Below are some of the most Frequently Asked Questions (FAQs) from Members. Click on the links below to view responses to each question.
September 1-August 31. The Fund year (also known as accident year) is the year during which the accidents that generate a group of claims occurs, regardless of when the payments are made, or reserves are established. All claims are tracked by Fund year to allow the actuary to observe how the claims of each Fund year are developing which assists in the prediction of ultimate loss of past and future years.
Ultimate loss is the estimated value of claim costs at a time when all claims have settled. The amount is continually re-estimated until all claims have actually settled. Ultimate loss is estimated for each Fund year and is made up of the following three components:
Unallocated loss adjustment expenses are claim settlement expenses that cannot be directly attributable to individual claims (e.g. fixed fees for claim adjusting services).
For the Workers’ Compensation, annual member contributions are earned on a pro-rata basis from the initial coverage date until the annual coverage renewal date, which coincides with the Fund’s year end.
Most members participate in a Minimum Contribution Plan (the “Plan”) for the Workers’ Compensation Program. The Plan provides coverage on a retrospectively rated basis. Eligibility for participation in the Plan is based on a member’s prior loss experience and initially the member must have a positive surplus position in the Workers’ Compensation Program to elect the 80%-100% MCP Plan. Should the center select the MCP option, it will pay monthly installments based on actual payrolls. The first of six retrospective adjustments will be calculated in March based on reported losses as of December 31st the year following the close of the Fund Year. The subsequent five adjustments will be calculated annually in March (with losses as of December 31st) of the years following the first adjustment, but in no case exceed the maximum limit chosen (the exception to the annual valuations would apply if a catastrophic occurrence pushed losses beyond the maximum contribution level during the first year). Under this Plan, the Fund recognizes contributions based on individual member experience adjusted for a share of total incurred but not reported (IBNR) losses and development of existing losses in the sixth and final adjustment. The adjustments are made for a six-year retrospective period.
Go to the TCRMF site, select the appropriate Loss Notice, and complete the Loss Notice.
Save a copy of the completed Loss Notice for your records and email a copy to:
Select the Automobile Accident Report/Loss Notice for all auto claims. This includes first party collision and comprehensive claims (hail, vandalism, hitting an animal, etc.) as well as third party auto liability claims.
Select the Liability Loss Notice for all general liability, professional liability, or errors and omissions liability (including employment).
Select the Property Loss Notice for all damage to property (excluding automobile damage – use the Automobile Accident Report/Loss Notice for reporting all automobile damage).
There is not a mechanism to track or code liability in Juris and it would not be best practice to place liability decisions in a report. Liability cannot be legally determined until adjudicated by a jury. This is why our Releases have language that “this compromise settlement is not an admission of liability”.
The liability insurance follows the vehicle and the insurance coverage on the employee’s vehicle is primary. The coverage provided by the Fund shall be excess over any valid and collectible insurance available to the covered party.
No. Regarding First Party damage, the Fund pays for loss to covered automobiles only. Covered Automobile means an automobile which is owned by the member and for which coverage is adopted in the coverage agreement or is leased by the member and for which coverage as adopted by the member is required under a lease agreement.
As a brief summation, the Replacement Cost Value (RCV) is what it costs to re-build to today’s standards with comparable materials at today’s costs. The Actual Cash Value (ACV) is RCV minus depreciation. As the Fund property coverage is for RCV (with a few exceptions), this depreciation is considered “recoverable depreciation” or another common term is “hold back”. ACV is paid up front less the applicable deductible. Once repairs are completed, a reconciliation is done to determine the actual cost incurred to complete repairs versus what was paid up front and any hold back due is then released. It is important to note that in order to receive RCV, the repairs must be completed within two years of the date of loss.
Step 1: Get care
In the event of a workplace injury or illness, make sure your employee gets immediate care.
Members’ injured employees are required to seek medical treatment from the Alliance’s provider list of treating physicians. A complete list is available online at http://www.pswca.org.
In case of an emergency, injured workers can go to the nearest emergency room; emergency care does not need to be approved in advance. Emergency care is covered under workers’ compensation.
Step 2: Report the injury
Our online workers’ compensation claims reporting tool https://intake.sedgwick.com/u/5856/intake (Smart.ly) gives Fund members an easy way to submit workers’ compensation claims. If a member cannot use the online claim submission tool, they can also submit a completed claim form (DWC-1) by emailing them to [email protected].
Reporting is the first step in getting us to work for you. Report the injury as soon as possible so that a specialized adjuster can begin to gather any additional details needed to determine eligibility and benefits and assist with getting all necessary care. Once the claim is reported and assigned to an adjuster, the employer or injured worker can directly call their adjuster for assistance related to an on-the-job injury.
The steps are the same for getting care after hours or holidays. If pain escalates through the night or over the weekend and you feel you need immediate care, go to the emergency room for medical attention. Certainly, you should seek immediate medical attention for any potentially life-threatening injury or illness.
Pay medical bills as the result of injuries/occupational disease.
Wage replacement for employees injured and unable to work job of injury or at a reduced capacity.
Compensates employees for impairment (partial/permanent) resulting from an injury/occupational disease.
Emily Rice, Workers’ Compensation Team Lead
Phone: 972-372-6181
After hours: 903-461-2578
Fax: 859-264-4061
Sedgwick
P.O. Box 14495
Lexington, KY 40512
Phone: (866) 495-4844
Please emphasize that injured workers should not use their personal insurance as that causes accounting issues that could result in the injured worker receiving bills for payment.
Toll Free: 877-922-7236
Fax: 866-286-0281
Optum: 888-764-1284
Alliance
Fund members’ injured employees are required to seek medical treatment from the Alliance’s provider list of treating physicians. However, in case of an emergency, injured workers can go to the nearest emergency room; emergency care does not need to be approved in advance. Emergency care is covered under workers’ compensation
A print friendly version is available on the Fund website at:
Email [email protected] for a login. Once logged in, members can view Federal and State cyber resources, Policies and Plan Templates, Cyber Trainings links, Cyber Breach Resources, Security tips and Cyber news.
On-site or virtually, the Cyber Risk Services Advisor has detailed look at the member’s cyber security controls, systems, policies, and processes. The meeting will take a few hours.
After all meeting questions have been answered and assets have been documented, a Cyber Risk Assessment and Recommendation Report is produced and presented to the member.
The Recommendation Report contains the top 5 recommendations addressing potential vulnerabilities, policy refinement and development, facility security, from the data collected at the assessment meeting.
The Recommendation Report is a great tool for budget planning and cyber insurance application reference.
The purpose of a table-top exercise is to test and discover gaps in your organization’s Incident Response Plan. The exercise is tailored to your organization’s specific needs and performed on-site at your location. TCRMF Cyber Risk Services Advisor can develop a table-top exercise to test and discover gaps in your organization’s Incident Response Plan. The TCRMF Cyber Risk Services Advisor will create a series of cyber-attack scenarios (Account Compromise, Ransomware, Double-Extortion Ransomware, etc.) that the member’s IRP team will collaborate on using their currently developed Incident Response Plan. Gaps in documentation or assignments will be reviewed and a plan of action for filling the gaps will be decided.
To schedule an Incident Response Plan Testing visit, contact Lee Cain, [email protected].
As a member of the Fund, Cyber Risk Consulting services are covered at no extra cost.
TCRMF Leadership Webinars are scheduled most Fridays at 9:00 AM CST. To register please visit the Texas Council Risk Management Fund’s website at https://www.tcrmf.org/events/. Under Services select “View/Register for Fund Events” and follow registration instructions.
To request and onsite Leadership Training please visit the Texas Council Risk Management Fund’s website at https://www.tcrmf.org/services-landing-page/. Under Services select View Training and Education Options. Select “Leaders” then select “Click Here to View List of Leadership Courses” to download a current Brochure with training course descriptions, training parameters and contact information.
To request login credentials, please email your first and last name and email address to [email protected]. Each user will need login credentials. Employees can then enroll in individual courses and receive a Certificate of Course Completion after passing a short quiz.
A User Guide with detailed instructions is available at this link NEOGOV User Guide.
View the list of Online Courses here: Course Catalog.
View and register to attend the Fund events from the Fund’s Events page.
Staff contact phone numbers and email addresses can be viewed on the Contact List.
Members have several information resources available to them. If you don’t already have a login to the secure Member Resources section of the Fund website, please email mailto:[email protected].
The Fund is a governmental self-insurance vehicle, created through interlocal agreements with members that pool their risks together. It is not an insurance company.
Fund membership is open to any community center created pursuant to Chapter 534 of the Texas Health and Safety Code. The Fund’s bylaws require that a center must also be a member of the Texas Council of Community Centers (Texas Council).
The Fund does not issue policies of insurance but provides coverage documents for the self-insurance. The Fund purchases reinsurance or excess insurance for financial protection in the event of catastrophic claims.
The Risk Management Consultant writes Risk Alerts, Bulletins, the Annual Report, and Risk Advisor articles based on current events, emerging risks, and expressed concerns from members. The Risk Management Consultant frequently reviews member’s contracts and works closely with members regarding coverage issues involving contractors and vendors and provides guidance on center’s insurance requirements for contractors.
Yes, the services are available to all members no matter the size of the member. The member’s contributions include this service.
The Risk Management Consultant provides onsite risk management assessments that examine risk sources for a center. A report is created based on the onsite assessment with discussion and findings as well as recommendations.
Another service is a security review for operations and facilities. The Risk Consultant creates a report with recommendations.
Risk Consultant reviews risk related policies and procedures, safety issues, claim history analysis, insurance coverages and insurance policies.
A contract review examines the indemnification clauses that should protect the center, safety provisions and insurance requirements. The insurance requirements define what the contractor or vendor are responsible for and their assumption of your risk. Other considerations tied to protecting the center include venue, mediation, and arbitration provisions.
Yes. We can help members with different aspects of their Safety Committee. Risk Control can help start a brand-new committee or offer ideas to liven up one that has lost its spark. We can also assist with hazard identification, claims analysis and accident investigation. We can sit in and observe meetings and provide feedback and even come in as an outside presenter, as well.
On a normal safety audit, Risk Control will come out, ask questions about the member’s Safety Committee, as well as processes/policies for accident investigation, hazard identification, claims analysis, safety training, and return to work. A hazard identification walk-through of facilities is also conducted.
Risk Control will walk through facilities looking for employee injury risk exposures. The more common types (slips/trips/falls, strains and sprains, and struck by) serve as the main focus but other observations will be noted, too. Recommendations to help mitigate risks are then made for each observed hazard.
Yes. We have a variety of safety training presentations and would be more than happy to come out to provide training to your staff. Contact the Risk Control consultant who normally visits with you or the Risk Services Manager Jeremy Wade ([email protected]) for more details.
Unfortunately, no we do not. Local Fire Departments and other organizations do offer this type of training and certification.
There is no simple answer because there are so many moving parts. The first thing in our estimation is to lead by example, showing that attention to safety and risk management are important and endorsed by top leadership. Request input and read reports about metrics, incidents, near misses and policies and procedures related to safety and risk management. If top leaders take interest and indicate their commitment, most employees will take notice and adopt similar attitudes. Disciplinary measures should not be a first resort, but not avoided if necessary. Tolerance and empathy are good but of limited value when there are egregious actions or violations of policy. The Fund’s risk control and risk management consultants can help you develop priorities and help you get your message out to your workforce.
The safety program analysis is meant to look deeper into leading indicators for safety (Safety Committee, Accident Investigation, Claims Analysis, Hazard Identification, Safety Training, and Return-to Work), that will help the Loss Control (LC) Consultants identify aspects where an individual member is excelling and where LC can help the member improve. The scoring system being used is meant first to serve as an identifier of areas needing improvement and second as an annual performance measurement (improvement versus regression). The desired result is an increase in awareness and a reduction in incident frequency through proactive actions.
The Fund Orders MVR’s:
at the time of renewal based on the list of all employees received from the center,
when an at-fault accident is reported to claims, or
when the Fund becomes aware of a driving violation from other sources, i.e. this frequently occurs when the member reports a violation to the Fund.
Before making an offer of employment. The center wants to make sure the employee is insurable with the Fund.
The center and the employee are excluded from automobile liability and automobile physical damage coverage with the Fund for any claim or suit involving this employee. This means the center would also not be covered if named in a suit arising from an accident involving the excluded driver.
A named driver exclusion form is sent to the center for acknowledgment and signature by an authorized representative.
The federal Driver’s Privacy Protection Act prohibits redisclosing the MVR to a third-party unless they meet one of the fourteen exceptions. None of the exceptions authorizes the “insured” to obtain the record from the “insurer” (The Fund). Absent the driver consent, the Fund cannot share specific individual driving history with anyone, including the “insured” or member. The Fund is not able to release any information other than whether the driver is insurable or not under the center’s coverage with the Fund.
If the center would like a copy of the individuals driving history, they need to request that the driver order a Type 2 MVR directly from the respective state’s Department of Motor Vehicles. Many states offer this service online.
Within 45 days of when the property is acquired or sold.
Newly purchased vehicles should be reported as soon as they are acquired.
Sold vehicles should be reported within 30 days after the vehicle is sold or no longer owned or leased by the center.
The Fund does not charge additional contribution or return contributions until the cumulative changes exceed plus or minus $1.5 million in values. Thereafter, all changes are billed as changes occur.
Member’s property policy protects your physical location, contents, and equipment. Commercial property insurance helps protect owned or rented equipment, buildings, and personal property at the center.
Some examples of items that need to be scheduled include property that is owned, leased, or rented by the member. Examples include:
Buildings (must be reported within 45 days of the date of purchase, lease, or rental)
Physical locations
New buildings
Additions under construction
Boiler and Machinery
Electronic Data Equipment
Mobile Equipment (not assigned to a building/location)
Miscellaneous property and equipment that is owned, leased, or rented by the member and is not part of the building or personal property and within 1,000 feet of a scheduled location, must be separately scheduled to be covered. Some examples of miscellaneous property include:
Fences, gates, retaining walls.
Radio or television antennas and their lead-in wiring.
Swimming pools, bulkheads, pilings, piers, wharves, or docks.
Fire hydrants, streetlights, traffic lights, traffic signs, free standing signs, masts, or towers.
Bridges, tunnels, overpasses
Playground equipment, tennis courts, roadways, sidewalks, patios, driveways, curbs, parking lots, and other paved surfaces.
Flag poles, free standing lights and light poles, guardrails, road signs, and any off-premises piping, off-premises underground wiring, off-premises optic cables or telephone and communication lines, or off-premises electric transmission and distribution lines including poles and pole-mounted transformers.
Please remember to always to reach out to the Underwriting team within 45 days to add newly acquired/purchased property or when the property is sold, including if you have questions about whether an item must be scheduled or covered.
