Your workers compensation experience modification worksheet (E-mod) is a summary of prior losses and payrolls. If your account is subject to an experience modification factor you will receive a copy of this worksheet from the National Council on Compensation Insurance (NCCI) or the proper rating bureau for your state approximately three months prior to the renewal date of your workers compensation policy. It is the form that tells you what your upcoming experience mod factor will be. If you have difficulty locating this form just let us know. We can assist you in securing the proper experience modification worksheet.
The worksheet is a detailed document where various experience rating elements come together to generate your EMR or Experience Modification Rate. Each worksheet is specific to an individual employer. Single state worksheets can be simple while multi state experience rating worksheets can be very detailed and much more difficult to read and understand. As you notice from the below example you will generally have a recap page where the rating detail developed from the individual policy years making up the total experience period will all come together. Expected Loss Rates, D-Ratio, Expected Losses, Expected Primary Losses are compared with Actual Incurred Losses and Actual Primary Losses. Ballasting and Weighting Factors are applied and the result is an employers EMR.
Experience Rating Worksheets will vary in appearance depending upon which rating bureau applies to an individual employer. While the visual form of the worksheet may differ the content and basic information gathered and presented will be similar from one rating bureau to another. Here's a sample of how a basic single state worksheet may appear.
As you can see there is a lot of information compiled onto these worksheets. The rating bureau will receive rating data from the insurance companies to include in the rating calculations on a scheduled reporting basis. Insurance companies must report audited payroll, classification code and claim data to the rating bureau by the UniStat, or Unit Statistical Date. Most of this information is reported to the rating bureau electronically.