Experience Mod Rate (EMR): How Workers' Comp Claims Change a NEMT Company's Premium

Two NEMT companies with the same payroll and the same class codes can pay very different workers’ comp premiums. The difference is the experience mod, a number built from your own claims that multiplies your premium at every renewal. Here is how it is built, how a driver’s injury moves it, and what you can do about it.

How an experience mod works

Your insurer prices workers’ comp in two steps. First, each class’s rate is applied to each $100 of payroll in that class, as insurance class codes explains. Then the total is multiplied by your mod.

In most states the mod comes from a rating bureau, not your insurer. NCCI’s plan is approved in 39 jurisdictions, and NCCI calculates the mods in most of them. Indiana, Massachusetts, and North Carolina use the plan, but each state’s own bureau produces its in-state mods (ABCs of Experience Rating, 2025 edition). The plan does not apply in California, Delaware, Michigan, New Jersey, New York, or Pennsylvania, or in the four states whose state funds run their own plans: North Dakota, Ohio, Washington, and Wyoming.

The bureau compares your actual losses over about three years with the losses expected for your payroll. Expected losses are each class’s expected loss rate times each $100 of payroll in it. Losses include what has been paid and what the insurer has set aside on open claims, so a claim still open counts at its reserve.

Not every company gets a mod. NCCI gives a mod of 1.00 to a new business with no data, to a company below its state’s premium threshold, and when ownership change data is missing. Each state sets its own threshold, and a company can meet it on its last two years of premium or on its average over the whole period. Pennsylvania lowered its threshold from $10,000 to $5,000 of premium on April 1, 2024, and employers below it get a merit rating instead.

A billing example

Say your six drivers and your dispatcher produce $30,000 of premium before the mod. At a 0.85 mod you pay $25,500. At a 1.25 mod you pay $37,500, which is $12,000 more for the same people doing the same work. Because each policy year sits in three mods in a row, one bad year raises your premium at three renewals.

How a driver’s injury moves your mod

NCCI’s plan counts how often your workers get hurt more heavily than how much each injury costs. It splits every claim at a split point that each state approves in its rate filing. The part up to the split point is a primary loss and counts in full. The part above it is an excess loss, and it gets less weight, especially at a small company. Each claim is also capped at a state limit.

NCCI’s own examples use a split point of $18,500. On that number:

• Five back strains at $8,000 each, all with lost wages, put the full $40,000 on your worksheet as primary losses.
• One $40,000 crash injury puts $18,500 there as primary loss, and the other $21,500 counts as excess at a lower weight.

The totals match, but the five small claims raise your mod more. In NEMT work, the tasks drivers repeat all day, such as pushing wheelchairs up ramps, running lifts, and helping riders transfer, are where small claims pile up. Passenger transfer techniques covers the equipment and methods that prevent them.

Claims that pay only medical bills, with no lost wages, count for less. Most NCCI states have approved an adjustment that enters only 30 percent of a medical-only claim, so a $3,000 medical-only claim counts as $900. NCCI says the adjustment lowers the incentive to pay medical-only claims yourself without reporting them to the insurer.

How long a claim counts

NCCI uses policies that started 21 to 57 months before the mod’s effective date. The current policy is left out, and insurers have 18 months after a policy starts to report it. If your policy renews each January 1, a claim on the policy that began January 1, 2026 first counts in your January 1, 2028 mod, then in 2029 and 2030, and drops off in 2031.

How to bring your mod down

1. Prevent the injuries that repeat. Frequency moves the mod most, so lifts, ramps, gait belts, and two-person stretcher moves pay off in your premium.
2. Report every injury to your insurer. A reported medical-only claim counts at 30 percent in most NCCI states, so paying small bills yourself saves little on the mod.
3. Bring hurt drivers back to work. NCCI says the plan rewards getting injured workers back as soon as reasonably possible. Light-duty work and the state programs that help pay for it are in workers’ comp for NEMT drivers.
4. Keep open claims accurate. Ask the adjuster to update the reserve or close a claim once treatment ends. California’s Department of Insurance warns that reserves set too high can inflate the mod.
5. Read the worksheet line by line when the new mod comes out. NCCI usually calculates a mod 60 to 90 days before its effective date. The worksheet lists each claim over $2,000 by number, open or final, with its amount. Compare it with your loss runs and your audited payroll, since missing payroll raises the mod too, as workers’ comp audit for NEMT explains. In California, your insurer must send loss runs within 10 business days when you ask in writing within 60 days before renewal (Insurance Code 11663.5).
6. Tell your insurer when another driver caused the crash. In Pennsylvania, losses that enter the mod are reduced by what the insurer recovers from the at-fault party (PCRB Filing No. 323).
7. Report ownership changes within 90 days. Use NCCI’s ERM-14 form or a signed letter on your letterhead, so the bureau assigns your past experience correctly.

If a mod looks wrong, start with your insurer. In California, the steps for disputing a mod, including appeals to the Department of Insurance, are in 10 CCR 2509.40 to 2509.78.

Where the rules differ

• Pennsylvania. PCRB’s plan update of April 1, 2024 replaced a single $42,500 split point for every employer with split points that vary with each employer’s expected losses. It also caps a mod at a maximum that starts at 1.10 and rises with expected losses, and limits a one-year rise to 40 percent over the prior mod. The older 25 percent swing limits ended with mods effective April 1, 2026.
• California. The Workers’ Compensation Insurance Rating Bureau (WCIRB) calculates mods from paid losses and reserves with a formula the Department of Insurance approves, and shows them as a percentage, with 100 percent as average.
• Leasing your drivers through a PEO. A PEO’s master policy can change whose experience sets your rate. See professional employer organization before you sign.