File Premium Reserve Reviews – Differences

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Workers Comp File Premium Reserve Reviews

Yes, they are all different.  Workers Comp file premium reserve reviews are three very different reviews that we perform for employers

Hand Presenting Dollar Currency File Premium Reserve Reviews On Cart Board
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I have posted on this issue more than a few times. This is most of what we do for a business. I felt the need to re-post on the subject as we receive questions daily on file  premium reserve reviews. Employers, agents, and others are sometimes confused by the terms.

  • File Reviews – also called Performance Reviews. File reviews are usually reviewing all aspects of the way that a Workers Comp Claims Adjuster handled a specific file or group of files. The performance on the set of files is scored against a group of weighted criteria. Any trends are noted. We do not and will not pick out a few things that an adjuster erred on in the handling of the Workers Compensation claims. We look for trends such as over-reserving of files, late three-point contact, etc. Most adjusters do very well in our audits.
  • Reserve Review – we should call this the Total Incurred Review, but most people outside the Insurance Industry refer to the Total Incurred as the reserves. We review the Workers Comp loss runs to make sure that the reserves are in line with the accident and the claims status provided by the adjuster. This can be part of the File Review.
  • Picture People Holding File Premium Reserve Reviews Employers
    123RF

    Premium Review – this is where we actually confirm all the premium calculations and the structure of the calculations. We examine areas such as classification codes, E-mods, original Workers Comp policies, year-end audits, etc.

Quite a few of our clients are now requesting E-Mod reviews. This is where we assist in lowering the E-mod or getting a company out of the Assigned Risk Pool. There are many areas where a company’s Workers Compensation premium payments may be reduced. We see so many companies just writing a Workers Comp premium check without questioning how the payment was calculated. Questioning the $ you pay out is the best place to start a Workers Comp premium reduction program.

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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