Posts Tagged ‘claims’

Primary and Excess Losses: Big Changes Beginning in 2013

Wednesday, January 2nd, 2013

This is Part 3 in 5 part series on Experience Rating changes. See Part 1: The Experience Rating Process: Significant Changes Are Imminent and Part 2 A Basic Review of Claim Losses, the Building Blocks of Experience Rating
Parts 4 and 5 will be posted next week.

Previously, we offered a basic review of workers comp claim losses, the building blocks of experience rating. Now it’s time to go deeper.
As we’ve seen, workers comp claims are made up of what has been paid and what has been “reserved” for future payments throughout the life of the claim. The “total incurred amount” projects total indemnity payments (lost wages), medical bills and expenses estimated to be paid for any given claim. From 1990 through 2012, the first $5,000 (called the “split point”) of the “total incurred” amount of each claim is considered “primary,” and all of it counts in the experience rating calculation. Any amount above $5,000 is considered “excess” loss, and is discounted in the experience rating calculation by at least 70%. Moreover, any amount above a state-specific rating point (ranging from about $125,000 to as high as $250,000) is excluded from the calculation; it does not count at all in the calculation of your experience rating.
Primary losses going up!
For the first time in 20 years, the Primary Loss split point is about to change. Beginning in Policy Year 2013 (PY 2013), primary losses will increase from the first $5,000 of each claim to the first $10,000. In subsequent years, primary losses will continue to rise, reaching $15,000 by PY 15.
So what does this mean? Experience rating places more emphasis on the frequency of injuries than on the severity. Given the increasing severity of claims over the past decade, NCCI has decided to make experience rating more sensitive to severity.
Under the current rating system, only the first $5,000 of each claim is primary; this means that one big claim will have a limited impact on the experience mod: the first $5,000 enters the calculation dollar for dollar, but all the losses above $5,000 will be sharply discounted.
The new rating system has been adopted by all NCCI states for 2013, and it will become effective concurrently with each state’s approved rate/loss cost filing on or after 1 January 2013. NCCI has published a chart detailing the split point changes effective dates for each state (PDF).
Under the new system, the first $10,000 of each claim will be primary and, as in the current (and soon to be old) system, all primary losses will enter the experience rating calculation dollar for dollar. For employers with individual losses above $5,000, the experience mod is likely to run higher than under the current rating system. (And keep in mind that the primary loss split point will continue to rise to the level of $15,000 by 2015.)
Here is a simple comparison of the current and pending rating systems in action:
Employer 1:
1 claim at $20,000 / Current Primary = $5,000 / Pending Primary = $10,000
Employer 2:
2 claims at $5,000 / Current Primary = $10,000 / Pending Primary = $10,000
Under the current system, all other things being equal, Employer 1 would have a lower experience mod than Employer 2 for two reasons, even though total losses are $10,000 greater than Employer 2’s total losses. First, Employer 1 has $5,000 less in primary losses. Second, Employer 1’s excess loss of $15,000 would be discounted by 70% to $4,500 in the calculation making total calculable losses of $9,500, compared to Employer 2’s total calculable losses of $10,000.
Under the new rating system, Employer 1 would be the one with the higher mod, because its primary losses would be equal to Employer 1’s, but Employer 1 would also have $3,000 of excess losses included in the calculation (10,000 – [10,000 x 70%]).
The split point change will lead to some interesting, as yet unaddressed, developments. For example, consider a loss that happened in PY 2010 to a driver for ABC Limo. The loss would first appear in ABC Limo’s Mod calculation for 2012. Let’s say its total incurred value at that time was $15,000. In 2012, before the split point changes, $5,000 would be primary and $10,000 excess. Fast forward to the Mod calculation for 2013, and let’s suppose that the claim was closed during 2012 for a total of $10,000. The 2013 Mod calculation, with the split point having been changed, effective January, 2013, will show $10,000 primary and $0.0 excess. Consequently, the closed claim of $10,000 will affect ABC Limo’s mod more adversely in 2013 than the open claim of $15,000 did in 2012. This will happen to many employers, and their advisors would be well-advised to advise them beforehand.
Medium-sized Employer, Big-sized Trouble
Here’s the worst-case scenario for a lot of medium-sized employers (premium in the $20-$100,000 range): if they have a frequency problem (a lot of relatively small injuries) and a severity problem (a few relatively big losses), the new split point for primary losses will more than likely increase their experience mod, perhaps substantially.
If you find yourself in this position, with an experience modification well above 1.0, you need to learn more about the intricacies of the rating process itself. There are opportunities for minimizing the impact of your losses. All of which are the subject of our next Experience Rating post.

Risk, creeping catastrophics, fraud, obesity, pachydermodactyly, and more

Wednesday, June 13th, 2012

Risk RoundupCavalcade of Risk #159 – Early Edition is posted at My Wealth Builder. We’d like to highlight Jason Shafrin’s post as particularly noteworthy for our readers: Healthcare Costs to Rise by over 7 percent in 2013.
Creeping catastrophics – Our colleague Mark Walls has a good article in Business Insurance on Creeping Catastrophic Claims – How to Spot Them and Stop Them. “These claims start out like any other case, usually with a back, knee or shoulder injury. However, because of a series of events, they end up costing the employer hundreds of thousands of dollars. These developmental claims share many common characteristics that, if identified and addressed in a timely manner, can prevent significant adverse development of the claims.”
Big bucks fraud – John D’Alusio unpacks the AIG debacle and explains how it hurts us all in his post Gaming the Workers Comp System at Workerscompensation.com.
Ergonomics of obesity – What does obesity look like to a workplace ergonomist? “Increased obesity in the workplace means more arthritis, larger waist circumferences, additional work limitations, compromised grip strength, decreased lower limb mobility and medical risks. Obese employees might be more vulnerable to falls and their manual material handling ability may be compromised. Obesity also can impact self-esteem, motivation, absenteeism, presenteeism, premature mortality and more.” More at Ergonomic Strategies for Managing Obesity in the Workplace
Case Law – The Tennessee Supreme Court found for an employer in a statute of limitations case involving PTSD. The employer argued that the statute of limitations clock began ticking when the event that caused the trauma occurred (viewing the bodies of two co-workers killed on the job), but the court found that the statute of limitations does not begin to run until an employee discovers the injury and, in this case, the employee did not know he had PTSD until some time after the workplace deaths occurred.
DOL Transparency – In 2011, the Department of Labor proposed a rule strengthening safety provisions for children under age 15 who work on farms. The rule had a parental exemption so that kids could still work on family farms. Apparently, industry pressure led DOL to withdraw the rule. DOL also removed the proposed rule from its website and Celeste Monforton posts that Government transparency groups are asking the Labor Dept to restore info scrubbed from website.
Texting while driving – Steve Yahn of Risk & Insurance looks at how Companies Fight Against Texting and Driving. He notes, “Gavejian and other experts who work with companies to develop cell phone and texting policies said that businesses need to first assess how technology is used in their workplace on a daily basis.”
Food processing hazard – A new report describes two cases of poultry workers who developed chronically swollen knuckles, the hallmark sign of a rare skin condition known as pachydermodactyly: Hand deformities turn up in poultry workers, report finds.
Other noteworthy news

Health Wonk Review, Irish style, and other noteworthy news briefs

Thursday, March 15th, 2012

Guinness is good for you – That’s the news from Tinker Ready, who is hosting the Health Wonk Review: Wearing the Green for the St. Patrick’s Day Edition at her blog Boston Health News. We think it’s pretty fitting to have a Boston blog hosting this particular edition!
From the bizarre file – Thomas A. Robinson ofRisk Management Magazine offers a list of the 10 most bizarre workers compensation cases during 2011. Robinson rightly notes that, “Despite their unusual nature, however, one must always be respectful of the fact that while a case might be bizarre in an academic sense, it was intensely real, affecting real lives and real families.” So true. We hope he’ll follow with a collection of the 10 most bizarre employer acts – we’ve seen a few in our day.
OSHA whistleblowers – Just a reminder: Don’t fire someone for reporting safety hazard. A Florida charter school is learning this lesson the hard way. OSHA is suing Manatee School for the Arts in Palmetto, Fla seeking reinstatement of the former employee with full benefits; payment of back wages, punitive damages, and compensatory damages, among other things.
New York’s Reg. 194 – There’s a big brouhaha in New York over N.Y. Reg. 194, with risk manager groups and agent groups coming down on opposite sides of the fence. N.Y. Reg, 194 is a broker-disclosure rule that requires agents to advise clients that they receive commissions from insurers. The ruling was proposed by the Division of Insurance in the aftermath of the Spitzer investigations against several large brokerage firms. Last week, a NY Appellate Court upheld the rule.
Exploding pig farms – We posted a link to this issue before – but the mysterious hog farm explosions continue to stump scientists. A strange, potentially explosive foam is surfacing near manure pits in about 1 ou tof every 4 hog farms, and has caused six explosions since 2009. According to the article: “This has all started in the last four or five years here. We don’t have any idea where it came from or how it got started,” said agricultural engineer Charles Clanton of the University of Minnesota. “Whatever has happened is new.” The National Hog Farmer has more background: Foaming swine manure poses explosive risks.
Wellness focus – Of cancers affecting both men and women, colorectal cancer (cancer of the colon and rectum) is the second leading cancer killer in the United States, and the number one cancer killer in non-smokers. Why not issue a reminder to your employees: Colorectal cancer screening saves lives.
Market conditions – Roberto Ceniceros notes that captives are thriving as the work comp market hardens. Rising prices for traditional insurance vehicles always means that alternative insurance programs see growth.

Health Wonk Review, OSHA, state reports, and the single best thing for your health

Friday, January 6th, 2012

Healthcare policy – Kick off the new year with a bit of health policy wonkery. Jared Rhoads hosts 2012’s first edition of Health Wonk Review at The Center for Objective Health Policy. We’ll be hosting the next issue here on this blog later in the month.
OSHA fines double for serious violationsOSHA Law Update has a good overview of statistics recently released by OSHA. While the number of inspections have dropped in 2011, fines for serious violations or workplace safety doubled. The average OSHA penalty per serious violation in 2011 increased to $2,132, more than doubling from 2010’s average of $1,053. OSHA head David Michaels points out that this is still too low, “We have to maximize the impact of our penalties because we’re trying to not just focus on the employer where we found the [violation], but the whole industry.” OSHA conducted 40,648 inspections, down from 40,993 in 2010. The drop was attributed to a change in inspection priorities, with a higher mix of health inspections and recordkeeping compliance, which take longer.
Wyoming – “Wyoming’s overall workplace death rate was more than three and a half times the national average in 2010 and has ranked worst in the nation five of the past 10 years.” A yearlong study and report to the Governor by epidemiologist Dr. Timothy Ryan points to a lack of workplace safety culture and finds that employers consistently fail to enforce safety rules. (Thanks to Joanne Wojcik for the pointer.
Hello, hard market – By year’s end, it looks as though insurers finally had something to toast. Joe Paduda posts that the soft workers comp market is over. He cites a MarketScout report, which indicated rates were up 3% in December, the highest increase among all P&C lines.
Claims adjuster workload norms – At Comp Time, Roberto Ceniceros asks if 12 to 18 minutes per claim file is adequate. He’s looking for feedback on “how much time should be devoted per file in order for adjusters to do a really great job.”
Michigan, Maryland – WCRI recently issued two new cost-per-claim reports on Maryland and Michigan. Both studies include observations about the impact of recessionary pressures on claim costs. The picture may change going forward in Michigan, where reform legislation was just signed, the state’s first overhaul in more than twenty years.
Brief takes

We close with this compelling video, which might provide some inspiration for your new year. It’s a great video to share with your work force. (Hat tip to the Renaissance Alliance Consumer Insurance Blog

Holiday Health Wonk Review, news notes, and holiday humor

Thursday, December 22nd, 2011

Gary Schwitzer makes his hosting debut with Unwrapping early presents, wrapping up ’11 Health Wonk Review series. Gary is the publisher of the excellent HealthNewsReview.org and its associated Health News Watchdog blog – take a look around while you are there.
Absence Management – The Disability Management Employers Coalition and Liberty Mutual recently released a set of best practice for absence management and easing the transition back to work after a disability leave. Download a whitepaper on Best Practices in Return to Work or view Taming the Intermittent Beast, a one-hour webinar on managing intermittent leave.
Support a good guy – Joe Paduda explains why you should join the Friends of Sandy Blunt on LinkedIn.
Desperate Housewives – Reality just got a little harsher for a would-be reality TV star caught in a huge California workers comp scam, She and her husband were charged with $30 million in premium fraud. “The couple gained notoriety in 2010 after fraud investigators raided several properties they owned and found luxury cars including a Bentley, two Ferraris, $500,000 in jewelry and $51,000 in cash. They also found an application for Kile to appear on the television show.”
Going and coming – Injuries that occur while traveling to and from work generally are not compensable. There are several common exceptions to this “going and coming” rule – if an employer provides transportation, if traveling is part of the normal course and scope of an employee’s job (such as a salesperson), or if the employee is on a “special mission” for the employer. Risk and Insurance reports on a recent benefit denial by the New Jersey Superior Court, Appellate Division in a case where a company president was invoking the “special mission” exception for an injury that occurred during an early trip to work for a special meeting. In denying the appeal, the court reasoned that the exception did not apply because the president was not required to be away from the restaurant’s usual place of business and he did not have “identifiable time and space limits on his employment.”
Up in smoke – Roberto Ceniceros posts about a denied claim involving a landscaper injured after a fall from a tree. Ceniceros notes that, “A urine sample taken at the hospital the day after the Tennessee man fell showed he had an intoxicant level 50 times beyond the threshold for a positive result, leading a doctor to describe him as a chronic pot user.” The court concluded that while the employee was not guilty of willful misconduct, his intoxication was a proximate cause of the injuries.
Hope for PTSD relief?Wired has an interesting article on a how the Navy is testing neck injections to relieve PTSD. The unorthodox procedure, which is called stellate-ganglion block (SGB), has secured immediate relief for some PTSD sufferers.
NYWCB Web change – Effective December 20, the New York State Workers’ Compensation Board (WCB) updated its website to use the standard “ny.gov” domain naming convention – the new web address is www.wcb.ny.gov. WorkersCompensation.com has more detail about related email changes.
On the lighter side: Holiday roundup
In honor of the holiday season, we’ve put together a grab bag of some fun holiday links. We wish all our friends the best for the season!

Health Wonk Review’s Spring Training edition & assorted news items

Thursday, March 17th, 2011

Health Wonk Review – What do baseball and healthcare have in common? Find out – Glenn Laffel of Pizaazz hosts a fresh helping of the best of the health policy blogosphere: Health Wonk Review: Spring Training Edition
Does an anti-immigrant climate affect workers comp costs? – At Comp Time, Roberto Ceniceros discusses a recent news story in which Tom Hensley, president of Fieldale Farms Corp, testifies before the Georgia General Assembly about the detrimental impact that anti-immigration measures are having on his business. The impact included higher turnover and higher workers comp costs. Roberto is interested in hearing if anybody else has witnessed a similar trend of Latinos fleeing a state because of anti-immigrant sentiment and then claims trending upward – drop him anot if you have something to add.
Can you hear me now? Musicians and other workers who are exposed to loud music in their workplace are typically given short shrift in the occupational safety and health literature. Recent studies at nightclubs show that all employees (waiters, bartenders, DJs, etc,) were exposed to noise levels above internationally recommended limits and were at a higher risk of early hearing loss and tinnitus. The NIOSH Science Blog discusses music-induced hearing loss.
Giffords covered by work comp – Stephanie Innes of the Arizona Daily Star reports that federal workers’ comp is footing the recovery bill for Gabrielle Giffords and two of her employees who were shot in January. Because they were working, it’s an on-the-job injury. The federal law has no cap on medical payments, which is fortunate since the story reports that, “The Brain Injury Association of America says inpatient rehabilitation costs can range from $600 to $8,000 a day depending on services, and outpatient rehabilitation can cost $600 to $1,000 a day.”
Shrinking employer appetite for RTW? – Joe Paduda looks at how the economy may impact workers comp in 2012. Is higher severity in the offing? Joe talks about why that might be the case.
What makes a good claims organization? – At PropertyCasualty360, Carl Van, president and CEO of the International Insurance Institute, Inc., has posted the first in a three-part series on The Five Standards of Great Claims Organizations. See how your organization or your vendor stacks up.
Complex care – the folks at TMS continue to demonstrate that in complex care cases, the devil is in the details – and those details may be impeding an injured worker’s recovery and costing you money. See Pressure mapping: The underwear case for another example of how a small problem can become a big one.
Cool tool – Calculate your injury and illness incidence rates for your organization and compare them with national, state-specific, or industry-specific averages: Incidence rate calculator and comparison tool
Jobs of yesteryearPtak Science Books features a series of photos of Pennsylvania Coal Boys on the job in 1895 excerpted from an issue of Scientific American.
JapanHR Web Cafe has posted various resources, including options for donations. The interactive before and after satellite images are very dramatic, giving some sense of scope.

Bosstown’s Health Wonk Review, and assorted other news briefs

Thursday, May 28th, 2009

Check out Health Wonk Review: Bosstown edition. Tinker Ready at Boston Health News makes her debut as host with an informative and entertaining edition of the biweekly roundup of the best of he health policy blogs.
News briefs
Michael Fox of Jottings By an Employer’s Lawyer offers a great rundown of Supreme Court Nominee Sonia Sotomayor’s opinions on labor and employment law.
More state AGs file against Chrysler bankruptcy – we’ve blogged about Michigan and Ohio; now Illinois and Indiana join the list of AGs that are attempting to protect both workers and their state workers comp systems from any adverse effects. The bone of contention is that under the terms of the proposed sale, Fiat would not be required to assume workers’ compensation liabilities of injured Chrysler workers and individual state systems would be forced to deal with these uncovered workers.
Joe Paduda of Managed Care Matters has completed his firm’s First Annual Workers Compensation Bill Review Survey.
Peter Rousmaniere’s article A Brutal Interpretation in Risk and Insurance tells the story of Taha Saad’s unfair treatment under the defense Base Act. Saad, an Iraqi translator, worked for the Army until he lost his legs in an IED explosion. A U.S. Department of Labor judge recently affirmed AIG’s weekly payment of $46.15 for his permanent disability.
Clamping Down on Claim Costs – nine practical tips for managing workers’ comp losses by Lori Daugherty of Claims Magazine
Safe Lifting Portal
Hearing Conservation Training That Works
Exotic Dancers Are Employees, Not Independent Contractors

Maryland officials monitoring GM solvency related to workers compensation

Monday, December 8th, 2008

With the Big 3 automakers discussing potential fallout if the federal government doesn’t come through with a bailout package, there is one aspect of the fallout that would likely be a mere footnote in the wake of such a massive failure, but that would be of interest to thousands of workers: the issue of what happens to workers compensation claims.
Maryland officials are considering and planning for such a scenario now in the case of GM. The state’s Workers’ Compensation Commission (WCC) is closely monitoring GM and other distressed, self-insured firms with operations in Maryland. Officials note that GM has 200 employees statewide that are covered for workers compensation under the company’s self-insured plan. They note that even in the case of a bankruptcy (which GM states it is not considering), the funding for claims would not automatically be wiped out. R. Karl Aumann, chairman of WCC, said it’s rare for a company to default on its workers’ compensation program. The last time this happened, he said, was with Bethlehem Steel Corp., which declared bankruptcy in October 2001.
In the case of property and casualty insurer insolvencies, every state has a safety net for policyholders, usually in the form of a Guaranty Fund. However, these funds do not necessarily cover self-insured employers, according to an overview of the insolvency process and guaranty fund laws by the The National Conference of Insurance Guaranty Funds:

Q: Am I covered by a state property and casualty guaranty association if I purchased my policy from an unlicensed carrier or a managed care plan?

A: No. Guaranty associations cover only licensed insurers. Companies not licensed in the state, surplus lines carriers, managed care plans, preferred provider organizations (PPOs), Health Maintenance Organizations (HMOs) and self insured plans are not covered under the property and casualty guaranty association statutes. If you purchased coverage from one of these entities, and the company is now insolvent, you may file a claim with the Liquidator. There may also be other guaranty associations that may provide coverage for policies issued by these types of organizations. Your state Department of Insurance can provide you additional information.

Q: How can find out if my company was licensed in my state?

A: Check with your state Department of Insurance. They should have a listing of all admitted companies.

However, many states have some type of guaranty mechanism established that covers self-insured entities. Here are some resources to learn more about the protections that your state affords:
State Insurance Departments
Self-Insurance Guaranty Funds of America
State Guaranty Fund websites
State Guaranty Fund Directory (PDF)
In the case of bankruptcies, workers comp claims payments are often considered a priority – see this discussion of a recent court ruling in Pennsylvania. However, insurers may be out of luck when it comes to payment for workers comp premium in the case of bankruptcy. In the 2006 case of Delivery Service, Inc., et al v. Zurich American Insurance Co., The U.S. Supreme Court ruled that a workers compensation insurer does not have a priority claim against a bankrupt business for unpaid premiums under bankruptcy law.
For more information on State Guaranty Funds and insurer insolvencies, see the Bob Hartwig’s excellent overview for the Insurance Information Institute, which includes a chart about the top 10 largest insurer insolvencies:
Year / Insolvent company / Payments / Recoveries / Net cost
– 2001 Reliance Insurance Co / $2,265,845,612 / $1,415,385,230 / $850,460,383
– 2002 Legion Insurance Co / 1,272,694,066 / 227,503,349 / 1,045,190,717
– 2000 California Compensation Insurance Co / 1,049,745,420 / 327,756,089 / 721,989,331
– 2000 Fremont Indemnity Insurance Co / 843,405,746 / 643,377,434 / 200,028,312
– 2001 PHICO Insurance Co / 699,420,144 / 205,770,569 / 493,649,574
– 1985 Transit Casualty Insurance Co / 566,549,902 / 379,499,906 / 187,049,996
– 2000 Superior National Insurance Co / 555,797,035 / 174,168,193 / 381,628,842
– 1988 American Mutual Liability Insurance Co / 543,085,140 / 238,199,539 / 304,885,602
– 1986 Midland Insurance Co / 531,641,477 / 50,648,348 / 480,993,129
– 2006 Southern Family Insurance Co / 516,844,804 / 246,101,399 / 270,743,405

Your Government at Work – Worker injury research you can actually use

Monday, November 19th, 2007

A cornerstone of Lynch Ryan’s work for more than twenty years, a long-held mantra, has been that employees who work for good employers — employers who care for their workers and show it by the way they treat them — report all work injuries when they happen, get expeditious treatment and return to work faster. Moreover, their injuries cost significantly less than those of employees who work for less caring employers. A major driver for low workers’ compensation costs is the quality of the relationship between employer and employee.
We’ve seen this in our consulting work time and again, but it’s nice to have independent research confirm the mantra.
In the mid-1960s, the Department of Labor’s Employment and Training Administration (at that time called the Office of Manpower, Automation, and Training ) wanted to understand specific issues pertaining to the U.S. labor market, such as retirement, the return of housewives to the labor force, and the school-to-work transition. To do that it began conducting longitudinal studies, studies that look at a random group of like people to see how they develop over time. The Office began four such studies following groups of young men, older men, young women and, no, not “older” women, but rather “mature” women. The studies were originally targeted for five years, but, because they were yielding a mountain of data, they were extended until 1983, allowing other agencies to piggy-back along to glean even more information about how these first baby-boomers and World War II veterans were maturing in post-war America.
Because of the success of these studies, the Bureau of Labor Statistics decided to conduct an even more ambitious project, and in 1979 it launched the “National Longitudinal Survey of Youth 1979,” (NLSY79)
NLSY79 randomly selected and interviewed a cohort of 12,686 young Americans, 14 to 22 years old, all born between January 1,1957 and December 31, 1965, and it has been interviewing them regularly ever since, for nearly three decades now. As of 2004, there were 7661 people still in the survey group. These people have provided profound and relevant data about the aging of the last of the eighty million American baby-boomers.
What does this have to do with workers’ compensation? Actually, quite a lot.
Until I read Joe Paduda’s recent blog post, I was unaware that any researchers had ever mined the NLSY79 data for workers’ compensation insights. Thanks to Joe I have been enlightened. Thank you, Joseph.
In 2005, Darius Lakdawalla, Robert Reville and Seth Seabury of the Rand Institute for Civil Justice published “How Does Health Insurance Affect Workers’ Compensation Filing” (this is a Working Paper, meaning it has not been formally peer-reviewed). Using NLSY79 data, they confirmed Biddle and Roberts 2003 Michigan study (purchase required), which found that only about 55% of workers sustaining lost time injuries ever file claims for benefits, as well as an Oregon state-sponsored study of the 2002 Oregon Population Survey suggesting that 54% of workers reporting workplace injuries filed claims. They also found that unionized workers were more likely to file claims following work injuries.
Moreover, the Rand researchers found that workers without health insurance are about 15% less likely to file a claim than injured workers with health coverage.
A still more surprising finding may be that workers at companies that merely offer health insurance benefits are 50% more likely to file a claim after suffering a work injury than workers at companies that do not offer health insurance benefits.
However – and here is the major finding for me – lost time, as well as the cost of lost time for these workers who file more claims is about 20% less than for the workers who are not offered health insurance.
Finally, other types of fringe benefits – like paid vacation days – also seem to be associated with higher filing rates. For example, when both health insurance offers and paid vacations are present in the same employer, both variables are significant (at the 95% confidence level) and both have coefficients around .10 for claim filing.
What does this tell us? Well, for me it reinforces our mantra. These employees may report more injuries, but, as the NLSY79 data show, they return to work faster and their injuries cost significantly less than do the injuries of employees who work for employers who do not provide these benefits. Quod est demonstrandum.
The Rand study is compelling and instructive, but you do have to know a few things about statistical research to get the most out of it. Nonetheless, it should provide fuel for further workers’ compensation research using the NLSY79 treasure chest of demographic data. This stuff is too good to sit on a shelf gathering dust.

NCCI 2005 Issues Report – a look back, a look ahead

Wednesday, April 6th, 2005

Every spring, NCCI publishes a series of reports that paint a portrait of the workers compensation industry’s health. These include an annual “Issues Report,” followed later by a “State of the Line” report. For those of us who work in the industry, these reports offer a quick look of where we’ve been and provide a cookie trail for where we are likely headed. They are mandatory reading for industry insiders, but they are not just for insurance wonks. If there’s one drum we continually like to beat here at Workers Comp Insider, it’s that the more employers understand about the insurance industry, the better prepared they can be to weather any market vagaries.
The 2005 Issues Report has been released, and in his Annual Snapshot (PDF), executive director Stephen Klingel paints a good news/bad news scenario of a market in transition. Some of his observations include:
Insurer reserve deficiencies were reduced by approximately $5 billion dollars. Although improved, reserve deficiencies are still a problem. In workers comp, losses have the famous “long tail” – that is, they play out over years. Insurers set aside reserves for the estimated cost of the claim. If they don’t set aside adequate reserves, when it’s time to pay the piper, insurer insolvencies occur and havoc ensues. Insurer insolvencies still loom as a potential problem.
Medical costs – particularly prescription drug costs – are still galloping away. Wage replacement was always the largest share of lost time claim cost, but now medical costs represent 55% of the cost, on average. In some states – AL, AZ, IN, KY, TX, and WI – the cost approaches 70%.
Frequency continues to decline. That’s good news. It means that employers are doing a better job in the area of safety. NCCI reports “significant declines occurred in fatal, permanent total, and permanent partial claim frequency.” But on the flip side of the coin, severity is increasing. That means that the medical costs and/or the duration of claims are rising. Not so good.
Terrorism Risk Insurance Act (TRIA) uncertainty looms. The uncertainty about whether Congress will extend TRIA casts a pall over the industry. The clock is ticking, it is due to expire at the end of the year. TRIA provides a federal backstop or safety net for insurers in the event of any catastrophic events. Because workers comp is mandatory coverage, it is a line of insurance that is particularly exposed – insurers can’t exclude terrorism coverage when issuing policies.
The residual market is stabilizing. The residual market is sometimes called the assigned risk pool, or more familiarly, “the pool” or “the market of last resort,” while the rest of the market is known as the voluntary market. If you are an employer, you might get thrown in the pool for any of a number of reasons: your loss experience may be terrible or you may simply be in a high-risk industry. For one reason or another, no one wants to write your policy. NCCI reports that the residual market now represents about 13% of the total premiums, up from about 10.7% in 2003. However, the rate of growth for the residual market appears to be appears to be slowing.
NCCI