Monday, January 25, 2010

Insurance Audit Survival Guide

What's the old adage? Genius is 5% inspiration and 95% perspiration?

When it comes to Insurance Audits, a little bit of perspiration will go a long way. Last year, I wrote about Audits, Auditors and the information that they want to review. (See The Insurance Auditor Cometh). Now, let's talk about how to prepare for them.

Insurance Auditors are not robots; they're people, too. People will respond favorably when work is made easier for them. Auditors may like numbers, but they hate having to dig for them. So, I tell my clients to...

DO THE WORK FOR THEM!

Unless your Auditor hates you, the above advice should ensure a quick and smooth experience. How does one do an Auditor's work for them?

Summarize, Summarize, Summarize.

Auditors ask for quarterly tax reports, individual payroll records, overtime reports, & 1099s. Help them out by preparing short summaries to guide them. Here are a few pointers:

A summary of all company employees separated by class code
Work Comp policies use class codes for different types of work. These class codes are referred to as "Scopes," and the Scopes for most states are developed by the National Council on Compensation Insurance (NCCI). For example, Clerical office employees are coded under 8810/Clerical; Plumbers are coded under 5183/Plumbing. Rates vary by class code according to the types and amounts of claims reported for each. General Liability policies use class codes as well. GL class codes are usually determined by the Insurance Services Office (ISO) or individually by your carrier.

List your employees & their gross wages according to their proper Class codes. Provide a subtotal of the employees' wages for each class code, so that the Auditor can just plug the figures into their worksheet.

Indicate OT
When tabulating employee wages, be sure to separate straight time from overtime. If you include a gross OT figure, then you are paying too much. Insurance companies only charge policyholders for 1/3 of Overtime. Indicate the OT figure on your summary.

List Company Owners
Most states do not charge company owners (sole-proprietors, partners, corporate officers, LLC members, etc.) for their total compensation. Their payroll is usually included at a minimum or maximum determined by the type of entity and your state. For example, the maximum chargeable payroll in VA is $58,500 for corporate officers. The max amount differs for sole-proprietors & partners. If your VA corporate officer makes more than that figure, they will only be charged premium up to $58,500. Find out the maximum and minimum chargeable payrolls in your state, and indicate such to your Auditor.

Make List of 1099s and provide Certificates of Insurance
After employees, Auditors want to know whom you paid on a 1099 basis. Make a list of these subcontractors along with the total amounts paid to them during the policy year. Auditors will want to see that these individuals or companies carried their own Work Comp & General Liability insurance. If these subcontractors did not carry their own coverage, then your insurance company will add their compensation to your payroll basis. This will cause an unexpected increase in your premium!

If subcontractors do not carry their own insurance, then they could create claims for your insurance company. Companies fund for this exposure by included uninsured subs on your policy. For my recommendations on protecting your liability exposure when using subs, see my Service & Sub Contractor Insurance Guide.


Insurance Auditors love summaries. A nice little spreadsheet means that they don't have to go through individual payroll records and piece together wage totals. It also means that they can pick up the information and slip silently out of your office. Auditors operate under tight deadlines. Their days are stacked with appointments around town. The faster they can finish yours, the better for them to stay on schedule.

My summary system has helped my clients to significanly cut audit times. In fact, my personal best is a 5-minute audit. Give it a try and let me know if you can beat it. Good luck.

No comments:

Post a Comment