AmFed - Workers' Compensation

Workers' Compensation

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AMFED NATIONAL INSURANCE COMPANY

We are pleased to be the largest writer and underwriting manager of voluntary, assigned risk, and third party administration workers' compensation business in Mississippi. Due to our success in workers' comp through the years we took more control of our destiny and formed AmFed National Insurance Company, a workers comp specialty company effective January 1, 2002. This new venture will give us more control and flexibility in servicing our policy holders. We are also very pleased to again be associated with one of the largest reinsurers in the world, General Cologne Re.

UNDERWRITING GUIDELINES

Our goal is to provide a stable workers compensation market and to build long term relationships with our agents in order to produce a portfolio of profitable business. While we consider a broad range of risks, we are aggressively seeking low to medium hazard, Mississippi based risks meeting the following general criteria:

Annual premium of $1,000 or greater
Experience modification of 1.20 or less
No single incurred loss greater than $50,000 in the past five years
Three year incurred loss ratio of 65% or less
Minimal exposure outside Mississippi
No employees in NCCI Hazard Group IV classifications

TARGET MARKETS

While we are actively seeking low hazard risks with better than average claim history from the general insurance marketplace, we have had much success in targeting these specific classes of business:

MEDICAL RELATED	MANUFACTURING	RETAIL
Hospitals	Clothing	Auto Dealers
Dental Clinics	Food Processing	Auto Repair Shops
Nursing Homes	Furniture	Restaurants
Physician Clinics	Printing	Retail Stores
Rehabilitation Clinics	Light Industrial	Cleaners
Veterinarians
SERVICE	MISCELLANEOUS
Accountants	Churches
Attorneys	Private Schools
Banks
Funeral Homes
Housing Authorities
Insurance Agencies
Property Management

RESTRICTED LIST

Due to reinsurance restrictions and other underwriting considerations, we are generally not a market for risks or coverages within the following descriptions. This list is not all inclusive and, on occasion, one of these risks may be considered:

USL&H exposures
Maritime exposure
Amusement parks, bowling alleys, carnivals, sports teams
Asbestos removal
Blasting or excavating operations
Chemical manufacturing
Convenience stores open twenty-four hours per day
Detective or guard services
Explosives manufacturing or handling
Firefighters
Gas or oil distributors
Gas or oil well operations
Grain elevator operations
Liquor stores
Logging, lumbering or pulpwood operations
Police operations
Railroad operations
Salvage operations, junk yards
Sand or gravel digging operations
Trucking
Underground mining
Wrecking or demolition operations

SUBMISSIONS / BINDING

The following information is required prior to quoting an account:

Completed ACORD Workers Compensation Application
Four year premium history and loss runs
Explanation of losses greater than $10,000
Lead time of 30-45 days in case a loss control inspection is needed
Any other requested underwriting information
Submissions are not accepted earlier than four months prior to the effective date

BINDING AUTHORITY

Once a quotation is released, it is good for 30 days. In addition, once a quotation is released, this is our indication we are willing to provide coverage. We must be notified by letter, fax, telephone call or e-mail when coverage needs to be bound. Due to contractual arrangements, we do not delegate binding authority to the producing agents.

AGENT OF RECORD LETTERS

Unless there are highly unusual circumstances, we only work on submissions with one agency. The first submission for the risk is the controlling submission and it must be mailed or faxed to us. We do not consider a telephone conversation to be a submission. We will accept an agent of record letter on the prospect’s letterhead stationary appointing a different agency as the agent of record and this must be accompanied by a submission from the second agency. As a courtesy, we will send a copy of the letter to the original agent and give them five working days to investigate and respond with a rescinding letter. Except under unusual circumstances determined on a case by case basis, we will not quote or bind coverage for the second agent during this "rescinding period". If an experience modification and/or schedule modification has been established, the same mods will be used for a quotation through the second agent.

PAYMENT PLANS

All of our business is direct bill. We can either bill the policy holder for the entire premium or for premiums over $1,500 we have an installment plan of 20% down payment and 8 monthly direct bill installments.

LOSS CONTROL SERVICES

We have consistently found that those policyholders with historically lower than average claim frequency and severity have a defined safety program with the active support of top management. We provide loss control services for our policyholders to work with management in order to actively prevent accidents and keep claim costs down.

RESPONSIBILITIES OF OUR LOSS CONTROL SPECIALISTS

Visit policyholders at their offices or job sites to gain a general overview of the operation and conduct a physical inspection of the premises.
Make specific recommendations to help eliminate or improve loss exposures.
Provide increased support to policyholders when they have too many losses.
Assist in developing or improving safety programs.
Serve as a valuable resource in counseling management on safety techniques that produce positive results.

RESPONSIBILITIES OF POLICYHOLDER

Cooperate with our loss control representative.
Comply with the recommendations made by our loss control representative within 30 days of receipt of the recommendation letter.
Assist in returning injured employees to modified duty as a process of bringing them back to full duty work.
Recognize that failure to cooperate with our loss control representative, including failure to implement recommendations, could result in termination of coverage or increased pricing.

FINAL AUDIT PROCEDURES

At the end of each policy period a final audit is conducted for each policyholder. This audit will adjust the policy premium based on the actual payroll for the policy period and will apply all premium payments made during the year to reflect the final; earned premium. In most cases either an additional or return premium will be developed.

If there is an audit dispute, we should be notified in writing within thirty days of the date the audit was processed and we need documentation pointing out the disputed area. We will be happy to work with the policyholder to correct any audit problem.

In the event a final audit is uncollectible, the agent has sixty days from the date the audit was processed to return it to us along with documentation of the attempts made to collect the premium. If there is current coverage, we are obligated to cancel the current policy.

THIRD PARTY ADMINISTRATION AGREEMENTS

We have TPA Service Agreements with the Builders and Contractors Associations of Mississippi (BCAM), Mississippi Hospitality & Restaurant Association Work Comp Trust (MHRWCT) and Fountain Construction.

Claims Administration

AmFed's Claim Department came into existence in January 1993 with two employees. Over the next seven years, our claim department has grown to become the largest workers' compensation claims handler in the state of Mississippi, employing over 65 people.

The Claim Department is guided by a three person senior management team with over 78 years claims experience. In addition, a highly experienced staff of 7 supervisors oversee the work of 22 adjusters, plus support staff.

AmFed's Claim Department is committed to fair and prompt deliverance of statutory workers' compensation benefits. At the same time we feel it is out duty to our clients to thoroughly investigate all claims and vigorously resist baseless, misrepresented or fraudulent claims. Of note, and in no small part due to the diligent efforts of our claim staff, a claim investigated and handled by AmFed was the first case to be successfully prosecuted under the relatively new Mississippi workers' compensation fraud statute.

Recognizing that medical costs represent the most significant outlay or workers' compensation dollars, AmFed's claim department also contains an "in-house" Managed Care Unit directed by Cherry Roberts, RN. Cherry's staff consists of a medical doctor (M.D.): 8 registered nurses, and several bill review technicians. AmFed's managed care program is multi-faceted, with focus on timely implementation of appropriate treatment plans which positively impact the clinical outcomes and return to work endeavors. AmFed's Managed Care program covers several aspects:

Utilization Review Services encompasses precertification of inpatient and outpatient procedures and treatments; retrospective reviews of treatment; and reviews by physicians on causal relationship issues and medical necessity issues and appropriateness of treatment issues.

Bill Review Services includes reduction of medical provider bills to appropriate fee schedule rates and applying discounts available through various PPO contracts or other negotiated agreements. Our staff nurses also review bills for coding correctness and making sure we have documentation to support the coding and charge.

Case Management Services, both telephonic and on-site, encompasses our staff registered nurses coordinating care between the injured worker and the medical treatment team, plus assisting in return to work efforts.

Clinical Consulting Services oversees the medical management services provided by outside vendors and ensures compliance with expected and required standards of practice and billing.

Perhaps the AmFed Claim Department Philosophy is best summed up by our Mission Statement:

"To provide exemplary claims service to all of our clients in a prompt, fair, professional and empathetic manner. To understand that communications, between ourselves and our clients, is the key component in successful management of the claims process"