Joint coverage claim error results in 59 Point X-Mod reduction

ESM identifies errors by two carriers on incorrect Joint Coverage claims reported to the WCIRB and obtains a 59-point reduction in the employer's X-Mod!

And we are not done yet.

We continue to work with the second carrier to submit correction of one more joint coverage claim, which is incorrectly still reflecting non-exempt claim status costing the employer. This is anticipated to be another 14-point reduction for 2018. 

ESM identified 5 claims that were incorrectly reported to the WCIRB between the 2 carriers.

ESM and our broker partner worked with the carriers and successfully reduced the 2 years of incorrectly calculated X-Mods.

 2018 X-Mod: 18-point reduction
 2017 X-Mod: 41-point reduction

Routinely, we are seeing carriers incorrectly report joint coverage claims as non-exempt claims or an incorrect pro rata share of the joint coverage resulting in an unfavorable Experience Modification Rate (X-Mod) for the employer.

For this client, this is the second year that their insurance carriers’ incorrect reporting of several Joint Coverage claims had a significantly unfavorable impact on their X-Mod. Joint Coverage occurs when a single cumulative trauma claim alleged by one employee spans the policy years of two carriers. Both carriers create two claims for the same alleged injury and that has a potentially double impact on the employer’s X-Mod.

Initially, the carrier refused to submit the corrections to the Workers’ Compensation Insurance Rating Bureau (WCIRB) to reflect the correct pro rata share of the joint coverage claims based on the records.

A conference call was held with the carrier to explain why these claims were incorrectly reported and the carrier agreed to submit corrections of these claims to the WCIRB.  After 4 incorrect re-submissions by the carriers, followed by ESM’s determination to have them corrected, and 4 subsequent re-rates, the client’s X-Mod was reduced by 18-points for 2018 and 41 points for 2017.

All X-Mod re-rates are retroactive to the inception of the policy. The current and two prior years can be re-rated.

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.