WCIRB XMod Decision Includes COVID-related Claims With Three Caveats 

The WCIRB XMod decision last week should provide employers somewhat of a break for incurring COVID-related claims. WCIRB is the Workers Compensation Insurance Rating Bureau of California.

(c) Wikimedia Public Use – Pharex Outbreak Map

A question was sent to NCCI (National Council on Compensation Insurance),  as I write this article, to see if the rating bureau for 40 states is going to do the same. I know the answer but wanted to verify it. Check out an article later this week to see what was discovered with my NCCI communique.  

The three caveats with on the WCIRB XMod ruling do not involve the WCIRB directly. By the way, the WCIRB treats me very well when I have questions for their staff. I attended their most recent mini-conference at their Oakland HQ in January.  

The three caveats involve your insurance carrier or Third Party Administrator (TPA) and the reporting employer. Think about the situation for a moment. What the carrier or TPA inputs from the First Report of Injury (FROI) becomes beyond critical information.   

Some readers may likely think that TPAs do not report claims to the rating bureaus.Two of our agent clients have placed policies with carriers that use TPA’s for claims handling. Whatever the TPA inputs the carrier reports. 

Caveats for WCIRB XMod Decision

The three caveats are:

1. The employer has to report the claim accurately as being related to COVID. No assumptions can be made with the FROI. If you have the treating physician’s note that relates the claim to COVID, attach it to the FROI.
2. Even more critical, the TPA or insurance carrier MUST CODE the claim as COVID. This is where the proverbial rubber meets the road. No matter what occurred in the claim, if it is not coded as a COVID claim, then #1 above and #3 below will mean very little. 
3. The physician must relate the claim to COVID-19. Without this diagnosis and report, the claim likely will not be reported as a COVID-related claim and will peg to your XMod. 

More minor caveats exist. The three above cover enough ground.   

FROI and Claim Verification 

How do you verify that the COVID-related claim will be excluded From Your XMod?   

1. Have a working relationship with the claims adjusters handling your claims – you do know who they are, correct?
2. Attach the treating physician’s note to the claim – may not be allowed in a few states 
3. Email the claims adjuster 15 days after filing the FROI to verify that the claim is considered COVID-related 

Take the time to make sure your company or organization does not pay a higher premium after the benefit of the WCIRB COVID decision. 

This blog post is provided by James Moore, AIC, MBA, ChFC, ARM, and is republished with permission from J&L Risk Management Consultants. Visit the full website at www.cutcompcosts.com.

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