Incorrect Joint Coverage Reporting Results in a 42 Point X-Mod Reduction!

Incorrect Joint Coverage Reporting Results in a 42 Point X-Mod Reduction!

ESM was successful in reducing a client’s 2017 Experience Modification by 26 points and their 2018 Experience Modification by 8 points with a second 8-point reduction projected for a total reduction of 42 X-Mod points.

 A carrier’s incorrect reporting of Joint Coverage claims had a significantly unfavorable impact on this employer’s X-Mod.  

2017 X-Mod. First published at 116%. Revised to 90%.
ESM reviewed the Workers’ Compensation Insurance Bureau (WCIRB) worksheet and the carrier’s claim status reports and identified several Joint Coverage claims that were incorrectly reported by the carrier to the WCIRB.

ESM notified the carrier to request a revision with the corrected data resulting in the 26-point reduction.

The revised X-Mod was applied retroactively to the inception of the policy.

2018 X-Mod. First published at 128%. Revised to 120%. Further projected reduction to 112% ESM was now familiar with the Joint Coverage Cumulative Trauma claims and caught the carrier’s error again in reporting the data to the WCIRB.

ESM requested and achieved an 8-point reduction. A subsequent revision and reduction will be requested when the next claim closes.

All X-Mod re-rates are retroactive to the inception of the policy.

It is very important to not only understand how X-Mods are calculated but to also know and understand the details of the claims. Joint coverage claims are easily overlooked and incorrectly reported to the WCIRB as a non-exempt claim or even incorrect percentages of liability.

Contact ESM if you need assistance reviewing your X-Mod worksheet.