Coverage | FAQs

We’re here to help you navigate work comp with confidence.

Click on a topic to see the list of frequently asked questions.

What if I have additional questions not listed here?

We’re here to help answer any questions you may have. Contact us or call 1.800.442.0593 with additional questions about your policy.

You can also find more information on the Missouri Division of Work Comp website.

Work Comp Basics
Payment Plans
Work Comp Benefits
Classification and Payroll Reporting
Reporting and Managing Claims
Return to Work
Fraud
Audits
Safety Grants
Safety Dividends
Work Comp Basics

You might. Specific coverage requirements vary by state, and generally depend on how many employees you have in your company. Visit our Basics of Workers Compensation page to review Missouri’s requirements. If you have exposures in states other than Missouri, visit Previsor Insurance.

It’s easy. Simply get in touch with your insurance agent, and let them know you’d like Missouri Employers Mutual as your workers compensation carrier. They’ll take it from there. Don’t have an agent? Click here to find an agent near you.

Premium is calculated based on three factors:

  • Your company’s total payroll, often called remuneration as it includes all forms of compensation
  • Your employee job classifications
  • Your experience modification factor, or e-mod

Your e-mod, or experience modification factor, is one of the primary measurements we use to determine what you pay for coverage. It is calculated by the National Council on Compensation Insurance by comparing the expected losses within your industry with your actual losses. If your losses are lower than expected, your e-mod will be less than 1.00, which will reduce your premium. If they are greater than expected, your e-mod will be greater than 1.00, increasing your premium.

Most states use the NCCI’s e-mod calculation, but your specific calculation and e-mod eligibility requirements may vary.

A loss ratio is your total losses, or claims expenses, divided by the
audited premium. The better your claims experience, the lower your loss
ratio.

Remuneration, commonly called payroll, is another key used in calculating your premium. It includes wages, commissions, bonuses, overtime pay, holiday pay, vacations and sicknesses, payment for piecework, value of housing, cafeteria plans and other forms of compensation.

The best way to control your premium cost is to build a safety culture in your organization and prevent injuries in the first place. Check out our safety resources as a starting point to helping your employees do their jobs safely – and with confidence.

If injuries do occur, managing claims costs can help you keep your e-mod low. Programs like return to work, telehealth and drug and alcohol testing can reduce the cost of claims and lower premiums over time.

The Certificate of Insurance, or COI, is evidence that your workers compensation is valid and currently protecting your employees. It shows the name of the certificate holder, the policyholder, insurance company, policy number, type of insurance coverage and policy effective dates. The COI will also indicate whether the owner is covered by the policy. It’s the certificate holder’s responsibility to ensure this certificate is up-to-date and signed. 

Not always. For an injury to be covered under your workers compensation policy, the injury must arise from and have occurred within the scope of the employee’s job duties.

Under very specific conditions, yes. For occupational diseases to be covered by a work comp policy, the disease must have arisen out of the scope of the employee’s normal job duties. If work-related exposure is found to be main cause, and meets the requirements of an injury, it may be covered. If work is merely a triggering or precipitating factor, the condition will likely not be covered under a work comp policy.

Missouri, along with most other states, requires workers compensation information to be posted in a common area. To download the posters required for your state, visit our virtual claims kit.

Payment Plans

A security deposit is necessary to protect us (as the insurer) from the risk of providing coverage for which a premium has not yet been collected. You will pay a premium on a period basis once your actual payroll for that period is determined. The security deposit serves as collateral for the coverage during this initial period.

If you would rather not pay a security deposit, we offer annual premium and installment billing options.

Electronic Funds Transfer, or EFT, involves transferring funds from one bank account to another. This allows you to quickly and securely pay your premium, and gives you the most payment plan options. Log in to your account to sign up.

Work Comp Benefits

Employees who suffer a disabling workplace injury or occupational disease exposure that temporarily prevents them from working may be eligible for temporary total disability, or TTD. TTD is generally awarded for the time employees receive treatment and are restricted from work by a physician. TTD benefits are typically two-thirds of an employee’s average weekly wage. Many states limit benefits to a certain amount per week, and number of weeks.

Most of the time, we average the employee’s wages for the 13 weeks immediately preceding the injury to calculate an average weekly wage. However, there are exceptions, and this calculation can vary by state.

Employers can provide injured employees with a pharmacy benefit coupon that lets them fill prescriptions pertaining to the injury with no out-of-pocket expense. Once we determine claims eligibility, the employee will receive a prescription card to cover ongoing medications. 

An injured employee’s prescription eligibility will be reviewed each month to ensure they are receiving the proper medications for recovery. Any changes to an employee’s condition or medication needs will be reported to the pharmacy by the physician.

Yes. The workers compensation statute calls for the payment of permanent partial disability (PPD) to compensate an injured employee for the permanent effects of a work-related injury. It is common for employees to have permanent partial disability, even if they can return to work full time.

The answer to this question may depend on your circumstance. Contact our Claims department for advice specific to your situation.

This will be determined on a case-by-case basis between you and MEM. Generally, we are obligated to pay TTD for the full period of disability, even if the injured employee no longer works for you. If you have questions, please review this aspect of your policy with your corporate counsel.

Classification and Payroll Reporting

The calculation used for company owners and officers varies by state and can change each year. It is generally indexed to the average wage, as determined by each state’s insurance-governing department.

If a subcontractor is injured on the job, they will be treated as an employee of the general contractor for workers compensation purposes. While they are not required by law to carry insurance on themselves, they can submit claims on a general contractor’s policy. Therefore, policyholders are charged a premium for the amount paid to subcontractors who can’t provide a valid workers compensation certificate of insurance. To learn more about subcontractor classification, click here.

Report overtime payroll at the straight hourly rate. The proper way to report time-and-a-half payroll is to divide the total overtime payroll by 3 and subtract that amount from the gross payroll. To report double-time payroll, divide the payroll by 2 and subtract that amount from the gross payroll.

Payroll records must show overtime pay, separately by employee or in summary by classification in order to be deducted. 

In some cases, yes. Typically, if employees are not engaged in construction work, they will be classified in the highest-rated classification for the work they perform. When performing construction work, wages may be divided into the appropriate classifications, provided the division is reflected in the original payroll records, in dollar amounts. 

If wage divisions aren’t properly documented, employees’ wages will be classified in the highest-rated classification for the work they perform. 

In general, no. The clerical classification code (8810) is a standard exception code, so division of payroll is not allowed. The only exception to this rule is for payroll for covered business owners, in which 10 percent of their payroll can be allocated to the clerical class code.

NOC means “Not otherwise classified.” You can use this code when there is not a classification that closely matches your operation in the Scopes Manual.

Reporting and Managing Claims

As a policyholder, you can report a claim online or call anytime at 1.800.442.0593. You can also fax the injury report to 1.800.442.0597. To download injury reporting forms, visit our virtual claims kit.

Initially, all we need to know is the:

  • Basic contact information for the company.
  • Injured employee’s name, social security number, state of hire and phone number.
  • Date the injury occurred.
  • Brief description of what happened.

You can follow up later with injury details, the injured employee’s employment status and treatment information. Report the claim online or call Missouri Employers Mutual anytime at 1.800.442.0593. You can also fax the injury report to 1.800.442.0597.

Yes. All work-related injuries, regardless of severity, should be reported to Missouri Employers Mutual. We will then report injuries to the state, as required. This allows the state to accurately track workplace injuries.

In some states, you may choose to pay claims out of pocket if they meet certain conditions. In Missouri, you have this option if the claim is 20 percent or less of your policy’s applicable split point, and does not involve more than three days of lost time. Visit the Division of Work Comp website or contact MEM Claims Services at claims@mem-ins.com or 1.800.442.0593 to learn if your claim qualifies for out-of-pocket payments.

It is difficult to estimate the exact effect an injury may have on your e-mod and on your premium. Your e-mod factor is based on your losses for the past three years, not including the most recent year, so a claim in 2019 will not impact your e-mod until 2021. The National Council on Compensation Insurance adjusts e-mod calculations each year to anticipate both a company’s losses and the losses of all businesses within the industry.

To both help your employee return to work quickly and reduce costs, we encourage you to report injuries within 24 hours. Missouri law requires employers to report injuries within five days, but state reporting laws vary, so check with your Division of Work Comp.

The rules vary from state to state. In some states, you have the right to direct medical care for your employees. In others, your employees can choose from an employer-specified network. In still others, they are free to choose their own provider. Check your Division of Work Comp website to learn about your state’s employee rights.

If you can direct care in your state, you should designate your network or company physician and communicate this decision to all employees. If an injury occurs and no physician or network has been designated, you should still direct medical care according to your state’s laws.

In Missouri, employers have the right to direct medical care. To find a provider in MEM’s network, use this lookup tool through our medical network partner, CorVel.

Return to Work

Transitional duty allows injured employees to transition back to work safely and successfully by modifying their job duties. The employee enjoys the self-esteem that comes from working and may be able to return to full salary, while the employer is able to curb claims costs. 

Yes, absolutely. This helps you stay up-to-date on an employee’s progress. More importantly, it shows that you care and keeps the employee in the loop, which are critical parts of the recovery process.

Once employees have been released for work, even if it is for modified duty, they should let you know right away. At this point you can discuss any necessary or mandated restrictions – our return-to-work coordinator can help. Once employees are released back to full work duty, they are no longer eligible for workers compensation benefits.

Fraud

Abuse happens when someone uses the system in a way other than the intended purpose, that is, to help an employee recover from an injury and get to work. Fraud involves blatantly false statements or representations to obtain or deny any benefit. Workers compensation fraud can come from various sources, including employers, employees, producers and more. Any time there is abuse or fraud within the workers compensation system, it can affect your premiums and even the availability of coverage or treatment.

As an employer, you play a significant role in preventing and identifying fraud and abuse, including maintaining open communication with employees about the seriousness of making false claims. You should:

  • Verify all certificates of insurance with subcontractors to ensure they are valid and have been properly issued.
  • Investigate all causes of work-related injuries.
  • Report work comp claims immediately to your insurance company.
  • Check in with injured employees on disability at different times of the day to ensure they are home.
  • Ensure your agent is listing proper job classifications and payroll accurately.
  • Encourage your employees to report suspected cases of fraud.

As soon as you suspect fraud may be taking place, contact us using the online form or by calling 1.800.442.0592. You may also contact the Fraud and Noncompliance Unit of your state’s Department of Labor.

No. Surveillance should be left to the insurance company or to a hired contractor. Any recordings you collect on your own may be inadmissible in court.

You can request a statewide criminal record history on any job candidate or current employee from your state’s Criminal Records Division. No permission is required.

We do not recommend this approach. In general, terminating an employee before an investigation may expose you to more risk. Be sure to contact your attorney and your insurer before you take any action.

Always ask for copies of any subcontractor’s COI. Often, the easiest way to get these is by contacting the subcontractor’s agent. To verify, ask the agent or contact the carrier listed on the certificate to confirm that coverage will be effective when the services are used and paid for. This is important because in some situations, you could be liable for claims involving a subcontractor’s injury.

Report fraud to our Special Investigative Unit online or by calling 1.800.442.0592. We will conduct an investigation and keep the employer advised of progress on the case.

Audits

Your business is always changing. As it evolves and grows, our premium consultation and audit services ensure you’re paying premiums based on your actual payroll and exposures. We conduct consultations for some customers to verify payroll and classification information. This allows us to help you account for things like employee turnover or growth.

In short, this year-end audit ensures you are paying on your actual payroll and risk exposures.

At the inception of your work comp policy, you will pay a deposit premium, based on estimated exposures. We will calculate your actual exposures at the end of your first policy period. One of our consultants will conduct this audit via phone or mail, or during a physical visit to your site. How your audit is conducted will depend on the size of your company and your potential exposures.

For some new policyholders (generally larger policies), we perform a new business consultation within the first three months of the policy. This is a great opportunity for you to ask questions about payroll classifications and payroll segregation to both ensure proper classification and avoid surprises (like higher-than-expected rates) later on.

Good recording keeping can save your business time and money during the audit process. As we begin the process, your consultant will let you know exactly what records you will need during the audit. This may include:

  • Payroll records: Payroll journal and summary, federal tax reports (941s and 1099s), state unemployment reports and individual earning records. Totals should be kept for overtime, when applicable.
  • General ledger: May be used to verify other records
  • Checkbook: May be used to verify other records
  • Cash disbursements: Subcontractor names and costs, costs of materials and casual labor
  • Certificates of insurance for subcontractors used during the audit period

Yes, you will have up to two weeks to get the appropriate certificates of insurance. However, it is always in your best interest to request a certificate from a subcontractor at the time the work is performed, rather than later, during an audit. You will be charged for those subcontractors who do not provide valid workers compensation certificates of insurance.

It may be easier to request certificates of insurance from your subcontractors’ insurance agents. You should request this information before the subcontractor begins work.

The actual time frame varies, but everything must be finalized 120 days after the expiration of the policy. 

At the time of the audit, your consultant will explain any differences in audit payroll versus estimated or reported payroll. This is a great opportunity for you to ask questions, and make sure you understand any differences. Once the audit is submitted, we will generate a statement with the final premium determination and any adjustments to payroll or class codes.

Final copies will be mailed to you and to your insurance agent.

Safety Grants

The Safety Grant program is available to all MEM policyholders, regardless of claims history. To receive a safety grant, you must:

  • Have an active MEM policy from the application date through the award date.
  • Be current on all balances owed to MEM.
  • Demonstrate the need for specific safety intervention through a properly completed application.
  • Not have received a safety grant in the most recent cycle.
  • Not have met the 24-month safety grant dollar limit of $20,000.

MEM will arrange a Safety and Risk consultation if the requested grant amount is equal to or more than your annual premium.

MEM Safety Grant funds may be used to purchase ergonomic, safety and/or industrial hygiene equipment.

Safety grants may not be used for:

  • Any purchases prior to the application submission date (ordered, received, paid).
  • Rented or leased equipment.
  • Expense of testing or trying out equipment.
  • Professional consultants or training.
  • Salaries, wages, internal labor or the cost of preparing the application.
  • Will not cover warranties.

Matching funds are designed to help your investments in safety go further.  For every $1 you’re willing to invest, MEM will match it for approved safety initiatives from $1,000 to $10,000.

There are two 30-day grant cycles per calendar year beginning the second full week of both January and July. You can apply during the open application period for each grant cycle. Click here to access the online application.

Be prepared to share specific information on the online application, such as:

  • Current safety concerns
  • Photos/videos of how work is currently being done
  • Claims data related to injury type
  • Training plan for proposed equipment
  • Specific information on requested items

You will be notified automatically when your application has moved from submitted to under review. You will be notified of the overall outcome of your application approximately 90 days after the application period ends.

A safety grant award from MEM may be taxable. We’ll send you a Form 1099. Please speak to your tax professional before applying.

MEM’s Safety Grant Review Committee evaluates applications submitted during each application period. This committee is made up of safety and risk experts with more than 20 years of experience improving workplace safety. The committee is provided each application without any identifying information. They evaluate the proposed intervention in the following categories:

  • Completeness of the proposal
  • Justification for the intervention
  • Durability of the intervention
  • Overall impact on injury prevention

You have up to 120 days to make your purchase and implement your intervention. An extension request beyond this timeframe must be received in writing prior to the expiration of the initial implementation deadline. Once you’ve made your purchase, complete a reimbursement request form and submit supporting documentation to MEM. After the form is approved, we’ll notify you within 30 days to provide details on reimbursement and post-award reporting.

Yes. You may reapply using the same application in a future grant cycle. Final application scores are placed in a rank order and grants are awarded based on available funds. 

Learning more about your safety initiative will help us better understand how to invest in future safety grants. We ask grant recipients to:

  • Monitor any claims data related to the safety grant award.
  • Complete a case study related to your awarded equipment after one and two years post-implementation with the assistance of your Safety and Risk Consultant.
  • Continue to track employee count, near misses, productivity or quality changes and employee feedback in the area where the grant equipment was implemented.

You can contact your Safety and Risk Consultant or MEM Customer Service at customerservice@mem-ins.com or 1.800.442.0593

Safety Dividends

All MEM policyholders are eligible to earn a safety dividend. To receive a dividend:

  • The policy must remain in effect for the entire policy period without a lapse in coverage.
  • The policy term must be at least six months.
  • Audit disputes must be resolved prior to the dividend payout.
  • There cannot be past due premium in collections.

We are committed to the Safety Dividend program and are investing in its success for our policyholders. Dividends are always up to board approval.

The safety dividend payout is determined based on premium, loss
ratio and a safety component. All policies must have a loss ratio less
than 50%. For policies with issued premium $50,000 and less,
the safety component is returning an online safety self-assessment that
will help MEM direct safety resources to your business. Policies with issued
premium more than $50,000 earn points for safety programs that
determine their dividend payout.

Safety dividend premium is issued premium before the Second Injury Fund surcharge.

Policyholders with issued premium of $50,000 and less are required to
return a safety self-assessment to receive a dividend.
The self-assessment is a short online survey regarding safety philosophy
and practices that help MEM direct safety resources.

Policyholders with issued premium of more than $50,000 earn safety
points that positively impact their dividend amount. These policyholders
earn safety points when an MEM Safety and Risk Consultant verifies
certain programs and initiatives are effectively in place.

Safety dividends are paid nine months after your policy ends.

To earn a larger safety dividend:

Non-compliance with important or urgent recommendations, as identified in writing by MEM’s Safety and Risk Consultant, will reduce any awarded safety dividend by 50%.

Since programs are evaluated based on what was in place from the
previous year, points may be removed from the overall score if the safety
program is deemed to no longer be in place or not effectively implemented.
This may be evaluated by looking at claims that have occurred, viewing
workplaces and job-sites, and speaking with management and/or employees.

Have additional questions?
Contact us today.