Work Comp Archives - Page 4 of 8 - Get Your Commercial Insurance Questions Answered by Licensed Professionals at My Insurance Question.com

How can I Lower my Workers Compensation Insurance Premium?

Workers compensation insurance premium is often a large portion of overall property and casualty insurance costs. Many business owners look at the workers compensation premium and wonder how they can reduce the overall cost of the insurance policy. The following ideas can help reduce your costs and hopefully help make your business more profitable.

Make sure you are classified properly

Business will have a classification code determined by National Council on Compensation Insurance (NCCI) or some cases the State will have a slightly different number that is used by insurance carriers to rate workers compensation insurance premium. For Example one way to reduce your cost is to take advantage of standard exceptions to the code classification. Employees who perform clerical duties and are physically separate from manufacturing operations may be classified as clerical employees with a much lower rate. Make sure the classification for your employees is appropriate.

Monitor your loss control and safety programs

Loss Control and Safety is critical for preventing losses in the workplace. Set the expectation in your safety manual. Follow up by reminding employees of safe practices including lifting, distracted driving, and the hazard of wet floors. Scheduled safety meetings and incentive programs should be used to promote workplace safety. Decreasing losses will reduce your overall insurance costs.

Develop an effective return-to-work program

Develop a return to work program. Having injured employees staying at home collecting workers compensation will raise your costs on premiums and also on additional labor you will need to hire while that person is out. A way to get your injured employee to return to work as soon as possible is to create a temporary position for that person. You can give them duties that are not taxing on the body so that they will still be able to recover while they are working.

Speak with your agent about adding a deductible

Evaluate the benefit of adding a deductible to your Workers’ Compensation program. A deductible provides an immediate credit to the workers compensation insurance premium calculation. Additionally, losses under the deductible will not be reported to NCCI and will cause a reduction in your experience modification. Be sure to analyze the cost of funding your deductible.

Notice if there is a pattern to workers compensation claims. Determine if certain areas of your business have fewer claims than others, and determine why the risk is lesser or greater in different areas. Reduce risk by duplicating safe behaviors and programs and eliminating risky behaviors.. Eliminate workplace hazards that have caused an employee to get sick or injured so it doesn’t happen again. Some carriers will even provide help in this area.

Report claims ASAP

Report Claims as soon as possible! Provide medical attention quickly if an employee is injured, as prompt medical attention may reduce complications that may arise from delayed care. Complications can make workers’ compensation claims more expensive, which may increase insurance premiums.Statistics prove that losses reported 24 hours or more after the loss are more expensive than those reported promptly. Managing your Workers’ Compensation program carefully can save money and improve your bottom line.

These are just a few ideas that can help you in either keeping your premiums low or driving them down. Every business wants to be more profitable and it can be as simple as investing in work place safety that could get you started in the right direction.

Travel exposure and work comp

I have had many conversations recently about employees and travel exposure in regards to workers’ comp insurance. Most employers understand that regular commuting does not result in a work comp claim. Even if there is an accident involving an employee. However, many carriers view every day or long distance highway travel as a higher risk exposure.

Salespeople, nurses, and other employees who are on the road a lot often are exempt from the coming-and-going rule. Travel is integral to their employment because they don’t work from a fixed office. This also holds true for construction risks. These businesses have employees that are going from their home state to another state to work. Basically from the time they leave their front door until they return home from that job they have 24/7 work comp exposure. The Walsh Test helps to determine jurisdiction when multiple states are invloved in a workers compensation claim for these employees.

Workers Compensation Coverage for Travelling Nurses.

On-call employees are likely covered from the moment they are called into work even if they get hurt at home. Employees who are injured during business travel may receive compensation, even if the accident happens during recreation. Courts generally are liberal in determining workers’ compensation eligibility in work travel accidents. In many cases, even if the activity that caused the injury is not considered work related.

If an employee is on a trip that is work related and they go to work out at the gym, if they injure themselves at the gym they are covered by workers comp. They are covered because a lawyer would argue they were only in that gym at that time because they were out of town for a work trip. For this reason the injury is covered.

With that being said, if an employee goes out for a business dinner and is in an accident after having too much to drink, work comp would most likely deny the claim. This is because the use of alcohol would exclude the injury whether they were on the clock or not. So with in certain limits would work comp kick in for traveling employees. It’s worth noting that workers’ compensation coverage for commuting employees varies state to state.

If an employee runs a work-related errand on the way home from work and gets in an accident, her injuries may be compensated. Another example of this would be if an employee is injured running a work-related errand while out for [personal time] lunch. This relates to the dual purpose or capacity concept.

Most of the time I run into having this conversation with a client if it is a higher risk construction company. A company like carpentry commonly has employees in the home state that are traveling into multiple states annually. Here is the outlook from an underwriting perspective. Not only is your business in a risky trade like carpentry, but we are throwing in across state lines travel. Where accidents happen in a vehicle with possibly one if not three or four employees could be injured. These are two big reasons insurance carriers are not interested in this type of risk.

MyInsuranceQuestion.com

Differentiating Workers’ Comp Insurance from being a Commodity Product

Workers’ Comp Insurance is often thought of as a commodity product. There is some logic to that line of thinking. Pricing is determined by classifying employees and then taking the percentage rate assigned to that classification and multiplying it by estimated payroll. In some states such as Florida and Wisconsin, the workers’ comp rates assigned to those classifications are set by states, whereas in some states the rates by classification can vary from carrier to carrier. In competitive states, pricing is often thought to be the main differentiator between workers’ comp carriers. Most of the benefits paid from claims related to workers’ comp insurance are set by statutes, so carriers should be viewed pretty similarly in that regard as well.

Other than pricing, what can separate workers’ comp insurance carriers? Carrier rating is one factor that is considered. It relates to the financial strength of carriers. A higher carrier rating should lead to more certainty that claims will get paid, but it is highly unusual for claims not to get paid by any workers’ comp insurance carrier. Higher carrier ratings are sometimes required to meet insurance requirements of vendors or customers. A carrier’s customer service reputation can also be relevant. Additionally, payment plans can vary by carriers. Some carriers offer pay as you go. This allows premium to be paid in line with how busy a company is at a particular time. Furthermore, it generally reduces large audit balances.

Another differentiating factor is, are different programs offered by workers’ comp insurance carriers. Missouri Employers Mutual is one carrier who offers several programs to enhance employee safety. They often safety grants to policy holders. The grants will provide dollar for dollar matching funds up to $20,000 for successful applicants to purchase more permanent type safety devices. Some applicants may be able to get a grant larger than their policy premium. Missouri Employers Mutual also offers safety dividends to policy holders with lower loss ratios as a way to reward good safety practices. The Hartford is another carrier that offers numerous programs to differentiate its product. They offer programs to provide discounted slip resistant footwear to employees, programs that can lead to weight loss and overall a healthier employee pool and discounts related to vendors which can provide a more ergonomic friendly workplace. The Hartford also provides a broad form policy which includes things like more cancellation notices, pays benefits for more additional expenses, includes complimentary waivers when needed and provides longer notification periods for insureds related to certain mandatory notification events. Some carriers, such as Employers, offer price differentiators such as filing for a 5% rate deviation in Florida which allows them to offer worker’s comp rates which are 5% lower than other carriers in Florida which must use the rates set by the state.

Another area carriers can differentiate themselves is by superior loss control or claims management services. Utah Business Insurance (UBIC) is a carrier that offers superior loss control. Very knowledgeable field reps meet with prospects and insureds to provide insight on safe work places. These field reps are strongly versed in OSHA and other safety protocols. Both UBIC and Missouri Employers Mutual also diligently investigate claims as they arise.

While price is always an important consideration as it relates to workers’ comp insurance, there are numerous other factors worth considering when selecting a workers’ comp provider.

What Do My Workers Compensation Limits Mean?

We get this question a few times a week because most business owners don’t quite understand their workers compensation limits. They try to compare them to their general liability limits and that is where some of the confusion sets in. The Limits on your workers’ compensation insurance policy provide coverage for a business against lawsuits arising from employment-related injuries or illnesses. For example, if an injured employee is not satisfied alone with medical and loss of wage benefits because they feel their employer purposefully put them in harm’s way on the job or were grossly negligent, and as a result they were injured, they may sue for punitive damages. In some cases, even the employee’s family can sue for the same damages. This is where Part II of a workers’ comp policy would kick and provide coverage.

It is important to note that employers’ liability coverage is limited, unlike medical benefits or loss of wages. This is the spot that a lot of business owners or anyone starts to get confused. They see limits on their workers’ compensation policy and naturally think that is the max that would be paid in an injury scenario. A workers’ compensation policy will pay out whatever it takes to rehabilitate an injured employee. Employers liability or Part II will not pay out unlimited amounts on behalf of employers who were charged with gross negligence or knowingly placing their employees in harm’s way. Employers’ liability coverage in most states starts at $100,000 each employee, $100,000 each accident and at $500,000 per policy limit for disease- these limits are statutory or minimum limits that come with the purchase of a policy. These coverage limits can be raised for a nominal additional premium percentage on most policies. Many businesses opt for increased employers’ liability limits. They do this because of a need for peace of mind or because their work contracts often require higher limits than statutory requirement.

To give you an idea on how these limits work, think about it in this manner. An employee working in a manufacturing plant is exposed to lead on a daily basis. The employer does not have proper ventilation or does not always check on the employee to make sure they are wearing proper attire. Whether that is long sleeve shirts and pants or to have a respirator so they are filtering the air quality they are breathing. The employee gets injured on the job after many years of never missing work. It is also discovered that they have come down with a serious illness that may be caused by years of lead exposure. The employee and his family are not satisfied with the level of benefits workers compensation is providing and has decided to sue the Employer for negligence. This is where the limits in Employers Liability or Part II would kick in. There are many other scenarios that could come into play outside of illness, but this is just one example of how a 3^rd party may potentially bring suit against your company. The best thing to do is always be proactive with safety, etc. which can be hard for a small business. Because your time is very invested in the day to day activities of the business.

4 tips of inured worker outcomes

Here are 4 ways to improve your businesses injured worker outcomes.

Injured workers are a part of running a business. If you stay in business long enough, you are going to have an incident where one of your employees is injured. This is not a bad representation of your business, but how you handle the situation can have a lasting effect on your relationship with your employees and your insurance company. Here are four ways in which you can manage and incident where you have an injured worker that are best for your injured worker, your business and the insurance company you partner with.

Take care of the injury, first and foremost

This is simply the right thing to do. The best way to improve injured worker outcomes is to first deal with the injury. Taking care of the injured employee is also the best thing to do for the insurance companies to help get the injured employee the best medical care and it can help the medical professionals treat the injured employee quickly and cost effectively.

Report the injury to your agent and carrier

A lot of business owners may not think it is so, but your insurance agent and carrier are on your side. It is in their best interest to help your business and to help your injured worker get the care they need and get back on the job as quickly as possible. They deal with these situations a lot. They can navigate the workers’ compensation system much more effectively than you can. More important than anything is the fact that they cannot help you with these injuries until you notify them an injury has occurred. Also, documenting the injury allows your business and the carrier to keep track of your claims history. If there tends to be a pattern of injuries, you can address it and the carrier can help you. They interact with business owner across the country in all industries. Chances are they have dealt with a similar situation and can give you some guidance as to how to prevent/fix the problem from continuing to occur.

Keep your Agent in the loop

Remember your independent insurance agent is on your side. At least they very well should be. If for instance, you feel your carrier may not be living up to their responsibilities the agent can speak with the carrier on your behalf. Agents interact with carriers very frequently for a number of reasons. They have an established relationship with these organizations and they can more easily get your claim in front of the right person to most effectively solve your problem. Also, they can only help you when they know an incident has occurred. The longer you go without getting them involved in a claim the more likely the claim is to get out of hand. This means more missed time for your injured worker, a larger cost to the insurance carrier and probably higher rates on premium for you in the future. Keeping your agent involved can help prevent all of this from occurring.

Let the carrier take care of the billing

Do not try to take care of the billing yourself. Even if you have been in business for a long time and you think you know the workers comp system fairly well. Things change. A medical facility that you have been taking your injured worker to for years may stop a relationship with your carrier. If you take the injured worker to a medical facility out of the carriers’ network, you may be liable for the costs. The network for workers’ comp is not necessarily the same network for health insurance, even if you use the same insurance company for both policies. It is always best to let your insurance company do what they do best.

4 Advantages to Pay as You Go Workers’ Compensation.

Small business owners have a lot to think about. Whether it be finding new clients, efficiently servicing the clients you do have, making sure your employees are paid on time, what type of insurance to offer your employees, to what type and how much insurance coverage is needed to adequately protect the business; a business owner must be involved in all of these decisions. One of the largest fixed costs most small business face is workers’ compensation insurance coverage. In 48 out of 50 states this is required by law for nearly all businesses to carry this coverage. For this reason, any way to limit the cost of this coverage is helpful to a small business. Especially a start-up, a small business with a seasonal business cycle or a small business with cash flow issues. Pay as You Go Workers Comp Insurance Coverage is one option to help these types of businesses.

Pay as You Go Workers Compensation is a great way for seasonal and cash strapped small businesses to free up cash.

Improves Cash Flow

Most Workers Compensation Policies require a portion of the policy up front to establish coverage. After this initial payment the company pays 9 monthly payments beginning 3 months in to the cycle. The amount that is due up front is typically 25 or 30% of the entire premium. With the Pay as You Go Option most businesses, depending on revenue, can get policies in place for only a few hundred dollars. This allows the business to free up cash for more immediate business needs.

Increases Payment Accuracy

Pay as You Go Billing allows businesses to accurately pay what they owe each month based on real time payroll amounts. In a traditional work comp policy the payroll amounts are an estimate and during an audit at the end of the period they either are offered a refund for overpaying or they are charged for the additional amount of premium owed. Pay as You Go lessens this burden by allowing companies to pay a more accurate amount each month in real time.

Simplifies the Auditing Process

Because the amount of premium is paid in real time based on the payroll each month there are less inaccuracies during the auditing process. Typically the biggest problem during the auditing process stems from the business being improperly classified. This can cause a dramatic over or under payment if the business is supposed to be in a classification code that is dramatically more or less dangerous. A good example of this is related to driving risks. If a company has employees drive to many different locations to do a job as opposed to do a similar job at only one location without the employees operating a vehicle those are two class codes that are dramatically different risks and premium is dramatically different for those two businesses.

Allows the Business to Budget more effectively

When a business has a more accurate assumption of what their premium will be from month to month and throughout the entire year they can more accurately budget for other expenditures. This is important for new or growing businesses. If you are adding on to your location, thinking of buying new equipment or adding new employees than what you pay in premium will determine what and how much you can spend on these other parts of your business. Businesses that use a traditional workers comp policy may have to be more conservative in their growth because they need to keep more cash on hand for the auditing process.

New Business- Starting from scratch

Ideas for Start-up Business Plans

So you have decided to (or maybe you are still considering) taking a leap most of us only dream of. That leap is to start your own business. Perhaps you have worked for someone else in your trade for several years and want something of your own. You may be fresh out of school (or still in school) and want to get started early. Maybe you just have a unique opportunity to start your own business. If this is you than you are probably looking at what you need to start:

Start up capital
Supplies
Office/shop space
Sales opportunities

These are things all first time business owners are looking for. One thing many new businesses put off until last moment is insurance. You will spend thousands of dollars just to start up your dream of owning your own business; you don’t want one accident to take it all away from you. Below are several insurance policies that can protect you from claims that could easily ruin your dream of owning your own business. Here we will go over the basic areas that you want to look at for starting your own business, and when you want to start looking.

First, Why is this important? Claims with new businesses can be more devastating for a few reasons.

The controls that are in place to prevent/reduce the extent of claims/liabilities are less established. Many of these types of firms can be started in a home office.
New businesses are many times less defined in their operations, which can bring the operations in to areas the business owner may not be as familiar with. These areas they may not have as much experienced in. This can bring up more risks a
Some businesses do not have an established LLC or Corporation established. Regardless of the insurance policies you have, it’s important to work with your attorney and CPA to make sure you choose the business entity type that works best for you. This separates your business liabilities from impacting your personal assets. It is bad enough if the incident you could have protected closes your business, but it is a much worse situation if the same incident causes you to lose your house or your savings.

Here are a few policies we recommend you start out with pretty early on:

Commercial Auto – Commercial auto is a topic in itself and oftentimes one of the most overlooked policies by a new business owner since many people just use their personal auto’s and don’t see this as something they need. This might not be the first new policy you look to get, it should be the first insurance policy you likely already have that you will want to look at changing though. If your using your personal vehicle for business purposes, at the very least you want to make sure your agent and insurance carrier is aware of that and that you have business use on your policy, upgrading your personal auto policy to a commercial auto policy might be a couple bucks more, but in many cases the difference is a lot less than you may expect, plus, a less expensive policy that doesn’t cover what you need isn’t really that valuable anyway.

General liability – Starting a business, general liability is the first policy most companies look for. If you’re a retail store its sometime referred to as “slip and fall coverage” to cover liability from bodily injury on your premise. Keep in mind, some of these policies only do that and might not cover all/any off premise damages. These policies come in a variety of forms and coverages and the pricing typically reflects that, that’s not also to say you cant shop to make sure you’re getting the best value. This for some business types can be packaged into a Business Owners Policy that can cover property and other additional coverages your company needs like Data Breach, EPLI and Hired/Non owned auto liability.

Workers Compensation – For starters let me clear a couple things up first: Workers Compensation is not automatic; it’s not something automatically gets taken out of payroll without you getting a policy in place first. This policy covers employee injuries when hurt on the job for medical expenses and a portion of lost wages. For some high risk businesses like heavy manufacturing, construction and transportation this can be one of the most expensive and hardest policies to get competitive quote’s on and can be frustrating for businesses owners that just want to buy the policy. The key in the beginning is getting a policy in place, pay your bill on time, and keep continuous coverage. Once you have a prover record, especially for 3 years with coverage in place the market is a lot easier to get coverage for companies that have established. If you are a labor intense business the pricing can seem very high, the expense for covering a claim out of pocket, and fines from many states can be just as expensive if not more than your premium would be anyway. This normally isn’t needed until you hire an employee, but sometimes contracts can still require it which can open up more business opportunities for your company.

Professional Liability – For some companies your biggest risks aren’t necessarily a customer slipping and falling, or an employee injuring themselves. Many professional firms have what can be equally as damaging of risks to them. The obvious ones are your Physicians Medical Malpractice, your insurance agents and accounts have Errors and Omission’s insurance to cover mistakes or professional errors made. Little mistakes can make huge claims but there are some companies you don’t think of needing this like Printing companies, Website Developers, IT Companies, Bookkeeping and Marketing Firms. Website Copyright infringement, or a faulty code in a software program that causes a glitch or even worse a breach could be a huge expense and could mean huge liability on your company.

Every business owner is worried about protecting what they own. The property you own can be devastating if its lost, damaged or stolen. However, the liabilities you take on during the everyday course of your business operation can be even worse and costlier. Even if you don’t own any property. There are insurance policies to cover the obvious, but also many things you wouldn’t think of. If there is a chance of an injury, fire, something stolen, or decreasing in value for something other than every day wear and tear (heck maybe there’s a policy for that too) there is likely an insurance policy for it. Working with a Professional Insurance Agent that can give you options and help guide you on the coverages that would be most important to you.

What exactly is the “Exclusive Remedy”

Exclusive Remedy

What is the exclusive remedy for risk management and small business professionals? In the world of insurance, the term ‘exclusive remedy‘ refers to the workers’ compensation system. These systems are administered by the sate governments of each individual state, not the federal government. In most states, this grand bargain began around 100 years ago. It was an agreement between employment and labor during a time when many employers severely abused the rights of workers. As a result of these abuses, many workers were beginning to unionize. In an attempt to keep both sides happy, most states created a workers compensation system to deal with both medical benefits to employees and protection from most lawsuits for employers.

workers-compensation-insurance-is-the-exclusive-remedy These workers’ compensation systems are administered by each individual state and not the federal government. Because of this, each state provides the system a tad bit different. Wisconsin was the first state to administer a workers’ compensation system in the year 1911. Mississippi was the last state to come around to the exclusive remedy in 1948.

workers-compensation-forms-aid-the-exclusive-remedy The term ‘exclusive remedy‘ came about because the benefits that are provided under the workers compensation system are supposed to be the sole remedy available to employees injured on the job. The benefits to employees are, they have the confidence to go to work knowing that if they are injured on the job they will have their medical costs covered and some lost wages. Employers benefit from the system by having most lawsuits taken away for injuries that occur as a normal part of business operations. Businesses are not covered for injuries that are caused by the intentional actions of the business and its management. This includes decision-making or neglect by the business to operate the way in which they do business in safe conditions.

Workplace-Safety-Toolkit-Exclusive-Remedy As time has passed and work environments have changed so has the opinion of many in the business community about the need for an exclusive remedy in todays’ business climate. A few states have removed workers compensation as a requirement for some types of businesses. A few other states have proposed the idea, but are still in a wait and see approach. At this time Texas and Oklahoma re the only states to implement what is referred to as an Opt-out program. This is a program where if the business qualifies they can elect not to carry coverage and provide an alternative to what most states give through the workers comp exchanges. Both have in place certain minimum standards that are similar to those standards required under most workers compensation systems. Opponents of these system frequently critique that there are very strict reporting policies put on the responsibility of the employee. In the system set forth by Oklahoma employees must report the injury to management within 24 hours or they may not be eligible for coverage. Most states are sitting in a wait and see approach and depending on the success or failure of these states will determine the future of the workers’ compensation system.

What does the rate reduction in California mean for everyone else?

This past week, the California Department of Insurance announced its approval for a 9.5 % reduction for rates on workers’ compensation premium for the state fund. This is good news for business owners within the state of California. It could also have ramifications throughout the California Workers Compensation Market across the country. Three things in-particular could impact the workers compensation market. Those three things are: Carriers on the open market will have to change their rates in the state to remain competitive against the state fund. Business owners who have less than favorable loss runs will be even more encouraged to control the frequency and severity of claims in order to take advantage of even lower premium on workers comp premium. Other states will be waiting to see if the rate reduction encourages businesses to continue to have a focus on safety and the rate of claims continues to lower. If this occurs than you can expect other states to follow-suit.

Carriers on the open market will have to change their rates

The main reason for having a state fund within the workers’ compensation system is to prevent carriers from charging outrageous rates on premium. When instances like this occur (Claims Costs throughout the state have gone down) the state fund lowers the rates to reward businesses for their actions. This will cause carriers on the open market to lower their rates in an attempt to remain competitive. It is in the carriers best interest for claims to be low. The less claims in an area means less claims the carriers have to pay for. If claims are low they in theory should be able to charge less in premium and still be able to turn a profit. In another state where claims are extremely high they will be forced to raise premium rates in order to deal with claims they are having to pay for. The amount the carriers lower their rates may not be directly proportional to the 9.5% reduction by the state fund, but rates should lower significantly on the open market.

Get the best answers to your questions about workers compensation in California at myinsurancequestion.com

Business owners will be encouraged to get their loss runs under control

The reason for the drop in rates is because of a drop in loss runs throughout the entire state. If people within the state fund see the benefit of lower rates on premium they will have even more motivation to fix whatever it is about their business that causes them to have to buy work comp coverage from the state fund. In many cases the reason for this is because of a lot of claims that caused their experience modification rating to be too high to find adequate coverage on the open market. Premium rates on the open market are significantly lower than rates in the fund.

Have a question about workers comp in California? Get the best answers here at myinsurancequestion.com

Other states will pay attention to see if the rate reduction encourages businesses behavior.

This action is rewarding businesses for a reduction in claims in the state. If this action makes the loss claim continue to fall, than other states will more than likely follow suit. If the loss runs again rise, many states may interpret that as the lowering of rates did not positively effect behavior. That being the case they probably will not lower the rates in their state if similar circumstances exist.

workers-compensation-california

Work Comp 101

Work Comp Insurance 101 – A Complicated Insurance Explained Clearly

I regularly speak to business owners that are purchasing workers compensation coverage for the first time. Most insurance agents do not take the time to explain how the basic process works. When this happens, business owners are purchasing a coverage they don’t clearly understand. It can lead to frustration on the part of the business owner and the insurance agent when something changes with the policy. Especially when the change demands more money. Work Comp Insurance is my niche. I make sure to take the time to explain the basic process of how premiums are developed at the beginning of the policy period and after the policy period ends. I feel it’s important to explain this coverage properly. By doing this I find that business owners understand why changes happen and what changes are important to pay attention to. I also make sure they know to notify their agent or insurance company throughout the policy period if any of these changes occur.

Work Comp Insurance and Employers Liability Coverage

The Basic Process:

Workers compensation rates are first dictated by the workers compensation classification code. Every industry does not have a specific code. A lot of times the process of how the work is completed is assigned to a work comp insurance code where the process is similar. For example, a business that puts waterproof coatings on parking lots would be classified the same as a painter because the process is similar.

After the workers compensation classification code is determined, in nearly every state the insurance company is able to file their rates depending on how competitive they want to be in an industry. The state typically sets the minimum and maximum rates, insurance companies file their rates within the range.

Work comp insurance policies require that business owners declare an estimated payroll for all covered persons for the annual policy period, 12 months from the date the policy begins. Business owners are tricky because states require that business owners are covered using a minimum annual payroll up to a maximum. If a business owner is included in coverage and takes less compensation than the state minimum, the additional payroll is added after the audit. If a business owner takes more than the maximum set by the state, then wage calculations stop at the maximum.

The total policy premium is determined by several factors. First the rate per $100 of payroll established by the insurance company per work comp insurance code. That rate is a percentage of the gross wages paid to employees in each workers compensation code. Second, different states can charge different taxes that are added to the bottom line. The insurance company typically charges an expense constant factor that is a flat fee. Then, the insurance company can apply credit or debits (discounts or increased pricing). All of these factors determine the final pricing when you activate coverage.

After the Workers Compensation Policy is finished a payroll audit must take place. The purpose of this audit is to determine the actual gross wages paid to covered persons throughout the policy period. Also, the auditor will double-check the work comp insurance classification codes for accuracy. If the agent used the incorrect workers compensation code OR something changed throughout the policy period, the auditor will adjust the workers compensation code. It’s very important to verify the workers compensation code for your business before purchasing a workers compensation policy. Your agent should be able to provide a detailed description of your workers compensation code to verify accuracy.

During the audit process, most insurance companies do not have the ability to staff auditors across the U.S. so they use 3rd Party companies to handle their audits. These 3rd Party auditors typically specialize in workers compensation audits for multiple insurance companies. Typically the auditor will make contact with the business point of contact within 60 days after the policy period has expired. It’s very important to set-up the audit as soon as you can coordinate schedules, make this a priority. The auditor will inform of the payroll documents needed, have all of them prepared. These auditors are required to complete the audit process within a small timeframe otherwise they return as non-productive. When an audit is returned as non-productive, the insurance company will process and mail to the business owner an “estimated audit” with a balance due and a cancellation notice. The business owner must contact the insurance company to re-open and process the audit. This is typically a headache, it’s a lot easier to make it a priority and take the necessary time to complete it.

After the audit is processed you will receive the results and either a balance due or a credit being returned. At this point the business owner should review and file a dispute with the insurance company IF the results are incorrect. The auditor’s duties are to capture the gross wages for covered persons and verify job duties. Auditor’s make mistakes, don’t ask the appropriate questions and sometimes they are new to the industry therefore, do not know all of the rules. I know these to be the truth, I speak with the auditor’s for clients frequently. Before filing the dispute the business owner should request the auditor’s notes from the insurance company to understand how they arrived at the results. Then, the business owner can file the dispute with the insurance company if there is an argument.

There are several rules within the workers compensation industry that surprise owners after audits are complete. The audit’s purpose is to accurately charge the owner based on what happened during the policy period. Workers Compensation audits are determined by the 4 bullets below:

Gross Wages for Employees of the business (no surprise here).

Gross Wages for Uninsured 1099 sub-contractors. This is the most common surprise. 1099’s is discussed further below.

Proper Classification Codes per employee job duties.

INCLUDED Business owners. In most situations, business owners are allowed to choose whether they want to be Included or Excluded in the workers compensation coverage. When a business owner chooses to be included, the State typically determines a minimum and maximum wage threshold. Rules for whether or not a business owner can be included/excluded and wage thresholds are determined by Entity Status (Individual, Partner, LLC, Corporation). If a business owner changes entity status during a policy period, it’s important to notify your workers compensation agent to determine if different rules apply. Otherwise, all adjustments are made at audit.

Uninsured 1099’s

This is one of the most common surprises for business owners after the audit is completed, especially in the construction industry. Uninsured 1099’s are added to the workers compensation policy based on the classification of work the 1099 is performing. Even if the state doesn’t require the 1099 to purchase workers compensation coverage, the only way for a business owner to exclude 1099’s from their policy audit is to collect a certificate of workers compensation coverage OR a “state approved exemption”.

It’s important to understand when a business owner can treat a 1099 like a true independent contractor and request a work comp insurance certificate.

1099 must use their own tools/equipment

1099 must drive their own vehicle

Contractor cannot determine when and where the 1099 is working. Must assign a project and let the 1099 execute on their own time.

1099 must also perform work for their own customers

1099 must carry appropriate licenses with state when required