Out Of Control XMod - What To Do From Here?

[twoplustwoisnot4]

Hey everyone,

I have a pretty big workers comp policy here in CA. —A property management company that's on codes 9011 mainly, also clerical and supervisors as well.

Anyway, this insured has a really frustrating situation occur, to where staff that was terminated, all of them hired lawyers fraudulently filing injury claims. This had to have been around 4 - 5 employees. But, these lawyers filed claims with every single carrier (prior, current, etc) pretty much increasing the frequency of the claims by double. None of these claims really ended with anything... But it's causing an Xmod to go through the roof... From 99 to 350 to now 450 plus.

Any recommendations on something like this or does anyone have any experience in dealing with something along these lines? How did it turn out? Any recommendations?

 

[alexmishchuk]

Does your Agency have a claims team?
Ever do a claims review? or an Xmod projection to prepare the insured for rising costs?

Claims happen but it all comes down to having a plan in place in order to manage them properly.

How big is this company? How many Employees?

 

[twoplustwoisnot4]

Hey Alex,

No claims team, very small agency.

Ever do a claims review? or an Xmod projection to prepare the insured for rising costs? We definitely review claims, throughout the year, in this case. X mod projection... not sure that's something I've ever learned to do! How do you do an Xmod projection?

Claims happen but it all comes down to having a plan in place in order to manage them properly. Understood, the insured is very on point, as I am too... But, from my understanding... Not much you can do with WC claims? —The insured has an incredibly tedious hiring process and does everything by the book, including reporting the claims when they are, a claim.

—The insured has had claims (they happen on a practical frequency (maybe 1/year max)), just everything sort of got out of wack on all of fraudy claims attempted. We've done everything to avoid further problems like this. For the time being, subing out as many jobs as possible. But, it's just that this Xmod, is uncontrollable. It's all from 9011.

The company probably has 30 employees. Made up of onsite property managers and maintenance workers.

-William

 

[alexmishchuk]

Hey Alex,


How do you do an Xmod projection?

No idea lol our claims folks do them for my clients. its a huge selling point when someone has an increasing Xmod. Often their current agent hasn't warned the prospect about it. Whenever I have a prospect with a high Mod my mouth water because I know they need help.

Usually its up to the claims team to review and determine whether claims are legit or not. I believe they either go after the claimant or prior insurance carrier if the same claim was filed in the past. This is where working for a larger agency helps, we have a huge team as well as a law firm on retention so they have methods of working it out.

But xmods are rated on past 3 years so after enough years (I think) the older claims will fall off of the Xmod history.

 

[twoplustwoisnot4]

Appreciate the insight, coming from a larger firm. —It helps for sure. In understanding what I do not have.

Sort of hoping for some prior experience, in dealing with this (without the supplemental help.) I get what can or would have been done, curious if I'm the only one out there that deals with this on their own?

Small business in CA... Life's rough. —To take a shot at hiring a law firm to be worth the cost to fight some claim attempts, for one problematic situation wouldn't make sense for me unless I had plenty of other issues taking place.

-William

 

[Hawaii Agent]

Probably best for the insured to move to a PEO, but you'll end up losing all of the group benes (WC, TDI, Medical, etc.). With the savings on WC, Med, and Unemployment, I bet it'll be pretty attractive to the insured. If you know anyone that owns a PEO or is a top performer, partner with them so maybe they can feed you their clients that need GL or other coverages that they don't offer. Use the opportunity to refer one client to them that will hopefully lead to 10 clients to you.