2019 Workers Compensation – The First $250 of Every Claim Is Excluded

Shaun Kelly, Tolman and Wiker

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Employers in California will be receiving some relief on their Workers Compensation Experience Modifications in 2019. The Workers Compensation Insurance Rating Bureau (WCIRB) will be eliminating the first $250 of each claim, before the calculation of an employers’ experience modification in 2019.

The rationale behind the change is as follows:

  •   Increase the reporting of all claims (Including First Aid) to obtain credible information on injury and accident experience.

  •   Eliminate disincentives to reporting claims which will enable insurance carriers to improve their ability to manage claims.

  •   Improve healthcare to employees, by giving employers an incentive to file first aid claims.

  •   The change will benefit the employer by lowering their experience modification, however the effect overall will be modest for employers. So, please do not expect significant reductions.

Here are some “Frequently Asked Questions” that were published on the WCIRB website regarding the change:

How does the $250 loss exclusion work? Under California’s Experience Rating Plan only the amount of each of your claims, up to your primary threshold, is used in the experience modification computation. With the $250 loss exclusion, that amount is reduced by $250. For example, if you have a $10,000 primary threshold and a single claim of $5,000. The amount used in the experience modification computation is $4,750. If you have a single claim of $15,000 the amount used in the experience modification computation is your primary threshold ($10,000) less $250, or $9,750.

Is the first $250 excluded from all claims? Yes, any claim incurred against policies incepting during the experience period for your 2019 experience modification, which include 2015, 2016 and 2017 policies, will be used in the experience modification computation at $250 less than its reporting value.

What if I file a claim that’s valued at $250 or less? A claim with a reporting value of $250 or less will continue to be shown on the experience modification worksheet, but will not be used in any way in the experience modification calculation.

How this will affect each employer individually will depend on how many claims are incurred during the experience period (3 years) used for the experience modification calculation.

The WCIRB will be monitoring the $250 value that is being used and will adjust in subsequent years for inflation.

If you would like more information on how this change will affect you or how the Workers Compensation Experience Rating Plan works, please do not hesitate to call.

 

 

Shaun Kelly joined Tolman & Wiker Insurance Services in 2005.  He specializes in all lines of property and casualty insurance for industries including contract security firms, agriculture, construction, oil and gas. Shaun received a BS in Business Administration with a major in Finance from California State University in Fresno, California. He is an active member of several industry associations, including the Association CALSAGA, the Kern County Builders Exchange and the Independent Insurance Agents of Kern County. Shaun can be reached at 661-616-4700 or skelly@tolmanandwiker.com.