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24 Hour Workers Comp and Health Insurance Policy – Rearview Mirror?

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24 hour Workers Comp and Health Insurance Policy Fades Away

In 2006, the buzzword (flavor) of the year pointed out that a 24 hour Workers Comp and Health Insurance policy answered the round-the-clock coverage concerns.

picture 24 hour workers comp coverage clock
Wikimedia License – Phillip James

The California Carpenters Union/Association initiated a carve-out program that looked attractive.  That concept quickly progressed to the rear-view mirror and then became a faded memory.

At that time, I was not a fan of anything cutting-edge in the area of insurance programs that combined health insurance with workers comp.  The 24 hour Workers Comp and health insurance policy looked complicated with so many coverage issues.

In one word, technology should push the combo policies over the line.  Every time I write an article  that covers combining Workers Comp with health, I receive many emails saying. “Oh wait, we have that program, and it is working.”

Law of Large Numbers

Unfortunately, after each of the programs failed, I wrote an article on those specific failures.  The 800 pound pumpkin (Halloween reference) in the room says “The Law of Large Numbers” will eat the program like a Thanksgiving pumpkin pie with whip cream, of course.

The Law of Large Numbers says that if you do not have enough membership, policyholders, self-insureds, etc. – absorbing the risk of paying claims becomes too burdensome.   E-Mods, X-Mods, Mods, EMR (all the same thing) have built this concept into their employer ratings since the 1930s.

Smaller insureds pay more per unit of coverage than larger ones.  Why?  Because two claims to a mega-company will be a small blip on the radar.  A roofer with 20 employees cannot pay enough premiums to cover the company’s amount of risk like a larger company.

Is it all fair?  The Workers Comp infrastructure was essentially built on the law of large numbers assumption.

Technology = 24 hour Workers Comp and Health Insurance Policy

I found a few apps that allowed a business owner to request a quote on my Android smartphone.   A client was searching for a new policy.  I  gave one of the apps a try to see if I could receive a Workers’ Comp quote within a few minutes.

Yes, I spent 90 seconds online and had a quote in front of me.  I am not an agent.  The app hooks into an agency that has no human intervention – kind of scary yet exciting.

If I could receive a quote from a non-human agency from a carrier in 90 seconds, one would have a very difficult time questioning whether or not a health and worker’s comp policy could be connected.

The Google search did not produce a website that creates the 90 second quote policies.  Why – because all the other agencies have taken over and dominated the keyword search of 90 second policy quotes.   The big online agencies know a good marketing segment when they see it.

Risk Retention Groups and 24 Hour Coverage

Risk Retention Groups (RRGs) combine many of the self-insured and group self-insured elements.    I attended a conference (CICA)in 2014,  where one of the sessions covered RRGs very well.   Risk Retention Groups remain one the most hybrid insurance programs that exist today.

One of the speakers from Chicago covered a model that combines Workers’ Comp and health insurance.  The RRG still exists today.  Due to privacy concerns, I will not mention the RRG by name as they had requested at the conference.

According to the Risk Retention Reporter . an RRG is:

A liability insurance company that is owned by its members. Under the Liability Risk Retention Act (LRRA), RRGs must be domiciled in a state. Once licensed by its state of domicile, an RRG can insure members in all states. Because the LRRA is a federal law, it preempts state regulation, making it much easier for RRGs to operate nationally. As insurance companies, RRGs retain risk. 

24 Hour Workers Comp Coverage and the Affordable Care Act

A few years ago, many articles appeared on this blog concerning how the Affordable Care Act could easily blend in with Workers’ Comp coverage.

The AFLAC model of benefits would be the best way to describe what the program would possibly look like for employers and carriers.

The Affordable Care Act faded into the rearview mirror – not exactly.   The program exists in at least 10 states today,  including our HQ state of North Carolina.

Unique Challenges For Claims Adjusters, Underwriters, and Actuaries

As with any new line of policies, many unique challenges occur with 24 hour workers comp and health coverages.

One of the main challenges actuaries and underwriters would face comes from how would you price and affix risk to an all day and all night coverage.  What happens if the employee travels over the water (USL&H?) or internationally?  The complex nature of the policies necessitates combining two coverages that could mix like oil and water.

What would the claims staff look like overall?  How would you investigate compensability?  How would the states respond if an Occ Acc policy substituted coverage for Workers Comp?

I have adjusted Occ Acc (Occupational Accident) policies for offshore captives.  Applying a Work Comp investigation to those claims caused  great concern as the policies were “taking all comers” and “paying for all accidents.”   Denial of a claim became a tenuous position to take with what was a disability policy, not a Workers Comp policy and coverage.

The most effective way to combine health care and Workers Comp comes from employers in a state demanding change of the status quo.  Until then, a 24 hour workers comp and health insurance policy will still be in the rearview mirror. 

 

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2 Responses

  1. Thanks for finally talking about >24 Hour Workers Comp
    and Health Insurance Policy – Rearview Mirror?

    <Liked it!

  2. Thanks, 24-hour workers comp policies have been a concern of mine since 1996. Some organizations and alliances have attempted to provide this info as a carve out that eventually went bankrupt. Proper worker’s comp underwriting would allow them to survive. Follow this link to a 2013 article on 24-hour healthcare as part of the Affordable Care Act.

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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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