Manage Your Experience Modification Rate

Transcription

1 Dave Smith & Co Inc Manage Your Experience Modification Rate Average View Of Insurance Why the Ex Mod is a Poor Safety Measure and What you Can Do About It Actual What Is The EMR? Workers Compensation Experience Modification Rate Other Names: EMF: Experience Modification Factor Mod Mod Factor Mod Rate Ex Mod 1

2 EMR as A Measure of Safety Performance Contractor Prequalification OSHA Enforcement Insurance Underwriting Workers Compensation Basics Social Insurance Program Employee Injuries and Illnesses Arising out of employment (AOE) In the course of employment (COE) No Fault Exclusive Remedy Mandatory (with some Exceptions) All states plus federal programs Why Experience Rating? How does the mod work? Compensate for variations in WC classifications Provide incentives for safety Employers with more losses pay more Employers with less losses pay less 2

3 EMR Who calculates Experience Mods? California Workers Compensation Insurance Rating Bureau Actual Losses Expected Losses = EMR Most states use the National Council on Compensation Insurance (NCCI) to collect data and calculate the experience modification factor. NCCI is a private corporation funded by member insurance companies. Other State Plans with government-run rating bureaus that are separate from the NCCI: Delaware, Indiana, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Carolina, Pennsylvania, Texas and Wisconsin. 3

4 Numbers Workers Comp Pricing Three Years of data - Skipping the most recent policy year Claims and payroll Submitted by the insurer 6 months after the policy expiration in a unit statistical filing ( unit stat ) Bad Data = Bad Mods How are rates determined? Vary by State Manual Rating Also called the Pure Premium Rate, Applied to all industries of the same type Dollars per $100 dollars of payroll XYZ Contractors ABC Contractors Class Rate Payroll Premium Class Rate Payroll Premium Concrete $ 10,000 Concrete $ 10,000 Carpenters ,000 Carpenters ,000 Clerical ,000 Clerical ,000 Pure Premium $26,000 Pure Premium $26,000 Ex Mod.75 $19,500 Ex Mod 1.75 $45,500 4

5 Problems with the EMR System California Ex Mods Variations in state programs Self-Insured Employers Discrimination Against Smaller Employers Trailing Indicator Insurance Payroll Auditing Insurance claim reserving Rating Plan Changes Reduced Expected Losses in recent have inflated ex mods Construction: 10 points higher Restaurant: 46 points higher WCIRB Task Force Average Expected Loss Rates $2.25 Report issued July 11, 2008 Recognizes Problems Expected Loss Rates $1.75 $1.25 $1.58 $1.56 $1.60 $1.65 $1.87 $1.66 $1.73 $1.27 $0.96 $0.75 $ Source: Report of the Experience Rating Task Force, WCIRB, July 8, 2008, p. 13 5

6 WCIRB Task Force Life is unfair sometimes Recommends changes Simplification Educational Outreach Any Changes will not stop the use of the mod as a qualifier Manage Your EMR Top 10 Ways to Manage EMR Process Employer Controls Workers Compensation Claims Management Actual Losses Workers Compensation Payroll Management Expected Losses 1. Engage a claims expert 2. Get your mod worksheet every year 3. Conduct regular claim reviews keeping in mind unit stat deadlines 4. Verify unit stat filings prior to submittal 5. Continue safety efforts the injury prevented is a claim that does not increase the mod! 6

7 Top 10 Ways to Manage EMR Top 10 Ways to Manage EMR 6. Project future Ex Mods and use in budgeting 7. Provide modified work for all injured works. Make it real work. 8. Use first aid claim payment programs allowed under the California Labor Code. 9. Pursue subrogation recoveries and make sure they are credited to claim reserve. 10. If more than 1.25 (125%) prepare for the Cal/OSHA High Hazard Employer Program So what Should Be Used? Alternatives to the EMR For Safety Evaluation: Leading Indicators Better Metrics to Measure Safety Performance Activity Based Measures Processes Processes are in Control of Individual or Team Models and Management Systems What is done not what happened 7

8 Figure 1 The OHSMS Model Management Activity Safety Metrics OSMSS Z10 Standard Model continual improvement IIPP Documented? Employee Safety Meetings Percent Complete Employee Safety Suggestions Reward Good ideas Accident Investigation Accident Reporting Timing Safety Inspections Percent Complete Safety Recognition & Communication Programs Modified work employee H&S productivity satisfaction image Check Act 8.0 Mgmt Review 7.0 Checking & Corrective Action 4.0 Policy Mgmt ldr & E. Participlation Plan 5.0 Planning 6.0 Implementation & Operation hazard risks incidents comp cost lost time Do DO NOT BREAK THE LAW Commit Premium Fraud Deprive injured workers of benefits Suppress reporting of all compensable injuries to insurers Lie about your mod Set up shell companies to obtain a lower mod (Evasion) 8