Filed Under:Risk Management, Public Sector Risk

Integrated Health/WC Program Saves Dollars, Lives For Knoxville

What gives the City of Knoxville, Tenn., such an effective workers’ compensation program, despite the myriad challenges inherent with managing a program for a municipal workforce and all the disparate job types that come with it? 

It’s “the integration of all the different pieces,” says Gary Eastes, risk and benefits manager for the city, this year’s winner of the 5th annual National Underwriter Award for Excellence in Workers’ Compensation Risk Management programs, sponsored by NCCI.

The sheer variety of the workforce in this city, located in the eastern part of the Volunteer State, goes well beyond what is generally found in the private sector. It includes police, road maintenance, fire, recreation, engineering, code enforcement, community development and fleet services, among others, Eastes says.

So the key to the city’s success, given this challenging set of circumstances, is being able to integrate the programs for employees’ health with workers’ comp.

“We don’t separate the resources, so if you have someone who is injured and they have a chronic disease impacting the recovery, we can deal with both of those at the same time,” Eastes says. 

“The team approach is what makes this program special,” he adds. “You don’t usually have your health program and your workers’ comp program under the same people.” 

The city, which offers on-site occupational medical services, is both self-funded and self-administered for workers’ comp, with self-administration of workers’ comp saving more than $300,000 per year in administration costs, Eastes says. Claims administration, legal support and safety are all done in-house, with these services interacting with all levels of supervision and management.


Eastes notes that 10 years ago he had a different philosophy about overlapping resources. “I tried to keep what’s occupational and what’s personal health totally separate,” he says. “You kept it separate because personal health was considered to be the employee’s business and not the [organization’s] business.”

Today, however, much has changed, with most employers realizing they have to make the employee’s health their business. “We can’t survive financially if we don’t,” Eastes says.

The fact that Knoxville, a city of about 175,000 in the Appalachian Mountains, has an aging workforce makes this holistic approach even more important, Eastes says, noting that the city’s workforce is about four years older than the average in the private sector.

The city has 1,550 full-time employees. With seasonal employees during summer months, the city’s employment total climbs to as high as 3,000, with added personnel to staff sports and recreation programs.

While seasonal employees are not a significant component of workers’ comp, they are covered under it, Eastes says.


The City of Knoxville’s top injury category is orthopedic, with the incidence of these types of injuries exacerbated by the physical demands of many of the city’s jobs.

One way the city addresses orthopedic risk is with an in-house physical therapist and fitness specialist, as well as an ergonomic specialist working with departments to reduce injuries. 

The physical therapist, who is certified in work conditioning, collaborates closely with the nurse practitioner and with city management. The therapist’s duties include issuing exercise plans for employees on restricted duty to perform during work hours.

The largest employment category for the city is police officers, who have long hours sitting in automobiles combined with the requirement to be ready for sudden physical reaction in stressful situations.

These law-enforcement situations often demand extreme physical exertion—and not infrequently include being assaulted, Eastes says.

The second-largest employment category is fire fighters, who have highly strenuous first-responder responsibilities to major accidents—including complicated extrications of severely injured bodies, in addition to all the stresses and dangers of their firefighting activities.

The third-highest employment category is public-service workers who maintain Knoxville’s streets, right-of-ways and other public areas. These employees perform physically demanding jobs in changing work environments, often under pressure from traffic and varying weather conditions.


While the potential for injury doing municipal work is obviously significant, local governments nationwide have tended not to highlight safety the way larger private companies typically do.

In fact, Eastes observes, it takes a lot of work for a local government to put the same spotlight on safety that, for example, a private-sector manufacturer does. “During this time of municipal budget cuts, however, there needs to be more emphasis on safety,” he says. “There are a lot of dollars at stake.”

Since meaningful changes in culture start at the top, Eastes strives to get senior management’s involvement by “continuing to push the message” with them. “You have to be consistent and smart with timing and tact.”

He adds: “Sometimes you catch them at a time when dollars matter. Other times, they may be more sensitive to the human aspects and what this is doing to employees’ lives when they get injured.” 

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