2001 costs2

orkers’ Compensation Costs
This section reviews recent trends in the cost of workers’compensation insurance in New Mexico including: Premium Rate in Voluntary Market Rises
Again While Assigned Risk Rate Falls
The average cost of workers’ compensation insurance in New Mexico’s voluntary market rose slightly for the second straight 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 year. In January 2002, New Mexico’s Superintendent of Figure 7. Net Premium Rate Change, New Mexico Voluntary
Insurance approved a premium rate increase of 1 percent after and Assigned Risk Markets, 1990-2002.
approving a 3 percent increase the previous January. The 1percent increase is an average across all sectors of industry.
Premium rates for Manufacturing, Contracting, Office and Employers with a history of higher than average losses began Clerical, and miscellaneous sectors increased (8.9 percent, 3.4 paying significantly higher premiums in 2002, even while overall percent, 0.9 percent, and 11.1 percent, respectively) while the rates decreased in the assigned risk market and increased only rate for the Goods and Services sector decreased (-8 percent; slightly in the voluntary market. This increase occurred when Retterath, Karpuk, Nielsen, & Kokulac, 2002). Average increases NCCI increased policyholders’ experience modifiers to raise over the last two years are small, considering the dramatic drop New Mexico’s average, which was below the target value of 1.0 in New Mexico’s workers’ compensation premiums since 1992.
(Discussion at NCCI State Forum in Albuquerque, NM, June Rate adjustments reduced premiums in the voluntary market by 2002). Basically, experience rating is a method for adjusting the 87.6 percent between 1992 and 2000, 1as Figure 7 shows (NCCI, premium rate according to the employer’s history of workers’ 2002a). New Mexico’s voluntary market consists of insurance compensation losses in the preceding three years. That history is carriers who may choose to insure a particular employer, expressed as a ratio called the experience modifier, which divides the employer’s actual losses by average losses expected Premium rates in the assigned risk market dropped by 11.7 from the population of employees in the same industry and percent in January 2002, adding to decreases since 1994 when occupation. The average rating in New Mexico was 0.93 or less the New Mexico Department of Insurance began approving a throughout the period 1996 to 2000. NCCI described the series of downward adjustments. These changes reduced difference between New Mexico’s average and the target value premium rates in the assigned risk market by 58.5 percent as a slight credit to policyholders.
between 1993 and 2002, 2as Figure 7 shows (NCCI, 2002a). NewMexico’s Assigned Risk Pool provides coverage for employerswho cannot purchase insurance from the voluntary market Earned Premiums Go Up After Long Decline
because their experience with claim losses is extensive, they arein a business that underwriters consider hazardous, or because Direct earned premiums in New Mexico’s voluntary and they are new employers who lack a loss history. Premium rates in assigned risk markets increased in 2001 for the first time since the assigned risk market are higher than those in the voluntary 1992, rising 7.7 percent to $119.4 million from a record low of $110.9 million in 2000 (National Association of Insurance The rapid decline in New Mexico’s premium rates during the Commissioners [NAIC], 2002). Direct earned premiums peaked 1990s is remarkable compared to rates countrywide. In 1994, at $232.9 million in 1992 (NAIC, 1989, 1990, 1991, 1992a, New Mexico’s premium rate index was seventh highest in the 1993a, 1994a, 1995a, 1996a, 1997a, 1998a, 1999a, 2000a, country at $5.75 per $100 of payroll (Oregon Department of Consumer and Business Services [ODCBS], 1994). It steadilydecreased to 42nd in the country, going to $1.66 per $100 ofpayroll by the year 2000, the most recent statistics available(ODCBS, 2001).
NM Workers’ Compensation Administration effectively self-insuring up to the threshold amount. The Direct Earned Premiums
Paid Losses
employer assumes less financial risk under smaller deductibles and, accordingly, pays more on premiums.
Incurred Losses Exceed Premium Earnings
Direct incurred losses in New Mexico turned sharply higher in 2001, rising 274 percent from $32.5 million to $121.7 million (NAIC, 2002, 2001). An incurred loss is the estimated value of benefits paid over the lifetime of a claim. It includes losses already paid and reserves set aside to pay for future losses.
Apparently the largest share of that rise is from increased reserv- ing because losses paid by insurance carriers in New Mexico only increased by 16.6 percent in 2001 (based on information reported to the WCA on the Annual Expenditure Report for InsuranceCarriers and Self-Insured Employers).
The increase in incurred losses pushed New Mexico’s loss ratio higher. Direct incurred losses in 2001 exceeded directearned premiums by 1.8 percent (NAIC, 2002). In other words, for every $100 of premium collected, $101.80 was incurred inlosses. Reports of loss ratios of 100 or more have become more common among the state’s carriers. In 1998 all carriers earning premiums in New Mexico reported loss ratios below 100 (NAIC,1999a). The share reporting a ratio of 100 or more steadily grew to 36.9 percent by 2001 (NAIC, 2000a, 2001a, 2002).
Statistics comparing New Mexico’s underwriting profitability in 2001 with other states are not yet available. In 2000, the state’sadjusted loss ratio was the fourth lowest in the country, accordingto A.M. Best. Direct losses incurred and dividends paid to policyholders were 34.9 percent of earned premiums 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 (Rousmaniere & Chadwick, 2001). New Mexico’s adjusted loss Data Sources: Direct Earned Premiums - New Mexico Workers’ Compensation InsuranceMarket Share Reports, 1989-2001; National Association of Insurance Commissioners.
ratio was substantially lower than the country’s between 1994 and Paid Losses - WCA Annual Expenditure Report, 1993-2001.
2000, and the gap increased after 1997, as Figure 9 shows (Farinella, 1995; Ryan & Ostermiller, 1996; Sweeney, 1997;Ostermiller, 1998; Bowers, 1999; Goch, 2000; Rousmaniere & Figure 8.
Insurance Carriers’ Direct Earned Premiums and Paid
Chadwick). New Mexico’s loss ratio leveled off at close to 36 Losses in New Mexico, 1989-2001.
percent between 1997 and 2000 while the country’s loss ratiosteadily worsened, going from. 62.7 percent to 84.2 percent.
Part of this increase comes from a reduction in premiumdiscounts that include dividends paid to policyholders; the loss costs departure, which is a modifier to account for changes in claim payments and loss adjustment expenses; and schedule rating, which debits or credits employers for certain risk factors (e.g. an employer might be credited for having safety and returnto work programs). During policy years 1996 through 1999, discounts in New Mexico’s voluntary market averaged 13.4 percent (Retterath, et al., 2002). The average discount declined to 5 percent in policy year 2000 when a 5 percent increase in losscosts — the first increase since 1995 — counteracted premium reductions from dividends paid to policyholders and credits from Earned premium may also be rising because of a recentdecline in deductibles paid by New Mexico employers. New Mexico employers paid an estimated $11.7 million in deductibles in 1996, decreasing to $3.1 million in 2000 (National Academyof Social Insurance, in press). Under deductible policies, Data Source: Best’s Review, 1993-2000, A.M. Best Co., Inc.
insurance carriers pay for all benefits on a claim and employers Figure 9.
New Mexico and U.S. Adjusted Loss Ratios,
reimburse the cost up to a certain threshold. The employer is 1993-2000.
The state had the fifth largest margin of underwriting profit in was revised upward by 21 percentage points at the end of 2001 the country in 2000, earning $35.50 for every $100 of premiums (Liu, 2002; see table in endnote).5 That gap, commonly known as collected (NAIC, 2001b). This value represents income on a reserve deficiency, has steadily grown since accident year 1995 insurance transactions after incurring losses and paying under- when the difference between initial and revised estimates was writing and administrative expenses, and dividends. Only 9 other states reported an underwriting profit in 2000. Insurance carrierscountrywide had underwriting losses every year since 1995, and Reinsurance Market Hardens
losses grew to 25.9 percent of earned premiums in 2000, asFigure 10 shows. New Mexico, on the other hand, had underwrit- The nation’s reinsurance market shifted dramatically after ing gains that stayed above 30 percent most of the time through carrying the major share of workers’ compensation losses from the terrorist attacks of September 11, 2001. Those losses led to Carriers serving New Mexico’s workers’ compensation market sharp increases in reinsurance premium and limited coverage for enjoyed superior profitability because underwriting expenses primary carriers and self-insurers buying excess insurance. An were remarkably low. New Mexico’s combined ratio, which NCCI survey of Florida reinsurers found that the cost of includes incurred losses, underwriting and administrative ex- coverage for losses up to $750,000 in excess of $250,000 has penses, and dividends, was 64.5 percent of direct earned premi- increased by an average 28.4 percent. The cost for losses up to ums in 2000 (NAIC, 2001b). New Mexico’s combined ratio $25 million in excess of $2.5 million has gone up by 483 improved dramatically in the two years following the 1991 percent, and rates for higher levels of coverage have risen by Workers’ Compensation Act,4 decreasing from an unprofitable more than 3,000 percent (Adams, 2002). NCCI said the survey 133.8 percent, as Figure 10 shows. In most years through 2000, gives a good picture of reinsurance trends nationwide.
the combined ratio was between 65 percent and 72 percent Reinsurers are restricting coverage overall and, in some cases, (NAIC, 1992b, 1993b, 1994b, 1995b, 1996b, 1997b, 1998b, excluding coverage altogether when employers have heavy concentrations of workers at one location in a major city (Auden& Schneider, 2002). Florida reinsurers are limiting coverage to acertain loss threshold where they formerly provided unlimitedcoverage (Adams, 2002). Twelve states have approved terrorist exclusions for excess insurance purchased by self-insured employers, though the decision is controversial and could have severe financial consequences for self-insurers and guarantee funds if another attack occurs (Fletcher, 2002; Heidrich, 2002).
New Mexico’s primary carriers and self-insurers are following the rest of the nation in paying higher premiums or retaining their Total Claim Costs Increase
The total cost (paid losses) of workers’ compensation claims rose by 10.9 percent in 2001, increasing to $164.9 million from $148.7 million in 2000. This is a noticeable change from a 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 succession of substantial decreases extending from 1993 through Data Source: Profitability Report by State and Line, 1991-2000.
1997 and level costs (or paid losses) from 1997 to 1999, as National Association of Insurance Commissioners.
Figure 11 shows. These paid losses reflect all payments made in Figure 10.
New Mexico’s Incurred Losses, Combined Ratio, and
a calendar year on new and old claims.
Underwriting Profit, and Countrywide Underwriting
Higher losses from indemnity claims and medical-only claims Profit, 1991-2000.
contributed to the increase in total losses. Indemnity claims,sometimes called lost work time claims, are from workers whohave lost more than seven days from work. Indemnity claim Loss Development Estimates Increasing
costs include benefit payments for wage replacement, health Insurance carriers periodically review the development of care, attorney representation, vocational rehabilitation, funerals, losses over the life of claims to adjust the funding they set aside and ancillary costs, as Table 8 shows. Medical-only claims are to pay for future losses on those claims. A comparison of initial from workers who require medical treatment but do not have and recently revised loss ratios for New Mexico shows that more than seven days lost from work. Therefore medical-only carriers have been raising estimates of paid losses and reserves, claim costs reflect benefit payments for health care, but not wage particularly in recent years. The loss ratio for accident year 2000 NM Workers’ Compensation Administration claims. In 2001 alone, carriers’ losses from indemnity claims went up a substantial 17.7 percent. A large part of the increase isdue to a 53.8 percent gain from 1997-2001 in the average cost of an indemnity claim. This average rose from $5,484 per claim in1997 to $8,435 per claim in 2001. Another part of the increase can be attributed to a growing number of open indemnity claims,which went up from 10,929 claims in 1998 to 11,328 claims in 2001, as Table 8 shows.
Higher losses from medical and wage replacement benefitsdrove up the cost of those indemnity claims. Average medical costs increased by 16.7 percent to $3,366 per indemnity claim in2001. Climbing medication costs, hospital fees, and doctors’ fees are behind this increase, as Table 9 shows. Average medication costs went up by 27.2 percent in 2001, going from$309 per indemnity claim to $393 per indemnity claim. Averagehospital fees also rose quickly by 20.4 percent in 2001, going Figure 11. New Mexico Workers' Compensation Insurance
Paid Losses by Calendar Year, 1993-2001
from $1,129 per claim to $1,359 per claim. Average doctors’ feeswent up 14.1 percent in 2001, climbing from $1,102 per Carriers' Self-Insured
indemnity claim to $1,257 per indemnity claim. At the national Paid Losses
Paid Losses
Paid Losses
level, the Hartford Financial Services Group reported that the useof more drugs by volume, and a shift to more costly drugs created a 67 percent increase in their total workers’ compensation medication costs within the past two years. In their studies of workers’ compensation drugs, they found Oxycontin, Celebrex, and Vioxx have replaced older and less costly drugs as the most common pain relievers prescribed to workers’ compensation patients (Hays, 2002).6 Wage replacement benefits increased an average 16.9 percent per indemnity claim in 2001 to $3,603. The average cost of medically related travel per claim rose 27.9 percent in 2001,from $861 per claim to $1,101 per claim. The remaining legalcosts associated with these claims also increased in 2001, but Paid losses from indemnity claims rose by 10.5 percent in their contribution was relatively small.
2001, increasing from $130.4 million to $144.1 million. This Carriers’ losses from open medical-only claims have increase comes from an 11.3 percent rise in the average cost per increased since 1993, though somewhat erratically. The average indemnity claim, which rose to $8,169 in 2001.
cost per medical-only claim has risen almost threefold, going Paid losses from medical-only claims increased by 13.8 from $365 per claim in 1993 to $892 per claim in 2001.
percent in 2001, rising from $18.3 million to $20.8 million. This Throughout the 1990’s the gain in average costs did not have a increase is due to a rise in the number of open claims and an significant impact on losses because the number of medical-only increase in the average cost of a medical-only claim. The average claims dropped by 36.9 percent through 2000. Rising costs first cost of a medical-only claim rose 7 percent to $823 in 2001.
became evident in 2000, when the number of medical-only Insurance carriers’ higher losses explain most of the rise in claims appeared to be leveling off. In 2001, the number of total losses (94.6 percent), though losses for self-insurers also medical-only claims reported rose 16.2 percent to 13,048 claims, went up. This marks the second straight year of increasing paid losses shared by insurance carriers and self-insurers in theworkers compensation market. The following paragraphs identify Self-Insurers’ Losses Increase Slightly.
the cost drivers behind these increases.
Total losses to self-insurers increased by 1.5 percent to $57.7 Insurance Carriers’ Losses Increase
million in 2001. Higher medical treatment costs associated with Significantly
medical-only claims created that increase, while self-insurers’losses from indemnity claims fell by 1.5 percent to $48.5 million.
Insurance carriers’ total losses increased by 16.6 percent to Self-insurers’ losses from medical-only claims increased by $107.2 million in 2001, and they have been climbing since 1997 21.4 percent to $9.2 million in 2001. Concurrently, the number from a low of $79.4 million, as Table 8 shows. This increase is of medical-only claims reported decreased by 2.8 percent to coming from higher losses in indemnity claims and medical-only 12,213 claims. Consequently, the average cost of a medical-only Table 8. Insurance Carriers’ (Voluntary & Assigned Risk) Workers’ Compensation Insurance Paid Losses by Calendar Year,
1993-2001.
Paid Losses
Loss Category & (Claims Count)
INDEMNITY Claims
A. Wage Replacement Benefits
$42,096,486 $35,615,428 $33,502,435 $31,061,948 $30,997,523 B. Medical Benefits
$37,291,345 $30,704,897 $29,323,733 $28,687,033 $29,343,577 C. Attorney Fees Benefits
D. Vocational-Rehabilitation Benefits
E. Other Benefits
F. Indemnity Claims Subtotal
$94,614,596 $78,028,347 $74,542,343 $69,904,577 $76,622,132 G. (No. of Indemnity Claims)
MEDICAL-ONLY Claims
H. Medical Benefits
I. (No. of Medical-Only Claims)
J. Grand Total Paid Losses
$120,610,207 $101,850,064 $85,106,087 $81,845,452 $79,421,560 $85,589,832 K. Grand Total : No. of Claims
L. Average Loss per Indemnity
Claim = F/G

M. Average Loss per Medical-Only
Claim = H/I
N. Average Loss per All
Voluntary & Assigned Risk
Claims =J/K
Table 9. Medical Costs Associated with Indemnity Claims for New Mexico's Insurance Carriers and
Self-Insured Employers, 1997-2001.
Self-Insured Medical Costs Associated with Indemnity Claims:
1997
Insurance Carriers' Medical Costs Associated With Indemnity Claims:
NM Workers’ Compensation Administration claim in the self-insurance sector jumped 25 percent to $750 in Higher Losses in Perspective
2001. From 1995-2001, the average cost of a self-insurers’medical-only claim has fluctuated from a high of $773 per claim Though New Mexico’s paid losses rose significantly in 2001, in 1995 to a low of $600 per claim in 2000. In comparison, the costs for benefits have been low compared to other states. In average cost of a medical-only claim in the insurance carrier 1999, New Mexico’s average cost of medical benefits associated sector has fluctuated even more broadly, from a high of $957 in with an indemnity claim was $4,107 (see Appendix E., accident year 1996, three years mature). This figure was lower than In 2001, losses from self-insurers’ indemnity claims decreased average medical costs in eight other states ($4,204 - $10,749) by 1.5 percent to $48.5 million, as Table 10 shows. Decreases in evaluated by the Workers’ Compensation Research Institute the number of indemnity claims open and in the amount of travel (Telles, Liu, Kowalczyk, & Tanabe, 2001).7 New Mexico’s benefits paid resulted in lower indemnity claims losses. The average cost for wage replacement benefits was much lower than number of open indemnity claims from self-insurers decreased averages for those states. Average costs for wage replacement by 1.5 percent between 2000 and 2001. Medically related travel benefits in the other states ranged from $4,906 per claim to costs decreased by 15.3 percent to $7.2 million, down from $8.5 $11,671 per claim, whereas New Mexico’s average cost was only million in 2000. Workers in New Mexico’s outlying communities $3,308 per claim (accident year 1996, three years mature).
are sometimes treated in larger cities where there are more health Every year a few hundred indemnity claims generate legal resources, and where insurers have negotiated lower charges for costs paid to defense or claimant attorneys. In 2000 for example, care. Self-insurers’ losses from medically related travel have only 246 indemnity claims out of 5,603 claims originating in ranged from as low as $5.0 million in 1995 to as high as $9.0 accident year 1999 had legal costs reported to the WCA. New Mexico’s average cost for legal benefits paid on those 246 claims The self-insurers’ decreases in indemnity claims number and was $1,418 (see Appendix E, accident year 1999, one year travel costs muted the impact of small cost increases for wage mature). Average costs for legal benefits paid to defense attor- replacement benefits and medical treatment benefits associated neys in other states ranged from $579 to $ 1,955 (accident year with indemnity claims. Self-insurers’ losses from wage 1998, one year mature) (Telles, et al., 2001).8 Continuing replacement benefits increased by 1.7 percent in 2001 to $19.3 research is needed to evaluate New Mexico’s increasing workers’ million. Losses from medical benefits associated with indemnity compensation costs in comparison to national cost trends.
claims increased slightly in 2001 (0.3 percent) to $19.8 million.
Within medical benefits losses for self-insurers, the average costof hospitalization visits and medications rose in 2001, but theaverage costs of doctor visits and therapy treatments fell, asTable 9 shows.
Table 10. Self-Insured Employers, Groups, and Pools Workers’ Compensation Paid Losses by Calendar Year, 1993-2001.
Paid Losses
Loss Category & (Claims Count)
INDEMNITY Claims
A. Wage Replacement Benefits
$31,671,019 $28,640,888 $23,996,886 $26,831,615 $21,786,849 $15,736,760 $18,615,314 $18,947,085 $19,273,570 B. Medical Benefits
$23,055,158 $21,215,133 $22,610,059 $24,058,140 $20,971,882 $20,052,423 $17,831,962 $19,782,724 $19,838,150 C. Attorney Fees Benefits
D. Vocational-Rehabilitation Benefits
E. Other Benefits
F. Indemnity Claims Subtotal
$66,163,105 $59,655,944 $54,608,554 $60,786,850 $51,569,535 $47,228,020 $45,036,955 $49,251,982 $48,507,173 G. (No. of Indemnity Claims)
MEDICAL-ONLY Claims
H. Medical Benefits
I. (No. of Medical-Only Claims)
J. Grand Total: Paid Losses
$72,971,713 $67,450,696 $63,871,489 $69,454,417 $58,920,801 $54,716,163 $53,130,319 $56,794,992 $57,667,451 K. Grand Total: No. of Claims
L. Average Loss per Indemnity
Claim = F/G

M. Average Loss per Medical-Only
Claim = H/I
N. Average Loss per All Self-Insured
Claims = J/K
1 Figure 7 indicates the net decrease in premium rates due to premium ratefiling changes in the voluntary and assigned risk markets. Premiums in the year1990 are the basis for the analysis. See Glossary for more definitions ofinsurance terms.
2 See note 1.
3 Statistics are tabulated from annual financial reports submitted to the NationalAssociation of Insurance Commissioners. Self-Insurance coverage is notincluded.
4 See note 3.
5 New Mexico Workers' Compensation Loss Development, Accident Year 1994-2000
Accident
Initial Net Loss Ratios
Latest Available
Latest Available Net Loss Ratios
Difference
Paid+Case Reserves*
Evaluation Date
Paid+Case Reserves
Data Source: National Council on Compensation Insurance (Liu, 2002).
* Case Reserves: Funds set aside by claims adjusters to cover future liabilities. 6 The Hartford is the eighth largest workers’ compensation underwriter in theU.S., ranked by written premium.
7 The WCRI estimates on medical and wage replacement costs per indemnityclaim represent cost averages on eight states’ (CA, CT, FL, GA, MA, MN, PA,TX) indemnity claims with over seven days lost work time. These claims aredrawn from a database of 5.5 million claims in accident years 1994-1999.
WCRI plans to add data from twelve more states in the near future. WCRIestimates these eight states account for at least 40 percent of all workers’compensation claims filed per year in the U.S.
8 The WCRI estimates on legal costs are based on a subset of claims that havelegal costs from accident years 1996-1999 in eight states (CA, CT, FL, GA,MA, MN, PA, TX). Some of these states require a defense attorney be involvedin preparing a claim (Telles, et al., 2001).

Source: http://www.workerscomp.state.nm.us/research/ar01/costs.pdf