Dirty Little Secret of Workers Compensation Insurance

Workers Compensation Insurance agents are paid commission based on the size of your company premium. The bigger the premium you pay the bigger your agent’s commission. Your agent may never cause your premium to go up unnecessarily but has he done everything he can to reduce it and reduce his commission?

The first workers compensation law was enacted in the United States in 1911 by the State of Wisconsin. By 1948, every state had some form of “workman’s comp.” Basically this is a government mandated social insurance pact between employers and employees. Employers are forced to cover medical care and provide wage replacement for employees hurt on the job: in return workers compensation benefits becomes the only remedy available for workers. Even though courts have upheld this concept for almost one hundred years occasionally in cases of bad faith courts have over ridden this exclusive remedy.

Workers compensation is compulsory insurance in every state but Texas. With some few exceptions, all employers are mandated by law to carry workers compensation insurance.

Workers Compensation Insurance premium is calculated by how employees are classified by their specific work and the rate assigned to each employee classification.

Workers Compensation insurers attach a premium rate to each employee classification code. These rates must normally be approved by the state insurance regulatory agency in the state the policy is in effect in. Agency approval of the rate is based on numerous items. One of the items taken into account is adequacy of the rate. Rates must be adequate to maintain the financial condition of an insurance company. Adequate rates allow the insurance company to maintain surplus to meet current and future claims..

The classification code and its corresponding premium rate are part of the formula. The premium rate itself is expressed as dollars and cents per $100 dollars of payroll. The payroll for each classification code is estimated and then each $100 is multiplied by the rate. The calculated amount is the base premium. The base premium is then modified (change up or down) using rating plans and experience modification.

The experience modification is calculated from losses that the company has reported in the past.
The insurance company used a government-approved formula to calculate an experience modification for each employer. The formula looks at paid losses, reserves necessary for claim made and payroll amounts for the past three years (usually). The experience modification shows average loss experience of employers with similar classified employees and works as a way to compare employers. The experience modification is added to the class rate, along with any other modifications and an estimated premium rate is created. This is called prospective rating and is the most commonly utilized rate plan.

The total premium for a workers compensation insurance policy is not certain until the policy period is complete and all payroll has been reported.

Now you know how the rates are calculated what is the “Dirty Little Secret”? In thirty years of working with companies I have never gone into a company of any size and found that its employees are correctly classified. The classification process is many times as much of an art as it is a science. Different people can look at the same job and classify it differently sometimes with extremely different results to the premium. Many classification titles are very similar but with much different rates. There are many jobs that don’t have a specific classification but have to be fitted into something that makes sense. If the insurance company decides the classification do you think it will be the best possible choice for the employers lowest premium?

If an employer is not only knowledgeable but also aggressive about classifications who is going to see to it that they are the lowest possible premium rates. The insurance company makes more money out of higher premium rate classifications. The risk to the insurance company does not rise if the employee is misclassify into a classification that commands a premium rate of say $10.13 per $100 of payroll as say a rate of $1.01 per $100 of payroll. The insurance company just makes ten times as much revenue. If there is a claim it will be paid at the same amount regardless of what the premium was.

The insurance agent that supposedly has the employer’s interest at heart makes ten times the commission if an employee is misrated as in the paragraph above. Is he going to take his time, energy and effort to deliberately cut his commissions by suggesting rate changes over his company’s objection?

If as an employer you don’t have an intimate knowledge of classification and ratings you need to either get the knowledge or hire someone who has it. You can’t trust your agent to be objective about this. You are talking about taking money out of his pocket and out of the pocket of people that pay him. You don’t pay him the insurance company does. It pays him a commission on what he sells you. Not necessarily on what you need. Your agent may be doing a bang up job but wouldn’t you like to be sure?