Archives for October 2011

Workers Compensation Fines Penalties – Who Pays?

October 28, 2011 By JL Risk Management Consultants

Who Pays For WC Fines Penalties

Some state jurisdictions issue Fines Penalties if state forms are not filed timely, if lost time benefits are not issued timely, or for frivolous litigation, etc. In our claim file reviews, we have found that many carriers charge these fines directly to the file as an expense.

These fines and penalties should be paid directly by the carrier or third party administrator if they were charged due to their lack of adherence to the state’s rules and regulations. The carrier or third party administrator should cover these costs under their errors and omissions coverage and not charge the costs to the file.

This may not be a large figure that would affect your company’s E-Mod in most cases. Fines and penalties are more prevalent in certain states. If you are a self insured, this may mean you have directly paid for expenses for which you are not responsible.

Fines and penalties being charged as an file expense is usually not a deliberate act by a carrier or TPA. It is mainly due to a lack of training by the bill paying or claims staff. Fines penalties cannot be eliminated completely.

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Filed Under: Fines Penalties Tagged With: charge due, E-Mod, jurisdiction

Certificates of Insurance – Earn Workers Comp Savings of $500+ Per Hour

October 27, 2011 By JL Risk Management Consultants

Earn Workers Comp Savings With Certificates of Insurance

Workers Comp certificates of insurance can be a great method to earn Workers Comp savings. This was one of my old tag lines in my Workers Compensation presentation. It is easy to do and can save a company or governmental entity large amounts of cash. How can this be accomplished without too much effort?

Employers should require Workers Compensation Certificates of Insurance (certs) from any subcontractor that performs a job for you. If your company or governmental entity is not requiring them for all contractors, then you should read this cert horror story.

I often hear at different Workers Comp meetings that “We are doing a great job of obtaining certs. All our contractors have provided us with current certs.” The problem is – how does one know if the cert is actually valid? Remember – it is just a piece of paper.

The $500 an hour saving could actually be a conservative figure. If one of your contractors certs is no longer valid, then you could subject your company to the Ladder of Workers Comp Insurance. Some company’s insurance policy is going to cover the injury. The states are just not going to let an injured worker pay out-of-pocket for Workers Comp injuries.

I suggest taking out the certs and calling all the agency that provided them or faxing over a letter that asks the agent to verify the cert. Most certs that you have received will have a phone number for the agent in the ACCORD form box 1. One of my assistants did that for one of our clients today. We found two out of 18 certs were not valid as the policies were cancelled due to non-payment of premium.

You can quickly see how the $500 an hour is a conservative figure. What if one of the contractor’s employees or subcontractors had a serious injury? Please see the above Ladder of Workers Comp Insurance link.

What do you do if you find an invalid cert? Your company should immediately ask for a valid cert or be prepared to eat the claim if someone is injured that is working with that cert. I am not saying that you should immediately remove the contractor. I have often seen where the contract is renegotiated with the idea that your company will pay the premiums for the contractor.

You may want to also put the expiration date of each cert on a calendar such as Outlook and then ask for the updated cert when the policy expires. I recommend diarying the request for a new cert 21 days ahead of the expiry to make give the contractor time to provide you with a new one.

This recommendation make take some time away from other duties, but it is better than having uninsured contractors and subcontractors working for you.

©J&L Risk Management Inc Copyright Notice

Filed Under: certificate of insurance Tagged With: Workers Comp injuries, Workers Comp savings

Telephonic Triage for Workers Comp – Is It Really Worth It?

October 25, 2011 By JL Risk Management Consultants

Telephonic Triage for Workers Comp

Is Telephonic Triage in WC really worth it in most instances? I had a great conversation with an old Workers Comp friend that had begun to sell triage service by phone for claims. As he mentioned, safety measures occur up to the time of an accident. Workers Comp triage can come into play a few seconds after an injury.

BTW, my definition of Workers Comp phone triage is having a nurse become involved telephonically immediately after the occurrence of an accident. Triage by a nurse can also be in-person. A plant nurse is a great example. However, if an employer is not large enough or the profit margins are too close, phone triage for Workers Comp may be a great option.

Telephonic triage can actually cut the reportable incident rate as certain injuries that can be self-treated may not require a work stoppage or a doctor visit. In most cases, a first report of injury may not necessarily need to be filed. You may want to check with your insurance carrier or TPA before deciding what constitutes a reportable injury.

I actually established a small phone triage nurse case management department a few years ago for state employees. It worked well. Controlling the medical will always reduce Workers Comp costs. Check out the keys to workers comp reduction from one of my old blog posts.

In this economy, the one area that I would say is a negative is the upfront cost. Convincing senior level management may be tough as the cost savings will not be realized for months to come as your E-Mod or for self insureds – the Loss Development Factor is a lagging system. As I pointed out in this blog post, Workers Comp results are delayed for sometimes up to three years.

A telephonic nurse company was doing a great business in the southeast 10 years ago. It is no longer in business. The main reason was its competition. There were almost no competing companies in the area. Convincing carriers, employers, and TPA’s of a new type of service is a very tough service to sell for an extended period.

My overall answer is a definite yes for telephonic triage as it enhances the immediacy of responding to an injured employee’s claim very quickly. As with any service, there are companies that perform at a higher level than others. I rarely make company recommendations on this blog.

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Filed Under: Triage first report of injury nurse case management Tagged With: E-Mod, safety measures, telephonically, Workers Comp costs

NAIC Investigates Captives Due To Newspaper Article

October 20, 2011 By JL Risk Management Consultants

NAIC Investigates Captives On A Whim?

The NAIC investigates captives due to a recent newspaper article. I recently read an article on captives being investigated by the National Association of Insurance Commissioners (NAIC). The NAIC is supposed to make recommendations or produce a new regulation model for captives. I think this is a grand waste of time. I have posted on captives previously here and here.

National Association of Insurance Commissioners Emblem Investigates Captives News Paper Article

The article seems to refer to captives as shadow companies. This flies in the face of various states that are ramping up their marketing efforts to be the domiciles for various captives. The list of states that can domicile captives are:

Alabama
Arizona
Arkansas
Colorado
Delaware
DC
Florida
Georgia
Hawaii
Illinois
Kansas
Kentucky
Maine
Montana
Nevada
New York
Rhode Island
South Carolina
South Dakota
Tennessee
Utah
Vermont
Virginia
West Virginia

The list points out that almost 50% of the US functioning as a possible domicile for onshore captives. The IRS has already ruled (see post)that captives do not violate the tax laws in any way. I have consulted with captives often over the last few years. If a majority of the states want to domicile captives, would one not assume the states have examined captives very thoroughly?

From the article – NAIC’s Executive Committee and plenary voted unanimously to adopt the new charge for the Financial Condition Committee. The committee will study insurers’ use of captives and special purpose vehicles to transfer third-party insurance risk in relation to existing state laws and regulations. If the study turns up any concerns, the committee will recommend possible modifications to existing NAIC model laws or the creation of a new model law.

What I find astounding is that the New York Times would call captives shadow insurance. The NAIC is basically responding to the article. It is sensationalism at best. Most of the insurance industry has “shadow” elements. I think the NAIC’s time could be spent better elsewhere.

This author from CFO World forecasted that this would happen. This is the NY Times article on captives that started all the hubbub. I think this can be summed up with a comment from Vermont’s Captive overseer as quoted in the NY Times –

David F. Provost, the deputy commissioner of captive insurance in Vermont, said he believed confidential treatment was appropriate because these entities were, in essence, insurance companies with only one policyholder — their parent. He said Vermont’s large and experienced staff of regulators vetted all transactions carefully to make sure they were sound.

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Filed Under: NAIC Tagged With: investigation, policyholder, shadow insurance

10 Workers Comp Premium Reduction Desktop Items – More On List

October 19, 2011 By JL Risk Management Consultants

Workers Comp Premium Reduction Desktop Items

These are the list of workers comp premium reduction desktop items.This post was originally started here. I decided to cover each one of the computer desktop items. I covered #1 here.

2. A status for each of your open claims – may be included in your loss runs. Quite often, the employer and adjuster may have two different statuses. The workers comp insurance adjuster or the employer may not have current information. Reducing the reserves can be difficult without the carrier and employer being on the same page. If statuses are not on your loss runs, or if you do not have online access to your claims, then the best way to obtain a status is by emailing, not calling, the adjuster on the file. See #5.

3. Experience Modification Rating sheets – provided by NCCI or your rating bureau – this is the official way to see your E-Mod and what reserves were reported by the insurance carrier to NCCI or your state rating bureau.

4. OSHA Log – this is the best place to see what incidents occurred and if all claims that should have been reported to your carrier are on your loss run.

OSHA emblem Premium Reduction Desktop Items

5. Your Workers Comp adjuster(s) email – notice I did not say phone number – if you do not have your Workers Comp adjuster’s email address, you can usually find it out from the loss run or by calling the adjuster. Emailing your adjuster will avoid a phone call out of the blue as the adjuster will usually need to review the file before answering your question. Emails are the best way to inquire about a file.

6. All first reports of injury filed with your insurance carrier for the last two years – may be in #1 if you have online access – this is a quick way to spot injury trends along with the OSHA log. You may also want to compare your loss run versus your First Reports to make sure the information on the first reports of injury match your loss runs. Carriers without the proper info can cost you premiums in many ways.

7. Knowledge or instructions how to file claims online with your insurance carrier – some carriers charge extra $ to input a first report of injury into their system. I have seen the charge as high as $150 per first report. Filing your info online gets the claim reviewed more quickly by the adjuster and adds accuracy to the carrier’s online file.

8. The name and contact info for a local industrial minded physician along with the contact info for a local orthopedist for referrals from the original treating doctor – this method is the hallmark of saving Workers Comp $. Treating physicians are always considered the only impartial witness if the claim ever goes to a hearing. I have posted on treating physicians here.

9. An email address for you that does not block too much spam and that you check often, and a promise to look in your spam box more often – one of the adjusters’ main concerns is their emails end up in the spam mailboxes. Each email system has a certain way to add an email address as a safe sender.

10. Your local safety council’s contact information or local trade group. I have found that most employers that join an association with similar companies seem to do much better with their Workers Comp. I am not sure exactly why – it does seem to be a trend.

There are other workers comp premium reduction methods to save on Workers Comp costs. These 10 are a good start.

©J&L Risk Management Inc Copyright Notice

Filed Under: NCCI, OSHA log, Reduction Tagged With: adjuster, Mod Rating Sheets, open claims

Tax Audits Due To Findings In Premium Audits – Connection?

October 18, 2011 By JL Risk Management Consultants

Tax Audits from Premium Audits?

Most Tax Audits make every business concerned due to the time required and possible costs. As I had expected, the federal and state taxing authorities and Workers Compensation insurance carriers have decided to share data on premium audits. I am not sure of the effect of a memorandum of understanding. This is the article verbatim from the DOL website. I highlighted the states that signed onto the memo.

Please note this article was written four + years ago. Many states are now sharing data among all departments for tax and other types of compliance. The term “misclassified worker” does not necessarily mean an employee that has the incorrect classification code.

Labor secretary, IRS commissioner sign memorandum of understanding to improve agencies’ coordination on employee misclassification compliance and education

11 state agency leaders also sign, agree to memorandums of understanding

WASHINGTON — Secretary of Labor Hilda L. Solis today hosted a ceremony at U.S. Department of Labor headquarters in Washington to sign a memorandum of understanding with the Internal Revenue Service that will improve departmental efforts to end the business practice of misclassifying employees in order to avoid providing employment protections. In addition, labor commissioners and other agency leaders representing seven states signed memorandums of understanding with the department’s Wage and Hour Division and, in some cases, its Employee Benefits Security Administration, Occupational Safety and Health Administration, Office of Federal Contract Compliance Programs and Office of the Solicitor.

The signatory states are Connecticut, Maryland, Massachusetts, Minnesota, Missouri, Utah and Washington. Secretary Solis also announced agreements for the Wage and Hour Division to enter into memorandums of understanding with the state labor agencies of Hawaii, Illinois and Montana, as well as with New York’s attorney general.

The memorandums of understanding will enable the U.S. Department of Labor to share information and coordinate law enforcement with the IRS and participating states in order to level the playing field for law-abiding employers and ensure that employees receive the protections to which they are entitled under federal and state law.

“We’re here today to sign a series of agreements that together send a coordinated message: We’re standing united to end the practice of misclassifying employees,” said Secretary Solis. “We are taking important steps toward making sure that the American dream is still available for all employees and responsible employers alike.”

“This agreement takes the partnership between the IRS and Department of Labor to a new level,” said IRS Commissioner Doug Shulman. “In this new phase of our relationship, we will work together more efficiently to address worker misclassification issues, and better serve the needs of small businesses and employees.”

Business models that attempt to change, obscure or eliminate the employment relationship are not inherently illegal, unless they are used to evade compliance with federal labor laws — for example, if an employee is misclassified as an independent contractor and subsequently denied rights and benefits to which he or she is entitled under the law. In addition, misclassification can create economic pressure for law-abiding business owners.

These memorandums of understanding arose as part of the department’s Misclassification Initiative, which was launched under the auspices of Vice President Biden’s Middle Class Task Force with the goal of preventing, detecting and remedying employee misclassification.

The mission of the U.S. Department of Labor is to foster, promote and develop the welfare of the wage earners, job seekers and retirees of the United States; improve working conditions; advance opportunities for profitable employment; and assure work-related benefits and rights.

See more at the DOL website article

Premium audits presently have not generated any type of tax audits.

©J&L Risk Management Inc Copyright Notice

Filed Under: Premium audit Tagged With: insurance carrier, tax audits

Workers Comp Premium Reduction Top 10 Desktop Items

October 13, 2011 By JL Risk Management Consultants

Workers Comp Premium Reduction – Top 10 Desktop Items

I was asked at a recent conference by an owner of a medium-sized business – What do I need to obtain to immediately cause a Workers Comp Premium Reduction or lower reserves? I thought for some time and came up with the following list. These should be scanned into a folder on your computer desktop called WC Reduction. Each item below should be a sub-folder:

1. Your company’s most recent loss run and the past three loss runs or online access to your Workers Comp claims.
2. A status for each of your open claims – may be in #1.
3. Experience Modification Rating sheets – provided by NCCI or your rating bureau.
4. OSHA Log
5. Your Workers Comp adjuster(s) email – notice I did not say phone number.
6. All first reports of injury filed with your insurance carrier for the last two years – may be in #1 if you have online access.
7. Knowledge or instructions how to file claims online with your insurance carrier.
8. The name and contact info for a local industrial minded physician along with the contact info for a local orthopedist for referrals from the original treating doctor.
9. An email address for you that does not block too much spam and that you check often, and a promise to look in your spam box more often.
10. Your local safety council’s contact information or local trade group.

I could have added more. The idea is to have all of this info at your fingertips – better known as your computer desktop. The need for some of these is very obvious. Others may need additional explanations.

I will cover the first one in this post. I will leave the others for later. Brevity is best. The reason that you will need your loss runs is obvious. If you do not know what claims you have now and have had over the last two years, there is no way to identify trends. Some of the great loss run reports (paper or online) allow you to sort your loss runs by types of injuries, cause of injuries, etc.

This is golden for your company as you can start to identify the origination of the injuries. If you notice severe wrist sprains for instance, you may want to investigate the source further. An injury that never happens will reduce your E-Mod dramatically. This is admittedly a very basic way to use your loss runs. Loss runs also contain critical info such as here and here.

I will cover the remaining list of workers comp premium reduction techniques in the next few posts.

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Filed Under: Premium Reduction Resolutions Tagged With: adjuster, business, E-Mod

Experience Mods Will Decrease For Some Employers – Really?

October 13, 2011 By JL Risk Management Consultants

Experience Mods Decrease When NCCI Increases Primary Loss?

The NCCI had reported Experience Mods will decrease for certain employers. One of the new twists to the Workers Comp Experience Modification Factor calculations is that NCCI is going to raise the Primary Loss part of the calculation for your E-Mods (also called EMR, Ex-Mods, Mods). In most states the Primary Loss will double to $10,000 and then another 50% will be phased in totaling $15,000.

The reasoning NCCI had for increasing the primary losses made sense to me. They have not altered this area of the formula in decades. Adjustments did have to occur across the board. Their article on the changes is here.

You may want to obtain a copy of your most recent rating sheet to examine the areas that I am referring to on the Experience Mod Rating Sheets. I walked through the basic formula for Expected Losses here

I was just reading another supposedly cutting edge blog’s answer to what that will cause in the Workers Comp market. They had said that a wait and see attitude is best. I am not so sure if a company should wait and see what will happen. It may be best to take corrective action now.

The changes to the NCCI formula will cause the following:

Employers with multiple injuries are going to see their E-Mods jump significantly
The buffer that was in place in case an employer had a few large losses is now reduced causing an increased effect on even large claims
States that do not have NCCI as the rating bureau will follow this idea, even California.

If large accidents or multiple small accidents will cause your E-Mod to increase, which employers will see a decrease in their E-Mod? The answer will likely be the ones with low E-Mods already in place. An employer with a very low E-Mod will see it decrease even more.

The savior will likely be the ELR or Expected Loss Ratio. The ELR is basically the expected loss level for a certain classification code in a certain state for a given year. The Expected Primary Losses should increase significantly. See the link above on how that may affect your E-Mod.

For instance if you have a loss of $23,500 the old loss split would have been:

$5,000 Primary Loss
$18,500 Excess Loss

The new NCCI rules would have the same loss as:

$15,000 Primary Loss
$8,500 Excess Loss

Even with adjustments in the ELR, I do not see how that the E-Mods overall will stay the same. I have gone through a few artificial calculations through by changing the old E-Mod Rating Sheets and even artificially adjusting the Expected Loss Ratios. I did not see one E-Mod decrease. Then again, I am using our client’s E-Mod sheets. Our E-Mod clients do not usually come to us with a rosy E-Mod picture.

This and all changes in the E-Mod system are really down to one area. SAFETY The best risk management method is to make sure that your company does not have too many entries on your E-Mod sheets. I used to say that keeping the numbers of claims down will always lower your E-Mod. I am now convinced that you will need to have no claims hitting your Experience Mod sheets.

There are many alternatives (even for very small employers) to the traditional insurance market. The possible alternatives are PEO’s and Rent-A- Captives. PEO’s have received a large amount of bad press for a very few unscrupulous providers that have been removed from the system. Rent-A-Captives are not new on the scene and can be designed for small employers.

Filed Under: E-Mod X-Mod Tagged With: calculation, ELR, experience rating formula, Mod Rating Sheets

California Changes Landscape On Premium Audits And Other Disputes

October 12, 2011 By JL Risk Management Consultants

California Changes Disputes With Bill Signed By Governor Brown

The State of California changes landscape of premium audits and others disputes. Last night, I was reading over a short article that covered a new area for insureds in California Workers Comp disputes. I will actually cover more on CA over the next few weeks. The state has been very active lately on Workers Compensation law changes.

One caveat is the bill signed by Governor Brown does not say that you can actually negotiate contract provisions AFTER the policy have been signed off on by all parties. Your company must act BEFORE the policy goes into effect. This is Risk Management at its best. Insureds being able to possibly change their insurance policies provisions BEFORE the policy may be of benefit.

We usually receive calls and emails after a policy dispute has begun with a carrier. One thing that we write in all of our reports to clients is that we must follow what is in the policy. Workers Comp policies are usually created cookie-cutter style when it comes to the policy provisions. By the way, when is the last time that you or one of your staff read your WHOLE Workers Comp insurance policy?

There are certain sections of the policy that define when and how your company has to proceed with any type of dispute. There are also provisions on coverages such as states in which your company has insurance. We have seen companies having to pay out-of-pocket in CA as their employee was injured in another state and filed a claim that was accepted in another state. This happens very often with trucking/transportation companies. Do you know which states your Workers Comp policy provides coverage?

We find those provisions in the back pages of the policy. I also recommend that you read your Workers Comp policy like you are studying for a test with highlighter in hand. If you find clauses in your policy that you do not understand or question, please forward those to your agent or you can always send me an email.

Filed Under: Policy Dispute California New Tagged With: article, governor brown

Charity Water – There Is Still Good In This World

October 7, 2011 By JL Risk Management Consultants

Charity Water – A Great Place To Donate

Charity Water is a story of tragedy and success.

http://mycharitywater.org/p/campaign?campaign_id=16396

I am not sure if I had published this in the newsletter. I do not recommend companies or charities very often. In this case, I am making an exception. I will not go into it too far. Check out the story that goes with it and the donation messages. I think they have a new page from which to make a donation.

It is interesting that her goal was $300 and what her web page finally raised for clean water. The results were close to a miracle.

The young lady who called everyone’s attention to this charity died in an unfortunate auto accident. The donations accelerated subsequent to the girl’s passing.

The idea of the organization is to provide clean water for underdeveloped nations. Clean water is the first step to improving an impoverished community. Thanks for checking out this charity’s website.

We try to mention as many charities as possible. If there are any charities that you think we should mention, please send us their website address. Update – Charity water has grown into a very large successful organization providing water to many underdeveloped communities.

Filed Under: charity Tagged With: donation, web page

Premium Audit Disputes and Collection Agencies Confusion

October 7, 2011 By JL Risk Management Consultants

Premium Audit Disputes vs. Collection Agencies

Most premium audit disputes may not be documented by a collection agency. I received a great question on Premium Audits this week. We are disputing our premium audit for 2009 – 2010. We are receiving letters from a collection agency and the carrier. Do we need to respond to all the letters (seven in total) from both companies while we are in a dispute?

My answer to this is an emphatic yes. I do not agree that you should have to answer to all seven letters. However, if you do not respond timely to either company, you would lose your ability to dispute the audit. I am not an expert in the creditor laws. I am not sure if the carriers in question can actually turn your file over to a collection agency during a valid premium dispute.

Most collection letters and carrier letters will give you a time frame in which to respond.. We received an email two weeks ago where a potential client had not responded to two collection letters from a collection agency. This can put an insured into a real conundrum as the carrier and collection agency will both considered your company to be in default on the dispute.

My recommendation is to respond within the time frames given in the collection letters from both the carrier and collection agency. Any letters written during a dispute and especially collection letters should be sent Certified Mail with a Return Receipt. The return receipt is legal proof you have responded timely. If I am correct, the Certified Return Receipt fee for a one ounce letter is $5.59. That is $ well spent.

Phone calls are great, but they do not preserve your credit or premium audit dispute rights. Responding by letter keeps everything upfront and documented. I do not even recommend emails in this instance.

One recommendation that is very important is to read all pages and both sides of a collection letter from the carrier or collection agency. I have seen one where the letter looked innocuous only to find the 30 days to respond or default clause on the bottom of the very last page.

Filed Under: Premium Audit Dispute Tagged With: agencies, collection letter, creditor laws

Workers Comp Supplements – Math Says No In Most Cases

October 6, 2011 By JL Risk Management Consultants

Workers Comp Supplements Can Skew System

The Workers Comp supplements paid by employers may not be a good idea. One of the most popular subjects in WC is employer supplements. This subject seems to come up in risk management meetings and seminars very often.

Supplements involve the employer offsetting the reduction in pay an employee allegedly experiences when they are on WC benefits.

Waiting Period
Employee’s Loss of Earnings (???)

Employee is restored to Pre-Injury Wage

6667 of Pre-Injury Wage (Tax Free)

Pre-Injury Wage = $600 week (Taxed)

Comp Rate = $400 week (Tax Free)

Employer Supplement = $200 week (Taxed)

Employer Supplement = $135 week (Tax Free)

Employee Receives = $535 week (Tax Free)

Employee Receives = $750 week (Taxed)

Motivation to Work? (Gone)

The first area concerning supplements is the Waiting Period. This is usually the first three to seven days that the employee is out of work. The Waiting Period is not paid until the employee has been out of work for a certain amount of days.

For example, the first seven calendar days may not be payable until an employee is out of work for more than 21 days. The main reason for a waiting period is to encourage the employee to rapidly return to work. If the employer pays the first week of benefits, this built in encouragement is eliminated.

The basic function of WC benefits (as with most insurance) is to make the employee “whole again.” Most states require the WC insurer to pay 2/3 of the employees’ average weekly wage subject to a maximum. The benefits are paid tax-free.

In the above chart, the employee is receiving $600 per week as an average weekly wage. The WC weekly benefit rate is $400. The employer has decided to provide a supplement of $200 (taxed) per week to raise the employee’s wages back to their pre-injury wage. The after tax rate of the supplement is $135. When added to the WC weekly benefit rate, the employee is receiving $535 tax-free. Converting the employee’s pay back to a taxed rate, the employee is now receiving $750 per week taxed. The employee is now receiving a larger pay rate without having to work.

The employee has little or no motivation to return to work. The WC Supplement has eliminated the employee’s motivation to return to work. I recommend the avoidance of providing WC supplements for this very reason.

Filed Under: Supplements Waiting Period Tax Free Tagged With: employer, pre-injury wage, Workers Comp benefits