BLOG: You can’t play by the rules if you don’t know the rules

In workers’ compensation, there are rules both the employer and the insurance company are required to play by, and it is the responsibility of the agent to help them play the game well

by Preston Diamond

In any endeavor where performance is measured, there are rules that need to be followed. In their new book, On the Origins of Sports, (http://www.amazon.com/Origins-Sports-Original-Everybodys-Favorite/dp/1579656846/) authors Gary Belsky and Neil Fine recount how the original sets of rules for most sports were created so that there was a consistent way that competitors from different places could face each other without controversy.

      It’s pretty much the same for Workers’ Compensation. There are rules that both the employer and the insurance company are required to play by. We can’t expect employers to know these rules, so it becomes the responsibility of the agent to help the employer play the game well. And in order to know the rules, you need access to the rule books.

     Depending on the state you conduct business in, we recommend a number of valuable resources that that are a must-read for any insurance agent in the business of selling Workers’ Compensation:
  • The Basic Manual. This is the manual that contains the fundamentals of how Workers’ Compensation works. Rules about how to classify a business, what money is and is not included in the premium audit, and much more. The basic manual also has information about individual classifications.
  • The Experience Rating Plan Manual. Here are the rules that govern how the experience modification factor works. Who is eligible, what happens when businesses combine, how mistakes are handled.
  • Scopes Manual. Written only for NCCI states, the Scopes Manual contains the definition for each class code that is currently available. An absolutely mandatory resource needed in order to be sure that your clients are classified correctly.
  • The Analysis of Workers’ Compensation Laws. Available from the U.S. Chamber of Commerce at https://publications.uschamber.com/, this book contains a simple breakdown of the individual Workers’ Compensation statutes of every state in the U.S., plus U.S. territories and Canada. If you have clients who operate outside of your home state, this resource will help you understand the differences between states.
      For the first three publications, if you are in an NCCI state the easiest way to gain access to these manuals is through NCCI.com. There is a fee associated with having a subscription to the manuals and NCCI can walk you through how that works. If you are in an independent bureau state, the manuals are available on the bureau website for free.

     Too often, agents try to dispute some result in their client’s Workers’ Compensation programs because “something doesn’t feel right” or “I don’t think that’s how it’s supposed to work.” That is unacceptible. When you don’t know the rules, you simply can’t do the best job for your clients and your ability to fight back against something that is wrong is severely hampered. Get your hands on the rule books. You owe it to your clients.
 
Preston Diamond is the founding member and current Managing Director of The Institute of WorkComp Professionals, which educates, certifies, and mentors insurance agents in Workers’ Compensation insurance. During his long career, Preston has taught insurance at a California Community College, chaired a week long insurance agency management school for six years, presented more than 300 times at seminars and workshops and has consulted with more than 400 insurance agencies. For more information visit www.workcompprofessionals.com

 

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