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.

Classification Error

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.

Experience Modification

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.

Claims Reserves

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!

Collections Problems

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 eliminated.

Revised Audits

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 client’s favor, and resulted in the payment of only $1,000.

Overstated Payrolls

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 auditor’s 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.

Rate Changes

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.

Managed Care

A leading brush manufacturer subscribed to a Certified Managed Care Program approved by the State. The managed care provider helped reduce the insured’s 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.

Subrogation

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.

Going Back in Time

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!

Self-insured

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.

Labor Department

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!

Re-written Policies

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.

Estimated Audits

A sawmill’s 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 auditor’s worksheets as a result of improper audit procedures, we negotiated a settlement for $60,000 and the case was closed.

Qualifying for Experience Rating

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 schedule.

Letter of Credit

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.