Comply with Annual Workers' Compensation Audit & if a Claim is Submitted

Submitted by admin on Tue, 05/04/2021 - 15:37
Policy: 

Annually, Workers’ Compensation Agent requests Workers’ Compensation audit data for the previous contract year. F/EA provides requested data to Workers’ Compensation agent within <<10>> business days of receipt of audit request.

Audit data is used to reconcile the estimated payroll data and policy cost to the actual payroll data. The total premiums due or refunded are adjusted per payroll data provided.
 
By comparing the premium deposit to the premium deposit earned, F/EA and the insurance agent determine if a Workers’ Compensation premium is due from or a refund owed to F/EA.
 
If F/EA owes an additional workers’ compensation premium, F/EA Accounts Payable Department cuts a check and mails it to insurance agent. If a refund is owed to F/EA, insurance agent cuts check and mails it to F/EA.
 
If an employee submits a Workers' Compensation claim, the Workers' Compensation underwriter may also request this, or other, information.  The F/EA always complies with Workers' Compensation information requests from policy underwriters and brokers.
Procedure: 

 <<Audit Process will vary depending on Program, State and Agent>>

Internal Controls: 

The internal controls used by F/EA to monitor this process establish responsibility, segregate duties, document procedures and ensure independent internal verification.

  1. <<Staff Title>> collects annual payroll data from Expense Reports that are independently reconciled monthly
    • <<Staff Title>> initials and dates annual payroll data report
  2. <<Staff Title>> reviews annual payroll data
    • <<Staff Title>> compares annual payroll data report to individual budget amounts
  3. <<Staff Title>> compares the deposited premium shown on the letter from the insurance agent to the payments made on participant's behalf
  4. F/EA A/P Check Requisition document is prepared by <<Staff Title>>, as applicable
  5. <<Staff Title>> reviews F/EA A/P Check Requisition document as compared to invoice
    • <<Staff Title>> signs and dates F/EA A/P Check Requisition document
    • Accounts Payable Department will not cut check without <<Staff Title>> signature on F/EA A/P Check Requisition document
  6. Accounts Payable Department cuts check payable to agent as applicable
  7. F/EA Department scans invoice and check and saves for a minimum of 7 years per File Retention Policy
  8. <<Insert internal controls for receiving a payment from Workers' Compensation Agent if F/EA overpaid on behalf of a participant>>