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Home » Archives for June 2020

Archives for June 2020

Workers Comp COVID-19 Presumption Was Already In Place

June 25, 2020 By JL Risk Management Consultants

Workers Comp COVID-19 Presumption – There’s An Occupational Disease Statute For That – J&L 

State after state enacted their Workers Comp COVID-19 presumption orders to make sure the frontline workers in the Coronavirus pandemic were covered if they contracted the disease.   The states then began to expand which workers were covered if they contracted COVID-19.   

picture of Workers Comp COVID-19 Presumption

Public Domain – NIH

The workers’ comp blogosphere was buzzed for many weeks with almost all states providing press releases of their Governors ordering coverage if their intrastate workers contracted COVID-19. 

Mark Walls of Safety National commented on his LinkedIn posts over the last few weeks that workers’ comp has long had workers’ comp laws and rules on occupational diseases.  He could not have been more accurate. 

I have spoken with a few workers’ comp expert consultants that raised the same point.  Why do we need Workers Comp COVID-19 presumption laws when they already exist “on the books?”

Radium Girls Started The Process

Ever since the Radium Girls of the early 20th century contracted horrible illnesses and disfigurement (read more on that here) each state, in turn, enacted occupational disease laws.  Please note some of the pictures of the Radium Girls show heavy disfigurement (be prepared).   

The Radium Girls painted the glow-in-the-dark on watch faces so that soldiers could see the time even at night while still operating under the cover of darkness.  The material used exposed the ladies to low-level radiation over long hours and several years.  

The public outcry for these young ladies to receive proper treatment for their injuries began the age of the non-accidental injury. 

Occupational Disease – A Different Animal 

Micro Coronavirus Workers Comp COVID-19 Presumption Figure

Wikipedia – NIAID

The statutes said some injuries come from exposures or the contraction of a disease.   An “accident” or “incident” was not required for workers’ compensation claim compensability.   

The main requirement for an occupational disease claim originates with a treating physician relating the disease to exposures in the workplace.  The Statute of Limitations becomes critical in these claims.  Why? 

If the treating physician diagnoses a condition as work-related, the injured employee’s timeclock for filing a claim starts at that time, not from the date of first exposure.    

The last injurious exposure debate starts at that point if the employee performed the same job for different employers over the years.  I will leave that point alone. 

Adjusters Heavily Trained In Occupational Disease Claim Handling 

Carpal Tunnel Syndrome represents well over 50% of the occupational disease claims I have handled or consulted on over the years (30+).   Most of the carpal tunnel claims were eliminated over the past decade.   Safety and Risk Management won a large victory with the 50% reduction of a very disabling disease.  

Other Occ Disease claims types I have handled or consulted on are:

  • Raynaud’s Syndrome 
  • Hearing Loss 
  • Black Lung 
  • Brown Lung
  • Popcorn Lung 
  • Silicosis
  • Mesothelioma 
  • Welder’s Eye 

The list goes on for many other types of disease claims.  

Microscope Workers Comp COVID-19 Presumption at the room

Wikimedia Commons – Acagastya

From Day one in the adjuster training that I received, carriers and TPA’s covered occupational disease claim handling.  Most workers comp claims adjusters receive extensive training in occupational disease claims.  Why? 

These types of claims become the most expensive claims in an adjuster’s file load.  The medical record review becomes tantamount before accepting or denying a claim.  The adjusters are required to request one or multiple independent medical exams for a compensability review on a very strict timeclock before making the accept/deny decision. 

With the file reserves increasing exponentially over time, the claims adjuster will review the claim with their supervisor, manager, and Vice-President at a minimum.  The claims adjuster needs to have their “ducks in a row” for these reviews. 

Work Comp claim departments often assign occupational disease claims to their Senior Adjusters due to the likelihood of very intense medical report reviews and the higher reserve amounts. 

Example of Occupational Disease Statutes 

I use North Carolina as an example of occupational disease statutes/laws/rules.  Our HQ is in the Tarheel State.  I bolded the parts that make a disease a “non-accident” accident. 

§ 97-52. Occupational disease made compensable; “accident” defined.

Disablement or death of an employee resulting from an occupational disease described in G.S. 97-53 shall be treated as the happening of an injury by accident within the meaning of the North Carolina Workers’ Compensation Act and the procedure and practice and compensation and other benefits provided by said act shall apply in all such cases except as hereinafter otherwise provided. The word “accident,” as used in the Workers’ Compensation Act, shall not be construed to mean a series of events in employment, of a similar or like nature, occurring regularly, continuously or at frequent intervals in the course of such employment, over extended periods of time, whether such events may or may not be attributable to fault of the employer and disease attributable to such causes shall be compensable only if culminating in an occupational disease mentioned in and compensable under this Article: Provided, however, no compensation shall be payable for asbestosis and/or silicosis as hereinafter defined if the employee, at the time of entering into the employment of the employer by whom compensation would otherwise be payable, falsely represented himself in writing as not having previously been disabled or laid off because of asbestosis or silicosis. (1935, c. 123; 1979, c. 714, s. 2.)

I will save you having to read through all the diseases in § 97-53.  That statute can be found here.  The occupational disease list takes up three pages – and it should.

Bottom Line On Workers Comp COVID-19 Presumption Orders 

Little girl with her mom during Workers Comp COVID-19 Presumption pandemic

Wikimedia Commons – vperemen.com

Yes, the Governors, Insurance Commissioners, and Workers Comp Commission tried to protect their citizens – especially frontline workers – in case they contracted COVID-19 from their very important jobs.  (Thank You) 

The Workers Comp systems in each state already allowed for the adjustment and compensability determination without having to have presumption orders in place.   

Even with presumptions in place, for example, the State of Colorado carriers denied over 30% of their COVID-19 claims.  Florida denials came in at 70%.  Either one of those numbers should be startling or did claimants in those states consider that COVID-19 automatically generated a compensable workers’ comp claim? 

The Workers Comp COVID-19 Presumption laws, rules, and orders are already on the record.  One must ask, were they necessary?

 

©J&L Risk Management Inc Copyright Notice

Filed Under: Occupational disease Tagged With: asbestosis, blogosphere, Mark Walls, mesothelioma, Radium Girl, silicosis, timeclock

How To Ruin A Workers Comp Claim in Five Seconds, Claim Number?

June 17, 2020 By JL Risk Management Consultants

Asking For Claim Numbers Can Wreck Any Workers Comp Relationship – J&L 

Yesterday, I was trying to locate a claim for a long-term client.  I was following the subrogation status on a claim for them.   I was told that I had left out one number in a 22-character claim number. 

pay phone booth workers comp claim number

Wikimedia Commons-Chriistina Helmsman

The claim was not showing up on a loss run the client ran for me to review.  This situation harkens me back to what I have not done in Workers Compensation for 30+ years.  

Why I Never Ask For Or Reference Claim Number – A Little Secret 

When an injured employee calls in, asking for a claim number does one thing – it reminds the caller or emailer that they are a number, not an individual.   In 30 years, I have not looked up any injured employee by a claim number – never, ever.  

Injured employees with resolved claims were interviewed by WCRI for a study they were conducting.  Dr. Savych produced a landmark study on what happens to injured employees post-claim. 

One word came up that determined whether an employee felt the claims process went well.  That word was “trust.”  If the employee trusted their employer before the accident, claims usually resolved more quickly. 

Asking for a workers’ comp claims number may be a great way to pull up a claim.  I have always looked up the injured employee by:

  • Name
  • Date of birth
  • Employer
  • Accident Date. 

I never used the claim number.  I thought that it impersonalized a somewhat personal transaction. 

An Example of Claim Number Alienation 

Man driving Claim Number rainy road

Wikimedia Commons – Oregon Department of Transportation

Approximately eight years ago, I, unfortunately, ran into a deer while traveling at 65 miles per hour.  Calling in a claim to my auto insurer at midnight from a hotel room was beyond stressful. 

After going through the usual phoned-in claims reporting question, the adjuster gave me a long claim number that I did not write down accurately.   

The next morning,  I called back in to see about obtaining a rental car.  My auto insurance carrier phone rep asked for the claim number.  I, due to stress, and sleeplessness misplaced the claim number. 

The phone rep kept asking for it.  I said that I have my policy number on my proof of insurance. or could he/she not look it up by my name and date of the accident?  After 15 minutes of waiting, they came back on the phone with my 20+ digit and letter claim number.   I was told it was critical to use that number when calling in after then.  

I never called the company again and switched auto carriers at the next renewal.

Bottom Line – I felt like just another number – not really a personal interaction. 

Best Way To Find a Person’s Claim

Injured Army Claim Number on knee

Wikimedia Commons – U.S. Army Europe Images

Pulling up the claim by the injured employee’s name and the employer was always the best way for me.   I did not ask them for something that the carrier or TPA had given them to remember and reference.  I always asked for info that existed before the claim, not after. 

The great adjusters and claim reps seem to always develop some time of personal relationship with the injured employee unless of course if they were represented by an attorney.

Did you ever notice when you deal with a doctor’s office, they do not ask you for a patient number?  I wonder why? 

Bottom Line – This advice may seem a little picky.  Try it and you will see how it changes your relationships with your injured employees.   Avoid asking for claim numbers.

 

©J&L Risk Management Inc Copyright Notice

Filed Under: claims department Tagged With: Alienation, Dr. Savych, harkens, impersonalized, landmark, rental car

Are The Recent Class Code Changes Saving My Company Premium?

June 11, 2020 By JL Risk Management Consultants

The Recent Class Code Changes – A Further Look – J&L 

The recent class code changes buzzed in the workers’ comp news for well over a month.   Why am I writing another article on this subject?  The class code changes convert into amounts of premium dollars > your company’s budget. 

picture - a closer look at recent class code changes in newspaper

Wikimedia License – Dutch National Archives

One does not have to be a premium auditor to appreciate how much budget can be expended with the change of code.  The answer is a huge amount.   

I had written a few articles concerning the changes over the last two weeks: 

Two very recent articles – 

California Adds 8871 Telecommuting Employee Class Code

Accounting For Paid Furloughed Employees 

 

Comparing The Advisory Rates (called different names in different states)

Examining the advisory rates (pure premium rates, Loss Costs, etc.) should give one an indication of what each rate will comparatively cost your company.    The most common classification code rates mentioned by me in the last few weeks are:

  • 8810  Clerical Administrative – The Magical Mystery Code
  • 8871   Telecommuting Employee 
  • 0012   Furloughed Employee – still paying their salaries or wages even though they are not currently working. 

Most of the comparable rates exist behind paywalls.  I will use our home state of North Carolina for comparison purposes.  North Carolina’s Rate Bureau converted from NCCI to a completely independent bureau in ***. 

The pure Loss Costs are per $100 of remuneration (modified payroll):

  • 8810 – .07 
  • 8871 – .04 
  • 0012 – .00 

Let us not go into the specifications of each code here.   These three codes have been covered often in our set of articles. Use the search box. 

If you have any questions on the class codes, please comment below or use the Contact Us page.  

Five Caveat/Caution/Cart Before The Horse Considerations 

U.S pennies recent class code changes 2008

Wikimedia Commons – Roman Oleinik

Looking at those rates, one might think – Hey, 8871 is a cheaper code.  Cheapest does not necessarily mean cheaper. 

  1. Any class code that starts with 88 has very particular rules.  Many unpublished Rating Bureau decisions shape those codes.  
  2. The insurance carriers file Loss Cost Multipliers to deviate from the rate.  No carrier HAS to accept those base rates.  The carrier’s underwriters can easily and often do change the rates by filing a list of Loss Cost Multipliers. 
  3. If you are in the Assigned Risk Pool, your rates will be different – much more expensive, use the Contact Us link above if you have questions concerning the Assigned Risk Rates.  
  4. An important one that an 80-year-old premium auditor taught me many years ago.   Say that many companies change some of their employee’s jobs to fit 8871.   More accidents now happen to 8871 employees.  The number of claims paid for the 8871 codes spikes and the accident rate for 8810 falls.   The rating bureau actuaries adjust the rates to fit the claims experience.   Now you have your employees in a rate code that increased 150%.  Uh-oh.  
  5. California has just now published the 8871 code.   It will not count until 2021.  The rates will have to be developed for a few years.  The pure premium rates (Loss Costs) may vary greatly. 
  6. Bonus – Each state is unto its own on the Advisory Rates.   States such as California, New York, Colorado, and others may have different Advisory Rates.  The very tech-heavy states may contain many telecommuting employees. The North Carolina codes above were used as an example for discussion.

Bottom Line On The Recent Class Code Changes

Know what you are doing when you start to reclassify employees in your company.   The main time to understand the recent class code changes comes at premium audit time.  The premium audit bill is usually your final bill for that policy year. 

 

©J&L Risk Management Inc Copyright Notice

Filed Under: classification code Tagged With: advisory rates, assigned risk pools, Loss Costs, Telecommuting

California Workers Comp Telecommuting Class Code 8871 Added

June 4, 2020 By JL Risk Management Consultants

 Telecommuting Class Code 8871 Added To California WCIRB Class Codes

California’s Workers Comp rating bureau (WCIRB) added in Telecommuting Class Code 8871 after a regulatory meeting this week.  

picture of train engine telecommuting class code 8871

Wikimedia Commons – Dan from PQ, Canada

If your company is domiciled in California or you have California-based employees,  you will need to separate these employees from furloughed employees and 8810 Clerical Administration employees.   

The Telecommuting Class Code becomes effective on January 1, 2021.   Regardless, preparing your accounting or bookkeeping software to add in this code will save many unneeded headaches when your premium auditor makes their yearly appointment or when you self-report your payroll. 

NCCI – the rating bureau for approximately 40 states released their advisory last month on reporting 8871 Telecommuting Class Code for in-home workers last week. 

The agenda notes from the WCRIB can be found here.  You can search for 8871 in the notes   They WCIRB  will have another meeting on this and other subjects in August.  

From The Meeting Agenda

Item III-A

Giving Presentation of Telecommuting Class Code 8871 in Conference Room

StockUnlimited

Clerical Telecommuter Employees
In response to state and local stay-at-home orders necessitated by the Coronavirus Disease 2019 (COVID-19) pandemic, many California employers have limited their employees’ duties to clerical work that can be accomplished from employees’ homes. In view of this recent and significant increase in “telecommuting”, at the April 14, 2020 meeting, members of the WCIRB’s Classification and Rating Committee noted that several other jurisdictions maintain a specific classification for telecommuters and recommended that the WCIRB consider establishing a similar classification so that statistical data can be captured for clerical telecommuter employees.

Currently, telecommuting employees whose duties meet the definition of Clerical Office Employees1 found in the California Workers’ Compensation Uniform Statistical Reporting Plan—1995 (USRP) are assignable to Classification 8810, Clerical Office Employees, or to their employers’ standard classification if that classification specifically includes Clerical Office Employees.

While California does not have a unique classification for clerical telecommuting, the National Council on Compensation Insurance (NCCI), as well as a number of other jurisdictions, use Classification 8871, Clerical Telecommuter Employees, for employees that spend more than 50% of their time performing clerical duties from a clerical work area located within their home, 2 provided the remainder of their time is spent engaged in clerical duties at the employer’s place of business. If 50% or more of their time is spent performing clerical duties at the employer’s place of business, Classification 8810 is applicable.

Since the use of telecommuting will likely grow in California, staff is proposing that Classification 8871, Clerical Telecommuter Employees – N.O.C., be established as a Standard Exception classification applicable to clerical employees who work more than 50% of their time at their home or other office space away from any location of their employer. This will enable the collection of payroll and loss data for these employees to determine if their exposure differs from that of other clerical employees who work primarily at their employer’s office location and will align California with other jurisdictions that assign clerical telecommuters to Classification 8871. Additionally, staff is proposing amendments to Classification 8810, Clerical Office Employees, and Section III, Rule 4, Standard Exceptions, of the USRP for consistency with this proposal.

There are 41 classifications that specifically include Clerical Office Employees and 2 classifications that specifically exclude Clerical Office Employees. 3 When a classification phraseology specifically includes Clerical Office Employees, all clerical employees are assigned to that classification, and not to Classification 8810. As the proposed scope of Classification 8871, Clerical Telecommuter Employees, embraces operations performed by Clerical Office Employees, staff recommends that each of these 43 classifications be amended to also specifically include or exclude Clerical Telecommuter Employees. These amendments are necessary to make clear that all clerical telecommuter employees are also included in, or excluded from, the scope of these 43 classifications.

Telecommuting Class Code 8871 and 8810 

Woman using laptop Telecommuting Class Code 8871 wearing headset

StockUnlimited

Do not rush to move employees after January 2021 from Class Code 8810 to 8871.  You will need to compare each of those codes once published by the WCIRB in its final form.  Class code 8810 tends to be less expensive than 8871.  With the wave of work from home employees, one cannot make that a 100% true cost statement yet. 

When the final Telecommuting Class Code 8817 has been published by the WCIRB, I will update this article or add a new one. 

 

©J&L Risk Management Inc Copyright Notice 

Filed Under: classification code Tagged With: bookkeeping, Clerical, phraseology, self-report

How Do We Account for Coronavirus Furloughed Employees – NCCI

June 4, 2020 By JL Risk Management Consultants

Account for Coronavirus Furloughed Employees – NCCI Adds Basic Manual Rules 

The Question – How do we account for Coronavirus Furloughed Employees has become the most popular question that we now receive from blog and newsletter readers.  

picture of accountant account for coronavirus furloughed

Public Use License – Wikimedia

This is not a replacement for Class Code 8871 – Telecommuting Clerical Employees.  See this article for that distinction. 

NCCI – the workers’ compensation rating bureau for approximately 40 states added in a few new sections to their rules.   If you are the person responsible for the bookkeeping or accounting with your company and you are trying to account for Coronavirus furloughed employees, you are in luck.  

Below is a summary of the rules that NCCI added to their manuals.  I am not going to paraphrase the rules. I do not like quoting NCCI rules verbatim.    In this case, the rules are very specific, so I added them in almost verbatim in parts.  The very important part of the rule has been bolded. 

Recording the payroll inaccurately could cost your business a large amount of insurance budget.   

Woman doing Account for Coronavirus Furloughed bills

StockUnlimited

Payments made by an employer or any public governmental entity to paid furloughed employees as a result of federal, state, and/or local emergency orders, laws or regulations, issued due to the COVID-19 (coronavirus) pandemic which impact an employer’s staffing or business operations.

Look at this part of the rule closely – 

However, any appropriated funds or loans received by an employer as authorized by any law or regulation, or public governmental entity, that are used by an employer specifically to retain or hire working employees are not excluded.

This rule has a built-in expiration date – 

This Rule 2-B-2-n is effective March 1, 2020. The expiration date of this rule will be December 31, 2020, which may be amended to an earlier or later date as circumstances warrant in consultation with state regulatory authorities. This rule will be removed from the Basic Manual automatically, upon the applicable expiration date.

Idle time does not count as furloughed. 

Middle-aged couple working Account for Coronavirus Furloughed on laptop in kitchen

StockUnlimited

For purposes of this Rule 2-F-1, idle time does not include “paid furloughed employees” or “payments to paid furloughed employees” as provided in Basic Manual Rule 2-F-3. The expiration date of this paragraph will be December 31, 2020, which may be amended to an earlier or later date as circumstances warrant in consultation with state regulatory authorities. This paragraph in this Rule 2-F-1 will be removed from the Basic Manual automatically, upon the applicable expiration date.

3. Payments to Paid Furloughed Employees During Federal, State, and/or Local Emergency Orders, Laws, or Regulations Issued Due to the COVID-19 (Coronavirus) Pandemic

Florida has a few exceptions that I did not note here.  

For purposes of this Rule 2-F-3, ”paid furloughed employees” and “payments to paid furloughed employees” are defined within this rule. “Paid furloughed employees” means employees who continue to receive payments during a temporary layoff or an involuntary leave and are not performing any work duties for an employer.

“Payments to paid furloughed employees” means payments made by an employer or any public governmental entity to paid furloughed employees as a result of federal, state, and/or local emergency orders, laws or regulations, issued due to the COVID-19 (coronavirus) pandemic which impact an employer’s staffing or business operations. Such payments do not include any appropriated funds or loans received by an employer as authorized by any law or regulation, or public governmental entity, that are used by an employer specifically to retain or hire working employees.

Your Workers Comp Premium Auditor and Your Payroll Records

Hand holding a calculator Account for Coronavirus Furloughed calculation

StockUnlimited

Payments to paid furloughed employees must be assigned to Code 0012, in accordance with the Statistical Plan. Payments to paid furloughed employees made in accordance with this Rule 2-F-3 are excluded from the premium and experience rating calculations only if the employer keeps separate, accurate, and verifiable records. If separate, accurate, and verifiable records are not maintained, payroll is assigned to the classification for work normally performed by the employee prior to any emergency orders, laws, or regulations issued due to the COVID-19 (coronavirus) pandemic.

This can cost your company a large amount of premium if you do not keep accurate payroll records that separate out furloughed employees. 

If an employee is requested to perform any duties for an employer, the employee is not deemed a paid furloughed employee for any period of time they are performing duties for the employer. If the employee is not deemed a paid furloughed employee, payroll must be assigned to the classification applicable to the work being performed in accordance with Basic Manual Rule 1-A. 

This Rule 2-F-3 is effective March 1, 2020. The expiration date of this rule will be December 31, 2020, which may be amended to an earlier or later date as circumstances warrant in consultation with state regulatory authorities. This rule will be removed from the Basic Manual automatically, upon the applicable expiration date.

Set Up Your Accounting Package Now To Handle These Employees 

Excel(r), QuickBooks(r), or Your Accounting Package can now be your best aide in keeping track of furloughed employees.   Keep the employees listed under 0012 Coronavirus Furloughed Employees.  Your premium auditor will ask for these records.  

 

©J&L Risk Management Inc Copyright Notice

Filed Under: NCCI Tagged With: circumstances, coronavirus, Furloughed, Manual Rule, warrant

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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
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• Claims Magazine
• Risk & Insurance Magazine
• Insurance Journal
• Workers Compensation.com
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Recent Posts

  • Home Ergonomics Advice Reduces Workers Comp Costs
  • Workers Comp Predictive Analytics Changed Loss Run Reviews Forever
  • Workers Comp COVID-19 Vaccinations – Part of Return To Work
  • Workers Comp Test Audits – Pain or Preventative Measure
  • WCIRB 8871 Webinar – What California Insureds Need To Know
  • Workers Comp Website – 10 Things To Know When Switching Providers
  • Workers Comp Zoom Presentation – Top Four Hard Lessons Learned
  • Experience Mod Increases While Loss Runs Show No Changes – WTR?
  • Workers Comp Allocated Expenses – Who Pays For Which Bills?
  • Workers Compensation Presentations Kawasaki Technique
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Raleigh, NC 27614
(800) 813-1386
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