Four things you need to do after an employee is injured

Your employee was injured at work. You took care of the employee’s immediate medical needs and reported the incident to your workers’ compensation insurer.

What’s next?

You can help prevent similar injuries, get the employee on the road to recovery and ensure a smooth claim process by doing the following:

1. Investigate the incident

The goal of investigating isn’t to find fault, but to understand exactly what happened so you can make sure the same type of injury doesn’t happen again.

Go to the scene of the accident and talk with witnesses to learn what happened. Take photos. Save any equipment involved. Our post on workplace accident analysis tells you how to prepare to investigate incidents and even provides a checklist that can help you think through what happened and how your organization can prevent similar incidents in the future.

2. Consult with your claims representative

Notify your SFM claims representative right away if the employee will be off work. This ensures that the claims representative will have enough time to get wage-loss benefits paid before your state’s deadline.

When the injured worker is released back to work, call your representative. Make sure you’re aware of the status of the claim and the employee’s treatment schedule, and don’t hesitate to ask questions.

3. Stay in contact with the injured employee

Make a call or a visit as soon as you can. It’s important to answer any questions an injured employee has about the expected recovery and return to work.

It’s not uncommon for injured employees to become isolated or depressed and fear they won’t have a job to return to. Reaching out to them early and often reassures them you care about their well-being and are looking forward to their return to work.

For more details on this topic, read our post about staying in contact with injured employees.

4. Arrange for return-to-work

As soon as a doctor clears the employee to return to work, find a way to bring the employee back, even if medical restrictions prevent returning to his or her pre-injury job. Options include finding a temporary light-duty position, reducing hours or adjusting the employee’s regular job to accommodate restrictions.

Make it clear when, where and to whom the employee is to report.

If the accommodation means the employee will be earning less pay, either because of reduced hours or the position pays less, SFM can make up some of the difference by paying temporary partial disability benefits.

Learn more about return-to-work with the post about why return-to-work matters now more than ever to your bottom line.

Benefits of a strong return-to-work program

Bringing injured employees back to work as soon as their doctor allows it is not only the right thing to do, it’s also the smart thing to do.

A strong return-to-work program benefits your employees and your organization. Employees typically benefit from faster recovery, feeling productive, maintaining their routine, and keeping their relationships with coworkers. Employers benefit from reducing the risk of litigation and controlling future workers’ compensation premium increases.

Even when injured employees can’t return to their regular jobs right away, you can bring them back to work as soon as possible by providing modified-duty tasks or reduced hours.

Waiting periods: Your window of opportunity

Workers’ compensation claims that do not result in wage-replacement benefits (called medical-only claims) have less impact on your future premium than lost-time claims.

Whenever possible, you can help claims remain medical-only by bringing employees back to work within your state’s waiting period.

The waiting periods are:

  • Three days in Iowa, Minnesota and Wisconsin
  • Seven days in Nebraska, Kansas and South Dakota

To accomplish this, you may have to move quickly. It pays to be prepared.

How to establish a return-to-work program

If you don’t have a return-to-work program already, follow these four steps to start one:

1. Draft your policy.
Formally state that your company intends to bring injured employees back to work as soon as they’re medically able and will provide adaptations or light-duty work when needed. For guidance, see our sample return-to-work program.

2. Appoint a claims coordinator.
This is an individual tasked with overseeing workers’ compensation claims and return to work. Have this person develop a plan for reporting injuries and communicate it to supervisors and employees. For more details, see our CompTalk on claims coordinator duties.

3. Select a primary care clinic.
Establish a good working relationship with a local clinic where the physicians understand occupational medicine and return-to-work. If possible, meet with doctors at your preferred clinic to give them an overview of your organization and tell them you are committed to returning employees to work as soon as they are medically able. Suggest that your employees go there if they’re injured. Note that in most states, employees have the right to choose where to have their injuries treated.

4. Identify transitional jobs.
Light-duty or modified-duty jobs provide opportunities for your employees to return to work even when medical restrictions prevent them from doing their regular jobs. Put together a list of light duty jobs in advance so that you’re ready when an injury occurs. To come up with ideas, ask your managers, “What would you do if you had an extra pair of hands?” You can also find lists of light-duty job ideas broken down by industry.

How to learn more

Check out our sample return-to-work program, more details on establishing a relationship with a medical provider, and more information on how return-to-work impacts future workers’ compensation premiums.

Retaliation claims: what they are and best practices to avoid them

Most states have laws prohibiting retaliation against an employee for filing a work comp claim. If an employee feels they’ve been wrongfully targeted for exercising their protected right, they may in turn file a retaliation claim.

Some examples of workplace retaliation include:

  • Failing to provide a First Report of Injury Form at the time of injury or telling the employee they can’t seek medical attention for their injury
  • Terminating, laying off, demoting or transferring the employee to a less desirable position
  • Denying the employee overtime, or denying them a promotion or pay increase
  • Reducing the employee’s pay, hours or benefits
  • Giving the employee unjustifiably low performance evaluations
  • Unexpectedly changing the employee’s schedule or work location
  • Intimidating the employee or creating a difficult or unpleasant working environment for them

The cost of termination

It’s important to know that termination of employment does not terminate the work comp claim. Some employers may try to reduce or limit the payable lost-time benefits on a work comp claim by terminating the employee for a reason unrelated to the work injury, however, this idea may ultimately make the claim more costly.

Depending on the circumstances surrounding the termination, temporary total disability and temporary partial disability benefits may still be available to an employee up to the statutory caps on the benefits. Therefore, terminating the employee may cost the employer more in wage-loss benefits compared to actively working with the injured employee to return to work.

Two other examples of benefits an employer could continue to pay after terminating employment are vocational rehabilitation treatments post-injury, and assistance in their search for a new job.

If the employer is found to have terminated the employee in relation to their work comp claim, they may be responsible for paying the employee civil damages, including punitive damages. For example, Minnesota’s work comp state statute 176.82 subd. 2 states that “an employer who, without reasonable cause, refuses to offer continued employment to its employee when employment is available within the employee’s physical limitations shall be liable in a civil action for one year’s wages.”

Insurability of a retaliation claim

Retaliation claims are civil claims made in state district court, and as such are not typically covered under work comp policies. This means you would need to hire your own attorney to defend against the claim.

Tips to avoid a retaliation claim

A work comp claim requires equal cooperation from both the injured employee and the employer, but an employer can take several steps to reduce their likelihood of a retaliation claim. Here are some tips to avoid litigation:

  • Communicate with the injured employee frequently and make sure they know the company cares about their recovery. Maintain a good relationship even if there is a dispute.
  • Include non-retaliation provisions in your company policies and educate employees.
  • Document any reports of harassment or retaliation of the injured employee and investigate them. Communicate your concern to the injured employee and keep them updated on any investigation.
  • Accommodate doctor-prescribed work restrictions.
  • Have a return-to-work plan and make sure to offer light duty job options, when appropriate.
  • Document any performance concerns as they arise, and address them with the employee in an appropriate manner consistent with company employment practices and policies.
  • Consider the possible ramifications before disciplining or terminating an employee.

This is not an exhaustive list. For tips on how to avoid litigation in general, view our Avoiding Litigated Claims webinar on sfmic.com/webinars.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

When is PTSD covered by workers’ compensation?

When an employee experiences a traumatic event at work, workers’ compensation coverage is probably the last thing on your mind. But knowing how post-traumatic stress disorder is defined and covered in your state can help you make sure your employee gets needed help.

For PTSD to be covered by workers’ compensation, it must meet the criteria as described in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, and be diagnosed by a psychologist or psychiatrist.

By definition, symptoms must last or start a month or more after the event to be considered PTSD. Symptoms that last less than a month are considered acute stress disorder. This nuance is important when it comes to how different states handle PTSD claims.

Some states specifically address PTSD in their workers’ compensation laws. In other states, whether PTSD is covered depends on what caused it and whether the state recognizes that event as a work injury.

If the event that led to PTSD was physical, most states will recognize that as a physical/mental injury (that is, a mental injury caused by physical injury) and treatment for PTSD will be compensable. If the employee was involved in a traumatic event, but there was no physical injury, some states may not recognize PTSD as a claim. This is referred to as a mental/mental injury.

Here are the specifics on PTSD in SFM’s core states:

  • Minnesota
    PTSD is specifically addressed in the statute. If an employee is diagnosed with PTSD by a licensed physician or psychologist and the employee meets the Diagnostic and Statistical Manual of Mental Disorders criteria, the claim is covered by workers’ compensation benefits. This is the only type of mental/mental claim recognized in Minnesota. If PTSD is diagnosed as arising from a physical injury, that would be compensable in Minnesota as a physical/mental claim.

    For injuries occurring after January 1, 2019, it will be a presumption that PTSD in first responders is compensable under workers’ compensation, absent preexisting history and limited statutory exceptions. PTSD claimed due to job performance issues, such as demotions and layoffs, is not compensable.

  • Wisconsin
    PTSD is not specifically addressed in the statute. Mental/mental injuries can potentially be compensable if the circumstances causing the injury arise from extraordinary stress. It must be a far greater stress than the expected emotional strain that employees encounter daily without serious mental injury.
  • Iowa
    Mental/mental injuries are recognized, but in order to be compensable under Iowa law, the work condition and circumstances lead­ing to the mental condition must exceed that which is typically experienced by peers in that same profession. PTSD may be compensable without any physical injury to the body under these circumstances.
  • Nebraska
    Mental/mental injuries are not compensable in Nebraska, so a diagnosis of PTSD without any physical injury would typically not be covered. If there is a physical injury to the body and PTSD is a condition that is a result of that injury, it could be compensable as a physical/mental injury.

    However, first responders are an exception. PTSD could be compensable as a mental/mental injury for first responders who are exposed to extraordinary and un­usual stimuli in comparison to normal conditions of their employment. Nebraska statute defines first responders as sheriffs, deputy sheriffs, police officers, state patrol troopers, volunteer or paid firefighters, emer­­gency medical technicians and paramedics.

  • South Dakota
    South Dakota does not cover mental/mental injuries. There must be a physical injury to the body. If an employee sustains a physical injury and claims PTSD as a consequential injury, then it could be compensable.

Intervene early to help employees who’ve experienced trauma

Although PTSD cannot be diagnosed until 30 days after a traumatic event, you shouldn’t wait that long to reach out to your employee. Early intervention can prevent situational anxiety from progressing to PTSD. Encourage any employee who may be susceptible to seek help through your employee assistance program, SFM’s Injured Worker and Family Assistance Program or from a psychologist or psychiatrist.

“If someone has experienced trauma, be it physical or mental, coping skills for them to be more resilient so they can manage their stress and anxiety is what’s going to get them better,” said Director of Medical Services Ceil Jung, RN, BSN, CCM. “Treatment is typically cognitive behavioral therapy (CBT). Symptoms can usually be effectively managed to restore the individual to normal functioning.”

Claim representatives’ best tips to avoid workers’ comp missteps

SFM’s claims representatives spend all day managing workers’ compensation claims. They coordinate with injured workers, employers and medical providers. Many of them have decades of experience in the field. So, when we asked them to give us their top tips for employers, they delivered.

Here’s what the claims adjusters said:

  • When hiring, include the physical demands of the job in the job description. Have prospective candidates sign off on the descriptions to signify that they can perform the essential functions of the job. Pre-employment physicals and criminal background checks are also important.
  • Always investigate after an injury. Document how, when and where the accident occurred. Talk with the injured employee and witnesses, and take photos. If you have surveillance cameras in the area, let the claims representative know. Then figure out how to prevent it from happening again. This information also helps claims representatives to verify what they are told by the injured worker.
  • When bringing employees back to work, work together with the employee to look for ways they can perform their job within their medical restrictions. Your claims representative can also provide suggestions and resources if needed. Require the employee and supervisor to commit to working within those restrictions. It’s always good to put it in writing and get everyone to sign off.
  • Be sure to tell your claims representative right away when an employee starts needing time off for a work injury and when the employee returns to work so that benefit payments are on time and correct.
  • Focus on building strong relationships between employees and direct supervisors.
  • Continue communicating with injured employees, even if they are totally disabled and unable to return to work. Keeping the lines of communication open and letting employees know you care about them is really important.
  • Address disciplinary issues with staff right away. If you don’t, and the employee is injured, these issues become much more difficult to deal with.
  • If an employee is injured in a work-related automobile accident, be sure to send the claim to both your workers’ compensation and auto insurer. If the injury is work-related, workers’ compensation provides primary coverage, and your insurer will pursue recovery from an at-fault party.
  • Make a copy of any paperwork an injured worker brings in, especially any doctor’s reports, and forward to the claims representative.
  • Report all claims right away.
  • Allow your claims representative to deliver hard-to-hear news to the injured worker versus doing it yourself. That helps you maintain a positive relationship with the employee, which is more conducive to a speedy and effective return to work.

 For more tips, read four things you need to do after an employee is injured.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Avoid common mistakes when reporting work injuries

Fast, accurate injury reporting can reduce frustration for everyone involved.

Sometimes it can even reduce costs by preventing:

  • State penalties
  • Litigation
  • Delayed return-to-work
  • Low employee morale
  • Unnecessary medical costs

Following are some of the most common reporting mistakes we see, and ways you can easily avoid them:

  • Not indicating that an employee is missing work due to a work injury.
    As soon as your employee begins losing time from work due to the injury, let your claims representative know, so the employee receives wage-replacement benefits on time. Failing to do this can lead to state penalties and financial hardship for the employee.
  • Reporting late.
    As soon as any supervisor, manager or claims coordinator becomes aware of an injury, the clock starts ticking toward your state’s deadline to determine whether the employee is due workers’ compensation benefits. Missing the deadline can result in significant state penalties. Reporting right away gives your claims representative enough time to investigate the injury before the deadline. See the How to report a work injury page for details on how to report.
  • Incomplete forms.
    If you choose to report your claim by filling out a form, leaving off important information can delay processing of a claim. Especially important details include: Social Security number and date of birth of the employee, date of injury, date of first day of lost time, date employer was notified about injury, and contact information.
  • Communications breakdowns.
    Make sure employees and supervisors understand the process for reporting a work injury at your organization. Delays in reporting injuries sometimes occur because employees simply don’t know who to tell if they are injured.
  • Including sensitive information in first reports.
    In some states, including Minnesota, the injured employee is entitled by law to receive a copy of the First Report of Injury. If you suspect fraud, or have other sensitive information about the incident, report it to your claims representative separately or report your concerns through our website. If you report through the SFM Work Injury Hotline, you can call or email your claims representative about your concerns. If you report the injury using a form, you can write it on a separate piece of paper and attach it to the first report. If you report online, you can type it in the confidential comments box on SFM’s online First Report of Injury.
  • Not reporting questionable claims.
    Sometimes employers don’t report an injury because they think it is suspicious, or not serious enough to report. This is a violation of state laws, which require the employer to report any injury claimed by an employee. Instead, report all injuries, but let your claims representative know about your concerns. Your claims representative will investigate the claim and its circumstances.
  • Sending a First Report of Injury to your agent.
    Please report workers’ compensation claims directly to us. Sending them to your agent can delay our receipt of the report, which can hamper our ability to investigate and respond promptly to the claim.
  • Filing in the wrong state.
    For employers with multiple locations, sometimes there’s confusion over which state to file the claim in. Due to the differences in states’ workers’ compensation laws, this can sometimes be difficult to determine. A good rule of thumb is to file in the state where the employee was hired or typically works. When in doubt, it’s still best to make the report right away and let your claims representative know that you have concerns.

This post was originally published on June 18, 2013, and updated on June 15, 2021.

This is not intended to serve as legal advice for individual fact-specific legal cases or as a legal basis for your employment practices.

Subrogation: When third parties bear responsibility for work injuries

By Tom Davern, Esq., Senior Defense Counsel with Lynn, Scharfenberg and Hollick, and Julie Bischoff, Senior Subrogation and Special Investigations Representative

When one of your employees is injured in the course and scope of employment and a negligent third party bears some responsibility, we can sometimes recover a portion or all of the workers’ compensation claim costs from the responsible party through subrogation.

Each of SFM’s core states have different workers’ compensation subrogation laws, but the basic principles are the same across the board. If a third party’s negligence causes a work injury to some significant degree, there is a possible subrogation claim. The employer and insurer have to prove negligence, causation and damages.

When we recover claim costs, it lowers the impact that the claim has on future workers’ compensation premiums by mitigating the hit to the employer’s experience modification factor (e-mod). In 2020, our Subrogation Team recovered more than $1.5 million. In many cases, SFM recovers 100% of what was paid on the claim. In fact, full recovery was received on over 50% of the subrogation claims in 2020. A complete recovery is most likely when there is no liability dispute and the injury is not serious enough to allow or motivate an employee to pursue a personal injury claim. If the employee pursues a claim for damages against the third party, it usually results in a partial recovery for the employer and insurer.

Common recovery scenarios

Motor vehicle accidents, slip-and-fall injuries and dog bites are just three types of claims where we can often make subrogation recoveries.

For example, if a pizza delivery driver is hit by a drunk driver, we may be able to recover the workers’ compensation benefits paid from the at-fault driver’s insurer.

If there is provable negligence, slip-and-fall claims can result in a subrogation recovery; however, these have to be carefully analyzed on a case-by-case basis. There is not going to be a viable claim if a slip and fall happened in a parking lot during a blizzard, but if a vendor spilled oil in a hallway and failed to clean it up, there may be a claim.

If a dog bites a home health care worker or delivery person at a customer’s home, we may be able to recover costs from the individual’s homeowners or rental insurance policy. SFM also pursues product liability claims, medical malpractice and restitution in criminal matters.

How employers can help

If you have a claim that has recovery potential, your claims representative or someone from our Subrogation Team may reach out for assistance in the investigation. It is helpful to gather and preserve any available evidence in cases that may have recovery potential.

Anytime you think a third party could be responsible for a work injury, let your claims representative know. SFM aggressively pursues recoveries on behalf of our policyholders when another party is at fault.

Common requests for subrogation claims

  • Motor vehicle accident: Police report, photographs of the property damage or scene, third-party driver/insurance information, and video of the incident (if available)
  • Dog bites: Name and address of the dog owner and police or incident report
  • Slip, trip and fall: Photographs of the area of the fall, any available video (we also recommend reporting the incident to the property owner)
  • Assault: Whether criminal charges were filed, and if so, the name of the assailant
  • Product liability claims: Secure the product and provide owner manuals, maintenance records, purchase receipts and manufacturer information (for equipment malfunctions, we recommend also taking photos and keeping any broken equipment)

Work injuries 101: Reporting injuries and supporting workers

No one starts out their day expecting a work injury.

On-the-job injuries are unanticipated, urgent and unfortunate for everyone involved, but there are best practices you can follow to make a bad situation better for you and your injured employee.

When to report work injuries

One key step is to report any work injury as soon as you can. Reporting immediately helps workers’ compensation claims go more smoothly for a number of reasons, including:

  • Employees get any needed care right away
  • Workers’ compensation benefits are paid promptly
  • The carrier has time to review and submit the injury to the state

To make this happen, employees and their supervisors must be trained to identify work injuries and report them immediately. If a supervisor sees an injury occur, or hears about it in another way, in many states the employer is required to report the injury. This is true even if an employee does not formally report a work injury, in most states. In South Dakota, employees are required to report injuries to their employers within a specified time period.

We recommend reporting all work injuries, even if they are so minor they do not require medical attention. This way if the injury worsens over time and does lead to a doctor visit or time off, you will have captured information needed to manage the claim.

Reporting incident-only work injuries (injuries which do not lead to medical or lost-time expenses) does not impact your experience modification factor (e-mod).

How to report work injuries

When you’re ready to report an injury to SFM you have a number of options, but the two most common methods are by phone and online.

You can call the SFM Work Injury Hotline anytime at (855) 675-3501 to report work injuries. Here are a few tips for reporting via the hotline:

  • We now offer a streamlined report-only option during business hours (7 a.m. – 4 p.m., M-F) for situations where the employee does not need to speak with a nurse. We recommend choosing the nurse option when the employee is unsure whether to seek medical treatment. (Calls outside of normal business hours will automatically go to a nurse.)
  • If a supervisor is not available, an employee can call the SFM Work Injury Hotline alone.
  • If the employee has already received medical treatment or is not available for the call, we recommend choosing the report-only option (Option 1) during business hours.

You can also report online on our website (sfmic.com) anytime. You do not need to log in to report injuries online. You just need your policy number. This is a fast and easy choice. Many employers opt to report online in cases where the worker has already received medical care.

For more information on reporting injuries, visit sfmic.com/report and download a copy of our claim packet.

Understanding the injury

After a work injury occurs, it’s important to figure out what happened and what you can do to prevent similar injuries in the future.

You can analyze a work injury in four steps:

  • Collect data: Talk to witnesses, take pictures and review maintenance and training records.
  • Identify the causes: Determine whether equipment, risky behavior, inadequate training, lack of personal protective equipment, the work environment, or other factors were to blame in causing the injury.
  • Analyze the findings: Examine all the facts and distinguish between the immediate causes (such as a broken ladder rung) and underlying causes (such as lack of training).
  • Develop a plan: Identify the steps to prevent similar injuries in the future.

For more information on accident analysis and a worksheet to guide you through the process, download our Accident analysis CompTalk from the resource catalog on sfmic.com.

How to assist employees who are recovering from injuries

When employees are off work due to on-the-job injuries, it’s important to show concern right away and stay in contact until the employee returns to work. When employers don’t reach out, employees can feel isolated and worry that they will not have a job to return to.

We recommend bringing employees back to work as soon as possible, even if you have to modify their regular job or provide light-duty work to accommodate medical restrictions. Bringing employees back to work as soon as you can helps them:

  • Recover faster
  • Stay in the routine of working
  • Feel productive
  • Maintain workplace relationships

This also helps keep wage-loss benefits down, which helps limit the impact of the injury on your future workers’ compensation premiums.

Work injuries are better prevented, but when they do occur, your SFM team is here to help. Your claims representative is always available to guide you through the process and answer any questions. You can also find more resources in the Employers section of sfmic.com.

When an employee is injured, these resources can help

Workers’ compensation waiting periods

A workers’ compensation “waiting period” is the number of days an employee must be off work before receiving wage-loss benefits.

This waiting period is established by state law, and differs from state to state.

It’s worth knowing your state’s workers’ compensation waiting period and the rules surrounding it, because bringing injured employees back to work within this timeframe whenever possible is one of the most important things you can do to control future premiums.

Bringing an employee back to work before the state’s waiting period ends will keep the claim “medical only,” which means claim costs will be reduced by 70 percent when determining your experience modification factor (e-mod).

Waiting periods and rules differ by state

It’s not always easy to figure out when your employee’s waiting period ends due to factors like weekends or partial days.

Different states handle these issues differently.

In all of SFM’s core states of Minnesota, Wisconsin, Iowa, Nebraska and South Dakota, days the employee isn’t scheduled to work (such as weekends) generally count toward the waiting period, with one important exception. In Wisconsin, Sundays do not count unless the employee was scheduled to work.

This means in Minnesota and Iowa, if your employee is injured on a Friday, the waiting period would be Friday, Saturday and Sunday, and benefits would be due on Monday. Therefore, you may have only until Monday to bring the employee back to work to avoid a lost-time claim.

Wisconsin is also the only state of the five where the waiting period does not start until the first full day of missed work. In the other four states, the waiting period starts on the first full or partial day of missed work.

Waiting periods in MN, WI, IA, NE, KS and SD

The following are the waiting periods in SFM’s core states:

  • Minnesota: 3 days
  • Wisconsin: 3 days
  • Iowa: 3 days
  • Nebraska: 7 days
  • Kansas: 7 days
  • South Dakota: 7 days

Days before wage-loss benefits are paid retroactively

State law also defines how many days an employee must be off work to be retroactively paid wage-loss benefits for the waiting period days that were not initially paid.

For example, in Iowa, this number is 14 days. This mean an employee who is off work for 20 days due to a work injury would receive wage-loss benefits for the first three days of time off, but an employee who is off work for 10 days would not.

Again, this number differs by state. The following are the number of days an employee must be off work to be retroactively paid wage-loss benefits for the waiting period:

  • Minnesota: 10 days
  • Wisconsin: 7 days
  • Iowa: 14 days
  • Nebraska: 6 weeks
  • Kansas: 3 consecutive weeks
  • South Dakota: 7 consecutive days

Bringing employees back to work

In many cases, a doctor may allow an injured employee to return to work, but not to their regular job. At times like these, it helps to be prepared with a list of light-duty jobs in advance. For ideas, find lists of light-duty jobs by industry in our blog post Free return-to-work resource provides ideas for light-duty jobs.

How your workers’ comp e-mod is calculated

If you want to lower your workers’ compensation premium, it’s worth learning about a little number called your e-mod.

Why? Because your premium is determined, in part, by your e-mod — and it’s one factor you can actually manage.

So what does e-mod stand for?

E-mod is short for experience modifier or experience modification factor.

The experience modification factor is a multiplier used to calculate your workers’ compensation premium. It shows how your organization’s workers’ compensation claims experience compares to other businesses similar in size and types of jobs.

If your claims history is average among similar businesses, your e-mod will be 1.0. If your e-mod is:

  • above 1.0 it means your business’ claims history is worse than your peers.
  • below 1.0 it means your business’ claims history is better than your peers.

An e-mod less than 1.0 directly reduces the premium amount you pay. The lower your e-mod, the greater the reduction.

That’s the short answer. The longer answer is valuable to know if you want to really take control of your workers’ compensation costs.

What goes into the e-mod calculation?

The e-mod usually takes into account three years of claims history, excluding the most recent policy year. For example, the e-mod for a policy period beginning January 1, 2023, includes claim costs for the policy periods beginning:

  • January 1, 2021
  • January 1, 2020
  • January 1, 2019

Who determines your e-mod?

A state or national rating bureau — not your insurer — calculates experience modification factors.

Depending on your state, either your state rating bureau (such as the Minnesota Workers’ Compensation Insurers Association or the Wisconsin Workers’ Compensation Rating Bureau) or the National Council on Compensation Insurance determines your e-mod. These data collection organizations use statewide claim data to calculate expected losses for different types of operations.

They also calculate individual employ­ers’ e-mods using the claims cost data reported by insurers.

Your data collection organization recalculates your e-mod each year about 90 days prior to your policy renewal date and reports it to you and your workers’ compensation insurer.

Who gets assigned an e-mod?

Not every business is large enough to have an e-mod.

Your workers’ compensation premium has to be above a certain dollar threshold specified by your state before your organization will be assigned an e-mod. This minimum premium amount is usually around $3,000-$7,000.

Which claims costs are excluded from the e-mod?

Not all claims costs are included in the e-mod calculation.

If a claim is medical-only (meaning the employee doesn’t miss any work time due to the injury, or returns to work within the state waiting period), only 30 percent of the claim costs are included in the e-mod calculation. That’s one of the many reasons for a strong return-to-work program.

If the claim is larger, typically involving lost time, there is a discounted rate for losses over a certain amount. This is known as the split point, and is set by each state. For example, in Minnesota in 2023, the split point is $18,500. That means that when the e-mod is calculated, less weight is given to a claim’s dollars over $18,500.

Where to find your e-mod

If your organization is large enough to have an experience modifier and you’re an SFM policyholder, you can find it in three places.

  1. The official notice you receive from your rating bureau each year prior to your policy renewal date
  2. Your SFM policy information page
  3. In CompOnline under the “Policy” tab, on the “Policy information” screen

How to calculate your e-mod yourself

You may want to try to figure out what your e-mod will be following a significant claim, or test out “what if” scenarios.

Each state rating agency calculates e-mods differently, so this isn’t always easy.

The Minnesota Workers’ Compensation Insurers Association offers a free Minnesota Experience Modification calculator . The Wisconsin Compensation Rating Bureau and National Council on Compensation Insurance (rating agency for Iowa, Nebraska, Kansas and South Dakota) offer similar tools for a fee.

To learn more about the e-mod calculation formula in your state, see the following resources:

Keeping an eye on your e-mod is a good habit that will help you understand and then work on lowering your workers’ compensation premium.

Learn more in SFM’s E-mods CompTalk .

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