What gives the City ofKnoxville, Tenn., such an effective workers' compensation program,despite the myriad challenges inherent with managing a program fora municipal workforce and all the disparate job types that comewith it? 

It's “the integration of all the different pieces,” says GaryEastes, risk and benefits manager for the city, this year's winnerof the 5^th annual National Underwriter Awardfor Excellence in Workers' Compensation Risk Management programs,sponsored by NCCI.

The sheer variety of the workforce in this city, located in theeastern part of the Volunteer State, goes well beyond what isgenerally found in the private sector. It includes police, roadmaintenance, fire, recreation, engineering, code enforcement,community development and fleet services, among others, Eastessays.

So the key to the city's success, given this challenging set ofcircumstances, is being able to integrate the programs foremployees' health with workers' comp.

“We don't separate the resources, so if you have someone who isinjured and they have a chronic disease impacting the recovery, wecan deal with both of those at the same time,” Eastessays. 

“The team approach is what makesthis program special,” he adds. “You don't usually have your healthprogram and your workers' comp program under the samepeople.” 

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

PHILOSPHICAL SHIFT

Eastes notes that 10 years ago he had a different philosophyabout overlapping resources. “I tried to keep what's occupationaland what's personal health totally separate,” he says. “You kept itseparate because personal health was considered to be theemployee's business and not the [organization's] business.”

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

The fact that Knoxville, a city of about 175,000 in theAppalachian Mountains, has an aging workforce makes this holisticapproach even more important, Eastes says, noting that the city'sworkforce is about four years older than the average in the privatesector.

The city has 1,550 full-time employees. With seasonal employeesduring summer months, the city's employment total climbs to as highas 3,000, with added personnel to staff sports and recreationprograms.

While seasonal employees are not a significant component ofworkers' comp, they are covered under it, Eastes says.

DOWN TO THE BONE

The City of Knoxville's top injury category is orthopedic, withthe incidence of these types of injuries exacerbated by thephysical demands of many of the city's jobs.

One way the city addresses orthopedic risk is with an in-housephysical therapist and fitness specialist, as well as an ergonomicspecialist working with departments to reduceinjuries. 

The physical therapist, who iscertified in work conditioning, collaborates closely with the nursepractitioner and with city management. The therapist's dutiesinclude issuing exercise plans for employees on restricted duty toperform during work hours.

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

These law-enforcement situations often demand extreme physicalexertion—and not infrequently include being assaulted, Eastessays.

The second-largest employment category is fire fighters, whohave highly strenuous first-responder responsibilities to majoraccidents—including complicated extrications of severely injuredbodies, in addition to all the stresses and dangers of theirfirefighting activities.

The third-highest employment category is public-service workerswho maintain Knoxville's streets, right-of-ways and other publicareas. These employees perform physically demanding jobs inchanging work environments, often under pressure from traffic andvarying weather conditions.

CREATING A Safety CULTURE

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

In fact, Eastes observes, it takes a lot of work for a localgovernment to put the same spotlight on safety that, for example, aprivate-sector manufacturer does. “During this time of municipalbudget 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, Eastesstrives to get senior management's involvement by “continuing topush the message” with them. “You have to be consistent and smartwith timing and tact.”

He adds: “Sometimes you catch them at a time when dollarsmatter. Other times, they may be more sensitive to the humanaspects and what this is doing to employees' lives when they getinjured.”