Free Workers' Compensation Claims Review

A free review reads your current policy, five-year loss runs, open claims, experience modification rating, and class codes the way an advocate would, not the way the insurer does. PCI Consultants looks for the gap between the inflated number on a file, say a $250,000 reserve, and what the claim will actually cost, often closer to $30,000 in real medical spend paid out over time. We flag padded reserves, exaggerated or potentially fraudulent claims worth contesting, misclassified payroll where clerical staff are rated like hands-on caregivers, and light-duty return-to-work openings that cut the real cost of open claims. Individual results vary.

Your premium is largely a function of loss history and experience mod, and here is what the insurance company will not tell you: once premiums rise after a claim, they rarely come back down, even after the claim resolves, so a single mishandled file can cost you for years. Left without an advocate, insurers tend to pay claims at or near face value and call it a win. A review challenges inflated reserves, disputes exaggerated or fraudulent claims, corrects class codes, and moves injured staff into light-duty roles sooner, all of which protect your loss runs and, over time, your premium. Individual results vary.

Yes. The review is a no-obligation look at whether your current program is costing more than it should before we recommend any changes. How we are paid matters too: PCI Consultants is compensated by commission from the insurer, not by how many claims you file or how much they pay out, so we are not incentivized to let a claim run high. You get an honest read on your loss runs and policy structure at no cost. It works much like our no-cost consultation.

Two documents get us started: a copy of your current workers’ compensation policy and your five-year loss runs. Together they show your class codes, experience mod, premium basis, and every open and closed claim. Premium statements, reserve worksheets, and payroll broken out by role help us go deeper, but the policy and loss runs are the concrete first step to quote your account or take over coverage.

A straightforward single-location review can begin as soon as the policy and loss runs are in hand. Larger healthcare accounts, several nursing homes or home-care agencies under one owner, multiple class codes, or a long claim history, take more analysis, and those multi-location employers can often be consolidated into a single master policy for better terms.

Healthcare employers feel this most. Nursing homes, home health, hospitals, and CDPAP agencies carry the highest injury risk and the biggest workers’ comp bills. The review delivers the most value for employers with 100 or more staff and $100K-plus in annual premium, open claims dragging on the experience mod, or payroll where low-risk clerical roles are lumped in with hands-on caregivers. If your premium looks high relative to your actual injury rate, that gap is exactly what a review finds.

Often not. In many cases the coverage and carrier stay the same while your real cost drops, through corrected class codes, faster return-to-work, disciplined claims handling, and accurate reserves. For qualifying businesses, a high-deductible structure can go further: the employer takes a defined first layer, say the first $200K of a $500K program, while an A+ rated carrier covers the rest, which can roughly halve annual premium. Not every business qualifies, and we only recommend it when your loss profile supports it.

Savings depend on premium size, loss ratio, deductible structure, and claim history, so any figures are illustrative rather than promised. The bigger lever is usually how claims are paid: instead of an insurer settling a file at its inflated face value, a genuine claim is paid incrementally, often around $1,500 to $2,000 a month, and payments stop when the worker recovers. For qualifying high-deductible programs, claim payments are structured monthly, roughly $3,000 a month, and premium can drop meaningfully before any claim is paid. Individual results vary.