Workers’ Compensation Insurance – What Employers Should Know

All U.S. employers, with very limited exceptions, are required to purchase Workers’ Compensation insurance. This state-regulated insurance provides state mandated medical and lost wage benefits to employees injured during the course and scope of their employment. Exceptions to purchasing this mandatory insurance include very small companies that do not meet the number of employees requirement, or in some cases, very large companies that prefer to self-insure this risk. An employer’s failure to comply with a state’s requirements will trigger economic penalties and possible criminal prosecution. A variety of Workers’ Compensation insurance programs are available from the employer’s risk finance perspective.

Exclusive Remedy & Employers’ Liability

Although each state’s regulations differ, they all share a common purpose. They provide an “exclusive remedy” in the form of a “no-fault” program for compensating employees in the form of medical benefits and lost wages in connection with injuries that arise in the course and scope of their employment. While Workers’ Compensation insurance responds to the “no-fault” consequences of workplace injury, Employers’ Liability insurance, which is typically joined with Workers’ Compensation policies, provides coverage for common law claims against the employer by the employee, their family or third-parties, if the claimant or plaintiff can meet the legal standard in their jurisdiction for establishing that the injury was caused by the employer’s negligence, gross negligence, recklessness or willful conduct.

The Broad Landscape of Special Funds and State Programs

Many states provide special funds to pay workers’ compensation benefits to injured workers employed by companies that failed to purchase insurance. Assigned risk pools or insurers of last resort are also available for employers that commercial insurers consider too risky.

Monopolistic States

There are currently four monopolistic states: Ohio, North Dakota, Washington and Wyoming. Puerto Rico and the U.S. Virgin Islands also operate under a monopolistic structure. These states legislated requirements that Workers’ Compensation insurance be provided exclusively by the state’s compulsory program. Commercial insurers may not offer Workers’ Compensation insurance in those four states, yet at least two of the states do allow limited opportunity for self-insurance for well-capitalized employers.

Competitive State Funds

In contrast to monopolistic state programs, Competitive State Funds are state-owned and operated insurance facilities that compete in the open market with commercial insurers to underwrite Workers’ Compensation insurance solely within their respective state.

Arizona, California, Colorado, Hawaii, Idaho, Kentucky, Louisiana, Maine, Maryland, Minnesota, Missouri, Montana, New Mexico, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Texas, Utah, and West Virginia operate Competitive State Fund programs.

Second or Subsequent Injury Funds

In most states it’s illegal for an employer to refuse to hire a prospective employee or terminate an employee if they have previously filed a workers’ compensation claim. To reduce the possibility of this form of discrimination, some states established a Second Injury or Subsequent Injury Fund. The purpose of these funds is to limit an employer’s (and their Workers’ Compensation insurer’s) exposure by reimbursing or covering the Workers’ Compensation benefits paid because of an aggravation or recurrence of a previously existing injury. Reimbursement eligibility requires that the injury must result from a qualifying permanent partial pre-existing disability, illness or congenital medical condition that may hinder person from obtaining employment.

Insurance Premium Calculation – The Loss Experience Mod Factor

This is a complex and often misunderstood concept that has a major effect upon a company’s Workers’ Compensation insurance premiums. On a general level, it is essentially a comparative analysis of your company’s Workers’ Compensation loss history for the prior three years against companies within the same or similar industries.

The standard Experience Mod, which is explained below, is calculated by the National Council on Compensation Insurance (NCCI). Employees are classified by standard identification codes depending upon their occupation. Depending upon an employer’s size and diversity of operations, many classification codes may be involved in the analysis.

Simply stated, the neutral point in the rating curve is 1.0. If a company’s Experience Modification Factor (“Mod”) is greater than 1.0, the employer is issued a “Debit Mod” meaning the premium will be increased by a certain mathematical factor. Alternatively, if the loss history is better than expected or lower than 1.0, the employer receives a “Credit Mod” factor that will decrease the Workers’ Compensation premium.

A Premium Calculation Illustration Using a simple example, suppose the employer only has one classification code for all employees, all of whom work in the same state, and the Workers’ Compensation expected loss rate or base premium rate (as established by the state in which the company’s employees are located) is $3 for every $100 of payroll.

If the employer has a Mod factor of 0.70, the premium will be calculated as 0.70 x $3 = $2.10. This means the employer is paying $2.10 per $100 of payroll, while its competitor peer group, on average, is paying $3 per $100 of payroll.

Assume the annual payroll for this employer is $2 million, the result is the employer would pay $42,000 in premium versus its competitors with a Mod of 1.0 paying $60,000 for the same coverage. Conversely, if the employer in this example had a Mod of 1.5, the premium would be 1.5 x $3= $4.5 per $100 of payroll. Using the same $2 million annual payroll, the employer in this case would pay $90,000 in annual premium while competitors with a 1.0 Mod would be paying $30,000 less for the same coverage. It’s easy to appreciate how these Credit or Debit Mods will have a significant impact upon a company’s bottom line, particularly as annual payrolls reach significant levels.

Many factors go into the actual calculation of a Mod including the company’s loss frequency (number of losses), loss severity (the cost of the losses), and an estimate of losses that are characterized as Incurred But Not Reported (IBNR), meaning expected losses that have not yet materialized into actual workers’ compensation claims.

Medical-Only vs. Lost-Time Claims

When calculating an experience Mod, Medical-Only claim reserves are generally factored at about 30% of ultimate value. Lost Time or Indemnity claims are treated very differently. The literature on calculating experience modification factors states that the first $5,000 of a Lost Time claim ultimate reserve is factored in at 100% with discounts applying above $5,000, including a catastrophic claim cap limit. Therefore, the frequency of Lost Time claims is a real driver of adverse experience. If a company has one Lost Time claim valued at $50,000, it will have less of an adverse affect upon the Mod factor than twenty Lost Time claims valued at $2,500 per claim.

The difference between how these two types of claims affect the Mod should be a strong incentive for employers to implement modified duty programs, with particular attention given to getting employees back to work during the mandatory benefit waiting period, whenever possible. This will cause the claim to be reclassified to “Medical Only” thereby reducing the multi-year adverse impact upon the company’s Workers’ Compensation insurance premiums.

Claim reserve management is critically important as having over-reserved claims will exponentially affect your Mod factor and correspondingly increase your premium. Having under-reserved claims is also no benefit, as the insurer’s audit may result in an unexpected assessment and, of course, increased premiums going forward. Periodic reserve evaluation by a qualified professional should ensure that over-reserved cases are negotiated downward to a reasonable level and under-reserved cases are reserved properly.

Loss Prevention

Loss Prevention is the best way to keep insurance premiums in check. The process can take many forms but essentially involves identifying potential areas of work injury risk and applying techniques to eliminate or substantially reduce the risk that an injury will occur.

Identification of potential causes of risk through performance of a workplace risk assessment is the first step. This process includes critical analysis of procedures as well as physical inspection of facilities and work environments, and discussions with operational personnel and key managers.

Once the causes of potential loss have been identified, modifications can be implemented to operational and business practices in order to reduce the associated risks. The assessment process should be performed by qualified consultants, combining qualitative elements and quantitative metrics including specifications of the physical requirements of each function and the associated loss costs.

Findings should be reviewed with key stakeholders. After agreed upon modifications to operational programs and/or safety programs have been implemented, it’s important to monitor results and make adjustments to the preventive measures. Periodic re-testing is important to ensure optimal results are consistently achieved as the company develops. This process has unique relevance in an acquisition scenario.

Loss Control

Loss Control is the process of reducing or mitigating the effect of losses once they occur. Similar to loss prevention safety programs, loss control should encompass well-formulated procedures to respond to various loss situations. The most common examples of loss control are obtaining immediate medical attention for injured workers and having a limited duty return to work program. Employers should conduct a post-loss analysis of the factors that precipitated the loss to determine whether modifications to the loss prevention plan are appropriate. Any post-loss control program should include a process for coordinating medical care to ensure that appropriate medical treatment is received timely so as not to exacerbate a condition while managing medical costs to avoid any unnecessary expenses. Additionally, developing a close working relationship with insurers to deal with potentially fraudulent claims, and implementing an early return to work or modified return to work program all factor into keeping losses at their lowest possible level.

OSHA Focuses On Ergonomics

The Occupational Safety & Health Administration (“OSHA”) publishes a variety of guidelines on the topic of workplace ergonomics for various industries and jobs. OSHA has announced plans to heighten its enforcement of ergonomics under the General Duty Clause which requires employers to “…keep their workplaces free from recognized serious hazards, including ergonomic hazards.”

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All About Workers Compensation Insurance

Every worker in any company needs to know a lot about various policies put in place for his or her benefit. In situations where there are accidents or injuries while workers are on duty, there are certain policies put in place to address the outcome of such occurrences. One of such policies is known as Workers Compensation Insurance.

What is Workers Compensation Insurance?

Workers Compensation Insurance is a special insurance system that pays all sorts of benefits to workers who are injured while on their jobs. The aim of the insurance is to cover the medical costs that may be involved, permanent disability and loss of salaries or wages. The insurance scheme also protects employers as they do receive immunity from any kind of civil lawsuit that may filed by injured employees. The insurance scheme is available in most states of the US. For instance, the California Compensation Insurance is mainly for California workers who may be injured while working in their various companies in the state.

The State Agencies Involved in the Scheme

In most states in the US, there are agencies that administer the compensation insurance scheme. The Department of Labor and Industrial Relations is usually the agency that looks into the compensation scheme in most states in the US. This agency usually receives diverse notification of injuries from workers as well as reports from their employers. The main duty of the agency is to mediate on issues concerning the benefits workers claim in the scheme. It also monitors the insurance company involved in order to make sure that the process of compensation is followed according to rules.

How to Obtain the Insurance Coverage

In order to benefit from the insurance scheme as a worker, you need to purchase the workers compensation insurance from a private insurance company that deals on that. Then, you need to meet all the requirements needed in the scheme. Once this is done, you can partake of the benefits of the scheme. If for any reason you are unable to locate a good insurance company that deals on compensation insurance, you can as well purchase the scheme from the state agency that handle such issues.

Benefits of the Insurance Scheme

Workers Compensation Insurance scheme comes with diverse benefits especially for the workers injured while on duty. You can receive proper coverage for medical treatment. Your salary or wages are covered. In situation where there’s a permanent disability, you’ll also be adequately compensated by the insurance company. If for any reason the injury results in death, the compensation is also paid to the next of kin or the employee’s dependents.

The Employer’s Responsibility under the Scheme

As an employer whose worker gets insured while on the job, you have the responsibility of filing appropriate report to the agency and the insurance company involved. You have to send the notice in time without any form of delay. If the injury is too much and demands urgent care, you and your company have to provide immediate medical care for the worker before the compensation procedure begins. This helps in saving the life of the employee before any other claim could be made.

In all, every worker must be conversant with the details of the California workers compensation insurance in his or her state and also be ready to follow the scheme to its logical conclusion whenever there’s an injury while on duty.

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