questioning of reserves. Understand- ing the reserving process and philos- ophy of each claim provider is very important. The reserving practices for each carrier differ and can greatly af- fect the value of claims reserves used to compute your EMR. The most critical time to have a claims review is prior to when the insurance carrier reports to the rating bureaus, an activity called unit statistical reporting (USR). USRs are performed six months aer policy expiration. We have found it critical to estimate the next years’ experience modification to eliminate the surprise of a large modification increase or to celebrate a reduction for the next year. This is best performed approximately four months prior to the expiration of your policy. Obviously, higher experience modifications create higher premiums. MEDICAL-CLINIC RELATIONSHIP Most of us know the cost of medical care has increased significantly over the years. Medical is the largest com- ponent of your claims cost. Time invest- ed with protocols of industrial medical providers is very worthwhile in claims outcomes. Many clinics are employer and employ- ee friendly. It is best to interview the clinic to learn about their intake prac- tices and general philosophy regard- ing treatment plans and ongoing care. Doctors set the stage for the claim and the ultimate medical cost. Some clinics have a return-to-work philosophy and others want to continually treat. It is imperative to know the medical clinic that will think of you as their client along with providing top-shelf care to your employees. CLAIMS-ADJUSTER RELATIONSHIP We all know that when we take time to establish close relationships, we achieve better outcomes with regard to responsiveness and engagement. Take the time to get to know your adjusters. It will pay dividends!
THE ROLE OF EMPLOYEE BENEFITS When no employee benefits are offered, the propensity for employ- ees to steer injuries from their personal pursuits to your work- ers’ compensation policy becomes greater. It is also hard to disprove
CLASSIFICATION APPLICATION We find that companies that misallo- cate their payroll to lower-rated class- es can have artificially high EMRs. Tree care is an all-operations class code, unless you have established your company as a multi-operational entity. If this is the case, it is your re- sponsibility to keep records of payroll segregation by job. A system for record keeping is neces- sary to validate your year-end audit. In most states, if anyone on a job site is working at height, all employees are considered to be in the tree class code. If all pruning is utilizing pole saws and pruners from the ground, this can be construed as a landscaping exposure. Other class codes like lawn care and millwright for separate stump grinding jobs may also be applied. Again, record keeping is incumbent on you. If records are not properly kept, the auditor will place all the field pay- roll in the highest-rated class, which is tree care. A large, additional premium will follow. Fighting an audit like this can be a big strain on your time, taking you away from other initiatives needed in your business. The companies that allocate their pay- roll to the correct class codes enjoy the lowest rates. When employees are mis- classified, it is a disservice to the whole industry. When claims from other class codes are applied to the tree care class code, it artificially drives up “expected loss rates” for tree care because there is no payroll associated with loss. CLAIMS MANAGEMENT It is important to have a claims-man- agement system to monitor how claims affect your EMR. Based on the size of your operation, claims reviews with the adjusters should be conducted at least annually. Large organizations should review their claims at least quarterly. You should enlist the help of a workers’ compensation claims expert to provide strategies for claim closures along with
the causality of soft-tissue injuries and back strains. Workers’ compensation is a “no fault” coverage. If there is only one per- ceived way to have medical treatment taken care of, the worker and care provider may look to find industrial causation. We find that tree compa- nies that provide employee benefits have lower turnover and higher em- ployee satisfaction.
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