Not Filing Workers Comp Claims Question

Oct 12, 2015

  1. riskad17
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    riskad17 New Member

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    I am fairly new into commercial insurance. I have not had this come up yet, but I have a very nice commercial prospect who is very conscious about their experience MOD. They have a very low mod I believe, like .70. However, in a initial meeting with the prospect they said a lot of times if an employee gets hurt they will simply pay for the doctors bill or any other expense related to the injury instead of filing the claim because they do not want their MOD to go up. I would think this is a big no no and would open the prospect up to a potential future claim that would not be paid by Work Comp since it was never reported. Am I correct in thinking this? I did not disclose this information during the meeting. I wanted to make sure I had my information correct so when I do present I can give them my advice. Thanks.
     
    riskad17, Oct 12, 2015
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  2. dean8287
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    dean8287 Expert

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    You are correct. That is a very bad idea. If the insured wants to do this suggest a high deductible plan to them. They will have to report it but then the company will bill them for the deductible later. Anything that involves liability of any type should always be reported to the carrier regardless of how small. What can happen is the insured may pay what they think is just a very small amount to make someone go away. What they have actually done is just accepted liability. If this mushrooms into something bigger later this will be a big problem with the carrier and the claim may be denied. It's a different story on the property side.
     
    dean8287, Oct 12, 2015
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  3. djs
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    djs Super Moderator Moderator

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    What kind of injuries and payments are we talking about?

    I mean, a lot of companies supply some basic first aid type of things to deal with cuts, burns, pulled muscles, etc. These tend not to be reported by the nature of they are minor.

    If they take something like a small cut and then say 'hey, go get it checked at the doctors', then they are probably fine. Its first aid with care.

    On the other hand, if they are taking back spasms and trying to pay a few chiropractor visits, that is a different story.

    Then, the other side of this is you need to look at frequency. If this is happening on even close to a regular basis, then there are some issues at the facility that need to be tended to. This is my biggest concern because if they are thinking they need to game the system, there is a bigger problem here.

    Dan
     
    djs, Oct 12, 2015
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