Tag Archives: EMR

ALL POSTS, Managing Your MOD, Price Matters

when do i actually qualify for an experience modification rating?

Leave a comment

A. Premium Eligibility

1. Premium

a. Subject Premium

(Additional Rules: FL, TX)

A risk’s eligibility for this Plan is based on the amount of subject premium as defined in Rule 1-C-7. Refer to Rule 2-A-2 and the State Table of Subject Premium Eligibility Amounts to determine premium eligibility for a specific risk.

b. Not Subject to Experience Rating

According to the Statistical Plan, some premium elements are not subject to experience rating. Premium may be charged for these elements under the standard policy. This premium is not:

   •    Subject to increase or decrease by an experience rating modification factor •    Used to determine premium eligibility for experience rating as detailed in Rule 2-A-2 •    Used in the calculation of an experience rating modification, unless otherwise stated in this Plan or the Basic Manual

2. State Subject Premium Eligibility Amounts

(Exceptions: MA, TX)

(Additional Rules: OR)

A risk qualifies for experience rating when its subject premium, developed in its experience period, meets or exceeds the minimum eligibility amount shown in the State Table of Subject Premium Eligibility Amounts in Rule 2-A-2-c. Refer to Rule 2-E-1 to determine a risk’s experience period.

   a.    A risk qualifies for experience rating if its data within the most recent 24 months of the experience period develops a subject premium of at least the amount shown in Column A. b.    A risk may not qualify according to Rule 2-A-2-a. If it has more than the amount of experience referenced in Rule 2-A-2-a, then to qualify for experience rating the risk must develop an average annual subject premium of at least the amount shown in Column B. Refer to Rule 2-A-3 to determine average annual subject premium. c.    A risk’s rating effective date determines the applicable Column A and Column B subject premium eligibility amounts required to qualify for experience rating. Refer to Rule 2-B for rating effective date determination.   State Table of Subject Premium Eligibility Amounts State Rating Effective Date Column A ($) Column B ($) AK 7/1/22 and after 5,500 2,750 7/1/21–6/30/22 5,500 2,750 7/1/20–6/30/21 5,500 2,750 AL 9/1/22 and after 11,500 5,750 9/1/21–8/31/22 11,000 5,500 9/1/20–8/31/21 11,000 5,500 AR 1/1/22 and after 9,000 4,500 1/1/21–12/31/21 9,000 4,500 1/1/20–12/31/20 8,500 4,250 AZ 7/1/22 and after 7,000 3,500 7/1/21–6/30/22 7,000 3,500 7/1/20–6/30/21 6,500 3,250 CO 7/1/22 and after 10,000 5,000 7/1/21–6/30/22 9,500 4,750 7/1/20–6/30/21 9,000 4,500 CT 7/1/22 and after 12,500 6,250 7/1/21–6/30/22 12,000 6,000 7/1/20–6/30/21 11,500 5,750 DC 5/1/22 and after 8,500 4,250 5/1/21–4/30/22 8,000 4,000 5/1/20–4/30/21 8,000 4,000 FL 7/1/22 and after 12,000 6,000 7/1/21–6/30/22 11,500 5,750 7/1/19–6/30/21 11,000 5,500 GA 9/1/22 and after 12,000 6,000 9/1/21–8/31/22 11,500 5,750 9/1/20–8/31/21 11,000 5,500 HI 7/1/22 and after 6,000 3,000 7/1/21–6/30/22 6,000 3,000 7/1/20–6/30/21 5,500 2,750 IA 7/1/22 and after 9,000 4,500 7/1/21–6/30/22 8,500 4,250 7/1/20–6/30/21 8,500 4,250 ID 7/1/22 and after 7,000 3,500 7/1/21–6/30/22 7,000 3,500 7/1/20–6/30/21 7,000 3,500 IL 7/1/22 and after 12,000 6,000 7/1/21–6/30/22 11,500 5,750 7/1/20–6/30/21 11,000 5,500 IN 7/1/22 and after 6,000 3,000 7/1/21–6/30/22 5,500 2,750 7/1/20–6/30/21 5,500 2,750 KS 7/1/22 and after 9,000 4,500 7/1/21–6/30/22 8,500 4,250 7/1/20–6/30/21 8,500 4,250 KY 7/1/22 and after 12,000 6,000 7/1/21–6/30/22 11,500 5,750 4/1/20–6/30/21 11,000 5,500 LA 11/1/22 and after 11,000 5,500 11/1/21–10/31/22 11,000 5,500 11/1/20–10/31/21 10,500 5,250 MD 7/1/22 and after 11,500 5,750 7/1/21–6/30/22 11,500 5,750 7/1/20–6/30/21 11,000 5,500 ME 10/1/22 and after 11,000 5,500 10/1/21–9/30/22 10,500 5,250 10/1/20–9/30/21 10,000 5,000 MO 7/1/22 and after 8,500 4,250 7/1/21–6/30/22 8,000 4,000 7/1/20–6/30/21 7,500 3,750 MS 9/1/22 and after 10,000 5,000 9/1/21–8/31/22 10,000 5,000 9/1/20–8/31/21 9,500 4,750 MT 1/1/22 and after 10,000 5,000 1/1/21–12/31/21 10,000 5,000 1/1/20–12/31/20 10,000 5,000 NC 4/1/22 and after 12,000 6,000 4/1/21–3/31/22 11,500 5,750 4/1/19–3/31/21 11,000 5,500 NE 8/1/22 and after 7,000 3,500 8/1/21–7/31/22 7,000 3,500 8/1/20–7/31/21 7,000 3,500 NH 7/1/22 and after 13,500 6,750 7/1/21–6/30/22 13,000 6,500 7/1/20–6/30/21 12,500 6,250 NM 7/1/22 and after 10,500 5,250 7/1/21–6/30/22 10,000 5,000 7/1/20–6/30/21 9,500 4,750 NV 9/1/22 and after 7,000 3,500 9/1/21–8/31/22 7,000 3,500 9/1/20–8/31/21 6,500 3,250 OK 7/1/22 and after 11,500 5,750 7/1/21–6/30/22 11,000 5,500 7/1/20–6/30/21 10,500 5,250 OR 7/1/22 and after 6,000 3,000 7/1/21–6/30/22 6,000 3,000 7/1/20–6/30/21 5,500 2,750 RI 2/1/22 and after 11,500 5,750 2/1/21–1/31/22 11,000 5,500 2/1/20–1/31/21 11,000 5,500 SC 8/1/22 and after 10,500 5,250 10/1/21–7/31/22 10,000 5,000 10/1/20–9/30/21 10,000 5,000 SD 1/1/22 and after 9,000 4,500 1/1/21–12/31/21 8,500 4,250 1/1/20–12/31/20 8,500 4,250 TN 9/1/22 and after 10,500 5,250 9/1/21–8/31/22 10,500 5,250 9/1/20–8/31/21 10,000 5,000 UT 7/1/22 and after 8,500 4,250 7/1/21–6/30/22 8,000 4,000 7/1/20–6/30/21 8,000 4,000 VA 10/1/22 and after 8,000 4,000 10/1/21–9/30/22 8,000 4,000 10/1/20–9/30/21 7,500 3,750 VT 10/1/22 and after 9,500 4,750 10/1/21–9/30/22 9,000 4,500 10/1/20–9/30/21 9,000 4,500 WV 5/1/22 and after 10,500 5,250 5/1/21–4/30/22 10,500 5,250 5/1/20–4/30/21 9,500 4,750

3. Average Annual Subject Premium

Determine a risk’s average subject premium on an annual basis for experience rating eligibility purposes as follows:

Total Subject Premiumx12=Average Annual Subject Premium
Total Months of Experience in Experience Period
(excluding gaps in coverage)

When the average annual subject premium is determined, refer to Column B in Rule 2-A-2 for premium eligibility requirements. The reference to total months of experience in this calculation includes partial months.

ALL POSTS

What if the employee was high at the time of the injury?

Image Leave a comment

I had a client recently tell me that he’d heard if the employee was found to have drugs in his system, workers’ comp would deny the claim.

Like a lot of stories in the insurance world, this isn’t black and white, and will also vary by state.

In Maryland, Injuries caused solely by intoxication or the effects of drugs not prescribed by a physician are not compensable.  Now, injuries caused where the primary cause is intoxication or
the effects of drugs entitle Claimants only to medical benefits, unless the controlled dangerous substance was prescribed by a physician and the use was not excessive or abusive.

Imagine the difficulty in proving the level of intoxication, as well as the burden to show the drug intoxication was the sole cause of negligence.  It can and has been done, but is difficult to prove.

Md. Lab. & Empl. Code Ann. §§ 9-506(b), 9-506(c).  and Md.Lab & Empl. Code Ann. § 9-506(d).

ALL POSTS, Managing Your MOD

Loss Runs, How, When, and Why

Leave a comment

While nearly every business owner is familiar with their “loss runs” it’s surprising how many companies aren’t reviewing their claims data on a regular basis.  Loss runs are a snapshot of all your claims, open and closed, for a given period of time.

Listen to this scenario and ask yourself if this is how you operate.  60-90 days out of your insurance renewal your receptionist or office managers are fielding call after call from agents and brokers looking to quote your insurance.  Maybe you “shop” every year or maybe it’s been a few years now and reluctantly you decide it’s time to bid out your insurance.  The new agent comes in and before he can give you the pricing, he needs to get a hold of your loss runs.  The meeting is over and your current agent or carrier reluctantly release the information, knowing very well, you’re making the request for competing agents and brokers.  Maybe when you get your loss runs you notice a claim or two that surprises you, either by a larger payout than you expected or were aware of or perhaps one that’s still open that could be closed.  A quick phone call to your broker and things are fixed or at least you get a good explanation of what happened to make the claim spiral the way it did.

Regardless whether you changed carriers, brokers, or otherwise, this is how many business owners only experience with their loss history.

I’m sure we can all agree there’s a better way to handle this.  At the same time, what if your company isn’t large enough to have a full time risk manager or safety manager who can review the claims on regular basis.  Let’s suppose the burden of reviewing the insurance and claims history is on a CFO, office manager, or owner.  Take it a step further that whoever that individual is just doesn’t have time to review claims on a regular basis.

So what should you do?

  1. Have a policy and procedure in place to handle claims when and if they happen
  2. Make time to check your claims prior to your valuation date- not just when it comes time to market your insurance

These two simple steps can have an immediate and drastic impact on your market rates when you shop the insurance, as well as the price you’ll pay for years to come.

Next post we’ll review the dollar impact with some claims examples.

ALL POSTS, Managing Your MOD

New Experience MOD changes in effect for Maryland

2 Comments

Marylanders with effective dates of January and February are receiving their new experience MOD’s.  Have you seen a big jump or drop in your rating based on your history?

Share your results!

So far I’ve seen a mixed bag.  Some mod sheets have remained unchanged, others have seen a significant increase.  The biggest surprise I think for some is the retroactive date of the increased split point for all years, not just the most recent year on the MOD sheet.

What does that mean?

If the last year of data on your experience MOD was Jan. 1, 2009 to Jan 1, 2010 and you had three claims that year that were:

$6500

$12,000

$7,000

On your 2012 EMR, each of those claims the primary split point was set at $5,000.  Under the changes, the split point for all three of those claims is now $10,000.  This will have a significant impact on your EMR.

If it’s not making sense, give your agent a call.  If you’re still not clear, send an email or give me a call. Good luck!