Program Description

Manage and regulate all aspects of workers insurance, including the processing of claims, administrative functions and support service. The Program is composed by the Offices of the Administrator, Internal Auditing, Contracting, Cooperative Security and Public Information; as well as the Areas of Administration, Finances, Information Systems, Actuarial Affairs, and The Legal Department.

Objectives

• Develop an automated billing and medical records processing system to reduce manual work and save on printing costs.

• Decentralize operations to promptly expedite employer and injured worker's proceedings by regionalizing the payment of lawyer's fees and the notification of payment to injured workers.

• Automated notification of decisions made regarding medical treatment to help expedite the reintegration of the injured worker into the workforce..

• To maximize real estate resources through the implementation of a construction and rehabilitation environmentally conscious plan that meets established injured worker's privacy policies.

• Increase collection of premiums by expanding the employer registry and by working with other agencies.

• Continue to establish Financial Control Measures.

Statistical Data	2010	2011	2012
Active cases	46,257	39,274	36,375
Cases filed	59,660	61,401	54,622
Cases in arrears	41,784	38,819	39,823
Cases not working	14,686	12,798	11,559
Cases working	31,571	26,476	24,816
Closed cases	63,149	67,114	64,666
Complaints investigated	11,975	10,625	10,304
Disability benefit payments ($)	159,400	150,840	171,200
New policies formalized	43,257	38,384	43,681
New policies imposition	40,300	43,770	34,600
Reopen cases	7,962	6,168	6,596
Research and investigations	13,667	12,958	12,122

The statistical data was provided by the Agency during the Fiscal Year 2011-2012 budget formulation process.

Customers

All the employers and workers that file a claim as a consequence of some work related accident whether the employer is insured or not.

Human Resources

Authorized and Proposed Positions	2009	2010	2011	2012
Managerial,Technical, Administrative, and Office Staff	819	799	758	758
Judges, Lawyers, and Legal Staff	26	25	49	49
Other staff	582	547	300	300
Planning, Budget, Statistics, Auditing, and Finance	310	290	372	372
Maintenance and General Services Staff	198	167	243	243
Total, Positions	1,935	1,828	1,722	1,722

Program Description

Offers medical examination services to injured workers, ambulatory medical treatment, physical rehabilitation, hospitalization, surgery and social services. Also, it provides rehabilitation services through the Department of the Family.

Objectives

• Develop an automated pharmacy system that provides the necessary controls and facilitates prescription processing.

• Follow the triage process at the regional dispensaries.

• Include medical services at the regional dispensaries.

• Establish Control measures by developing a health provider's billing system.

• Expand operations at the Industrial Hospital to decrease the number of surgeries performed at other hospitals.

• Expand service offerings to include the Industrial Hospital and its operating rooms. In this manner, we can maximize the use of the Industrial Hospital.

Statistical Data	2010	2011	2012
Admissions	2,361	1,933	1,843
Assessment service to patients in clinics	498,720	508,213	455,055
Assessment service to patients in industrial hospital	155,675	152,303	142,563
Average stay	9	10	11
Deaths and Discharges	2,377	1,913	1,868
Number of beds	121	121	121
Occupancy percent	48	45	45
Patient/days	21,241	19,957	19,665
Public attitude survey noise	58	55	54

The statistical data was provided by the Agency during the Fiscal Year 2011-2012 budget formulation process.

Workers injured by some accident or occupational injury

Human Resources

Authorized and Proposed Positions	2009	2010	2011	2012
Managerial,Technical, Administrative, and Office Staff	849	872	686	686
Other staff	0	0	86	86
Planning, Budget, Statistics, Auditing, and Finance	43	41	46	46
Maintenance and General Services Staff	36	30	48	48
Families and Community Services Staff	13	13	21	21
Health Services	1,066	1,035	1,036	1,036
Total, Positions	2,007	1,991	1,923	1,923

FISCAL YEAR 2011-2012 ADOPTED BUDGET

The adopted budget for fiscal years 2011-2012 is $504,946,000 from Revenues from Internal Sources. These funds are generated via the collection policy payments established by Act No. 45 of April 18, 1935, as amended.

The Revenues from Internal Sources are distributed as follows: $473,509,000 for operational expenses $31,437,000 for renovation works at the Industrial Hospital and $55,000 to refurbish the central and regional offices.

These resources will help the Corporation meet its goals and programmatic commitments, for example: standardization of policies, increase revenues from premiums, faster recoveries and provide additional services to the Industrial Hospital and other areas of the community. I will also allow the corporation to comply with their law and promote the well-being of the workers class by guaranteeing worker's right to receive quick and efficient Medical attention, appropriate Compensation and access to doctors.

Law states that the Corporation's operational costs cannot exceed 22% of the revenue generated from premiums. Resources will be used to provide quality service, specifically in the areas of physical and mental rehabilitaton. Additional areas include: specialist evaluations, hospitalization, surgery, prescriptions, x rays, labs and other.

SUMMARY OF RESOURCES BY PROGRAM

Administrative Services, Workmen's Insurance Affairs and Claims

Medical Services to injured workers