The first $5,000 of the Total Incurred on each claim (reserves + paid) is called the Primary Loss. This is a very expensive part of a Workers Comp claim. Due to the way the Workers Comp system has been structured, there is no such thing as a small claim.
The original thought was that employers with many small claims are more likely to have more large claims out of the many small claims. This was actually a great way to structure the E-Mod calculation. There is a penalty that was never really assessed properly which may be an unfair part of the E-Mod process.
For example, if an adjuster sets a reserve on a small claim at $10,000. The two parts of the loss would be:
- $5,000 Primary Loss
- $5,000 Excess Loss
Looking at the numbers, you might think that your company will pay the same amount of premium for the first $5,000 as for the next $5,000 of the claim.
Check out my next post to see how the Primary Loss (less than $5,000) can cost your company up to 500% more than the Excess part of the loss.