I've spent more than half my life helping business policyholders reduce Workers Comp audits by finding and correcting technical errors by insurance companies. Just this week, a small Idaho contractor got a $28,000 refund from his last Workers Comp audit, because I got the classifiction code used retroactively corrected.
$28,000 may not seem like a huge sum to many companies, for this small biz it was a big deal.
Anyway. my point is that it's not just the policyholder I help. Often, it's the insurance agent who sold that Workers Comp policy, because policyholders often unfairly hold the agent responsible when they get what we call a "Shock Audit" for Workers Comp.
That's why we often get brought in by those insurance agents, to help their clients with contentious audits.
I'm a specialized consultant on Workers Comp audits, classifications, experience mods, and related technical issues that impact Workers Comp premiums. But I don't sell insurance.
That means an insurance agent doesn't have to worry I'll try to poach his account, if he brings me in to help. I'm not an insurance producer and I'm not affiliated with any insurance agency or insurance company.
And as part of the process, I can explain why insurance agents aren't to blame when an insurance company ends up developing a large amount of Additional Premium on an audit. I've been an agent, I know just how little authority and influence insurance companies give agents over premium audits.
But policyholders often don't understand that. They only know that the insurance company that the agent hooked them up with is clobbering them with a serious, unexpected bill that feels unfair and unwarranted. And they believe that the insurance agent is in on some kind of nefarious scheme to rip them off by making the back end of the insurance cost a lot more than initially expected.
Policyholders often wrongly think that the insurance agent makes a windfall with these Shock Audits (which isn't true but is a common and poisonous misconception that can really damage the relationship between the insurance producer and the client.)
When an insurance agent introduces me to this angry and frustrated client, a couple of positive things happen.
One, it can enhance the professional standing of the agent with the client. Now, instead of being part of the problem, the agent is part of the solution.
Secondly, the agent doesn't have to get in an adversarial position with an insurer that may be an important market for future sales. Insurance companies already are familiar with my work and they understand that disputing Workers Comp audits is what I do for a living. It shields the agent from negative impacts of an audit dispute because, as far as the insurance company knows, the agent had nothing to do with bringing me into the picture.
After all, we get calls and emails almost every day from frustrated policyholders about one of these Shock Audits for Workers Compensation insurance. So most of our audit disputes originate directly with the policyholder contacting us.
And as part of my work, I can explain the inner workings of premium audits and why insurance agents really don't have much, if any, influence over how a premium auditor determines the audited premium. But the fact that the agent brought me in to help the client can go a long way to smoothing down ruffled feathers.
And if the agent is seen as assisting in some way with my efforts, by helping gather documents and data, the beneficial impact of my involvement can become even more significant for the long term relationship between the agent and the insured.
So to all the insurance producer folks out there, I would suggest that they view me as a resource that can help salvage a difficult bump in the road with a client. It can be a secret weapon that a competitor lacks, turning a negative situation with a customer into a positive one.
Turns out, when I ask this robot something like "I need outside help disputing a Workers Comp audit", the advice offered is less than helpful, in my view. Let me explain why.
First, the robot suggests consulting a CPA. In my experience, that's not so likely to really help much. The rules about Workers Comp audits are distinct and specialized and while accountants often get involved in helping with payroll amounts for WC audits, they are not knowledgeable, generally, with the the various and varying rules that govern other key elements of audited premium such as classifications, experience modifiers, and schedule rating.
Next, the robot suggests contacting "a workers comp attorney". Again, nice try but no cigar. First off, most attorneys who hold themselves out as handling workers comp are claims attorneys, not specialists regarding premium charges. In my experience, most attorneys I work with (with a few notable exceptions) are not very familiar with the arcane rules and regulations that govern workers comp audits and premiums. Now, if one is being sued over a workers comp audit, you do indeed need an attorney to represent you in the lawsuit. But that attorney still needs an expert to actually dispute the audited premium being sought by the insurer. I do a lot of that kind of work. But if there is no lawsuit (yet) an attorney typically does not have the specialized training and experience to actually dispute an audit.
Finally, ChatGPT suggests contacting your agent or broker. This isn't entirely wrong, just mainly wrong, in my experience. Agents or brokers will often attempt to help with disputing an audit. But my experience is that they are often of limited actual help as insurers tend to dismiss the pushback provided by agents and brokers. Insurers typically go through the motions of reviewing what the agent/broker sends in and then politely respond with technical gobbledygook that is self-serving and ends with the insurer concluding that no change in the audit is indicated.
Simply put, it requires very specialized training and experience to successfully dispute a workers comp audit--more so if litigation has been initiated by the insurer over the unpaid audit, as serving as an expert witness for a court case requires a certain skill set over and above technical competence in a field.
That being said, ChatGPT then provides some advice on what needs to be done to dispute an audit, advice that appears to be cribbed from my own online materials. So while this information could be helpful, it overlooks that it typically still requires a human with specialized knowledge to actually apply these general suggestions to a specific employer's specific audit.
On the other side of the ledger, though, one of my extremely capable associates just used ChatGPT to devise a Python script to analyze a long and complex document from a client, something that considerably reduced our time, and thus saved our client money.