Workers’ Compensation Mistakes That Will Increase Your Mod Factor

Bob Babcock, Warren G. Bender Co., RCAC Premier Sponsor

When you have a workers’ compensation claim that you feel is fraudulent, you must tell your workers’ compensation insurance company to investigate it. This will give them a 90 day window to investigate the claim before they pay out any money.

However, after the investigation it is very important that you calendar to call back your claims adjuster every three (3) months to see if the claim has been closed. It could take as long as two years to close a claim, and if you are not on top of your claims adjuster, that claim could slip through the cracks and be paid without you being notified.

If the insurance company believes it would be cheaper to get the claim off their books, they have no obligation to contact you if they want to negotiate with the claimant to close the claim. As long as a claim is open, there is a chance that it could be paid and go against your claims history and affect your mod factor.

So, if you see a claim open on your loss runs, keep in contact with your claims adjuster until it is closed. If you don’t, this could cause your mod factor to increase, and you will learn about that after it happens.

There are many changes to the workers’ compensation rules that have been happening and will continue to happen of which you need to be aware, and many of these changes impact your bottom line. If you are not getting phone calls, personal visits or letters from you current agent keeping you aware of these changes, please give us a call at Warren G. Bender for help at (916) 380-5347.