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WCRI – Blogging Live – Controversial Opt Out Panels


Controversial Opt Out Panels

The blogging live controversial Opt Out panels in WCRI

Two Presenters –

Trey Gillespie – Property and Casualty Insurers Association of America

Bill Minick – PartnerSource

Graphic of Controversial Opt Out Panels Concept

Opt outs as a form of Workers Compensation coverage has been in Texas for quite some time.   Texas’s program has been successful.  Oklahoma is still the fulcrum of a recent controversial decision.

Opt out is ERISA based.

No admission of liability .

Many common exclusions.

Many of the cause of injury aspects  in the regular insurance market look very similar to the Oklahoma Workers Compensation Opt out rules.

However, there are  Conditions and Limitations:

  • Benefits stop if employee leaves the company
  • FMLA protections to 12 weeks
  • Reporting requirements (24 hour delay max)
  • NCCI say only 20% of  Lost Time injuries are reported within 24 hours.
  • 93% of costs are allocated to Lost Time vs. Medical Only claims
  • Medical plans are made by plan administrator
  • Medical benefits may be terminated before care ends- this varies greatly from regular WC coverage
  • Medically necessary – the cheapest way to treat, if no treatment in 60 day = termination of benefits
  • Continuing medical maintenance differs greatly from regular WC coverage.  Palliative care – whether required or not is not covered
  • Voluntary settlements are based on Plan Administrator evaluation
  • Often refers to “Dillard Decision”
  • Limited appeal rights
  • No payment of PPD (Permanent Disability) benefits are not covered.
  • Quote From Dillard’s decision – Injured workers not treated equally under opt out

Bill Minick presentation-

  • Same mutual goals
  • Determining Good Public Policy
    • Experiments -rigorous assessments
    • No anecdotal experiences
  • 1.5 million workers covered
  • 50,000 claims resolved annually
  • $0 spent by regulatory industries
  • $125 million annual claims cost
  • $1 Billion in direct written premiums over the past decade.
  • 1,000 private sector jobs
Woman Controversial Opt Out Panels At Office

Benefits are mandated

Liability Exposures

Financial Security Requirements

Employee protections – safety such as OSHA

Disclosure rules

  • Written plan document
  • Definitely determinable benefits
  • Understandable

Fiduciary rules

  • Acting in employee’s interest

Claims Procedures

Enforcement- there are civil and criminal penalties

There is no perfect grand bargain

93 Texas settlements in Excess of $1 million

ERISA requires that Opt Out benefits are communicated to the employees in a language that they can understand  – Workers Comp has an issue with being mysterious

Immediate reporting requirement leads to better outcomes

Medical providers should be held accountable

Evidence based medicine

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James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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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