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Recent Florida Decision Make All Reserves Inadequate In Sunshine State?

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Florida Decision Could Cause Crisis

The recent Florida decision makes all reserves possibly inadequate.  The Florida Workers Comp Claim that was mentioned earlier this week shows how little the upper courts understand the intricacies of  certain Workers Comp claim systems.  There had been published cases by Supreme Court Justices that said they were enacting “social legislation.”

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If the Supreme/Appeals Court justices could step back and see what this will cause in the near future, I am not sure they would make the same rulings.  As in Florida, many states have had upper court decisions made that severely impacted the underpinnings of the respective WC systems.

In Florida, are now all claims with Temporary Total Disability benefits now going to be reserved at more than 104 weeks?  Is that really fair from one decision?   Were proper past  rates of premium paid with this decision now possibly causing the TTD limits to be raised from 104 weeks?

A great example of this actually occurred in North Carolina in 1994.   A North Carolina Supreme Court decision involving medical benefits caused a temporary Workers Comp policy and coverage crisis.  The decision said that all medical benefits for Workers Comp since 1938 could be reopened for medical benefits.    One Justice wrote a 16 page dissension.

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This decision caused:

  • More files to be reopened causing already overloaded claims departments to almost burst at the seams.
  • Benefits paid that carriers or rating agencies did not expect until the decision
  • Carriers struggled to recapture some of the premium as the time to charge premiums to each employer’s Mod had long passed
  • The big carriers stopped writing business in the NC
  • Self insured and alternative methods of insurance flourished
  • The Industrial Commission’s caseload increased sharply as ancient claims had a benefit reopened
  • Files that needed to be litigated were now in the mix with old medical benefit files causing delays.
  • File settlements on small medical files were rampant just to close them out.

The same situation may occur in Florida unless the Supreme Court overturns the decision.  The decision involved an injured firefighter – a public servant.

The case on its own single merits did seem to point to paying above the TTD limit.   When one looks at the forest, though, this single Workers Comp decision could cause a WC mess in Florida.

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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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