There are many ways claims can affect an employer's experience mod and worker's compensation premium. Here are my top 10 tips for keeping costs to a minimum:
1. Timely reporting to insurance carrier
Time is of the essence. You must report a claim within 24-48 hours to your insurance carrier if you want to obtain the best outcome. Your insurance company cannot do their best job for you if you are reporting claims after that time. This does not totally rest on your shoulders; your employees and front line managers need to know this too.
Insurance adjusters are extremely busy people. In Wisconsin, if your employee is off more than three days of work, your adjuster has only 14 days from the last day worked to make a payment to your employee. That gives them very little time to do a proper investigation. Without appropriate medical documentation, they are only obligated to make a one week payment of lost time and then can suspend the claim pending the outcome of the investigation. Do you think your employee will be happy with a delay? Probably not.
2. You aren’t paying claims yourself, are you?
It is never a good idea to pay any workers compensation claims yourself. The Office of the Insurance Commissioner frowns on this practice. The Wisconsin Rating Bureau gives employers a significant 70% discount on all medical-only claims. If you make paying out of pocket a common practice and then decide to quit paying as medical treatment has gone on or gotten serious, your insurance carrier will have to play catch up. This makes it very difficult to recoup those dollars spent.
3. Cooperation with adjuster
Your adjuster is your best friend. They have the knowledge to investigate, analyze, and obtain a timely outcome for your employee’s claims. They know the law, and between the two of you, a successful outcome is bound to occur. Make sure that when you receive that first phone call from the adjuster you discuss expectations and what information they will need when communicating with you. Tell them about your employee if you had any concerns about them before the claim, warts and all. You know your employees, the adjuster does not. This truly helps the adjuster in handling a claim with difficult people. Also, if the adjuster calls you, please return the phone call as soon as possible, especially in lost time claims. The only one you are hurting is your own pocket book if you do not.
4. Work with your insurance carrier’s Loss Control Services
Each insurance carrier has employees who specialize in preventing losses. They are available to come to your business and help you assess your major risks and how to remove those risks. Knowledge is power. You are better off to work with these people than to have a claim. If they send you a letter with recommendations they are giving you the ways and means to save money if you comply with their suggestions. It truly works. Hausmann-Johnson Insurance also employs two Senior Loss Control Specialists who are able to work with you to identify potential risks.
5, Have temporary light duty work available
If your employee has a sprain or strain to their back, shoulder, neck, or knee they will not be allowed to immediately go back to their regular job duties. To mitigate your loss, you need to have temporary job duties in place that will enable your employees to come back to work and progress back to their normal job duties. If you are unable to find temporary light duty work, please contact your claims adjuster or the Claim Department at Hausmann-Johnson for ideas to make this happen.
I feel that the best way to rehabilitate an injured worker is to get them back into their work environment as soon as possible. If you are unable to find any light duty work, your insurance carrier will be paying them 2/3 of their gross wages, tax free. If you can bring injured workers back to work within three days at their regular hours and wage within work restrictions, you can keep the claim at a medical only status. Remember that 70% discount the Wisconsin Rating Bureau gives you on medical only claims? That would apply if you can have temporary work duties to present to the treating doctor.
Here is a bonus tip for you: If your employee refuses an offer of light duty work, you do not have to make any payments nor does the insurance carrier, ultimately having a positive effect on your experience mod.
6. Communicate with the treating physician
As the employer, you do have the right to talk to your employee’s physician. HIPPA laws do not apply with workers compensation claims. You or your staff are able to contact the physician’s office for work restriction information and to also tell them what job duties you have available. Your goal is to match the physician’s work restrictions to temporary jobs you have available for your employee. Be prepared to send a job description to the treating physician to help them assess return to work.
7. Stay in touch with the injured worker
The number one complaint we receive is that injured workers do not hear from their employers once they have had an injury. This is a two way street. Even if the injured employee is difficult, you are still their employer. Your responsibility is to keep that relationship healthy and let the insurance carrier be the bad guy, if that has to occur.
8. Is the insurance carrier closing claims on a timely basis?
The longer a claim stays open, the more it will cost you. There is a real birth, life, and death to each claim. If you think a claim is open too long, you should contact the adjuster for education and facts of the timeline. If you are not satisfied or unsure of the answer, then please call us at Hausmann-Johnson Insurance so we can help explain the situation. We advocate for claim closures with insurance carriers all of the time and we get results.
9. Remember that the current policy term does not affect your experience mod in the rolling three year policy term.
There is a rolling three year period of policy terms that are part of the claims history used to determine your experience mod. The current policy term that you are in does not affect the experience mod for that equation. For example: employee Jones is injured on 4/10/2017. You are currently in the policy term that is effective 1/1/17 to 1/1/18. This claim will not affect your experience mod at this time, the following three prior terms will: 1/1/16 to 1/1/17, 1/1/15 to 1/1/16, and 1/1/14 to 1/1/15.
At the next renewal, the 1/1/17 to 1/1/18 term comes onto the rolling three year period and the oldest policy term, 1/1/14 to 1/1/15, falls off. If you have high dollar claims on the term that falls off and you are adding a claim free year for the term coming in, you are on your way to a lower experience mod.
10. Is the insurance company filing unit stat card revisions on your behalf?
A unit stat card is like a report card of your claims history. If your insurance carrier has reserved a claim for $100,000 and the claim closes with a payout of only $10,000 there is a window of time that you can ask the company to file a revised unit stat card to show the true payout to the appropriate regulatory agency that monitors your policy. Most companies will not do this unless you ask. If there is a difference of more than $5,000 and the time period after the closure is appropriate, the insurance carrier must file a revised unit stat card. Hausmann-Johnson Insurance initiates the filing on our clients’ behalf, saving them hundreds of thousands of dollars.
With some patience, you can lower your experience mod and save money. Please contact our Claims Department at 608-257-3795 and ask for Susan Dorsch or Peg Kramer with questions.
If you'd like to learn more, sign up for Peg's webinar: Life Cycle of a Worker's Compensation Clam