We evaluate each client independently. Each policy is different. Some
clients are covered voluntarily while others are in the assigned risk market.
Your dispute may stem from an NCCI Inspection Report that changed your classification
from one you’ve used for years. It may be from improper charges for subcontractors
or payrolls that should have been excluded. Perhaps your experience mod went up, or a
credit was removed from your renewal policy. Or maybe the auditor or underwriter was
unfamiliar with a specific rule in one of their manuals and charged an improper premium
that violates state regulations. Maybe, even the wrong rates were charged or you just
suspect that something does not appear right! So, now what?
We can answer these questions and many more, in complete confidence, as your advocate.
What surprises most of our clients is that overcharges occur frequently, and the
agent, broker, underwriter, auditor, and rating bureau are unaware of them until the charges
are brought to their attention.
A clothing manufacturer had been classified improperly for many years.
The governing classification appeared to correctly describe the business
at first glance, but a review of the Workers Compensation Basic Manual
indicated that a lower rated classification was more applicable. We
convinced the insurance company of their error, and the client received
a refund of $98,000.
A large transportation company received an increased experience modification.
The modifier increased by 38 points, or $460,000 additional premium.
After reviewing the experience rating worksheet and the policy, we were
able to reduce the additional premium owed by $230,000 because the insurance
carrier failed to follow the rules in the Experience Rating Manual.
A claim was reserved and remained open for 3 years on the experience
rating worksheet of this Visiting Nurse Association. After analyzing
the claim, it was determined that the insurance company needed to remove
the claim from the worksheet, resulting in refunds of $9,000
for each year!
A woodshop was taken to court for $40,000 additional premium owed to
the insurance company. Our review determined that the insured had been
charged premiums on several independent contractors who did not have
certificates of workers compensation insurance. An analysis of audit
worksheets indicated that the carrier could not justify including the
subcontractors for premium purposes, and the court ruled that the carrier
acted improperly. The case was closed and the entire $40,000 debt was
A small landscaper disputed his final audit which indicated an additional
premium owed of $6,000. The insurance company conducted a re-audit,
and billed the insured for even more ($8,000) premium. We reviewed the
audit worksheets and invoices, and advised the insurance carrier that
their re-audit violated State rules and was void. In addition, the original
audit contained many classification mistakes. The insurance company
refused to correct their errors, so we requested a ruling from the Department
of Insurance. The ruling was in our clients favor, and resulted
in the payment of only $1,000.
A non-profit social services organization was in the Assigned Risk Pool.
The servicing carrier conducted physical audits and billed the client
for additional premiums each year. After reviewing the auditors
worksheets, it was determined that the auditor failed to exclude certain
types of wages from the audit, and the premiums were overstated. We
met with the auditor, and revised audits were conducted for the last
3 years, resulting in refunds of $49,000.
The State implemented a 10% rate decrease which was not endorsed to
the policy of this nursing home. The insured had no way to know of this
rate change, and the agent did not catch it. After notifying the carrier
of their mistake, the client received a refund for $8,000.
A leading brush manufacturer subscribed to a Certified Managed Care
Program approved by the State. The managed care provider helped reduce
the insureds experience modification by 20 points over a three
year period. However, the insurance company failed to follow state mandated
rules pertaining to managed care programs, and the client was entitled
to additional credits. The insured received refunds of $38,000.
Thanks to the aggressive claims handling of their insurance carrier,
a claim that had been reserved for $14,000 was subrogated for this
VNA. Once we learned that the claim was successfully subrogated, we
contacted the insurance company and advised them that the Unit Statistical
reports had to be revised. The insured received a refund of $9,000.
An assigned risk carrier overcharged this foundry 7 years earlier! The
audit was clearly incorrect, but the carrier stated that the insured
had only 3 years after expiration to contest an audit. After careful
research and a detailed explanation as to why the overcharge must be
returned, we convinced the insurance carrier to refund the $70,000 overcharge!
A plastics manufacturer decided to enter the voluntary market after participating
in a self-insured group for many years. An experience modification was
produced by the rating bureau, and properly endorsed to the policy.
After reviewing the experience rating worksheet, we determined that
the modifier was incorrect because it contained data not falling within
the rating period. A revised modifier was calculated, and the client
received a refund of $15,000.
A plumbing contractor in the assigned risk pool refused to pay the $12,000
additional premium billed by the insurance company for a final audit.
Notice of cancellation was sent out, and the client received letters
from the Labor Department reminding them that workers compensation insurance
was mandatory and that stiff fines would be assessed if the policy lapsed.
We were able to delay the cancellation by following the dispute resolution
procedures found in the Workers Compensation Manual. We then reviewed
the final audit invoices and determined that the insurance company actually
owed the client $4,000!
A mid-sized housing authority switched insurance carriers during the
policy period because they got a lower premium. The former insurance
company assessed a short-rate penalty, which we were able to eliminate.
The new carrier issued the current policy with improper rates. The insured
received refunds and credits totaling $6,000.
A sawmills final audit was estimated by the insurance company.
The insured paid the premium. The following year, the insurance company
conducted a physical audit on the policy just expired, which resulted
in a large additional premium. Because of the large additional premium,
the carrier decided to re-audit the policy which was estimated. The
client now owed $240,000 additional premium and was sued for it. After
identifying mistakes on the auditors worksheets as a result of
improper audit procedures, we negotiated a settlement for $60,000 and
the case was closed.
This hospital had been insured by a Self-insured Trust for several years.
Due to competitive pricing in the voluntary market, the hospital
left the Trust. The carrier issued the policy with a 1.00 Experience
Modification. Because of excellent claims experience, we submitted payroll
and claims data to the ratemaking authorities so that a more favorable
experience modification could be promulgated. The hospital received
a revised experience mod of .72, a savings of $26,000 on the current
policy. Future savings also resulted and were not subject to our fee
The printed circuit board manufacturer agreed to a one-year Retrospective
Rated policy which required an Irrevocable Letter of Credit. The client
received an additional premium on the 1st adjustment, and the carrier
advised that the additional premium would be paid by accessing the Letter
of Credit unless the bill was paid in full. A review of the retro calculation
indicated that experience modification was overstated because it contained
multiple claims which were subrogated with their general liability carrier.
The client received a refund of $47,000.