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June 2010

Exclusive Remedy Doctrine – Two Views From Two States

Two Views From Two States-Exclusive Remedy Doctrine I received a note today on the Workers Compensation Exclusive Remedy Doctrine to ask if there are any recent updates. The last two that I have seen are from Connecticut and West Virginia. A recent CT decision ruled that the Exclusive Remedy Doctrine should

Exclusive Remedy Doctrine in Workers Compensation

Term Of The Day – Exclusive Remedy Doctrine The Exclusive Remedy Doctrine makes Workers Compensation claims a no-fault process. The Workers Compensation insurance provided by an employer will cover the employee no matter who is at fault or even if the incident was purely an accidental occurrence.   An injured employee’s benefits

Cherry Picking – Is The Practice Legal In Workers Compensation?

What is Cherry Picking in Workers Comp? Cherry picking is one of the old terms in insurance coverage including Workers Compensation. This very overused term can have a negative or positive connotation depending upon the audience and the writer’s or speaker’s intention. This situation occurs when an insurance carrier seeks

West Virginia Workers Comp – Travelers Dominant Carrier

Travelers West Virginia Workers Comp The State of West Virginia added in a new major player to its workers comp market.  I have read a number of recent articles concerning the loss of insureds by Brickstreet over the past few months. Brickstreet had been the monopolistic carrier for West Virginia Workers

Unit Stat Date Article Caused Confusion – Better Explanation

Prior Unit Stat Date Article Caused Confusion I may have some caused confusion on my last Unit Stat date article on the most important day in Workers Comp. From the emails that I received, I may not have been as clear as I should have been on the Unit Stat

Guaranteed Cost Is Safest Yet Most Expensive Workers Comp Coverage

Term of the Day – Guaranteed Cost A guaranteed cost plan is the most predictable type of insurance policy. In these policies, the premium is a fixed cost based on the final audited payroll, manual rates, and any applicable pricing programs. It is not subject to adjustment due to losses that

Indemnity Claim – Workers Comp

Term Of The Day – Indemnity Claim An Indemnity Claim is a part of insurance contracts in which the insurer agrees to cover the cost of losses suffered by the insured. These claims included medical payments and payment for lost time by the injured worker, including lost weekly wages and permanency.

Final Workers Comp Answer For Two Prior Related Articles

The Final Workers Comp Answer = 6 months after policy expiration This is the Final Workers Comp answer for when a policy expires.  Last week and yesterday I posted on the importance of June 30th if your Workers Comp policy expires on 12/31 or 1/1. Why is June 30th important

Hybrid Premium Audits Good Bad Points With Technology Assistance

Hybrid Premium Audits May Become Future of Audits (Almost) Most Hybrid Premium Audits on a Workers Comp policy are when the insurance company auditor asks for the material required to perform the audit without visiting the client’s business. As the Internet has made the flow of information much easier, hybrid

Workers Comp and June 30th – What Is The Big Deal?

Workers Comp and June 30th Critical Relationship I had posted the question last week on why June 30th is such an important day in the Workers Comp insurance cycle. The answer has two parts. Thanks for all the email inquiries everyone sent in last week. The largest percentage of Workers

What Is The Jones Act In Workers Compensation?

Jones Act – Workers Comp Concern The Jones Act, or Merchant Marine Act of 1920, was passed due to concerns about the legal protection of the Merchant Marine. Prior to the Jones Act, sailors who were injured on the job had few options for receiving damages. Now, injured seamen can

Hartford Pays $72 Million Fine For Exactly What – Administration Fee

Hartford Basically Pays Each Claimant Hartford pays $72 million penalty for an Annuity administrative charge. The Hartford was recently assessed a huge fine. I was surprised to see why the company was fined. It was for basically setting up settlement annuities (including Workers Comp) and charging a 15% administration fee

Sliding Scale Dividend Plans Are Loss Sensitive Policies

Sliding Scale Dividend Plans Definition In workers comp insurance, Sliding Scale Dividend Plans are established to return a portion of the premium to the policyholder if the losses are better than expected and a dividend is declared. This is a type of Loss-Sensitive Policy.   Loss sensitive policies have been know

Short Rate Penalty Expensive Choice To Change Policies Mid-Term

The Short Rate Penalty Eliminates Policy Hopping A workers comp insurance policy may be cancelled before the end of the policy period, but not without penalty. Most policies require a short rate penalty when a policyholder requests cancellation. The amount of the penalty is determined by a table of factors

Federalization Of Workers Compensation – Starts Now – Warning

The Federalization Of Workers Compensation I had coined the phrase Federalization of Workers Comp a few months ago. I was told that I was a tea leaves reader; black swan proponent; and other choice terms. No one would believe me when I warned the new Healthcare Legislation would be the

Is Employer’s Liability Really Needed in Workers Comp?

Employer’s Liability Part B on Policies Employer’s Liability Insurance is an additional part of Workers Comp Insurance policies.  While Workers Comp Insurance is designed to cover your employee’s medical and disability expenses, Employer’s Liability Insurance protects your company against lawsuits due to work-related injuries. Employer’s Liability Insurance covers work-related injuries

Disfigurement Benefits – How Are They Calculated?

Term of the Day – Disfigurement Benefits Most disfigurement benefits are for those who have suffered a work-related injury to the head or neck, resulting in a permanent loss of specific bodily functions, scarring and/or disfigurement. The scars must be located on the face or neck. This can result from

D Ratio On My Experience Rating Sheets – What Is It?

Term Of The Day – D Ratio A D Ratio is a variable used in a workers compensation experience rating plan. It is applied to the expected losses to determine what percentage of those expected losses are to be considered as primary losses within the rating formula. Once discovered, the

Is Pharmacy Benefit Management Useful in WC?

Term of the Day – Pharmacy Benefit Management Pharmacy Benefit Managers (PBMs) are one of the most widely used services in the US for prescription drug administration. They are third party and contract with pharmacies to negotiate discounts and rebates with drug manufactures. Today, more than 210 million Americans receive

Workers Comp Claims Adjuster – Defending Tough Job

Workers Comp Claims Adjuster Can Be A Tough Job The Workers Comp Claims Adjuster possesses a job that can be nerve wracking.  One of our services is to review files to see how the claims adjusting staff performed on a group of claims. I had recently read a LinkedIn post

Proximate Cause – Does A Bear Smoke Pot In The Woods?

Drugs vs. Proximate Cause The proximate cause of an accident may not always be that obvious in a WC claim. One area that Workers Comp insurance companies and self insureds spend a large amount of money to deny and defend claims is when an injured employee is deemed to have

Negligence In Workers Comp And Exclusive Remedy

Term of the Day – Negligence The Workers Comp term for today talks about the different definitions of negligence. I was taught this definition a long time ago and it has always stuck with me. Negligence= duty owed + duty breached – contributory. Dictionaries define it as “the failure to use

Governor Crist Vetoes Bill for Controlling Costs in Workers Comp

Governor Crist Vetoes Workers Comp Bill I wrote a post a few days ago on the recent veto of a promising Workers Comp bill by Florida’s Governor Crist. While he signed off on bills that would improve the Florida Department of Health and extend a controversial Medicaid managed-care pilot program,

Federal Terrorism Risk Insurance Act (TRIA) Cause Extra Premiums?

Federal Terrorism Risk Insurance Act The Federal Terrorism Risk Insurance Act appeared on Workers Comp policies since 2003. .Since the September 11 terrorist attacks, there has been a lot of concern over whether the insurance industry would continue to provide insurance for losses due to terrorism. So in 2002, congress

Is The ARAP Considered A Penalty For Unsafe Employers?

ARAP – Workers Comp Definition  ARAP charge appears on many policies. Over the past decade, various states have approved a new premium surcharge known as ARAP, Assigned Risk Adjustment Program. Massachusetts is an exception and here it stands for All Risk Adjustment Factor.  The charging structure is very similar. The

Florida Has Workers Comp Improvements Vetoed

Improvements Vetoed  – Workers Comp In Florida Workers Comp improvements vetoed in the Sunshine State. There has been quite a large amount of buzz in the Workers Compensation world in reference to Governor Crist’s veto of what looked to be a great piece of legislation for businesses in Florida. The



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