Correcting billing errors to reduce your insurance premiums

Employers have a love-hate relationship with workers' compensation insurance. While the program protects business owners from lawsuits for workplace injuries, the required premiums continue to threaten profits.

"The cost of workers' compensation is a huge concern for most employers," says Ed Priz, president of Advanced Insurance Management in Chicago. "In some regards it is more of a widespread problem than health insurance." Unlike that optional medical benefit, workers comp is mandated virtually everywhere, except for some states that exempt the smallest of employers.

Cut Your Costs

The foremost problem is, of course, the size of the premiums. "Outside of health insurance, workers' comp is the most expensive insurance policy the typical employer buys," notes Scott Simmonds, author of a book on the topic. It also seems to be the most problem-prone: "Everyone seems to have a horror story either on the premium side or the claims side."

Experts say the most effective way to shave costs is to spot errors in the way premiums are calculated. "The insurance industry makes a lot of mistakes in providing workers' comp insurance," notes Priz, whose job is to spot overcharges in his clients' paperwork. "I find that in one-third to one-half the time, the client has been overcharged somewhere along the way. That's a significant error percentage."

One of the costliest errors is misclassification of employees. In the workers' comp world, different classes of workers are assessed different premiums that reflect injury risk. "There are more than 900 classifications for employees and rates are all over the place," cautions Simmonds.

While actual premiums vary widely by state, clerical people have less risk of injury and are thus rated relatively low - with a premium often as little as 60 cents for every $100 in payroll. A manufacturer or retailer, on the other hand, might pay $5 to $6 per hundred. And construction can go as high as $25 to $40.

You can find out how your own employees are classified by obtaining the relevant document. "Normally you can request a copy of your audit worksheet from your agent, who passes along the request to your insurance company, which then sends the report directly to you," says Simmonds. (The direct carrier-to-employer contact is intended to avoid having your private payroll information revealed to your agent.)

Check Your Records

Your workers' comp premiums are affected by a second factor: your claims history. The insurance industry compares the number and severity of your workplace injuries with those of similar operations in your industry. The resulting ratio is your experience modification or "x-mod" for short. The lower your x-mod, the lower your premiums. "Many business owners aim for an x-mod of 1.0, a figure which indicates your claims are no higher or lower than the average," says Simmonds. "To me, though, that's like getting a 'C' grade in school. I urge my clients to try to do better."

How can you lower your x-mod? The first way is to tally up your own history of claims and compare the results with those on your official x-mod worksheet. That document outlines the losses you have had, specifies your total payroll and provides the calculations that result in your x-mod. It is prepared by an agency called the National Council on Compensation Insurance (NCCI), which then provides it to your insurance carrier, who in turn forwards copies to your agent and to you. Calculating your x-mod can be complicated, but taking the trouble to do so will assure you the figure assigned you by your carrier is accurate.

Improve Safety

You can also reduce costs by instituting a safety program that brings down your accident rate. Obtain feedback from your workers on ways to make their jobs accident-free and institute their suggestions. (For some additional ways to reduce costs see the sidebar, "Internal Programs For Reducing Premiums.")

Using safety programs and other techniques, some employers have lowered their x-mod to 0.8 or even 0.6. "The lowest mod I ever saw was 0.48," recalls Simmonds. "That was for a county government in Pennsylvania. They had a tremendous program of loss control . . . and great luck."

Smaller businesses are often not assigned x-mods. That's because, from an actuarial standpoint, the data available are insufficient to make a meaningful calculation. At what point does a growing business enter x-mod territory? It varies widely but Simmonds offers this useful benchmark: "Generally speaking, if you are paying more than $5,000 a year in workers' compensation premiums, then you have most likely been assigned an x-mod."

And just how large might an employer be before reaching that premium level? By way of rough examples, an employer with two or three employees in low-risk positions might be paying around $2,000 annually in premiums; one with 15 to 20 employees might be paying $8,000 or $9,000.

If your business is too small to be assigned an x-mod, you can still benefit from a favorable workers' comp claims history, offers Simmonds. "If you have few claims, use the competitive-bid process to pressure your insurance company to provide you with credits that result in lower premiums."

Report Injuries

Because workplace injuries affect workers' comp premiums, many employers are tempted to avoid reporting accidents. That's bad. "Failing to report a workplace injury is illegal in virtually every state," warns Ron Peters, a partner in the San Jose, Calif., office of Littler Mendelson, the nation's largest labor and employment law firm representing management.

There are two reasons for the illegality, explains Peters. First, the states feel that injured workers have a right to receive benefits at a level that may be higher than what employers would provide without legislative mandate. Second, the insurance industry needs to have a realistic way of measuring risk for the purpose of setting adequate premiums.

There is an exception, however: You need not report minor injuries that require only first aid. "If you are in the habit of reporting 'first-aid-only' injuries, then you may end up paying higher premiums than necessary," warns Peters. While such over-reporting may seem counterintuitive, the fact is that employers are often tempted to do so out of fear that what appears to be a minor injury may turn into something more serious. "Employers can get nervous because sometimes it's not easy to identify a serious injury," says Peters.

Shop For A Deal

When it comes to workers' compensation insurance, shopping around can make a huge difference in premiums. "One of my clients recently experienced a 30 percent drop in his workers' comp premium, even though his payroll had increased by 8 percent," says Simmonds. The reason? "He had not been shopping around for over six years and didn't realize that new insurance carriers had entered his market offering lower rates. Suddenly his current insurer, afraid of losing a good customer, lowered his rates because of competition."

Your short list of candidates can include carriers that have sold similar goods to others. "Talk with friendly competitors," suggests Simmonds. "Find out who they are doing business with."

Prudent shopping means comparing brokers as well as carriers. "The broker you choose can make a big difference," says Priz. "Some agents give the impression they can access the whole market and get quotes from all kinds of insurance companies, but that may be misleading. Often agents have contracts with only a handful of companies and can really only market to those. As a result, you might not get the best fit. So you need to talk with several different insurance agents to make sure you are thoroughly covering the available options."

There's one last weapon in the cost-cutting arsenal: insurance policies with high deductibles. Not all states allow such policies, however. And even in states that do, not all insurance carriers sell them. Again, shop around.

Join A Group

The cures for high workers' comp premiums vary by state. Be sure to check with your local chamber of commerce, which may already be involved in a lobbying program with your state legislature. If workers comp is a continuing irritant, the prudent employer can keep a lid on premiums by taking some of the rational steps outlined in this article.

Internal Programs For Reducing Premiums

Employers can institute workplace programs that help lower workers' compensation premiums. Here are some ideas from Ron Peters, a partner in the San Jose, Calif., office of labor and employment law firm Littler Mendelson.

Institute a safety program. Employers should take time to create safety programs that help keep accidents from happening.

Investigate claims.
A lot of employers just send to the doctor every worker who reports an injury. That can lead to a lot of abuse. Once a culture of abuse gets started it's difficult to stop. Investigate all claims to see if they are legitimate.

Process claims quickly.
Establish and communicate a policy that accidents must be reported immediately. It is hard to investigate a report that is two days old and late reports are often red flags for false claims.

Establish return-to-work plans.
The faster people get back to work the lower your expenses. Get guidance from the doctor on how an injured worker can be accommodated in the workplace. Very often the individual can perform light duties.

Get More Information

Need help understanding the fine points of workers' compensation insurance?

Try these sources:

  • Insurance Information Institute
    This organizaton offers a primer on workers' comp at www.iii.org/smallbusiness/intro/. Click on "Workers' Compensation."
  • Advanced Insurance Management
    How do you spot significant overcharges in your workers' comp bill? That question and others are answered at www.cutcomp.com/questions.htm.
  • Scottsimmonds.com
    Perhaps the most difficult task in workers' comp cost control is understanding your experience modification or "x-mod" worksheet. A helpful video is available at www.scottsimmonds.com/articles.html.
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