Workers' Compensation

Your Unit Statistical Date is a very important date that should be marked on every employer’s calendar. It’s the date your worker’s compensation insurance carrier reports that information to your rating bureau for use in calculating your next EMR (Experience Modification Rate).

While other factors reported will have an impact on your EMR calculation, claims will more than likely make the greatest difference. It is important that someone make sure that the worker’s compensation claims and reserves adjustments are worked on prior to this important date before they take that information and apply it to your next upcoming experience modification. 

Let’s say you’re Unistat date is June 30th. You have a large claim, and your current loss runs show a total of $100,000 in current payments and open reserves. The claim has been working its way through the system. Your injured employee is now fully recovered; the claim is closed on June 15th by your insurance company, and your employee is back at work.

The insurance company failed to correct their file in time, and your claim record still shows an open reserve of $50,000 on June 30th, which is reported to the rating bureau and included in your January 1st EMR. Or a more likely scenario may be where the claim has not yet closed, but a final number has been developed, and the claims adjuster could have made the reserve reduction but did not only have the adjustment made shortly after your uninstall date, and the reserve remain on your next EMR calculation.

How to determine your Unistat Date. You can calculate your Unistat Date by simply adding six months (180 days) to the renewal date of your experience-rated policy. For example:

A California experience modification is a rate factor “Score Card” given to eligible California employers annually by comparing an employer’s 3-year loss experience to the “average” for employers in the same classification. For example, a Grocery Store is compared only with other Grocery Stores.

An experience modification rate, also known as an experience modifier rate, “x-mod,” or EMR rate, is a debit or credit calculated by the Workers Compensation Insurance Rating Bureau (WCIRB) based on payroll size and the frequency and severity of an employer’s claims experience.

A high-experience mod will increase your annual insurance premiums. A low experience rating will result in a credit (discount) to your annual premium.

Each worker’s comp insurance claim will affect your experience mod for at least 3 years.

The lowest possible experience rating is the experience modification rate when calculated with zero claims for the entire 3-year experience period. This is often called the “minimum modification.”

Calculating a minimum insurance x-mod is easy. An analysis report of the current experience modification rate will include the experience modification rate with no claims. LIBERTY can provide you with the analysis report for your business very quickly. Not only does the analysis report show you the minimum experience modification rate, but it also displays the estimated additional ex-mod insurance cost for all of the claims currently affecting your actual worker’s compensation pricing.

With the analysis of claims and the claims’ impact on your EMR, a proven strategic plan to eliminate expected losses begins. It is a powerful way to lower time and expense throughout the organization.

To begin with, let’s review the definition of “first aid.” Per Labor Code 5401(a), “first aid” is defined as: “any one-time treatment, and any follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, or other minor industrial injury, which do not ordinarily require medical care.

By deploying an EMT service for first aid-type injuries that come to your location, you can save time and effort by having professional first aid care for your injured employee. You will not have to deal with driving to and from the clinic; wait times will be reduced while you head to the clinic while providing white glove care for your injured employee.

Our Workers’ Compensation claims handling supports a partnership approach, so employers play a critical role throughout the life of the claim. Success is based upon immediate intervention and proactive guidance to facilitate expeditious return to work. We monitor claims monthly and report quarterly with an effective course of action for the closure of claims; we negotiate reserves established by current and previous carriers for medical and lost time claims and help reduce the instances of attorney involvement.

The longer the claim stays in your 3-year pricing formula, the more costly it becomes. Staying close to your Medical Provider is crucial. Every time a physician authorizes a treatment plan, he/she has, in essence, a “blank check” for the cost involved. In a way, the clinic and physician responsible for treating your insured employee have unlimited authority to spend your money.

How many others would you give a blank check to with the power to sign your name for any amount? The occupational medical clinic that treats your injured employees must be on your side. Oftentimes, there is miscommunication between the insurance company, the injured worker, and you.

Poor medical provider selection, not knowing you provide “modified duty or “first aid” understanding. The results are unnecessary time off and workers not satisfied with the medical experience, thus costing you additional premiums.

So, it is important to evaluate and investigate each and every claim. Few claims are fraudulent; many claims are exaggerated. If there is an expectation of fraud, we will dive deep into the concern, evaluate it, and take appropriate steps. When we submit claims that are under review, we submit these claims with a note to “put on delay” while we pursue investigation.