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Home My WebLink About20243034.tiffBOARD OF COUNTY COMMISSIONERS PASS -AROUND REVIEW PASS -AROUND T TLE: Obtain Signature for Work Comp experience modification Data Agreement DEPARTMENT: Human Resources DATE: 11/5/24 PERSON REQUESTING: Kelly Leffler/Jill Scott Brief description of the problem/issue: Finalization of We d's workers' compensation experience modification (e -mod) rating requires the BOCC Chair's signature on the attached agreement for Risk Broker Arthur J. Gallagher (Gallagher). The attached agreement submitt I form states the attached modification snapshot is correct to the best of Weld County's knowledge. Gallagher will submit the rating data to the National Council on Compensation Insurance (NCCI) for review, analysis, and a -mod calculation. The a -mod calculation will allow Gallagher to move forward and finalize the 2025 Workers' Compensation Insurance Renewal with Pinnacol. What options exist for the Board? The BOCC can aprove to sign the attached submittal form to allow Gallagher to move forward with sending the documents to NCI to receive a final a -mod calculation, or the BOCC can not approve signing the attached document. Consequenes: If the documll�ent is not signed, we will risk losing our workers compensation insurance by not completing the renewal brocess. Impacts: This would 'ncrease the risk the county obtains in regard to workplace injuries by not obtaining a partnership with a Third Party Administrator to manage the claims. Costs (Current Fiscal Year / Ongoing or Subsequent Fiscal Years): There is no cost associated with signing the attached document. Recommendation: It is recommended that the BOCC approves signing the submittal form to allow Gallagher to continue the renewal process. Support Recommendation Schedule Place on BOCC Agenda Work Session Other/Comments: Perry L. Buck, Pro -Tern Mike Freeman Scott K. James Kevin D. Ross , Chair Lori Saine Cons"" 19 k k/t 8/Zy do. cc 0nbase(E) M3/24- 2024-3034 O03 APPENDIX A6 Experience Rating Plan Manual -2003 Edition NON -AFFILIATE FORMAT INSTRUCTIONS FOR SUBMITTING EXPERIENCE RATING DATA PAYROLL AND LOSSES MUST BE ROUNDED TO THE NEAREST WHOLE DOLLAR. COLUMN 1 COLUMN 2 COLUMN 3 COLUMN 4 COLUMN 5 COLUMN 6 COLUMN 7 COLUMN 8 Fill in the effective month, day and year of the period for which information will be provided. A total of three years of experience can be included in the rating, not including the year immediately prior to the effective date of this rating. Each year's payroll and losses should be listed separately. Fill in the expiration month, day and year of the period for which information will be provided. Fill in the NCCI classification codes(s) that best describes your type of business. If you have any questions regarding these classifications, please contact Customer Service at 800-NCCI-123. Fill in the payroll amounts associated with the classification code(s) for each year being reported. Provide the claim number used for internal record keeping should you desire this information on the modification worksheet. If claim numbers are not used for internal record keeping, leave column blank. Fill in the appropriate injury type code (see following list). Only one injury type code is applicable per claim. Medical only claims should be listed as a "6," but claims that include both medical and disability or death benefits should be listed under the applicable disability or death code, such as "5" (Temporary Total or Temporary Partial Disability). Injury types must be noted for each entry. 1 = Death 6 = Medical Only = Permanent Total Disability 7 = Contract Medical or Hospital Allowance 5 = Temporary Total or Temporary Partial Disability 9 = Permanent Partial Disability ndicate whether the claim is open or closed/final by placing an O or F in the column. 1n Column 8, fill in the sum of incurred (paid plus reserved) losses per row. If no claims occurred, place a 0 In that space. Claims must be reported individually regardless of claim amount. The experience ratilig will be completed in accordance with the NCCI Experience Rating Plan Manual for Workers Compensation and Employers Liability Insurance. However, because we do not verify the accuracy of the data submitted by non -affiliates, the modification factor will be issued with a disclaimer. Name of the self -insured entity requesting the rating Weld County, Colorado Name of the entity submitting the data (if different) Arthur J. Gallagher Address 1150 "O" Street State CO Zip 80632 Phone 970--400/4220 Fax 970-352-0242 City Greeley, CO E-mail kleffler@weldgov.com AGREEMENT We hereby certify that the information given in this report is correct to the best of our knowledge and belief. BY SUBMISSION OF THIS INFORMATION, WE REQUEST THAT NCCI PRODUCE EXPERIENCE MODIFICATION FACTORS ON EACH OF THE RISKS LISTED AND AGREE TO PAY THE FEES FOR THIS SERVICE. In consideration of NCCI's agreement to produce the requested experience modifications, we release and discharge NCCI, its officers, drectors, employees and agents from all liability (except for gross negligence) in connection with the production or application of the same. The person signing this agreement certifies that he/she has the authority to execute this agreement on behalf of the self -insured entity requesting the rating. Authorized signers include the risk, the group self -insured and the TPA ONLY. Signed O M Printed Nagle of Signer Kevin D. Ross ATTEST: ^e By:. Clerk to the Board Deputy Clerk to the 1Yoard © 2002 National Council on Compensation Insurance, I Date NOV 1 3 2024 itle Chair, Board of Weld County Commissioners ERM-6 (Rev. 12/03) Oct 2003 (1) Mod Analysis for Weld County, Colorado Mod Snapshot Effective date: 1/1/2025 The Key Numbers Total expected losses Total expected primary losses Total expected excess losses $579,798 $214,159 $365,639 Total unlimited losses Total limited/adjusted losses Total actual primary losses Total actual excess losses $253,943 $253,943 $114,668 $139,275 Computed ballast value Computed weighting value Modification factor ARAP factor 59,400 0.36 0.72 1.00 Impact of Top Itemized Losses State Injury Date Incurred Loss Impact on Mod Mod w/o Loss CO 6/17/2021 CO 8/11/2021 CO 10/18/2021 CO 5/17/2021 CO 3/29/2021 CO 4/18/2021 CO 7/28/2021 CO 11/6/2021 CO 1/19/2021 CO 7/12/2021 The Mod Formula Actual primary losses $88,647 $51,782 $25,800 $25,230 $18,571 $16,245 $9,799 $7,783 $6,657 $3,429 + Ballast value 0.0644 0.0437 0.0290 0.0287 0.0250 0.0237 0.0153 0.0122 0.0104 0.0054 Weighting value x 0.6524 0.6731 0.6878 0.6881 0.6918 0.6931 0.7015 0.7046 0.7064 0.7114 Mod Breakdown 1.20 1.00 0.80 00.60 2 0.40 0.20 0.00 0.72 1.00 aii- 0.46 0.26 Current Average Minimum Controllable Actual vs. Expected Losses by Policy Period $579,798 $463,838 $347,879 $231,919 $115,960 $0 12/31/2020 to 1/1/2022 Actual excess losses (1 - Weighting value) x Expected excess losses Expected primary losses + Ballast value + $114,668 + 59,400 Weighting value x + 0.36 x Expected excess losses $139,275 (1 - Weighting value) + (1 - 0.36) x x Expected excess losses $365,639 $214,159 + 59,400 + 0.36 x $365,639 ModMaster ' Mod Analysis brought to you by Gallagher + (1 - 0.36) x $365,639 - Current mod - 0.72 Page 1 Proprietary and Confidential. ModMaster software frnvi; H, for an ESTIMATE of ar experience modification factor. Your official experience modification factor is issued solely by The applicable workers' compensation rating bureau.© 2024 `ywave, Inc. All Rights Reserved. Weld County, Colorado Mod Effective Date: 1/1/2025 WORKERS' COMPENSATION EXPERIENCE RATING FOR SELF -INSURED NAME OF RISK Weld County. Colorado ADDRESS OF RISK P.O. Box 758 CITY ZIP 80632 RISK IDENTIFICATION NUMBER Greeley STATE CO EFFECTIVE DATE 1/1/2025 FEDERAL IDENTIFICATION NUMBER 84-6000813 STATE OF COVERAGE CO Coverage Period (1) Effective Month/Day/Year (2) Expiration Month/Day/Year 131 Class Code (4) Payroll (5) Claim Identification No Assigned (6) Injury Type Code 171 Open/Closed - Final (O/F) (8) Incurred Losses (Paid+Reserves) 12/31/2020 1/1/2022 5506 7720 8385 8742 8810 8820 8832 9014 9015 9410 10,475,891 36,396,844 720,266 13,044,657 29,153,373 9,605,154 6,265,787 224,036 2,000,739 7,458,810 W221WLD090 W221WLD075 W221WLD003 W221WLD133 W221WLD048 W221WLD038- W221WLD058 W221WLD132 W221WLD104 W221WLD069 2 5 5 5 5 5 5 5 5 5 F F F F F F F F F F 9,799 3,429 6,657 7,783 16,245 18,571 25,230 25,800 51,782 88,647 Please follow NCCI instructions for completing this worksheet, including an NCCI-supplied agreement form, if necessary, and return to NCCI prior to the rating effective date Proprietary and Confidential ModMaster software provides for an ESTIMATE of an experience modification factor Your official experience modification factor is issued solely by the applicable workers' compensation rating bureau Ct Entity Information Entity Name* Entity ID* ARTHUR J GALLAGHER RISK @00000344 MANAGEMENT SERVICES, INC ❑ New Entity? Contract Name* Contract ID WORKER'S COMP EXPERIENCE MODIFICATION DATA 8844 AGREEMENT Contract Status CTB REVIEW Contract Lead * BPETERSON Contract Lead Email bpeterson@weld.gov Parent Contract ID Requires Board Approval YES Department Project # Contract Description * WELD COUNTY'S WORKERS' COMPENSATION EXPERIENCE DATA AGREEMENT, ENABLING RISK BROKER ARTHUR J. GALLAGHER TO SUBMIT THE DATA TO NCCI FOR CALCULATION AND FINALIZE THE 2025 WORKERS COMP INSURANCE RENEWAL WITH PINNACOL. Contract Description 2 Contract Type * AGREEMENT Amount* $0.00 Renewable NO Automatic Renewal Grant IGA Department HUMAN RESOURCES Department Email CM- HumanResources@weld.g ov Does Contract require Purchasing Dept. to be Department Head Email included? CM-HumanResources- DeptHead@weld.gov Requested BOCC Agenda Due Date Date* 11/09/2024 11/13/2024 Will a work session with BOCC be required?* NO County Attorney GENERAL COUNTY ATTORNEY EMAIL County Attorney Email CM- COUNTYATTORNEY@WEL RN EY@WEL D.GOV If this is a renewal enter previous Contract ID If this is part of a MSA enter MSA Contract ID Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in OnBase Contract Dates Effective Date 01/01/2025 Review Date 11/03/2025 Termination Notice Period Committed Delivery Date Contact Information Contact Info Renewal Date Expiration Date* 12/31/2025 Contact Name Contact Type Contact Email Contact Phone 1 Contact Phone 2 Purchasing Purchasing Approver Purchasing Approved Date CONSENT 11/07/2024 Approval Process Department Head JILL SCOTT DH Approved Date 11/07/2024 Final Approval BOCC Approved BOCC Signed Date BOCC Agenda Date 11/13/2024 Finance Approver CONSENT Legal Counsel CONSENT Finance Approved Date Legal Counsel Approved Date 11/07/2024 11/07/2024 Tyler Ref # AG 111324 Originator BPETERSON Hello