The three-minute videos helping your employees receive better medical care

The health care industry is evolving every day with rapid growth particularly in digital health technologies like smart watches, calorie counter apps and pedometers. Patients can benefit from this transition when there is a united front between quality care and digital innovation.

Workplace diagnosis body map and logoKnowing how to diagnose a workplace injury like trigger finger requires training and experience in occupational medicine. That’s why Texas Mutual is addressing the need for innovation in the treatment of workplace injuries. Texas Mutual’s medical director, Dr. Nicholas Tsourmas, is helping to lead this effort, and one of the ways he is doing so is through Workplace Diagnosis. The tool is the first online, real-time patient diagnosis video tool for physicians treating workers’ comp patients.

By visiting texasmutual.com or using our mobile app, physicians can select an area of the body to watch a video and learn about specific injuries. Each video averages three minutes and features Dr. Tsourmas with a patient discussing a common workplace injury and offering tips on how to diagnose it.

Dr. TsourmasDr. Tsourmas was recently recognized for his achievements in the workers’ compensation health care field when he received the Medical Professional of the year award at Work Comp Central’s Comp Laude Awards. His work is helping ensure that Texans with occupational injuries are accurately diagnosed and treated, and have options for modified job duties during recovery.

Dr. Tsourmas has been with Texas Mutual since 1993. Since then, he has traveled throughout the state to give onsite training to our network providers and educate the medical community on workers’ comp and musculoskeletal ailments. The same training he shares with providers throughout the state is shared with Texas Mutual’s team of adjusters to improve the claim process for injured workers and give our team the tools to understand doctors’ recommendations.

At Texas Mutual, we put a lot of effort into preventing workplace injuries, but when they do occur, we are dedicated to making sure that the injured workers we cover receive the quality care they need. Innovative resources like Workplace Diagnosis are a part of that collective effort. Dr. Tsourmas’ recognition is reflective of his leadership in these areas and speaks to our ongoing commitment to creating a stronger, safer Texas.

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Control your costs by controlling your e-mod

Unless you’re an insurance agent or work in the industry, insurance terminology can seem confusing or full of jargon. Your experience modification rate, also known as an e-mod, EMR, or experience modifier, is a good example. Put simply, your e-mod represents the workplace safety record, but there is a lot that goes into calculating it.

We discussed e-mods, how they are calculated, how they affect your premium, and what they mean for your business in our July webinar. These monthly webinars are one of the ways we cut through insurance industry jargon to help you understand workers’ compensation. They take place on the first Friday of every month. Watch the presentation and see what you can do to keep control your e-mod, or read on for our key takeaways.

Experience Modifiers

Click to watch the presentation

What is an e-mod and what is its purpose?

An e-mod is a numerical factor that reflects a company’s historical cost of injuries and future risks. It is used to calculate premium.

E-mods serve two main purposes. The first is for comparative analysis. An e-mod reflects the past loss experience of a company compared against other employers in the same industry. This comparison generates the e-mod, which is used to adjust the workers’ compensation premium up or down. The second purpose is to create incentive in the workplace for employers to maintain a safe work environment by preventing hazards and properly training employees.

Loss experience is a more reliable predictor of future losses for larger premium, so we do not apply an e-mod to employers who have less than $5,000 in premium.

It’s important to keep in mind, though, that while e-mods are used to calculate premium, they aren’t a great measure of how safe a company actually is. We explain this in greater detail in There’s Nothing Wrong with a 1.0 and 10 Reasons to Stop Using E-mods to Evaluate Safety.

How your e-mod is calculated

An e-mod compares an employer’s actual losses (experience rating) against the expected losses for their industry as a whole. To determine your company’s expected losses, your company’s payroll and class codes are taken into consideration.  A simple explanation of how your e-mod is calculated is actual losses divided by expected losses for the industry.

E-mod calculation

Your current e-mod takes into account claims data from the most recent three-year period. The image below is a representation of how your losses can affect your e-mod and illustrates how losses can fall outside the three-year window. Because three full years of data is needed to determine your e-mod, losses don’t immediately affect it and they eventually drop off.

3 years of data

How your e-mod affects your premium

E-mod ratings are determined by the National Council on Compensation Insurance (NCCI). Most states, including Texas, use the NCCI to calculate experience modifiers. A score of 1.0 represents an average risk and means the company should perform as expected for the industry. A multiplier of less than 1.00 is a credit mod and indicates a company is safer than average within its industry. A multiplier greater than 1.00 is a debit mod and indicates a company that is less safe than average. The chart below shows examples of how your experience modification factor can affect your premium.

Credit debit e-mod

What you can do to control your e-mod

Although accidents happen, there are steps you can take to keep your e-mod under control. Encouraging safe practices in your workplace and implementing return-to-work programs can help. Read our tips below:

  • Create a culture of safety. A positive safety culture starts at the top.
  • Report injuries early. Allow adjusters and doctors to address the injury as soon as possible. This helps to ensure the injured worker gets the necessary medical attention, so that an injury doesn’t become more serious.
  • Implement an injury and illness program. Visit the safety resource center in your Texas Mutual Online account to take a safety program assessment. You’ll answer a few questions about your company’s operations and potential hazards, and receive a sample safety program.
  • Train employees on safety topics. Provide a new employee orientation, refresher training, and remedial training as needed. Our safety resource center offers 2,000 free resources, including more than 200 e-Learning online training modules. Make sure to keep safety training records for OSHA reporting.
  • Investigate accidents and near misses. Accident investigations can prevent safety incidents from occurring again. Attend our August webinar to learn how to conduct job safety analysis to identify hazards.

If you still have questions about e-mods

We encourage you to talk to your agent, utilize NCCI resources, or view our recent blog on experience modifiers from our Your Claims Questions Answered video series.

Your Claims Questions Answered – What can the Texas Star Network do for my business?

Texas Mutual offers a workers’ compensation heath care option called the Texas Star Network. Comprised of medical professionals with the return-to-work goal in mind, our network is one of the many ways we save you money.

Watch our next video in the Your Claims Questions Answered series on what the Texas Star Network can do for your business and take a look at the key benefits below.

Benefits of the Texas Star Network:

  • Policyholders receive a discount of up to 12 percent off their premium
  • Patients treated by an in-network doctor return to work eight days sooner on average
  • Injured workers receive top quality medical care with lower than average costs
  • It’s easy to find in-network providers through the network app or online directory
  • You can reduce your premium by lowering claim costs

We encourage you to consult your agent to determine if the network is the right choice for your business, but keep in mind you do not have to wait until your policy renews to enroll. The network comes with responsibilities for you and your employees.

Visit texasmutual.com for information on how to enroll in the network, and to find other network tools.

Your Claims Questions Answered is a six-part video series covering the most commonly asked claims questions. We’ve featured each episode on the blog with our key takeaways. You can watch the full series here or visit our recent posts about return-to-work programs, e-mods, the claims process, and reporting an injury.

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.

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