Your Claims Questions Answered – How do claims affect my experience modifier?

We kicked off our new video series Your Claims Questions Answered with key takeaways on your role in the claims process and how to report an injury. This week, we’re diving a little deeper into how claims can affect your experience modifier. Watch the video below and take a look at our key takeaways to learn about experience modifiers and what it means for your workers’ compensation premium.

What is an experience modifier?

An experience modifier or e-mod is a factor applied to your workers’ comp rate that is a comparison of your company’s loss experience against other employers in the same industry as you. If your company has had severe and medical-only losses, the e-mod will adjust your premium to lower the impact of those claims. Typically only mid-to-large size businesses will receive an e-mod.

How is an e-mod calculated?

The National Council on Compensation Insurance (NCCI) adjusts and rates e-mods in Texas. They look at payroll and claim history from the past three policy years to help identify potential losses. In general, employers with better-than-average loss history will see lower premium compared to the average, and employers with below-average loss history will see higher premium compared to the average.

All data is reported to NCCI, but not all losses are entered into the e-mod formula. In some cases, a small loss will have no impact or a proportionately small impact on your experience modifier.

Always report claims

A good rule of thumb is to always report your claims. Taking care of small claims on your own is not always in your best interest and most business owners are not experts in workers’ compensation law. From missing out on network savings to opening up your business for penalties, not involving Texas Mutual is not worth the risk.

The best way to manage your e-mod is with effective loss prevention and return-to-work programs. But remember, an e-mod is a pricing modifier and isn’t always a direct representation of a company’s commitment to safety. For more information on e-mods and how to qualify for one, visit texasmutual.com.

In our next installment of Your Claims Questions Answered, we’ll share our tips on creating an effective return-to-work program for your injured workers.

Your Claims Questions Answered – What do I do if an employee gets hurt?

In our new YouTube video series Your Claims Questions Answered, we address the most commonly asked claims-related questions. We covered your role in the claims process recently on the blog. Next up, we are discussing what to do when an employee gets hurt while at work. Watch the video and take a look at our key takeaways below.

Address the employee’s health

If an employee is injured on the job, the first thing you should do is assess the situation and determine if it is an emergency. Call 911 if needed and make sure the employee gets timely care to facilitate a quick recovery.

Using the Texas Star Network can help employees get the care they need and can help you manage claim costs. Injured workers can search for a treating doctor, pharmacy, or specialist through the Texas Star Network’s provider portal online or through the Texas Star Network’s mobile app.

Report the claim to Texas Mutual

To report an injury, we will need a DWC-1 Form known as the Employer’s First Report of Injury or Illness. We’ve made it easy to report claims to Texas Mutual online, by phone, fax or mail. Whichever way you choose to report, it’s best to make a report as soon as you can, so Texas Mutual can help you with the claim. The law allows employers up to eight days to report the injury.

Keep open lines of communication

Open communication supports a culture of safety by empowering employees to voice their concerns. Make sure employees know how to report safety hazards and how to access the resources they need to be safe on the job.

In the event someone is injured on the job, getting them back to a productive life is always best. Stay in touch with the employee throughout their recovery to help mitigate their feelings of isolation and maintain team comradery.  A return-to-work program can be started before an injury occurs. Visit the Return-to-Work page at texasmutual.com for more resources.

Training and preparation

There are steps you should take to be as prepared as possible for when a workplace injury occurs. Making safety a habit starts with providing the right training for your employees to do their jobs safely. Texas Mutual has free resources available for you and your employees including webinars and e-Learning online training courses.

Assign a point person to take the lead during injury incidents and create an action plan that is accessible for your employees. Practice drills can help your workplace prepare for an emergency situation and can help you identify any shortfalls in training.

Keeping these tips in mind will help you be prepared when a workplace injury occurs. Next in the Your Claims Questions Answered series, we’ll cover how claims affect your e-mod.

Your Claims Questions Answered – What’s my role in the claims process?

When a worker is injured on the job, an employer may have a lot weighing on their mind. Determining the next steps shouldn’t be one of those things. At Texas Mutual, we provide you with the resources you need to understand the claims process and help employees get the care they need so they can recover and return to a productive life. That’s why we launched a new video series called Your Claims Questions Answered, which addresses the most commonly asked claim-related questions quickly and clearly. In this six-part series, we’ll cover your role in the claims process, reporting an injury, experience modifiers, return-to-work programs, the medical network, and reporting fraud.

To kick off this series, watch “What’s my role in the claim process?” and review our highlights below on how to manage your claims.

Keep an open line of communication with Texas Mutual and the injured employee. This helps the injured worker from feeling isolated, increases trust and fosters loyalty. Check in with the employee to let them know you care about their recovery. A little bit of encouragement goes a long way to motivate an injured worker to get back on their feet.

We’re here to help you and the injured worker throughout the whole process. Our licensed claims adjuster will be there for the injured worker every step of the way. As a large carrier, we’ll work to keep your claims costs down and we can help you to create an injury recovery plan. You can also login to texasmutual.com to check the latest status of a claim.

Build a return-to-work plan. Injured workers out six months or more have only a 50 percent chance of ever returning to work. Implementing a return-to-work plan engages the worker and saves you money. For more resources, visit the Return-To-Work page at texasmutual.com.

Stay tuned for our next installment of Your Claims Questions Answered where we will discuss how to report an injury, or take a look at the whole series now. For safety resources to help you prevent workplace injuries, login to texasmutual.com and visit the Safety Resource Center.

Other states claim data download now available on texasmutual.com

iStock-484100324[1].jpgWhen it comes to determining what type of safety training your employees need, a little information can go a long way. From understanding the most common risks for your industry to knowing exactly where things are going wrong on the job, having this type of insight can help keep workers safe.

Now, Texas Mutual is making it even simpler for policyholders with other states coverage to get valuable information about their claims by downloading data as an Excel file in the same way that Texas data has been available. This can reveal trends, such as employee knowledge gaps, unsafe practices, new employees lacking adequate training or a specific time of day injuries occur. With this information you can put safety training in place that will make a difference.

The other states data shows all the claims that have been filed outside of Texas and provides specific information about each claim, including the injured worker’s occupation, location of injury, date and time of the injury, description of the incident, date of hire, and more. Texas data is available in a similar format and provide the same great benefits that the new other states data download provides. These reports can be extensive depending on the business size, but having the data in an Excel files gives you the ability to sort and filter data in a way that best fits your needs and helps provide more targeted training. By focusing your training on key areas that have historically been an issue, you have the power to lower your e-mod, keep your workers’ comp costs down, and most importantly, keep your employees safe.

At Texas Mutual, we work hard to give you the tools and resources you need to keep employees safe. That’s why we’ve made it easy for you to access loss data, loss runs and other insightful reports by simply logging in to texasmutual.com. When you’re ready to review claims history for your Texas or out-of-state operations, visit our website and click on Loss Runs & Claims to access your data.

Subrogation protects employers’ premium dollars

subrogation

Texas Mutual’s dedicated team of full-time subrogation specialists are celebrating a banner year in 2016.

Remember when you were a kid and adults told you it’s wrong to point fingers? That’s not always true. Take the workers’ comp world, for example.

Workers’ comp is no-fault insurance. That means if a claim is compensable, your insurance carrier will be there to make sure your injured employee gets the benefits they’re entitled to. That’s a promise financially strong carriers make and keep to their customers.

Sometimes, however, third parties contribute to workplace accidents. In those cases, your workers’ comp carrier might recover the costs of benefits from the responsible party through a legal process called subrogation.

What is subrogation?
Subrogation protects you from paying for someone else’s mistake. That’s because subrogation can have a positive impact on claim reserves and experience modifiers, both of which affect your premium.

Many insurance carriers assign subrogation to adjusters, whose primary job is administering benefits to injured workers. Texas Mutual employs a team of dedicated subrogation specialists. They spend the bulk of their time subrogating claims involving vehicles, products and premises.

Regardless of how your workers’ comp carrier handles subrogation, you can facilitate the process by following a few simple tips.

Vehicles
Your employee is making a delivery. Another driver, who is not one of your employees, rear-ends the vehicle your employee is driving. Your carrier may pursue the other driver’s auto insurance carrier to recover the costs of claim-related benefits.

Tip: Document the exact location of the accident, as well as the law enforcement agency that responded. This information will help your workers’ comp carrier locate the accident report.

Products
A ladder breaks and injures your employee. Your accident investigation shows the employee was using the ladder correctly; however, the ladder was faulty. Your carrier may pursue the ladder’s manufacturer to recover the costs of claim-related benefits.

Tip: Documentation is critical to the subrogation process. Keep receipts and thorough maintenance records on ladders, vehicles, equipment and your facility. In addition, secure the ladder in case it is needed as evidence in the case.

Premises
An employee slips on a recently mopped floor at a customer’s workplace. There are no cones or signs warning pedestrians about the hazard. Your carrier may pursue the entity responsible for maintaining the customer’s premises to recover the costs of claim-related benefits.

Tip: Take photos of the area where the employee was injured, noting whether there were warning signs posted around the hazard. Get witness names, note the type of shoes the employee was wearing, and document the time of day and associated lighting conditions.

More information
For more information about subrogation, visit Texas Mutual’s case archives and the National Association of Subrogation Professionals website.

This Week in Comp, October 27-31

This Week in Comp provides an overview of workers’ compensation news from across the country.

TRIA expiration fast approaching
With TRIA set to expire at the end of the year, its renewal remains in limbo…MORE

Wellness as an injury prevention tool
The proportion of older workers (55 years and older) in the U.S. climbed from 16% in 2004 to 22% in 2013, according to the U.S. Bureau of Labor Statistics. The aging workforce presents new opportunities for safety professionals to implement wellness as an injury prevention tool…MORE

NNT in pain management: You’ve been right all along
The National Safety Council’s Dr. Don Teater, M.D. has penned a white paper that contains powerful data and interesting insights regarding the use of opioids for chronic non-cancer pain. Essentially, Dr. Teater’s research indicates that for most patients, ibuprofen and acetaminophen are safer and more effective than opioids…MORE

Distracted driving: The self-correcting nature of science
A majority of research on driver distractions has focused on cell phones. More recent studies remind us that other distractions, such as daydreaming, talking to passengers or correcting children also take our focus off the task at hand…MORE

CDC tightens PPE guidelines for health care workers
The new guidelines focus on three areas: 1. Training, including how to put on and remove PPE. 2. No skin exposure when PPE is worn. 3. Supervision by a trained monitor while putting on and removing PPE…MORE

No chief’s disease here
David DePaolo recounts a workers’ comp success story from the California Highway Patrol…MORE

Regulatory roundup
Texas Mutual’s weekly mash-up of health and safety-related regulatory news…MORE

Workers’ comp study looks at California’s reforms
Large increases in office visit fee schedule rates under SB 863 will likely lead to substantial increases in prices paid in California, as the reforms intended.  However, the reimbursement rule change regarding reports, record review, and consultation codes may moderate the potential increase in payments, according to a recent study released by the Workers’ Compensation Research Institute…MORE

Consequences of failing to report & respond to work injuries
Even for the best employers following workplace safety guidelines, accidents happen. When they do, it is important to follow recognized procedures when responding to work injuries. Failure to properly report and respond to the injury can have significant adverse consequences…MORE

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

This Week in Comp, October 13 – 17

This Week in Comp provides an overview of workers’ compensation news from across the country.

Ohio man fakes workplace injury, employer discovers it on security video
The employer’s security video revealed that the employee  stomped a hole in a wooden floor the night before he said he was injured and on the following day, lowered his foot into the floor and laid down on the platform…MORE

Click the image above for a Centers for Disease Control and Prevention podcast on driving safety.

Click the image above for a Centers for Disease Control and Prevention podcast on driving safety.

Ebola: Call for preparedness
At this time, Ebola is not a major workplace health hazard for most workplaces in the United States. Nevertheless, being prepared for any infectious disease event should be a priority for every employer…MORE

Test your driving IQ in the Oct. edition of TDI’s newsletter
The Oct. edition of “Safety and Health Update” includes a short quiz on driving laws, eye safety tips and the benefits of return-to-work…MORE 

Study compares medical costs across 16 states, including Texas 
The Workers’ Compensation Research Institute study provides a baseline of current medical costs and trends for policymakers and other stakeholders by documenting how medical payments per claim and their cost components compare over time with other states….MORE

OSHA releases Oct. 15 edition of QuickTakes
The edition features OSHA alliances with the Association of Energy Service Companies and the Federal Communications Commission. The alliances’ goal is to reduce workplace injuries among cell phone tower and oil field workers, respectively…MORE

Regulatory roundup
Texas Mutual’s weekly mash-up of health and safety-related regulatory news…MORE

OSHA: proposed fines up, inspections down for FY 2014
OSHA initiated 30,679 inspections and cited 55,163 alleged violations during the first 10 months of the current fiscal year, compared to 39,228 inspections and 78,196 alleged violations in FY 2013…MORE

Links to and from this blog do not reflect any affiliation between Texas Mutual Insurance Company and third parties, and are not an endorsement by Texas Mutual Insurance Company of the linked sites (or their owners or operators) or of any content located there. Texas Mutual Insurance Company does not vouch for the availability or accuracy of any information contained on linked sites. Read more of this post

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