The Workers Compensation Audit: What It Is & How to Prepare

In our previous post, we gave a general overview of what Workers Comp insurance is, and ran through a couple of examples of how the policy might be set up.  We really limited that to some very general information.  Today, we’ll start getting into more detail by going over one specific part of every workers comp policy – the Workers Compensation Audit.

What is the workers compensation audit and what is its purpose?

First of all, take a breath.  The word “audit” has a pretty negative connotation and can be taken to mean an intrusive, difficult and adversarial process.  That’s not typically what the Workers Comp Audit is, and definitely not what it should be. Because your Workers Comp policy premium is based upon what your employees are doing and what their payroll is, the insurance company verifies this information via an audit, and it’s usually a fair and straight-forward process.

The Audit can come in several forms.  The most common form for small businesses is a form the insurance carrier sends you, either via mail, email, or through a web portal.  Many carriers use a Third Party to conduct the audit, so it would be common for you to work with a representative from that third-party company.

If you’re dealing with a third-party company and you’re not sure if they really represent your carrier – contact your agent.  Protecting your information and your employees’ information is always important.

Depending on the carrier, the size of your business or the industry you work in, an in-person audit may be more common.  In this instance, the auditor should contact you to set up an appointment and let you know ahead of time what information you should have on hand.

Preparing for the Workers Compensation Audit

There are a couple of things that you should have ready for the audit.  These include:

  • Payroll Reports from every check date between your policy’s effective dates.
    • Summary reports are the best way to go – they have the same information and help reduce the amount of paperwork.
  • Quarterly 941 Reports from the 4 quarters closest to your policy period
  • Quarterly UC-2 Reports from the 4 quarters closest to your policy period
  • Gross Receipts (not all carriers ask for this, but it is becoming a more common practice)

If you don’t have these reports on hand, you can usually get them pretty easily from your payroll company.

An audit can be completed with this information for many businesses; however, there is additional information needed if you use subcontractors or 1099 independent contractors.

Subcontractors & Certificates of Insurance

Almost every audit asks if you use any subcontractors or 1099 independent contractors.  If you don’t, simply answer no and that’s all that’s typically needed.  If you do ever use subcontractors, make sure you have Certificates of Insurance that show they had their own Workers Comp coverage at the time they worked for you.

The use of subcontractors and how it relates to your Workers Comp is a complicated topic and we’ll address it in specific detail in part 3 of this series.

Requirements to Complete and Penalties for Non-Compliance

The Audit is a requirement of your Workers Comp policy.  This is a policy condition and there’s no way around not doing it.  Even if you’re enrolled in a Payroll Billing program (more on this below), the audit is still required.

If you don’t complete the audit, the first step the carrier takes will be to “estimate” the audit.  The “estimated” audit will typically assume that you had twice the amount of payroll you had originally estimated, and you’ll be charged the premium associated with that payroll increase.  If that premium isn’t paid, the carrier can then cancel your coverage.

If the audit is “estimated,” you can appeal to the carrier to complete the audit, which is often as easy as giving them the information they originally asked for.  If you pay the estimated audit premium but don’t complete the audit, it’s likely your carrier will non-renew your policy unless it’s completed.  When your policy is non-renewed for this reason, if can be hard to find replacement coverage.

In short, the carrier has effective options to enforce the completion of the audit and it usually benefits you to complete it as early as you can.

Workers Compensation Audit Results

Once an audit is completed, you’ll receive a statement from the carrier outlining the differences between what you paid during the year and the adjusted premium due, based on your actual payroll.  Typically, if you have more payroll than originally estimated, there will be an additional premium due.  The opposite holds true as well – if you had less payroll than originally estimated, there will typically be a premium refunded to you.

An exception to this would be if payroll were assigned to the wrong class code originally.  For example, if you had all employees assigned to the “Office” class, but actually qualify for the “Salesperson” class, you can have payroll decrease and still be charged an additional premium because the Sales class has a higher rate.

All Workers Comp policies are subject to minimum premiums as determined by the classifications your employees qualify for.  It doesn’t come up too often, but minimum premiums can prevent a refunded premium, even if you have less payroll than originally estimated.

Payroll Billing Program

One of the best ways to combat the uncertainty regarding your Workers Comp premium is to enroll in a Payroll Billing (aka Pay As You Go, aka PAYGO) program.  This program coordinates your payroll company and your insurance carrier to accurately track payroll as it’s being reported.  When it works perfectly, there is a negligible difference between the Workers Comp premium you pay and the final premium determined by audit.

Unfortunately, the Workers Compensation Audit is still required, even when enrolled in a PAYGO program, but it is often easier to complete.  We’ll go into more details about the Payroll Billing programs that are available in another post.

Looking for More?

This post is part of a series aimed at providing more information about Workers Compensation.  Any additional information we’ve published will be linked here as they get posted:

What Now?

For now – here’s what to do:

If you’re having trouble with your audit, have any questions we might able to help you with, or if you’re looking for more details about the Payroll Billing / PAYGO program – call me (215-643-3490 x23) or email me (ryan@robertjstillwell.com) or click HERE to submit your contact info through our website and we’ll get in touch with you soon.

If you’re having problems with your audit, it can be a complicated topic to discuss, but we’re happy to go into the details to help you solve the problem.  We have a lot of experience with Workers Comp audits and while this may be a problem you’ve never encountered before, there’s a good chance we have.