RIMS Webinar January 20, 2011 An Overview of Nonsubscription from Texas Workers Compensation Answers to Participants Questions Prepared by PartnerSource Q: What are the litigation rates associated with non subscriber claims vs. traditional workers comp? A: We do not have historical litigation rates in aggregate for traditional workers comp in Texas, and as far as we know, they are not available. We do know the litigation rate for nonsubscribers is very low (2.2 out of every 1000 claims for PartnerSource book of business). Q: How do premiums compare between nonsubscriber and traditional workers comp policies? A: A nonsubscriber insurance policy will commonly be equal to or less costly than a Texas workers comp policy. This is assuming a quality nonsubscription insurance product that covers the expanded liability exposure, is placed with a Top Tier carrier, and which carries a similar self-insured retention level. Q: What size employee population best fits a non-subscriber program? A: There is no minimum or maximum size requirement. Tens of thousands of nonsubscribing employers have less than 100 employees. Several nonsubscribing employers have more than 20,000 Texas employees. Q: Non-subscribers not addressed in the presentation include small residential contractors who would not set up an "Injury Benefit Plan". Hence, the project owner or upstream contractor will be subject to "third party over actions" which can be incredibly expensive (defense and indemnity costs). My view is that your programs are not designed to address the small contractor exposures to homebuilders. Is this correct? A: You are correct that many small residential contractors will not setup an Injury Benefit Plan or otherwise properly handle their employee care and risk management needs. But consider this: (1) you have the same general liability exposure whether they carry WC or not. You simply reduce the likelihood of such a claim being pursued by ensuring that the small contractor has a program in place to take care of its employees, (2) you can either mandate that all of your contractors carry WC coverage which increases your costs and frequently provides inadequate medical and disability management of significant claims- or you can setup minimum nonsubscriber contractor criteria and/or setup your own nonsubscriber contractor program that all vendors who can t prove WC coverage must participate in. Q: Your stats on page 16 are from 2001. Is any recent data available? A: The litigation statistic on page 16 refers to the fact that only 3% of nonsubscribers were sued during the previous 5-year period. The statistic is from 2001. This is statewide data. 2001 was the last time the state asked for this information, and then provided the result in its survey. We have more updated metrics from our own database.
Q: Question for Dollar General: Your call out on page 17 states that 4 out of 1,000 have attorney involvement. How does this compare to subscriber claims? A: Rick Sumner from Dollar General: In 2009 (our 1st year of nonsubscription) we had 2 litigated claims, and in 2010 we had 1 litigated claim. This compares with 22 litigated claims we had in Texas during 2008, which was our last year in workers comp. Q: Please clarify the 68 examples. Is this for all Texas nonsubscribing employers or just PartnerSource data and gt? A: The 68 settlements and judgments over $1million during the past 21 years include ALL Texas nonsubscribing employers, based on an annual PartnerSource survey of insurance carriers, defense attorneys, TPA s and others. Q: Liability protections - many CGL policies NOW include an exclusion for injuries to subs employees and these exclude claims from the sub's employee's family, spouse, etc. These exclusions have become mandatory for small contractors. Larger clients may be able to negotiate removal of said exclusions, but that is not possible for small contractors as they lack clout. A: There is no need to modify this CGL exclusion due to the availability of a very competitive nonsubscriber insurance market. This market provides coverage for employee and family, spouse, etc. claims, at virtually any deductible (or SIR) and virtually any coverage limit. Q: Your cost savings stats on slide 20-savings of 50%-are you comparing premium to premium or premium plus costs to premium plus costs? A: These comparisons are claims cost to claims cost. The comparisons do not include insurance premiums and TPA costs, which are normally about the same as they should be in workers compensation. Additionally, the insurance costs for nonsubscribing employers are frequently less costly. Q: Do the indemnity policies cover the liability claims? Do GL policies respond? A: Yes, there are nonsubscriber indemnity policies in the marketplace that include coverage for employers liability as a result of a finding of workplace negligence. It is our understanding that GL policies do not respond as a work-related injury is usually an exclusion. Q: Is the reduction in expected claim payout the cause of the drastic reduction in collateral? A: The answer to your question is, no. Nonsubscription does not require collateral because the employer should never owe any money to an insurance carrier to reimburse the carrier for paying claims inside a deductible (or SIR). All claims are selffunded by the nonsubscribing employer, with the insurance carrier reimbursing the employer for any claim payments above the deductible (or SIR). Q: Are any other states considering Non-subscription? A: Yes. We will publish a newsletter article on this shortly. You can go to the PartnerSource website to add your contact information to our email distribution list.
Q: Why has the coverage been written on a non-admitted basis? Does that mean the carrier is NOT subject to the Guarantee Fund set up by the state? A: You can purchase nonsubscriber polices that are written on an admitted basis and policies that are written on a non-admitted basis the latter are considered surplus lines policies. It is our understanding that surplus lines coverage that reimburses a nonsubscribing employer for claims is subject to the Texas surplus lines tax and stamping fee, but is not subject to the guaranty Fund s protection. Q: Do you use waiver of the right to sue from employees? A: Pre-injury waivers were outlawed in 2001. Post-injury waivers can be used as part of an injury benefit plan design strategy (that few employers adopt) or can be used to resolve contested benefit and/or negligence liability claims (which all nonsubscribing employers should be prepared to use, from time-to-time). Post-injury waivers are subject to certain requirements found in the Texas Labor Code. Q: Has Dollar General had any claim issues around loosing the common law defenses and exclusive remedy? A: No. Q: Is the current administration a concern for Non-subscribers? A: Not as long as they continue to move to a more centrist position on business issues. A more left-leaning administration that supports legislation like Senator Baca s bill to nationalize the WC system would pose strong concerns. Q: Are there a number of markets to write N/S coverage in excess of a $5mm deductible? A: Yes. Q: How does USL& H affect nonsubscribers? Can an employer subject to USL& H nonsubscribe? A: USL&H coverage is mandatory for covered workers. And employers subject to USL&H can only nonsubscribe its non-usl&h workers who are employed in a separate legal entity. Q: Question for Dollar General Are you finding that you have fewer repeater claims for employees? A: In 2009, only 11% of the nonsubscription claims came from claimants that had a previous claim. This decrease is in comparison to 2008 during which 22% of our workers comp claims came from claimants that had a previous claim. (Note that Dollar General has only been a nonsubscriber for two years; so the 11% figure will likely continue to decline.) Q: Can any size of business nonsubscribe? A: Nonsubscription is not right for every employer, regardless of size. Sometimes it does not make sense for large or small employers. In general, if an employer has any significant volume of claims in Texas, the severity of those claims usually can be reduced via nonsubscription. PartnerSource has created a process for identifying the amount of potential savings which helps determine if nonsubscription is a viable option for specific employers.
Q: What impact, if any, does this cover have on the Umbrella carrier in Scheduling the Nonsubscription coverage? How are selected limits determined? A: Most of our clients have been successful having their Umbrella carrier schedule the N.S. coverage. The key question is what coverage is the Umbrella providing? Coverage for all negligence claims, or just for the same claims that would have been covered under WC (e.g., gross negligence death claims)? Q: Are the coverages provided in your loss comparisons equal. Specifically how do they each address indemnity? A: Yes. The financial comparisons in the case studies are equal as they include all benefit and liability expenses, (including relevant settlements and judgments for a true apple to apple comparison). The benefits under nonsubscription vary from employer to employer. Generally better than workers compensation in several key areas, but the workers compensation automatic coverage for life provision is removed. Q: Dollar General has a large TX presence. Could similar impact be expected for smaller employers? A: Normally yes, but it varies. As well, the claim reduction is common for employers of all sizes. However, there are some administrative expenses for a nonsubscription program, which should be considered when evaluating this option. As a normal part of the process, PartnerSource outlines all of those expenses to ensure financial viability of the overall program. Q: From a TPA partnership, who do you feel has been great to work with and produce good results? A: There are a variety of good TPA options available including national and regional TPAs. Q: What are the major differences between self insurance and non subscription? What kind of security is required for nonsubscription and self insurance? A: Texas has several security and other requirements to become a certified selfinsured employer within the workers comp system. There are currently only about 60 self-insureds in Texas. Major differences include the fact that, even as a self-insured, you still must follow all of the same statutory benefit and administrative schemes of the WC system; whereas, with nonsubscription, you can design your own benefit and administrative schemes. Q: How are insurance certificates evidencing workers comp insurance different between standard workers comp vs. nonsubscribed? Do we still need to show evidence of coverage to vendors, customers, etc? A: We provide certificates of N/S insurance to our clients showing there is benefits and excess employers liability coverage for work-related injuries. Most vendors are satisfied with these certificates. Q: Are PEOs allowed to nonsubscribe in Texas? A: Yes, but few do.
Q: Are you seeing any resistance or issues with excess liability carriers attaching above the nonsubscribers policy? What is the typical underlying limit required by excess carriers...presumably separate and distinct from employer's liability? A: Most of our clients have been successful having their Excess carrier attach above the nonsubscriber policy. The key question is what coverage is the Excess Umbrella providing? Coverage for all negligence claims or just for gross negligence death claims? The typical underlying limit is $5mil. We should discuss further. Q: What is the nonsubscription notification process required by the TX WC bureau? A: State compliance requires the following: DWC Form-5 (Notice to State of Texas) o Notifies the Department of Workers Compensation if a business chooses to become a nonsubscriber. This form must be filed initially within 10 days after notifying the insurance carrier of cancellation and annually on the anniversary date of the original filing. DWC Form-205 o Lists additional business locations of a nonsubscriber. Used in conjunction with DWC Form-5 above. DWC Notice 5 & DWC Notice 5s (Notice to Employees and Workplace Posters) o Notifies employees of employer s nonsubscriber status. This notice must be posted in the workplace in English, Spanish, and other languages common to the workplace within 15 days of the employer dropping or cancelling insurance coverage. Written notice must also be distributed to all Texas employees using this same language. DWC Form-7 & DWC Form-7s (Lost Time/OD/Death Claim Notice) Reports all fatalities, occupational diseases and on-the-job injuries resulting in more than one day s absence from work for the injured employee. Must be filed no later than the 7 th day of the month following the reported incident. Q: Does Dollar General have a no-gap coverage between N/S and group insurance? Are they all on the same page, if N/S denies, group picks up with no complaints? A: No, Dollar General does not have a no-gap process between nonsubscription claims and group health insurance. For any employer, generally group health insurance will only pick up nonsubscription claims that have been denied because the injury has been deemed not work related, whether from a medical or circumstance perspective. Q: On average, what % of the total nonsubscriber claims cost is attributed to medical benefits? In WC, indemnity is roughly 40% and medical is 60%. A: We do not track this information on a combined basis; however, a review of $36.5M in total claim costs showed that 68% were medical.