

40

60

80

100

120

Fiscal Year Comparison - Smyrna Referrals

FY 2010 FY 2009 FY 2008

Restricted Duty ImpactTTD COST AVOIDANCE

$1,423,854

$1,618,808

$1,078,680

$695,433

$-

$200,000

$400,000

$600,000

$800,000

$1,000,000

$1,200,000

$1,400,000

$1,600,000

$1,800,000

2006 2007 2008 2009

$4.8m Cost Avoidance2006 - 2009

Workers’ Compensation

• Realized $4.8m cost avoidance in Workers’ Compensation Program costs

• Favorably impacts loss pick forecasts used for Global Captive Funding

• Favorably impacts ACE stop loss premiums

Safety Performance

• Favorably impacts Safety KPIs and OSHA reporting requirements

• Improves Safety LT rate by 51%

• Improves Decherd LT rate by 17%

Plant GoalReported

LT Rate as of 1/31

Adj LT Rate

ALTIMA 2.89 2.43 5.41BODY ASSY 1.25 1.33 2.12PAINT 0.68 0.98 1.72PQ 0.50 0.71 1.07SCM 0.70 0.00 0.61STAMPING 1.31 0.48 0.95TRIM 2.55 1.66 3.56

Smyrna 1.45 1.14 2.35

Decherd 1.84 1.60 1.92

Reduce Lost Work Days

• Baseline:– 2007 to 2009: average 129 days for all lost time claims– Varying placement mobility from plant to plant– Majority of 90 day restriction being used prior to surgery

• Goal: Reduce average lost work days– Lost time rate– Duration of disability

• Solution:– Performance analytics– Performance incentives for operations– Treating MD’s no longer determines return to work status– Non surgical stay at work– Transitional job banks– Disability management plans/care mapping

Claim Management

Surgeon Utilization

1

29

10

15

2

10

3 3

0

5

10

15

20

25

30

35

GENERAL SURGERY HAND ELBOW SURGERY NEURO SURGERY ORTHOPEDIC SURGERY

Total NNA - Physician for FY09 & FY10 (as of 12/31)

FY2009 (as of 12/31/2009) FY2010 (as of 12/31/2010)

Surgeries by Site

8

3

19

7

2

12

0

2

4

6

8

10

12

14

16

18

20

Nissan Canton Nissan Decherd Nissan Smyrna

Surgical Cases by Site for FY09 & FY10 (as of 12/31)Surgery - FY2009 Surgery - FY2010

$0

$5,000

$10,000

$15,000

$20,000

$25,000

2004 2005 2006 2007 2008 2009 2010 2011Year

Initial Loss Projection Current Loss Projection

$22.5M/39% Reduction to Loss Rates

In $000s

Increase in severity

Continuous Improvement