An employer question came in over the holidays that I thought needed to be addressed to lower the confusion on experience mod disputes.

James Moore

I have paraphrased/shortened the excellent question:

• One claim that we had three years ago involved one of our drivers. The company truck was struck by an automobile that crossed the centerline. The local police ticketed the other driver. The driver’s insurance reimbursed our company for the workers' comp payouts due to the accident.
• Our X-mod needs to be 1.0 or lower for our company to bid on contracts. We are at 1.02. The claims adjuster applied the reimbursement by the other driver’s insurance to the file and then closed it. The claims loss run shows the reduced numbers. Those reduced numbers seemed to not have made it to the rating bureau. Do we contact our agent, the rating bureau or where/whom?

Be courteous 

The department that handles experience mod disputes usually does not reside at the rating bureaus (WCIRB, NCCI, etc.). Yes, all workers' comp rating bureaus contain a dispute department that handles mod reviews. In this case, if you need a quick result, an unknown department can be the best place for your dispute.

Usually, the best place to start is inside your workers’ compensation carrier. The company will have many names, such as the statistical department, data reporting and others. They are good people to work with in most situations.

From what you have explained to me, the experience mod dispute made it to your workers' comp claims loss run. The results are not showing in your mod. The carrier’s data reporting department will be the quickest way to solve your problem.

Send an email with a copy of your claims loss run along with your experience mod dispute, or call/email me. Time is of the essence if you are bidding on projects and need your mod corrected.

Caveat: Each state has very specific rules on how subrogation refunds are applied to the experience mod. I am advising in general overall terms.

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.