HR and workers comp

Workers’ Comp Audit Mistakes: What to Look For

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Article:

No company owner wants to undergo a workers’ compensation audit, but they are a fact of life if you run a business and have employees.

Unfortunately, many audits don’t go smoothly and sometimes your insurer may make mistakes. Missouri-based Workers’ Compensation Consultants, which helps employers through the workers’ comp audit process, recently listed the 10 most common audit mistakes that insurance companies make.

The list highlights a common problem and how you can detect the mistakes to avoid being stuck with a massive audit bill. Insurance companies allow you to review the audit with your broker. If you notice that you have received an audit bill that is obviously overstated, you should contact us.

Here are the things to look for when reviewing an audit by your insurance company:

Wrong class code – Misapplication of job classifications occurs in many workers’ comp audits. With hundreds of job classes to choose from, mistakes can happen. Talk to us and review your old policies to see if any of your class codes have changed.

X-Mod is changed – After your insurer finishes the audit, it will use the information to calculate your premium. When that happens, it has to include your X-Mod to get the right rate. But sometimes the insurer may use an incorrect X-Mod. Check carefully.

Subcontractors are counted – Sometimes insurers will include subcontractors as employees, which results in a new audit bill to account for the additional “employees.” But if they are genuine subcontractors, they should not be counted. Often, uninsured contractors will be included as employees. Make sure to use insured contractors only.

Disappearing credits – Most policies will have some sort of premium credits or other modifiers. Sometimes during audits, the insurer will remove them when recalculating the premium they think you owe. Watch out for missing credits and other modifiers if you get an audit bill, like:

  • Premium discount
  • Schedule credits
  • Deductible credits
  • State-specific credits

Audit worksheets missing – If the auditor fails to provide you with audit worksheets, which are used to compile your payroll and other audit information, you should ask to check their work. They will provide you with the information you need to carry out such a check.

Your rates changed – The rates you are charged at the beginning of your policy period must remain the same for the entire policy period. If your base rates have changed, the insurer may have made a mistake.

Separation of payroll – Depending on your industry, you may or may not be able to split your employees’ payroll between job classifications (like cabinet installers and sheetrock hangers). This is a pinch point when errors can occur. If the auditor says you are not allowed to split job classifications even though you have in the past, your audit may be in error.

Unexpected large premium due – If you get a significant bill for your insurance company after your audit, the auditor may have made mistakes, particularly if you know that your employment has remained relatively stable and you’ve had no significant claims, if any. If it seems out of whack, call us. 

Payroll data doesn’t match – If there is a discrepancy between your payroll data and what you see on the audit, a mistake may have been made. Try to match the payroll on the audit with that generated from your accountant. If the insurer made a mistake, you could end up paying for phantom payroll numbers.

No physical audit – There are three types of audits:

  • Mail audit
  • Phone audit, and
  • Physical audit

The mail and phone audits are prone to errors since neither you nor your staff likely have any experience in premium auditing. If you have a big bill after a mail or phone audit, mistakes could have been made. 

BGES Group’s office, located in Larchmont, NY is a full service insurance agency offering, Property, Liability, Umbrella Liability, Business Auto, Bid & Performance Bonds, Inland Marine, Worker’s Compensation, New York State Disability, Group Health, Life insurance, Personal lines and Identity Theft.  

BGES Group are Worker’s Compensation Specialists for the States of New York, New Jersey and Connecticut – Issues we address: 1) Lowering pricing – we have specialty programs that can save you up to 40%; 2) Finding a new company; 3) Being cancelled or non renewed; 4) Audit disputes; 5) Company creating fictitious payroll at audit time; 6) Lowering high experience modifications factors; 7) Misclassification of payrolls; 8) Lowering or eliminating renewal deposits;   9) Getting coverage when you’ve been without for a few months; 10) Covering multiple states under one policy; 11) Eliminating 10% service or policy fees; 12) Timely issuance of certificates; 13) Always being able to get someone on the phone or by email when you need to.

Special Contractor Insurance Programs (NY) – We we have 50 insurance companies to market your general liability, umbrella liability, business auto, workers compensation, bid & performance bonds and group health coverages.  We help contractors set up proper risk transfer mechanisms.  If you’re a contractor we offer extensive information about insurance markets, coverages, risk transfer mechanisms, subcontractor screening, ways to lower your insurance costs that lower them.    

New Jersey and Connecticut Contractors:  We have a fiercely competitively priced (savings up to 50%)  General Liability, Umbrella Liability, Business Auto, Workers Compensation program.  Want to lower these costs?  Get a quote today! 

Identity Theft – Over the past year hundreds of thousands of people have had to deal with identity theft.  This has become such a huge problem so we now offer Identity Theft Protection. We heard stories of kids going for car loans and learning they owe $200,000+ to companies they never heard of.  Under our program you can protect yourself, spouse and children.  Anyone you know can purchase this protection though our plan!  Click here to learn more or sign up. 

If you would like to speak with us call Gary Wallach at 914-806-5853 or click here to email or click here to visit our website.

Company: BGES Group, 216A Larchmont Acres West, Larchmont, NY 10538

e-mail: bgesgroup@gmail.com

website: http://www.bgesgroup.com

© – Copyright – 2019 – BGES Group

Protect Personal Finances By Preventing Identity Theft

Workers Compensation Fraud Lands Employers in Hot Water

Workers’ Compensation is a compromise between employers and employees. Employers cover injured employees’ medical costs and lost wages. They do this even if they were not at fault. Employees lose the right to sue their employers over injuries.

State laws require most employers to buy Workers’ Compensation insurance. Employers may see this as money unnecessarily spent. They must pay it even if no injuries occur in their workplaces. Consequently, a minority of them try to cheat the system. Things do not end well for these employers.

Some try to get away with not buying insurance.

  • A Florida married couple owned and operated four supermarkets. One of them went without insurance for 10 years. They were arrested for this and other fraudulent transactions. Authorities estimated the amount of their fraud at $35 million.
  • The owner of a Florida employee leasing company charged his clients millions of dollars for insurance premiums. However, his  policy did not exist. The fraud left 33,000 workers unprotected. His jail sentence was 14 years.
  • Two employees of a Vermont home improvement contractor who skipped insurance got hurt. He was forced to cover $80,000 in medical bills and serve 30 days in prison.

More commonly, employers buy insurance but give their insurers false information. A moving services company in California took this to an extreme.

  • They under-reported payroll to the State Compensation Insurance Fund.
  • They pressured employees to lie about how they were injured. This made the company’s loss record would look good.
  • They failed to pay premiums due, resulting in policy cancellations.

The owner pled guilty to multiple felony counts, received a 16-month jail sentence and was ordered to pay $2.385 million in restitution. His wife also pled guilty, received three years’ probation and had to pay a fine plus $470,000 in restitution.

A common tactic is to misclassify employees.

  • Connecticut construction company told its insurer that it had one employee who did carpentry work. When the insurer audited the company’s books, it found that it had several employees who performed roofing work. The premium jumped from $750 to $51,000. The policy subsequently cancelled for non-payment of premium. Two months after cancellation, an employee suffered serious injuries while doing roofing work. The insurer refused to pay for the claim. The employer sued, but two courts ruled against him.
  • New York tree surgeon was charged with a felony after falsely reporting that an injured worker was an independent contractor and not an employee.

Some employers also try to pass off false evidence of coverage. The owner of an Ohio excavating contractor created false certificates of insurance and submitted them with bids to help him get jobs. In addition, he misclassified employees as independent contractors. He got six months in prison, three years of monitoring, and had to pay restitution.

Employers who try to cheat the Workers’ Compensation system rob their employees of the benefits to which they are entitled. They also gain an unfair advantage over their law-abiding competitors. Employers who decide to play this game should understand that they will eventually lose.

BGES Group’s office, located in Larchmont, NY is a full service insurance agency offering, Property, Liability, Umbrella Liability, Business Auto, Bid & Performance Bonds, Inland Marine, Worker’s Compensation, New York State Disability, Group Health, Life insurance, Personal lines and Identity Theft.  

BGES Group are Worker’s Compensation Specialists for the States of New York, New Jersey and Connecticut – Issues we address: 1) Lowering pricing – we have specialty programs that can save you up to 40%; 2) Finding a new company; 3) Being cancelled or non renewed; 4) Audit disputes; 5) Company creating fictitious payroll at audit time; 6) Lowering high experience modifications factors; 7) Misclassification of payrolls; 8) Lowering or eliminating renewal deposits;   9) Getting coverage when you’ve been without for a few months; 10) Covering multiple states under one policy; 11) Eliminating 10% service or policy fees; 12) Timely issuance of certificates; 13) Always being able to get someone on the phone or by email when you need to.

Special Contractor Insurance Programs (NY) – We we have 50 insurance companies to market your general liability, umbrella liability, business auto, workers compensation, bid & performance bonds and group health coverages.  We help contractors set up proper risk transfer mechanisms.  If you’re a contractor we offer extensive information about insurance markets, coverages, risk transfer mechanisms, subcontractor screening, ways to lower your insurance costs that lower them.    

New Jersey and Connecticut Contractors:  We have a fiercely competitively priced (savings up to 50%)  General Liability, Umbrella Liability, Business Auto, Workers Compensation program.  Want to lower these costs?  Get a quote today! 

Identity Theft – Over the past year hundreds of thousands of people have had to deal with identity theft.  This has become such a huge problem so we now offer Identity Theft Protection. We heard stories of kids going for car loans and learning they owe $200,000+ to companies they never heard of.  Under our program you can protect yourself, spouse and up to 10 children.  Anyone you know can purchase this protection though our plan!  Click here to learn more or sign up. 

If you would like to speak with us call Gary Wallach at 914-806-5853 or click here to email or click here to visit our website.

Company: BGES Group, 216A Larchmont Acres West, Larchmont, NY 10538

e-mail: bgesgroup@gmail.com

website: http://www.bgesgroup.com

© – Copyright – 2019 – BGES Group