Is Nurse Triage a Viable Solution for Employers in the Assigned Risk Workers’ Compensation Pool?

Is Nurse Triage a Viable Solution for Employers in the Assigned Risk Workers’ Compensation Pool?

Company Nurse explores how employers can reduce burdensome Assigned Risk debit by implementing high quality nurse triage at the time of injury

By Paul Binsfeld, president and founder of Company Nurse, LLC

Normally, “Bob” has run a very tight ship and had minimal workers’ compensation claims.  However, over the last two years, Bob’s company experienced a rash of workplace injuries, two of which turned into expensive disability claims.  At renewal, Bob’s insurance company refused to renew his policy leaving him with no choice but to insure with the Assigned Risk Plan. Bob’s workers’ compensation premiums are now more than 40 percent higher than the previous year!

 

What is Assigned Risk?

Employers generally are required by state law to provide workers’ compensation benefits to their employees for work place injuries and illnesses.  These benefits cover medical expenses associated with those injuries or illnesses AND provide a disability benefit in cases where employees are unable to return to work. Notably, benefits are governed by state statute and vary throughout the country.

Most employers buy insurance to cover their workers’ compensation obligation from insurance companies. In some cases, employers are not able to find an insurance company willing to provide them with a policy. In these situations, employers can seek coverage in what is known as an “Assigned Risk Plan.”

Reasons employers might find themselves in an expensive assigned risk program include:

  • New in business
  • Poor loss history; high claims frequency and/or severity
  • Nature of their work being extremely dangerous

Employers that obtain coverage in Assigned Risk Plans may likely end up paying higher premiums as a result of an additional charge known as the ARAP, or Assigned Risk Adjustment Program. Generally, if the Assigned Risk policyholder has an experience modifier above 1.00, there will be a debit ARAP, increasing premium costs to the policyholder by 10% to 30% in some cases. This ARAP charge is on top of an employer’s already high experience modifier. ARAP debit can be found on an employer’s experience modifier rating worksheet.

The fact that an employer is in an Assigned Risk Program likely means that they are spending 50 to 100 percent more than standard premium on their workers’ compensation premiums.

How Could Nurse Triage from Company Nurse Help?

Most employers find themselves in the Assigned Risk Pools due to poor loss history. They may have many more claims than would be expected or some claims that are much costlier than expected; or a combination of high claim frequency and severe, costly claims. Generally, employers in the Assigned Risk Pool have had negative claims experience over a period of years rather than a one-off event.

Adding Company Nurse Triage to an employer’s workers’ compensation injury procedure can benefit the employer in multiple ways. By implementing high quality nurse triage at the time of injury, employers will find that they can:

  • reduce their total claim frequency
  • minimize costly emergency room visits
  • maximize in-network clinic utilization
  • implement immediate action to reduce likelihood of lost work days
  • immediately provide claims adjusters with necessary information to proactively begin work on the claim
  • quickly engage safety personnel to mitigate the risk or hazard

Implementing nurse triage, in concert with pro-active safety and loss control efforts, can quickly reduce claim frequency and costs of claims, helping employers to eliminate burdensome Assigned Risk debit charges AND lower experience modifiers.

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