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The Case of the "Big 4" Claims


A manufacturer of copper wire manufacturer with 150 employees.


The employer was faced with four large Workers' Compensation claims in one year that were driving up the company's Experience Mod, and, therefore, hurting its bottom line.


In reviewing the situation, there were actually two problems that needed immediate attention. First, how to reduce the long-term costs of Workers' Comp claims. And, second, how develop a strategy to combat the "Big 4" to reduce the short-term costs.


Certified WorkComp Advisors (CWCAs) and the HR department met to review the company's Return-to-Work program. There was none, so the answer was easy, implement one. While the HR department knew a RTW program was needed from the beginning, it could not get buy-in from top management. At first, it was difficult to get management to sit down to discuss the issue, but eventually a meeting was scheduled. In preparation, the CWCAs conducted a Mod Analysis to show management what the cost of those claims would be over the course of their lifespan. The results were shocking to CWCAs, even though they knew what to expect. After the discussion with management an ongoing RTW program was implemented.

At that point, the CWCAs addressed the "Big 4" issue. Although the answer was obvious, the process was more tedious. Recognizing that most Experience Mods are either mismanaged or not managed at all, the CWCAs dug-in and actively monitored the "Big 4" claims, knowing that by resolving them within reason prior to the claims stats being delivered to the Workers' Compensation Bureau, the client would save money on its Mod. The CWCAs met monthly with the HR Manager, the insurance company's adjuster and the Nurse Case Manager to resolve the claims quickly, and get injured employees back to work.


Currently, claims are down more than 90% as a result of having management's buy in to using a tested system for bringing the employees back to work as quickly as possible. The CWCAs' efforts with the "Big 4" yielded results that speak for themselves: 1) there was a 79% reduction in total claims dollars; 2) the Experience Mod was reduced by .18; 3) there was a Workers' Comp three-year premium savings of more than $66,000 and a three-year savings on the claims of more than $400,000.