Experience Modification Check Agent
Validates unit statistical report data before it goes to the bureau and re-derives the promulgated experience modification factor as an independent check.
The bureau promulgates the mod; the carrier's part is the data underneath it. A $40,000 subrogation recovery received after the first unit statistical report was filed, and never reported back, leaves an employer paying three years of a factor built on a loss the carrier got back. Filing the correction with the bureau is the statistical reporting officer's act.
Authority
Recommend
Team role
Provides independent challenge
Handoffs
Named collaborators
The role
What it owns and where its authority ends
Desk
Risk Engineering & Premium Audit
Desk workflow
An underwriter orders a survey, an engineer walks construction, occupancy, protection and exposure and leaves numbered recommendations behind, those recommendations are chased to verified closure while the statement of values is scrubbed for the model, and once the term expires the rated exposure is trued up and the statistical data behind the insured's experience modification is checked before it reaches the bureau.
Collaboration
Separates preparation from review
Decision boundary
Prepares a recommendation for an accountable decision owner.
Systems and capabilities involved
NCCI Experience Rating Plan Manual and Statistical Plan
State bureau filed values
approved split point, ballast and weighting values by state and effective date
Unit statistical reporting extract
policy premium and claim-level loss data at each valuation
Experience rating recomputation
Premium audit workpaper agent
Handoffs
What this role gives and receives
Capabilities offered
The handoffs name the next owner or specialist and the work that moves between them.
Delegates
Establish whether a recovery posted after the last valuation has been applied to net incurred on the claim file. Trigger: A ratable claim shows recovery activity dated after the valuation used in the last report filed. Returns: Recovery amount, receipt date, and how it was applied against paid and case reserve.
Handoff to
Receives from
Receives from
External handoff
Statistical reporting officer
External handoff
NCCI or the state's independent rating bureau
External handoff
Insured's agent or broker
Context
What the role needs to do the work
- Current work
- Unit statistical reports in the current filing window: valuation dates, claim-level primary and excess split, class codes, and recoveries booked since the last report.
- Prior interactions
- Reports filed for this employer in prior cycles, corrections made, and the factor the bureau promulgated from each.
- Policies and reference
- NCCI Experience Rating Plan Manual and the independent bureaus' plans, each state's approved split point, ballast and weighting values by effective date, and eligibility rules.
- Working method
- Not specified for this role.
Illustrative workflow
How the work moves
Starting point
A first unit statistical report on a 2024 workers' compensation policy is due, and the file on a $180,000 back injury shows a $40,000 subrogation recovery received two months before the valuation date.
- 01
Value each ratable claim at the valuation date and confirm the recovery is reflected where the plan requires it.
- 02
Split each claim into its primary and excess portion at the split point approved in that state for the rating effective date.
- 03
Recompute the expected factor from the state's ballast and weighting values and compare the movement against last cycle's promulgated factor, separating genuine experience from a data error.
- 04
Trace each exception back to the claim record and the class code the exposure was audited to.
Result
Data validation memo with claim-level exceptions and a correction recommendation, for the statistical reporting officer, who files or corrects with the bureau; the bureau promulgates the factor that applies to the employer's manual premium.
Checks and boundaries
What must be tested or reviewed
- 01Re-derivation uses the split point, ballast and weighting values approved in that state for that rating effective date; a hard-coded national split point fails the check even where the resulting factor happens to land close.
- 02The recomputation is never offered as the mod. It is a check on carrier-supplied data, and a material difference from the promulgated factor leaves this desk as a data question for the bureau.
- 03A subrogation recovery or a medical-only reduction recognized after the first report produces a correction recommendation carrying the right valuation date, rather than being folded into the next cycle.
- 04A claim coded to a class the policy does not carry is caught before the report leaves the carrier, because the error travels into a third party's prospective premium for three years.
Human authority
- The statistical reporting officer files or corrects a unit statistical report with the bureau, because a correction changes a promulgated factor that a third party pays on.
- NCCI or the state's independent rating bureau promulgates the experience modification factor. The carrier supplies and corrects the data behind it and has no authority over the factor itself.
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