Auditing workers' compensation policies requires verification of payroll records, employee classification data, and business operational information to validate premium calculation accuracy. The process adjusts premiums through actual data instead of initial estimates to maintain state regulatory compliance and fair pricing. Here's a detailed breakdown:
Frequency of Reviews
In Pennsylvania, insurers audit workers’ compensation insurance policies annually, reviewing your actual payroll, employee classifications, and related records to ensure your premium accurately reflects your business operations. Audits are also conducted if you cancel your workers’ compensation policy to reconcile estimated versus actual exposure during coverage.
What to Audit
Workers' comp audits ensure your premium reflects actual payroll and job risks during the policy period. The key objectives include:
- Verifying payroll: Actual wages (including overtime and bonuses) are compared to initial estimates, as premiums are partially based on payroll.
- Assessing job classifications: Roles are reviewed to determine the risk levels influencing premium rates.
- Regulatory compliance: Audits provide data for state agencies to calculate experience modifiers and classification rates.
Insurers typically notify you via email or mail within 35 days of policy expiration, requesting documentation, including:
- Payroll records (W-2s, 941 forms, overtime payments)
- Employee classifications and job descriptions
- Subcontractor certificates of insurance
Physical audits are conducted on-site within 60 days of the policy's expiration and involve record reviews and operational assessments. Virtual audits entail remote verification via documents and interviews.
Handling Discrepancies
When discrepancies occur during a workers’ compensation policy audit, such as differences between estimated and actual payroll, misclassified employees, or missing documentation, they are handled through a structured process:
Audit Summary and Notification
After completing the audit, the insurance company summarizes the findings, detailing any discrepancies and how they affect your premium. This summary explains whether you owe an additional premium or are due a refund.
Premium Adjustment
If the audit reveals that the initial premium was too low (for example, due to underreported payroll or misclassified employees), you will be billed for the additional premium owed. If you overpaid (such as by overestimating payroll), you will receive a refund or credit for the difference.
Opportunity to Dispute
If you disagree with the audit findings, you may dispute them. You should promptly contact your insurer, provide supporting documentation, and explain the specific points of disagreement. During the dispute process, the insurer may place the billing in dispute and investigate further. You may be required to pay the undisputed portion of the premium while the dispute is resolved.
Further Resolution
If the issue is not resolved directly with the insurer in Pennsylvania, you can escalate the dispute. This process may involve filing a petition with the Workers’ Compensation Office of Adjudication, where a Workers’ Compensation Judge (WCJ) will review the case and decide.
We Can Help Your Company with Workers’ Compensation Insurance
Looking for an experienced and reliable workers' compensation insurance agency? Contact American Insuring Group online, or call (800) 947-1270 or (610) 775-3848. Our independent agents will find you the perfect policy at an excellent price.
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