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Home » Archives for July 2014

Archives for July 2014

Ingress Egress Rules – North Carolina example – Confusing

July 31, 2014 By JL Risk Management Consultants

 Ingress Egress Rules

The Ingress Egress rules are confusing and controversial in North Carolina. Ingress-Egress is one of the most confounding sets of rules that employers, injured employees, adjusters, and WC courts face very often.  Ingress- Egress is sometimes also referred to as the “going and coming” rules.

Vector Graphic Of Ingress Egress Injured Worker

StockUnlimited

The definition of ingress is the act of entering a place or a way to enter a place. The definition of egress would be exactly- the opposite – a place or means of going out.  

The ingress and egress rules are also referred to as the “parking lot rules.”   The debate seems to start when a First Report of Injury is received in a claims department where an injured employee slips and falls on a sidewalk or parking lot.   


The ingress-egress rules are not limited to just parking lots and sidewalks.  Most of the serious ingress-egress rules can be stretched to vehicles.  


What happens if an employee is in a vehicular mishap:

  • On his/her way to/from work?
  • During a company errand?
  • In an employer-supplied vehicle?
  • While on the cell phone/texting?
Picture Of Ingress Egress Work Injury Claim Form

123RF

These will not be completely covered in this article, however, these are the questions company owners, risk managers, adjusters, and others in the WC industry should be asking themselves now, instead of post-accident. 


Usually, I can provide a blanket statement that covers most of the US.  This subject is too complicated to make any type of statement.   There are many court rulings in the same state that even making a blanket statement for one state is almost impossible. 


Deviation from the clear path is one of the terms that are very important to this subject.  If an employee is on a company errand and deviates from the clear path, the claims are often denied and contested.  Establishing a clear path can be a task with some routes.  


Using Google Maps, I decided to see what the clear path is from our offices to a local Italian restaurant.  According to Google Maps, (click on the link or here).there are three clear routes, depending on traffic.   Some GPS units will choose one or the other depending on traffic.  


A recent North Carolina Court of Appeals decision shows how complicated an ingress/egress or employee travel case can be when looking at all the facts.   You may have to register to read the article (sorry for the inconvenience).  


The bottom line is to know your state’s ingress-egress rules now even if they may be inconsistent. 

©J&L Risk Management Inc Copyright Notice

Filed Under: egress, ingress, North Carolina Tagged With: company owner, Deviation, GPS, post-accident, workers comp court

Discounted Experience Mod – West Virginia Blog Readers Question

July 30, 2014 By JL Risk Management Consultants

Discounted Experience Mod Likely A Rating Bureau Adjustment 

We received this email over the weekend concerning a discounted experience mod. The West Virginia company found the CutCompCosts blog on Google.

Cart With Discounted Experience Mod Vector Graphic

StockUnlimited.com

Our agent informed us that our E-Mod (Experience Modification Factor) for next year was going to be 1.29. When we received our policy quote the E-Mod was 1.03. Can the new E-Mod actually be correct? Did we receive a discounted Experience Mod for some reason? The question was paraphrased for readability as it was much longer. The answers are::

  • Something may have occurred between the time that your agent informed your company of the 1.29 E-Mod and the policy renewal.  This rarely happens. Your E-Mod was tallied six months before your policy renewal date.
  • Your agent and new carrier cannot arbitrarily discount your Mod at will.  I have never seen a premium auditor discount an E-Mod at the final premium audit.
  • NCCI – the rating bureau for WV-is the organization responsible for your E-Mod.
  • You may inquire with NCCI to see what your (and this is important) Final E-Mod for your policy was calculated for the corresponding year.
  • T
    Dollar Discounted Experience Mod Cash

    123rf.com

    he carrier’s premium auditor would adjust the E-Mod back to 1.29 at the final premium audit – usually 30 days after policy expiration.  This increase would cause your final premium bill to be much larger than expected with the lower E-Mod.

  • Carriers and in turn, agents sometimes make inadvertent mistakes.  It is advisable that you check with your agent and NCCI.

It is advisable for employers to always review their policies front to back. This WV employer likely saved itself a large premium bill by reading their WC policy and asking questions. Always read your old expiring policy when looking over your new policy to see if there have been any major changes. Surprises equal $$.

©J&L Risk Management Inc Copyright Notice

Filed Under: E-Mod X-Mod Tagged With: arbitrary, inadvertent mistakes, WV employer

Ohio’s BWC Provides 83.5 Moon Roundtrips Overcharging

July 28, 2014 By JL Risk Management Consultants

Ohio’s BWC Provides 83.5 Moon Roundtrips

Unsurprisingly, Ohio’s BWC (Bureau of Workers Compensation), a monopolistic state fund,  had  a very scorching court decision rendered

Picture of Gavel and Book Ohio's BWC Provides 83.5 Moon Roundtrips

Wikimedia Commons – howtostartablogonline.net

against it a few months ago.  Rather than keep appealing the Appeals Court decision, the BWC decided to settle with certain policyholders.

If you have not had the opportunity to read the decision, you should follow the link above and read the decision.  The judges lambasted Ohio’s BWC.   The BWC was on the hook for $845 million.

The BWC allegedly picked the companies for discounts on an almost random basis.  There was no tried and true discount structure as with all the other rating agencies including the NCCI and WCIRB.

The BWC was wise for not having the decision reviewed in the Ohio State Supreme Court.  The settlement seemed to be a split between $0 and the $845 million owed to certain policyholders.

How was the 83.5 moon roundtrips calculated?   According to WikiAnswers,  5,026,560 dollar bills, stacked end to end would cover a roundtrip to the moon.  So, $420 million would be 83.5 roundtrips to the moon ($420,000,000 / 5,026,560). 

Ohio’s BWC will likely rectify the situation to a point, but what of actually becoming a non-monopolistic state?

©J&L Risk Management Inc Copyright Notice

Filed Under: BWC, Monopolistic State Funds, Ohio Tagged With: Appeals Court, lambasted, WikiAnswers

First Aid Kit For Workers Comp Premium Savings – Seven Items

July 24, 2014 By JL Risk Management Consultants

Workers Compensation Premium First Aid Kit

A good Workers Compensation premium first aid kit contains seven main items.

Picture of Workers Compensation Premium First Aid Kit

Wikipedia – ProjectManhattan

One of the most popular questions we receive at presentations, emails, and social media is “How do we fix our Workers Comp situation  now?”   As mentioned often in this blog,  WC is a very delayed system.  Fixing your Workers Comp now will show fully in the results 3 -4 years in the future.

The seven items to include in your Workers Comp premiums first aid kit are: (clicking on each will bring up an associated article)

  1. Loss Runs – you have to know where you are financially on each claim.  Online loss run access is a very important part of fixing your WC wounds.  You cannot treat something if you do not know where it is located on your body.   There are many articles on loss runs in this blog.  Use the search box to find more on loss runs.
  2. Policies – these are similar to the little instruction manuals in first aid kits.  You have to know what is available in your WC first aid kit.  Policies are similar to the contents list in the first aid kit.   You need to read these BEFORE you have a WC problem.  As with Loss Runs, using the search box will list many articles on policies.
  3. Hand Holding Magnifying Glass Workers Compensation Premium First Icon

    StockUnlimited

    Experience Mod Sheets – Knowing the seriousness of the wound will point you to use the proper material.  Access to Experience Mod sheets has become much simpler over the last few years.  As an employer, you have the right to receive a copy of your E-mod sheets each year.  Most of the time, we have seen the sheets end up in the trash or being just filed away.

  4. Premium Audit Workpapers and Bill – the most lacking in what we see in everyone’s first aid kit.  Your true final result for the year is the FINAL premium audit.  How do you know how well your efforts have healed your program without the final results?
  5. Adjusters Contact Information – your WC adjuster should be thought of as a team member of the Risk Management, Finance, and HR departments.  If you do not have this information, you should go find it after reading this article.  Adjusters can be thought of as wound dressing.  Without them, the wound could become quickly infected.
  6. Medical Network (2nd Level) – sometimes the wounds become infected no matter what treatments are applied to it.  Knowing the first level  PCP’s (Primary Care Physicians) is good, but does the PCP know where to refer your injured employees for orthopedic, neurological, dental, vision, or other kinds of treatment?  You need to have this list at your fingertips.
  7. Vector Graphic of Workers Compensation Premium First Stethoscope with Money

    StockUnlimited

    Scans vs. Paper – your first aid kit needs to be accessible and organized.   Scanning the documents- if that is OK with your IT department -will easily organize your first aid kit.  You may need to treat a wound quickly.  Shuffling through piles of paper and/or numerous files may not be the best method.

There may be other items to include in your kit.  These seven will have you on your way to workers’ compensation premium savings.

©J&L Risk Management Inc Copyright Notice

Filed Under: Workers Comp Strategies Tagged With: Experience Mod Sheets, orthopedic, social media

Top Four Workers Compensation Definitions – Back To Basics

July 23, 2014 By JL Risk Management Consultants

Workers Compensation Definitions

There are many Workers Compensation definitions on the internet. I was recently interviewed by a college student on Workers Compensation for his term paper.   He had asked if he could reference articles in the blog, which of course I allowed him copyright permission.   

Picture Of Man Workers Compensation Definitions At Work

Wikipedia – Alfred T. Palmer

One question that he asked me is “What is Workers Compensation?”   I started reeling off info on underwriting, claims, premiums, state laws/rules, etc.  He then said, “No I was just wanting the basic Workers Compensation definitions . ”  

I was reminded that we in the WC world become so wrapped up on the technicalities and legalities that we should possibly take a step back and look at the basics.   I decided to google the definition of Workers Comp to see what results would appear.    

The theme that stands out is the lack of one true definition of Workers Compensation.  One can see why WC is a complicated subject even when trying to keep it simple. 

According to Investopedia:

A state-sponsored system that pays monetary benefits to workers who become injured or disabled in the course of their employment. Sick pay may qualify as workers’ compensation under certain conditions. Workers’ compensation first appeared in the U.S. in the 1930s and 1940s. 

The Legal Dictionary’s definition is very long and can be found here.

Merriam Webster’s Dictionary definition:  

 

Picture Of Merriam Webster Dictionary Workers Compensation Definitions In Library

Wikipedia – Noah1806

A system of insurance that reimburses an employer for damages that must be paid to an employee for injury occurring in the course of employment.  Program through which employers bear some of the cost of their employees’ work-related injuries and occupational illnesses or disabilities. It was first introduced in Germany in 1884. 

In Britain and the U.S. in the late 19th century, there was a movement to secure the right of injured workers to compensation and to improve working conditions through court decisions, employer liability statutes, and safety codes. By the mid-20th century most countries in the world had adopted some sort of workers’ compensation. Some systems take the form of compulsory social insurance; in others the employer is legally required to provide certain benefits, but insurance is voluntary. 

The system of workers’ compensation serves as an economic incentive for employers to prevent accidents and illness among employees, since liability for medical costs and the income lost by placing workers in hazardous environments can easily exceed the costs of establishing safe working conditions.

Wikipedia’ definition:

Workers’ compensation is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee’s right to sue his or her employer for the tort of negligence. The trade-off between assured, limited coverage and lack of recourse outside the worker compensation system is known as “the compensation bargain”.

©J&L Risk Management Inc Copyright Notice

Filed Under: Google, Tort Tagged With: definitions, internet, Investopedia, monetary, social insurance, state laws

Converting to Self Insurance – Five Important Considerations & Alternatives

July 17, 2014 By JL Risk Management Consultants

Converting to Self Insurance – New Tasks To Accomplish

Converting to self insurance is a very popular option for many companies.

Picture Of Hand Converting to Self Insurance With Plan And Coins

Wikimedia Commons – 401(K) 2012

We receive many inquiries every year from employers that wish to cover to self insurance for their Workers Compensation coverage.  

The inquiries to our offices reached a fever pitch in 2002 – 2005.   Self insurance can save $$ for the right employer in the right situation. There are many considerations to analyze before converting to self-insurance.

 Five of the top considerations are:

  1. Your company or organization will have a new partner with a very close fiduciary relationship.   If you stop and think before you were just paying an insurance premium and letting the carrier handle the claims.  You will have an outside company – Third Party Administrator (TPA) spending directly out of one of your bank accounts.  In other words, the method you use to monitor the claims must change overnight.
  2. With self insurance, you lose the ability to absorb many claims or a few large claims.  Unless your company or organization has a large insurance budget,  this can severely impact your budget.  The buffer of the insurance policy and the E-Mod system is no longer yours.   Reinsurance may help to a certain degree.
  3. You have to calculate your own E-Mod better known as the Loss Development Factor (LDF).   The outlook in the E-Mod system is up to four years in the past.  LDF’s survey a 10-year period.  Your LDF may not match your old E-Mod.   If your organization is self insured and you do not know your LDF or have not had one calculated, your insurance budget is no more than a bad guess.
  4. The state requires certain minimums to be self-insured.   There is a reason for these minimums.  The minimums keep your company afloat if #2 above occurs in your insurance budget.
  5. There may be less expensive and risk-averse alternatives such as:
    • Gray Shield Converting to Self Insurance With dollar Icon

      StockUnlimited

      Large deductible plans- are very popular with companies that want to retain some, but not all of their WC risk.

    • PEOs – becoming very popular with mid-sized employers and companies with high E-Mods.
    • Small deductibles-I have not seen  a very significant amount of savings in these plans
    • Captives – becoming more popular due to flexibility, they do carry a certain amount of unique risk

The #1 concern with an employer converting to self insurance is #2 from above.   Congrats as your company are or have grown in a tough economy.  Patience and risk diversity such as PEO’s are the keys.   Even though your company may be in line to be self insured in the future, now may not be the best time.

©J&L Risk Management Inc Copyright Notice

Filed Under: self insurance Tagged With: bank accounts, fiduciary, Loss Development Factor

Small Deductible Policies Worth It? – NCCI – Varies by State

July 16, 2014 By JL Risk Management Consultants

Small Deductible Policies

Using small deductible policies can be a great cost-saving technique in some states. One of the long standing assumptions I had made was that small deductible policies really did not make that much of a difference to the cost of a Workers Comp policy.  Small deductible policies had a deductible in my observations of $2,500 or less.

Picture Of Coins Dropping Into Piggy Bank Small Deductible Policies In Blue Background

StockUnlimited

NCCI (National Council on Compensation Insurance) recently performed a study on small deductibles.  They considered a small deductible to be $25,000 or less.  I had not really considered a $25,000 deductible as small.   NCCI had split their analysis as:

  • Small – $1 to $24,999
  • Medium  – $25,000 to  $99,999 
  • Large – $100,000  and up 

There are three main definitions that should be pointed out:

  • Frequency- number of claims over a given time period
  • Gross of claims- certain states do not allow the removal of the deductible when reporting values  to NCCI or other rating bureaus for E-mod calculation
  • Net of claims – certain states allow the removal of the deductible when reporting values

One would have to conclude the net of claim states would actually have more of a benefit that the states with gross of claims.  The gross of claims states indirectly devalue the effect of having a small deductible. 

The three main conclusions drawn by NCCI were:

  1. As expected employers with high frequencies chose small deductibles – or did the carrier force the higherrisk employer to take a deductible before they would cover their business or organization?
  2.  Contractors and employers in the most hazardous group (Group G) selected small deductibles more often than other industries or as in #1, did the carriers require the employer to have some type of deductible before being underwritten? 
  3. A significantly greater number of employers select small deductibles in states that mandate the use of losses net of the deductible than states that mandate the use of losses gross of the deductible. 

Conclusion #3 makes great sense as the employer would want the deductible amounts taken out of the E-Mod calculation.  This would seem to be a very large incentive.  

 

Picture Of Businessman Receiving Small Deductible Policies Bag Of Money

StockUnlimited

The net of deducible states are:

  • Alabama  
  • Colorado 
  • Georgia 
  • Hawaii 
  • Idaho
  • Iowa  
  • Kansas 
  • Kentucky 
  • Maine  
  • Missouri 
  • New Mexico 
  • Oklahoma 
  • Oregon  
  • South Carolina 
  • South Dakota 

The gross of deducible states are:

  • Alaska
  • Arizona
  • Arkansas 
  • Connecticut
  • District of Columbia
  • Florida 
  • Illinois
  • Indiana 
  • Louisiana
  • Maryland
  • Mississippi
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • North Carolina
  • Rhode Island
  • Tennessee
  • Texas- with exceptions
  • Utah
  • Vermont
  • Virginia 

©J&L Risk Management Inc Copyright Notice

Filed Under: NCCI, small deductible Tagged With: deductibles states, frequency, hazard group, incentive, mandate, net of claims

NCCI Updates Website User Friendly – Hidden Enhancements

July 15, 2014 By JL Risk Management Consultants

NCCI Updates Website

The NCCI updates website with many improvements.  Actually, the NCCI has updated their website often in 2014.  The much-appreciated upgrades were long overdue.  

Picture of NCCI Updates On Computer

123RF

Some of the upgrades were:

  • RiskWorkstation 
  • Manuals Library
  • Policy Data Reporting
  • Data Manager Dashboard

All of the updates or enhancements come with a webinar which covers the updates and enhancements.  As we all know, upgrades and updates sometimes overdo their intended purpose.  NCCI did not change things so much that navigation of the website was the least bit confusing.  The navigation was similar to the old website.

Unlike most websites, the webinars are actually chock-full of great information and very easy to navigate.  Webinars are becoming the bane of web user, but not in this case.

One of the big enhancements is for Google Chrome and Firefox  web browser users.  Many web savvy user now use these two web browsers.  One of the most complex uses of NCCI’s website was the browser requirement of Internet Explore only.   This was due – without sounding too geeky- to most of the NCCI website being built on frames.   This was a reliable but very old way to program websites.

The complexity kicked in when I had to have Internet Explorer, Chrome,  Adobe (PDF), and Microsoft Word or Excel open when working on the NCCI website.  Internet Explorer would crash so many times that on some days, NCCI was unworkable.  One very interesting was that NCCI seemed to work the best with Windows XP.

In case you are interested, you can find Chrome here and Firefox here.

Google Chrome NCCI Updates Graphic

Wikipedia – Google

The NCCI website now seems to work with Chrome and Firefox.  The upgrades may not work with all of the website, but so far so good.

One nice update is the pricing any data such as E-Mods or Worksheets is very transparent.  If you do not have a username and password from NCCI, a large portion of the website can be reached by the general public.

©J&L Risk Management Inc Copyright Notice

Filed Under: NCCI Tagged With: dashboard, manual library, policy data

Independent Medical Exam (IME) Dozen Mistakes To Avoid

July 9, 2014 By JL Risk Management Consultants

Independent Medical Exam (IME) Mistakes – Dozen Blunders

An independent medical exam can make or break a WC file. Yesterday, I wrote a list of the Top 10 Ways that IME’s can harm a WC file.  The first five from the article are covered more in-depth today.      These Independent Medical Exam suggestions may not fit all files in all states.

Logo of independent medical exam Medical Company

(c) 123rf

  1. Can backfire if the claim is from a state that allows directed medical care.  If you have an employer-directed care state, then the IME is basically a 2nd opinion on your own opinion.   Obtaining a 2nd surgical opinion is a different matter.   Establishing a physician treatment network and using it will avoid IME’s on your own directed care.   The injured employee should be receiving treatment from your approved medical providers when using the treatment network to its fullest.
  2. Performed on a very old claim with no prior IME’s.   Waiting for years to schedule an IME will lessen the validity of the exam.  How can one expect to question a physician’s opinion or treatment plan with a single out-of-date IME?   The treating physician has been seeing this patient for years.   How can one appointment question a long-established treatment plan?  The WC courts usually detest seeing these and will usually rule with the treating physician’s opinion.
  3. Not discipline-specific – if the treating physician is, for example, a neurosurgeon, the best IME will be provided by another neurosurgeon.   An orthopedic opinion may not necessarily hold the same weight.  There are so many IME physicians available in most parts of the country.
  4. Picture Of Nurse Independent Medical Exam Writing On Paper

    Wikipedia – goodcatmum

    Takes the claim on a tangent – there are files where the IME physician identifies non-related medical conditions and has other incorrect info that is actually written in the IME report.  See #5 for how to avoid having an IME actually causing more problems than it helps prevent overall.   These do happen now and again and are sometimes unavoidable.

  5. Starts with one of those form letters – not good.   Spending a large amount of time and money can be easily fettered away by using a form letter.   The specific information needed may not be enumerated in a pre-filled form letter.  As there is so much on the line with an IME,  a letter that covers the file and medical history is a great idea.  The physician should not be solely relied upon to come up with a report without some input in the IME appointment letter.   Sending a form letter for an IME will raise the risk of #4 occurring on the file.  Ask the questions you want to be answered by the IME physician.
  6. The IME physician may not like the fee schedule – some states allow the fees to be negotiated directly without using the fee schedule.   This may be a good idea as nothing can sour a relationship with an IME physician that feels shorted in what they were paid to see the injured employee.  Do not assume the IME physician will just accept a set amount.  This should be negotiated upfront and please do not wait 60 days to pay for the IME appointment.
  7. The court has seen reports from the same physician too many times.  WC umpires, judges, and commissioners are very adept at noticing a trend where a certain employer, carrier, or TPA (Third Party Administrator) sends all of their inured employees to the same IME physician.  That is not a trend you want to establish overall.  There are so many IME physicians to choose from in most areas. 
  8. The treating physician is not informed an IME has been requested for a 2nd Opinion.   An act of great courtesy is to inform the treating physician that you are requesting an IME.   Almost all physicians will not take offense, especially if the IME is a surgical second opinion.  In fact, the treating physician’s office may even recommend an IME physician.  The relationship between the carrier/TPA/employer and the treating physician is very important to return the employee to work as soon as practical. 
  9. Does not have all the medical records included with the IME request letter.  This is a big potential mistake as the IME physician is going to base a large proportion of their opinion on a review of the medical records.  One of the most overlooked types of medical records is the radiological studies.   The review of the medical records that accompanies the IME appointment letter is beyond crucial.  Leaving out one report can take a file down the incorrect path very quickly.  
  10. Is rushed so heavily the IME physician is not given time to review records and do a full report.  An appointment should be scheduled far enough in advance to give the IME physician record review lead time.  Copying/scanning the records and writing the proper IME letter (an art) takes time if done properly.

    Picture of physician and Man Mistakes To Avoid on IMEs Concept

    123RF

  11. Bonus – Not involving the rehabilitation nurse– Most rehab nurses will know who the best physician in the area for the type of IME that you have requested for the injured employee.   The rehab nurse is invaluable in these instances.  If she/he has a working relationship with the IME physician’s office, that is golden for having successful IME.   The injured employee will also likely heavily trust the rehab nurse’s recommendation. 
  12.  Bonus –  Sloppy records- See #9 above – the easier you can make the review of the medical records for the IME physician, the better the results for all involved.   Ordering the notes from oldest to newest is a great idea.  Using tabs will also result in a better IME appointment.
  13. Bonus – Not following up for the results – in some of our recent file reviews, we noticed that the adjuster may forget to follow up to discover the results of the IME.   Waiting for the report to arrive may delay any file developments for 4 – 6 weeks.    We have noticed that many adjusters are not diarying the IME follow up actions such as reviewing the IME report or even requesting it.  Do not rely on the IME physician’s office to forward the report.  

Please note that each state has its own rules on Independent Medical Exams that should be followed.  These two lists were just general recommendations. 

©J&L Risk Management Inc Copyright Notice

Filed Under: IME, Independent Medical Exam Tagged With: backfire, medical care, tangent

Independent Medical Exam (IME)- 10 Ways To Harm File

July 8, 2014 By JL Risk Management Consultants

Independent Medical Exam (IME) Can Easily Blow Up A File

An Independent Medical Exam is one of two-edged swords in WC Risk Management.  One of the most controversial and fund-leaking Risk Management techniques for Workers Compensation is the Independent Medical Exam (IME).

Picture Of Clip Paper Touch Independent Medical Exam Paper

123RF

This list is not just for adjusters.  Anyone that comes in contact with the process should keep the following list in mind.  IME’s are a great tool when used properly.  IME’s are also one of the riskier techniques to control WC costs.   A few considerations before scheduling an IME are listed below.   The most detrimental to the WC file is an IME that:

  1. Can backfire if :the claim is from a state that allows directed medical care.
  2. Is performed on a very old claim with no prior IME’s
  3. Is not discipline-specific
  4. Takes the claim on a tangent
  5. Starts with one of those form letters – not good
  6. The physician may not like the fee schedule and wants to be paid more than the CPT code allows – touchy subject

    Stethoscope Independent Medical Exam Picture

    StockUnlimited

  7. The court has seen reports from the same physician too many times
  8. The treating physician is not informed an IME has been requested for a 2nd Opinion
  9. Does not have all the medical records included with the IME request letter
  10. Is rushed so heavily the IME physician is not given time to review records and do a full report

This article was going to be an all-in-one analysis.   The article would have been too long if each was of the 10 was enumerated now.  There will be two follow-up articles as this is a very important WC risk management consideration.

An Independent Medical Exam can be the most expensive and time-consuming risk management techniques on a Workers Compensation file.   Following the above list should help in avoiding the pitfalls.

©J&L Risk Management Inc Copyright Notice

Filed Under: IME, Independent Medical Exam, Risk Management Tagged With: CPT, detrimental, pitfalls, tangent

Top 10 Industry Gender Pay Gaps – Double Shocker 2 Insurance Related

July 3, 2014 By JL Risk Management Consultants

Top 10 Industry Gender Pay Gaps – Two Insurance Related (?)

Any gender pay gaps should be a concern to that industry.

Another holiday is upon us. I had already written two articles this week. I decided to Google what other subjects to write about just before a holiday. One of the best online newspapers on earth is the Daily Mail out of the UK. The Daily Mail provides an outsider’s objective view to what is happening in the US.  

Drawing Of Gender Pay Gaps Graphic

StockUnlimited

I came across this shocking article on gender pay gaps. Even though the article was over six months old, it was still relevant.   The original article from another publication can be found here.  The original article – a great analysis delves much more into the gender pay gap.

The industry with the highest gender pay gaps was Insurance Agents along with the #10 rated industry as Claims Adjusters and Examiners.  

Female insurance agents made less than 2/3 of their male counterparts.  The number of female vs. male workers in this area are basically the same.  

Women claims adjusters/examiners made less than 70% of their male counterparts even though as of 2012,  women held nearly two thirds of the jobs in these professions.   

I, or the articles, did not explore the reason for the gender pay gaps.   The full list is enumerated below.  

1. Insurance

Women’s wage as pct. of men’s: 62.5%

 

2. Retail

Women’s wages as pct. of men’s: 64.3%

 

3. Real estate brokers and sales agents

Women’s wages as pct. of men’s: 66.0%

 

Man And Woman Gender Pay Gaps Arm Wrestling

StockUnlimited

4. Personal financial advisors

Women’s wages as pct. of men’s: 66.3%

 

5. Education administrators

Women’s wages as pct. of men’s: 67.2%

 

6. Physicians and surgeons

Women’s wages as pct. of men’s: 67.6%

 

7. Marketing and sales managers

Women’s wages as pct. of men’s: 67.7%

 

8. Security, commodities and financial services sales agents

Women’s wages as pct. of men’s: 69.1%

 

9. Inspectors, testers, sorters, samplers and weighers

Women’s wages as pct. of men’s: 69.2%

 

10. Claims adjusters, appraisers, examiners and investigators

Women’s wages as pct. of men’s: 69.3%

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Agent, claims adjuster Tagged With: Daily Mail, Educate, examiner, gender, inspector, retail, security, sorters

Insurance Industry Employment Numbers – Better Than Last Year

July 2, 2014 By JL Risk Management Consultants

Insurance Industry Employment Numbers Still Not Great Figures

In late 2012, Workers Compensation insurance industry employment was stable. The numbers for Workers Comp actually were mixed in with property and casualty. A few insurance industry employment areas have actually reduced greatly over time.  Some of the reduction was due to the Bureau of Labor Statistics reclassifying certain lines of employment in the insurance industry.

The actual numbers of insurance employment has actually stayed the same for the last 15 years. The total number of insurance workers has totaled between 2.3 – 2.4 million during that time.

Third Party Administrator (TPA) employment has been a bright spot as the numbers have grown over the last twenty years steadily. Self insurance and other market drivers have caused this steady growth.

Two other bright post in the insurance employment numbers was the increase for brokers and  the health carrier segment – up 2.7% and 4.8% respectively. One has to assume the Affordable Healthcare Act was partially responsible for the growth in the health carrier segment.

The one area of concern may possibly be the life insurance segment. According to the Insurance Information Institute, the segment has declined a large amount over the years and has declined once again.

Diagram of Life Insurance Industry Employment U.S

(c) slideplayer.com

 

©J&L Risk Management Inc Copyright Notice

Filed Under: BLS Tagged With: Insurance Information Institute, market drivers, Third Party Administrator

Shocking Insurance Industry Numbers – 25% Gone By 2018 – Brain Drain?

July 1, 2014 By JL Risk Management Consultants

Insurance Industry Numbers Show 25% Drop In Employment

The following are insurance industry numbers that should be very concerning to the insurance world. A very short but chilling article pointed out a few numbers of the upcoming insurance company personnel crisis.  By 2018, 25% of all insurance company personnel will retire.

Picture of Insurance Industry Numbers Gun Gesture with Insurance Concept

StockUnlimited

That is a hard number to believe in this article.  I checked and the Bureau of Labor Statistics (BLS) and the article were correct. The average insurance professional is 45 years old.   That seems to be a very stark number.  This article shows the microcosm of insurance, risk management, and safety personnel in North Carolina.  Even though my observation of the age gap was made in a bar, the same theory applies overall.

The insurance industry numbers do not really reflect a brain drain, but instead, an age and experience drain.   One of the more interesting numbers from the aforementioned article is that only 5% of the millennials have expressed an interest in working in the insurance industry.

Usually, every crisis has a silver lining.  Due to the increasing level of technology, there will be a large number of job openings in the insurance industry including:

  • Customer Service Reps
  • Sales agents
  • Business Analysts
  • Claims Adjusters
  • Underwriters
  • Actuaries

There will be 220,000 more jobs in the insurance industry in the next 10 years.   The personnel to work in those jobs will come from an unknown source.  Usually, if there are not enough qualified recruits, then a brain drain will occur which will make the insurance industry and their customers suffer through having lower quality workers.

©J&L Risk Management Inc Copyright Notice

Filed Under: millennial Tagged With: Business Analysts, Customer Service Reps, Sales agents

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James J Moore
Raleigh, NC, United States

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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