Archives for February 2016

Workers Comp Policy Includes Five Important Parts To Remember

February 24, 2016 By JL Risk Management Consultants

A Workers Comp Policy Is Similar To All Insurance Policies

A Workers Comp policy has five parts to it. Each part of the policy is important. Some are more important than others, but all part of a policy should be read, even if it is slightly boring.

StockUnlimited

The five parts of the policy can be more easily remembered by the acronym DICEE:

Declarations

Insuring agreement (Inclusions)

Conditions

Exceptions

Endorsements.

The Declarations page can be thought of as the meat on the sandwich- unless you are a vegetarian. The most important parts of the policy are here. The Declarations are sometimes called the Dec Page.

If you sign a Workers Comp policy or any other policy without reading the Dec Page, you may be in for surprises down the road. Unless your company has a large number of locations or classification codes, it will only take a few minutes to read it over. A highlighter is the best for paper. Most PDF readers will also allow you to highlight any passages.

StockUnlimited

If you find anything on the Dec Pages that you question, then highlight it and contact your agent. If you follow this link > Dec Page, then you will be able to see what is included in it

The other part of the Workers Comp policy that we receive the most questions concerning is the Endorsements. Endorsements can be added during the policy year (with a few exceptions) that can change the policy. Follow this link to read more concerning Endorsements.

Any time that you receive an Endorsement it should be read in full. If you do not understand the Endorsement, contact your agent. We have seen up to 30 endorsements in one policy year on a larger account. Think of the Endorsements as an Appendix that modifies that policy.

These two areas of the policies seem to cause the most concern with employers. You may also Google any term that you see in a policy as there are multitudes of explanations online or use the search box on our blog home page.

©J&L Risk Management Inc Copyright Notice

Mobile Site Is Fixed – Dates Corrected – Full Access To 1,625 Articles

February 18, 2016 By JL Risk Management Consultants

Cutcompcosts.com – J&L Risk Management Fixes Mobile Site

Our mobile site was malfunctioning. Thanks for the many emails letting us know something was amiss. We researched the problem and corrected it. We were using date suppression software to allow for easy searching that totally whacked the mobile system. At the sacrifice of our URL’s, we decided to keep the mobile website.

Picture of Man Checking Mobile Site with Cell Phone

StockUnlimited

All the article dates were showing on January 1, 1970. I am guessing that the default date is what WordPress defaults to when no clear date is provided.

If you have not tried it, check out our mobile site on your smartphone, Ipad, or similar device. Just open cutcompcosts.com and it will default to the blog. We have been mobile compliant for a year.

We decided to keep the interface very simple to use. Please drop a note to [email protected] if you have any suggestions for improvements.

If anyone would like to know the provider we use for our mobile site, please email me for the company name and website. I try not to advertise any services directly in the articles.

Update 2020 – J&L decided to switch to a provider that makes the site much easier to read – prose style.

©J&L Risk Management Inc Copyright Notice

Hawaii Monopolistic State Fund – Shocking Possibility

February 17, 2016 By JL Risk Management Consultants

The 50th State May Create Hawaii Monopolistic State Fund

The idea of a Hawaii Monopolistic State Fund may not just be a subject tossed around by Workers Comp aficionados. A new piece of legislation referred to as House Bill 2715 may change the Hawaii WC landscape permanently. Please remember HB 2715 is quite a few steps from being enacted including surviving a veto by the Governor.

Picture of Hawaii Monopolistic State Fund Map

123RF

The shocker is that all the states that have decided to switch from a monopolistic state fund to more of a regular insurance market discovered paydirt for the employers. Nevada and West Virginia are among the successful transitions from monopolistic to the regular marketplace.

You can find the Hawaii Monopolistic State Fund bill here > HB 2715 . It is a .PDF file. It may be worth downloading to follow along with my analysis or to read on your own. The first part of the bill is original. The second part amends older legislation.

My curiosity overcame me and yes, I had to read this complete bill. Some of the more interesting passages from the bill are: (my comments are in italics)

Page 1 Line 12 – The workers’ compensation law includes certain statutory presumptions that place on the employer the burden of producing substantial evidence to the contrary to rebut a claim for a covered work injury. Despite this presumption, recommended medical treatment or vocational rehabilitation plans are delayed or arbitrarily and capriciously denied; approved services provided by medical or other healthcare professionals go unpaid; and there is a reluctance to accept workers’
compensation cases for fear of being denied reimbursements, all of which contribute to a dysfunctional health care system that cannot rehabilitate the injured worker.

Woman Pulling Hawaii Monopolistic State Fund A Giant Briefcase

StockUnlimited

A state fund is going to solve this concern or add to it?

Page 7 Line 15 – An employer with two or more lost-time claims greater than $10,000, and a loss ratio greater than 1.0, over the immediately preceding three years shall be placed in the high
risk division.

That is not the definition of a high-risk employer.

Page 8 Line 16 The contingent liabilities of members provided in section 431:4-317 may be separated so that members assigned to the high risk division have a further contingent liability for deficits in the high risk division; provided that no contingent liability shall be in the aggregate for more than five times the annual premium rate of the member’s policy nor for a term of more than one year.

Does this mean a 500% addition to an employer’s premium? Ouch – if I am reading that passage correctly.

Interestingly enough, the bill has been voted on twice.

©J&L Risk Management Inc Copyright Notice

James J Moore To Conduct Insurance Academy Webinar February 25th

February 11, 2016 By JL Risk Management Consultants

Webinar – Destroy Your Competition Using Workers Comp Loss Runs

James J Moore, AIC, MBA, ChFC, ARM founder of J&L Insurance Consultants, J&L Risk Management Consultants, and Cutcompcosts.com will conduct an Insurance Academy© Webinar on February 25, 2016 at 1:30 PM Eastern Time. The link to sign up for the webinar is here.

The webinar titled – Destroy Your Competition Using Workers Comp Loss Runs is an hour long (including 10 minutes for questions) look at how claims loss runs can be viewed as a treasure trove of information that will put agents ahead of the competition in the area of devout customer service.

These techniques can be implemented whether the client is a first-dollar insured; large-deductible, self-insured, or other type of insurance program.

According to the presenter – “Workers Comp loss runs have long been ignored or briefly scanned for information. Many areas of loss runs jump off the page to the trained eye. ” Mr. Moore also commented “The webinar is not only for agents. Claims adjusters, underwriters and most insurance personnel will find the webinar helpful in this oft ignored area.”

StockUnlimited

The general topics are:

Online vs. paper loss runs
Verifying the minutia
Status reports
Loss run timing
All-or-none reviews
Top 13 adjuster responsibilities
Claims reserving cycle
Authority levels
Number secrets – Elvis’s Gold Cadillac Conundrum
Stair-stepping
Under-reserved vs Over-reserved
Loss run example(s)
Three main cost areas
Time and expense billings
Fines
Rehabilitation and bill review charges
Team Approach

Loss run examples will be supplied to cover the aforementioned topics with specific examples. A claims veteran of 28 years with a working knowledge of adjusting in over 45 states will walk the participants through a process that can easily be followed long after the webinar.

According to Mr. Moore, “This webinar will be a great accompaniment to the upcoming team building strategies webinar in July 2016.”

©J&L Risk Management Inc Copyright Notice

Answers To Workers Compensation Questions – Outside US

February 11, 2016 By JL Risk Management Consultants

Answers To Workers Compensation Questions

The answers to workers compensation questions below are from this Cutcompcosts article from last week. The theme is Workers Compensation Outside the US. Follow the link to the original article for the questions. Thanks. The pic has nothing to do with WC. I just liked it. The pic is from a local animal rescue conservatory that I visit often- that is the famous Arthur the Tiger.

Picture Of White Tiger Workers Compensation Questions Arthur The Tiger

Wikimedia Commons – ConservatorsCenter:

Yes, China does have a Workers Compensation system. The system is a monopolistic system as it is administered by the central government. It is similar to our Social Security Disability system. The benefit calculations are more complicated than the US. The treating medical system seems to have an element of corruption throughout.
The coverage is called USL&H (United States Longshore and Harbor Workers Act) There are a different set of rules for this coverage. In fact, the US Department of Labor has a complete chapter (Chapter 18) devoted to this coverage. The states cannot modify the Federal Act. The states, however, may have their own maritime WC laws on a state level. Interestingly, certain employees have the choice of filing under the State Act, Federal Act, or in California, under both.
StockUnlimited
The Jones Act is very important to claims adjusters, underwriters, and agents. Inland navigable waters can be a river, lake, or other bodies of water. Some Workers Comp agreements and policies may exclude this coverage. The Jones Act is federal legislation that protects American workers injured at sea. There is much confusion over where. Also referred to as the Merchant Marine Act of 1920, this law allows qualifying sailors who have been involved in accidents or become sick while performing their duties to recover compensation from their employers. Pursuant to the act, negligence claims can be brought when an injury results from the careless acts of an employer or coworker. Ship owners can also be liable if an accident is caused by the unsafe condition of their vessel. And no matter how or why a sailor was injured, certain medical and living expenses must be paid.
The Defense Base Act (DBA) is a different set of Workers Comp rules/laws for persons in any branch of the Armed Forces while on base and certain subcontractors. As the DBA can be complicated follow this link to a Cutcompcosts article on the DBA.
StockUnlimited
Employers do not necessarily have to buy Foreign Voluntary Workers Compensation coverage. However, it may be a good idea and will lower your WC risk as an employee that is injured in a far off venue may have basic coverage provided by their home state. There are many complexities to an international WC claim that are not foreseen by local WC rules. A few years ago, J&L assisted an employer that had an injured employee in an island country. The claims process became very messy as there was no voluntary coverage.
No, Workers Compensation actually started by ancient Sumerians. They even had Permanent Partial Disability payments (PPD)! These laws were found on ancient tablets. This predates the Wisconsin WC systems by thousands of years!
Does NCCI, WCIRB, and the other rate bureaus have special rates for foreign workers or countries? Bonus – Google
Do any countries provide 24-hour healthcare including WC for their citizens? Bonus – Google

On the last two answers to workers compensation questions, those I have left for you to explore. Google them and analyze the results. If you still cannot find the answers, drop me a note to [email protected]

I was going to finish the last two. The article is longer than the concise articles I like to write in this blog.

Workers Comp Articles – Outside of US

February 5, 2016 By JL Risk Management Consultants

Workers Comp Articles

The 1,530+ workers comp articles on Cutcompcosts cover some of the topics outside the US. I will try to cover more of those in the upcoming weeks.

StockUnlimited

The last workers comp questions and answers were very popular. Below are questions that pertain to WC outside of the US, so to speak. The links are provided to links in the blog and to external sources.

Does China have a WC system? Are the benefits similar to the US? Would it be considered a monopolistic system?
What is the WC coverage called if you are on navigable waters outside of or in the US? Is there a different set of rules for this coverage? Does each state have their own rules for this type of coverage?
What is the Jones Act? What type of injuries/locations does it cover? Why is it so important for adjusters and agents to understand this Act?
Is there a set of WC laws/rules for men/women in the Armed Forces while on base? What is it called? What is the main difference between regular WC and this coverage?
If you have employees who travel internationally, do you have to buy international WC?
Did WC actually start in the US? If not, then where and when?
Wikimedia Commons – Brian Kerrigan
Does NCCI, WCIRB, and the other rate bureaus have special rates for foreign workers or countries?
Do any countries provide 24-hour healthcare including WC for their citizens?

The answers are going to be entered into the next article on Monday or Tuesday of next week. Most of the answers are in the Workers comp articles on this blog. The last two will be more difficult as there are no links supplied to the answers.

Please think of the test as having 16 questions instead of eight. Good luck and remember to use Google searches if you cannot find the answers on this blog.

Hint: Question #6 was answered in the Q&A from earlier this week.

Work Comp Answers – See Article From Yesterday

February 4, 2016 By JL Risk Management Consultants

The Work Comp Answers

The Work Comp answers to yesterday’s cutcompcosts.com article are as follows – if you have not read the previous article, it is advisable to do so as this article may not make sense as a standalone. Links are provided to the associated articles

Concept of Work Comp Answers Q&A on Street Sign

123RF

What is workers comp called in Australia? – Compo
Where did WC originate – think a long time ago and not in the US – Ancient Sumeria
The best Workers Comp risk management technique is ____? Can be more than one answer. Properly managed field case managers/nurses is the one that I recommend overall. A trusted industrial-minded initial treating physician is another.
Who is always viewed as an impartial witness on WC claims? The treating physician
How many states allow carrier reimbursement for medical marijuana? Which state(s)? One – New Mexico
What is a PEO and define the term. Professional Employment Organization
What is the designation ChFC and the ARM-P? Chartered Financial Consultant, Associates in Risk Management- Public. I have attained my ChFC and ARM, but not the ARM-P. I may have to add the -P some day soon.
StockUnlimited
The normal waiting period for WC benefits is _______? Trick question? There is no waiting period for medical benefits. I did not say specifically indemnity benefits.
What disease/injury has fallen over 50% due to WC safety measures? Amazing. Carpal Tunnel Syndrome (CTS) – and what a disabling injury this can become over time.
The best thing to do to prepare for a Workers Comp audit is ________? Be as organized as possible.
Bonus – The first article on this blog is dated? ________
Self-serving Super Bonus – What services do we provide as a company?