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First Reports Of Injury – File Them Online Now Or Pay 400% Later

October 31, 2012 By JL Risk Management Consultants

First Reports Of Injury Should Be Filed ASAP – No Excuses

Workers Compensation First Reports of Injury (FROI) are an employer’s first step in Loss Control.  Loss Control is not the same as Loss Prevention.  Loss Control to me is defined as the prevention of future losses AFTER an occurrence of a claim.

Picture of First Reports Work Injury

(c) 123rf.com

In fact, immediate filing of the first report of injury is one of my Five Keys To Cutting Workers Comp Costs.  In  a study of two different large collections of claims, I found that not filing a FROI quickly will increase claim costs by 400% on the average.  *** Thanks to Frank Pennachio of The WorkComp Advisory Group for pointing out the mistake I made on the original post of this article.   

Involving your claims adjuster very early in the process will always cut workers comp costs.  In fact, the adjuster can rarely proceed without the filing of the FROI.  One can look at the FROI as giving the adjuster permission to proceed on the claim.

One of the most important aspects of  an employer that files FROI’s quickly is the impression that the employer is on top of their claims.  Remember that this is the same person that will be setting reserves on this file and on files in the future.  The FROI is the first impression that the adjuster has on the claim for your company.

Picture of First Reports Work Injury Claim Form Bandage and pen on top

123RF

Laggard companies (insurance company lingo) will always have higher reserves on their files, plain and simple.  If your company does not care enough to file an injury report timely, it is seen as a negative connotation on the file.

Electronic/online FROI filing has been around for quite some time.  This is an example of an insurance carrier’s online filing page.   In fact, some companies charge extra to input a claim off paper.  Filing a paper FROI when online filing is available is seen by the clams staff as a negative connotation similar to late reporting of injuries.

Your company is almost guaranteed higher reserves than normal when the first time your claims staff or adjuster hears about the claim from a medical provider.  What can the Workers Comp claims staff do when the medical provider is the first one to report the claim?   They are going to refer them back to the employer as the FROI has not been filed.

Picture Xraymachine First Reports Injury

Wikipedia – Thomas Bjørkan

Once again, this is the same person that will be setting the reserves on the file that figure directly and are the most important variables in your E-Mod (X-Mod) or Loss Development Factor if you are self-insured.   First impressions do count.

Insurance companies and TPA’s all keep very close track of the time it takes to file the FROI.  The term is called “lag time.”  It is measured from the time the claim occurs until an employer files the claim.  If you mail it in, the days it takes for the FROI to be processed by the employer, mailing time, and for the carrier to process the mail all are figured into your lag time.

The easiest way to avoid all this is to file your claims online.  If for some reason, your carrier or TPA does not have an online claim filing system, you should fax them.  If a carrier or TPA does not allow for online claims filing, their claims processes should be viewed  as antiquated at best.

Companies often contact us concerning their high E-Mods and ask us to help reduce them quickly. This is one of the areas we examine upfront in our E-Mod reduction programs.

©J&L Risk Management Inc Copyright Notice

Filed Under: claims adjuster, First Report of injury, FROI, Lag Time, Six Keys Tagged With: antiquated, connotation, loss prevention, track

What Is An Experience Modification Factor in Workers Compensation?

April 28, 2010 By JL Risk Management Consultants

Experience Modification Factor E-ModCan Be Debit, Credit or Neutral

There has been much discussion in the last week on the Experience Modification Factor  (E-Mod or X-Mods). My definition is your company’s Workers Comp credit score.

Vector Graphic Of Employees Experience Modification Factor Presentation

StockUnlimited

From NCCI – Experience modifier (mod) is a multiplier applied to the premium of a qualifying policy and provides an incentive for loss prevention. The mod represents either a credit or debit that is applied to the premium before discounts. If your company’s loss experience is more costly on the average than other company’s loss experience in your industry, the result is a debit mod, or surcharge, on premiums. If your company’s experience is less costly than the industry average, you will receive a credit mod, or discount, on your premium. The acronyms are Mod, E-Mod, or Emod.

If your Mod is equal to 1.0, you have a neutral Mod.  A neutral Mod means that you receive no credit or debit from the Mod part of your calculation.   Your company has the average Experience Mod for your industry judged from your associated Classification Codes.   The rating bureaus such as NCCI, WCIRB, or an independent rating bureau publishes and often updates the class codes in your company’s states of operation.  

From CA’s WCIRB – which are expressed as a percentage, compare the loss or claims history of one company to all other companies in the same industry. Generally, an experience modification factor of less than 100% reflects a better-than-average experience, while the same number that exceeds 100% reflects a worse-than-average experience. Accordingly, an experience modification factor that is greater than 100% usually increases the cost of your workers’ compensation premiums, while an experience modification that is less than 100% usually decreases the cost of your workers’ compensation premiums. The acronym is X-Mod or Xmod.

©J&L Risk Management Inc Copyright Notice

Filed Under: E-Mod X-Mod Tagged With: credit score, loss prevention, surcharge

Workers Comp Premiums Can Be Lowered – But It Takes Time

February 2, 2009 By JL Risk Management Consultants

Workers Comp Premiums Quick Fix Takes Patience 

Your Workers Comp premiums -Immediately lower them for your company. This is probably the question that I am asked most often at presentations, conferences, and meetings. 

Vector Graphic of Man Pointing workers comp premiums With Dollar Sign And Building Background

StockUnlimited

There is no “quick fix” for your Workers Comp premiums.  Reducing your companies premiums takes at least three years of constant effort.  As Workers Comp is on more of a delayed system, anything that reduces the reserves will not show up in your premiums until two policy years later.  

One of the best ways to reduce your premiums is to institute a new safety program or enhance one that is already in place.  Preventing accidents is the best way to reduce your premiums and will have a long-term effect on premiums.  Almost all states offer assistance in Loss Prevention from educating employees to safety DVDs.  Check with your local department of insurance or industrial commission.  You may be surprised what is offered for free. 

Another way to quickly reduce workers comp premiums is to heavily review your Workers Comp premium audits.  We have seen companies just write checks without questioning the premium audits.  If there is something that does not look or feel right, you have the right to have the audit explained to you in detail by the auditor including classification codes, payroll (remuneration), and any other areas of the audit.  

Vector Graphic Of Dollars Sign Immediately Lower workers comp premiums Icons

StockUnlimited

One area that most companies do not attempt to question is their Workers Comp loss runs.  If you are not receiving your loss runs monthly, call your agent, or insurance carrier and ask to receive them monthly.  Most insurance carriers will offer to send them quarterly, but you need to review them monthly for changes in reserves.  Having online access to your claims info is critical.  When shopping for a carrier to renew with, ask that your agent inquire to see if the company she/he recommends has online access to your claims.  

Even with all the technology that is in place, there are a few carriers that do not allow access to your claims info.  Having this access may be worth paying a little extra over the lowest-priced carrier.  This will also save your company a large amount of $ if you decide to have a company such as ours to review your claims.  Most companies that allow online access will have a place for status updates.  Those are golden as you can review those quickly to have an idea of how the claim is progressing.  If you do not agree with or have questions on the loss runs, you should email (not call) the adjusters that are on the files. 

Questioning everything that comes across your desk in relation to your Workers Comp policies is always the best thing for reducing your Workers Compensation premiums.                           

©J&L Risk Management Inc Copyright Notice

Filed Under: premium Tagged With: agent inquire, department of insurance, loss prevention, lowest-priced

Experience Modification Factor Mysterious Number

August 15, 2008 By JL Risk Management Consultants

Experience Modification Factor Known By Many Names

We have received quite a large number of questions regarding the Workers Comp Experience Modification Factor over the past few weeks.

The Experience Modification Factor also goes by Experience Modification Rating, and Experience Modifier.

Picture of Man Hand Experience Modification Draw Arrow Inside House with Dollars sign

StockUnlimited

The E-Mod has many acronyms such as:

  • Ex-Mod (California)
  • X-Mod (California)
  • Mod (National)
  • E-Mod (National)
  • EMR
  • ExMod, XMod, and EMod.

The definition of an E-Mod is: A multiplier applied to the premium of a qualifying policy and provides an incentive for loss prevention. The mod represents either a credit or debit that is applied to the premium before discounts. If your company’s loss experience is more costly on average than other companies’ loss experiences in your industry, the result is a debit mod, or surcharge, on premiums. If your company’s experience is less costly than the industry average, you will receive a credit mod, or discount, on your premium.

There are three types of E-Mods:

  • Debit –  More Than 1.0
  • Credit-  Less Than 1.0
  • Neutral – Equal to 1.0

E-Mods are one of the most confusing areas of Workers Comp insurance, as it affects such a large number of policies.

Experience Modification Factor Calculations Easy Formula

The E-Mod X-Mod calculations are simpler than one might think. The experience modification is determined by comparing actual losses to expected losses for the experience period based upon the employer’s industry. In other words, clerical employees are compared only to other clerical employees; a restaurant is compared only to other restaurants.

Vector Graphic of Man and dollars sign E-Mod X-Mod in background

StockUnlimited

The number of man-hours worked is used to indicate the employer’s audited premium dollars, since an employer with 200 employees would be expected to have more claims than an employer with two employees. For example, a restaurant is only compared to other restaurants with approximately the same gross premium amount.

The formula adjusts the actual losses used so that frequency is given greater weight than the severity of an injury or illness. For example, six claims that occur over a three-year period totaling $20,000 have a greater impact against the experience mod than one claim in three years totaling $20,000. Again, both the industry and business size are considered. Claims with zero costs are not included in the experience modification calculation.

Bottom Line – why does this sound so hard? The harder it sounds, the less you can check behind the insurer to make sure there were no mistakes in your policy or premium/payroll audit.    

Educating yourself on how the Mod system work will help you realize the way you are charged for your Workers Comp premiums.  Check out the many articles on the workers comp insurance rating system in the blog.    Click on the E-Mod X-Mod Category at the bottom of this article to view pages upon pages of articles to help you in your quest. 

If you need any assistance, we are here to help by using our Contact Us page. 

©J&L Risk Management Inc Copyright Notice

Filed Under: E-Mod X-Mod Tagged With: industry average, loss prevention

Disturbing Trend From Workers Comp Insurance Carriers

May 31, 2008 By JL Risk Management Consultants

Insurance Carriers Disturbing Trend

We have noticed a very disturbing trend from Workers Comp insurance carriers.

Often, after accepting a new policyholder, the insurance carrier will send out what is considered to be a Loss Control Consultant.

Vector graphic of man Disturbing Trend insurance carriers

StockUnlimited

Often, we have seen the Loss Control Consultant actually fill out Work Comp Audit Workpapers and submit these to the carrier.  We do not see this as any type of Loss Prevention or Control function. 

If the insurance carrier or employee is more of a premium auditor, then the carrier should inform the employer that they company will be doing a premium audit of sorts.   

I have six of those back on my desk at the office.  Hopefully, this will not be a trend that continues.  The most concerning item is the employer is never shown the workpaper.  One has to wonder why the employer is not advised of the initial premium audit part of this visit. 

I will keep you updated on this trend if it develops.  BTW, this is not one carrier that is doing this type of premium audit. 

Do not take this appointment as just Loss Prevention or Loss Control. Many times, and in one very particular instance, we have found the appointment to be a Premium Audit of sorts. Please see our post tomorrow for more information. I am having trouble with the hotel wireless system I am on as of now.

©J&L Risk Management Inc Copyright Notice

Filed Under: Premium audit Tagged With: disturbing trend, Loss Control Consultant, loss prevention, workpaper

Safety Person Should Be Most Concerned With This Number

February 4, 2008 By JL Risk Management Consultants

A Safety Person vs. The X-Mod or E-Mod

Is there one number that a safety person should be the most concerned with in their job?  I have asked this question often when presenting to Loss Prevention, Safety Engineers and similar positions. The answers that I often hear are:

Vector Graphic Of Safety Person Workers

StockUnlimited

  • Number of accidents
  • Lost workdays
  • Self-inspection results

Those are all important. When a VP or President of a company asks me what number is the most important in evaluating a Work Comp program, I always say the Experience Modification Factor (E-Mod or X-Mod). Why? Because it is the distilled number of what the claims costs are for a certain company. In other words, it is the insurance carrier’s notation of how the safety program is performing over a few years, not just one.

Many safety personnel have been fired due to the E-Mod X-Mod not turning around quickly enough.   Employers and their safety departments sometimes do not realize that the Mod covers from four years ago until one year ago. 

What just happened in the prior year, be it good or bad, does not show up on the E-Mod X-Mod until the following year.  A great way to avoid concerns with the safety department or risk manager is to forecast the Experience Mods into the future.      

Oh, and self-insureds are not immune from the E-Mod. There is a different term for the E-Mod for self-insureds and it is the Loss Development Factor (LDF). The LDF may cover more years than the E-Mod, but it is still the ultimate evaluator of a company’s safety program.

I often hear from safety personnel that the insurance is “some other department’s problem.” Nothing could be further from the truth.

Bottom Line – The LDF or E-Mod/X-Mod is the Workers Comp safety program’s effectiveness turned into cash.

Next Up – How long does one bad year of claims cost a company’s Workers’ Comp program?

©J&L Risk Management Inc Copyright Notice

Filed Under: E-Mod X-Mod Tagged With: loss prevention, lost workdays, safety engineers

Workers Compensation Loss Prevention Does Not Stop With Accident

September 10, 2007 By JL Risk Management Consultants

Workers Compensation Loss Prevention Keeps Going After The Accident

Workers Compensation Loss Prevention – where does it end and begin?

As I was reviewing my notes for my presentation tomorrow to the North Carolina Mid State Safety Council quarterly meeting, I noticed one common theme. Loss prevention does not stop when an accident happens. It is instead an ongoing process, especially soon after an incident.

Vector illustration of Accident Icon Loss Prevention Incident

123RF

From my viewpoint, a Loss Prevention/Safety Officer should be heavily involved in the reporting of the injury to the insurance carrier and in the initial physician referral. Safety personnel is often judged by the E-Mod (see previous posts) that are produced each year.

However, the Safety personnel may not have control over where the injured employee is sent for medical treatment. The safety department has to be involved, as the tone is set for the complete claim within the first 48 hours of a Workers’ Comp claim.

I have heard safety personnel say that their job ends once the accident happens. This could not be further from the truth. I have coined the phrase post-accident safety.  

Post-accident safety equates to loss control.  Once an accident occurs the safety of an employee involves:

  • Reporting the accident immediately to the insurance carrier or TPA .  The carrier or TPA cannot adjust the claim without having the first report of injury (FROI) on file. 
  • Sending the employee to an industrial-mined physician as previously mentioned
  • Returning the employee to work safety – making sure their job restrictions prescribed by the industrial-minded  physician are not violated
  • Treating the injured employee with respect makes the employee have trust for their boss.  Trust is the key to a successful return to work. 

I recommend the safety departments become more heavily involved, as you are judged by the E-Mod as a testament to your safety program. Ignoring what happens after an accident/incident can affect your performance greatly.

©J&L Risk Management Inc Copyright Notice

Filed Under: Loss Control Tagged With: accident safety, loss prevention

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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:
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