All posts by Lisa Schorfheide

Other, Workers Compensation Insurance, Workers Compensation Premium Audits

Questions On The Guarantee Insurance Company Liquidation?

 Do you have questions on the Guarantee Insurance Company Liquidation?

On November 27, 2017, Guarantee Insurance Company ordered into liquidation by the Second Judicial Circuit Court in Leon County, Florida. The Florida Department of Financial Services is the court-appointed Receiver of the company. The Florida Receiver began working to transition claim files and claim data to the New York Workers Compensation Security Fund. As of January 03, 2018, the Ancillary Receivership Order has not yet been approved. This has caused a delay in the transition as well as processing of open and new claims.

Employers insured through GIC began receiving notifications from the New York Liquidation Bureau (NYLB) on specific claims.

They advised the delayed transition and employers would be responsible for providing WC benefits. However, payments made by the employer may get reimbursed if the claim is subject to the WCB rates and covered.

This focuses on those unequipped on deciding which claims to pay, how much to pay, and what documentation is enough to seek reimbursement. To assist folks struggling, contact New York Liquidation Bureau for instructions on employer responsibilities pending the transition.

By January 25, 2017, we learned that the Ancillary Receivership Order expects to become approved by a judge at a hearing. The recommendation is that employers handle existing and also new claims as follows:

  • New claims should be reported through the normal channels to get the claim on record.   If the employee is losing time from work the employer should seek medical documentation on the disability.  If the disability exceeds 7 days, we recommend employers pay at the smallest rate of $150.00. You should do this until the transition takes place or until the Workers Compensation Board establishes the appropriate rate.  Paying the least ensures payments made are timely to the injured worker but limits the risk of overpayment.
  • The injured worker already receiving compensation benefits will continue to get paid for a period of time on existing claims where benefits were being disbursed. It wasn’t specified who is making those payments, but it seems the employer doesn’t need to start disability payments on these claims.
  • It is possible some of these claims need investigations completed and a controversion filed (formal denial). To protect employers from potential fines/adverse consequences, it may be necessary to hire an independent adjuster to conduct a compensability investigation.  If the investigation warrants a controversion, clients may need to hire an attorney to assist with filing the forms with the Workers Compensation Board. Contact your claims advocate for help. We can suggest an independent adjusting firm and law firm. We will ensure only necessary work is getting done however, still assisting with the assignment. Reimbursement for expenses is not clear once the transition takes place.
  • Our contact @ (NYLB) indicated employers are not expected to pay medical bills. Moreover, if the order becomes signed by late January as expected, medical bills will be processed by an assigned claims administrator.

Still want more info? Feel free to contact us if you have further questions or concerns by CLICKING HERE.

Claims Management, Construction Practice Group Content, Workers Compensation Insurance, Workers Compensation Premium Audits

Why You Need Claims Management on OCIP Workers Compensation Claims

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CCIP or OCIP Workers Compensation claims can cost you a lot.

Contractor Controlled Insurance Program (CCIP) and Owner Controlled Insurance Program (OCIP) are insurance programs that are designed to “wrap up” most, if not all, all of the insurance needs for a project and generally include general liability insurance, workers compensation insurance, builder’s risk insurance and excess or umbrella insurance coverage as well.  The owner or general contractor of the OCIP / CCIP purchases workers compensation for all enrolled contractors; relieving them the responsibility of purchasing and providing coverage on the sub contractors workers compensation policy.  The insurance company issues a “master” policy to the OCIP / CCIP owner. Each individual sub contractor is assigned an individual policy number. Think of it like a mother with children.  The “mother” has the master policy and all of the “children” or sub-contractors, have an individual policy number.

When claims arise, somebody sends the individual contractor’s policy a code. This allows the loss experience to follow the contractor, not the OCIP / CCIP owner. Claims occurring on an OCIP/CCIP project will impact your EMR the same way as claims occurring on non-OCIP work.  For this reason, you still need claims management on these claims.

For those who don’t understand the impact of the EMR:

Assigned to your company is an EMR stands for Experience Modification Rating. This tells the state, potential clients, and the insurance carriers how well you are managing your employee injuries. The higher the integer (factor) the worse your workers compensation claims and employee injuries are. Although the OCIP/CCIP provides the workers compensation coverage, these claim statistics follow your individual company irrespective of who actually pays for the loss. Further, the EMR facotr predicates your credits or surcharges on your own workers compensation policy. This EMR factor increases or reduces your insurance costs. 

OCIP owner’s insurance company or third-party administrator manages workers’ compensation claims arising out of an OCIP project.

The claim handler gives primary consideration to the OCIP owner and ignores the fact that the individual contractor is also an insured.  For this reason we strongly recommend contractors continue to apply their own internal BEST PRACTICE reporting procedures so they can track and maintain their own records internally as these employee injury claims will still impact your organization.   Best practice claims procedures were designed to ensure critical information is gathered early on and documented which allows the claims to settle faster and a much lower payout. The longer the delay in reporting the claim, the higher the payout. The payout can increase as high as 40% or more.   

By managing claims in a similar way we encourage them to be, this will lessen the financial impact on both the employee and the business. We encourage you to have a point person within your organization who is tasked with closing out every open claim if you are not doing so already.

 
An action plan should associate with each employee injury claim to be complete. Insurance marketplaces frown upon open claims when you bring your account out to market for price quotes. Further, they impact your EMR adversely as well.

Reporting, monitoring, and closing out all of your employee injury claims.

These are key takeaways respective of OCIP / CCIP programs your company may be enrolled in.

This is irrespective of who is actually writing the claims check. The worker’s comp claims report to the Wrap administrator and will follow your company in the form of the EMR. Your state’s workers’ compensation rating board or the NCCI (National Council of Compensation Insurance) gives you this.

This drives the ultimate cost of your worker’s compensation insurance premiums in the form of either surcharges or credits. If your EMR exceeds 1.2 you may not be eligible to bid on certain federal contracts which has an “opportunity cost.” Some General Contractors may set a maximum allowable EMR of 1.0.  No sub-contractor with above a 1.0 can bid on future work with that GC.

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You keep building, we will keep helping you manage your risk so you can win future work.

 

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Claims Management, HR Challenges, Workers Compensation Insurance

Late Reporting of Employee Injuries will Lead to NY Workers Comp Board Fines

At Metropolitan Risk, our best practice clients understand the critical importance of getting employee injuries into the workers compensation system. Each injury that goes undetected or unreported costs the employer up to 39% more for the same exact injury if unreported for more than 4 weeks. This is why Day of Injury protocol can be such a powerful tool if your goal is to lower the high cost of employee injuries.  Recently timeliness has become even more imperative as failure to comply with timely injury reporting not only drives your workers compensation costs up, it will now be a fineable offense through the eyes of the NY State Workers Compensation Board.

From Then to Now

In June of 2013, the eClaims for First Report of Injury (eFROI) was initiated which required all New York State Insurance Fund policyholders to report electronically all “First Report of Injuries” In addition, an expectation that all carriers not just the NYSIF will move to this electronic reporting platform. This eFROI mandate was went into effect on April 23rd, 2014. As a part of this mandate, effective May 23rd, 2014, all employers are required to use Form C-2F, which replaced Form C-2.

As of October 1st, 2015, the Board announced strict enforcement of  timely reporting ; assessing all available statutory penalties to EMPLOYERS for non-compliance in reporting claims.Fines range from $1,000 to $2,500 for late reporting of workplace injuries.  

What Should You Do About This?

Minor Incidents (Internal Incidents Only):

For all incidents that have resulted in a minor injury that only requires first aide of 2 or less treatments and/or lost time of not more than one day beyond the day or shift when the injury had taken place, you MUST complete Form C2-F which is a formal notice of incident. This form does NOT get submitted to the carrier or the NY State Workers Compensation Board. It must be kept in an internal file for no less than 18 years, love that, UGH! If you are a client of Metropolitan Risk it should be attached to the incident record in our portal for safe keeping, please retain your own copy for your internal records. This should be submitted to Metropolitan Risk within 24 hours of the incident.

Filing A Formal Claim:

If your employee has been injured, reported the incident to someone on your staff AND it DOES NOT fit the criteria of a MINOR INCIDENT (see above) you must complete and file a C2-F and submit to your workers compensation carrier of record. Please supply Metropolitan Risk a copy so we don’t keep pinging reminders at you that it needs to be done.

Please note if you are insured with the New York State Insurance Fund you must report the claim electronically by clicking HERE as they do not accept paper forms.

If you neglect to report the CLAIM via the C2-F Form or the NYSIF’s (eFROI)  within 10 days, the New York State Workers Compensation Board may be sending unwitting employers penalties for late reports per the aforementioned change of policy on October 1st , 2015.

New York State has secure procedures in place that allows them to track just how timely you are reporting claims. They have the power to issue a $1,000 fine or a $2,500 penalty directly to your company which maybe the policyholder of record if you neglect to report the claims within 10 days.  We are curious as to how this will be enforced as quite often the employers are not the first to know of a worker’s injury. Thus we recommend that a notice be placed inside each worker’s pay slip advising them that all workplace injuries MUST be reported within 10 days of the injury to be considered and leave it at that. Just to reinforce it. We are not certain how the State will rule when an employee reports an injury. We have inquiries into the State and will issue an advisory to clear some of these ambiguities up.

So, what should you do about all of this? Best practice firms in any industry will make sure to report all incidents to us within 24 hours. We will then guide you when we think it should be reported up to the carrier so as not to trigger a potential fine and reserve your rights as a policyholder.  As of October 1st, 2015 it’s not only a requirement of your workers’ compensation policy, but also the law in New York State.

Coming Soon: The Easiest Way to Report Claims:

We expect to have our mobile app deployed soon, which lets all stakeholders know an employee was potentially injured so our team and yours can jump on the incident. It will also guide you to the nearest medical center. You may even have an account right within the app.

We are also changing our incident reporting procedures for all client HR point people at the client level. You will be reporting the incidents directly into our website which is built to match the C2-F. Once complete you hit a button, the C2-F form will print for your 18 year record. Should we have to report this incident to the carrier we have all the info in our system and can report for you directly so you will be in compliance.

As of this writing we are still building the back end of the system. Until this is deployed, you will be responsible for reporting to the carrier directly as only you have the payroll records, etc.

We hope you find this notice helpful as we are continually working to make your lives more efficient. Any suggestions or recommendations are always welcomed. Thank in you in advance for your cooperation with these new changes in the rules and regulations with respect to NY Workers Compensation Insurance. Just want to be sure all our clients are up to date with the latest and greatest.

To download the C2-F Form directly, click here.

 

Kind regards,

Lisa Schorfheide

(914) 357-8444

lisas@metropolitanrisk.com

Claims Advocacy Supervisor &

Your Metropolitan Risk Claims Advocacy Team