Insured:
The insured is social service agency in Massachusetts with 390 employees
in 22 locations. The organization provides occupational training
and rehabilitation services to developmentally disabled adults.
Situation:
In one six-month period, this insured experienced 27 workers’
compensation claims totaling $89,000.
Assessment: A Certified WorkComp Advisor (CWCA) looked into the
situation and discovered supervisors played no role in managing
their employee injuries. It was left to the employee to seek medical
attention and return to work when their doctor recommended it.
Employees routinely went to the emergency room or to their personal
primary care physician. These doctors ordered lengthy periods of
rest and made no effort to assess the employee’s work capacity.
Supervisors made no effort to stay in touch with employees or return
them to work on modified duty.
Solution:
On May of 2006, a Certified Work Comp Advisor conducted a training
session with the organization’s 34 supervisors. The training
explained how claim costs impact workers’ compensation insurance
premiums; how to work with an occupational medical clinic; and how
to support and manage a comprehensive recover at work program.
With this new awareness, supervisors took steps to resolve safety
issues and employee behavioral problems. They began directing employees
to an occupational clinic whenever possible. They stay in contact
with employees during any disability and actively seek opportunities
for modified duty.
Result:
In the 6 months since the training, the insured’s claim frequency
has been cut in half (only 11 claims). Amazingly, these 11 claims
total less than $1,000. The CWCA is now planning a celebration
to congratulate the insured’s supervisors for this remarkable
turnaround.
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Insured:
The insured is a large commercial and residential real estate developer
in Rhode Island.
Situation:
An employee suffered a laceration to his finger while using a saw.
The carrier set the highest possible reserves for disfigurement,
permanent loss of use, and temporary disability warranted for this
type of injury.
Assessment:
Knowing that insurance carriers routinely set high reserves on claims
and keep those reserves active until the claim is closed, a Certified
WorkComp Advisor (CWCA) resolved to keep close tabs on every aspect
of the claim. Along with skilled in-house claims specialists, the
CWCA worked with the employer, medical providers and claims adjusters
to continually assess the case and adjust reserves accordingly.
Solution:
As soon as the employee was released to full duty, the CWCA asked
the insurance carrier to remove any remaining reserve for disability.
A short time later, the carrier made a payment to the employee for
scarring, and the CWCA requested they remove any remaining reserves
for disfigurement. Later, the CWCA argued successfully to lower
reserves for permanent loss of use.
Result:
By the insured’s next valuation date, reserves on this claim
had been lowered by more than $57,000. As a result, the client’s
experience mod rating was 19 points lower than it otherwise would
have been. This resulted in a premium savings of more than $4,000
annually. |
Insured:
The insured is a large social service non-profit in Massachusetts.
Situation:
The organization’s 2004 Experience Mod jumped to 1.85 from 1.55
and 1.58 the previous two years. The insured had no idea why their
premium or experience mod was so high.
Assessment:
Our first step was to verify the accuracy of their experience mod
rating. We collected loss data from St. Paul Travelers Insurance Company
and Artis Group (a subsidiary of Royal/SunAlliance), compared them
to the experience mod worksheet, and found errors in all 3 policy
years.
2002-2003 St. Paul Travelers Insurance Company:
This policy year included one aggravated inequity claim. The insured’s
Mod showed the claim as open for $15,877, when in fact it had closed
a few days after the valuation date for $944. This correction alone
lowered the insured’s mod by 5 points.
2001-2002 Artis Group:
The next policy year contained 7 errors. All of these are closed claims
with incorrect loss amounts listed. Correcting these errors reduced
the insured’s mod by an additional 4 points.
2000-2001 Artis Group:
The final policy year on the mod contained 27 errors. Most of these
were closed claims with loss amounts listed as double their actual
value. For example, the loss runs report a claim of $133; the mod
would list that same claim as $266. Correcting these errors reduced
the client’s mod by another 7 points.
Solution:
We made both Artis and St. Paul Travelers aware of the errors and
asked that revised unit stat reports to the state Workers’ Compensation
bureau. Then we contacted the bureau and asked for a revised mod calculation.
Result:
The insured’s mod rating dropped from 1.85 to 1.69 and they
received a returned premium check for $24,879. |
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