New Jersey Register

September 11, 2013

A rule amendment proposed by the New Jersey Division of Workers' Compensation will increase the maximum weekly workers' compensation benefit rate 2.1% − to $843 from $826 − on January 1. Maximum workers' compensation benefit rates are adjusted each year based on the average weekly wage. New Jersey claimants receive a maximum of 70% of their weekly wage up to 75% of the statewide average weekly wage, to be adjusted annually, according to the statute. A public hearing on the proposed rules change is scheduled for September 25.

What does this all mean for New Jersey employers? Most likely, a lot more claims for a lot more money. The reason why I say this is based on experience. Somehow people who are making very high salaries never seem to stay out of work when they get injured on the job. It is the low salary people who tend to stay out of work for long periods of time. When employees receive 70% of their salary tax-free while out of work, they tend to stay out of work longer. All this translates into higher experience mods and higher premiums for the employer.

The quickest and easiest way to lower your workers compensation experience mods and premiums is through workers compensation premium recovery. We knock down your current and prior experience mods and obtain refunds on your premiums. Our fee is contingency-based so you ONLY pay us for results. It's a win-win.

August 20, 2013

The National Academy of Social Insurance

WASHINGTON, D.C. – After declining in the wake of the recession, workers’ compensation benefits paid to injured workers and costs borne by employers increased in 2011 as the U.S. economy continued to recover, according to a new report by the National Academy of Social Insurance (NASI).

Total benefits rose by 3.5 percent to $60.2 billion. The benefits include a 4.5 percent rise in medical care spending to $29.9 billion and a 2.6 percent rise in wage replacement benefits to $30.3 billion. Total costs to employers rose by 7.1 percent to $77.1 billion.

"Workers’ compensation often grows with the growth in employment and earnings,” said Marjorie Baldwin, chair of NASI’s Workers’ Compensation Data Panel and Professor of Economics in the W.P. Carey School of Business at Arizona State University. When benefits and costs are measured relative to total covered wages, then benefits remained unchanged, and costs to employers rose very modestly (to $1.27 per $100 of wages) after declining in the previous five years.

The new report shows changes in coverage, benefits, and employer costs for all 50 states and the District of Columbia. State-level changes in 2011 include:

• Coverage and wages increased in all 50 states and the District of Columbia.
• Total benefits paid to injured workers increased in 29 jurisdictions. However, benefits as a percent of total wages increased in only 17.
• Employers’ costs of workers’ compensation as a percent of total wages increased in 31 states, and remained unchanged in four.
• The share of benefits paid for medical care exceeded 50 percent in 33 states.

Workers’ compensation was the first social insurance program in the United States; 2011 marked the 100^th anniversary of the first state laws. NASI’s report, Workers’ Compensation: Benefits, Coverage, and Costs, 2011, is the 16^th in an annual series. “The NASI report is an essential tool for experts in the field,” said Eric Nordman, member of NASI’s data panel and Director of Research at the National Association of Insurance Commissioners. The report provides the only comprehensive data on workers’ compensation benefits, coverage and employer costs for the nation, the states, the District of Columbia and federal programs.

As the economy continues to bounce back, more employers are hiring. This means higher payrolls, more workers compensation claims, and ultimately higher workers compensation premiums. Apex Services offers the quickest and easiest way to lower workers comp costs by reviewing employers' current and prior years' policies, identifying errors and overcharges, and obtaining workers compensation refunds for employers nationwide. This is done on a contingency basis, which means this service does not cost a penny to employers unless they get a refund, credit, or reduced premium in hand.

Risk & Insurance

July 24, 2013

Managing workers' compensation claims imposes a constant test of personal judgment, team skills and support systems. But the conventional image of a person at the center of this function, the claims adjuster, portrays a rules-bound, beleaguered worker of marginal professional stature.

This role or image conflict seems ever more peculiar today as technology empowers claims adjusters to better predict, coordinate and affect claims results. The professional status of adjusters should be higher than it is.

I discussed the traits of a top claims worker with Wayne Salen, the leader of the claims document team of the Standards and Practices Committee of the Risk & Insurance Management Society. Salen is former director of risk management at Labor Finders International, Inc. The temporary staffing firm fields some 16,000 workers a day, for mostly average or above-average injury risk worksites. Salen has contracted with a range of claims vendors over the years.

Our phone call revealed demarcations between professional and less-than-professional claims environments. Claims executives behave in ways that can impact the environment, and their staff's careers.

One of those factors is measurement agility. It is remarkable how one's professional image can grow by adding nuance in analysis while making the summary clearer.Herein is a lesson for claims leaders.

Typically, TPAs when pitching business, talk about staffing targets, such as 100 open lost-time claims per adjuster. The TPA and the prospect implicitly agree that the ratio reliably compares claims organizations.

But this doesn't make sense, given the huge variances in technology capability and in how claims staffs use nurses, claims intake, and other resources. Some claims systems, Salen noted, are so proficient that "You can really pare the human element down with the system making decisions." When he evaluates a TPA, he focuses first on service design and postpones talking about the staffing ratio until the end.

In another over-used measurement practice, TPAs tend to accept from discount-driven medical provider networks "savings" reports. But medical savings and reduction in duration of disability are more closely related to the quality of the medical provider, not to discounts. These discount "savings" reports are bad analysis driving out good analysis.The claims leader who is reluctant to address quality of provider sends a signal about the professionalism of her or his enterprise.

Another factor is adjuster discretion. Salen took pains to praise the "empowerment" of the individual adjuster, who does not always have to get approvals from layers of supervisors to depart from guidelines. For instance, an experienced adjuster should be able to adjust a reserve as part of a strategy to work the claim to a desired end.

Attention to the customer is another factor. Employers want to learn about claims in an employer-focused way.

One of the big changes in the past five or 10 years, Salen said, is the ability of claims systems to automatically produce for an employer's operating units clear reports. A good summary delivered without lag time is invaluable, yet he noted that only a couple of TPAs and insurers produce these automatically, without having to be asked.

Each of the above factors characterize a claims organization's internal proficiency and its capacity to anticipate the external world. That's professionalism, viewed inside and out.

Workers compensation claims adjustors handle a tremendous amount of claims at a time. The number of claims handled by a single adjustor can exceed hundreds of claims at a given time. Like with any job, if you have too much on your plate, it's hard to be keep a good handle on things. Certainly many adjustors are having a hard time giving the proper attention to each individual claim file and as a result many claims are neglected, leading to significant overcharges to an employer's workers compensation policy. Apex Services reviews your current and prior workers compensation policies on a contingency basis to identify these errors and recover refunds for employers. Either we'll get you a refund from your insurance companies or you'll know that you haven't been overcharged. Apex Services workers compensation premium recovery service is a win-win!

July 11, 2013

New York Liquidation Bureau

New York Superintendent of Financial Services Benjamin M. Lawksy has been appointed ancillary receiver of Ullico Casualty Company, according to an order approved by The New York County Supreme Court.

The company, which was domiciled in Delaware, was seized by Delaware regulators in March and as it had a negative surplus of $52 million and accrued $380 million in liabilities against assets of roughly $327 million.

Employers who had been insured by Ullico at some point can safely assume that their claims were not handled in the best manner possible. The mishandling of claims by insurance carriers can lead to thousands of dollars in overcharges in workers compensation insurance costs. Even though Ullico may not be able to return workers comp premiums, subsequent insurance companies that you placed your policy with used Ullico's claim experience to determine your premiums. This claims experience can be reduced and you can obtain workers compensation refunds if you act now.

Business Insurance

April 15, 2013

Former New York Giants linebacker Marcus Buckley and a Gallagher Bassett Services Inc. workers compensation adjuster allegedly schemed to defraud the third-party administrator out of more than $1.5 million, an indictment states.

Mr. Buckley played with the Giants from 1993 to 2000, then played for the Atlanta Falcons for one season. During the time he played with the Giants, the team purchased workers comp insurance from Pennsylvania Manufacturers Association Insurance Group, according to the grand jury indictment filed April 10.

PMA contracted with Gallagher Bassett for third-party administration services, states the indictment filed in the U.S. District Court for the Eastern District of California in Sacramento.

The indictment charges Mr. Buckley and Kimberly Jones with wire fraud and Mr. Jones with money laundering.

It states that Mr. Buckley filed a workers comp claim in 2006 for cumulative stress injuries sustained in California.

But he allegedly requested reimbursements for fictitious medical expenses he didn't incur while a senior claims representative for Gallagher Bassett allegedly requested checks for Mr. Buckley even though she knew evidence was lacking that the medical services had been provided.

The adjuster also schemed to thwart the detection of fraud, the indictment alleges.

Workers compenstaion fraud cases are one of many instances where an employer's experience is wrongly reflected and thereby causes the employer to end up paying overcharges on their workers compensation insurance. When we review your workers comp policies, we are always mindful to look for fraudulent claims and have the insurance company correct them so your experience modification is reflected correctly. This is just one of the ways that workers compensation premium recovery offers to get you back refunds on your old policies and make sure that you have the best underwriting profile upon renewal.