Expert Experience Rating Production Service

The NCCI experience rating is the factor the National Council on Compensation Insurance calculates to compare your actual workers comp losses against the expected losses for other employers of your size and class. The result is your experience modification rate, the EMR or 'mod,' and it multiplies your premium. Here is what most healthcare employers miss: the mod is built almost entirely from how your past claims were handled and reserved. A nursing home that let a shoulder strain sit open at a $250,000 reserve carries that number into the calculation, even if the real medical cost lands closer to $30,000. Managing the claim well is how you manage the mod.

Your experience modification rating shows up on your workers comp policy declarations, your renewal packet, the experience rating worksheet, and your carrier's reports; you can also request it from your agent or the rating bureau. But finding the number is the easy part. PCI Consultants reads it against your loss runs, open claims, and class codes to check whether it is even accurate. Open reserves that never got revised down, a claim that should have been contested, or payroll booked to the wrong class can all inflate the mod that follows you into next year's premium.

A mod below 1.00 means your losses came in better than expected for your industry and payroll, 1.00 is average, and anything above 1.00 pushes your premium up. But chasing a target number misses the point. The mod is a lagging record of how claims were handled, so the way to move it is upstream: create an accurate medical record on day one, get people back to work on light duty within weeks instead of months, and contest the exaggerated claims while paying the legitimate ones without a fight. Lower frequency and lower real severity today become a better mod later. Individual results vary.

Yes. Rating errors are common and often correctable when they involve incorrect payroll, misclassified employees, duplicate losses, or reserves that were never revised as a claim resolved. That last one matters most: insurers frequently set a high reserve early and leave it there, and that inflated 'lawyer number' sits in your mod. We have seen a claim reserved at $250,000 settle for a fraction of that, yet the mod was still calculated on the big figure until someone pushed. Corrections need documentation from policies, audits, loss runs, and carrier records. PCI Consultants helps identify the issues and pursue claims review and correction where the data supports it.

The mod multiplies your premium, so on a large healthcare account even a small swing is real money, and the damage lingers. Once a claim drives your premium up, it rarely comes back down the year the claim closes; you carry that higher cost for multiple policy years. That is exactly why we manage claims aggressively from the first incident rather than letting the insurer pay near face value and call it a day. Getting the real cost down, and the reserves accurate, is how you keep the mod, and the premium behind it, from compounding against you. You can read more on how claims push premiums up after the fact.

Employers with significant comp premiums, multiple class codes, open claims, or a claim history that does not match their real risk benefit most, and healthcare leads the list. Nursing homes, home health agencies, and hospitals carry high injury exposure, so an unmanaged mod costs them the most. It also helps to have your workforce segmented by actual risk: your clerical and administrative staff should not be rated as if they lift residents all day. PCI Consultants supports these employers with risk management and mod oversight. Our sweet spot is 100-plus employees with meaningful annual comp spend.

A strong review starts with your current and prior workers comp policies, the experience rating worksheets, payroll audits, class code detail, five-year loss runs, and open claim reports. Those records let us compare what you are being charged against how your operation actually runs and how your claims actually resolved. The two documents that unlock everything are the current policy and the five-year loss runs, which is exactly what we ask for to quote or take over an account. Complete data is how we spot the misclassifications, stale reserves, and rating errors that a quick glance at the mod would never reveal.

Some of it is immediate. For qualifying businesses, a high-deductible structure can cut upfront premium substantially, sometimes roughly in half, because you take on a defined first layer of loss while an A-rated carrier covers the rest; not every business qualifies, and we only recommend it where the numbers and cash flow support it. Claim payments in that structure are handled monthly and stop when the condition resolves, rather than as a lump sum, which is easier on your accounts. Other savings build over time as we manage claims, correct classifications, and your future experience rating improves. Because we are paid by commission from the insurer, not from your claims, we are not incentivized to let costs run. See how large-deductible plans work in practice. Individual results vary.