Classification Error
A clothing manufacturer had been classified improperly for many years. (The governing classification appeared to correctly describe the business at first glance, but a review of the Workers Compensation Basic Manual indicated that a lower rated classification was more applicable. We convinced the insurance company of their error, and the client received a refund of $98,000. )[read less]
Experience Modification [read more]
Experience Modification
A large transportation company received an increased experience modification. (The modifier increased by 38 points, or $460,000 additional premium. After reviewing the experience rating worksheet and the policy, we were able to reduce the additional premium owed by $230,000 because the insurance carrier failed to follow the rules in the Experience Rating Manual.) [read less]
Claims Reserves
A claim was reserved and remained open for 3 years on the experience rating worksheet of this Visiting Nurse Association. After analyzing the claim, it was determined that the insurance company needed to remove the claim from the worksheet, resulting in refunds of $9,000 – for each year!
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Revised Audits
A small landscaper disputed his final audit which indicated an additional premium owed of $6,000. (The insurance company conducted a re-audit, and billed the insured for even more ($8,000) premium. We reviewed the audit worksheets and invoices, and advised the insurance carrier that their re-audit violated State rules and was void. In addition, the original audit contained many classification mistakes. The insurance company refused to correct their errors, so we requested a ruling from the Department of Insurance. The ruling was in our client's favor, and resulted in the payment of only $1,000.)
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Overstated Payrolls
A non-profit social services organization was in the Assigned Risk Pool. (The servicing carrier conducted physical audits and billed the client for additional premiums each year. After reviewing the auditor's worksheets, it was determined that the auditor failed to exclude certain types of wages from the audit, and the premiums were overstated. We met with the auditor, and revised audits were conducted for the last 3 years, resulting in refunds of $49,000. )
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Re-written Policies
A mid-sized housing authority switched insurance carriers during the policy period because they got a lower premium. The former insurance company assessed a short-rate penalty, which we were able to eliminate. The new carrier issued the current policy with improper rates. The insured received refunds and credits totaling $6,000. [read less]
Estimated Audits
A sawmill's final audit was estimated by the insurance company. The insured paid the premium. (The following year, the insurance company conducted a physical audit on the policy just expired, which resulted in a large additional premium. Because of the large additional premium, the carrier decided to re-audit the policy which was estimated. The client now owed $240,000 additional premium and was sued for it. After identifying mistakes on the auditor's worksheets as a result of improper audit procedures, we negotiated a settlement for $60,000 and the case was closed.)
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Qualifying for Experience Rating [read more]
Qualifying for Experience Rating
This hospital had been insured by a Self-insured Trust for several years. Due to the competitive pricing in the voluntary market, the hospital left the Trust. (The carrier issued the policy with a 1.00 Experience Modification. Because of excellent claims experience, we submitted payroll and claims data to the ratemaking authorities so that a more favorable experience modification could be promulgated. The hospital received a revised experience mod of .72, a savings of $26,000 on the current policy. Future savings also resulted and were not subject to our fee schedule.)
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