Frequently Asked Questions

These FAQ’s are grouped by General Information, Group Benefits, Liability and Property and Workers’ Compensation to assist you in locating the answer to your question(s) faster.

• General Information
• Group Benefits
• Liability and Property
• Workers' Compensation
• Definitions

GENERAL INFORMATION

What are the advantages of being in the NCACC Risk Management Pools?
The NCACC is focused on designing and delivering risk management programs that meet the unique needs and exposures of the counties. The Pools, which are not-for-profit, are governed by a Board of Trustees which is comprised of county elected officials and county government staff.

Who owns the Pools?
The Pools are owned and governed by the participating members - the North Carolina counties and county entities.

Under what circumstances might I need a broker or insurance agent?
Some individual county members of the NCACC obtain the services of local agents, brokers or consultants to assist them in making their employee benefit decisions. As stated in Board policy, although the NCACC Risk Management Pools do not utilize these services, the Board of Trustees recognizes that these insurance professionals can provide a valuable service to some counties and county-related entities in helping them manage their individual insurance programs.

However, certain questions arise in this type of business relationship that should be addressed by each individual county as a way of evaluating the effectiveness and performance of their consultant and the service they provide. For instance, is the consultant’s service fee-based or commission-based? Once you take into account the annual cost vs. the quality of the services provided, is the consultant’s charge a good value?

In an effort to provide our members with helpful information to assist them in making their employee benefit/group health decisions, we offer the following points for consideration:

1) Is your agent/broker/consultant’s service fee-based or commission-based?
Many employers have decided that a fee-based relationship serves them best, as they feel more confident that this arrangement will guarantee them an unbiased review and recommendation of all products in the market. A concern some employers have expressed is that if the service relationship is commission-based, the consultant may be knowingly or unknowingly influenced by this commission and biased in their recommendation. Typically, commission-based service fees are expressed as a percentage of the total cost and are bundled in premium quotes. Also, keep in mind that fee-based services are more easily negotiated and can usually cost the client much less than the alternative.

2) Does your consultant give you a complete and reliable overview of the entire market, all available insurers, and all viable plans and options?
Besides the recommendations that are brought to the table, what other companies has your consultant reviewed? What did they base their criteria on for contacting companies, requesting quotes and reviewing proposals? Ask questions and do research of your own, to make sure that you are getting a thorough and accurate review of the entire market from your consultant. This is your fiduciary responsibility as a representative of the county, who has made the decision to hire a consultant and contract for their services.

3) Is the consultant’s charge a good value?
Value is a combination of cost and quality. It should be evaluated constantly by the county, not just at renewal time but also throughout the entire year. What level of customer service does your consultant and their representative firm provide? Do they provide a service that is proportionate to/justifies the amount of fees or commissions that are paid? What other services do they provide throughout the year, other than review of policies and options at renewal? Make sure you are getting full-service consulting, if this is indeed what you are paying for, and put your consultant to work for you throughout the entire year. At the very least, make sure the quality of service/benefit is commensurate with the amount of fees you are paying and incurring as an annual budget item.

We hope this information is helpful to our members as you evaluate an existing or potential relationship with an employee benefits consultant. As a reminder, please keep in mind that current Board policy for the Risk Management Pools is that consultants will have no bearing on the cost of the coverages quoted to current or prospective members, that all fees charged by the consultant are the responsibility of the member, and that because the contractual relationship is between the member and the consultant, the Pools cannot be responsible for any billing or payment of consultant fees. If you have any questions, please feel free to call a staff member of the NCACC Risk Management Pools.

How do I take my multi-pool discount if my group benefit renewal date is NOT July 1?
Members who have an “off-cycle” renewal date for their group benefits and who participate in all three pools, take their two pool discount at July 1. Then when the group benefit renewal occurs and the member continues to participate in the Group Benefit Pools, they take the difference between their two and three pool discount.

What is the process for getting a quote from the Pool?
The county or entity will need to complete a risk questionnaire and return it to their marketing representative. Upon receipt the questionnaire will be reviewed by Underwriting for completeness. Once it is determined the questionnaire is complete a proposal will be provided to the member.

What information do I need to provide to the Pools to receive a quote?

The risk questionnaires, when fully completed, will provide all the information a county or renewing member will need to provide. Due to certain exposures or claim loss history, the Underwriter may need additional information and will have the marketing representative contact you to obtain this information.

NOTE: Engineering reports are needed on dams when a member is requesting excess or umbrella coverage. If this is not provided, the excess carrier will exclude dams. This could affect coverage if the excess underwriter feels the dam is too big, is faulty, downstream exposures, if the dam generates electricity – something that is not

How can I benefit by reducing my losses?
The Risk Management Pools provide access to loss control consultants from Marsh, our service partner. By instituting safety and wellness programs that prevent losses over a period of years the results should reflect a decrease in occurrences and loss payments. By demonstrating an ongoing commitment to loss prevention and risk control the resulting decrease in the total incurred loss ratio will allow the underwriter to rate your risk on the improved results.

What is a Participation Agreement?
The NCACC Participation Agreement is the annual agreement between the members and the Association that sets forth the terms and conditions the county and the pool must abide by to participate.

Why do I have to sign the participation agreement?
The Participation Agreement is the contract between the Risk Management Pools and the county or county entity to provide coverage or reimburse for the coverage.

Where do I send my contribution payment?
Members send their payments to the address listed on their invoice. The Pools have accounts set up at Wachovia bank and the payments are held at a lockbox with the method of payments varying by Pool.

How do I contact Sedgwick Claims Management Services to discuss a claim?
Liability and Property
Contact: Myra Norman, Operations Manager
Sedgwick Claims Management Services
4824 Parkway Plaza Boulevard, Suite 150
Charlotte, NC 28217
Phone: (800) 822-4469 ext. 6220
e-mail: Mnorman@sedgwickcms.com

Workers’ Compensation:
Contact: Tom Stuart, Workers Compensation Supervisor
Sedgwick Claims Management Services
4824 Parkway Plaza Boulevard, Suite 150
Charlotte, NC 28217
Phone: (800) 822-4469 ext. 6217
e-mail: TBA

Should I report all claims regardless of size or severity?
You should report all claims regardless of size in accordance with the terms and conditions stipulated in the coverage document.

Is the Pool subject to the Terrorism Act?
No, the Pool is not subject to the Terrorism Act but does provide coverage for losses as a result of a terrorist attack. Coverage is afforded under the following sections of your policy.

The annual aggregate limit is $100,000 after a $10,000 which is listed on the Declarations Page of each member policy.

What are administrative costs?
Those are the fees charges by the pool to oversee the Pool programs to reimburse the vendors such as Marsh, CIGNA and Sedgwick for the services they provide to the pool. Often the administrative cost is the dollars it costs the Pool to do business above and beyond the cost of the reimbursement of claims and the stop loss charges.

What benefits do I receive as a member of the Pools at no additional cost?

Property and Liability:

• Annual Property Appraisals
• Risk Control services to help identify claim loss trends and corrective action plans
• Quarterly detail claim loss and payment reports (STARS)

Workers Compensation:

• Unlimited statutory coverage
• Quarterly detail claims loss and payment reports (STARS)

Group Benefits:

• Access to the new CAPE network
• Access to the CIGNA North Carolina and national provider networks, disease management programs, claims administration, mental health and Caremark's pharmaceutical programs.
• Stop-loss coverage provided by the pool
• Access to your own NCACC marketing representative to assist you with buying decisions and interpretation of your health risks
• Annual, quarterly and monthly reporting on group claims activity through MedStat
• Pooling and group purchasing power to assist in controlling costs
• For self-funded groups, a certified actuarial statement on IBNR
• Hands-on and attentive customer service provided to you by NCACC staff
• Cost controls on administrative fees
• Governed by your peers to make decisions in your best interest
• No-charge COBRA administration for health or dental benefits

Who do I contact with questions or problems?
Contact your Marketing Representative with questions or problems. They will assist you by answering your question or help resolve your problem.

Who is my representative?
If you do not know who your representative is contact the NCACC Risk Management Pools at (919) 719-1100 and we will get you in touch with them right away.

Is there a telephone number where I can talk to a live body?
You can reach the NCACC Risk Management Pools offices at (919) 719-1100. Your call will be directed to the right person depending upon your need.

Why doesn’t the NCACC and the League combine their insurance Pools?
The NCACC and the League have spoken and continue to discuss the option of combining portions of their Pooling operations, such as risk control. While the NCACC chooses to quote those prospects that meet the criteria for inclusion to the Pool, and quotes them accordingly, the League does not quote every prospect that is identified.

How do I qualify for multi-pool discounts?
After one year, members earn discounts for participating in at least two Pools. Members who participate in all three Pools receive an additional discount.

How do I take/receive credit under the Multi-pool Discount?
A discount statement is issued upon receipt of all required renewal/enrollment paper work. The coupon allows the member to apply the credit to the invoice of their choice by attaching to the coupon to that invoice when submitting payment.

If I forget to take my Multi-pool Discount, can I take it in the following year?
A member must take their multi-pool discount in the year that it is earned.

Who re-insures the Pools?
The North Carolina Association of County Commissioners operates three insurance pools, for 2006-2007 coverage provided is:

Property is covered under blanket replacement cost with a pool limit of $250 million for any one occurrence. Crime is covered with a $250,000 limit. The pool retention is $250,000 for any one occurrence. Equipment coverage is placed outside of the pool.

Workers’ Compensation is covered to statutory limits with the pools retention of $750,000 and additional coverage provided by County Reinsurance Limited and AIG.

General and Automobile Liability is covered at a $2,000,000 limit with optional additional limits. The pool retains $500,000 of any one occurrence additional with reinsurance provide by County Reinsurance Limited and AIG.

Employee Benefits are covered with an annual unlimited benefit amount. The pool retains $250,000 of any claim with reinsurance provided by Symetra.

What is the assigned risk pool?
This is the market of last resort; the State assigns a carrier to the group.

GROUP BENEFITS

How do I contact CIGNA to discuss a medical claim?
You may call (866) 622-2288. Send medical claims to: CIGNA, P.O. Box 5200, Scranton, PA 18505-5200.

How do I contact CIGNA to discuss a dental claim?
You may call (866) 622-2288. Send claims to: CIGNA, P.O. Box 188037, Chattanooga, TN 32422-8037

What is the difference between an Administrative Services Only Program (ASO) also known as a self-funded program and a Standard Program?

Administrative Services Only (ASO)
Administrative Services Only groups is a self funding mechanism through the NCACC Group Benefits Pool. Services are provided for group medical specific, aggregate, and administrative rates and dental administrative rates at a specified amount for a 12-month period. An Expected Claims rate (dollars incurred) is set from the claims experience the member has provided to the pool. In addition to the expected claims payments the member is responsible for Specific Stop Loss, Aggregate Stop Loss, Administrative Costs, and other costs if applicable.

Available only to member groups, 200 lives or more, unless prior approval is given by the Pool.

The Member is at full risk on the account. CIGNA and Caremark administers the paid claims for NCACC-GBP. The member group purchases specific and aggregate stop loss from NCACC-GBP.

All claims paid in a given month are the responsibility of the member and their chosen specific stop loss is applied to each member’s cumulative claims. Once a claim reaches the specific level, the member group is reimbursed for claims amounts over the stop loss in their monthly standing of accounts. Aggregate Stop Loss does not apply until the end of the contract year when all paid and incurred claims are adjudicated. The Pool will settle up with the group approximately two months after the close of the plan year.

Standard
Standard funding programs from the NCACC Group Benefits Pool are designed to provide group medical and or dental coverage at a specified set of rates for a 12-month period. The rates are inclusive of all costs including expected claims, administrative fees, specific pooling and incurred but not reported claims. The Members purchase set rates on a tiered basis for employees and dependents.

Rates are developed from group experience, NCACC-GBP manual/book rates and/or a combination of both. The NCACC Group Benefits Pool takes on the full risk of these groups.

Available for all size groups.

How long does it take for stop-loss credits to show up on my invoice?
Group Benefits tracks stop loss on a monthly basis. Therefore, you should expect to receive stop loss credits no later than two billing cycles after the claim is paid. Actual monetary credits are given only to self-funded groups and show as Stop Loss Credits on the monthly standing of accounts.

Who is responsible for communication HIPAA privacy issues?
The NCACC issues a Notice of Privacy to each new main subscriber on the Group Benefits Plan. Likewise, the Pool retains Business Associate Agreements with its ASO Member Groups, Large Groups (those having over $5 million in annual contributions) and its vendors. The Pool has taken all reasonable steps to insure compliancy in its own operation and that of its vendors.

Counties have HIPAA implications that go beyond the group health plan and should refer to these issues to their county attorney and/or Privacy Official for help with HIPAA compliance.

How long does it take to get an employee added (new)/deleted (terminated) and what is the process?
All modifications to an employee’s coverage or the enrollment of a new employee or dependent must be done in writing on the NCACC's forms. Once the Manager Self Service has been provided to a member group these types of enrollment activities can be handled at the member level through the internet and paper enrollment forms will not be necessary. The NCACC will collect the data within its Benefits Workstation system. Two times weekly, the NCACC will send a full file transfer to CIGNA and Caremark. They will receive the data and download it into their system. Any system discrepancies or “kick-outs” will be worked through a concerted effort between the NCACC customer service unit and CIGNA and Caremark. Once the data is uploaded it overwrites the record (or adds the record). An ID card is prompted and sent to the member, when applicable.

Do I have the option to modify my plan to help manage my costs based upon utilization?
You may modify your plan(s) annually at renewal with the advice of our marketing representatives.

How often can I modify the plan to better meet the needs and financial position of the County?
You may modify your plan(s) annually at renewal.

Who do I contact for an explanation of plan modifications and potential savings? Plan designs/plan options?
Contact your Marketing Representative who will work with you and make recommended changes and the savings to the county and the impact on employees.

What are an employees COBRA rates?
COBRA rates are based on the contribution amount currently being paid by tier. The member does not establish the amount charged for COBRA; instead, the Pool requests that ASO members provide to the Group Benefits Pool, the amount they charge employees, by tier. This is truly the amount that is charged to a COBRA participant.

Is there a cost to the County for the Group Benefits Pool to administer the COBRA benefits?
The Group Benefits Pool does not charge for COBRA administration although many traditional health insurers charge a 2 percent administration fee.

What benefits do I receive as a member of the Pools at no additional cost?
We provide to our groups, free of charge, actuarial services (incl. actuarial opinions and IBNR letters) group benefits accounting and reporting, etc. Normally these services would be additional costs to the county should they request them from their TPA or insurer.

Do I need to retain someone for rate forecasting, IBNR figures, etc.?
It is always your option to seek outside advice in these areas; however, the Pool provides these services to you free-of-charge.

When an employee is terminated, when is their coverage terminated?
The employee needs to contact their Human Resources Department to determine the actual date their health insurance coverage is in force as the date more than likely is different than the termination of employment date and the county sets its own eligibility parameters based on their employment policies.

Does the Pool Provide inmate medical coverage?
The Group Benefits Pool does not provide inmate medical coverage; however, there is inmate medical coverage available through Marsh that acts like specific stop loss coverage. Counties may choose levels of $5,000, $10,000 or $25,000.

LIABILITY AND PROPERTY

How do I report a new claim for Liability and Property and Workers’ Compensation?
We offer several options to meet your needs. You may submit the claim through the web via the online reporting service www.ncacc.org, click report a claim and then choose the type of claim, fill out the form and submit.

What if I need help filling out the form?
Contact the Help Desk at (886) 647-7610 for assistance Monday through Friday between 8 a.m. and 6 p.m. EST.

Toll Free Number
The Toll Free Number to report a new claim – (877) NCACCRM (622-2276). This number is available 24 hours a day, 7 days per week at no additional cost to member.

Faxing a new claim report
You may also fax the completed report to (740) 329-1942.

Who do I call if I want online access to my P&C/WC claim information?
Contact the Supervisor of Claims and Risk Control Services at (919) 715-2893.

Should I report all claims regardless of size or severity?
All claims are under the terms and conditions of the coverage document must be reported.

What services are offered to help me identify and control my losses?
Risk Control Services are provided at no cost to work with the member Safety and Risk Management personnel to identify claim loss type frequency and severity. An action plan with specific recommendations is provided to correct or mitigate the adverse loss trends. Through an aggressive Risk Control plan the member should see frequency and severity trends improve.

When and where will the next Risk Control seminar be held?
For the next scheduled Risk Control seminar, speak with your Marketing Representative.

How do I add/delete (remove)

• Vehicles
• Buildings/Property
• Art
• Equipment

Go to www.ncacc.org and click on Risk Management, click on Underwriting Forms and then choose the correct form. Complete the form, download and then print. Then fax the form to the NCACC to the number at the bottom of the sheet.

When should I report newly acquired property?
All newly acquired property should be reported immediately as a matter of procedure. When the replacement cost value of the property is less than $500,000 the property is automatically covered under your policy at no charge until renewal.

All newly acquired property over $500,000 must be reported immediately for coverage to be effective.

What do I fill out to receive my renewal quote?
At the end of January each year, members receive an application along with property and auto schedules. They are to review their exposures and make modifications to the schedules as necessary. This means they need to review the auto schedule and make sure all their vehicles are correct. Members need to work with their EMS Director to get updated replacement costs for their ambulances and note that on their schedule.

Members should review the property schedule to make sure all their properties are listed correctly. Members can make address changes on these schedules.

New in 2004, are the supplemental applications that assists the underwriter to secure re-insurance for the Pool. These include: day camp/day care/nurseries, gas and electric utilities, water and sewer authorities, dams/levees/reservoirs/spillways. If these supplemental applications do not apply to the member, they still must note “not applicable” and send them in with their application.

What does total value, desired limit mean on the application?
Total values are items that have an appraised value such as fine art.

A desired limit means the limit the member wants.

Do I always have to take replacement cost on my ambulances?
It is not necessary to take replacement cost on ambulances if it is an old one or if the member knows they will not replace it.

Communication Towers
Communication towers should be listed on the property schedule. If a claim occurs on a communication tower it is at replacement cost.

Fences
Fences not attached to a building are to be listed separately on the property schedule.

Bikes
Bikes should be listed as part of the property schedule.

How is building inspection claims handled?
There is no coverage for property damage because a building inspector passed the property. The Pool will defend the member because it’s not part of the policy.

How long after my property appraisal is completed will I receive a copy of the appraisal?
In most instances you should receive your property appraisals within 60 days of inspection. Otherwise contact the Supervisor of Claims and Risk Control at (919) 715-2893.

If I disagree with portions of my appraisal, who do I call (can I appeal)?
Members have 30 days after receipt of the appraisal to dispute an appraisal, according to the terms of the participation agreement. The county should call their Marketing Representative who will assist them in this matter.

How often do I receive an appraisal for the county property?
An on-site, detailed appraisal of all of the county owned property is completed every three years. This is provided at no additional cost to the member. During the off years, an updated desk appraisal is done. Whenever an existing member adds a new property or a new member joins the pool, an on-site appraisal occurs.

Should I list computer hardware and software separately on a schedule?
Computer hardware and software is included in the contents value when property is appraised. When a new quote is issued, a separate computer schedule may be issued depending upon how this detail is listed on their application.

Is square footage used to determine liability costs on buildings?
No – square footage is a function within the property appraisals and the Pools use the property values when doing rating calculations.

Can these appraisals be used for GASB reporting?
Yes.

If a law enforcement officer is moonlighting at another job, and becomes injured on the job, who’s coverage applies?
If a sworn law enforcement officer is moonlighting and becomes injured for example, attempting to stop a robbery in progress, the county’s workers comp would be responsible because they are considered sworn officers 24/7. If they are working for example as a clerk and slip and fall as a result of those duties, the store would be responsible for that workers comp claim. If a sworn law officer is working as a security guard and becomes injured, Sedgwick would work with the other carrier to subrogate.

If we have a vehicle insured on our Liability & Property plan, is the vehicle covered if a non-county employee is driving it?
Yes, the vehicle is covered if the person driving has gotten permission to drive the vehicle.

Who covers boiler and machinery covered for members?
Hartford handles this from the first $1 individual claim.

Do I schedule office equipment that is leased?
Schedule it if the lessor requires it.

How do I account for ambulance contents?
Contents (things that are not permanently attached to the ambulance such as the bags the EMT’s use) of ambulances are placed on the inland marine schedule as misc. equipment and are lumped together – example – 20 ambulance contents at $20,000 = $400,000. Contents of an ambulance doesn’t include disposable items such as gauze.

What are generators, compressors, or cherry pickers considered?
These are considered mobile equipment for the purposes of scheduling them.

Can I lump items together on the property schedules?
Items such as police radios 20 radios at $100 each, may be lumped together on the inland marine schedule.

What are valuable papers/records?
Anything outside the norm such as an original constitution.

Do the Pools pay replacement cost or cash value?
The Pools pay replacement cost on property and inland marine.

The Pools pay the total value (appraised value) or cash value on communication towers, misc. equipment, law enforcement dogs and horses, fences, docks, piers, and wharves, mobile equipment, non licensed trailers/boats and boat trailers. Cash value is the replacement cost less depreciation. This is not paid by the Pool unless the member replaces it.

WORKERS' COMPENSATION

Who is now handling the WC case management?
Concentra Case Management provides the nurse case management in partnership with Sedgwick Claims Management Services.

Why? How do I contact them?
Depending on the severity of the case, a Concentra Nurse Case Manager will be assigned to the claim and either work by phone or on site with the employee, the health care provider, the claims adjuster and the member. Should a member need to reach their Concentra Nurse Case Manager, they should call the Sedgwick Claims Adjustor assigned to them to get in touch with the nurse.

Do I use/need a designated doctor for WC?
You can choose a designate doctor to treat your employees who are injured on the job.

How can I locate a designated doctor?
Go to the NCACC Web site and click on Risk Management, then click on Workers’ Compensation Section and then click on Useful Links. Next click on www.geoaccess.com/Concentra/PO/begin_1.asp. You will then find a list of doctors to choose from in your area.

Does the Pool provide workers’ comp coverage for jail inmates?
No – this is the state’s responsibility.

What services are offered to help me identify and control my losses?
The Pool provides Risk Control Services at no charge to analyze the claim loss trends for frequency of certain type claims as well as severity. The Risk Control Engineer will develop an action plan with specific recommendations to help prevent the number and severity of losses.

When and where will the next LC seminar be held?
For the next scheduled Risk Control seminar, ask your Marketing Representative.

Where are injuries to volunteers covered under our Workers’ Compensation coverage?
Volunteers are covered under the workers comp policy but ONLY for medical expenses. Traditional insurance carriers would typically not cover the injuries to volunteers however the Pool has taken the position it will provide coverage to the volunteers for injuries will volunteering their time to the county. Coverage for lost time benefits (wages) are not covered and will not be considered.

Do we cover volunteer firemen?
If the county has included these volunteers within the payroll count of their application, and a volunteer fireman is injured while fighting a fire, they would file the claim and it will be processed and paid. Better coverage exists through VFIF or the Volunteer fireman’s Insurance Fund.

How quickly will an employee begin receiving workers’ compensation?
The member files a Form 19 or a 1A, the initial report of injury, with Sedgwick who then processes the claim. There is a seven-day waiting period and by the 14th day, the employee begins receiving two-thirds of their salary. This check is received between day seven and 14.

How can the workers’ compensation payment be stopped?
There are 2 ways for payment to be stopped:
1. The employee returns to work
2. Through the industrial commission – Sedgwick files a form 24 to stop payment along with evidence (because they are doing work).

What is a form 33?
This is a form to request a hearing for the case.

Who is selected to sit on the Industrial Commission?
This is a political appointment by the governor.

What do I do to obtain my renewal quote?
At the end of January, the member receives their renewal application that includes the most current payroll amounts by class code. The payroll amounts in the application are either the estimated or actual payroll from the audit, whichever is higher. There is opportunity for the member to review this and to make corrections to the payroll. For example, if they know they will be giving merit increases, bonuses or plan to add additional staff for any reason, they should add it. There are some counties who will simply sign the application based on the numbers on the application. It is the choice of the member how they choose to view review the payroll. Each year, there is a payroll audit which will identify and correct the payroll amounts.

How do I cover a leased vehicle?
The Member would have coverage for leased or rented vehicles already under Non-owned vehicles. Therefore they would not have to purchase any additional insurance.

DEFINITIONS

Experience modification

Workers’ Compensation - A factor (expressed as a percentage) that is developed by a rating bureau for workers’ compensation insurance. The calculations relate an employer’s losses, payrolls, and premiums, segregated according to classifications of operations, all as reported to the bureau by the employer’s insurance provider.

Casualty – A factor that attempts to reflect an insured’s actual losses in relation to the same insured’s premium. This factor will either increase or decrease the insured’s premium, based on the outcome of an experience rating calculation. A prospective plan will examine prior periods, such as the last three years, to produce a premium. A retrospective plan modifies the premium after the policy period or after most of the policy period.

Loss experience – A summary of losses for a specific insured, (member or entity).

Loss expectancy – An underwriter’s estimate of the losses that a large risk will generate during the next policy period based on prior loss experience and projected exposure bases (i.e. receipts, payroll, and vehicles). Consideration may be given to the potential for loss reduction in losses from loss prevention (risk control) programs implemented or a change in the risk’s operations.

What is subrogation?
The assignment to an insurer by terms of the policy or by law, after payment of a loss of the rights of the insured to recover the amount of the loss from one legally liable for it.

Who does subrogation?
Pool or its contractor will handle this on behalf of the member.

What does it cost?
There is no cost to the member.

Where does money go?
Money that is recovered from the legally liable party or the party’s insurance carrier is credited back against the member’s specific claim. Once satisfying the claim of the Pools any additional monies recovered will be reimbursed to the member for deductibles paid by the member.

What is a SIR?
SIR stands for self insured retention. A dollar amount specified in an insurance policy (usually a liability policy) that must be paid by the insured before the insurance policy will respond to a loss. SIRs typically apply to both the amount of the loss and related costs, e.g., defense costs, claims costs and other allocated loss expense.

The workers compensation pool offers an SIR option called the ASO Workers Comp Program.

What is a deductible?
A portion of covered loss this is not paid by the insurer.

What is the difference between a deductible and SIR?
An SIR differs from a true deductible in at least two important ways. Most importantly, a liability policy’s limit stacks on top of an SIR while the amount of liability insurance deductible is subtracted from the policy’s limit. As contrasted with its responsibility under a deductible, the insurer is not obligated to pay the SIR amount and then seek reimbursement from the insured; the insured pays the SIR directly to the claimant.

What is stop loss coverage?
A form of reinsurance also known as “aggregate excess of loss reinsurance” under which a rein surer is liable for all losses, regardless of size, that occur after a specified loss ratio or total dollar amount of losses has been reached.

Specific stop loss coverage
Provides coverage once claims arising out of a single occurrence exceed the retention specified in the policy declarations.

What does NCCI stand for?
National Council of Compensation Insurance – this is specific to workers’ compensation and what the commission uses to rate claims.