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Late Reported Claims Info = Increased Mod and Premium

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Late Reported Claims Info by Carrier Can Cause E-Mod Increase 

Increased Mod and Premium were due to Late Reported Claims Info from insurance carrier employer.

We received this emailed in question over the weekend.  The business owner was not very happy about receiving a policy amendment and bill during the policy.

Picture Of Man Checking Time Late Reported Claims Info With Woman Walking
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My agent just informed us that we are receiving an increased bill due to a policy adjustment as one of the carriers on our state rating bureau (NCCI in this case) was very late in reporting our claims information to the rating bureau.  Is this allowed?   Do we owe it?

The answer without going into policy specifics was actually yes.  The actual date the Mod E-Mod or X-mod) was promulgated six months before the policy ended will apply to the next policy period.  This is called the Unit Stat date.

However, the insurance carriers and state Workers Comp departments are allowed quite a bit of slack on these dates.  The insurance carrier can report the claims information up to nine months late or three months into your next policy with usually no retribution of any kind.

I always think that the insurance carrier should be fined for running so late.  There are some instances such as carrier insolvency; employer not allowing audit, and others where the carrier is not actually 100% at fault.

Man Hand Holding Late Reported Claims Info Paper
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Some carriers are habitually late.  We have a large multi-state client that has experienced 44 rating changes due to carrier late reporting and certain states’ Workers Compensation departments both filing late with the rating bureaus.

If, which is not the case in this instance, your Mod was adjusted after three months into the policy would be a cause for further investigation.  There is a slightly complicated formula on late reported Mods that needs to be used in these instances.

Also, if your company receives a Mod reduction, there will be a credit to the policy that will very likely be settled up at premium audit time.

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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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