There's a lot to understand when it comes to insurance. That's why we've compiled a list of answers to the most frequently asked questions we recieve from policyholders.
WORKERS' COMPENSATION CLAIMS
Timely reporting is closely related to the total cost of the claim. The video below provides additional details.
Any injury to an employee that may require attention from a medical professional should be reported immediately. You should also report any injury for which you receive written notification from the injured worker, an attorney, or a state workers’ compensation board.
It's important to understand your responsibilities when an injury occurs in your workplace.
A claims adjuster can take up to 24 hours to respond after you file a claim. To ensure the injured worker gets initial medical care from an in-network provider, visit the TalisPoint website to locate a professional nearby.
TalisPoint Login Credentials
Note: Please do not save searches or panels on the TalisPoint site.
1. FWCI’s partner, CCMSI, will assign a claims adjuster to contact you and the injured worker within 24 hours to provide the claim number.
2. The claims adjuster, a licensed professional, acts as “gatekeeper” of the claim, investigates and determines compensability, administers benefits, oversees adjudication when necessary, and works closely with FWCI’s claims management team.
3. When applicable, a nurse case manager (licensed healthcare professional) will work with the claims adjuster and the injured employee to coordinate medical care and communicate with the employer and medical provider to facilitate a safe return to work.
4. As the case proceeds, you should contact the claims adjuster with any questions that arise.
5. If a medical provider contacts you, direct them to the claims adjuster or CCMSI.
6. Optum is the pharmacy benefits management program administrator. Please be sure employees are directed to purchase prescriptions at their participating CVS and Walgreens locations. To contact Optum, call 833-486-7886.
7. If you receive documentation such as work status notes or notification of legal representation or proceedings, refer them to your claims adjuster immediately, as these are time-sensitive.
8. If you receive medical bills, refer them to your claims adjuster. Do not pay them, as some states view this as an admission of liability.
9. Our partner, Job Fit Accommodation Specialists, can help you craft a return-to-work program for the injured worker that will help mitigate claims costs. Reach out to your claims adjuster or the claims management team at FWCI for more information.
WORKERS' COMPENSATION PREMIUM AUDITS
When your premium was established, it was based on ESTIMATED payroll and other information you provided to your agent. When the policy ends, the audit determines whether you’ve paid the correct amount based on ACTUAL payroll, operations, and job classifications during the term.
A little preparation goes a long way toward a smooth audit.
Premium audits are required as part of policy contracts and workers’ compensation law. Failure to participate can lead to policy cancellation and additional audit fees.
Safety performance is the most significant factor in cost increases and decreases in premiums. Having a formal and active safety program is the key to success.
1. Start by holding regular meetings with employees to review risks and safety measures to avoid injury.
2. As an FWCI policyholder, you have access to a team of loss control professionals. Depending on your needs and insurance program, we will work with you to implement a risk management program that fits your culture. Learn more about FWCI Risk Management Services.
3. Our Policyholder Resource Library has hundreds of templates, programs, policies, and training tools available for your use as a policyholder. Visit the Policyholder Resource Library.
Yes. FWCI rewards workers’ compensation policyholders in Florida; eligible policies qualify for a dividend reward.
Since general liability covers property damage and bodily injuries to a third party, claims typically come from them, requesting reimbursement for damages.
Yes. Our general liability policy includes automatic FCG 1002 (similar to CG 20 10), CG 20 11, CG 20 28, and FCG 1004 (automatic waiver of subrogation). We also offer a broad menu of inexpensive options for both additional insureds and waiver of subrogation coverages.
Your agent is your representative. Contact them with questions about coverage, policy issues, and requests for certificates of insurance (COIs). You should also advise your agent of exposure changes, like updates to payroll or job functions throughout your policy term.
You may contact FWCI for matters pertaining to: Invoices, Billing Statements, Premium Audits, Risk Management Services, and Claims Management Services. Visit the Contact Us page for more information.
Yes. We will mail the state-specific postings. Be sure to post the notices and medical provider panels in a place where employees can easily view them.
An experience modifier or “modification” is an adjustment (up or down) of the annual premium based on previous loss experience. Usually, three years of loss is used to determine it. Since base premium rates are regulated by law, the experience modifier adjusts workers’ compensation insurance premiums for a particular employer based on comparing past losses to the “average” losses of other employers in that state in the same business, adjusted for size.