Click on a topic to see the list of frequently asked questions.
If you have additional questions please contact us or call 1.800.442.0593.
Work Comp Benefits
Classification and Payroll Reporting
Reporting and Managing Claims
Return to Work
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
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.
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. View our payment plans.
Benefit checks will arrive three to five business days after they’re processed. If ten business days have passed and the employee has not received the check, contact your claims representative.
Please note: Receipt of temporary disability compensation payments depends on the injured worker’s compliance with the Workers’ Compensation statutes. Failure to comply with the following requirements can result in discontinuation of your benefit payments:
- Keeping scheduled medical appointments
- Cooperating with an assigned rehabilitation program
Workers compensation benefits are considered reportable but not taxable in most states. Please consult your tax professional for details.
The injured worker should contact Customer Care at 1.800.440.0593 as soon as they know about the change. Failure to notify us about changes related to the claim could result in delayed benefit payments.
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.
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.
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. Learn more about subcontractor classification.
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.
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.
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.
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.
If your employee is injured at work, you should always file a claim with us. However, you can file a report-only claim if it involves three days or less of lost time and no permanent disability. The benefit of a report-only claim is that it doesn’t impact your e-mod and, therefore, your insurance premium. In Missouri, employers have the option to self-pay up to $3,600 in medical costs on report-only claims. If you wish to self-pay, confirm your eligibility with your claims representative when you report the claim.
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 2020 will not impact your e-mod until 2022. 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.
If you do not have your claims representative’s name or contact information, contact Customer Care at 1.800.440.0593.
We mail the injured worker a confirmation letter with the claim number on the business day after the claim is entered into our system. If your claim is medical only or lost time, your employee should have received this letter. They will not receive a confirmation letter for a report only claim. If you do not know your claim number, contact Customer Care at 1.800.440.0593.
Your claims representative is available by phone or text to help in many ways:
- Evaluate your claim and explain next steps
- Explain your benefits
- Coordinate your care
- Process payments for medical treatment
- Process payments for lost wages, if applicable
- Answer your questions
- Update your employer
The medical provider should send all medical bills related to the injury directly to MEM at PO Box 12250, Overland Park, KS 66282. We will evaluate each medical bill and, once approved, issue payment directly to the provider.
If you or an employee receives any medical bills for the injury, please mail them to us at PO Box 12250, Overland Park, KS 66282. We will evaluate each medical bill and, once approved, issue payment directly to the provider.
No, you are not responsible for any outstanding balances for treatment related to a compensable injury or illness. If you receive an outstanding balance notice, please contact your claims representative.
Please contact your claims representative immediately.
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.
They should bring the following information to the appointment:
- Any medical records or films related to the injury
- List of current medications
- Work status report
- Job description
The employee should also provide the medical facility with their claim number and MEM’s mailing address to send medical bills: PO Box 12250, Overland Park, KS 66282-2250
Yes, the employee should provide your claims representative with a status update after each appointment. They can answer any questions about the claim and will work with you and the injured worker throughout recovery and return to work.
Sometimes a claims representative will assign a nurse case manager to the file to assist with medical management. The nurse can help:
- Ensure the employee gets the right treatment at the right time
- Coordinate the treatment plan
- Facilitate a safe return to work
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.
Modified duties are tasks an injured worker can complete with restrictions during recovery. Your claims representative will work with you and the medical provider to determine whether temporary modified duties are a good fit for your employee.
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. Learn more about a return to work program.
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.
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. View examples of work comp fraud.
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.
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.
MEM Safety Grant funds may be used to purchase ergonomic, safety and/or industrial hygiene equipment.
For the current cycle only, we are allowing prior purchases that were specific for COVID-19 to be eligible for a safety grant award. This will be limited to items purchased after March 1, 2020.
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.
Equipment for the purpose of training may be considered.
MEM wants to help your safety investment go further. For every $1 you’re willing to invest, we’ll match it for approved safety initiatives from $500 to $10,000 for those selected to receive an award.
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.
Our next application window will open in early January 2021. You will be notified when your application has moved from submission to under review.
Be prepared to share specific information, 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
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
Applications are scored and placed in rank order. Safety grants are then awarded based on available funds. If you are not selected for an award, you may reapply for the next cycle. View past safety grant winners.
In consideration of COVID-19’s financial impact on policyholders, winners from cycles eight and nine have a full year to purchase and implement interventions.
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 check reimbursement and post-award reporting.
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’s Safety Resource and Support Center at email@example.com or 1.888.499.7233.
We’re retiring the program because it is not creating the value for our policyholders that we intended. While the program was effective for some accounts, we are not experiencing a big enough connection between safety dividends and losses.
Policies written before Feb. 1, 2021 will remain on the current Safety Dividend program until their policy term expires. This means that we’ll continue to pay safety dividends through 2022. Any policy written on or after Feb. 1 will not qualify for the Safety Dividend program.
For policyholders prior to Feb. 1, 2021 to receive a dividend: To receive a safety 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.
Previsor Insurance policies are not eligible for MEM’s Safety Dividend program.
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.
Accounts with policies written before Feb. 1, 2021 will receive their dividend nine months after their policy ends. Policies written on or after Feb. 1 will not qualify for a safety dividend.
MEM’s Safety Dividend program will be retired on Feb. 1, 2021. New policies prior to Feb. 1, 2021 will continue to be evaluated for safety points through Aug. 1, 2021. Payouts are nine months after the policy expiration.
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.
The Safety Dividend program elements are the primary means by which business owners can promote safety and ensure effective claims management. Safety remains important to price and to keeping people safe.