Your Foreign-Born Workers Essential Advice on Work Safety

Your Foreign-Born Workers Essential Advice on Work Safety and Health TA 007 Recording of this session via any media type is strictly prohibited. Page 1

Moderator • Directs the Medical Department at Broadspire • The department produces clinical guidelines and criteria that support sound medical claim and case management practices • Participates in analysis, reporting and benchmarking of outcomes and quality improvement initiatives JACOB LAZAROVIC, MD SVP, Chief Medical Officer Broadspire • Develops educational and training programs that update the clinical knowledge and skills of claim professionals and nurses • Provides expertise that enhances the medical bill review process • Operates a comprehensive and unique in-house physician review (peer review) service Recording of this session via any media type is strictly prohibited. Page 2

Speaker • Journalist and consultant in the field of risk, with a special focus on work injuries • Award-winning author of more than 200 articles on many aspects of workers compensation, and often writes on immigration and work in the United States PETER ROUSMANIERE Journalist, Author co-author with Broadspire and Concentra, Work Safe: An Employers Guide to Safety and Health in a Diversified Workforce • Former columnist with Risk & Insurance magazine. Now writes for Work. Comp. Central • Holds a BA and MBA from Harvard Business School • Resides in Woodstock, Vermont, a picturesque New England village Recording of this session via any media type is strictly prohibited. Page 3

Speaker CHARLES DANIELS Director, Environmental Health and Safety (EH&S) Bolthouse Farms Managing Director Comprehensive Safety Professionals, LLC • Proven success in controlling risk in a variety of working environments, ranging from news paper printing and distribution, television data gathering and distribution to agriculture operations, food manufacturing and distribution, to retail sales and distribution as well as achievement in controlling risk factors through behavior based safety, loss prevention and security process implementation. • Owner and Principle Operator of Comprehensive Safety Professionals, LLC. • Realized tremendous success in current role at Bolthouse Farms, in identifying loss generators and controlling loss sources Recording of this session via any media type is strictly prohibited. Page 4

Why Diverse Worker ES&H? • Broadspire continuously strives to develop programs, strategies and thought leadership that ultimately reduces risk and improves outcomes. • We identified large numbers of claims associated with diverse workers. • We asked ourselves, how do we best reduce the number of work injuries and ensure timely return-to-work for a huge and extremely diversified, foreign-born workforce that largely has low English proficiency and fewer skills in navigating our health system? Recording of this session via any media type is strictly prohibited. Page 5

Why Diverse Worker ES&H? • Employers need better guidance and support to make foreign-born workers safer and healthier • Engaged with renowned subject matter and thought leader on work injuries, Peter Rousmaniere. • Partnered with Concentra, a leading provider of health care services • Through conversations with several hundred individuals, from medical professionals to claims adjusters, safety experts, lawyers, immigrant labor activists, translators, and others, captured the most essential and beneficial expert advice • Developed an easy-to-read resource for employers on strategies and resources to reduce risk Recording of this session via any media type is strictly prohibited. Page 6

In the guide: • • • Safety First Workers Compensation Medical Care Across Cultures Translate This! Free Online Resources Recording of this session via any media type is strictly prohibited. Page 7

Work Safe An Employers Guide To Safety And Health in a Diverse Workforce • Offers employers real-world guidance on establishing healthcare resources and proper safety practices for a culturally diverse workforce. • Developed by acclaimed author Peter Rousmaniere • Co-developed by Broadspire® and Concentra as an additional tool to employers and brokers in advancing the productivity of their business. • Launched at the National Workers’ Compensation and Disability Conference® and Expo in Las Vegas – November 21, 2013 Recording of this session via any media type is strictly prohibited. Page 8

What to Expect You will learn: • Why safety and health in immigrant and diverse workforces require special attention. • What professional bodies and governments expect from employers. • Special techniques for safety, medical and claims personnel. All attendees will receive a copy of Work Safe while supplies last. Recording of this session via any media type is strictly prohibited. Page 9

Immigration Situation in the US Recording of this session via any media type is strictly prohibited. Page 10

Immigration Situation in the US • 2011: 25. 3 MM foreign-born workers in the US • 1990 -2012 US immigrant population grows to 12 percent, concentrations in Calif. , Texas, and NY. • Foreign-born workers more concentrated in working ages and relatively small share of children. • 75 percent of immigrant men engaged in civilian labor force • Employed foreign-born working men work in construction, agriculture, meat processing and other higher risk occupations • Women work in service and personal care occupations • The top five countries of birth foreign-born workers are: Mexico (50%), China (8%), India (6%), the Philippines (5%), and the Dominican Republic (4%) Recording of this session via any media type is strictly prohibited. Page 11

Facts about Immigrant and Diverse Worker Safety and Health Immigrant workers today: • Are 16% of the workforce • Probably sustain 20% of work injuries • After immigration reform, will spread more evenly throughout the workforce • (1/3 of foreign-born workers are undocumented) • A global phenomenon Recording of this session via any media type is strictly prohibited. Page 12

Language & Other Barriers • Many immigrant households are linguistically isolated • Worker’s English is good enough for work -- not good enough for safety. • Safety and health expectations may be centered on country of origin, not U. S. • Fear, uncertainty and doubt re: rights Recording of this session via any media type is strictly prohibited. Page 13

Red Flag Safety Issues • Spoken and/or written language barriers • Limited on-the-job experience • Educational gaps in safety awareness and rights • Cultural miscommunication Recording of this session via any media type is strictly prohibited. Page 14

Disproportionate Injury Risk • Moderate or low-skilled immigrants and diverse workers are working in jobs that have an average or above average risk of work injury or illness. • Most are likely to face safety issues on the job even if they work the same job as U. S. born workers. Recording of this session via any media type is strictly prohibited. Page 15

ASSE & OSHA Standards American Society of Safety Engineers(ASSE): • “Training should always be delivered in the native language of the student when possible. ” • As of today, apparently no OSHA fines for training issues Recording of this session via any media type is strictly prohibited. Page 16

Safety Techniques • Participatory training • Pictures vs. written text • Think through how workers are to be tested Work Safe includes specific techniques, how to create cartoons and evaluate competency of translators Recording of this session via any media type is strictly prohibited. Page 17

Medical Care Special challenges: • Limited English Proficiency (“LEP”) • Cultural miscues (ex: role of relatives) • Health illiteracy (ex: medications, specialists) Recording of this session via any media type is strictly prohibited. Page 18

Joint Commission on Accreditation of Hospitals “It is not appropriate to rely on untrained individuals as the primary source for bridging communication barriers during medical encounters with individuals who are deaf or speak a language other than English. ” Recording of this session via any media type is strictly prohibited. Page 19

Translation in Medicine Good: Onsite or telephonic/Skype on demand TM Bad: Family member especially children Recording of this session via any media type is strictly prohibited. Page 20

Workers Compensation • Inventory/strengthen language assets • Indemnity debit cards Recording of this session via any media type is strictly prohibited. Page 21

Presenting a Safety Case - A Case Study Charles Daniels Bolthouse Farms www. bolthouse. com www. facebook. com/bolthousefarms www. twitter. com/bolthousefarms Recording of this session via any media type is strictly prohibited. Page 22

History of Bolthouse Farms • • • Fourth-generation farm Located in California’s fertile San Joaquin Valley Known for high-quality consumer brands and innovative products Market share leader in growing and distributing carrots Also produces and sells super-premium juices, smoothies, protein shakes and café beverages under the Bolthouse Farms brand name • Recently diversified its offerings by launching a line of premium refrigerated yogurt dressings and extra virgin olive oil vinaigrettes Mission Inspire the Fresh Revolution™ and change the way people consume healthy foods and beverages. Recording of this session via any media type is strictly prohibited. Page 23

One Company – Three Environments 1. Corporate – Highly Educated Managerial / Administrative ü Foreign-born PHD level chemist filed claim and litigated because he didn’t fully understand the workers compensation adjudication process 2. Manufacturing – Mix of Managers & General Laborers ü Foreign-born Supervisor filed claim, had surgery and returned to work with no litigation. Second surgery required 7 years later – still no litigation. The difference was the amount and quality of communication. 3. Agricultural Operations – Farm Managers – Farm Laborers ü Issues associated with managing safety for the foreign-born workforce are more frequent among general laborers but are certainly not exclusive to general laborers. Recording of this session via any media type is strictly prohibited. Page 24

Evolution of the Bolthouse EH&S Process Prior to 2009 EH&S Staff: • promoted from within | not subject matter experts • task oriented | no holistic safety strategy • Foreign-born workers not a specific focus of safety programs • Safety training translated using Google translator – presented by Monolingual presenters • Poor, incomplete understanding led to increased incidents • Injury rates = double digits • Workers Compensation costs more than $1 million dollars per year • Lack of knowledge - due to cultural differences- often led to increased medical costs and litigation rates …. (Litigation rates consistently 76% annually) • Monolingual Medical Providers used at network clinics • Nearly 5000 lost time days in the prior 24 months Recording of this session via any media type is strictly prohibited. Page 25

Evolution of the Bolthouse EH&S Process Prior to 2009 …continued EH&S Staff: ü Upgraded and credentialed with subject matter expertise ü Implemented a comprehensive / holistic safety strategy ü Foreign-born worker safety became the specific focus through Key Concept Process – specifically “Expectations & Involvement” ü Implemented “Comprehensive Site Training System” ü All safety related signs posted in Spanish and English ü All safety training presented in Spanish or English based on 1 st language of participants ü All safety training translated by Spanish risk resources ü Switched Medical Providers – to bilingual physicians, educated in various cultural perspectives, re: medical delivery systems Recording of this session via any media type is strictly prohibited. Page 26

Impact of Implemented Changes • Estimated future liability decreased $1 MM per year for 5 years straight • Annual WC Cost decreased from averaging $3 MM - $4 MM to $225 K • Injury frequency decreased 88% from 8. 5 to a current OSHA total incident rate of 1. 16 • Injury Severity / Average cost per claim decreased from $38, 000. 00 to $1900. 00 Recording of this session via any media type is strictly prohibited. Page 27

Proper Management Decreases Frequency and Severity BHF - Historical Frequency & Severity 1 14 Recording of this session via any media type is strictly prohibited. Page 28

Lost Time Days By Year Recording of this session via any media type is strictly prohibited. Page 29

More Information & Helpful Links • Peter Rousmaniere at PFR@Rousmaniere. com • Consult the Online Resources Chapter in Work Safe provides numerous contacts and ideas for organizing a safety training program for your diversified workforce. • Download this presentation through the RIMS mobile app or online through the RIMS Website Recording of this session via any media type is strictly prohibited. Page 30

More Information & Helpful Links Copies of Work Safe: • Bound Versions: o o RIMS Bookstore | $7. 98 while supplies last Amazon. com | List price 12. 98 • Download Free PDF: o Broadspire & Crawford Websites – – http: //www. choosebroadspire. com/elibrary/whitepapers. aspx http: //www. crawfordandcompany. com/media-center/publications. aspx Recording of this session via any media type is strictly prohibited. Page 31

Questions Recording of this session via any media type is strictly prohibited. Page 32