1 Workers Compensation 101 Dave Young EMC Insurance Companies
2 Outline I. Brief history of Workers Compensation Insurance II. What does Workers Compensation do? III. Calculation of the Workers Compensation premium IV.Workers Compensation Experience Modifier V. What can be done to reduce Workers Compensation costs? VI.Upcoming changes to the Workers Compensation Experience Modifier formula
3 History of Workers Compensation in Wisconsin Before 1911, the only recourse to a worker who was injured in the course of his or her employment was to sue his or her employer in a civil or "tort" action, which was the same remedy available to a person injured under other circumstances. The tort remedy, however, had a major problem: it required the worker to prove that the injury occurred because the employer was negligent. In tort actions the employer had three almost unbeatable common law defenses: (1) that the worker was also negligent, (2) that the worker knew of the dangers involved and "assumed the risk," or (3) that the injury occurred because of the negligence of a "fellow employee." Under this system it was very difficult for workers to recover against their employers. If they won, however, there were no dollar limits on what a jury could award.
4 History of Workers Compensation in Wisconsin In 1911, Wisconsin adopted a Workmen's Compensation Act. This remedy is essentially a "no-fault" system under which a worker no longer has to prove negligence on the part of the employer, and the employer's three common law defenses are eliminated. The intent of the law was to require an employer to promptly and accurately compensate a worker for any injury suffered on the job, regardless of the existence of any fault or whose it might be. In return, the WC Act limited the amount of money that a worker could recover. Thus, workers are only entitled to: certain wage loss benefits, the cost of medical treatment, certain disability payments and payments for vocational rehabilitation retraining.
5 Who is Covered by WC You must have Worker's Compensation to be in business if: Usually employ three or more full-time or part-time employees. Employ one or more full-time or part-time employees to whom you have paid combined gross wages of $500 or more in any calendar quarter for work done at one or more locations in Wisconsin If you are a farmer who employs 6 or more workers on the same day for any 20 days during the calendar year. Out-of-state employers must have worker's compensation insurance if they have employees working in Wisconsin. The policy must be with an insurance company licensed to write in Wisconsin and endorsed to name Wisconsin as a covered state.
6 What About Volunteers? The Wisconsin Worker s Compensation Act does not provide for worker s compensation coverage for volunteers, including volunteers of non-profit organizations that receive money or other things of value totaling not more than $10.00 per week. A volunteer is a person who provides services of his or her own free will to or on behalf of an organization or entity who neither receives nor expects to receive any kind of pay or compensation for his or her services. Volunteers status may be changed to employee status if the worker receives or expects to receive compensation (almost anything of value including discounts, certificates, credits, vouchers, etc.) in exchange for his or her services.
7 Independent Contractors Under s (8), Wis. Stats., a person is required to meet a nine-part test before he or she is considered an independent contractor rather than an employee. If the nine-part test cannot be proven, your Workers Compensation insurance coverage will be extended to those workers.
8 Independent Contractors To be considered an independent contractor and not an employee, an individual must meet and maintain all nine of the following conditions: 1. Maintain a separate business 2. Obtain a Federal Employer Identification number from the Federal Internal Revenue Service (IRS) or have filed business or self-employment income tax returns with the IRS based on the work or service in the previous year. 3. Operate under specific contracts. 4. Be responsible for operating expenses under the contracts. 5. Be responsible for satisfactory performance of the work under the contracts. 6. Be paid per contract, per job, by commission or by competitive bid. 7. Be subject to profit or loss in performing the work under the contracts. 8. Have recurring business liabilities and obligations. 9. Be in a position to succeed or fail if business expense exceeds income.
9 WC Benefits to the Injured Worker Coverage of all reasonable and necessary medical expenses. Benefits for temporary wage loss during the healing period - temporary partial disability (TPD) or temporary total disability (TTD) are provided to sustain an employee while recovering from an injury. TPD means that the injured workers is only able to do some type of limited work for a short period of time and that further recovery is expected while TTD means that a person is unable to do any type of work for a temporary period of time. Workers' compensation payments are usually paid while the injured worker is out of work. Benefits for TTD due to disability are based on two-thirds of the employee s wage up to a specified maximum amount for the year of injury.
10 WC Benefits to the Injured Worker Benefits for permanent partial disability (PPD) or permanent total disability (PTD) are paid if the employee does not fully recover from the injury. Permanent disability is awarded for the potential or actual loss of earning capacity. The amount of benefit payment for permanent disability depends on the severity of the permanent disability. PPD means the permanent loss of use or function of any portion of the body while PTD means the loss of use or function of any portion of the body in combination with any preexisting disability that permanently prevents the worker from regularly performing gainful and suitable work. Vocational rehabilitation and retraining. If a death occurs, death benefits and burial expense will be paid to qualified beneficiaries up to specified limits.
11 Injured Workers Responsibilities In the event you are hurt at work or become ill, it is your responsibility to: Tell your supervisor that you are hurt immediately, even if you think your injury is minor and will heal without medical attention. Obtain any necessary medical attention, which may be getting first aid, seeing a doctor or going to the emergency room. Maintain all relevant medical and payment records for possible future use.
12 Employer and Insurance Carrier Responsibilities It is your employer's responsibility to report your injury/illness to his/her insurance carrier. The insurance carrier will then report your injury/illness to the Wisconsin Worker's Compensation Division. The insurance carrier will pay for reasonable and necessary medical expenses. If your doctor authorizes you off of work for more than three days, you will receive compensation for lost wages. If you are due compensation for your injury or illness: You should receive a check from your employer's insurance carrier generally within 14 days after your injury/illness.
13 Who Sets WC Costs?
14 Cost of Workers Compensation Chapter 626, Wis. Stats. is part of the Wisconsin Insurance Laws. It licenses the Wisconsin Compensation Rating Bureau (WCRB) and sets all of the rules, regulations and procedures relating to the classification of employers and worker s compensation rates. The WCRB is not a State agency. The WCRB is an unincorporated association of insurers who, by law, must be members of the WCRB.
15 Workers Compensation Subject Premium Worker s Compensation premiums are determined by multiplying a manual rate times the amount of payroll remuneration, measured in $100 components, times any experience rating modification applicable. Rates are established by the WCRB, based on employment classifications (fixed amount) Your payroll numbers are used (fixed amount) Subject Premium = (Payroll X Rate) / 100
16 Rate Examples Expressed in terms of: $ per $100 of payroll 2710 Sawmills $ Landscaping Gardening $ Sheet Mtl. Work Shop $ Carpentry shop $ Furniture Mfg. Wood $ Machine Shops $ Printing $ Paper Mfg. $ (School: Professional Employee) $ (School: All Other) $ 5.15
17 Workers Compensation Modified Premium Modified Premium = Subject Premium X Experience Mod Experience rating uses the historical loss experience of the individual employer as a predictor of future losses to adjust the premium the employer pays. Under experience rating, the premium of individual employers will be adjusted upward or downward by an experience modification factor. If an employer s actual past losses are greater than the expected average losses for all employers in the same business or industry, then an experience rating surcharge (or debit) will be applied to the policy and the employer s overall premium will be increased. If the converse is true and the employer s actual losses are lower than the expected average employer s losses, a rating credit is assigned and the employer will pay a lower overall cost.
18 The Experience Modifier Based on the last 3 complete years of Workers Compensation Claims Uses Total Incurred losses, includes reserves on open claims Even with no losses during the 3 year rating period, there is a minimum Mod There is a calculated Mod cap Medical only claims are discounted by 70% Only the first $5000 of indemnity claims goes directly into the calculation (split point) There is a $171,000 cap on Actual Incurred Losses
19 The Experience Modifier Actual Losses Expected Losses Because the Experience Modifier is based on your specific workers compensation loss history, it is the only variable part of premium calculation. Reducing your losses will reduce your WC premium Increasing losses will cause your WC premium to rise
20 Experience Modification Formula Total A = Actual Losses Total B = Expected Losses An Experience Mod of 1.00 means your losses are average for a school with similar payroll and your premium will not be affected.
21 Example Yourtown School District, Yourtown Wisconsin # Students 3000 # Employees 360 # Buildings 6 (4 elementary schools, 1 middle school, 1 high school Workers Compensation Policy Policy Period 7/1/2012 7/1/2013 Payroll 8868 (School: Professional Employee) - $16,000, (School: All Other) 1,200,000 Rates 8868 $0.53/$100 of payroll $5.15/$100 of payroll Subject Premium $84, $61,800 Total $146,600
22 Example $250,000 Work Comp Claims by Exp Year Claim $ Claim Count $222, $200,000 $150,000 $204, $177, Claim Data $0 Claims 126 claims Med Only 46 claims MO $ Incurred - $187,657 M+I > $ claims M+I > $ $319,299 $100,000 $80, Totals 3 Yr Range 172 Claims $506,956 Incurred $50, $25,493 $
23 Example Expected Loss Calculations
24 Example Experience Rating Summery Information A B C D Policy Yr Actual Incurred Losses* Primary Actual Losses Expected Losses 08/ / / Totals * Reflects 70% reduction on Med Only claims Actual Excess E= A-B Expected Excess F=C-D Weighting Value G 0.2 Balast Value H Experience Mod Formula B + (EXG) + (1-G)XF + H D + (FXG) + (1-G)XF + H Experience Modification 1.32 Primary Expected Losses Subject Premium = $146,600 Experience Mod = 1.32 Modified Premium = $193,512
25 Example Effects of the Experience Modifier Min Mod Pts to 1 Pts over 1 Min Premium Premium to 1 Premium > $46, $42,514 $104,086 Variable Mod Points = 0.61 Variable Premium = $89,426
26 Example Effects of the Claims on the Mod Mod Points 0.04 Premium $5, (1) 2008(2) Med Only Fixed Year Act Inc $ Mod Pt Premium 2008(1) $ $ (2) $ $ $ $ $ $7330 $104,086 $21,990 $17,592 $7, (1) 2008(2) Med Only $ $36650 Fixed $ Totals $ $ $36,650 Med Only Fixed
27 Who doesn t want cash back?
28 What Can You Do To Reduce Your Experience Modifier? Add An Accident Reduction Process to Your Safety Program Accident Investigation Return to Work
29 Accident Reduction Process
30 Accident Reduction Processes
31 Accident Reduction Example As you walk around Yourtown school buildings it is common to see teachers standing on chairs, desks and other devices to place items on walls and access storage on top of cabinets. Yourtown school district has several accidents related to this practice that resulted in workers compensation claims. Does your current safety program address this practice? What could be done to eliminate this hazard? What effect could this have on the experience modifier?
32 Accident Reduction Example Lets assume that the large medical & indemnity claim from 2009 was a fall from a chair. Remember the cost? $17,592 in additional WC premium If just 1 serious claim is avoided through accident reduction is it worth it?
33 Accident Investigation A formal process used to review accidents and near miss situations.
34 Accident Investigation The goals of accident investigation are: Find the root cause(s) Take the appropriate corrective action(s) Prevent a similar accident/incident from happening again No accident investigation has ever changed what has already happened Accident investigation should not assign blame, it should identify breakdowns in the safety process
35 Benefits of Accident Investigation Prevent future accidents by identifying and eliminating hazards Expose deficiencies in process and/or equipment Maintain worker morale Greater safety awareness Facts gathered in the event of litigation Reduce injury and worker compensation costs
36 Accident Investigation Example A food service worker for Yourtown School District was injured during the 2008/2009 school year while cleaning filters in the exhaust hood system. The injury was serious and resulted in a torn rotator cuff, surgery, and extended time away from the job. The cost of the claim was $149,678. What was this employee doing to get so severely injured? If no investigation of this incident occurs, could a similar accident happen in the future? Let s investigate!
37 Accident Investigation Example Interview the injured worker Interview the supervisor Determine: Direct causes - Unplanned release of energy or hazardous materials Indirect causes - Unsafe acts and/or unsafe conditions Root causes - Policies and decisions, personal factors, environmental factors
38 Accident Investigation Example Direct Cause(s) Cart Moved resulting in loss of balance and fall Indirect Cause(s) Use of an inappropriate climbing device Why? Because that s the way we have always done this Root Cause(s) Appropriate climbing device not provided No procedure in place No training on proper procedure
39 Accident Investigation Example Remember the cost? $21,990 in additional WC Premium If future occurrence of this activity is eliminated through accident investigation is it worth it?
40 Return To Work An early return to work (RTW) program is an organized system that aims to bring injured or disabled employees safely back to work as soon as they are able. Transitional work duties are matched to the injured worker s abilities by their physician for a specific time frame, allowing the worker to rejoin the workplace sooner an advantage to both the employer and the employee.
41 Return To Work RTW programs can help your organization effectively manage situations that involve workers compensation and employee health concerns. Benefits of a timely and medically-approved return to work program may include: Quicker recovery rates Supervision of injured employee activities, staying within restrictions Positive effect on Workers Compensation premium through reduced medical and indemnity costs
42 Return To Work Example Yourtown School District has a policy of not accepting injured workers back to work until they are at the end of the healing process and can perform 100% of their jobs. There are 3 claims in the loss history that resulted in significant medical bills and time away from the job but were not serious enough that the injured workers could not have been brought back on modified duty. Year Act Inc $ Mod Pt Premium 2008(1) $ $ $ $ $ $7330 The combined effect on the Workers Compensation premium was $30,786. Could Return To Work change that effect?
43 Return To Work Example Remember, although an injury may be significant and require medical attention, if the injured employee is able to return to the job within 3 days, even if in a limited capacity, the indemnity portion of the claim can be eliminated. Also recall that Medical Only claims are reduced by 70% in the Experience Mod calculation. Here s the effect on the Experience Mod from the same 3 claims assuming they were Medical Only, even keeping the $ amounts the same Year Act Inc $ Mod Pt Effect Premium Effect 2008(1) $ $ $ $ $ $5464 The combined effect is a reduction of 0.15 Experience Mod points and a premium reduction of $21,590. Is that worth the effort to manage a Return to Work program?
44 Changes in the Mod Calculation Effective in October this year the split point (amount of the claim $ that is used to calculate Actual Excess in the WCRB formula) will be raised from $5000 to $10,000. Why? The split point calculation has remained the same for over 20 years but medical expenses have risen greatly in that same time, creating artificially low calculated Experience Modifiers Potential effects: Employers who would have had an experience modifier of around 1.00 will see little if no effect. Employers who would have had an experience modifier significantly less than 1.00 will see an even greater credit. Employers who would have had an experience modifier significantly more than 1.00 will see an even greater debit.
45 Examples w/ Split Pt Change
46 Examples w/ Split Pt Change
47 Conclusions Workers Compensation insurance is an important part of our State Law that protects employees who are injured on the job from being significantly affected monetarily. The Experience Modifier is the only variable part of the Workers Compensation premium calculation. Workers compensation claim experience can greatly affect Workers Compensation cost, both positively and negatively. You can have an effect on your school district s Workers Compensation cost by implementing: Accident Reduction Processes Accident Investigation Return to Work
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