Employers Think Insurance Boards Funding Fairness Report is Unfair

 

The Ontario Workplace Safety and Insurance Board’s recently released review of the province’s workers compensation system has raised several questions and indicated challenges still lie ahead, according to the Ontario Trucking Association.
 
The nearly-200-page “Funding Fairness” report, conducted by law professor, Dr. Harry Arthurs, was designed to give direction to the WSIB for the next 15-20 years and restore the system to financial health. But the report looks only at funding issues, not expenditures – a concern the Ontario Trucking Association and other employer groups raised during the consultations with Dr. Arthurs last year. The report did contain a chapter on the subject; however, due to the mandate, no recommendations were given.(WCx)
 
 
In response to the report, and issues related to unfunded liability, Ontario Minister of Labour Linda Jeffrey announced the provincial government would introduce a new regulation under the Workplace Safety and Insurance Act to require the WSIB's insurance fund to reach sufficiency of 60% funding in 2017, 80% funding in 2022 and 100% funding by 2027.
 
 
However, the OTA notes: “What she didn’t say, but which is implicit in the report, is the way the WSIB is going to reach these targets is by increasing premiums, which are paid solely by employers.”
 
One of Dr. Arthur’s recommendations is that WSIB premiums should be based on actual costs, not whether rates are affordable. He says there should be no government interference with rate setting unless the province is experiencing a severe economic crisis. He also recommends each rate group should pay the full current and future costs of new claims, which the WSIB must accurately price.
 
It goes on to say that the current rate groups should be replaced with sectorial groups. This would take place over the next several years with appropriate transitional measures to avoid sudden premium rate increases, according to the report.
 
Additionally, the report raises questions over the future of experience rating programs. Dr. Arthurs’ recommends, for example, that experience rating should be maintained only if the board declares the purpose is injury reduction and return to work; it achieves these purposes; and is resourced to prevent abuses. He calls for a time-limited experience-rating experiment to be conducted in one industry.
 
Other recommendations include the reestablishment of medical/scientific panel to identify occupational disease and the full indexing of all benefits.
 
It will be imperative that meaningful consultation with employers takes place,” says OTA president David Bradley. “If the WSIB administration has already made up its mind what it is going to implement from the Arthurs report and how it is going to do it, then the process will be doomed to failure. These are enormously important issues. Employers want a better system too, but we cannot afford to sign a blank check.
 
Gutting experience rating programs is not the answer,” Bradley continued. “We’ve got to make sure that all employers are paying their fair share and I don’t see how anyone can talk about the future sustainability of the WSIB without dealing with the expenditure side of things.”(WCx)
 
 
The release of the report has prompted OTA to form a WSIB issues committee to help guide the association’s analysis and positioning on these issues over the next couple of years. 

 

 

Author Michael B. Stack, CPA, Director of Operations, Amaxx Risk Solutions, Inc. is an expert in employer communication systems and part of the Amaxx team helping companies reduce their workers compensation costs by 20% to 50%. He is a writer, speaker, and website publisher.  www.reduceyourworkerscomp.com Contact mstack@reduceyourworkerscomp.com

  
WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com
MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

PA Man and Wife Allegedly Cook up Kickback Scheme

A Commonwealth of Pennsylvania employee was arrested recently by agents from the Attorney General's Public Corruption Unit and charged with soliciting and receiving bribes in exchange for favorable treatment of businesses insured through the State Workmans Insurance Fund (SWIF).

 
 
Attorney General Linda Kelly identified the defendant as James McDonnell, 53, of Scranton, Lackawanna County. McDonnell is an auditing supervisor with SWIF, which is a division of the Department of Labor and Industry. Kelly noted that McDonnell's wife, Michelle McDonnell, 44, of the same address, was also arrested and charged with criminal conspiracy. [WCx]
 
 
According to the criminal complaint, between 1999 and 2011 James McDonnell and his wife received more than $80,000 through a scheme where he solicited and promised Pennsylvania business owners, who were insured through the SWIF program, that he could reduce their insurance premiums in exchange for kickback payments.
 
 
Kelly said that all businesses in Pennsylvania are required to carry workers comp insurance, which can be purchased through any private insurance company or can be obtained through the SWIF program.
 
 
The charges state that there were at least 15 instances where James McDonnell released refunds to businesses without documentation to support the transactions.
 
 
Kelly said that the bribes James McDonnell allegedly solicited were either paid directly to him in cash or by the solicited businesses putting his wife, Michelle McDonnell, on the company payroll as a ghost employee.
 
 
James McDonnell is charged with five counts of bribery in official and political matters, three counts of conflict of interest – restricted activities, three counts of conflict of interest – statement of financial interest required to be filed, two counts of dealing in proceeds of unlawful activity, and two counts of criminal conspiracy. [WCx]
 
 
Michelle McDonnell is charged with two counts of criminal conspiracy.
 
 

Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.

 


WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

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CANADA Alberta 58 Percent of Employers to See No Change or Reduction in 2012 Premiums

Fifty-eight percent of Alberta (Canada) employers will see no change or a reduction on their 2012 WCB premiums, according to a report from Alberta’s WCB.
 
 
Good performance means that top employers and their workers have developed suitable strategies to help those injured on the job recover at work, in a more positive environment than alone at home.
 
 
On the flip side, WCB-Alberta’s poor performance program aims to galvanize 1,600 poor performing employers to take immediate action to improve return-to-work planning and injury prevention practices. The strategy is working.
 
 
In 2012, 592 employers joined the PPS program, while 710 employers have improved their performance significantly enough to leave the program behind.
 
 
We all share responsibility for getting better at managing workplace injuries,” said Guy Kerr, president and CEO of WCB-Alberta. “Modified work, investments in safety and prevention, safety associations, occupational injury clinics, and many more of our joint initiatives are making a difference.”
 
 
Key 2011/2012 Trends
 
The number of workers with lost-time claims is expected to increase to approximately 27,400 (7.5 per cent) for this year and 3.7 per cent next year.
 
 
Average claim duration is expected to increase somewhat to 37.2 days in 2011 and 38 days in 2012.
 
 
Fully-funded claim costs are also on the rise as WCB forecasts year-end costs of $748.1 million, with another increase of 6.5 per cent expected for 2012.
 
 
Worker wage protection will also increase in 2012. WCB has raised the maximum insurable income (MIE) level to $86,700.
 
 
Alberta employers mitigated these inflationary trends through long-term investments in safety and return-to-work programs so that overall injury trends remained stable, leading to positive expectations for 2012. (WCxKit)
 
 
The lost-time claim rate should remain stable at 1.5 lost-time claims per 100 covered workers for the third year in a row.
 
 The disabling injury rate is expected to remain steady at 2.8 per 100 covered workers.

 

Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. He is an editor and contributor to Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: Info@ReduceYourWorkersComp.com.

 

 

WORKERS COMP MANAGEMENT MANUAL:  www.WCManual.com

VIEW SAMPLES PAGES

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

Out of State Insurance Coverage for Workers Compensation

As any employer with locations in more than one state knows, the workers compensation policy is written specifically for the states where the employer has physical facilities.  On the Information Page that comes with each new policy or policy renewal, is Item 3.A (for most insurance carriers) which designates the states where the workers compensation policy is applicable.  Workers compensation coverage does not apply to claims filed in other states.

 
While the insurance carriers attempt to limit the exposure to claims occurring where they may not have claims offices, or knowledge of the workers compensation statutes, the states take a much broader approach. The workers comp statutes of most states specify when and how the workers comp act applies out of state.  Normally, the state statute will indicate that if the contract to hire was negotiated within the state, the workers comp laws apply regardless where the injury occurs. (WCxKit)
 
 
Most state workers comp statutes will have extraterritorial provisions that state if the principal place of employment is within the jurisdictional boundaries, a workers comp injury occurring outside of the state boundaries is still covered by the state law.  The workers comp statutes also normally specify that any work related injury occurring within the borders is subject to the workers compensation statutes, even for employers and employees whose place of business is not within the state line boundaries.
 
 
When the employee is injured in another state where the employer does not normally do business, the extraterritorial provisions of the state workers comp act work great, as long as the employee elects to utilize the benefits of the home state workers compensation act.  The problems occur when the employee elects to file the claim in a state where the employer does not have a physical location and the employer does not have workers compensation coverage. 
 
 
The usual reason an employee files for benefits in a state other than the home state is the amount of temporary total disability (TTD) benefits that will be paid.  Consider the highly successful salesman from Georgia earning $1,500 per week.  If he is injured in Iowa with its high maximum weekly TTD rate, he will receive $1,000 per week while he is unable to work, if he elects Iowa for workers comp benefits.  If he elects Georgia benefits, the TTD rate is capped at $500 per week.
 
 
This creates a coverage issue for the employer.  When the workers comp policy is purchased, the employer should have the insurance agent or broker specify in Item 3.C of the Information Page the other states for which coverage is requested.  Some agents will approach this by listing every state and territory except North Dakota, Ohio, Washington, Wyoming, Puerto Rico and the US Virgin Islands (the four monopolistic states and two monopolistic territories where the state/territorial governments provide the workers comp coverage). This can result in an accidental oversight where the agent leaves out a state. 
 
 
A better approach is to insert the following on the Information Page in Item 3.C: “All states and US territories except North Dakota, Ohio, Washington, Wyoming, Puerto Rico and the U.S. Virgin Islands and those states listed in Item 3.A of the Information Page.” While this is the best approach to out of state coverage, some insurers, especially single state insurers or small regional insurers, will object to providing workers comp coverage in other states where they are not licensed to do business.
 
 
Most employers think of the workers compensation policy and the workers compensation coverage as one and the same.  Actually, the workers comp policy is divided into several sections with Part 1 being the actual workers comp coverage.  Part 2 is employer’s liability insurance which covers injuries to employees when workers comp coverage does not apply. Part 3 is Other States Insurance.  With this coverage, workers compensation and employers liability insurance is provided for incidental exposure in states not listed in Item 3.A of the Information Page.
 
 
It should be noted that Other States Insurance covers only incidental exposures.  When the employer starts to have employees in a state on a regular basis, the states needs to be included in those listed in Item 3.A of the Information Page. If your business has employees who occasionally travel out of state, it is a good idea to routinely review your coverage with your insurance agent to confirm that your policy provides for incidental out of state exposures.
 
 
Author Rebecca Shafer, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality, and manufacturing. She is the author of the #1 selling book on cost containment, Workers Compensation Management Program: Reduce Costs 20% to 50%. Contact: RShafer@ReduceYourWorkersComp.com.
 
 
NEW 2012 WORKERS COMP MANAGEMENT GUIDEBOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2012 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact us at: Info@ReduceYourWorkersComp.com.

WorkSafeBC Reports Flat Average Rate for 2012

WorkSafeBC recently announced that the average base premium rate for registered employers in British Columbia remains unchanged from 2011.
 
 
According to a report from the WBC, the 2012 average published base rate will be $1.54 per $100 of employers assessable payroll. WorkSafeBCs average published base rate for 2008 through 2010 was $1.56. The rates continue to be among the lowest in Canada and the lowest rates in B.C. for the last 30 years. (WCxKit)
 
 
The average published base rate is a composite of rates in 67 individual rate groups, or insurance pools, which are compilations of various classification units. Insurance premium rates for B.C.’s 206,000 employers are based on the claims cost (or safety) history of their industry and of similar employers, and are further adjusted based on individual performance.
 
 
For 2012, 53 percent of employers will experience a base rate decrease and eight percent of employers will have their base rate remain unchanged, while 39 percent of employers will experience a base rate increase.
 
 
WorkSafeBC projects a deficit at the end of 2011 and modest increases to the average base rate starting in 2013.
 
 
Premium rates charged to employers must be sufficient to cover the current and future needs of B.C.’s injured workers, some of whom will require financial and medical aid for the rest of their lives. To support financial requirements and maintain low and stable rates, WorkSafeBC invests a portion of the funds collected from employers.
 
 
Rate decreases are projected for the following industries: municipalities, public schools, fishing, ranching, log hauling, real estate, steep- and low-slope roofing, retail art galleries, movie theatres, bingo halls, telephone and cable services, ferry services, heavy equipment manufacturing, general retail, private schools, greenhouses, wineries, couriers, auto servicing, dentists, optometrists, most health care services, orchards and berry farming, coffee shops, wood mills, libraries, garbage removal services, recycling depots, public art galleries, and construction management consulting.
 
 
Most accommodation services, finishing carpentry, supermarkets, butcher shops, colleges, law and notary public offices, travel agencies, insurance, accounting, business and computer consulting services, restaurants, taxis, and general trucking will see their rates remain virtually unchanged or will incur modest rate changes. (WCxKit)
 
 
Industries whose rates are projected to increase include: movie and television production and post-production; television or radio broadcasting; ski hills; retail bakeries; animal boarding; airports; flooring stores; farm labour supply services; dump truck operations; campgrounds; liquor stores; residential framing; most waterfront operations; sawmills; construction labour supply; log-home construction; helicopter services; log towing; house construction; unions; residential tree services; casinos; manual tree falling; and grain, hay, white-mushroom, and vegetable farming.
  
 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.

Our WORKERS COMP BOOK:  www.WCManual.com
 
WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact

California Insurance Fraudster Gets 3 Years for Failure to Pay Restitution

A judge sentenced a Rancho Palos Verdes, Calif., woman to three years in state prison for refusing to pay $75,000 in restitution on a 2007 insurance fraud and grand theft conviction stemming from a phony accident claim.
 
 
According to the Los Angeles County District Attorney’s office, Sheila Burke was remanded to prison by Superior Court Judge Judith Champagne after roughly 20 probation violation hearings dating back to Aug. 26, 2007, when she was sentenced to one year in county jail and 5 years of probation and ordered to pay restitution to APM Terminals.(WCxKit)
 
 
But Burke refused to comply with the restitution order, despite owning several properties and still being employed. A Rancho Palos Verdes property she owns was valued at $218,000, according to Deputy District Attorney Anthony Colannino who prosecuted the case.
 
 
At a recent hearing, Judge Champagne provided Burke with a final opportunity to show progress toward paying the restitution, said Colannino of the District Attorney’s Healthcare Fraud Division.
 
 
But during another hearing, Judge Champagne found Burke had refused to make any meaningful attempt to pay restitution and did not comply with orders to produce documentation about her assets.
 
 
In 2007, a jury found Burke guilty on two counts of insurance fraud and one count of grand theft stemming from insurance claims she filed. Burke claimed that in November 2006, while a long shore worker, she was injured in a collision involving her pickup truck and a tractor-trailer.(WCxKit)
 
 
Since her conviction the only meaningful income obtained toward paying the restitution was roughly $17,000 in California income tax refunds that were impounded by the state.
 
 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.


Our WORK COMP Book: www.WCMANUAL.com

 
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

Five Signals Your TPA is Doing a Great Job

pic7In the world of insurance, it is hard to tell if your carrier or third-party administrator (TPA) is doing a good job if you do not interact with them often. Of course, the goal is to have as little interaction with them as possible — if you do not have to file any claims that is a good thing.

 

 

But, accidents will eventually happen. Property damage happens. Workers get injured. Customers get injured. So how can you tell if your carrier or TPA is doing a great job and looking out for your bottom line?  (WCxKit)

 

 

5 Ways to Tell Your TPA Is Looking Out for Your Bottom Line:

  1. Ask your injured workers when they return to work how their interaction went.

Your injured worker should have had plenty of interaction with their adjuster during the course of the file. The amount of interaction depends on the severity of the injury, but they should at least be able to name their adjuster and give some feedback on how the claim went.

 

 

If your injured employee’s claim was denied, you may not get a truthful answer. But, for a normal, routine claim that was accepted and uncomplicated, the worker’s responses should be a good indicator of how their claims process went.

 

 

A sample of questions you might ask a recently returned worker:

Was the adjuster helpful?

Did he or she explain you worker’s rights as defined by the Comp Act?

Did he or she explain your medical condition to you?

Did the adjuster return phone calls promptly?

Did the adjuster listen to your questions and answer them to your satisfaction?

 

 

Any negative responses to these questions is usually a good indicator of how your carrier is doing while handling your claims. A lot of negative responses from your workers could indicate it is time to explore using another carrier or TPA.

 

 

  1. Ask your agent what they hear about your carrier or TPA within the industry.

If you have a good-sized agency, or broker, that handles your insurance needs, it should be more than familiar with their clients’ companies. If you ask for an unedited opinion, chances are they will give it to you. Agents hear a lot about the pros and cons of certain carriers and TPAs from other clients. Issues an agent speaks of may or may not be of importance to you, but, the more information you have the better.

 

 

Ask your agent about these factors to learn about your carrier or TPA:

What is the carrier’s reputation with other agents?

What does your agent hear about the carrier or TPA’s litigation response; do they deny and fight every claim, or accept and pay out on every claim? (either is bad – there should be a balanced approach)

How are their reserving practices? Do they constantly bump or stair-step reserves? Do they inflate reserves in an effort to raise premiums?

How are their adjusters? Do they return calls and help agents with questions or are they impossible to reach?

How is the carrier’s local management? Are they knowledgeable and experienced?

Does your carrier/TPA write a lot of businesses like yours, similar in size?

Does this carrier/TPA only like to write very large national accounts or do they prefer lower-level, local markets?

How are your TPA’s underwriters? Are they usually accurate or do they have to do a lot of work when submitting a premium estimate?

 

 

All of these questions will give you a feeling about how your business fits in with the other businesses your carrier/TPA writes for. A smaller company that uses a carrier/TPA that prefers large national accounts may find their business needs are not tended to when you need them.

 

 

  1. Ask for a meeting with your carrier/TPA management and the team of adjusters assigned to your account.

The best option is a team handling your account within your immediate community. If it is a major road trip to meet with your insurance team, question if they are the right fit for you; if it’s a flight, question it even further. Some businesses want that local presence so they can physically meet with them when issues arise. Some businesses do not really care about the location, as long as their needs are met immediately. It is your choice. Consider TPAs that will provide a dedicated unit ON SITE at your location if you wish; yes, there is a price for such a high level of service, but the overall value may have an excellent ROI. Short-sighted companies concerned only with today’s price rather than total price might want to reconsider the price-first approach.

 

 

Every Carrier/TPA knows who would be handling your claims if any were to happen, so meet with this person. Get to know him or her and find out about their industry experience. Find out if you mesh with them or not. If you get a good vibe, then there should not be a lot to worry about. But, if you walk away feeling less than confident, you already know you should start shopping around before it is too late. Check their “grades” — the best TPAs score their adjusters.

 

 

  1. Ask for your business peers thoughts.

This will not apply to everyone, but typically if you are a niche business and know your competition, ask your peers about their experiences. Ask how their claims were handled and if they were satisfied. All business competition aside, most managers run into the same people from their competition at certain events, trade shows, etc. If you are amicable with any of them, it will not hurt to ask. It is almost like a test drive. If your competitors had bad experiences with certain carriers/TPAs, chances are you would as well. This can save a when it is your turn to file a claim with your Carrier/TPA.

 

 

  1. Do your research.

Most Carriers/TPAs will have websites that show their capabilities, office locations, new technology, agent relationships, etc. Do some searching around to see who you like.

 

 

Some things to look for include:

Who has cutting-edge technology for claim handling?

Who has invested time and effort into research and hiring practices to ensure they have the best of the best in staffing adjusters and counsel?

Who has local offices in your area?

Which agents are partnered up with your carriers/TPAs of choice?

Is your carrier/TPA involved in local charities and in giving back to their community?

 

 

Not all of these items may play a factor in learning if you have the right carrier/TPA for your business needs, but it cannot hurt to find out the answer to some of these questions. (WCxKit)

 

 

The goal is to not ever have to file an insurance claim. But, as we all know, that is unlikely. You will have to cross paths with your carrier/TPA at some point. Making sure you have the right one who will take care of your needs when you need it the most is worth the effort. Ask around; do your research, and take time to meet with your prospective team of insurance professionals. This will help you know you made the right choice, and not a choice you will regret when you need help or have questions about your insurance needs.

Author Rebecca Shafer

, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. Rebecca is the author of Manage Your Workers Compensation Program. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.

 

Our WC Book: www.WCManual.com

WORK COMP CALCULATOR: http://www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  http://www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP: http://www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE: Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

 

Tennessee Workers Compensation Law Summary

In Tennessee, every employer who has five or more full or part time employees, is required to carry workers compensation insurance. Employers in the construction or coal mining industry must provide workers compensation coverage if they have any employees. Corporate officers may decline workers compensation insurance. But they are included in the count of employees. Family members working in the business are also included in the count of employees. State and local governments are exempt from the workers compensation law, as are employers of farm laborers and domestic help. But all can elect to purchase workers comp coverage.

 

Obtaining Coverage

To obtain workers compensation coverage in Tennessee, the employer has 4 options

  1. 1.purchasing a workers compensation insurance policy from an insurance company licensed to do business in Tennessee
  2. self-insurance for the employer who has sufficient assets to self insure
  3. purchasing insurance from the state owned Tennessee Workers Compensation Insurance Plan
  4. setting up a self-insurance trust (WCxKit)

 

 

Claim Reporting

The employee must report the injury to the employer within 30 days in writing. when the employee receives medical care outside of the employer’s premise. If the employer does not have actual notice, the employer must report the injury to the Tennessee Department of Labor within 14 days

 

 

Medical Benefits

The employer must provide the employee a panel of three physicians. From this panel, the employee will choose a medical provider. If it is a back injury, the panel must include a chiropractor. However, chiropractic visits are limited to a maximum of 12 visits under the workers comp law.  If specialized treatment is needed, the selected medical provider will make a referral. At this time, the insurer or employer is required to form another panel of three physicians that offer the specialized medical care needed.

 

 

There are neither time nor monetary limitations on medical care. The medical care will continue as long as the authorized panel physician deems it necessary. Mileage to and from medical treatment facilities is reimbursed only if exceeding 15 miles. The mileage rate is set by the state.

 

 

Temporary Total Disability Benefits

The temporary total disability (TTD) benefits are calculated as two-thirds of the employee’s average weekly wage earned over the 52 weeks prior to the injury. The TTD weekly maximum and minimum is adjusted each year on July 1st. The weekly maximum is capped at $867.90 for injuries occurring from July 1, 2011 to June 30, 2012. The weekly minimum TTD amount is $118.35. TTD benefits are paid every two weeks and can be for a maximum of 400 weeks.

 

 

The first 7 days of disability (the waiting period) is not paid to the injured employee unless the employee is disabled for more than 14 days.

 

 

Temporary Partial Disability Benefits

In Tennessee, temporary disability (TPD) benefits are paid if an employee is able to return to any type of work but is earning less than prior to the injury or working fewer hours per week. The TPD benefits are paid at two-thirds of the difference between the pre-injury wage and the post-injury wage.

 

 

Permanent Partial Disability Benefits

Tennessee employees who incur a permanent partial disability (PPD) are entitled to two-thirds of their average weekly wage, not to exceed a maximum of $789 per week. The minimum for PPD is  equal to the minimum TTD benefit. For non-scheduled injuries, the maximum period of payments is 400 weeks. For scheduled injuries, the loss of a body part has a maximum of 200 weeks of benefits for a limb. The number of weeks declines based on the body part to only ten weeks of benefits for a toe other than the great toe.

 

 

Permanent Total Disability Benefits

Permanent total disability (PTD) benefits are set identically to PPD benefits. The exception is that if the worker is 100% disabled, the PTD benefits are payable to age 65 and may be offset by social security benefits. (WCxKit)

 

 

Death Benefits

Burial expenses in Tennessee are covered for a work-related death up to $7,500. The death benefits for a surviving spouse and dependents follow the same guidelines as TTD benefits. They are two-thirds of the average weekly wage up to a maximum of 400 weeks. If the spouse remarries, the spouse loses the benefit. But the children continue to receive the death benefit. until they are 18 years old, or 22 years old if enrolled in an accredited educational institution. When the deceased employee does not have any dependents, $20,000 is paid to his or her estate.


Author Rebecca Shafer
, JD, President of Amaxx Risk Solutions, Inc. is a national expert in the field of workers compensation. She is a writer, speaker, and website publisher. Her expertise is working with employers to reduce workers compensation costs, and her clients include airlines, healthcare, printing, publishing, pharmaceuticals, retail, hospitality, and manufacturing. See www.LowerWC.com for more information. Contact: RShafer@ReduceYourWorkersComp.com.


Our WORKERS COMP BOOK: 
www.WCManual.com

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php

MODIFIED DUTY CALCULATOR:  www.LowerWC.com/transitional-duty-cost-calculator.php

WC GROUP:   www.linkedin.com/groups?homeNewMember=&gid=1922050/

SUBSCRIBE:  Workers Comp Resource Center Newsletter

 

Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.

 

©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

 

Oklahoma Insurance Commissioner Notes NCCI Decrease Cost Request

 

Oklahoma Insurance Commissioner John Doak, recently reported the company, which manages the nation’s largest database of workers compensation insurance information, has filed a request with the Oklahoma Insurance Department to decrease the cost of workers comp insurance in Oklahoma.
 
 
According to Doak, the National Council on Compensation Insurance Inc. (NCCI) filed to reduce workers compensation insurance rates in Oklahoma by 1.7 percent starting Jan. 1, 2012. The Commissioner said NCCI attributed the rate drop to this year’s passage of Oklahoma Senate Bill 878. Before the passage of SB 878, rates were expected to increase again. (WCxKit)
 
 
Reforming Oklahoma workers comp law was high on Governor Mary Fallin’s agenda, and SB 878 received overwhelming support from both parties in the Legislature.

Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.


Our WORKERS COMP BOOK:
www.WCManual.com

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

New Employer Premium Assistance Initiative Proposed by Ohio BWC

The Ohio Bureau of Workers Compensation has proposed an economic development initiative that could discount a new Ohio employer’s premium by as much as 51 percent.  If approved by the BWC Board of Directors, Grow Ohio would offer eligible employers a 25 percent discount on their workers compensation premiums for two years. Or they give them immediate access to participation in the Group Experience Rating Program.

Employers have many factors to consider when choosing a location, and the costs of conducting business, including workers compensation, are high on that list,” said BWC Administrator/CEO Stephen Buehrer. “By lowering the initial premium of new businesses, Grow Ohio is freeing up more money for those companies to invest in job growth and help restore prosperity to Ohio.” (WCxKit)
 
 
Under Grow Ohio, new employers will receive the 25 percent discount on their workers comp premiums, unless they elect to participate in another program incompatible with the Grow Ohio discount. The discount will be applied for the effective new employer’s coverage date and the four subsequent six-month payroll periods.

 
If new employers prefer, they may instead elect to immediately participate in the Group Experience Rating Program. This program normally is inaccessible to new employers until they have had workers comp coverage for a full year. Employers have 30 days to pursue the Group Rating option, or the 25 percent Grow Ohio discount will be automatically applied.    

 
Participation in group rating could reduce their premiums up to the maximum allowable amount, Currently that amount is 51 percent for the July 1, 2011 policy year. (WCxKit)

 
If approved by the board on Sept. 29, the incentives will apply to new Ohio business entities or out-of-state businesses and report payroll in Ohio on or after July 1, 2011. Those incentives will be reflected on bills employers pay beginning in February 2012.

 
Author Robert Elliott, executive vice president, Amaxx Risk Solutions, Inc. has worked successfully for 20 years with many industries to reduce Workers Compensation costs, including airlines, healthcare, printing/publishing, pharmaceuticals, retail, hospitality and manufacturing. See www.LowerWC.com for more information. Contact: Info@ReduceYourWorkersComp.com.


Our WORKERS COMP BOOK:
www.wcmanual.com

WORK COMP CALCULATOR:  www.LowerWC.com/calculator.php
 
Do not use this information without independent verification. All state laws vary. You should consult with your insurance broker or agent about workers comp issues.
 
©2011 Amaxx Risk Solutions, Inc. All rights reserved under International Copyright Law. If you would like permission to reprint this material, contact Info@ReduceYourWorkersComp.com.

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