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

WC Premiums and “Idle Time”

Leave a comment

Wages paid to employees not actively working is nothing new. So how are wages handled for WC premiums if the employees aren’t actually working? Despite what many of us might think, determining what payrolls to charge for is not entirely to the carriers or auditors. This is actually up to the regulatory bodies in each state. For example, the Pennsylvania Compensation Rating Bureau specifically addresses “Idle Time” in their workers’ compensation manual.

PENNSYLVANIA WORKERS COMPENSATION MANUAL SECTION 1 UNDERWRITING RULES EFFECTIVE DATE: APRIL 1, 2015 Page 24

Wages Paid for Idle Time a. The entire amount of wages paid for idle time shall be included as payroll. b. Wages paid for idle time due to the following causes shall be assigned in their entirety to the classification which applies to the work normally performed by the employee involved: 1. Suspension or delay of work on account of weather conditions. 2. Delays while waiting for materials. 3. Delays while waiting for another contractor to complete certain work. 4. Delays arising from breakdown of equipment. 5. “Stand-by” time where employees such as operators of cranes, hoists or other equipment are on the job but their active services are not required continuously. 6. Special union requirements or agreements between employer and employees calling for pay for idle time under specified circumstances. 7. Other cause of similar nature. c. Wages paid to key employees of construction, erection or stevedoring risks, such as superintendents, foremen or engineers, for periods during which no jobs are in progress, shall be assigned to the classification applicable to the work which each one normally performs. (Exception: Reference Strike Periods – Wages Paid.) d. The entire amount of wages paid for idle time to an employee engaged in work other than construction, erection or stevedoring must be assigned without division to the classification which normally applied to that employee.

OK, with that being said, what presumably wasn’t expected when this was written was what we’re seeing today with COVID-19 and the federal assistance that has come with it. Fast forward to today and your company has just received a PPP Loan- Congratulations, let’s hope we can keep our businesses alive until things get back to normal… One of the keys to the PPP loan is to use at least 75% of the loan for payroll, even if the employees aren’t actively working. Well regardless of what type of company you have or the rate for your WC, your most likely hoping to NOT pay WC premiums on wages made to employees not actually working… I don’t blame you. So you talk to your carrier, broker, or an auditor to get the answer. Depending where you are or when you asked you may not like what you hear.

As a result, regulatory bodies are working hard to find a solution for this new type of wage payment.

NCCI recognizes that the circumstances around COVID-19 were extraordinary and, as a result, submitted an expedited rule change (Item Filing B-1441) to address the question of payroll for employees who are being paid but are not working as it relates to the basis of premium. Upon approval, this rule change will be distinct from “idle time” under our current Basic Manual rules (Rule 2-F-1), and a corresponding code 0012 will be created for reporting these payments. These payments will not be used in the calculation of premium.

The details of the rule changes proposed in Item Filing B-1441 were submitted to state regulators in all NCCI states.

https://www.ncci.com/Articles/Pages/Insights-Coronavirus-FAQs.aspx

Let’s start with the good news. Most states in the US have already approved a new classification code for payroll to be allocated for employees not working as a result of COVID-19 but still getting paid.

Disclaimer: This is an ever changing situation. Information is recorded as accurately as possible at the time posted. The information will continue to change and we’ll do our best to update accordingly. For the most accurate information check with your state rating bureau or commission.

Payroll during COVID-19 Code 0012 is approved in the following states as of May 4, 2020.

Alabama

Arkansas

Arizona

Colorado

Connecticut

District of Columbia

Florida

Georgia

Iowa

Idaho

Illinois

Indiana

Kansas

Kentucky

Louisiana

Maryland

Maine

Missouri

Mississippi

Montana

Nebraska

New Hampshire

New Jersey

New Mexico

Nevada

Oklahoma

Ohio Employers are not required to report to BWC the wages paid to employees who are idle at home because of the COVID-19 pandemic. Ohio is not using code 0012.

Pennsylvania – Just approved the exclusion of wages per circular released 5/5/2020. PA doesn’t use the same classification system, code 0012 is not applicable. PCRB CIRCULAR NO. 1740

Rhode Island

South Carolina

South Dakota

Tennessee

Utah

Vermont

West Virginia

Wisconsin

To date (5/4/2020) the following states have not made an exception to the exclude wages paid for employees not working during COVID-19, or the exception just isn’t approved yet:

Alaska

California – The WCIRB is working to determine the scope of any emergency regulatory changes to be proposed to the California Insurance Commissioner. We anticipate completing this time sensitive effort within the next few weeks. Approval is in the works in California- https://www.wcirb.com/content/wcirb-july-1-2020-special-regulatory-filing

Delaware

Hawaii

Massachusetts

Michigan

Minnesota

New York

North Carolina- Pending Approval

Oregon

Texas

Virginia- Pending

Washington

Wyoming

Even if you find yourself in one of the states on the second list, it’s highly recommended you record any payroll made to employees not actively working- OR ANY other payroll abnormalities due to COVID-19. There may be options available come policy audit and it’s easier to have the breakouts done prior to the audit than trying to go back and recreate the records.

Many of the states have legislation pending, even if it’s not found on the commission or bureau site at this time. Track it so if it is approved, you don’t pay WC premiums where you shouldn’t have to!

ALL POSTS, Uncategorized

Insurance Coverage and COVID-19

We’ve added a video summary of the original post below.  The date of the video below is 04/16/20

At the time of this writing (03/22/20), there are 30,347 infected and over 388 fatalities due to COVID-19 in the US alone.  Businesses across the country are shuttering in the wake of unprecedented government-imposed restrictions and recommendations by the CDC, NIH and others for individuals to stay home in self quarantine.

Businesses are left wondering what options they have to stay afloat or at the very least replace some of the lost revenue.  One of the first places companies turn to is their commercial insurance policies.  The most common question we see is “Does my business income coverage apply to a shut down or income loss due to COVID-19?”.

To answer this question, we have to first take a closer look at business income coverage.  For the purpose of this writing, I am referring to the most common policy forms nationally.  Such forms are created by ISO (Insurance Services Offices, Inc.) and adopted by carriers and state insurance departments.  Business income coverage triggers as a result of direct physical loss or damage from a covered cause of loss.  What many policy holders may not realize is that business income coverage is a part of the commercial property policy (CP 00 99 04 or CP 00 10) are two examples. This means that coverage must be triggered or started by a covered direct physical loss on the property policy.  While many property policies are written with an “All-Risks” property insurance coverage form, the All-Risks policy covers losses arising from any loss except those specifically excluded.  The stance taken by many insurance carriers to date is that the presence of Coronavirus is not a direct physical loss or damage to property.  Under this interpretation of the virus, coverage does not apply under business income, civil authority, or contingent business income. (CP 00 30 and CP 00 32)  two common business income coverage forms.  The most thorough coverage interpretation on the grounds of a denial I have found thus far is from Zelle, LLP, a firm representing Lloyds of London against a lawsuit defending their denial of Coronavirus claim from Oceana Grills.  A link to the white paper can be found here.  The publication by Zelle, LLP, also goes into detail regarding the coverage or lack of triggering events from Civil Authority and the limitations of contingent business income.

Another excellent read on coverage concerns relevant to claims being filed today is from Strook & Strook &  Lavan, LLP, a team of  transactional, regulatory, and litigation lawyers.

Read their article here. 

To further exacerbate coverage concerns, there is an endorsement that is mandatory in many states where approved that specifically excludes coverage that is the “loss or damage caused by or resulting from any virus, bacterium, or other microorganism that induces or is capable of inducing physical distress, illness or disease.” (CP 01 40)

In response to the initial denials, the argument from policyholders and advocates on behalf of policyholders is contrary to the opinion expressed by Zelle, LLP that Coronavirus doesn’t cause direct property damage.  Coronavirus lives on surfaces for days at a time and as a result the contamination itself would be a direct physical loss and thereby should trigger the business income coverage.  Under this scenario, complications still arise for those policyholders with the endorsement (CP 01 40), exclusion for loss due to virus or bacteria.

While none of this seemingly gives comfort to business owners looking for answers it does give us the direction on what needs to be done next.  Filing a claim for damages or loss.  Unfortunately, discussions with your agent are likely to be unsatisfying as agents themselves don’t have the authority to make coverage determinations on behalf of the carriers.  Your agent may tell you the unfortunate news that they have yet to see a carrier accept coverage or make a claim payment, but you shouldn’t let that discourage you from actually filing a claim.  By filing a claim, you force the carrier’s hand to make the official determination of coverage.  With a coverage denial the carrier has to give you the policy provisions they determine provide the exclusion or coverage limitation giving them the authority for the denial.

Your state insurance administration has likely published a bulletin or notice advising of current actions regarding to coverage under COVID-19.

One such notice is below by the Maryland Insurance Administration

Link to MIA notice

FOR IMMEDIATE RELEASE:
3/18/2020		 FOR INFORMATION, CONTACT:
Craig Ey, 410-468-2488

Maryland Insurance Administration Advisory on Business Interruption Insurance
​BALTIMORE – The Maryland Insurance Administration is receiving a high volume of inquiries about Business Interruption insurance.

Business Interruption coverage is typically triggered under a commercial insurance policy when a covered risk / peril causes physical damage to the insured premises resulting in the need to shut down business operations.  For example, if a fire damages a business and the business cannot operate during repairs, business interruption coverage would be available subject to the terms and limits in the policy.

Most policies require a waiting period of 24 to 72 hours before coverage begins and coverage continues for the reasonable period of time to restore the property and reopen, subject to the coverage limit of liability.  Some commercial policies provide Business Interruption coverage when a business is shut down due to an Order by a civil authority.  However, the policy still typically requires a physical loss from a covered peril as the underlying cause of the business shut down to apply.

All insurance policies have exclusions of coverage for risks that are too great to be underwritten at an affordable price.  For example, commercial and personal property insurance policies typically contain specific exclusions for loss or damage caused by war, nuclear action and radiation.  The potential loss costs from such perils are so extreme that providing coverage would jeopardize the financial solvency of property insurers. Global pandemics like COVID-19 usually fall into this category. However, policies can be different. We recommend that businesses review their policies and reach out to their insurance professionals with any questions.

The Maryland Insurance Administration would like to reassure Maryland businesses that we are closely monitoring insurance issues related to COVID-19. Our core mission is making sure insurance companies treat customers fairly and follow the provisions in their policy and applicable state laws. We are monitoring relief activity efforts aimed at assisting individuals and businesses at the local, state and federal levels.  As information regarding relief programs becomes available, it will be posted on our website:  www.insurance.maryland.gov.

Although it’s not  the news you want, it is what you need on hand in the event things do change.  How or why can things change?  State insurance departments, state and federal officials, litigation, the courts, and others will all play a role in what happens in the weeks and months ahead.  While coverage may not exist today by the carrier’s interpretation, those interpretations may not hold up or simply be overruled by regulators or legislators.   Policy holders should be cautioned however that failure to file a claim in a timely fashion could further jeopardize coverage leading to additional complications in an already complex scenario.

Bottom line, file the claim now.  If you’re looking for immediate premium relief, you may also want to consider reducing the payrolls on your workers’ compensation and ratable exposures on your liability policy (likely paryoll or sales).   Many carriers have also adopted grace periods or are providing premium payment flexibility during the pandemic.  Some have even suspended cancellation notices for non-payment of premiums.  Reach out to your broker or carrier billing department to see what options may be available to you.

Jason Rilley is Vice President at The Jacobs Company, Inc. in Columbia, MD.  Jason is a licensed Insurance broker for over 18 years and holds several professional designations, Commercial Lines Coverage Specialist (CLCS),  Certified Professional Insurance Agent (CPIA), an  Professional Workers’ Compensation Adviser (PWCA). 

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, Audit, Managing Your MOD, Price Matters, Reading your MOD Worksheet

Uncovering Loss Cost Multipliers

Leave a comment

I’d written previously about knowing your carriers LCM and why that’s important to you.  If you don’t know what it is, start HERE. 

If you’re ready for step two, I’m sharing links to the various states LCM’s.  These aren’t always easy to find and some states deliberately don’t publish them.  In some instances, the link will go directly to a list, others will involve another step or two to complete the search.

Continue reading Uncovering Loss Cost Multipliers →

ALL POSTS, Managing Your MOD, Price Matters, Reading your MOD Worksheet, Uncategorized

Start the clock… 3, 5, or 7 days before lost wage payments?

Leave a comment

Check out this quick chart for answers on what the waiting period is in your state or province before lost wages kick in from workers’ compensation.

What is the retroactive period when an employee is able to recoup those first unpaid days?

How about who gets to direct care?

It varies by state.  The answers are here!

Continue reading Start the clock… 3, 5, or 7 days before lost wage payments? →

ALL POSTS, Audit, Managing Your MOD, Price Matters, Uncategorized

Audits and your Liability Policy

Leave a comment

A common topic of discussion is the workers’ comp audit.   Either through the horror stories of friends or self experience, you’ve heard the terrible tale of the large comp audit.   You’re now keenly tuned in to the payrolls and exposures on your work comp policy vowing never to let this happen to your organization again (or ever)!

Perhaps you’ve even transitioned to a “pay as you go” program to virtually eliminate the chance of an audit bill.

But… and there always seems to be a but.  What about your liability policy?  While you find yourself plugging the holes in one area, don’t forget the GL policy is often  an auditable policy like the WC.   Don’t make the mistake of assuming that since you’ve notified your carrier or broker of accurate payrolls for the workers’ compensation policy, those same updates translated to your liability policy!  You might be surprised to learn otherwise and we already know, that’s rarely a good thing.

Keep track of your liability policy exposures just as you do on the WC!

You can't manage what you don't understand.