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Late Breaking News

Important Information Regarding Workers Compensation Rate Hikes

The California Workers Compensation Rating and Inspection has issued the following announcement:

March 27, 2009

Today, the WCIRB submitted a pure premium rate filing to the California Insurance Commissioner recommending a 24.4% increase in advisory pure premium rates with respect to new and renewal policies as of the first anniversary rating date of a risk on or after July 1, 2009.

The recommended increase in pure premium rates is based upon (1) the WCIRB’s evaluation of loss and loss adjustment expense experience as of December 31, 2008 and (2) the WCIRB’s analysis of anticipated cost increases stemming from two recent Workers’ Compensation Appeals Board en banc decisions (Ogilvie v. City and County of San Francisco and Almaraz v. Environmental Recovery Services / Guzman v. Milpitas Unified School District). If adopted by the Insurance Commissioner, the average July 1, 2009 pure premium rate would be approximately 54% below the pre-reform rates in effect July 1, 2003.

A public hearing on the matters contained in the WCIRB’s filing will be held Tuesday, April 28, 2009 at 10:00 AM in the 22nd Floor Hearing Room at the California Department of Insurance office located at 45 Fremont Street in San Francisco, California.

Response by Elliot Katzovitz

What does this mean exactly?

Basically,  the bureau believes that the actual underlying cost of claims is rising and that rates need to go up to reflect these increased costs. When the WCIRB recommended a 12% increase in October of last year, Steve  Poizner (the current insurance commissioner),  decided to approve only  a 5% increase rather than the amount recommended. This proves that inflation is not and mandated increases to total disability claims do not lend themselves to an insurance commissioners proclamations. So the 24.4% increase reflects the actual cost increases over the past 6 months plus the 9% increase they did not get the last time around.

It is important to note that insurance companies can set their own rates but are supposed to be guided by the recommendations. What the insurance carriers choose to do is anyone’s guess.   Each company will look at their costs and evaluate their need to write additional premium. However, they will also need to be sensitive to the fact that insureds just don’t have more money to spend on insurance right now and that some premium is better than none. So, in my opinion, I  don’t believe we will see increases of this magnitude any time soon. Will there be increases to work comp rates? Probably Yes. Will these rate increases be significant? I doubt it.

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Division of Workers’ Compensation – Answers to frequently asked questions about workers’ compensation for employers

The following FAQ comes from the California Department of Industrial Relations website:

About insurance coverage

Q: Do I need to have workers’ compensation insurance?

A: Yes, California law requires employers to have workers’ compensation insurance if they have even one employee. If you are a roofer and don’t have any employees, you are still required to carry workers’ compensation insurance. If you are a real estate broker you are required to carry workers’ compensation insurance for your agents, even if they are independent contractors.

Out-of-state employers may need workers’ compensation coverage if an employee is regularly employed in California or a contract of employment is entered into here.

Q: My spouse and I are the sole owners of our business. We have no employees. Are we required to obtain workers’ compensation coverage?

A: Generally, coverage for sole owners is optional. You would, however, need to have workers’ compensation coverage for any employee you may hire, even if it’s just one employee, and even if it’s just temporary employment. You should consult with your attorney, insurance agent or broker, or carrier regarding the specifics of your situation and your options.

Q: Are executive officers or directors of the company covered under its workers’ compensation policy?

A: Generally, all employees of the company, as legally defined, including corporate officers and directors, must be included in the policy unless they are the sole owners of the firm. In the case of sole owners, they may elect not to be covered. Several sections of the California Labor Code must be considered to answer this question. You should consult with your attorney, insurance agent or broker, or your carrier regarding the specifics of your situation.

Q: Where do I get workers’ compensation insurance?

A: You can purchase workers’ compensation insurance coverage through an agent or a broker from any of the privately licensed insurers authorized to write policies in California. You can find a list of authorized insurers on the California Department of Insurance Web site.

If you can’t find an insurer willing to cover your business, the State Compensation Insurance Fund (State Fund) is required to provide you with coverage.

If you belong to a trade association you might want to check with it first – some trade groups negotiate special rates for members. Your local chamber of commerce may also be a source of good advice.

Q: What about self insurance?

A: Self insurance requires state approval, a net worth of at least $5 million, net income of $500,000 per year and posting of a security deposit. While historically only very large companies could self-insure because of legal requirements, in recent years group self insurance, in which several small employers in the same homogenous industry pool their workers’ compensation liabilities, has increased in popularity as an alternative to traditional coverage. Contact your broker or the state’s Office of Self Insurance Plans for information on how to self insure.

A self insured employer has the option of administering its own workers’ compensation claims or contracting with a third party administrator (TPA) to provide these services.

Q: How much does workers’ compensation insurance cost?

A: Workers’ compensation insurance premium rates are not regulated by the state. While the Workers’ Compensation Insurance Rating Bureau – the licensed statistical agent for the state insurance commissioner – issues recommended rates and carriers must file their rates with the California Department of Insurance, rates can vary from carrier to carrier. Like any good consumer, you should shop around for a carrier that best meets your needs. Cost is one consideration, but there are other factors to look at: the services provided, ease of access to the claims adjusters, their familiarity with your industry, etc. If you have a broker or agent, he or she should be able to give you expert guidance.

Q: What determines how much I’ll pay for my premiums?

A: A number of factors go into determining the annual premium your insurance carrier will charge. These include your industry classification, your company’s past history of work related injuries (known as your experience modification), your payroll, any special underwriting adjustments such as use of a certified health care organization, and any special group or dividend programs you may be eligible for.

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About my employees:

Q: Can my employees help pay for my workers’ compensation insurance?

A: No. Workers’ compensation insurance is part of the cost of doing business. An employer cannot ask employees to help pay for the insurance premium.

Q: What are my posting requirements?

A: You must post the “notice to employees” poster in a conspicuous place at the work site. This poster provides employees with information on your workers’ compensation coverage and where to get medical care for work injuries. Specific requirements are contained in sections 3550-3553 of the California Labor Code. Failure to post this notice is a misdemeanor that can result in a civil penalty of up to $7,000 per violation. Contact your insurer to get the posting notice and the required information that must be included on it. You may also download a poster from the forms page of the DWC Web site.

Q: Where do I get the claim forms I need to give my employees if they get sick or hurt because of work?

A: Your workers’ compensation claims administrator – generally your insurance carrier or third party administrator if you are self insured and have one – provides the claim form in the quantities you need. You can also download it from the forms page of the DWC Web site.

Q: How do I make sure my employees are taken care of properly if they get sick or hurt on the job?

A: Stay involved and maintain an open dialogue with your injured employee — don’t assume your claims administrator is taking care of everything. If there is a problem, try to work it out as quickly as possible and be willing to make adjustments to the workplace to bring your employee back to the job. The state now has a reimbursement program for expenses you may incur if you return your injured employee to the job. Talk to your local information and assistance officer to learn more about this program.

Your employee can find out how to navigate the workers’ compensation system and keep their own claim on track by attending a seminar for injured workers at a local DWC office.

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About medical care:

Q: What are these new medical provider networks?

A: A medical provider network (MPN) is a group of health care providers set up by your insurer (or you if you are a self-insured employer) and approved by DWC’s administrative director to treat workers injured on the job. Each MPN includes a mix of doctors specializing in work-related injuries and doctors with expertise in general areas of medicine. If your employees are covered by an MPN, their workers’ compensation medical needs will be taken care of by doctors in the network unless they were eligible to pre-designate their personal doctor and did so before their injury happened.

Q: What does pre-designating a personal doctor involve?

A: This is a process your employees can use to tell you they want their personal physician to treat them for a work injury. Employees can pre-designate their personal doctor of medicine (M.D.) or doctor of osteopathy (D.O.) only if: you offer group health coverage; the doctor has treated them in the past and has their medical records; prior to the injury the doctor agreed to treat them for work injuries or illnesses and; prior to the injury they provided you the following in writing:
(1) Notice that they want their personal doctor to treat them for a work-related injury or illness and
(2) Their personal doctor’s name and business address.

The DWC has a form for pre-designating a personal physician on the forms page of its Web site.

Q: This is a family business and I’d like to pay the doctor cash. Is that OK?

A: No. It is illegal for an employer to pay medical bills directly. You must file a claim form (DWC form 1) with your claims administrator for all injuries that require more than first aid.

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About reporting fraud:

Q: What can I do if I think an employee’s workers’ compensation claim is not valid?

A: You should report that opinion to your workers’ comp claims administrator. Tell them all the facts you know, any witnesses you may be aware of, and the people they should talk to. Follow up any phone or verbal report with a letter.

Q: I received a notice of hearing on a claim for a person I never heard of and didn’t hire. What should I do?

A: Inform your claims administrator and follow up with a letter.

Q: Isn’t workers’ comp fraud a crime? Who investigates these cases?

A: Yes, workers’ compensation fraud is a crime and it can come in many forms: a worker saying they were injured on the job when their injury really occurred while skiing; an employer saying their employees work at desk jobs when they’re really construction laborers; a medical provider billing for six treatments on an injured worker when they only provided two, etc. These are just a few examples of fraud in the workers’ comp system. Fraud is a serious problem and should be reported to the California Department of Insurance (CDI) or your local district attorney for investigation. The CDI has a fraud page on its Web site. The CDI works closely with local district attorneys to prosecute those caught violating the law.

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About being illegally uninsured:

Q: What happens if I’m uninsured and an employee is injured?

A: Failing to have workers’ compensation coverage is a criminal offense. Section 3700.5 of the California Labor Code makes it a misdemeanor punishable by either a fine of up to $10,000 or imprisonment in the county jail for up to one year, or both. Additionally, the state issues penalties of up to $100,000 against illegally uninsured employers.

If an employee gets hurt or sick because of work and you are not insured, you are responsible for paying all bills related to the injury or illness. Contact the information and assistance officer at your local DWC office for further information. You should be aware that workers’ compensation benefits are only the exclusive remedy for injuries suffered on the job when you are properly insured. If you are illegally uninsured and an employee gets sick or hurt because of work, that employee can file a civil action against you in addition to filing a workers’ compensation claim.

If you fail to pay required benefits you may also be contacted by the Uninsured Employers’ Benefit Trust Fund.

Q: What is the Uninsured Employers’ Benefit Trust Fund?

A: The Uninsured Employer’s Benefit Trust Fund (UEF) is a special unit within the Division of Workers’ Compensation that may pay benefits to injured workers who get hurt or ill while working for an illegally uninsured employer. The UEF pursues reimbursement of expenditures from the responsible employer through all available avenues, including filing liens against their property.

Q: Can I be fined for not carrying workers’ compensation insurance?

A: Yes, and more. If the Division of Labor Standards Enforcement (state labor commissioner) determines that an employer is operating without workers’ compensation coverage, a stop order will be issued. This order prohibits the use of employee labor until coverage is obtained, and failure to observe it is a misdemeanor punishable by imprisonment in the county jail for up to 60 days, or by a fine of up to $10,000, or both. The Division of Labor Standards Enforcement will also assess a penalty of $1,000 per employee on the payroll at the time the stop order is issued and served, up to $100,000 (Labor Code section 3722(a)).

Additionally, if an injured worker files a workers’ compensation claim that goes before the Workers’ Compensation Appeals Board and a judge finds the employer had not secured insurance as required by law, when the dispute is resolved the uninsured employer may be assessed a penalty of $10,000 per employee on the payroll at the time of injury if the worker’s case was found to be compensable, or $2,000 per employee on the payroll at the time of injury if the worker’s case was non-compensable, up to a maximum of $100,000 [Labor Code section 3722(b)].

Finally, as noted in answer to a previous question, failure to secure workers’ compensation insurance is a misdemeanor punishable by imprisonment in the county jail for up to one year, or by a fine of up to ten thousand dollars ($10,000) or by both that imprisonment and fine. (Labor Code Section 3700.5)

Q: How do I get proof of coverage?

A: Request a certificate of insurance from your insurance carrier.

Q: Where can I report an employer for not carrying workers’ compensation insurance?

A: You may report an uninsured employer to the nearest office of the Division of Labor Standards Enforcement. The offices are also listed in the state government section of the white pages of your local telephone directory under industrial relations, labor standards enforcement.

How to Smash Operating Costs


Are you burdened with petty pilferage, unauthorized fuel purchases, vehicle neglect and low driver productivity? How do you relieve your drivers of the burden of operating a company car, monitor their habits to protect yourself, and save money that is going in the trash?

Each year about 25% of all fleet vehicles are involved in an accident. The average cost of the direct damage is $1400. Who knows what the indirect costs of downtime, increased insurance premiums, medical bills, workers compensation, morale, and even jury awards are?

1.    Does your purchasing policy mandate which type of fuel to purchase? Can your driver include personal items like coffee on the credit card charge slip without your knowing about it?

A fuel card can solve your problem by monitoring exactly what your driver purchases at the gas station. The card system captures data that identifies drivers who violate your policies.    Your driver runs his or her personal ID number, the odometer reading of the car and other information through the point-of-sale terminal. You’ll then know the time, date and place of purchase, how much and what type of gas your driver purchased, and the miles per gallon, so you can check if the driver is using the card on another non-company car. The gas card costs about $2 monthly per card.

2.    Do you have a service arrangement with a fleet management service facility to ensure your vehicles are maintained at regular intervals to maintain their resale value?

3.    The obvious annual driver’s license check verifies driving records of your drivers. What is your policy toward drivers with marginal driving records or those who receive more than one violation per year?

4.    Would it make sense to sell your company cars at attractive prices to the drivers who have taken exceptional care of them when you’re ready to change vehicles? How much money will you save over the life of owning the car when your drivers have that incentive?

5.    If your driver is responsible for an accident that could have been prevented can you “fine” them? Why not, as long as you continue to publicize the policy and the driver knew about it way in advance of the preventable accident.

6.    Are your drivers well trained how to react in case of an accident? Does each car have a camera?

Your driver’s are an important asset to your company. Your drivers are in control of important assets of your company. Communicate with them as partners. After all they’re responsible for big bucks for both your vehicle and insurance costs. (Manuscript from CFO Magazine)

Are Your Employees Your “Best Customers”?


Employee Dishonesty

Do you have a dishonest employee? Billions of dollars are lost each year because of dishonest acts of employees.

In practically every case a “trusted employee” caused the loss. Of course you trust your own employees.

Good business people and their bankers, have realized that rather than taking the chance of escaping dishonesty forever, it’s better to:

  • Confirm judgment in trusted employees
  • Exert a restraining influence on those possibly tempted
  • Guarantee the honesty of all employees by building a partnership with an insurance bonding company

MAKE SURE YOU PROTECT YOUR “IQ” (Infidelity Quotient) by purchasing Fidelity Bonds
Fidelity bonds protect you from fraudulent or dishonest acts committed by your employees. Coverage includes loss of money, merchandise or property.

Unlike Most Insurance Policies, There Are Three Parties To Dishonesty Bonds:
1.    You, the employer
2.    Your employee(s)
3.    The insurance company

You can protect yourself against dishonest acts from one employee or go all the way and cover yourself against acts committed by every employee. Most commonly,  businesses choose to cover all employees with the amount of insurance applying to any one claim regardless of the number of employees involved.  New employees are automatically covered with no requirements to notify the insurance company. You only need to prove your loss, without identifying those responsible. In addition, you can increase the amount on any one employee and you can even have the loss limit apply separately to each employee. However, you must report your losses within one year after your policy ends, with coverage extending to the first 30 days after employment ends to cover situations as fired employees using a key to steal from you.

Note: Fidelity insurance doesn’t cover losses that are caused by independent contractors or partners/corporate officers.  If this hazard exists, you should see about extending coverage to protect you.

Coverage remains in force until either party terminates it. If an employer learns of any employee act that could result in a claim, coverage terminates automatically. In this way, you are kept from giving dishonest employees a “second chance.” There is no coverage for accounting errors or mysterious disappearance of money or property.

Each employee completes a “one page back ground” sheet on themselves which starts the process of letting them know some one else is watching your “IQ.” And, it’s a good idea to repeat this annually.

After all, a high “IQ” is something to strive for, isn’t it?

5 Insider Secrets – Putting the Brakes on Rising Benefit Costs

If you have had the same group health plan over the past five years, you have more than likely noticed the double-digit cost increases every year.

Health insurance has probably become one of your largest insurance costs.

These costs are expected to continue increasing for the next decade. On a similar note, the pool of qualified employees continues to shrink.  A solid employee benefits plan will be critical to attracting and retaining skilled employees. The federal government has offered new alternatives to help offset these costs.  If you are not taking advantage of these alternatives and proactively managing your benefits, then you are failing to get the most for your benefits dollar.
The Goal of This Report
1.    Help curb your rising health insurance costs so that you get the maximum value for the dollars you spend on employee benefits.
2.    Enable you to match your employee benefit program to your employee’s needs which will help you to obtain maximum employee satisfaction for the dollars you spend.
3.    Assist you in implementing a proactive system to control your benefit expenditures.
4.    Broaden the benefits offered without adding to your costs.
?    This Could Be You
Greg owns an eyeglass store & lab with 24 employees. He was spending $8,000 a month for a Blue Cross HMO. When I met Greg he had just been handed another 10% increase that he could not afford.  At an average of $10.00 per hour, his employees could not afford to pay it either. He did not want to drop their coverage, but he had to do something. That is when Greg found me.

After surveying his personnel so that we knew exactly how often his employees were accessing their health insurance, I helped him implement a high deductible PPO combined with a health reimbursement account. Two years later, this plan has saved him nearly $40,000 a year from his old plan.

Now, you must be asking, “Why didn’t Greg’s previous agent show him how to do this, and why don’t the insurance companies give this as an option instead of constant rate increases?” Could a similar alternative work for you? Is there a solution that your current agent has failed to offer to you? Insurance companies have no interest in actively offering these alternatives to companies because the difference between implementing these strategies and keeping things status quo would mean a large hit to the insurance company’s profits. Many agents, if they do not specialize in benefits and commercial insurance, lack the expertise to implement these types of solutions.  If they are aware of them, it means that they need to be willing to take a voluntary pay cut to implement them for you. Unlike these other agents, I have the philosophy that the reason you have a broker is that you are relying on someone to give you the best advice. You want someone to evaluate your specific needs and issues and to give you a customized solution to meet those needs and eliminate waste from your benefits budget. And I am that someone.

?    Why Would I Give Away Our Secrets?
That is a good question.  The answer is simple. It is good for my business. I also want to demonstrate to you that in order to curb your rising costs you need an experienced broker who understands how to implement creative alternatives. This will enable you to get the best return for the benefit dollar. The standard solutions being peddled today aren’t the best alternatives any longer. Once you see what isn’t being done for you by your current broker, your decision to use me or someone as qualified will be an easy one to make.

Know Your Company’s Health Profile

?    By knowing the general health of your employees and the quantity of dollars spent on prescriptions every year, you will have a better idea of what waste there is in your current benefit program and how to maximize the dollars you spend.

For example, if you have a predominately healthy employee base with no chronic illnesses, your options are much different than if you have an employee base where the majority of employees have chronic illnesses that require costly treatments. Each of these profiles will have different needs and expectations from their health plan.  If their expectations are not met, they will be unhappy and dissatisfied with the plan you are offering.

If you have 30-40 employees, you may find that there are two distinct groups within your company and that each need different types of health care. That situation may require having multiple plan options for employees. If you would like help on how to gather this information and interpret it correctly, it is free service that I offer to all of my clients, and I would be happy to offer it to you as well.

Secret #2
?    An HRA is a health reimbursement account.

The federal government created this plan in 1995.  It allows an employer to subsidize co-pays, deductibles, and maximum out of pocket expenses on behalf of their employees.  There is no set amount or guidelines of what you must do. This is at the business owner’s discretion. How you structure an HRA will reflect the needs of the employees as well as the resources you wish to spend.

If an employer currently has a low-deductible PPO, or a traditional HMO, this allows you to change to a high-deductible PPO and fund the difference yourself. For example, if you are currently spending $250 per employee, per month for health insurance and the high deductible PPO only cost you $125 per head, you have cut your costs in half. If you take that difference, multiply by 12, and then multiply by the number of employees have, you will see how much you could save every year in premium. This is where secret number #1 will assist you greatly. If you have an essentially healthy group that seldom sees a doctor, this becomes a cheap alternative to traditional health plans.

To employees, the benefits have not changed.  You might spend a couple of thousand dollars on co-pays and deductibles, but the rest of the premium savings drops right to your bottom line. If the group is a severely unhealthy one that uses large quantities of health care, this will not be an alternative you would want to pursue. The money that will be spent out of the HRA will be as much as the savings, negating the benefits of this alternative.

If you would like to know more about how this could possibly help you, we will be happy to figure out the exact economics for your group and assist you in a feasibility study.

Secret #3
?    This is the newest alternative for helping with medical costs.

The money put into the HSA account is the employees’, not the employers, unlike an HRA or FSA.  Any contribution that an employer makes, the employee takes when he or she leaves the company. These are similar to IRA’s for retirement, but the money in it can only be taken out to pay approved specified medical expenses. The annual contribution for the plan is the same as the plans deductible, or $2,600 per person or $5,150 for a family, whichever is lower. These accounts can only be used in conjunction with an HSA compatible high-deductible health insurance plan. The major defining characteristics of an HSA compatible plan are that it will have high deductibles, typically $2,600 per person and $5,150 per family and a person’s prescriptions costs are counted toward the maximum out of pocket expenses for the year.

Given the extremely high deductibles, the HSA compatible plans are the most inexpensive plans on the market. Unfortunately, the high deductibles will make most employees groan the first time they go to the doctor. One way to solve this problem is with an employer contribution to the HSA. What you, the employer, contribute, is the first money used.  To employees, it will continue to have the same feel as a low deductible plan.

This is a very good strategy for several types of individuals:
?    Those that have unhealthy employees that access health care constantly. Given the inclusion of prescriptions as part of the maximum out of pocket on the plan, this caps the employee’s exposure to pharmaceutical costs. This can provide great benefit to employees, and with a small employer contribution, will be the best alternative health care plan for an employee.
?    Those employers who do not want to take the risk associated with an HRA. This alternative will allow you to know exactly how much you will be contributing during a given plan year, with no potential catastrophic risk if everyone should fall severely ill during a plan year.
?    Those employers who want the employees to appreciate the value of the benefits that they are receiving by getting a “bonus” if they are not sick, to be used in future years.

The economics on this one can be tricky. If you give us a call, we will be happy to assist you with evaluating whether or not this is a good alternative for your company.

Secret #4
Optimizing the use of an FSA
?    This plan is used in order to allow employees to pay for their portion of the health insurance cost with pretax dollars.

It can also be used for offsetting other medical costs, such as dental, eyeglass purchases, and eye exams. The typical vision plan will cost you $12-$18 per month, per employee, and will provide for a visit to the optometrist every year, and a new pair of glasses every other year.  If only half of your staff wears glasses, you have just spent a minimum of $144 on those employees for nothing because do not use the benefit at all.  The benefits that employees receive if they do access the insurance do not exceed the premiums that you have paid.

If you contributed $200 to each employee’s FSA to provide for their vision needs, any unused portion of that contribution goes back into your pocket at the end of the year.  If you have a group of 20 employees and you are spending $2,900 a year on your vision coverage, under the FSA alternative, if half your employees access the benefit, you will only be spending $2,000 to provide a better benefit than the vision plan is offering.

A similar concept can be used for dental coverage, but it is too complicated to be covered in the scope of this report. If you are interested in how to implement a similar strategy for dental bills, please contact us and we will be happy to explain and assist you in evaluating if it is a good alternative for your company in the context of your whole benefits program.

Secret #5
Use of Mexican Insurance
?    If you have a heavy concentration of Mexican Immigrants in your work force or are situated near the Mexican border, there is another alternative that you should seriously consider.

An American health insurance provider has teamed up with a Mexican health insurance provider to provide employees with a network which covers both Mexico and America. The cost of these plans can be as much as 30% less than traditional HMO’s like Kaiser. If you have a workforce that will not be able to adapt to the alternatives above, this may be a choice for you.

Significant savings are achieved because Mexican medical costs are much cheaper than American costs. Given that a significant portion of the people enrolled in the plans access Mexican health care instead of American health care, the overall costs incurred by these plans are lower than traditional HMO’s.  The differential between the two allows for large savings on health costs, of which, a portion is passed on to the employer in the form of premium savings. Even if your employees do not want to access Mexican health care, you will still realize savings from this alternative.

If your current broker has already brought all of these alternatives to your attention then you are probably already set. If your current broker has not brought all of these alternatives to your attention and you want this type of guidance for the money you are spending on your benefits program, we recommend that you give us a call or send us an email.

Top Seven Worst Work Comp Mistakes

California Worker’s Compensation guru Elliot Katzovitz shows employers how to save on their work comp policies.

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