Workers’ Compensation Claim Audit and Loss Control Services FAQs

WHAT IS THE PURPOSE OF WORKERS’ COMPENSATION CLAIM AUDIT AND LOSS CONTROL SERVICES?
The purpose of workers’ compensation claim audit and loss control services is to identify ways to obtain refunds for you and reduce the cost of future premiums for your workers’ comp insurance program.

WON’T WORKERS’ COMPENSATION CLAIM AUDIT SERVICE FEES BE AN UNNECESSARY EXPENSE IF I DON’T RECEIVE FAVORABLE RESULTS?
All services are contingency-based, so there are no fees unless we secure a refund for you.

WHAT ARE THE PHASES OF THE WORKERS’ COMPENSATION CLAIM AUDIT PROCESS?

  • Phase 1 involves authorization, preparation and documentation.
  • Phase 2 involves reviewing policy rating data.
  • Phase 3 involves applying for refunds and adjustments for future policy terms.
  • Phase 4 involves issuing refunds and corrected data for future policies with reduced premiums.

HOW MUCH TIME DOES IT TAKE TO COMPLETE THE AUTHORIZATION PAPERWORK?
Most clients take no more than 10 or 15 minutes to complete the paperwork.

WHAT IS THE AVERAGE LENGTH OF TIME FOR THE CLAIM AUDITING PROCESS TO BE COMPLETED?
The process is often completed in around 90 days.

WON’T A CLAIM AUDIT PUT MY COVERAGE AND INSURANCE CARRIER RELATIONSHIP AT RISK?
No. The process is risk-free. Your coverage will not be disrupted and there will be no detrimental effect to your rapport with your insurance carrier. You are entitled to a fair and accurate premium calculation.

WHAT IS THE EXPERIENCE MODIFICATION RATE AND WHAT IS ITS IMPACT ON PREMIUMS?
The Experience Modification Rate (EMR), sometimes called an “e-mod”, is a number used by insurance providers to gauge the past cost of injuries and future chances of risk. The lower the EMR of your business, the lower your workers’ compensation insurance premiums will be. Incomplete or incorrect claims data may result in you being given an EMR that is higher than it should be, costing you more than you should be paying for your workers’ compensation insurance program.

HOW IS MY EXPERIENCE MODIFICATION RATE CALCULATED?
Most states use the National Council on Compensation Insurance to collect the data on your business’s actual losses and compare it to the anticipated losses of a business in your industry take to calculate your EMR score. Areas of comparison include company size, unexpected large losses, loss frequency, and loss severity.

HOW CAN A SAFETY PROGRAM LOWER MY WORKERS’ COMPENSATION PREMIUMS?
By implementing a safety program in your workplace you can identify and prevent many workplace hazards that may cause accidents. Having a written program of safety standards and procedures complete with management involvement and hands-on employee training will lead to fewer accidents and fewer workers’ comp claims resulting in you paying lower premiums. Additionally, it will show your commitment to providing a safe work environment for current and future employees.

WHAT ARE THE BENEFITS OF A RETURN-TO-WORK PROGRAM FOR INJURED EMPLOYEES?
A return-to-work program is a helpful catalyst that enables a recovering employee to quickly return to the workplace on a light-duty or part-time basis. Tasks can be modified in accordance to their tolerance and medical provider’s recommendation. This allows the employee to make a smooth transition back to work performing tasks they’re physically capable of doing. As the employer, it not only enables you to demonstrate appreciation for your employee’s contribution, but also create direct cost-savings from less benefits paid out on the workers’ compensation claim.

WHAT STEPS SHOULD I TAKE IF AN EMPLOYEE GETS HURT ON THE JOB?

  1. Your first priority when your employee gets injured in the workplace is to seek immediate medical attention. It’s an important step to ensure your employee’s safety and to protect yourself from a possible lawsuit.
  2. Gather the facts about the injury from the injured employee and from witnesses. Take photographs or view video footage and keep a record in order to clarify any disputes.
  3. Provide the injured employee with a claim form so they may file a claim.
  4. Once you’ve been informed about the injury report it to the compensation insurance company and provide a copy to the employee.
  5. Stay on top of the claims administrator and consult an attorney if you have any difficulty holding the employee’s position for their return.

HOW CAN AN EMPLOYER REDUCE THE RISK OF MISHANDLED CLAIMS?

  • Be involved in the claims process and keep track of what is happening with the claim.
  • Periodically request a copy of your loss runs or claim history from your insurance company.
  • Set up a safety program or improve the one you have with the goal of eliminating workers’ comp claims
  • Contact Chernoff Diamond, an independent consultation firm, to perform a workers’ comp claim audit.

WHAT ARE RISK PROFESSIONALS LOOKING FOR WHEN CONDUCTING A WORKERS’ COMPENSATION CLAIM AUDIT?
Claims data is carefully examined by highly experienced Chernoff Diamond risk professionals to uncover anything that is incorrect — for example errors such as overpaid claims or incorrectly settled workers’ comp claims. Once corrected, adjustments are made to secure you refunds and lower your workers’ comp program’s insurance premiums.

I HAVE ADDITIONAL QUESTIONS; WHERE CAN I GET MORE INFORMATION?
For more information, visit our Workers’ Compensation Claim Audit Services page or contact one of our Risk Advisors today at: 411risk@chernoffdiamond.com.

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