Case study: 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, Certified WorkComp Advisors 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, a Claims Advocate 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
CWCAs 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.
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