Proposed 2019 Changes to Experience Rating

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1 W o r k e r s C o m p e n s a t i o n I n s u r a n c e R a t i n g B u r e a u o f C a l i f o r n i a WCIRB Mod Talks Proposed 2019 Changes to Experience Rating The webinar will begin shortly. Notice The information provided in this Presentation was developed by the Workers Compensation Insurance Rating Bureau of California (WCIRB) solely for the purpose of discussion during this Presentation. The WCIRB shall not be liable for any damages, of any kind, whether direct, indirect, incidental, punitive or consequential, arising from the use, inability to use, or reliance upon information provided in this Presentation. Workers Compensation Insurance Rating Bureau of California. All rights reserved. No part of this work may be reproduced or transmitted in any form or by any means, electronic or mechanical, including, without limitation, photocopying and recording, or by any information storage or retrieval system without the prior written permission of the Workers Compensation Insurance Rating Bureau of California (WCIRB), unless such copying is expressly permitted by federal copyright law. No copyright is claimed in the text of statutes and regulations quoted within this work. Workers Compensation Insurance Rating Bureau of California, WCIRB, WCIRB California, WCIRB Connect, WCIRB Inquiry, X-Mod Direct, escad and the WCIRB California logo (WCIRB Marks) are registered trademarks or service marks of the WCIRB. WCIRB Marks may not be displayed or used in any manner without the WCIRB s prior written permission. Any permitted copying of this work must maintain any and all trademarks and/or service marks on all copies. To seek permission to use any of the WCIRB Marks or any copyrighted material, please contact the WCIRB at customerservice@wcirb.com. Webinar Agenda WCIRB Mod Talks is a series of 30 to 45-minute webinar discussions on changes to experience rating. Today s session includes: $250 Per Loss Exclusion Simplifying the Experience Rating Formula Question and Answer Session 3 1

2 Proposed 2019 Changes to Experience Rating What to Expect - Timeline February Mod Talk First Aid Claims June Plan Changes Proposed to Commissioner July Mod Talk Proposed 2019 Plan Changes August CDI Public Hearing September CDI Decision on 2019 Filing November Mod Talk Implementing CDI Decision September 2018 Begin Issuing 2019 Mods 5 Experience Rating Insurance Code Section requirements Reasonable eligibility standards Adequate incentives for loss prevention Sufficient premium differentials to encourage safety 6 2

3 What is Experience Rating?... a rating procedure utilizing past insurance experience of the individual policyholder to forecast future losses by measuring the policyholder s loss experience against the loss experience of policyholders in the same classification to produce a prospective premium credit, debit or unity modification. Section of the California Insurance Code 7 What Does an Experience Modification Represent? An experience modification is a forecast of future losses Not a recoupment program past experience is used only to the extent it is predictive of future experience An experience modification is expressed as a percentage Less than 100% means employer has better loss history than average expected for the employers industry Over 100% means employer has worse loss history than average expected for the employers industry Experience rating is premium neutral on a statewide basis Experience rating is only one component of employer s premium determination Loss experience and risk characteristics are also considerations in insurer underwriting and pricing 8 3

4 What is the WCIRB s Role? The WCIRB is a licensed rating organization and the California Insurance Commissioner s designated statistical agent Administers and proposes amendments to the Insurance Commissioner s workers compensation regulations Uniform Statistical Reporting Plan Experience Rating Plan 9 The WCIRB s Process for Proposing Changes to Experience Rating WCIRB Research WCIRB issues experience modifications Review by WCIRB committees Insurance Commissioner s decision WCIRB submits Regulatory Filing to CDI Public Hearing / Public Comment Period 10 4

5 Recent Changes to Experience Rating in California 2015 Formula was amended to limit experience modifications for employers with only a single claim in the experience period to be no more than 25 percentage points above the loss free rating 2016 The Experience Rating Plan uses expected loss rates instead of advisory pure premium rates to determine eligibility for experience rating 11 Recent Changes to Experience Rating in California continued The Experience Rating Plan replaces the fixed $7,000 primary and excess loss split point with a variable split point that changes based on the size of the employer 2019 (Proposed) Eliminate first $250 of each claim from formula and simplify formula 12 5

6 What s Being Proposed? Excluding first $250 of each loss from formula Addresses potential underreporting of first aid claims Modest impact on most employers x-mod Simplify Formula Eliminate credibility terms No impact on computed X-Mods 13 $250 Per Loss Elimination Plan WCIRB Working Group Recommendations In 2015 WCIRB Formed Broad Working Group on Non-Reporting of Small Medical Only Claims Working Group Findings & Recommendations Non-reporting of these claims is a significant issue affecting worker access to benefits, fairness & insurer s ability to manage claims Consider removing dis-incentive to report small claims by eliminating the use of such claims in experience rating formula Recommendation Proposed in June to be Effective in

7 $250 Per Loss Exclusion Why $250? Most Claims Meeting California Definition of First Aid will be less than $250 in Value Higher Alternative Thresholds Reviewed had Significant Impact on Plan Accuracy, Loss Free Credits and X-Mod Distribution WCIRB Will Regularly Review $250 Threshold and Adjust for Inflation as Needed 15 $250 Per Loss Elimination % of All Claims Eliminated by Alternative Threshold Amounts 60% 54% 50% % of Total Claims Eliminated 40% 30% 20% 15% 36% 10% 0% First $250 of Claim Eliminated First $500 of Claim Eliminated First $1,000 of Claim Eliminated 17 7

8 $250 Per Loss Exclusion How Will it Work? Proposed Changes Will Apply to all claims not only medical share of claims Reduce primary losses by $250 Result in modified Experience Rating Worksheet Show all claims individually (not only those over $2,000) Primary Losses For Incurred Loss Amounts $250 or Less: Actual Primary Loss = 0 For Incurred Loss Amounts Between $250 and Primary Threshold: Actual Primary Loss = Actual Loss less $250 For Incurred Loss Amounts Above Primary Threshold: Actual Primary Loss = Primary Threshold less $ $250 Per Loss Exclusion Examples Primary Losses with Primary Threshold: $10,000 For Incurred Loss of $200: Actual Primary Loss = 0 For Incurred Loss of $5,000: Actual Primary Loss = $4,750 For Incurred Loss of $10,000: Actual Primary Loss = $9,750 For Incurred Loss of $50,000: Actual Primary Loss = $9,

9 $250 Per Loss Exclusion How Will I Be Impacted? No Overall Pure Premium Impact - No Significant Impact on Average X-Mod Impact on Individual Employer X-Mod will Depend on Individual Employer s Claim and Exposure History Impact of New Plan Modest More than 85% of X-Mods will be Impacted by 2 points or less 19 $250 Per Loss Exclusion How Will I be Impacted? All Employers Estimated Impact of Change from Variable Split to Variable Split with $250 Exclusion: Policy Years Combined 35% 30% 25% Share of Employers 20% 15% 10% 5% 0% Experience Modification Change from Variable Split to Variable Split with $250 per Claim Exclusion Statewide 20 9

10 $250 Per Loss Exclusion How Will I be Impacted? Small Employers: Expected Losses of $25,000 and Below Estimated Impact of Change from Variable Split to Variable Split with $250 Exclusion: Policy Years Combined 35% 30% 25% Share of Employers 20% 15% 10% 5% 0% Experience Modification Change from Variable Split to Variable Split with $250 per Claim Exclusion Small Employers 21 Simplifying the Experience Modification Formula Current Formula: Cp Ep 1 Cp Ae Ce 1 Ce E Ap = Actual Primary Losses Ae = Actual Excess Losses Cp = Credibility Primary Value Ce = Credibility Excess Value Ep = Expected Primary Losses Ee = Expected Excess Losses E = Expected Losses *Current variable split indications are for 100% primary credibility (Cp) and 0% excess credibility (Ce)

11 Simplifying the Experience Modification Formula With Cp = 1 and Ce = 0, the experience rating formula simplifies to: Ap Ee E Ap = Actual Primary Losses Ee = Expected Excess Losses E = Expected Losses 23 Register for the Next Mod Talk Webinar WCIRB Mod Talks Implementing the 2019 Changes Thursday, November 16, at 10am PDT The Insurance Commissioner s decision on the Regulatory Filing Implementation Plan for Approved 2019 Changes Register at