Copyright 2014 National Council on Compensation Insurance, Inc. All Rights Reserved. WCI Worker s Compensation Educational Conference August 19, 2014

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1 WCI Worker s Compensation Educational Conference August 19, 2014

2 Risk Classification and Rules Utilizing ncci.com and Online Manuals

3 Who Is NCCI? Classification Rules Tools and Information Break Agenda Part I 3

4 Who Is NCCI? 4

5 National Council on Compensation Insurance (NCCI) Established in 1922 to coordinate the interests of insurers with those of regulators and other public policy makers Operates under a not-for-profit philosophy Guided by the regulatory agencies in the jurisdictions where we are licensed or designated as statistical agent and/or rating/advisory organization (nearly 40) 900 employees nationwide Most experienced provider of workers compensation and employee injury data and statistics in the nation 5

6 NCCI s Mission To foster a healthy workers compensation system by providing high-quality information and analytical services that result in: Tangible value for stakeholders Adequate loss costs/rates Objective reform evaluation Self funded residual markets 6

7 What NCCI Does Comprehensive Data: Policies Claims Financial Results Objective Analysis: Transforming data into value information and providing workers compensation expertise Stakeholder Network: Sharing insights and knowledge to help ensure a healthy workers compensation system 7

8 Classification 8

9 Purpose of the Classification System 9

10 Why Classifications are Necessary If a classification system did not exist, and a single rate was used to determine the premium for all businesses, the premium charged to: High-hazard businesses would be insufficient Low-hazard businesses would be excessive Insurance providers would be reluctant to write high-hazard operations if the rate were not specifically developed to cover the cost of the exposure 10

11 Why Classifications are Necessary Through the NCCI classification system, the cost of loss is distributed fairly among similar businesses. The experience reported by insurance providers for each classification in each state is used in calculating the manual rate for that classification in that state. In most states, NCCI files advisory loss cost rates that represent projected losses. The carrier adds an increment for expenses to the advisory loss cost to develop the manual rate. In administered pricing states, manual rates are filed by NCCI that include estimated expenses. 11

12 Three Steps to Classification 1. Look for a classification entry in NCCI s Basic Manual for Workers Compensation and Employers Liability Insurance (Basic Manual)that best describes the employer s business Part Two Classifications 2. Review the classification code in NCCI s Scopes Manual for additional information Check for state exceptions 3. Review NCCI s Basic Manual for specific rules related to classification 12 Rule 1 Classification Assignment

13 Step 1 Find a classification in NCCI s Basic Manual Part Two Classifications that best describes employer s business 13

14 Step 1 Check the code data table to see if there are any state special exception(s) 14

15 Step 1 Review NCCI s Basic Manual Florida state exception wording 15

16 Step 2 Review the Florida state exception entry in NCCI s Scopes Manual for any additional information related to the assignment of the code 16

17 Step 3 Review NCCI s Basic Manual Rule 1 Classification Assignment for rules that might impact classification assignment: Standard Exceptions General Inclusions/Exclusions Words and Phrases Classification Procedures State-Specific Rule Exceptions 17

18 Standard Exceptions NCCI s Basic Manual Rule 1-B-2 Standard Exception Classifications: Occupations common to many businesses not included in a basic classification unless specified in the classification wording: Clerical Office Employees NOC (8810) Clerical Office Telecommuter Employees (8871) Drivers, Chauffeurs, Messengers, and Helpers NOC Commercial (7380) Salespersons or Collectors Outside (8742) Automobile Salespersons (8748) 18

19 General Inclusions NCCI s Basic Manual Rule 1-B-3 General Inclusions: Operations that appear to be separate businesses but are included within an insured s basic classification: Restaurants or cafeterias operated for employee use Manufacture of containers for sole use in the operations of the business Hospitals or medical facilities operated for employees Printing or lithographing on insured s own products Company store operated by insured for employee use (Florida) 19

20 General Exclusions NCCI s Basic Manual Rule 1-B-4 General Exclusions: Operations so unusual for the type of business described by the basic classification that they are separately classified even though they are not conducted as a secondary business: Aviation All operations of the flying and ground crews New construction or alterations Stevedoring Sawmill operations Employer-operated day care service 20

21 Classification Wording Classification Captions and Notes: 8006 STORE FRUIT OR VEGETABLE RETAIL. No handling of fresh meats. Store is the caption No handling of fresh meats is the note 21

22 Assignment of More Than One Basic Classification NCCI s Basic Manual Rule 1-D-3 Assignment of More Than One Basic Classification: More than one basic classification may be assigned to an insured who meets certain conditions 22

23 Assignment of More Than One Basic Classification Condition: Insured s principal business is described by a basic classification that requires certain operations or employees to be separately rated: 3632 MACHINE SHOP NOC. Foundry operations to be separately rated. 23

24 Assignment of More Than One Basic Classification Condition: Insured conducts one or more of the following operations: Construction or erection 5645 Farming 0170 Employee leasing; labor contracting; temporary labor service Mercantile business

25 Assignment of More Than One Basic Classification Condition: Insured conducts more than one operation in a state: Must be able to exist as a separate business if the principal business ceased to exist Must be located in a separate building, or separate floor in same building, or on same floor physically separated from the principal business Must maintain proper payroll records 25

26 Importance of Correct Classification Avoids additional policy premium due at audit Employer bid and/or completed work based on policy-issued premium Employer can t go back and collect unbudgeted premium from customers 26

27 Vague descriptions Changes in the employer s operations 27

28 NCCI Inspections On-site review of an employer s current operation to determine classification Not an audit Results are reported to authorized parties NCCI Inspection types Special Inspections Classification Quality Assurance Inspections (CQA) 28

29 NCCI Inspections Inspector meets with the owner, officer, or other designated employee to: Verify names and locations of covered entities Review relationships to other commonly owned entities Discuss any changes in business operations Verify any subcontracted operations Verify any leased employees Verify any general exclusion operations 29

30 How to Order an NCCI Classification Inspection 30

31 NCCI Classification Inspection Service Alphabetical or Categorized Directory Look for Classification Inspection Service 31

32 32

33 2013 Top Five Reclassified Codes Classification Codes Commonly Reclassified Reclassified to Classification Code 4299 Printing 8015, 2501, 9501, 4251, Store Retail NOC 8018, 8010, 8044, 8045, Architectural or Engineering Firm Including Salespersons & Drivers 5191 Office Machine Installation, Inspection, Adjustment or Repair 9015 Building or Property Management All Other Employees 8602, 8603, 4511, 8810, , 9516, 3681, 8107, , 8855, 8810, 9014,

34 Rules 34

35 Rating and Premium Elements NCCI s Basic Manual Rule 3 Rating Definitions and Application of Premium Elements: Basic Manual rules, classifications, and rates are applied on an Anniversary Rating Date (ARD) basis in states where ARD applies ARD does not apply in AL, GA, IL, LA, ME, NM, TX, and WV 35

36 Rating and Premium Elements Common rating and premium elements that can impact policy premium: USL&HW Act and Admiralty Law benefits Coal mine disease charge Expense constant Experience rating Increased limits of Employers Liability Premium discount Waiver of subrogation 36

37 State Specific Pricing Programs Assigned Risk Specific Programs Coinsurance Contracting (CCPAP) Deductible Drug/Alcohol Free Credit Managed Care Merit Rating Safety Schedule Rating 37

38 Bid Requirements Workers Compensation Policy Provisions $1,000,000 Employers Liability Insurance Limits Waiver of Subrogation 38

39 Employers Liability Insurance Increased Limits Standard limits included with the policy: Bodily Injury by Accident:$100,000/Accident Bodily Injury by Disease: $500,000 Policy Limit Bodily Injury by Disease: $100,000/Employee Increased limits are available for additional premium. 39

40 Employers Liability Insurance Increased Limits Premium Premium Details NCCI s Basic Manual Rule 3-A-14 $1,000,000/$1,000,000/$1,000,000 limits requested Premium Charge $40,000 estimated manual premium x 1.4% Florida increased limits factor/percentage $560 (subject to $120 minimum premium) 40

41 Waiver of Our Right to Recover From Others (Subrogation) Endorsement (WC ) NCCI s Basic Manual Rule 3-A-22: Allows carrier to waive its right of recovery against a third party that may be liable for a covered injury Waiver may be specific or blanket In the voluntary market, insurance carriers generally file their own rates/charges for WOS 41

42 Dispute Scenario Carrier audits employer s expired policy Carrier adds class code and payroll to policy for additional exposure developed during the policy Carrier sends bill to employer for additional premium Employer does not agree with carrier audit findings Recourse? 42

43 NCCI Dispute Process Employer attempts to resolve with carrier NCCI attempts to resolve with carrier Dispute heard by state s appeals/dispute mechanism Appeals Board, Panel, or Committee issues decision Employer may further appeal the decision to the state s insurance regulatory authority 43

44 Florida Dispute Resolution Processes NCCI s Basic Manual Florida Miscellaneous Rules Florida Workers Compensation Appeals Board NCCI serves as a nonvoting Administrator to the Appeals Board Purpose is to review the application or interpretation of NCCI manual rules to the employer s policy Request for dispute resolution within four years after the expiration of the policy in question Process must be exhausted before dispute can be appealed to next level 44

45 Tools and Information 45

46 ncci.com Your source for workers compensation information, services, and tools. 46

47 Home Page 47

48 My Preferences 48

49 My Preferences 49

50 Circulars 50

51 Circulars 51

52 My Preferences 52

53 Manuals Library 53

54 Manuals Library 54

55 Manuals Library 55

56 Manuals Library 56

57 Manuals Library 57

58 Manuals Library 58

59 Manuals Library 59

60 Education 60

61 Questions? 61

62 Break 62

63 Experience Modifications: Understanding, Managing, and Helpful Tools

64 Agenda Part II Purpose and Benefits of Experience Rating Basics of Experience Rating Claim Limitations Experience Rating Worksheet Review Ownership Riskworkstation 64

65 Fast Facts on Experience Rating 650,000 insureds 1,000,000 ratings produced 48,000 ownership rulings processed 25,000 contractors credits calculated 65

66 Piece of the Puzzle Rates Rules Data Experience Rating 66

67 Introduction to Experience Rating Tailors the cost of insurance Modifies manual premium Gives opportunity to manage cost Provides added incentives 67

68 NCCI s Experience Rating Plan Manual NCCI s Plan applies in 38 jurisdictions: Alabama Iowa New Mexico Alaska Kansas North Carolina Arizona Kentucky Oklahoma Arkansas Louisiana Oregon Colorado Maine Rhode Island Connecticut Maryland South Carolina District of Columbia Massachusetts South Dakota Florida Mississippi Tennessee Georgia Missouri Utah Hawaii Montana Vermont Idaho Nebraska Virginia Illinois Nevada West Virginia Indiana New Hampshire 68

69 NCCI s Experience Rating Plan Interstate only: Minnesota New York Texas Wisconsin Does not apply in: California Delaware Michigan New Jersey Pennsylvania Monopolistic states: North Dakota Ohio Washington Wyoming 69

70 Types of Experience Ratings An intrastate rating is produced for a risk with exposure (payroll) in only one state during the experience period An interstate rating is produced for a risk with exposure (payroll) in two or more states in the experience period 70

71 Status of Experience Ratings A preliminary mod uses rating values from the previously approved rate filing while a new rate filing is pending. A final mod uses rating values that have been approved for use in a specific state. Note: Interstate modifications can have states with both preliminary and final rating values. Only when all states are final is the mod considered final. A contingent mod is one that is produced when the rating organization is unable to obtain some of the payroll and/or loss data to produce a rating. 71

72 Time Period Used Three years of payroll and loss data May include up to 45 months Example: Rating effective date: 1/1/2014 Policy Period 1/1/12 1/1/13 1/1/11 1/1/12 1/1/10 1/1/11 Unit Reports 1 1, 2 1, 2, 3 72

73 Rolling Experience 1st Report Level 2nd Report Level 3rd Report Level 1/1/12 Rating 1/1/10 1/1/11 1/1/09 1/1/10 1/1/08 1/1/09 1/1/13 Rating 1/1/11 1/1/12 1/1/10 1/1/11 1/1/09 1/1/10 1/1/14 Rating 1/1/12 1/1/13 1/1/11 1/1/12 1/1/10 1/1/11 73

74 Qualification for Experience Rating Mandatory program for qualifying risks Premium eligibility set by the state Individual risks qualify if they achieve: Premium Threshold Most recent two years of the experience period, or Average in overall experience period Refer to the Premium Eligibility table in Rule 2A of NCCI s Experience Rating Plan Manual. 74

75 Premium Qualification Example Florida requires: $10,000 of subject premium in the most recent two years, or an average of $5,000 in the overall experience period Rating effective 1/1/14 Policy Period Subject Premium 1/1/12 1/1/13 $6,500 1/1/11 1/1/12 $5,500 1/1/10 1/1/11 $2,000 Does this insured qualify? YES 75

76 Premium Qualification Example Florida requires: $10,000 of subject premium in the most recent two years, or an average of $5,000 in the overall experience period Rating effective 1/1/14 Policy Period Subject Premium 1/1/12 1/1/13 $4,000 1/1/11 1/1/12 $5,000 1/1/10 1/1/11 $5,500 Does this insured qualify? NO 76

77 Premium Qualification Example Florida requires: $10,000 of subject premium in the most recent two years, or an average of $5,000 in the overall experience period Rating effective 1/1/14 Policy Period Subject Premium 1/1/12 1/1/13 $4,500 1/1/11 1/1/12 $4,800 1/1/10 1/1/11 $5,900 Does this insured qualify? YES 77

78 Timeline of Rating Production 1/1/12 1/1/13 7/1/13 9/1/13 10/1/13 1/1/14 1/1/12 1/1/12 1/1/12 1/1/12 1/1/14 1/1/14 policy effective policy expires policy valued unit submitted rating produced rating effective 78

79 When a Mod Will Be Revised Pending rate filing is approved, and rating changes from preliminary to final NCCI receives payroll or loss correction reports NCCI receives missing data for a previously contingent modification There is a change in ownership The risk is reclassified There is a transfer of experience from a professional employer organization s mod to the mod of a former client 79

80 Formula E E B E.1E 2570 G E E E 700 G 1.1E 2570 G 1 E 700 G 1.1E 2.57 SACC 1 E.7 SACC E.7 SACC E.7 SACC.1E 2.57 SACC E.7 SACC 1.1E 3.27 SACC E.7 SACC 3 (1 f ) 1 A p 1.1E 3.27 SACC dm dm 3 MP Ap A p 3 MP 1 A da p da p E.7 SACC E.7 SACC E.7 SACC.1E 2.57 SACC 1.1E 3.27 SACC E.7 SACC 3 (1 f ) 1 1.1E 3.27 SACC dm dm 3 MP Ap Ap 3 MP 1 A da p da p A p p p 80

81 Basic Formula Actual Losses Expected Losses Experience Modification Formula Overview Only 81

82 Application of Modifications Premium Mod Modified $100,000 X 0.75 = $75,000 $100,000 X 1.00 = $100,000 $100,000 X 1.25 = $125,000

83 Claim Limitations Primary vs. Excess Split Point Single State Claim Limitation Experience Rating Adjustment (ERA) 83

84 Split Point The split point separates the overall claim value into primary and excess components The split point is currently $13,500* Ratable Primary Ratable Excess Claim Value Loss Loss $2,000 $2,000 $0 $5,000 $5,000 $0 $15,000 $13,500 $1,500 $50,000 $13,500 $36,500 *In most states effective with rate filing on or after 1/1/

85 Frequency vs. Severity Claims Cost per Claim Total Losses Total Primary Losses Employer 1 1 $100,000 $100,000 $13,500 Employer 2 10 $10,000 $100,000 $100,000 Which is the better situation? Employer 1 85

86 State Per Claim Accident Limitation Claims may be limited by the state per claim accident limitation Limitations vary by state and by rate filing Example: State per claim limit of $246,500 Loss Actual Incurred Loss Actual Incurred Limited Loss Actual Primary Loss 1 $450,000 $246,500 $13,500 2 $200,000 $200,000 $13,500 3 $50,000 $50,000 $13,500 86

87 Experience Rating Adjustment (ERA) The ERA reduces medical only (Type 6) claims by 70% Ratable Ratable Excess Claim Value Primary Loss Primary Loss Excess Loss Loss $5,000 $5,000 $1,500 $0 $0 $10,000 $10,000 $3,000 $0 $0 $15,000 $13,500 $4,050 $1,500 $450 $50,000 $13,500 $4,050 $36,500 $10,950 87

88 Expected Losses Expected Losses = (Payroll/100) x ELR ELR = Expected Loss Rate ELRs vary by class and are calculated from filed loss costs Expected Losses are also broken out between primary and excess Primary Losses = Expected Losses x D-Ratio Excess Losses = Expected Losses Primary Losses 88

89 Impacts to Expected Losses Types of Operations ELRs are tied to loss costs The higher rated the class code, the larger the ELR The larger the ELR, the greater the expected losses Payroll (Exposure) Base The larger the exposure, the greater the expected losses Note: Although there are caps to actual losses, expected losses are not capped in the experience rating calculation. 89

90 Experience Rating Worksheet 90

91 Experience Rating Worksheet 91

92 Example 92

93 Calculate Expected Losses Expected Losses = ELR x Payroll x 108, =140 (140.4) 93

94 Example 94

95 Calculate Expected Primary Losses Expected Primary Losses = Expected Losses x Discount Ratio 140 x 0.24 = 34 (33.6) 95

96 Example 96

97 Actual Losses 97

98 Experience Modification Factor 98

99 Experience Modification Factor 99

100 Ownership Examples: An individual sells his gas station to another individual BellSouth and AT&T merge in an $86 billion deal The Seminole Indian Tribe buys Hard Rock International for $965 million Sirius Satellite Radio s $3.3 billion buyout of former competitor XM Satellite Radio 100

101 Qualitee Construction Joe s Lawn Service 101

102 Why Does NCCI Produce Ownership Rulings? Rule 3-E-1 of NCCI s Experience Rating Plan Manual for Workers Compensation and Employers Liability Insurance: The experience for any entity undergoing a change in ownership will be retained or transferred to the experience ratings of the acquiring, surviving, or new entity unless specifically excluded by this Plan. 102

103 Impact of Ownership Changes Seller s mod is similar to an asset or liability Client is buying the seller s experience modification Experience transfers, unless: There is a material change in ownership Governing classification is changed Process and hazard are changed 103

104 ERM-14 Form 104

105 Section A Transaction Jan 1, 2014 Jan 15, 2014 Jan 1, 2014 Jan 15,

106 Section A Entities 106

107 Section A Entities 1/1/14 1/1/14 107

108 Section B Ownership Qualitee Trucking 123 Main Street, Any Town, USA WC (Stanley Qualitee 55%, Larry Qualitee 45%) 01/01/

109 Common Majority Ownership 109

110 Sale/Resulting Combinability 110

111 ERM-14 Section C Joe s Lawn Service was fully acquired by Qualitee Construction, which is 100% owned by Stanley Qualitee. 111

112 ERM-14 Section D 112

113 ERM-14 Section E Stanley Qualitee 1/15/14 113

114 Ownership Letter Example of a sale with resulting combinability Multiple mods may apply Letter will give additional information 114

115 ERM-14 Reminders Indicate all transactions on the ERM-14 form Include transaction dates and reported dates Include complete ownership information for all entities Add explanation, if necessary Ensure the form is signed and dated 115

116 ERM-14 Form and Instructions 116

117 ERM-14 Form and Instructions 117

118 Summary of Plan Essentials of experience rating: Mandatory for all risks that meet the premium eligibility threshold Measures how the performance of an employer differs predictably from similarly classified employers 118

119 Summary Basic statistical principles: The larger the premium size, the more reliable the actual record is in predicting future losses Cost of an injury may vary over a large range Cost is less predictable than the occurrence of an injury 119

120 Riskworkstation

121 Navigating to Riskworkstation

122 Home Page

123 Recent Risk Searches

124 Home Page

125 Home Page - Search

126 Search Results

127 Order Risk Products 127

128 Order Risk Products

129 Mods and Worksheets

130 Mods and Worksheets 130

131 Mods and Worksheets 131

132 Mods and Worksheets 132

133 Mods and Worksheets 133

134 Worksheet Order 134

135 Order Confirmation 135

136 Ordered Products 136

137 Worksheet PDF 137

138 Test Mod From Existing Worksheet 138

139 Test Mod From Existing Worksheet

140 Test Mod From Existing Worksheet 140

141 Create New Test Mod 141

142 Create New Test Mod 142

143 Test Mod from Existing Worksheet 143

144 Saved Test Mods 144

145 CCPAP Factors 145

146 CCPAP Factors

147 CCPAP Name Search

148 CCPAP Factors 148

149 RiskSnapshot Report 149

150 RiskSnapshot Report 150

151 Risk History Report 151

152 Risk History Report

153 Risk History Report Payroll 153

154 Risk History Report Losses 154

155 Notifications

156 Notifications 156

157 Recent Purchases

158 Quick Tools

159 Quick Mods

160 Quick Scopes

161 Scopes Detail Link 161

162 Applicable Jurisdictions Link 162

163 IRMI Link 163

164 Quick Rates

165 IRMI Cross-Reference Guide 165

166 IRMI Cancellation Guide 166

167 IRMI Cancellation Guide 167

168 IRMI Cancellation Guide 168

169 Quick Links 169

170 Direct Contacts Linda Colbert, Regulatory Assurance Phone: Jon Rutstein, Product Management Phone: Freddie July-Johnson, Experience Rating Phone: Laurie Kurtz, Product Management Phone:

171 Questions? 171

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