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Is Your Carrier or TPA Charging You For Their Mistakes?

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Carrier or TPA Overcharging You?

Your Carrier or TPA could be charging you for their mistakes.  Some state jurisdictions issue fines and penalties if state forms are not filed timely, if lost time benefits are not issued timely, or for frivolous litigation, etc.  This is a more common occurrence than in the past years as many states have added more rules on top of an already ominous amount of rules.  The number and amount of fines are increasing over time. 

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Workers Comp claims adjusting has become even more complicated than in the past.  States seem to be very motivated to fine carriers for new rules that have just been enacted.   The fining on the files also seems to be inconsistent from file to file.  

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.

Businessman Carrier or TPA With Heads in Hands
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Charging fines to the file under the expense category will only increase an employer’s E-Mod or increase the WC budgets for self insureds.  The fines are usually denoted in the Expenses as being paid to the respective states Workers Compensation Commission or Department of Insurance.  

One cannot assume these payments are always for fines and penalties.  The WC Commissions very often assess fees for certain processing in the file. 

Some of the fines and penalties can be very large or occur multiple times in a file.  Your loss runs may be the first clue if the Expense category seems to be very large or has a large number of payments.   For reference, the three categories of payments are Indemnity, Medical, and Expense.   

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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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