Nondisabling Claims Reimbursement program
Employers may choose to reimburse their insurance company for medical service expenses on accepted nondisabling claims. Under this option, employers can totally eliminate or partially reduce claim costs from future consideration in determining experience modifications or other charges based on losses.
The maximum claim reimbursement varies by date of injury and is published annually by the Oregon Department of Consumer and Business Services (DCBS). However, the reimbursement of claims is generally not recommended if your annual premium is less than $15,000, since the reimbursed claim costs may exceed any premium savings. Here's how the process works:
- If you choose to participate in the program, you must complete, sign, and mail the enrollment form to SAIF prior to the start of the policy year. If you have previously made this election, have had continuous coverage with SAIF, and you are not changing your plan option, you do not need to make a new election.
- SAIF must receive your enrollment form within 30 days of the policy inception date to establish your business as eligible for participation at the start of your policy. If the form is received more than 30 days after the policy inception date, participation in the program will be on a prospective basis.
- Enrollment in the program will continue until: a) You notify SAIF in writing to cancel participation, or b) Your coverage with SAIF is canceled.
Participation in the Nondisabling Claims Reimbursement program does not eliminate your responsibility to file a claim. You must still submit a completed 801 Form (Report of Occupational Injury or Disease) immediately upon learning of an injury. SAIF will continue to determine benefit eligibility, audit medical bills, and otherwise ensure that the claim is processed accurately and timely. Oregon Administrative Rules do not permit an employer to pay a medical provider directly; the insurer is responsible for determining entitlement to benefits and must process claims accurately and timely.
Definition of a nondisabling claim
A nondisabling claim is one in which the injured worker does not receive any payment from SAIF Corporation for time lost from work or any permanent disability. These claims are considered minor in nature and the injured person returns to work within a few hours or days. Generally, time lost from work is less than three days. If nondisabling claim expenses exceed the maximum reimbursement allowed for each claim, you may only reimburse an amount up to the maximum.
The reimbursement method varies by type of insurance plan. Please refer to your insurance policy to determine your plan type, or contact your agent for assistance. Reimbursement methods and options are described below. If you change plans from one policy period to the next, the reimbursement method may also change.
Guaranteed cost and regular retrospective rating plans
You may choose to reimburse on a quarterly or annual basis.
Quarterly reimbursement option: Each quarter that SAIF pays for a medical service on an eligible claim(s), you will receive a billing statement. You may choose to pay all, part, or none of the billing by indicating the amount you wish to reimburse per claim on the billing statement.
If you choose to reimburse SAIF, return a copy of the billing statement along with your payment within 60 days of the billing date. You may also view your statement, make reimbursement selections, and pay online by going back to the Employer Guide home page and logging in to Business Online.
SAIF will continue to bill you every three months, up to 27 months from the policy period effective date, for any payment made on eligible claims.
Annual reimbursement option: Fifteen months after the effective date of your policy, SAIF will evaluate the claims that occurred during the policy period and bill you for medical service expenses on eligible nondisabling claims. You may choose to pay all, part, or none of the billing by indicating the amount you wish to reimburse per claim on the billing statement. If you choose to reimburse SAIF, return a copy of the billing statement along with your payment within 60 days of the billing date. You also may view your statement, make reimbursement selections, and pay online by going to saif.com and click "I am an employer."
We will perform a second evaluation and send a second and final billing one year later.
Any payment received more than 60 days after the billing date will not be accepted by SAIF and will be returned to you if submitted by mail, or disallowed if entered online. In addition, you will lose your option to reimburse SAIF for the claim costs incurred during that statement period. However, your decision not to reimburse SAIF for any billing period will not terminate your participation in this reimbursement program.
Cash Flow (Incurred Loss and Paid Loss) Retrospective Rating plans
At the end of each quarter in which SAIF pays for a medical service on an accepted nondisabling claim(s), we will automatically apply the payments on your behalf. Since your plan requires you to pay claim costs on a monthly basis, a separate payment under this program is not required. To review this quarterly activity in an online statement go to saif.com and click "I am an employer."
Your Cash Flow Retrospective Rating plan evaluation, produced six months after the policy period end date, will include a claims list showing all the nondisabling claim payments credited to you under the plan. SAIF will perform a second and final nondisabling claims evaluation one year later at the same time we perform your second Cash Flow Retrospective Rating evaluation. Remember, SAIF will automatically apply all eligible claim costs when you elect a Cash Flow Retrospective Rating plan. You do not send separate payments.
Background of the reimbursement program
The 1987 Oregon Legislature enacted this law to help employers reduce or eliminate claims used in their future experience modification (ER Mod) calculations. The maximum reimbursement amount is tied to the injury date and may be changed annually by DCBS. At the time the employer reimburses SAIF, it is impossible to determine the effect the reimbursement will have on the experience modification factor. For more details see:
If you have any questions, or need additional information, call your agent or SAIF representative at 800.285.8525.