One Claim Wreck Our E-Mod and Premiums – What Can We Do?

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 Can One Claim Wreck  – Completely Ruin Your Workers Comp Premium

Just one claim does not wreck  an E-Mod. My company has had a great Workers Comp safety record over the past eight years. We had one serious injury two years ago. I know that it will start to hit my E-Mod this year. The Total Incurred of the claim is $75,890. Other than a few medical benefits only claims, this is the only claim we have had for many years. Is this one claim going to wreck my E-Mod and Workers Comp premiums?

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Actually, this one claim is going to negatively affect your E-mod, but it is not going to wreck it. The way that Workers Comp E-Mods are calculated diminishes the effect of one bad claim.

Your claim of $75,890 is split into two figures:

  1. The first $5,000 is called a Primary Loss. This part of the claim is charged against your E-Mod and premiums at full cost, so to speak.
  2. The other $70,890 is reduced by some factor like 80%. This part is called an Excess Loss.

As you are a medium sized business, you will have a claim here or there that may be more than minor. The Workers Comp E-Mod system shelters employers from the full brunt of one bad claim.

2018 – Update – The Primary Loss as of 2015 is $15,000.   When the question was asked the primary loss in #1 above was correct.   NCCI changed the primary loss figure over a three year period from $5,000 to $15,000.   

The result of this is to make companies with repetitive claims pay more of their fare share by increasing the E-Mod significantly.  One bad claim still does not kill your E-Mod.   The problems we now see are companies with more than one claim. 

Next Up – The Other Side of the Coin – many small Workers Comp claims, but no major ones.

Two Days from Now – Warning – There is no such thing as a small Workers Comp claim.

©J&L Risk Management Inc Copyright Notice

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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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