Workers’ compensation is a critical piece of coverage for any employer, but the rules and regulations—which often vary by region—can make it difficult for employers to manage on their own. Moreton & Company’s risk management team supports clients in evaluating their loss runs—providing crucial information for safety & loss control teams—and managing workers’ compensation claims.
Brandi Vriens is Moreton’s top workers’ compensation expert. For over fifteen years, Brandi’s primary focus has been workers’ compensation, allowing her to cultivate an intricate knowledge of best practices and common pitfalls while staying current on any new legislation that could affect her clients’ programs. We asked Brandi to give us an insider’s view of workers’ compensation.
What are the most common types of claims you see, and how do you approach them?
It varies so much by industry. With our municipality group, we’ve been doing analyses lately that showed a trend. Firefighters are never off-duty; they’re at the fire station for three-day shifts, but sometimes they’ll do a pickup game of basketball, and we’re seeing a bunch of injuries from that. Police officers are also considered on duty when off the clock, and we were seeing several injuries with police officers who were getting hurt while working out to stay fit for the job. We’ve been helping our municipal clients set some more parameters, like explaining to the firefighters that they can’t play pickup games while they’re technically working.
However when we go to construction, it’s different. Our clients have been so good at implementing our safety suggestions, but you still get those strains and injuries. Construction employees, in general, are good, hard-working, salt-of-the-earth guys. But they have this mentality of, “I’ve got this, I don’t need to ask for help.” And that’s where we see the injuries happen.
It all depends on the client and what they’re involved with. So once we see a trend start to develop, we’ll pass that along to either our internal Safety & Loss Control team or the safety specialist at the carrier. Then, they can work with the client to address the problem.
What strategies do you use to reduce claim costs while ensuring fair treatment for injured workers?
All claims have an impact. There are things a client can do to lower those overall expenses, which lowers their E-mod (if they qualify for one), which in turn lowers their premium. We will help them set up a return-to-work program. That is by far the biggest thing we have helped set up with numerous clients—just getting their employees back to work.
Some of those clients were hesitant. They thought, “What’s the point? The employee’s getting paid whether we bring them back or not.” But then we were able to show them the data. When you bring an employee back, their morale is different. They want to get back to their regular job. It encourages them to get back to normal, and it gives them purpose. They’re not sitting on the couch watching The Price is Right and just thinking about their injury and the fact that they can’t work anymore. We all know that if we get depressed, we’re not going to heal as fast. Of course, sometimes some injuries require time to heal or reach a certain point and we’ll tell them, “Don’t push it, let them be off work for a while.”
We help guide them through the process, especially understanding why we treat conservatively at first. For example, maybe we pay for physical therapy instead of doing the MRI first. Or maybe we pay for this injection before we approve surgery. We lean on the claims adjusters because they see so many of these injuries every day. They’ve seen this injury, and they know what’s most likely to help. But overall, the biggest thing is implementing a return-to-work program. It’s easily the most important thing anyone can do to help their E-mod.
Healthcare costs have been skyrocketing for years now. Are you also seeing that reflected in workers’ compensation?
Workers’ compensation is interesting in that they basically have their own PPO network. The carriers will work with local hospitals to negotiate discounted rates, and that helps. Of course, we can’t tell anybody where to get their treatment, but we can tell them that they need to go to a certain place first.
Overall the claims costs have gone up, but premiums have been trending down. NCCI, the National Council on Compensation Insurance, sets our rates, and they’ve actually trended all of our rates down. It’s finally started to plateau a little bit, or increase in some class codes, but it’s been trending down for years. And the carriers are pushing for more premium because these health care costs are going up tremendously.
NCCI is changing the way they do their split points. Before, everybody was subject to one split point. And now they’ve recognized that Utah or Idaho claim dollars are not the same as California or New York claim dollars, and they’re splitting it up. So that’s helped a lot. We’re hoping to see a reduction in E-mods for our local clients based on that change.
How has the rise of remote work affected workers’ compensation coverage and claims?
It’s wonderful. When the pandemic hit, it was scary; nobody knew what to do. Everybody thought that with people working from home, every injury would get reported, things like tripping when they get up to get some water. There was a big concern about ergonomics, as well. People were sitting at their home computers, but maybe their home computers are laptops and they’re on the couch. So everybody was concerned that it would be a huge driver in claims, but that turned out to not be the case. There are very few telecommuters who are actually filing claims.
Are fraudulent claims a common concern? And if so, how do you handle that?
Yes. When the employer fills out the first report of injury, there’s a field that asks, “Do you doubt the validity of this claim?” We make sure all of our clients are aware of that, because we want them to mark that box if they’re questioning even a little. The employee doesn’t know, and the adjuster doesn’t handle it any differently when they talk with the employee. But it may help them ask a few more questions to get that context.
Fraud does happen. We live in a very litigious world right now, especially if you look at California. But the fraud is usually pretty obvious, and the HR departments are pretty savvy. We have really honest people that live here in the state of Utah, though. The problem here is that employees that don’t file a claim when they should. Because they just feel bad. You’ll hear, “I tripped and it’s not your fault.” It’s up to the employer to say, “No, you got hurt, let us take care of you.”
If a company has a high E-mod, is there a set process to go about lowering it? Or do you have to come up with a custom plan for each client?
It usually comes down to a custom situation for each client. Take Moreton & Company, for example. If one of our IT guys was doing something and hurt his knee, we would then have a large claim. But Moreton isn’t expected to have a ton of claims because we’re not climbing on roofs or putting out fires, so our compensation premium would increase.
Sometimes, their E-mods will jump up above a one, and they’ll lose jobs because their clients want only people who are safe on their jobs. Sometimes a carrier will decline to renew because of a high E-mod. So, in these cases, where there’s a one-off, we will help our clients by putting together a letter explaining the impact of that one particular claim, including what their E-mod would have looked like without that one particular claim.
