The workers comp insurer reserves sometimes hide a reserve deficit. AM Best released a report on May 2nd that was startling to me. Of the 11 insurance companies that failed, nine were due to inadequate reserves and pricing. The carriers were not necessarily Workers Compensation insurers.
StockUnlimited
Reserves that are too low on your Workers Comp claims can be as harmful to your Workers Comp budget as reserves that are too excessive. I have dedicated a portion of this blog on how to lower your company’s Workers Comp reserves.
As I have said very often in presentation, the Workers Comp claims adjuster walks a tightrope between excessive and deficient reserves. When I post about reserves, I am actually referring to (Total Incurred – Paid).
How do deficient reserves harm your Workers Comp budget? I will break it into two parts – regular Workers Comp policy and self insurance.
There is nothing wrong with making every effort possible to lower your workers compensation reserves with risk management techniques such as a return to work program, etc. Having deficient reserves on certain claims can cause a huge unexpected reserve increase. This can cause a very large increase in your E-Mod that your company was not expecting.
StockUnlimited
One of the main signs of this is a major claim where the outstanding reserves on your loss runs are approaching zero. For instance, if a claim has a back surgery pending and the reserves are very low, you can expect an increase in the reserves. Timely increases in reserves sometimes functions are a red flag that something major is going on in your Workers Compensation claims.
My advice is to never call or email your adjuster about having deficient reserves. I would just make sure that you have analyzed the reserves and are properly budgeted for an E-Mod increase. The timing of the reserve increases is very critical to your Workers Compensation budget.
Self Insurance – critical
One of the main ways to wreck a self insurance program is with deficient reserves. I have also seen this when handling claims from a self insurance risk pool. This is one of the major misunderstandings by clients that we have assisted in becoming self insured.
Low reserves in a self insured or a large deductible will kill the program. If the reserves are deficient, then a self insured company may be under the impression that all is fine with their Workers Compensation budget.
Wikimedia Commons – 401(K) 2012
With self insurance, the employer may not necessarily have an E-Mod, but you should have a LDF (Loss Development Factor) calculated each year for your program to assess its health. Most self insureds budget their Workers Compensation yearly.
If you are looking at your reserve figures from last year to set your budget, how much of an impact would 20% of your claims not being reserved for upcoming surgeries? You have budgeted for payouts of for instance $2.6 million and you actually have a hidden risk of another $900,000?
Having an outside consultant company such as ours – shameless plug – perform a statistical analysis of the reserves and claims would show the true amount you need to budget for your present and future claims.
The easiest way to spot the lower workers comp insurer reserves and deficiencies is to be very involved with your claims process. As I have said at least 20 times in this blog, having online access to you claims and claim reserve figures is golden. Quite a few carriers allow you to run ad-hoc reports, which is the best way to find the files with deficient reserves.
Both self insurance and regular commercial policies suffer heavily with the term – stair-stepping.
California Insurance Carriers Update Allstate Says No New HO Policies Two California insurance carriers are now not writing new policies in certain lines of insurance.
2023 Medical Price Index – WCRI – Annual Free Thorough Comparison Study If you go to WCRI’s (Workers Compensation Research Institute) main page, you should
Ergonomics Expert Post-Pandemic Q&A @ Mindy Smith, MEng, CPE During the pandemic, I wrote an article based on a great at-home ergonomics article written by
Workers Comp Field Case Managers Post-Pandemic Critical Claims Component Workers Comp field case managers, also known as rehab nurses have become even more critical in
Workers Compensation Claim Reserves Difference Among Carriers and TPAs Most Workers Compensation Claim Reserves begin when the data input division of a carrier sets the
Final Claim Reserves Set Earlier Than Expected The final claim reserves are set much earlier than one might expect in the reserving process. Most adjusters
$250,000 Claim Reserve Level Creates Many Critical Responsibilities The $250,000 claim reserve level causes many necessary actions. Some of them are obvious. The other not-so-obvious
James founded a Workers’ Compensation consulting firm, J&L Risk Management 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
