2024 Sees COVID-19 Claims Reporting Changes in California

Author, Megan Lockhart, Client Communications Coordinator, Rancho Mesa Insurance Services, Inc.

As of January 1, 2024, several COVID-19 claims reporting requirements are changing for employers in the State of California.

Beginning this year, employers are no longer required to report COVID-19 cases to their carrier in order to determine workplace outbreaks.

Additionally, COVID-19 is no longer automatically assumed to be a work-related illness. Previously, if a certain number of employees tested positive for COVID-19 within a specific amount of time, those employees’ workers’ compensation claims were presumed work-related, making them eligible for benefits. Now, if an employee claims a COVID-19 injury, it will be treated as a regular claim instead of a presumed work-related illness.

Also, the time frame for deciding liability in COVID-19 injury claims, previously 30 to 45 days, has now returned to the original 90-day timeframe.

Employers are still required to follow Cal/OSHA’s reporting requirements regarding a COVID-19 case, and clients should be aware of their location’s county health department reporting standards. Although most no longer require reporting, health departments such as Los Angeles County still demand companies report employee COVID-19 cases over a certain number.

For questions regarding these changes, visit  www.dir.ca.gov/dosh/coronavirus.

The Importance of Timely Workers’ Compensation Claims Reporting

Author, Casey Craig, Account Executive, Rancho Mesa Insurance Services, Inc.

Injuries, accidents, and mistakes happen. When a work-related injury occurs, a common reaction from many business owners is an instinct to NOT report the injury to their workers’ compensation carrier for fear of increasing their company’s Experience Modification (EMR). However, they couldn’t be more wrong. Timely reporting of all claims is the first step in controlling claim costs and lowering their EMR.

Best Practices would demand that all claims get reported within 24 hours, if at all possible. By doing this, it provides the best possible outcome and will impact the claim in several positive ways:

Reducing Fraudulent Claims

One of the biggest frustrations in the workers’ compensation industry for most employers are the number of fraudulent claims that find their way into the system. Immediate accident investigation, witness statements and pictures followed by reporting the claim to the carrier within 24 hours of the injury, will give the employer and the carrier the best opportunity to deny a claim. The insurance carrier only has 90 days from the date of injury (not from the date reported) to deny a claim. This shortens that time-frame and allows more fraudulent claims into the system.

Lowering Litigation Rates

Another area employers find both frustrating and costly are the number of litigated claims that occur within the workers’ compensation system. Litigated claims on average will add 30% to 35% to the ultimate cost of a claim. While there are many ways employers can impact this area, perhaps the most controllable is the timely reporting of any injury. To further support this, it has been proven that the litigation rate for claims goes up 300% if the claim is reported 5 or more days after the injury occurred.

Identifying Claim Trends Early

By not reporting all claims or by reporting them late, employers can develop unreliable data in their effort to identify claim trends and root causes. Without this information, businesses in all sectors run the risk of a severe injury occurring from an area that could have been addressed if all claim data was accurate and analyzed.

When an injury occurs, do a thorough accident investigation that details all events that caused the injury and immediately call your workers’ compensation carrier. This one habit alone will help you lower claim costs and manage your EMR.

To learn more about this process, including benchmarking and analytics that can help control your loss ratio and lower premiums, please reach out to me, Casey Craig at (619) 438-6900 or ccraig@ranchomesa.com.

Protecting Employees from Third Party Harassment

The recent changes to California’s Anti-Harassment Training Requirements have prompted employers to take a closer look at their internal operations and how they can eliminate harassment from the workplace. A question that is frequently asked is “What happens if the harassment comes from someone other than one of my employees?” This is known as Third Party Harassment.

Third Party Harassment is when someone outside the organization harasses an employee. With a heavy focus on home care/home health care, third party harassment can arise between a nurse and an elderly client. In some cases, advances are made towards a nurse - further compounded in some cases by dementia or Alzheimer’s. Restaurants and bars are another common place where this type of harassment can occur when a patron or supplier harasses an employee. However, this type of harassment can occur in any industry where employees interact with people outside the organization. Several questions arise in these instances: As the employer, am I liable for third party harassment?  What can I do to address this? Can I insure against this type of harassment?

Is the employer liable for Third Party harassment claims?

The short answer is yes. An employer is responsible for creating and maintaining a harassment-free workplace for their employees. Failure to act on a third part harassment claim is not an option.

What can an employer do to address a potential situation?

If you become aware of an alleged act of harassment, act quickly. Engage the employee with sympathy. Not only will this show them that you care, but you need their input if you are going to maintain a safe work environment. Implement corrective actions immediately and ensure the employee will not be adversely affected. Investigate the incident through interviewing and evidence collection. Document all that was discovered and determine who is involved and what occurred. Depending on the seriousness of the incident(s), legal action may be necessary. In many cases, simply removing the employee from the situation and have a conversation with the alleged harasser is all it takes. For example, with the employee’s input, you may switch their schedule to work with a different client. If your employee is a sales representative, you might try switching accounts with another employee so they no longer need to work together.

If the harassment continues or is severe, you may need to stop doing business with the alleged harasser. While this might be difficult to do, the long term effects on employee morale and decreased likelihood of a harassment suit are worth it.

Does insurance cover these suits?

An Employment Practices Liability Insurance (EPLI) policy can cover against such claims, but only if it specifically includes “Third Party” in the wording. Some EPLI policies exclude or limit coverage. It is important when working with a broker that you clarify the coverage so you aware of what you are buying. 

Rancho Mesa Insurance clients have access to free online supervisor and employee Anti-Harassment training designed to educate the entire organization on the types of harassment, remedies, and the organization’s responsibilities.

If you have any questions, or any questions regarding California’s New Anti-Harassment Laws, please contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.

Understanding Your Claims: What Do You Have To Lose?

Author, Daniel Frazee, Executive Vice President, Rancho Mesa Insurance Services, Inc.

Claims happen. They come in all shapes and sizes, from all types of parties, and can cost your company in many different ways. An important aspect of managing the costs of risk start with gaining a clear understanding of your claims. Our clients are always looking to improve their bottom line. This article focuses on just one piece of the pie chart; workers compensation claims. Understanding the nuances of these cases can create measurable plans in the future to reduce frequency and severity of claims and ultimately lower your costs.

DIG UP THE ROOTS

Perhaps the most common problem solving method for identifying causes of problems or faults is referred to as a “Root Cause Analysis.” As someone who likely manages many facets of your business, developing systems that analyze failures of a process makes complete sense. Once a claim occurs, initiate an Accident Investigation that is meant to uncover all of the small details that ultimately led to the injury or incident. In many cases, a Best Practices approach involves this same process for “near miss” incidents. That is, perform the same process despite the fact than injury did not actually result from the incident. This allows your company to refine the approach, improve the analysis, and develop training modules addressing the failure(s).

MORE QUESTIONS LEAD TO ANSWERS...

When claims occur, proactive business owners build a list of specific questions that deliver uncensored facts. Those facts build a story and allow your team a clear view of what really happened. Some examples of questions that can be used by your team are listed below:

• How long had this injured worker been employed with us before the claim occurred?

• Was the employee following protocol when the injury occurred?

• Did the claim occur at the beginning or end of the day?

• How quickly did our team provide assistance and get him or her the care they needed?

• How quickly was the claim reported to our insurance company?

• Have we had incidents like this in the past?

ROLE PLAYING EXAMPLES

While role playing actual incidents and scenarios is not factual, it helps your team walk down a path to understand “what if” scenarios and forces discussion on how to address issues.

Example: Employee ‘A’ was injured when he fell from a ladder and fractured his leg. He had been employed for only two months. The injury that occurred was caused by a lack of proper training as the ladder was not properly secured. This claim occurred in the early morning and the area surrounding the ladder was wet. The team reacted quickly and was able to transfer the injured worker to an emergency room in less than an hour. The claim was reported 3 days from the incident. There have been two other similar “near misses” with ladders that did not result in injury.

Understanding your claims is a vital step in preventing future incidents. An investigation of an incident or near miss can uncover the root cause, explain the circumstances surrounding the incident, and help to identify scenarios and prevention plans. To learn more about understanding your claims, register for the Accident Investigation and Analysis training in Rancho Mesa’s Risk Management Center.

3 Practical Reasons for Timely Claims Reporting

Author, Jim Malone, Claims Advocate, Rancho Mesa Insurance Services, Inc.

When a work-related accident occurs, as a business owner or manager, it is our nature to want to analyze the situation in order to learn how to avoid it in the future. However, the reporting of the incident is equally as important. With the recent requirement to report first aid claims, timely reporting for all claims is recognized as being critical for a number of reasons. 

Employee Morale

First and foremost, timely reporting allows for immediate care of any injuries that may have occurred as a result of the incident. It promotes prompt referral for medical evaluation, documentation of the bodily areas affected, and provides recommendations for treatment. 

Promptly reporting an injury shows the injured employee, and their coworkers, that the company cares about them. When an employee knows the employer cares, they are less likely to litigate the claim, which can significantly reduce the overall cost to the employer.  

Elimination of Hazards

Timely reporting can trigger the immediate assessment of the scene and cause of the accident. The initial focus is to document the area and determine if there is still an injurious exposure or condition present that may need to be addressed to prevent further incidents or injuries. Timely reporting also allows for prompt investigation of the accident and the scene of the accident, identify witnesses, secure faulty tools or equipment for safety and subrogation purposes, and to convey a sense of responsibility and concern for the employee that their safety is of extreme importance.

Prompt investigations into the cause of a near miss, accidents, and injuries can lead to an understanding of the factors that lead up to the incident. Thus, the employer has the opportunity to make changes in processes and improvements in safety in order to prevent future near miss events or accidents from occurring.

Cost Savings

Timely reporting can directly affect the overall costs of a claim. Decreased medical costs are realized when injuries are promptly assessed, allowing for treatment to start immediately. Injured employees tend to recover quickly when treatment is provided right away. Swift recoveries usually result in shorter periods of temporary total and/or temporary partial disability, fewer diagnostic studies, physical therapy visits, injections, surgeries, permanent physical limitations, work restrictions or permanent disability percentages, and lower future medical care needs. This translates into lower financial resources allocated to these claims.

The timely reporting of a claim promotes positive morale among employees; helps remove potential future hazards from the workplace and can significantly reduce overall the cost of incidents.

 
For more information about claims reporting, contact Rancho Mesa Insurance Services, Inc. at (619) 937-0164.

Timely Claim Reporting Lowers Work Comp Claims Costs and Improves Your Bottom Line

Author, David J. Garcia, A.A.I., CRIS, President, Rancho Mesa Insurance Services, Inc.

Studies have shown, by reporting your workers compensation claims in a timely basis, not only will your injured employee receive better medical treatment, it will boost company morale.  Both the injured worker, as well as other employees, will see your sincere concern for their wellbeing.  In addition, timely reporting practices will also improve your risk profile through reducing the overall cost of the claim, which leads to lower loss ratios and lower experience modifiers, thus, resulting in lower premiums and improvement in your bottom line.

The following are four areas that support the early and timely reporting of claims:

1. Manage Claims More Efficiently
Reporting a claim quickly allows the claims examiner:
• To determine whether or not the claim is compensable.
• To meet state regulations that prohibit denial of claims after a specified time period.
• To secure appropriate treatment for the injured worker.
• To conduct an investigation and determine if fraud is suspected.
• To receive timely witness statements and pictures of the incident.


2. Keep The Claim Costs Down – Improve Loss Ratio – Improve Experience Modifier
Delayed reporting can significantly increase workers’ compensation claim costs, according the National Council on Compensation Insurance.
• Claims reported after 2 weeks of occurrence are 18% more expensive than those reported within 1 week of occurrence.
• Claims reported after 3-4 weeks of occurrence are 30% more expensive than those reported within 1 week of occurrence.
• Claims reported 1 month of occurrence are 45% more expensive than those reported within 1 week of occurrence.



Reporting (Lag) Time	Expense Increase
2 Weeks	18%
3 Weeks	29%
4 Weeks	31%
4 Weeks	31%
5 Weeks	45%

_{First Report of Injury: Impact of Claims Cost, 2001 Anne Enleman and Patrick Vice.}

• Most significantly, back injuries, as a group, are 35% more expensive if not reported within the first 7 days post-injury.
3. Reduce Litigated Claims
• 47% of all claims reported after 4 weeks become litigated, which on average increase claims costs by 30%.
  _{Source: NCCI’s Detailed Claim Information data for Report Years 2010 and 2011 case incurred losses valued as of 18 months after report date; not developed to ultimate}
4. Close Claims Faster
• 50% of claims that are reported within the first two weeks close within 18 months.
• Only 29% of claims that are reported more than a month after the accident close within the same timeframe.
  _{Source: NCCI’s Detailed Claim Information data for Report Years 2010 and 2011 case incurred losses valued as of 18 months after report date; not developed to ultimate.}

If you’re not currently reporting your claims timely, we strongly encourage you to adopt this “Best Practice” and make it a part of your company’s overall risk management program. Reporting your claims on a timely basis will get your injured employee the proper treatment quicker, provide your carrier the controls they need to manage the claim effectively, improve your risk profile, and lower your insurance costs.