In late 2021, SFM became a servicing carrier for the Wisconsin Worker’s Compensation Insurance Pool and the first year has been busy.

Through the first two quarters of the year, SFM has been writing 60-80 new policies per week, totaling 1,800 policies for $5.3 million in premium. SFM will take on new pool accounts until reaching 20% of the state’s pool policyholders.

In addition to all the new business, the team is simultaneously preparing for the renewal process, which will begin later this year.

We have increased staff to ensure top quality service as we grow in this new market. While the residual market is separate from voluntary business, all Wisconsin pool customers will receive the same care and service.

“Agents who have worked with us in the voluntary market in Wisconsin and are now working with us in the residual market will see no interruption in service and capabilities,” said Rhonda Wills, SFM Assigned Risk Plan Business Manager. “Our response time, customer service and other offerings are consistent with what you have come to know and appreciate about SFM.”

SFM is one of five servicing carriers for the Wisconsin residual market, and currently has a five-year contract with the option for three one-year extensions.

For questions related to the Wisconsin Worker’s Compensation Insurance Pool, please contact us.

You can also learn more on our website at sfmic.com/state-programs.

View more Agent Agenda articles

As an agent, you know you can rest easy when one of your customers has a workers’ compensation claim being handled by SFM.

Our unique combination of effort, expertise and empathy allows us to provide the superior service that our customers and their employees rely on.

As a monoline carrier solely focused on workers’ compensation, we’re able to offer specialized service that’s tough to match.

Experienced claim adjusters and team-based approach

Our claim adjusters average 10 years of tenure with SFM, and many had prior experience before working here.

They’re highly skilled in guiding injured workers through challenging times and helping them regain their health and productivity. They also support policyholders as they navigate their role in the workers’ compensation claim process.

When they encounter a difficult claim, our claim representatives have a variety of resources available to them including doctors, nurses, claim technical specialists and workers’ compensation attorneys.

Experienced claim representatives often say our rich support structure, and lower-than-average caseloads set us apart from other carriers.

Another differentiator is our team-based approach. SFM claim representatives work as part of cross-functional teams including underwriters, nurse case managers and loss prevention representatives, allowing them to provide holistic service to their customers. For example, a claim representative may provide insights to a loss prevention team member, who can then work with the policyholder to prevent similar injuries in the future.

Enhancing the customer experience of our injured workers is a key focus area for us as well. For example, workers can speak with specially trained nurses when they report through our SFM Work Injury Hotline, and they can access their claim and payment information 24/7 through our online portal.

We are not only proud of the significant tenure of our experienced claim representatives, but we’re also investing in the future of our claim operations through a claims training program this summer. At SFM, we are continually working to ensure we maintain our high level of claim handling for years to come.

Medical cost containment and better outcomes

We help employers keep their claim costs, and resulting premium increases, under control in a variety of ways, including:

• In-house medical bill review — ensures bills are within state guidelines and reflect services delivered
• In-house special investigations unit — investigates potential fraudulent claims and makes subrogation recoveries
• In-house prescription drug clinical review nurse — monitors prescriptions closely to identify signs of addiction and cost containment opportunities
• Pharmacy benefit manager — provides best pricing for prescription drugs

Our in-house doctors and nurses help make sure injured workers are getting the most effective treatments for their injuries, improving the chances of reaching the best possible outcomes for the employees.

Claim service support in growth states

Over time, SFM has established claim handling expertise in a growing number of states. We have teams based in Minnesota, Wisconsin, Iowa and Nebraska. Claims in these states and South Dakota are all handled by our in-house claims representatives.

Claims from other states are handled by Gallagher Basset with oversight by SFM’s claims technical team. Our claims technical specialists pay special attention to claims originating in these states and they can assist agents and policyholders when needed.

Service you can count on

No employee or employer wants to deal with a work injury, but when injuries occur, our skilled and compassionate SFM claim staff is here to offer the expertise and support needed to reach the best resolution possible for everyone involved.

For more information on SFM’s services, contact your SFM underwriter.

View more Agent Agenda articles

A number of changes to the Wisconsin Worker’s Compensation Act were signed into law in April.

One significant change affects the way wage-loss benefits are calculated for part-time workers — employees who work fewer than 35 hours per week.

Under the new law, these workers’ hours will be expanded to 40 hours per week for the purpose of calculating wages if they are also employed by another employer, or they have worked part-time for less than 12 months before the date of injury. An employer can rebut this wage expansion if they can show proof that the employee chose to restrict their hours to part-time.

For other part-time workers, the average weekly wage will be calculated as the greater of:

• The actual average weekly earnings for the prior 52 calendar weeks prior to the injury, excepting any weeks they didn’t work, or
• Their hourly rate at the time of injury multiplied by the hours they were scheduled to work that week

Other changes signed into law in April include:

• An employee who is undergoing an independent medical examination required by an employer and workers’ compensation insurer may now have an observer present at the exam.
• The maximum weekly permanent partial disability benefit increased from $362 to $415 for injuries occurring on or after April 10, 2022. It will increase again to $430 for injuries occurring on or after January 1, 2023. This is the first increase in the rate since 2017.

View more Agent Agenda articles

On April 1, 2022, the Iowa Supreme Court affirmed a district court’s finding in Chavez v. MS Technology LLC/Westfield Insurance Co. that an employee’s injury was a scheduled member injury to her shoulder rather than an unscheduled whole-body injury, agreeing that the definition of “shoulder” should not just be limited to the joint.

In 2018, Rosa Chavez filed a workers’ compensation claim seeking permanent partial disability benefits after she claimed to have suffered a shoulder injury while wringing out a mop at work for MS Technology.

An independent medical examination found that Chavez sustained an acute injury to her right shoulder that included the rotator cuff, tendons and cartilage around the shoulder joint and the attached muscles. Court records indicate Chavez underwent corrective surgery to repair the damage. The independent medical examination also found that the employee was at maximum medical improvement at the time of examination, and she had a 10% upper extremity impairment, which was equal to a 6% impairment of the whole body. Permanent partial disability benefits are generally higher for unscheduled whole-body injuries.

Chavez’s attorney argued that her injury should be classified as whole-body since her symptoms and impairment extend beyond the shoulder joint, and she should be awarded permanent partial disability benefits based on an unscheduled whole-body injury.

Under Iowa workers’ compensation law, the classification of a claimant’s injury as either scheduled or unscheduled determines the extent of the claimant’s entitlement to permanent partial disability benefits.

After several appeals, the case was brought before the Iowa Supreme Court, which upheld the district court’s finding that the employee’s impairment was only to the upper extremity, awarding Chavez permanent partial disability compensation benefits for a scheduled member injury.

This case further interpreted what constitutes a “shoulder” in light of the 2017 amendments to Iowa Code 85.34, sub. 2, that identify the “shoulder” as a scheduled member when classified for workers’ compensation benefits.

You can read the full court decision here .

View more Agent Agenda articles

On May 16, 2022, the Minnesota Supreme Court upheld an award of workers’ compensation benefits to an employee for his hearing loss due to long-term exposure to noise over a 30-year period working for five employers.

In Sershen v. Metropolitan Council, the Minnesota Supreme Court found that Dennis Sershen had suffered occupational hearing loss during his time working in manufacturing. He worked in various roles in manufacturing starting in 1986, in which he claimed he was regularly exposed to hazardous noise levels on the job. He reported his hearing loss began around 1994, requiring him to wear hearing aids.

Following his retirement in 2017, Sershen filed a workers’ compensation claim for medical benefits for hearing loss and permanent partial disability against his five past manufacturing employers – Streater Inc., Truth Hardware Corp, SPX Corp, ATEK Cos. and his most recent employer, the Metropolitan Council.

Sershen then settled his claims against SPX and ATEK on a Pierringer basis prior to the hearing, with the two companies paying lump sums to the employee to be released from the litigation and making it so that neither the employee nor the other employers and their insurers could later collect from them.

At the hearing, the compensation judge ordered Sershen’s last employer, the Metropolitan Council, to pay his medical benefits, citing Minnesota Statute 176.135, subd. 5, which assigns liability to the employer and insurer on the date of the last exposure to the hazard. The judge found that Sershen’s last exposure to a noisy environment was at the Metropolitan Council and his last significant exposure was at SPX. The judge did not make any findings on whether the employee had sustained a disablement and was owed permanent partial disability, instead declaring the issue moot.

The Metropolitan Council appealed the judge’s decision and the Workers’ Compensation Court of Appeals (WCCA) affirmed. The WCCA also clarified that the permanent partial disability issue was moot because of the Pierringer settlement between Sershen and two previous employers, one of which was SPX, which was found to be Sershen’s last significant exposure and a contributing factor to his hearing loss.

The Metropolitan Council appealed again, and the Minnesota Supreme Court once again affirmed that under Minnesota Statute 176.135, subd. 5, the Metropolitan Council was liable for paying the medical expenses as it was the last exposure, regardless of whether that exposure was significant. The Minnesota Supreme Court then remanded the case to the hearing court to determine whether Sershen sustained a disablement and is therefore owed permanent partial disability benefits.

The Minnesota Supreme Court explained that if disablement is found, then under Minnesota Statute 176.66 the Metropolitan Council will be able to seek reimbursement for medical benefits paid to Sershen from the employer deemed the last significant exposure to the employee’s hearing loss, SPX. However, since SPX settled on a Pierringer basis, the employee would then have to reimburse the Metropolitan Council if disablement is found.

The Minnesota Supreme Court reasoned this approach matches the legislative intent which allows the employee to timely collect benefits while the employers and insurers parse out liability for the last significant exposure.

You can read the full court decision here .

View more Agent Agenda articles

Policyholders continue to give SFM’s premium audit experience high marks in follow-up surveys.

For 2021, ratings from policyholders who completed online or mail-in audits averaged 4.1 out of 5, and ratings from those who had physical audits averaged 4.6 out of 5.

“We take pride in the high ratings and positive comments we get from policyholders on our premium audit process,” said Premium Audit Team Leader DeAnne Misgen. “We’re continually striving to provide excellent service and add convenience for our customers.”

View more Agent Agenda articles