Information Regarding Your Workers Compensation Policy

Transcription

1 The Beacon Mutual Insurance Company Information Regarding Your Workers Compensation Policy

2 Thank you for choosing The Beacon Mutual Insurance Company As your workers compensation insurer, we look forward to a long and beneficial relationship with you. By working together, we can create a safe and more productive workplace for you and your employees. We are dedicated to Rhode Islanders because we are Rhode Islanders. We are your neighbors, and we are here to protect your business and your most important asset your employees. You can count on Beacon Mutual to always be here when you need us. Within this booklet, you will find information regarding our premium payment plans, how to file a claim, our Preferred Provider Network (PPN), our Stay-At-Work/Return-To-Work Program, and our best-in-class Loss Prevention services - FREE to all Beacon Mutual policyholders. If you have any questions, please feel free to contact your agent or your Beacon representative. Brian J. Spero, Esq. President & CEO Our success is measured by our ability to serve you. We thank you for your business and look forward to partnering with you for your workers compensation needs. Our Competitive Advantage Creating Exceptional Value for Our Policyholders! Local Expertise Loss Prevention - At No Additional Cost To Policyholders Exceptional Claims Services Efficient Medical Cost Savings Program Secure Online User Portal BEACONNECT Need excellent workers compensation insurance? You ve found it. We are Rhode Island s experts with a local presence ready to help. Looking for FREE safety training? We have the largest team of loss prevention and ergonomics specialists in Rhode Island, providing open seminars, on-site, and online safety training. Protect your most valuable asset - your employees. Our experienced local claim representatives, nurses, and case managers are committed to getting workers well after an injury. Our innovative Stay-At-Work/Return-To- Work Program is focused on supporting your injured employees to help them get back on the job. Concerned about the cost of insurance? We work with medical providers and pharmacies to reduce the cost of medical services throughout the claims process. Reducing medical costs results in better rates and lower premiums for you. You ll have 24/7 access to policy information, loss prevention documents and claims reporting whenever you need it. 2

3 Contents Our Competitive Advantage. 2 About Beacon Mutual 4 Register for your NEW BEACONNECT Account. 4 BeaconMutual.com. 4 Follow Us 4 About Your Workers Compensation Policy. 5 How Your Premium is Calculated 5 Your Payment Plan.. 5 Claims 6 What to do when a Workplace Injury Occurs. 6 Online Claim Reporting - First Notice of Loss (FNOL). 6 By Law, You are Required to Report Any Employee Injury What other information will I need to report the injury?... 6 What happens after the injury is reported? Stay-At-Work/Return-To-Work Program. 7 Preferred Provider Network (PPN).. 7 Loss Prevention 8 Why Loss Prevention?. 8 Need Training and Education? Who performs Loss Prevention Services?. 8 How do you benefit from Loss Prevention Services? 8 Beacon s Loss Prevention Commitment... 8 Ergonomics 9 What is Ergonomics?... 9 Why Ergonomics?... 9 Safety Partnerships 9 Premium Audit 10 Scheduled Audits.. 10 Financial Records Needed for an Audit. 10 Audits for Subcontractors.. 10 Remuneration (Money Paid for Work or Service).. 10 Fighting Fraud 11 Workers Compensation Fraud Hurts All Policyholders. 11 Learn the Types of Workers Compensation Fraud 11 Take Action and Help Fight Fraud 11 3

4 About Beacon Mutual As a leading provider of workers compensation insurance in Rhode Island, Beacon Mutual is committed to protecting the state s most valuable asset - our workers. No one works harder to prevent workplace accidents, and get injured employees back to work with compassion and care. Beacon has the largest team of local ergonomic and safety professionals dedicated to creating safer workplaces, and an exceptional team of claim representatives, nurses, and case managers to assist Rhode Island employers and their injured workers. While large insurance carriers operate from thousands of miles away, Beacon s experts are never far from the policyholders they serve. Beacon Mutual is the largest writer of workers compensation insurance based on all Rhode Island paid policy premium, and thus, the largest writer of commercial insurance (property/casualty) in Rhode Island. We are financially secure with approximately $400 million in admitted assets. As a mutual insurer, we know that competitive pricing and innovative services are what policyholders like you deserve. Register for your New BEACONNECT Account Access your workers compensation policy information 24/7 in the Beacon Mutual secure online portal. 1. Open and click Create an Account to register. 2. Submit your Beacon Mutual policy number, Federal Employer Identification Number (FEIN) and address. 3. Follow the prompts to create your new BEACONNECT account. Note: Initial registration will allow limited access to select services, such as reporting a claim. A PIN code will be sent to the principal at the business address on record. Log into BEACONNECT with the PIN code to finalize your registration. Follow Us Connect with to access the latest workers compensation news, safety information, community projects, and career opportunities! BEACONNECT allows you to: Report an Injury. Make a Payment Online. View Policy Information. Access the My Business page to view one or more of your policies, your policy periods, invoices, loss prevention documents, and claims that correspond to each policy. Print Reports. You can download and print a variety of reports including your Claim Loss Run Report. Visit BeaconMutual.com BeaconMutual.com provides information about your new workers compensation policy and details on the complimentary services offered to policyholders including loss prevention consultation, safety training, our Stay-at-Work/Return-to-Work progam and more. Rhode Island workers compensation insurance is all we do and nobody does it better. We are committed to creating exceptional value for our policyholders every day. 4

5 About Your Workers Compensation Policy Beacon Mutual provides workers compensation insurance for thousands of satisfied customers. Our Underwriting staff works with your insurance agent to provide the right coverage at the right price. Our improved auditing and billing systems make renewing your policy quick and convenient. Underwriting specialists are available to work with you and your insurance agent to ensure the highest customer satisfaction. Your Rhode Island independent agent secures your workers compensation insurance coverage from Beacon Mutual. How Your Premium is Calculated Your premium is calculated based on the rate for your business classification code (or combination of codes) that best describes your operations. The National Council on Compensation Insurance (NCCI) is the national organization that determines the class codes for your operation. Each class code has a rate per $100 of payroll that is multiplied by your total estimated annual payroll for that code. Other rating factors may also affect your premium, such as your safety practices and your experience modification factor. Your experience modification factor is determined by the National Council on Compensation Insurance (NCCI) and reflects your claims history compared to other businesses in your classification. Premiums are positively impacted if your claims history is better than average or adversely affected if your claims history is worse than average. The experience period generally consists of the last three completed policy years. Your business can reduce your experience modification by reducing the frequency and severity of your claims. Reduce the number of injuries as much as possible and, when you do have a claim, reduce the costs by getting the employee back to work as soon as medically possible. Your Payment Plan Beacon Mutual offers various payment options: secure online payment, check payment to our lockbox, or Pay As You Go. Your agent selected your payment plan when your policy was bound. Depending on the size of your business, some payment plan restrictions may have determined the type of plan that has been established for your policy. If you selected the Pay As You Go payment option, you will need your Beacon Mutual-assigned PIN code to log into BEACONNECT to report your payroll. If you would like to find out if you meet the criteria for the Pay as You Go program, contact your agent to learn more. We are proud to be a Trusted Choice Company Partner. 5

6 Claims What to do when a Workplace Injury Occurs 1. Make sure medical care is provided. 2. Report the injury as soon as possible: visit beaconmutual.com or call toll-free 24/7 (out-of-state claims, call ) Or complete a First Report of Injury (DWC-01) form and mail or fax it to: The Beacon Mutual Insurance Company One Beacon Centre, Warwick, RI Fax: Beacon will file the claim electronically with the RI Department of Labor and Training, or the appropriate out-of-state agency. Online Claim Reporting - First Notice of Loss (FNOL) To Report an Injury online you must have a BEACONNECT account. 1. Open BEACONNECT ( and log into your account. 2. Click Report an Injury. The How to Report an Injury window will open. (This page has a link to a Report an Injury video with step-by-step instructions.) 3. Click the Report Injury button and follow the prompts to enter information about the injured worker. If you do not have a BEACONNECT account, you must register before you Report an Injury online. See the Register for your New BEACONNECT Account section earlier in this booklet for step-by-step instructions. What other information will I need to report the injury? Besides your company name, FEIN, Beacon Mutual account and policy number, you will also need: the injured worker s name and social security number, address, date of birth, and telephone number; the date, time, and place of the injury; how the injury occurred; the type of injury (burn, cut, etc.); the name and address of the medical facility; and witness information. What happens after the injury is reported? Beacon will electronically file the DWC-01 form with the RI Department of Labor and Training for all RI claims. The Beacon Mutual claim representative assigned to the claim will work with you and the injured worker to ensure all medical treatment necessary is received with the goal to return to work. See Preferred Provider Network and Stay-At-Work/Return-To-Work Program sections of this booklet for more information. By Law, You are Required to Report Any Employee Injury By submitting the claim online or by calling us, Beacon Mutual will submit the First Report of Injury on your behalf. The form must be submitted even if you dispute the legitimacy of the claim. A thorough investigation will be performed, including speaking to you, as soon as the injury is reported. The sooner we receive the notification, the quicker we can help and commence an investigation. 6

7 Stay-at-Work/Return-to-Work Program Beacon Mutual s Stay-at-Work/Return-to-Work Program enables you to control your workers compensation costs and retain your most valuable resource - the skills, knowledge, and experience of your employees. With the Stay-at-Work/Return-to-Work Program, employers will have a formalized plan in place before an injury occurs, to identify potential modified duty and transitional positions for employees. Employers will experience a reduction in workforce interruption and workers compensation insurance costs, while injured employees retain their salary and benefits. Beacon Mutual has assembled a group of specialists that are dedicated to assisting policyholders in developing their own unique Stay-at-Work/Return-to-Work Program including: claims representatives, nurse and disability case managers, ergonomists, and physical therapists. Our specialists will assist injured workers, employers, and physicians with the development and implementation of best practices for transitional employment. Interested in learning more? Beacon Mutual periodically hosts collaborative workshops for policyholders and medical providers to explore the program benefits. Call the Claims Department at or visit Preferred Provider Network (PPN) As the State of Rhode Island s leading workers compensation carrier, Beacon Mutual is dedicated to promoting and supporting the highest quality medical care available. Our Preferred Provider Network (PPN) helps us maintain this mission by offering superior medical care and state-of-the-art treatment options. All medical providers are expected to follow Medical Advisory Board (MAB) protocols and bill according to the Rhode Island Fee Schedule. Find a Doctor: If you would like assistance selecting a physician or health care provider best suited to treat your work-related injury, call Beacon Mutual to speak with your claim representative at The listing of medical providers in our PPN is available in printable format on the Beacon Mutual Medical Providers page: 7

8 Loss Prevention - We re Serious About Safety! Why Loss Prevention? Loss Prevention programs help businesses prevent accidents and manage claim costs, which are both critical factors in determining insurance premiums. Effective loss prevention programs begin with a safety commitment by owners and top management to create the proactive approach needed. Need training and education? Each year, Beacon Mutual s Loss Prevention Department trains over 15,000 workers. A program of any size will make a significant contribution to an accident prevention and loss control goal. Visit beaconmutual.com for training topics, seminar dates, and other safety information including safety alerts and ergonomic bulletins. Beacon Mutual offers loss prevention services to policyholders at NO ADDITIONAL COST. Depending on your company s needs, Beacon can offer you the following programs: Training: Open Safety Seminars at the Beacon Conference Center in Warwick, Rhode Island On-site Training for employees during first, second or third shift at your location Online Safety Training through the Beacon University Resources and Services: Safety Committee and Program Development Noise Level Testing Ergonomic Assessments Educational Safety Materials (PDF downloads) On-site Safety Consultations Who performs Loss Prevention Services? As a full service insurance provider, Beacon Mutual has a dedicated staff of qualified loss prevention consultants and ergonomic specialists who have significant years of field experience in accident and illness prevention. Each member understands current safety and health issues and their potential impact on Rhode Island employers. See the section regarding Ergonomics in this booklet. How do you benefit from Loss Prevention Services? Companies that make a committed effort to reduce their losses can make a positive impact on employee morale, productivity, quality, and profits. More importantly, safety and health programs help protect a company s most valuable asset: its employees. Beacon Mutual s Loss Prevention Commitment Because our only business is workers compensation and our market is Rhode Island, we are able to address your company s safety problems and concerns promptly. Our ongoing Loss Prevention consultation and support has helped many of Rhode Island s businesses significantly reduce employee injuries and workers compensation costs. We would like to do the same for you. To discuss specific needs or schedule a consultation, call our Loss Prevention department at

9 Ergonomics As a leader in workplace safety and ergonomics, Beacon Mutual understands how just one musculoskeletal injury could negatively impact the bottom line of your business. Beacon offers a full menu of ergonomic services performed by highly trained and certified ergonomists to meet the needs of Rhode Island companies from small to large. These invaluable services are provided to policyholders at no additional cost. What is Ergonomics? The word ergonomics comes from two Greek words: ergon - meaning work, and nomos - meaning natural laws. It denotes the science of work or the science of designing the job to fit the worker, not forcing the worker to fit the job. Ergonomics covers all aspects of a job, from the physical stresses it places on joints, muscles, nerves, tendons, bones and the like, to environmental factors which can affect hearing, vision, and general comfort and health. All ergonomic services are included in the cost of your workers compensation premium. Why Ergonomics? No matter how you or your employees define ergonomics, the science of ergonomics has never before played a more direct role in the safety and health of your workforce and the productivity and quality of your products. With each passing year, organizations such as the Occupational Safety and Health Administration (OSHA) and the Bureau of Labor Statistics (BLS) report on the increased frequency and cost of musculoskeletal injuries (MSDs) across all industries. Lower back injuries alone have been estimated to cost U.S. businesses between 30 to 50 billion dollars annually. Many of the common ergonomic risk factors are present in every industry, from construction to healthcare. Our ergonomics team can help your business identify and mitigate those risks impacting your employees and operations. Schedule a consultation with a Beacon Mutual ergonomist today at beaconmutual.com or call Safety Partnerships The Beacon Mutual Insurance Company is proud to partner with the National Institute for Occupational Safety & Health (NIOSH) and the National Safety Council to provide the most up-to-date safety education and services to our policyholders. 9

10 Premium Audit Scheduled Audits To ensure that Beacon charges the correct premium for your workers compensation coverage, an audit of your operations is required. This audit verifies that your workers compensation classification codes are accurate and determines your exposure to risk during the policy period. You will be contacted in advance by letter or with a phone call to schedule an audit appointment. We suggest that when the appointment is made for the audit, you should obtain your auditor s name and phone number. If you need to cancel your appointment, please reschedule with the auditor as soon as possible. If you do not have a current workers compensation certificate of insurance on file at the time of the premium audit or a DWC-11-1C form, payments made to subcontractors will be included on your premium audit. The DWC-11-1C Notice of Designation as Independent Contractor form is to be filed with the RI Department of Labor & Training. There is no fee and a date stamped copy can be obtained by sending a self-addressed stamped envelope. Remuneration (Money Paid for Work or Service) Premium = Rate x Remuneration Financial Records Needed for an Audit Your company s financial records, including the following, should be available at the auditor s request: Payroll records (preferably year-to-date payroll registers), Quarterly Payroll Tax Reports (the RI DET-TX-17 and the Federal 941), Cash Disbursement Journal or Business Checkbook, Job Contracts, General Ledger, Business Invoice, and a General Liability Certificate. Audits for Subcontractors The auditor will review your cash disbursements journal to account for payments made to your subcontractors. For each subcontractor you hire, the auditor will require either a Certificate of Workers Compensation Insurance or a DWC-11-1C form. When applicable, a General Liability Certificate and a Business Invoice must accompany the DWC-11-1C form. Money: gross wages, commissions, bonuses, holiday pay, vacation pay. Substitutes for money: the rental value of an apartment, meals or lodging to the extent they show in the payroll records, the value of a store certificate or merchandise received as pay. Remuneration excludes: severance pay, business expense reimbursements, uniform allowance, payments for active military duty, employer-provided prerequisites (perks) such as the use of an auto. Exclusions of overtime payroll: the extra pay for overtime shall be excluded from the payroll on which premium is computed, as long as it is kept separate in the payroll records. For example: If an employee s hourly wage is $10 per hour and the over-time wage is $14 per hour, the extra $4 per hour is excluded. Note: Once an audit is complete, the policy premium might be adjusted and result in either return premium to be paid to the policyholder or an additional premium balance due from the policyholder. 10

11 Fighting Fraud Workers Compensation Fraud Hurts All Policyholders Virtually all of the employee workers compensation claims filed in Rhode Island are legitimate on-the-job injuries. Unfortunately, those few who cheat the system by committing fraud drive up costs for employers, consumers, and insurers. Likewise, virtually all employers report all payroll to determine their premium. However, those few who intentionally understate payroll and misclassify employees are committing a crime and increasing the cost to all other employers. At Beacon Mutual, we have zero tolerance for fraud. We take workers compensation fraud seriously, and we are committed to being part of the solution. Learn the Types of Workers Compensation Fraud An employee commits fraud by: Faking an injury at work to get paid time off Reporting that an injury occurred on the job when it actually took place somewhere else Exaggerating the severity of a legitimate injury to receive additional time off with benefits Reporting that he or she is unable to return to work while working a new or second job for which he or she conceals the income An employer commits fraud by: Understating the amount of company payroll to reduce premium payments Reporting that employees are independent contractors Misrepresenting the type of work employees do in order to qualify for and pay for a lower premium Not reporting the total number of employees in order to pay a lower premium Failing to carry workers compensation insurance Take Action and Help Fight Fraud To report suspected fraud, visit and provide as much information as possible including: Name and address of the employee (injured worker) or employer you wish to report Reasons you suspect workers compensation fraud If you wish to remain anonymous, inclusion of your name is optional on the fraud report form. You may also report fraud by calling us at or by calling the State of Rhode Island s Fraud and Compliance Unit directly at Help Lower Your Premium and Eliminate Workers Compensation Fraud in Rhode Island. 11

12 Your Rhode Island Workers Compensation Experts. One Beacon Centre Warwick, RI COMP