Premium Auditor Asked Employer To Sign Audit Agreement Part II
WORKERS' COMPENSATION PREMIUM REFUNDS POSSIBLE
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Jan 30, 2013

Premium Auditor Asked Employer To Sign Audit Agreement Part II

Yesterday I covered the situation where a premium auditor asked an employer to agree to a premium audit just completed by signing an agreement to the audit findings.

As I mentioned previously, I have never seen in any policy the requirement to sign off on a premium audit whatsoever.  There are a few exceptions that I noted in the last post.

An employer would give up most of their rights by signing such an agreement.  These rights would include:
  • The right to later question the audit is eliminated.  If you agreed to the audit, it is too late to even consider a premium audit dispute.  Get the out the checkbook and pay up.  
  • Some of the agreements may require that your company also give up all rights to the present audit and all of the past ones.  If you find a mistake in your next policy or the current one, you cannot ask for premium refunds on past policies. 
  • Your company may be required to pay the premium audit bill very quickly according to the auditor's side agreement. 
  • The insurance carrier may possibly still be able to audit your past and present policies and charge your company more premium.  This would all depend on the agreement you signed with the auditor. 
  • Your company may have to pay all or a portion of the audit findings on the spot.   This is rare, but it does happen.  
Please note that most premium auditors are good people just doing their jobs.  I cannot imagine why these good people would want you to sign such an agreement.    

As I pointed out in the last post, there are certain instances where an agreement might be appropriate, but not on a just-completed premium audit.  

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2 Comments:

Anonymous Vrseintl@hotmail.com said...

In the state of FL there is a requirement to sign a statement that the insured or rep has provided the information to the auditor (link provided below - forms 1560, 1561, & 1562).

Most carriers & fee companies use a similar signed statement that the auditor was there, and the audit information was provided to them and by who.

http://www.floir.com/siteDocuments/OIR-B1-1560.pdf

But it in no way does these types of forms finalize the audit, nor does it restrict any dispute or appeals board rights that the insured has to dispute an audit as outlined in the Basic Manual in each state

Jim, if you can send me a copy of one of these statements from the insured, I am sure that the respective State's Department of Insurance would love to have a legal chat with any company doing this type of activity.

Let's play devils advocate with this type of agreement just to show what a double edge sword it can be if it exists or is used as indicated.

I once did an audit of a USL&H company with an average of $1.6 million in payroll for each quarter with the exception of 1 which only showed $516,000 in payroll. Their operation was consistent the entire year, but the auditor failed to enter 1 at the beginning of this quarters (should have been $1,516,000) gross payroll.

Another example is if a contractor with extensive uninsured subs during the year (lets skip the why for this example), with the auditor missing most if not all of them during the audit.

This type of agreement would precluded the carrier in both of these examples from going after the missed additional premium when claims start showing up. Let alone the problem it would cause in a test audit state.

In 2012, the top fraud case was in Florida with shell companies renting out their cert's to other contractors while having minimum premium policies with minor payroll that cost the carriers over several years in excess of $5 million in premium.

The insureds interpretation of the auditors statement regarding this type of signature form, or the overstating of the meaning of the signature form by an auditor to an insured may be the problem.

Insurance people should understand the terminology, and explain it to the insured in terms that they can understand so that both parties are of the same understanding of the meaning of any insurance document. CG

11:20 PM  
Blogger James J Moore said...

CG, thanks for your input on this post. I always appreciate your input. I should have clarified the form/agreement was post-audit agreeing to the amount that the auditor found. I did not mean to infer that no forms by the premium auditor are to be signed. There are some that are OK as you have pointed out.

12:19 PM  

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