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Workers Comp Insurance Claims: Documentation is Key

Posted by David Ross on Sat, Nov 21, 2015

Documenation is critical to lowering Workers Compensation Insurance Costs in Philadelphia, Reading, Lancaster, York, Allentown, Lehigh Valley, Harrisburg, Pittsburgh, Erie, PA and beyond.When one of your employees is injured on the job, it sets off a sequence of procedures that must be adhered to in order to protect your business. If a claim is filed--whether compensable or contested—it is imperative that you have the necessary documents on file. Documentation for workers compensation insurance becomes particularly crucial with contested claims, as these documents become the lynchpin for a solid defense.

Start Documenting Workers Comp Claims Immediately

Documentation begins as soon as the compensation claim is received. An early intervention process allows for a claims expert to properly document pertinent information associated with the accident while the critical details are still fresh in the minds of the injured employee and anyone else involved.

Early workers comp insurance documentation has another advantage: often, the employee is still working, which allows unrestricted access to the worker before representation. This can lead to evidence that would be harder to uncover once a lawyer is involved. 

Other reasons for early documentation include:

  • The injured worker and witnesses might change their stories if given the time
  • Physical evidence can change or disappear
  • Opportunities for research may be lost
  • Proof of fraud or malingering may be missed
  • Independent medical opinions may be jeopardized
  • Symptoms are often exaggerated after a lawyer enters the picture

In addition, late documentation can damage an employer’s credibility and will sometimes lead to additional claims including harassment and discrimination.

Be Thorough in Collecting Evidence for Workers Comp Insurance Claims

It is worth noting that documentation of non-industrial injuries, tardiness, warnings, write-ups, and other personnel actions help to show the injured employee in a different light prior to litigation. Employers should be vigilant about maintaining proper WC documentation in the employee’s personnel file. This can be helpful in constructing an accurate portrayal of the worker before and after the injury.

Other workers comp documents that must be on file include…

  • A comprehensive statement of the facts of the accident
  • Witness statements, taken as early as possible
  • Medical evidence obtained prior to litigation identifying the injury and body part
  • Past medical records that are pertinent to the claim
  • Independent medical examinations
  • Personal and physical background information on the claimant
  • Past claim records
  • Photos and videos of the accident site
  • Information procured from private investigators
  • Copies of training programs and the employee’s participation in them
  • Reports from professional experts and technical advisers
  • A record of all telephone discussions with anyone connected with the claim
  • A log of all employees’ functions from an up-to-date job description of all positions, especially modified duties

Medical Evidence is Key to a Workers Compensation Insuance Claim

While not every insurance claim will require this level of documentation, claim technicians will need many or all of these documents in some difficult cases. Many factors can affect the outcome of these cases. Experts seem to agree, however, that nothing is more important than medical evidence, procured prior to litigation, which identifies the injury or body part with a fair description of symptoms. Witness statements are also important, but witnesses have unreliable memories and are prone to leading questions. These factors lead back to the importance of early documentation.

Documenting a worker’s compensation claim is complex and time-consuming. But it is worth the hard work if it becomes necessary to defend a claim. Courts appreciate when complete and well organized paperwork is presented at a hearing.

Obtaining the Right Workers Compensation Insurance

Contact us for help in obtaining the best workers comp insurance in Philadelphia, Lancaster, York, Harrisburg, Allentown, Lehigh Valley, Pittsburgh, Erie, PA and beyond.Click here to contact us or give us a call at (800) 947-1270 or (610) 775-3848 to learn more about worker’s compensation and all of your insurance options. We'll help you choose the right policy and ensure you get a great deal because as indepenent agents we're free to shop among many competing workers comp insurance providers. Call or click today to get started.

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Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs

Workers Compensation Insurance Fraud: What’s the BigDeal?

Posted by David Ross on Tue, Nov 10, 2015

Guard your business against costly Workers Compensation Insurance Fraud. We serve Philadelphia, Pittsburgh, Erie, Reading, Lancaster, Allentown, Lehigh Valley, Harrisburg, PA and beyond.Workers' compensation insurance allows employees who are injured on the job to receive payments for medical expenses, lost wages, and other expenses as they heal. It is usually paid by an insurance policy that has been taken out by the employer. Workers' compensation is required by law in most states, and receiving payment for workplace injuries may be an employee’s legal right.

But not everyone plays fair. Dishonest employees, employers, and health care providers are using fraudulent tactics to take money they do not deserve.

Fake Workers Comp Injury Claims by Employees

Most employees are honest, but the lure of free money, combined with the opportunity to bring in even more money at a second job, can be tempting. While only a small number of employees scam this coverage for personal profit, the damage can be substantial. Here are some of the ways dishonest employees can cheat the system:

  • Embellished injuries: A worker insists that a minor injury received on the job is much more serious and requires a longer time away from work.
  • Hurt off the job: Workers get injured elsewhere, but claim that they were hurt at work.
  • Faking an injury: Some workers simply invent injuries. Injuries such as muscle problems with the back and neck are hard to disprove and easier to get away with.
  • Previous injury: A worker with an old injury that never quite healed will claim he just got hurt on the job.
  • Malingering: Workers pretend they're still disabled, even though they've healed enough to return to work.

Workers Comp Premium Scams by Employers

Fake injury claims far outnumber premium scams, but most workers comp insurance premium scams are much larger. A worker's bogus injury claim normally costs $2,000-$50,000 total. Employers can illegally reduce the workers comp insurance premiums they owe, costing hundreds of thousands of dollars in unpaid premiums in one year. Some scams can last for several years, resulting in millions lost. These cons can be complex and are hard to discover. Here’s how they work:

  • Hiding employees: The company reports fewer employees or a lower payroll than it actually has. The owner might also falsely claim that some of the workers are independent contractors and don't count toward workers’ comp premiums.
  • Misclassifying employees: The dishonest employer tells the workers’ comp insurer that many employees work at safer jobs than they really do.
  • Avoiding coverage: The business doesn't buy state-required workers’ comp insurance, leaving workers dangerously exposed if they're injured.

Health Care and Lawyer Scams

Sometimes medical clinics and lawyers will team up to cheat workers’ compensation insurance. These are often well-organized and can steal millions of dollars a year. Here are some of the most common scams:

  • Inflated injuries: Clinics may overstate the seriousness of injuries to workers, and bill insurers for costly and worthless treatments or tests.
  • Phantom injuries: Clinics may bill insurance for treatment of injuries that never happened.
  • Bogus lawsuits: Disreputable lawyers working with crooked clinics encourage uninjured workers to seek useless treatment. The lawyers then may threaten to sue unless the insurance company settles the phony claim quickly.
  • Kickbacks: Dishonest clinics and lawyers hire recruiters to bring workers into the scams. The recruiters receive illegal kickbacks for referring patients to the lawyers or clinics.
  • Bogus clinics: Some clinics are fakes. There are no licensed doctors or useful medical equipment. The clinic is merely a staging ground for bogus workers’ comp claims.

Workers’ Comp Insurance Fraud IS a Big Deal!

Workers’ comp fraud is a large crime in America. Tens of billions of dollars in false claims and unpaid premiums are stolen every year. That makes it a very big deal! Insurers pass on higher premiums to businesses, while consumers pay higher prices for goods and services from businesses. Workers may have their pay reduced or their jobs eliminated, while those who remain employed may be at risk in businesses that illegally avoid buying insurance.

Call Us to Get the Right Workers Comp Insurance Policy for Your Business

Call us for help in avoiding workers comp fraud in in obtaining the best workers compensation insurance protection for your business.No businee is exempt from this problem.

Click here to contact us or give us a call at (800) 947-1270 or (610)775-3848 to get the right workers’ compensation insurance for your business.

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Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs

Workers Compensation Insurance & Employee Wellness

Posted by David Ross on Tue, Oct 27, 2015

Do you have workers compensation insurance to cover your wellness program in Philadelphia, Lancaster, Reading, York, Harrisburg, Allentown, Lehigh Valley, Pittsburgh, Erie, PA or beyond? Here's what you should know.Today’s businesses are paying greater attention to their employees’ wellness. Some are even taking a more holistic approach in which “wellness” is being supplanted by “well-being.” Whether your business is providing employees with fitness programs, diets, and screenings or adding meditation and massages into the mix, your employees reap tangible benefits…and so do you.

A healthy employee is more productive, has less absenteeism, does higher quality work, and gets injured less often. Production and quality help a company to be profitable and competitive. Fewer injuries lower workers compensation rates.

Sounds great, right? Why doesn’t every employer do this for their employees?

Connecting Wellness Programs to Workers Comp Insurance

While all of these wellness initiatives play an important role in improving employee satisfaction--along with the company’s bottom line--it is worth noting that if an employee is injured during an activity that was encouraged by the employer, it may be compensable. That's where having the right level of workers compensation insurance can make a real difference.

An Injury at a Fitness Center

Recently, an employee of a New York business suffered a spinal cord injury while participating in an exercise class at a fitness center. His employer had made the center available for all employees during working hours. The employer had also offered to pay some of the employees’ cost of the center. A Workers’ Compensation Law Judge determined that the claimant’s injury arose out of and in the course of his employment, and ruled that the employee was entitled to compensation for his injury.

The New York Appellate Division agreed. The court reasoned that the employer encouraged the claimant to have a gym membership, and offered reimbursement to its employees for half of their center’s membership fees. The court also noted that the claimant’s position required him to develop contacts with clients, and the claimant stated that he advanced that objective by taking classes at the fitness center. Since the employer sponsored the fitness center activity in this manner, the claimant’s injuries were ruled to be compensable.

A Lunch-time Basketball Game

In Pennsylvania, a Commonwealth Court found that an employee, injured while playing basketball on his lunch hour, was entitled to workers’ comp insurance benefits. The Court found that the employer had encouraged employees to engage in physical activities to improve their health, relieve stress, and to give them a better mental attitude at work. The employer encouraged such activities with postings on a bulletin board and by allowing its employees to use company facilities, including their gymnasium. Based on these facts, the Court found that the claimant was furthering the business interests of his employer when he was injured.

The Implied Requirement and the Need for Workers Comp Insurance

The South Carolina Supreme Court recently ruled that a man who organized a voluntary kickball game for fellow employees and shattered his leg during the game must be covered under workers’ compensation. In its decision, the court cited the testimony of the man’s supervisor, who said that while attendance at the game was not mandatory, he would have been “surprised and shocked” if the employee had not attended after organizing the event.

The case turned on the court’s view that the man was “impliedly required” to attend the event because of his role in organizing it. The decision doesn’t necessarily apply to other employees who are injured at an event where employees are encouraged--but not required--to attend. It does suggest, however, that employers should be aware that encouraging attendance may be regarded as an implied requirement.

Getting the Right Level of Workers Compensation Insurance Protection

For most employers, the benefits of promoting workforce wellness far outweigh the potential liability. But if your company is considering a wellness initiative, or continuing an existing one, it would be wise to seek the advice of an attorney in order to develop initiatives that promote the goals of the program while minimizing the risk of legal exposure.

Also, click here to contact us or give us a call at (800) 947-1270 or (610) 775-3848 to ensure that you have the right level of worker's compensation insurance to properly protect both your business and your employees.

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Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance

Workers Compensation Insurance & Pre-Claim Nurse Triage

Posted by David Ross on Sat, Sep 12, 2015

Workers compensation insurance savings are possible by implementing a pre-claim nurse triage program. Call us to learn more. Providing workers comp insurance to Philadelphia, Reading, Lancaster, Harrisburg, Allentown. Lehigh Valley, Pittsburgh, Erie, PA and beyond.Businesses today face challenges in managing a workers compensation insurance program, and these challenges can seem daunting immediately after a job-related injury.

Supervisors must make decisions for which they are not trained. Complicated medical questionnaires and claims forms must be filled out, leading to late and inconsistent reporting. These delays can create an opportunity for injuries to be embellished and, therefore, to become more costly.

Once an injured employee enters the medical system, the cost of a claim will escalate. A pre-claim nurse triage program addresses these issues and can provide help for rising workers’ comp costs.

What is Workers Compensation Pre-Claim Nurse Triage?

Telephone triage consists of specially trained nurses who are available 24/7 to receive calls following a worksite accident. This is a pre-claim activity in which the injured employee and a supervisor speak with a nurse who, in turn, assesses the injury and determines medically appropriate treatment. All recommendations come from an evidence-based medical protocol that ensures objectivity and uniformity. If the injury is minor, the nurse will provide first aid instructions that are specific to the injury. More serious injuries are referred to an off-site care facility. All information is recorded at the time of the accident, and the nurse collects all of the necessary data for reporting.

Workers Comp Benefits to the Employer

  • The nurse triage system is easy to use.
  • Company supervisors are no longer responsible for making decisions on injuries.
  • The process is handled in a timely manner, leaving less chance for an employee to exaggerate the injury.
  • Workers with minor injuries avoid unnecessary and costly treatment.
  • Employees return to work sooner.
  • Detailed reports of the incident are completed by the nurse and sent to the company.
  • Typically, the money saved from claims reduction is substantially greater than the cost of the triage service.

Workers Comp Benefits to the Employee

  • Immediate access to a medical professional who is trained to assess injuries.
  • Medical attention is given sooner, resulting in better health outcomes.
  • Early medical attention alleviates fears and concerns.
  • Medical information acquired by the triage nurse prepares the employee’s primary care physician to determine a course of treatment, if needed.
  • The employee is given self-care advice and instructions.

Your Workers Compensation Insurance Program Can Gain a Competitive Advantage

Today, business owners must be proactive and address the risks they face in injury management. In the past, costly trips to the hospital emergency room or unnecessary visits to urgent care and clinics may have adversely affected your bottom line. Pre-claim nurse triage can eliminate many of these trips and make your workers’ compensation program more efficient.

Typically with the use of a nurse triage, half of all sprains, strains, contusions, and lacerations, which collectively comprise about 70% of total injuries, are never entered into the medical system. Instead, a triage nurse is able to direct appropriate first aid treatment, resulting in significant savings.

This valuable program is not only for Fortune 500 companies. Any company, regardless of size, can take advantage of 24/7 nurse triage. Businesses report an average return on investment of 6:1 after one year in the program. Overall, workers comp claims are reduced by 44%. Less time off from work means greater productivity from employees. Add to this the decreased probability of fraud and lawsuits from disgruntled workers, and you have savings that find their way to your bottom line and give you a competitive advantage.

We Can Help Create a Better Workers Comp Insurance Plan

Contact us for PA workers compensation insuranceWorkplace injuries occur in the safest companies.

Call American Insuring Group at (800) 947-1270 or (610) 775-3848 or click here to contact us for help in creating a better workers compensation plan. 

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Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs, Commercial Insurance, Business Insurance

Handling Mental Injury Workers Compensation Claims

Posted by David Ross on Sat, Aug 29, 2015

Mental injury workers compensation insurance claims. Here's information you should know.In the early 1990’s when many states began passing workers compensation insurance acts, there was a prerequisite that any compensable injury had to have a physical impact. That has changed over the years.

Today most states accept that mental injuries can occur and, therefore, can be classified as a compensable injury. Mental injury workers comp claims can be expensive to defend, and expensive if found to be compensable.


3 Types of Mental Injury Cases Affecting Workers Compensation Insurance 

Pennsylvania workers compensation law distinguishes between three (3) types of mental injury cases:

 

  • Mental / Physical
    A work-related mental or emotional experience causes physical consequences. Sometimes a heart attack or cardiac condition can qualify as a compensable event under this standard. In this case, most courts apply a two-part test. The first part is the need for an accumulation of workplace stress beyond the ordinary day-to-day stress employees are exposed to. The second part is the need for legal causation between the stress and the alleged work injury.

  • Physical / Mental
    A physical stimulus causes a mental injury. A good example of a “physical/mental” case involves an amputation or orthopedic injury of sufficient severity to necessitate later psychological counseling or psychiatric treatment for a condition such as depression or PTSD. Although the physical injury need not be the only cause of the mental injury, the element of “contact” is required.

  • Mental / Mental
    A mental or emotional stimulus causes purely emotional sequela (an aftereffect of a disease, condition, or injury).  There is no physical impact or harm. This applies to any employee that is subjected to “abnormal working conditions.” Typically a verbally abusive boss is not sufficient grounds, but a store clerk who has been robbed at gunpoint, is traumatized by the event, and can no longer function normally may be.

The categorization determines the burden of proof.  In physical/mental and mental/physical cases, the claimant needs to provide evidence that establishes that his or her injuries arose in the course and scope of employment.  Mental/mental injuries require a higher burden of proof. The Claimant needs to demonstrate the presence of “abnormal working conditions.”

Proper Handling of Workers Compensation Insurance Claims

In addition to understanding the laws in your state regarding mental injury workers’ compensation claims, you also need to learn how to work with medical experts. Here are three tips when choosing and working with medical experts.

  1. Prior to the independent medical/psychological evaluation by your medical expert, provide a complete set of medical records  - including review of all pre- and post- injury medical records related to the employee’s conditions - if you want your expert’s opinions to be accepted.

  2. You never know how a court may respond to a medical expert. It may accept your expert’s opinions based on a rational explanation that the employee’s condition is affecting their recovery or they may be more receptive to the medical expert’s opinion when the report is detailed and supported by deposition testimony. Therefore, provide a detailed and logical explanation for an expert’s opinions to help prove your theory or position.

  3. Accurate and concise reporting is essential when it comes to the acceptance of an expert’s opinions. If your expert makes the slightest error or omission, all of his opinion could be disregarded.

Learn More About Your Workers' Compensation Insurance Options

Workers-Comp-Insurance-Mental-Health-InjuryTo learn more about saving on workers’ compensation insurance costs and all your workers comp insurance options,  click here to contact American Insuring Group or call us at (800) 947-1270 or (610) 775-3848.

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Tags: Workers Compensation Insurance, workers comp, PA Workers Compensation Insurance, workers comp costs, Commercial Insurance, Business Insurance

3 Types of Restaurant Insurance Coverage

Posted by David Ross on Tue, Aug 25, 2015

The best restaurant insurance for PA businesses in Philadelphia, Reading, Allentown, Pittsburgh, Harrisburg, Lancaster, PA and beyond.All businesses are at risk for some type of damage, liability or loss, and need to ensure that they have the right commercial insurance to protect themselves, their business, and their employees from those risks. 

Food service businesses – whether it’s a café, diner, or gourmet restaurant - are no different and actually present some unique risks that need to be addressed.

Often the most cost-effective way to protect a restaurant is with a Business Owners Policy (BOP) that is tailored specifically to the needs of the restaurant business. That's what we mean by  restaurant insurance.

Here are the Three Main Categories of Business Insurance for Your Restaurant

Restaurant Insurance Category #1: Property Insurance

Property insurance protects… well… property. That could include the actual building that your restaurant is located in if you own the property and all of the property within the building (whether you rent or own), such as equipment, dishes, food, and furniture. In the event of a fire, flood or other damaging event, property insurance allows you to replace those items so that you can resume business.

Many BOPs also include Business Interruption Insurance and Business Income Insurance. Interruption insurance helps you recover as quickly as possible by paying extra expenses caused by the interruption in your business —such as rent for temporary quarters.    Business Income Insurance helps pay for ongoing expenses – such as rent - incurred while your business is closed. 

As a food service business, you carry the added risk that your food could cause food poisoning or transmit a communicable disease, which makes a Food Contamination Endorsement Insurance a good idea for many restaurant owners. Typically, this endorsement helps pay for lost income if the business is shut down by a government authority, clean up expenses, food replacement, and additional advertising expenses required to restore your restaurant’s reputation.

Other property insurance coverages you may want to consider as a food service business owner include…

  • Spoilage
  • Mechanical Breakdown
  • Outdoor Signs
  • Burglary and Robbery
  • Employee Dishonesty

Restaurant Insurance Category #2: Business Liability Insurance  

Commercial liability insurance helps protect your business against lawsuits – from someone breaking their leg walking up your steps to claims of libel or slander. We live in a very litigious society, and you never know what your restaurant could be liable for. Remember the woman who sued and won the lawsuit against McDonalds because she spilled hot coffee on herself? Even if you win the lawsuit, the cost of defending yourself can seriously affect your bottom line. Liability insurance helps protect you and your business.

If your restaurant has a liquor license, you should also include a Liquor Liability Endorsement to help cover the cost of your defense in the event of a lawsuit and any damages awarded if you are found liable.

Restaurant Insurance Category #3: Workers Compensation Insurance

Worker’s Compensation Insurance is a type of small business insurance that is mandatory in most states and covers employees for work-related injuries. A typical "workers comp" insurance policy pays an employee lost wages and medical expenses incurred due to a work-related accident, while also protecting the employer against accident-related lawsuits. 

Need Better Restaurant Insurance?
We Can Help! 

Contact us for help in finding the best restaurant insurance in Pennsylvania and beyond.Whether you own a sandwich shop or an elegant restaurant, the independent insurance agents at American Insuring Group can help find the right insurance at the right price for your food service business. Because we're independent, we're free to shop around for the best deal among many competing providers of restaurant insurance based on your particular needs.

So give us a call at (800) 947-1270 or (610) 775-3848, or click here to Contact Us today.

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Tags: Workers Compensation Insurance, Restaurant Insurance, Business Insurance Reading PA, workers comp, workers comp insurance, Commercial Liability Insurance, Commercial Insurance, Business Insurance, Pennsylvania Business Insurance, Commercial Insurance Philadelphia PA, commercial property insurance

Save on Workers’ Compensation: Get to Know Your TPA

Posted by David Ross on Mon, Jul 06, 2015

How to use a TPA to cut your workers compensation insurance costs. Serving Philadelphia, Reading, Lancaster, York, Lebanon, Allentown, Harrisburg, Lehigh Valley, Erie, Pittsburgh, PA and beyond.Changing your Workers’ Compensation Insurance provider will cost money and time.  Not only will you need to spend time researching your options, but you will also probably end up spending more time answering employees’ questions. One way to save money on Workers’ Compensation expenses is to develop a strong long-term relationship with your third-party administrator (TPA).

A competent TPA can help lower your worker's comp insurance cost

The best TPAs have strong medical management skills that allow them to control the medical cost of your claims and work in conjunction with workers’ compensation adjusters.

Before hiring a TPA, ask which of the following techniques they use to control medical costs:

  • Telephonic nurse case mangers (TCM) or Field nurse case managers (FCM) – experienced nurses help coordinate and manage the medical care of an injured employee, including consulting with physicians; providing frequent updates to the adjuster; and facilitating communicate between the employee, employer, and physician.
  • Senior nurse reviews – a highly experienced nurse who provides continuous oversight of medical care, identifying recovery obstacles early in the claim.
  • Utilization reviews – provides an independent confirmation that medical services are necessary with a pre-certification review, a concurrent review, and/or a retrospective review.
  • Medical bill reviews – reviews and verifies the accuracy of the diagnostic codes and charges.
  • Prescription management – helps ensure the best prices and the prevention of overutilization of drugs.
  • Physician review – If an injured worker isn’t responding to medical care within the normal recovery time, a specialist can evaluate and document the past, current , and future medical treatments.
  • On-site clinics – a medical clinic located on an employers’ worksite can reduce the cost of medical care for both personal and work-related injuries and illnesses.
  • Injury triage – a triage nurse evaluates the injured employee’s needs and directs them to the most appropriate medical providers within the network.
  • Wellness programs – a company sponsored wellness program lowers the cost of health insurance and the cost of workers’ compensation costs, lowers absenteeism, and increases productivity.
  • Preferred provider networks – a network of doctors, hospitals, diagnostic facilities, and other medical providers that have agreed to provide medical services at a reduced cost to injured employees covered by workers’ compensation insurance. 

Get educated and lower your Workers Comp costs!

  • Become more informed about the services offered by your claims administrator. Ask for samples of reports and deliverability’s. Read through their brochures and ask lots of questions.
  • Visit one or two of their claims offices and learn their processes. Find out if adjusters have backup or clerical assistance. Watch the process as a medical bill enters the system through to the time that it is paid. You’ll have a better understanding and appreciation of how they work and how you can work with them more efficiently.
  • Educate your adjusters on your business. Invite them to come in and see what your business does, the kinds of jobs and skills your employees have. This will help them understand better how an injury can occur. This may also allow them to offer more possible transitional duties for injured workers.

Get help finding a TPA and better workers compensation insuranceNeed help finding a good TPA?

Amercian Insuring Group can help you find the right TPA for your organization. We can also help you find the best Workers Compensation Insurance coverage. That's because as independent agents, we're free to shop among competing insurance providers to find the best workers comp insurance to meet your unique needs at the best price.

Give us a call at (800)947-1270 or (610)775-3848 or click here to contact us. 

 

 

 

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Tags: Workers Compensation Insurance, workers comp, workers comp insurance, PA Workers Compensation Insurance, workers comp costs

Surviving a Workers Compensation Insurance Premium Audit

Posted by David Ross on Fri, May 15, 2015

Workers Compensation Insurance Audit Survival Tips. Serving Philadelphia, Lancaster, Harrisburg, York, Reading, Allentown, Lehigh Valley, Pittsburgh, Erie, PA and beyond with the best workers compensation insurance protection for your business.Workers Compensation Premium Audits - a necessary evil (some would say) for any employer - determines the final cost of your workers compensation insurance premiums. Sometimes the results of these audits can significantly change your premium compared to the estimated insurance premium originally used in the policy – and not always in a positive way. These audits can be stressful, disruptive and time-consuming for you.

Don’t wait until you receive a notice that you are about to be audited to begin collecting data.  Sometimes you only know a few weeks ahead of time, and you don’t want to scramble around for information, which can cause incorrect, missing or inadequate information. 

Here are a few tips to make a workers comp insurance audit as painless as possible:

Before the Workers Comp Audit:

  • Review your original workers compensation insurance policy to see how the initial estimated premium was determined – including classification codes, rates, and payrolls.
  • Look at your last audit report to see what information was required and what errors were made.  If this is your first workers comp audit, ask the auditor for a list of documents and information that they will be requesting.
  • Review all job descriptions and ensure that the correct NCCI class code descriptions are applied to each job.
  • Review all of your payroll records and check that employees are on the correct corporate payroll.  Make sure that any outside contract employees are kept separate from corporate employees and have copies of other insurance provisions for these contracted employees, such as hold harmless agreements or insurance certificates that show the employer as also insured on the contracted employees’ insurance policy.
  • If there are unusual situations, such as an unexpected project that required additional over-time, make sure that you understand and are able to explain the situation.
  • Place documents and physical evidence in chronological order.
  • Ensure that information on your website or any other places a workers compensation insurance auditor would have access to is up-to-date, correct and not misleading
  • Secure a private and comfortable room for the auditor(s) and ensure that internet is available in that space.

During the Workers Compensation Insurance Audit:

  • Be professional and friendly
  • Make sure that the workers comp insurance auditor is comfortable and knows where everything is (coffee, restrooms, photocopiers, etc.)
  • Assign a primary contact person from senior management who will act as a liaison between the company and the auditor.   This person should be very familiar with all the work done within each department and by each employee, audit procedures, and the materials prepared for the audit.
  • Do not lose your temper.  Be cooperative and answer all questions accurately and to the best of your abilitiy.  Keep your answers short, direct, and to the point.
  • Do not invite auditors to lunch or dinner or offer any other items that could be interpreted as a bribe.
  • You should have the opportunity to meet with the workers compensation insurance auditor(s) before they leave the premises to go over his or her findings and make corrections if needed.   This wrap-up meeting should be held in a private location.

After the Workers Comp Audit:

If you do not reach an agreement on the published report at the wrap up meeting, immediately prepare a written document along with all the necessary documents to support your position and request that any adverse premium changes be held until the challenge is resolved.  Legal assistance may be required.

Premium audits are a part of being an employer.  In order to see the best results, be prepared and cooperative, and be ready to provide any information the auditor requires. 

Get the Right Workers Compensation Insurance

Help with workers comp insurance and info on WC auditsFor more information about premium audits or how to get the best deal on workers compensation insurance, contact an American Insuring Group independent agent at (800) 947-1270 or (610) 775-3848. As independent agents, we're free to find you the best insurance at the best price, selecting from among competing insurance carriers. We serve Phildelphia, Lancaster, Harrisburg, Allentown, Reading, Pittsburgh, Erie, PA and beyond. Call today.

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Tags: Workers Compensation Insurance, workers comp, workers comp insurance, workers comp costs, Commercial Insurance, Business Insurance

4 Kinds of Business Insurance Employers Must Have

Posted by David Ross on Thu, Apr 30, 2015

4 types of business insurance for employersYou’re about to become an employer.  Maybe you’ve been in business for a while, but now you’re ready to hire your first employee.  You’re excited; this means your business is growing.  Or, maybe you’re just starting a business and you need employees to help run that business. 

Either way, being an employer comes with many responsibilities, including ensuring that you purchase the right business insurance.  You may be asking yourself, “What insurance is required by law and what is optional?  What’s in the best interest of both my business and my employees?” 

There are four primary types of insurance every employer should take a look at – Workers Compensation Insurance, Unemployment Insurance Tax, Disability Insurance, and Health Insurance.

Workers’ Compensation Insurance

Workers Compensation Insurance coverage ensures medical and wage-loss benefits to employees who are injured on the job. Plus, it helps protect employers against lawsuits filed by injured workers. Worker’s Comp insurance requirements vary by state.  In Pennsylvania, if you employ one or more employees - whether they’re part-time or full-time (including family members) workers’ compensation insurance coverage is mandatory.

If you are a sole proprietor, Workers' compensation insurance is not required by law, which can save you money; however, if you’re ever injured on the job, workers’ compensation insurance can help pay medical bills and supplement lost wages until you’re able to go back to work.

Click here for information about workers compensation insurance requirements in other states.

Unemployment Insurance Tax

Unemployment Insurance (UI) is a joint state and federal program financed through federal and state employer payroll taxes. It provides temporary payments to individuals who are unemployed through no fault of their own.  Each state has its own unemployment insurance program, which includes additional eligibility requirements, but they all follow guidelines established by the federal government.

Most employers must pay federal employer payroll taxes if they pay employee wages of $1,500, or more, in a quarter or if they have at least one employee during 20 weeks in a calendar year.  Most employers are also required to pay state unemployment taxes. In Pennsylvania, all employers providing employment to one or more workers must register Form PA-100 with the Office of UC Tax Services.

Employment that is not covered under the UC law includes the following:

  • An individual employed by his or her son, daughter or spouse
  • A child under the age of 18 who is employed by his or her parent
  • A student in the employ of an organized camp that did not operate more than seven months in the preceding calendar year

Disability Insurance

Some states require that employers provide partial wage replacement insurance coverage to their eligible employees for non-work related sickness or injury. Currently, if your employees are located in any of the following states, you are required to purchase disability insurance:

  • California
  • Hawaii
  • New Jersey
  • New York
  • Puerto Rico
  • Rhode Island

In Pennsylvania, there are two types of disability insurance available if you decide to purchase it for your employees: short-term and long-term.

Again, if you are a sole proprietor, Disability Insurance is not required in Pennsylvania; however, if your family relies on your income, you may want to consider disability insurance for yourself to help pay medical bills and supplement lost wages if you become sick or injured.

Health Insurance

If you have more than 50 employees you are required to provide health insurance benefits to your full-time employees.  If you have more than 50 employees and don’t offer health benefits, you may be subject to a penalty call the shared responsibility payment.  96% of employers in Pennsylvania are exempt from the shared responsibility requirement. 

Learn more about all your business insurance needs and options. We serve Reading, Lancaster, Philadelphia, Allentown, Lehigh Valley, Harrisburg, Lebanon, York, Pottstown, Pittsburgh, Erie, PA and beyond with high quality commercial business insurance.Contact Us for All Your Business Insurance Needs

If you’re an employer, contact American Insuring Group at (800) 947-1270 or (610) 775-3848 for more information about required and recommended business insurance, including health insurance, disability insurance, workers compensation insurance, or any other insurance your business may need. We've been helping businesses like yours acquire affordable, high-quality insurance for over 25 years.

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Tags: Workers Compensation Insurance, Commercial Insurance Allentown PA, Commercial Insurance Lancaster PA, Commercial Insurance Harrisburg PA, workers comp, workers comp insurance, Disability Insurance, Health Insurance, Commercial Insurance, Commercial Insurance Reading PA, Business Insurance, Commercial Insurance Philadelphia PA, Commercial Insurance Berks County

Safety Measures to Control Workers Compensation Costs

Posted by David Ross on Thu, Apr 23, 2015

Safety and Lower Workers Compensation Insurance Costs Go Hand in Hand

Creating a safe working environment for your employees is one of the best things you can do to help control the cost of Workers’ Compensation Insurance.  Whether you run an office, a warehouse, or a manufacturing facility, there are certain steps that apply to the main structure of any successful safety program.  Here are a few:

4 tips to lower workers compensation costs for your business. Serving Philadelphia, Reading, Lancaster, Allentown, Erie, Pittsburgh, PA and beyond.Set the Standard

Create an atmosphere and culture of safety; it will spread to your workers.  This can be as simple as carpeting that is free of rips and holes, clearly marked hazards, clean floors, and machines with real guards in place.  If you set the right standard, everything will follow.  

Create an Emergency Response Team

Your workforce may be the most efficient and responsive team during the course of regular business, and you may assume that they would react the same way in an emergency, but too often that efficiency and responsiveness turns to confusion and chaos during an emergency situation.  Employees need to know ahead of time what their responsibilities are in the event of an emergency, so they can react quickly like a group of well-trained marines rather than the bumbling Stooges. 

First, create a team that is a mix of serious-minded workers, supervisors, and management that understand that – in the event of an emergency -  lives may depend on them.  Make sure every employee knows who those team members are and how to reach them.  Consider creating a special code for emergencies or maybe a special name tag for members of this team.  Then, establish protocol for reporting an injury along with the chain of command.  Everyone on that team needs to understand what his or her responsibility is – whether that’s calling 911, applying CPR, or alerting other staff.

Finally, stage a few “accidents” for practice drills.  Don’t let employees know ahead of time and start easy, working your way up to accidents with increasing severity.

Communicate!

Your goal with Workers’ Compensation is to report zero claims, but if you do find yourself filing a claim, make sure your adjuster and carrier are good at communicating with the injured worker.  Set standards and make sure they are followed.  An injured worker should receive a call from a triage nurse or the adjuster within 24 hours.  The injured worker’s manager should call him or her once a week to check in on them.  Let the employee know that he or she matters and that you care about their welfare.

Lack of communication has been the down-fall of many marriages and statistically, it’s one of the biggest complaints of insurance claimants.  Too often, injured workers don’t know what is going on, what doctor they can and can’t go to, etc.   Effective communication decreases litigation, gets workers back to work more quickly, and keeps the claim moving forward to a resolution.

Get Upper Management Involved

My dad used to say to me, “Do as I say, not as I do.”  How do you think that went?  Not very well.  Good leaders lead by example.  If upper management repeatedly breaks the rules, you’ll lose whatever cooperation you’ve achieved with your employees.  Safety standards need to apply to everyone, even if that means writing up someone in senior management for a safety violation.  Your safety program needs to be enforced 100 percent of the time.

We Can Help You Save on Workers Comp Insurance

To find out more ways to save on workers’ compensation insurance, contact American Insuring Group at (800) 947-1270 or (610) 775-3848.

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Tags: Workers Compensation Insurance, workers comp, workers comp costs, Commercial Insurance, Business Insurance

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