Workers Compensation Premium Costs or Private Health Plan Costs?

Workers compensation costs being covered by other sources

Market experts dispute assumptions used in research

Business Insurance – July 1, 2012

SACRAMENTO, Calif.—Researchers at the University of California Davis say nearly 80% of direct and indirect costs that could be covered by workers compensation insurance are being paid by private health plans, government insurance programs or from workers' own pockets.

The study's lead author says underreported workers comp claims have resulted in discounted insurance premiums and decreased incentives for employers to improve their safety records.

However, workers comp experts are skeptical of the study, saying that workplaces have become safer over time, and that workers comp often covers costs for treatment unrelated to work injuries.

Harry Shuford, chief economist at Boca Raton, Fla.-based NCCI Holdings Inc., said the study shows the need for greater understanding between workers comp experts and the public health community, including researchers.

“At the base, our concerns and interests are the same,” Mr. Shuford said. “We want a safer workplace. We don't want employees getting hurt, much less being killed, on the job, and I think both groups have lots of value to contribute if we can just get past this hurdle.”

The report, Workers' Compensation Benefits and Shifting Costs for Occupational Injury and Illness, was published in the April edition of the Journal of Occupational and Environmental Medicine. It found that there were $249.6 billion in medical and indirect costs related to workplace injuries and illnesses in 2007.

As per our previous blog called "Workers Comp, Health Reform, and the Supreme Court Decision," when an employee is looking to abuse the system and weighs in about going out on workers comp versus short term disabilty using private health insurance, the scale quickly tips to works comp simply by following the money in the indemnity payments and settlements–in many cases for life.  So I am convinced this article should read "private health plans, government insurance programs or workers' own pockets are being covered by workers compensation premiums. Employers can recover workers comp overcharges and obtain workers comp refunds with a workers compensation audit.

Workers Compensation Rates for Employers Likely to Increase

Workforce – July 5, 2012

Employers renewing their workers compensation policies likely will pay more for the coverage as claims costs rise and insurers' combined ratios deteriorate, experts say.

Purchasers of primary and excess workers' comp insurance are seeing price increases, mostly in the single-digit range, brokers and insurers say, but insurers are fighting to hold on to favored accounts.

There also have been some increases in employer retention levels as insurers tighten their underwriting standards in an attempt to improve the line's profitability, they say.

"What we are seeing happening this year is that there is a growing recognition that changes need to be made in terms of workers' compensation profitability," said Curt LeBeau, vice president of insurance operations in Milwaukee for United Heartland, a unit of Accident Fund Holdings Inc. "And I think most carriers are taking some type of action to try to improve their results in the workers' comp line."

Brokers also say underwriting standards are tightening.

"They are actually underwriting and looking at losses," said Bob Jacobsen, area vice president for brokerage Arthur J Gallagher & Co. in Chicago. "The discipline is certainly back in the marketplace and, unfortunately for buyers, that means they are all going to pay more, at least in the guaranteed-cost market."

In general, the "cream of the crop" among guarantee-cost accounts are experiencing price increases ranging from about 5 percent to 7 percent, with some 10 percent increases, particularly in the Midwest, Jacobsen said. Similar accounts with loss-sensitive programs may see their pricing stay flat, "but those are harder to come by," he added.

A year ago, the nation's largest comp insurers held firm on pricing while regional underwriters still offered deals, sources said.

But now, "the regional insurers are actually being more firm" because they often don't have other lines to help drive their overall premium volume, Jacobsen said. "All the carriers are on the same page."

Overall, average price increases are in the mid-single-digit range, with guaranteed-cost programs seeing the greatest increases, said Jonathan Zaffino, managing director/U.S. casualty leader for Marsh Inc. in New York.

Buyers with less favorable loss experiences are getting additional underwriter scrutiny and higher prices, he said. While the market is transitioning, there are still deals to be had as insurer competition has not disappeared, Zaffino said.

Because of its very favorable loss experience, four insurers including the incumbent were "deeply interested" in his workers comp program when he prepared for a June 1 renewal, said Dave Dolnick, risk manager for the Brady Cos. in San Diego.

He ended up with a price reduction provided by the incumbent, which Dolnick declined to name.

Other construction companies he has contacted recently have seen renewals range from flat to 3 percent to 7 percent higher, Dolnick said.

The excess workers comp market also is firming, but it is not yet a "hard market," said Gene Maier, senior vice president of workers' comp underwriting for St. Louis-based Safety National Casualty Corp.

"We are seeing increases in rates and self-insured retentions, especially where an account has an unfavorable loss experience," Maier said. "We are underwriting on an account-by-account basis and taking the necessary action based on the specific experience of that account."

In some cases, insurers are pushing for higher retentions; in other situations, buyers are opting for higher retentions, sources said.

Overall, discussions with buyers about increasing their retention levels, shifting to loss-sensitive programs or moving to an alternative program, such as a captive arrangement, are on the increase, they added.

"I would not say that we have seen a lot of shifting to that yet, but we have seen some increased consideration of (loss-sensitive) plans," LeBeau said. "There is still anxiety on the part of customers to getting into a program where your costs can vary."

While rates can vary depending on the account, LeBeau said he is seeing price increases ranging from about 2 percent to 5 percent.

A range of issues are driving insurers to increase their pricing, sources said. Those include rising medical expenses, recession-related claim cost increases driven by an inability to return injured workers back to work and lackluster premium volume growth.

Last month, Fitch Ratings Ltd. reported that the workers' comp line posted a 117 percent combined ratio nationwide for 2011, its worst result in 10 years and worse than the combined ratio for other lines.

Recent rate increases are an encouraging sign that the market has reached a cyclical bottom, but Fitch said it expects rising medical severity will continue to hit workers' comp costs and the line's pricing will need further improvement.

"Fitch estimates that it will be difficult for the workers' compensation market to have a combined ratio of 110 percent or better in 2012 or 2013 without significantly more price improvement," the rating organization said in a statement.

Meanwhile, the combined ratio for California workers comp insurers rose to 122 percent during 2011, up from 117 percent in 2010, the Workers' Compensation Insurance Rating Bureau of California reported in late June.

This article points out that employers with poor claims experience are seeing big increases upon renewal.  The fastest and easiest way to have a better underwriting profile in the renewal marketplace is to sign up for workers compensation refunds.

 

Workers Comp: Facebook Photo Admissible As Evidence

An injured worker was denied benefits when an Arkansas Court admitted into evidence Facebook pictures that were posted on line showing him drinking and partying. The worker had alleged that as a result of a hernia, sustained at work, he was in excruciating pain.

The trial court held that the evidence went to the weight to be given his testimony and it was within the province of the Court admit them into evidence. The Court dismissed the injured worker's argument that the Facebook photos "are a disgrace to the dignity of the workers' compensation proceeding and the legal system." The case was dismissed.

Clement v. Johnson's Warehouse Showroom, 2012 Ark. App. 17, 2012 WL 11285 (Ark.App.)

Employers should remember that today's world has changed and there are easy to use and free social media tools availabe at their fingertips that are very powerful as you can see from this case as the claim was dismissed.  Another service that has no-out-pocket expenses is workers compensation premium recovery.    

Workers Compensation Rates for Employers Likely to Increase

Business Insurance – July 1, 2012

Rising medical costs, insurer profitability affect overall pricing

Employers renewing their workers compensation policies likely will pay more for the coverage as claims costs rise and insurers' combined ratios deteriorate, experts say.

Purchasers of primary and excess workers comp insurance are seeing price increases, mostly in the single-digit range, brokers and insurers say, but insurers are fighting to hold on to favored accounts.

There also have been some increases in employer retention levels as insurers tighten their underwriting standards in an attempt to improve the line's profitability, they say.

“What we are seeing happening this year is that there is a growing recognition that changes need to be made in terms of workers compensation profitability,” said Curt LeBeau, vp of insurance operations in Milwaukee for United Heartland, a unit of Accident Fund Holdings Inc. “And I think most carriers are taking some type of action to try to improve their results in the workers comp line.”

Brokers also say underwriting standards are tightening.

“They are actually underwriting and looking at losses,” said Bob Jacobsen, area vp for brokerage Arthur J Gallagher & Co. in Chicago. “The discipline is certainly back in the marketplace and, unfortunately for buyers, that means they are all going to pay more, at least in the guaranteed-cost market.”

In general, the “cream of the crop” among guarantee-cost accounts are experiencing price increases ranging from about 5% to 7%, with some 10% increases, particularly in the Midwest, Mr. Jacobsen said. Similar accounts with loss-sensitive programs may see their pricing stay flat, “but those are harder to come by,” he added.

No matter how bad or how well you're doing at managing your workers compensation claims, your renewal workers comp premiums are on the rise! In addition to state rate increases, insurance companies are buckling down as they continue to lose money year after year. Insurance companies are watching the accounts that they're writing now and looking more closely at the losses of each account. Some accounts will just see rate increases, while others will see rate increases plus big scheduled debits on their policies due to bad loss experience. No matter what, you can easily obtain refunds on your past and current years and obtain savings on future years for you to keep with no out of pocket expenses. Workers compensation premium recovery is the only solution to go back on prior and current policies for refunds and is the best and quickest way to obtain a better underwriting profile to enter the renewal marketplace with.

Workers Comp, Health Reform, and the Supreme Court Decision

There has been much debate as to whether The Patient Protection And Affordable Care Act will actually reduce or increase workers comp costs. Some are saying that employees without health insurance have been filing workers comp claims to get medical treatment but now that they will have their own health coverage, the number of fraudulent workers comp claims will fall. Also, employees will get better workers comp care. As the additional 32 million people in this country obtain health insurance, the availability of primary care physicians decreases due to higher demands and workers comp cases will see specialized occupational health physicians who are better suited to treat workers comp injuries.

I believe these optimists are missing the fundamental reason as to why these people are filing workers comp claims in the first place. In my experience, when these people file workers compensation claims, it's not always about medical care, but about the employee getting benefits (indemnity payments) and settlements while giving employees tax-free dollars while staying out of work. Furthermore, As health insurance carriers experience a dramatic increase in claims, they will need to question whether or not these new claims are work-related. As they send out their questioneers, make phone calls, and do their other investigative work, once again employees will have to balance the payments they receive on short-term disability for 6 months versus workers comp payments and settlements that can last for years or for life. The other distorted notion that employees will get better care while treating with occupational doctors or doctors that understand disability and impairment ratings better under workers comp is very false because there aren't that many occupational medicine doctors relative to the amount of regular treating physicians in the country and most doctors that are treating workers comp have no idea about disability and impairment ratings. These are usually left for independent medical exams.

In conclusion, while I do believe that most people are legitimately injured and we are all thankful for the workers comp system to help them out, there are still those that abuse the system. They didn't just abuse the system to get medical treatment in the past. They abused the system and will continue to do so in order to get workers compensation indemnity benefits in the future.

The bottom line is that the complex nature of workers compensation claims makes insurnace carriers susceptible to errors that lead to overcharges in your workers compenstion premiums. Healthcare reform will only make the workers comp claims environment even more confusing, giving even more reason to have an independent workers compensation audit.