Impact of Reducing the Experience Modifier

• Reduce excessive workers’ compensation premiums, through our innovative claim reserve audit services, which will lower your experience modifier.

A thorough Audit will assess the following variables:

• Verify accuracy of reserves using first reports of injury and review the circumstances that let to the injury.
• Review claims investigation procedures, including whether subrogation and second injury fund are appropriate.
• Review attending physician’s reports and independent medical reports.
• Review the potential for returning the claimant to either full or light duties, medical rehabilitation or vocational rehabilitation.
• If using medical or vocational rehabilitation, review the appropriateness of this service.
• Request activity checks and surveillance by the insurance company or third party administrator if appropriate.
• Determine whether the insurance company has requested appropriate DIA hearings, including discontinuance, earning capacity, vocational rehabilitation, fraudulent claims, impartial physicians and non compensable claims.
• Review the lump sum demand and advise on appropriateness of settlement.