YOU VE GOT QUESTIONS? For All That Matters

Transcription

1 YOU VE GOT QUESTIONS? For All That Matters

2 WE VE GOT ANSWERS! Workers compensation is complex, and we re sure you have many questions. Here are some of the most frequently asked questions about work comp. RATING, PREMIUMS, AND GENERAL POLICY INFORMATION How do work comp rating bureaus obtain the information used to calculate insurance rates? By law, insurance carriers are required to report all policyholder payroll and loss data to the designated work comp rating bureau. For example, if you have employees based in Wisconsin and Minnesota, the information must be submitted to both states. What is a medical-only deductible? Some states allow businesses to directly pay part of their injured employee s medical expenses in exchange for an up-front premium credit. A firm with a work comp medical-only deductible policy must continue to have their insurance carrier handle all losses. The insurance carrier pays the medical bills, and then follows up with the policyholder to collect the deductible. Should I elect to have a medical-only work comp deductible if allowed in my state? Evaluate your work comp loss history to determine if a medical-only deductible is right for your organization. While the up-front savings may be attractive, the net result could be costly. For example, a business paying $50,000 per year in work comp premium has requested a $1,000 medical-only deductible on their policy in order to save 3%, or $1,500, on their premium. However, just two small accidents during the policy term can easily wipe out these savings, as the business is responsible for the first $1,000 of every injury event.

3 Can employees help pay for my company s work comp insurance? By law, employers are required to pay for work comp insurance. An employer cannot withhold or collect money from employees or any other person to pay for the coverage. Where can I obtain work comp posters, claim forms, and safety videos? If you are an ACUITY policyholder, safety and work comp resource information is available, free of charge, through our website. How do I obtain proof of coverage, or a Certificate of Insurance, showing I have work comp coverage? Contact your insurance agent to obtain a Certificate of Insurance. What is a loss run? A loss run is a report provided by your insurance company, free of charge, which documents your policy s claims activity. If no claims have been submitted on the policy, the report reflects zero losses. Loss run reports are helpful to businesses when seeking competitive insurance quotes. ACUITY s website provides policyholders with immediate, secure access to loss run reports. What is a work comp premium audit? When a work comp policy is written, the insurance cost is based on your firm s estimated annual payroll and classifications for the specified policy period. Insurance carriers review your actual payroll and classifications after the policy expires to calculate the final premium. The premium audit can result in your organization receiving a refund or needing to pay additional money for the prior policy period.

4 EXPERIENCE MODIFICATION FACTOR (E-MOD) What is a work comp E-Mod? An E-Mod is a credit or debit applied to your work comp premium. For more information on this specific topic, refer to ACUITY s work comp educational video and brochure, Workers Compensation Experience Modification Factor. What is the purpose for including business payroll in the E-Mod? Work comp bureaus have several factors included in the E-Mod formula, leveraged by payroll for each job classification. Doing so allows the E-Mod to be properly weighted for your particular business. For more information on this specific topic, refer to ACUITY s work comp educational video and brochure, Workers Compensation Experience Modification Factor, or reference the National Council on Compensation Insurance website. My business has grown to the point where I think a work comp E-Mod is necessary in calculating my insurance premium. How do I go about requesting an E-Mod? An E-Mod can be obtained from your state s rating bureau at no cost. Your work comp insurance carrier, familiar with each state s rating agency, can handle the request on your behalf. How do I know if my business qualifies for a work comp E-Mod? Contact your insurance carrier, who has access to current E-Mod eligibility threshold information from each state s work comp rating bureau. Can OSHA affect my E-Mod? Occupational Safety and Health Administration (OSHA) is a government agency responsible for establishing the standards and rules that employers must follow to protect their workers. With the sole focus on safety, OSHA has the right to inspect your business and levy fines for failing to comply with the law. OSHA inspections have no bearing on work comp E-Mod.

5 Does OSHA know my E-Mod? Your E-Mod can be viewed by OSHA. A debit E-Mod is considered an alert of a potentially unsafe work environment. Why is a work-related accident from two years ago still affecting my E-Mod, even though I ve taken steps to ensure the accident won t happen again? Your E-Mod is calculated using the last three complete years of payroll, classification, and loss data. For more information on this specific topic, refer to ACUITY s work comp educational video and brochure, Workers Compensation Experience Modification Factor. Is there a cap, or maximum amount, applied to a work comp loss? Work comp insurance policies do not limit the amount paid for an injured worker s entitled benefits. However, there is a cap on how much a claim can impact the E-Mod calculation, which is dictated by each state s rating bureau. Across ACUITY s operating states, the maximum loss cap ranges from $92,000 to nearly $300,000 per loss. Why are medical-only losses reduced by 70% in the E-Mod formula while other losses are included at the full amount? Work comp bureaus discount medical-only losses in the E-Mod formula as a means to reward employers for taking steps that allow an injured employee to keep working. For more information on this specific topic, refer to ACUITY s work comp educational video and brochure, Workers Compensation Experience Modification Factor. Consult your insurance carrier s claims department to learn more about your state s definition of medical-only losses. Do work comp rating bureaus ever recompute a firm s E-Mod in the middle of the policy term? Bureaus occasionally release revised E-Mods if an insurance carrier s policyholder data submission was incomplete or inaccurate. If, for example, you have a loss from two years ago showing significant cost changes, better or worse, it will be reflected in the next policy term s E-Mod calculation.

6 MANAGED CARE AND CLAIMS For small-cost work comp injuries, why can t I simply pay the medical bills out-of-pocket and not report the loss to my insurance carrier? Most states prohibit businesses from directly paying work comp medical bills, penalizing those firms which do not follow the law. Consult your insurance carrier s claims department to learn if your state allows such payment practices and the guidelines for doing so. Do all work comp insurance carriers provide a free nurse hotline, similar to ACUITY M.A.S.H.? No. In fact, some work comp insurance companies offer very little to their policyholders in the way of managed care programs, because such services are not required by state work comp law. Some work comp insurance companies allocate managed care administration costs to policyholders losses, which can raise the E-Mod. Does ACUITY apply such costs to claims? No. ACUITY does not pass managed care administration fees onto customers. We absorb the costs as a customer service to our clients and an effective means to help policyholders: Keep the E-Mod as low as possible Ensure loss run information accurately reflects the cost of the loss without hidden charges Can my employee work while recovering from a work-related injury? States advocate employers adopting a return-to-work (RTW) program, which gets an injured employee back to work as soon as possible, accommodating any medical restrictions identified by an authorizing physician. For more information on this specific topic, refer to ACUITY s work comp educational video and brochure, Controlling Your Workers Compensation Costs, or consult your insurance carrier s claims department. Can I tell my injured employee which doctor to see within my work comp insurance company s PPO network? Some states permit employers and/or insurance carriers to direct the injured employee to a specific physician. Consult your insurance carrier s claims department to learn if your state allows such practices and the guidelines for doing so.

7 Can I require my injured employee to have applicable prescriptions filled with generic medications? Some states permit employers and/or insurance carriers to specify the use of generic medications, when available. Consult your insurance carrier s claims department to learn if your state allows such practices and the guidelines for doing so. If I suspect fraud is associated with my employee s work comp loss, what should I do? If you suspect claim fraud, immediately contact your insurance carrier so they can promptly investigate. ACUITY s fraud hotline: , Ext Is my injured employee entitled to wage replacement benefits if they only missed a few hours of work to visit the walk-in clinic? Time loss compensation varies by state. Consult your insurance carrier s claims department to learn about the laws which govern benefits in your state. When does a work comp waiting period apply to a loss? A work comp waiting period specifies when the injured employee is entitled to receive wage loss benefits. The waiting period guidelines vary by state. Consult your insurance carrier s claims department to learn about wage replacement regulations. Do I need to report a claim to my work comp insurance carrier if the injured worker only required basic first aid and didn t need to see a doctor? By law, you do not have to report easily-remedied injuries to your insurance carrier, provided the injured employee did not receive professional medical treatment. ACUITY encourages policyholders to report the incident, allowing us to promptly react should subsequent professional medical attention be necessary. Such claims are considered record-only and are not required in rating bureau reporting.

8 To learn more about work comp insurance and how ACUITY can help your bottom line, visit acuity.com/insidewc or talk to an independent insurance agent. Information presented is a high-level summary and subject to the laws in your state. Please contact your agent for specific coverage detail. WC-619 (5-13) For All That Matters