CWCAs help Excavating Company dig up answers to reasons for high open reserves

INSURED

The insured is a large trucking and excavating company with a fleet of 50 trucks, 90 employees and $10 million in annual revenues.

SITUATION

The company had large open claims that negatively impacted its Experience Mod. The current agent was not vigilant in identifying or monitoring the claims.

ASSESSMENT

In reviewing the data CWCAs quickly realized that the high Experience Mod was due to an open reserve claim by a prior carrier of $304,138. The current agent had no communication with the adjuster on this claim and it was not being monitored.

SOLUTION

Using the skills learned at the IWCP workshops, they agency determined the treating doctor had concluded that an expensive, recommended two level fusion surgical procedure was not suitable for the injured worker. Since this information was not communicated accurately to the carrier, the claim remained open and active. The CWCAs contacted the adjuster and it was agreed to lower the reserves to $121,070. The Claims Advocate then continued to work on the claim and assisted in a lump sum settlement that was pending in Workers’ Compensation Court. The settlement was approved and the total payout was $89,520.

RESULT

This CWCA saved the client $183,068 on the open reserve. The lowering of the reserve reduced both the company’s Workers’ Compensation cost and Experience Modification Factor.