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WCIRB XMod Decision Gives Employers COVID Reprieve – Sort Of


WCIRB XMod Decision Includes COVID-related Claims With Three Caveats

The WCIRB XMod decision this week should provide employers somewhat of a break for incurring COVID-related claims.   WCIRB is the Workers Compensation Insurance Rating Bureau of California.

world covid outbreak map WCIRB XMOD Decision
(c) Wikimedia Public Use – Pharex Outbreak Map

A question was sent to NCCI (National Council on Compensation Insurance),  as I write this article, to see if the rating bureau for 40 states is going to do the same.   I know the answer but wanted to verify it.  Check out next week’s article to see what was discovered with my NCCI communique.

The three caveats with on the WCIRB XMod ruling do not involve the WCIRB directly.  By the way, the WCIRB treats me very well when I have questions for their staff.  I attended their most recent mini-conference at their Oakland HQ in January.

The three caveats involve your insurance carrier or Third Party Administrator (TPA) and the reporting employer.   Think about the situation for a moment.   What the carrier or TPA inputs from the First Report of Injury (FROI) becomes beyond critical information.

Some readers may likely think that TPAs do not report claims to the rating bureaus.  Two of our agent clients have placed policies with carriers that use TPA’s for claims handling.   Whatever the TPA inputs the carrier reports.

Caveats for WCIRB XMod Decision

The three caveats are:

  1. Hand holding pencil with WCIRB XMod Decision bacteria and scientific notes

    The employer has to report the claim accurately as being related to COVID.  No assumptions can be made with the FROI.   If you have the treating physician’s note that relates the claim to COVID, attach it to the FROI.

  2. Even more critical, the TPA or insurance carrier MUST CODE the claim as COVID.  This is where the proverbial rubber meets the road.  No matter what occurred in the claim, if it is not coded as a COVID claim, then #1 above and #3 below will mean very little.
  3. The physician must relate the claim to COVID-19.   Without this diagnosis and report, the claim likely will not be reported as a COVID-related claim and will peg to your XMod.

More minor caveats exist.  The three above cover enough ground.

FROI and Claim Verification

How do you verify that the COVID-related claim will be excluded From Your XMod?

  1. Have a working relationship with the claims adjusters handling your claims – you do know who they are, correct?
  2. Attach the treating physician’s note to the claim – may not be allowed in a few states
  3. Email the claims adjuster 15 days after filing the FROI to verify that the claim is considered COVID-related

Take the time to make sure your company or organization does not pay a higher premium after the benefit of the WCIRB COVID decision.


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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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