What Makes A Complete Workers’ Compensation Insurance Submission?

Home care provides vital medical and personal care assistance to ill, elderly, convalescent, or disabled individuals who live in their own homes instead of a healthcare facility, and is one of the most rapidly expanding industries in this country. Workers in this sector often facilitate a smooth transition of patients from a hospital to a home setting. They offer patients the unique opportunity to receive quality medical and personal care in the comfort of their own homes.

Along with contributing greatly to the well-being of others, these home care workers also face unique risks on the job to their own personal safety and health, with hazards that include overexertion; stress; slips and falls; verbal abuse and other forms of violence in the home or community; blood-borne pathogens; needle sticks; latex sensitivity; temperature extremes; and unhygienic conditions. Additionally, moving from worksite to worksite (in the home care setting) also exposes a home healthcare worker to transportation-related risks.

Having the safety net of Workers’ Compensation insurance is critical to home health care employees, especially in the unfortunate event of an on-the-job accident or loss. For an employer, Workers’ Compensation coverage is mandatory in most states, and serves to help get workers the medical care they need to heal and return to work as soon as they are able.

When looking to place Workers’ Compensation coverage with an insurance carrier, it’s important for insurance agents and brokers to submit all the necessary information in order to receive accurate underwriting evaluation and premium determinations. When information is missing or inaccurate, miscalculations and problems can occur (for example, in how employees are classified) and appropriate rating or premium discounts may not be applied.

The following components are required to submit a complete Workers’ Compensation application for home care providers:

  • ACORD Application: Including the insured’s FEIN, description of operations, Workers’ Compensation class codes and payroll, and details of the exact nature of work performed.
  • Supplemental Application: Specifically designed for the home health care and related industries, with questions unique to the type and location of operations the workers and volunteers in these niche markets perform.
  • Experience Modification Worksheet: Depending on the state, a typical worksheet will include, among other items, the following: employee classification codes; effective date of the experience modification, which typically corresponds with the policy’s effective date; payroll by classification code; expected loss rate; expected losses; D-Ratio – the mechanism used to divide expected losses into primary and excess amounts (the difference between the D-Ratio for each classification reflects differences in the severity of claims by job classification); summary of claims and actual losses; injury type and number of claims (for example, death, permanent total disability, medical-only claim, etc.); open/closed claims; actual primary and excess losses; experience period totals; experience modification; and loss-free rating, which is the experience modification that would have been calculated if zero actual losses were incurred during the experience period.
  • Current Loss Runs: Current year plus three to five years of loss runs. A basic loss run will include: claim number; employee’s name; date of loss; status of each claim – medical only, complex medical only or indemnity; amount of money paid on medical benefits; amount of money paid on indemnity benefits; amount of money paid on claim handling expenses; and amount of unpaid reserves for medical, indemnity and expenses on each claim. The insurance underwriter will review for trends in both frequency and severity.
  • Proof of MVR Review/Safe Driving Training in Place: Home health care workers may often use their own vehicles to transport clients to outings or appointments and are exposed to vehicular accidents. Not only does a Workers’ Compensation exposure exist, but there are also liability considerations if a home health care agency is sued by the client and was deemed to have not taken adequate safety precautions or otherwise failed to ensure that the employee is qualified to perform his or her job duties. Home health care providers can be held vicariously liable for damages if it can be proven that they negligently entrusted a driver to operate his or her own automobile on the job without first looking into the driver’s record, where they would have discovered the driver was unfit. For example, drivers may be deemed incompetent if they were not qualified to operate a vehicle at the time of the accident, had a history of accidents or violations, or lacked proper skills. This is why obtaining and submitting motor vehicle records (MVRs) of employees who drive on behalf of a home health care agency should be checked regularly. It allows for screening of high-risk drivers, minimizes organizational exposure and helps to assess both Workers’ Comp and liability exposures. Additionally, a safe driving training program and documented practices support an insured’s commitment to do it all it can to minimize potential vehicular accidents among its employees that are traveling in their own vehicles in the course of the business day.
  • Return to Work (RTW) Program: With a RTW program in place, a home health care firm demonstrates its’ dedication to having a productive workforce and getting workers back on the job. RTW programs assist in helping to control Workers’ Compensation costs by establishing transitional jobs within the company for injured workers, providing them with temporary employment that takes into consideration their physical restrictions, skills, interests and capabilities. Employers improve cooperation between them and the injured, which results in less litigation, reduced system abuse and higher worker morale. Health care firms can also participate in programs that temporarily place their injured workers with a non-profit organization until they are able to return to their regular duties.

Manchester Specialty provides Workers’ Compensation insurance to home health care, hospice, companion care and medical staffing firms, and is available to assist agents and brokers in securing the coverage these employers require to protect their workers in the event of an on-the-job accident or illness. Our submission requirements and applications can be found here for easy reference. If you would like additional information about our products, please contact us at 855.972.9399.