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Are You Ready for the Work Comp Audit? Confirming Payrolls Used

Author: Chris Boggs

Workers' compensation policies are generally based on payroll. At the beginning of the policy term payrolls are estimated; when the policy expires, payrolls are confirmed via an audit. I'm sure you already know this, but I needed to provide a basis for this article.

There are two questions surrounding the audit that every agent must be able to answer:

  1. What pay (remuneration) is included in the audit; and
  2. What pay (remuneration) is excluded from the audit.

Following are the answers to both questions. 

What Remuneration is INCLUDED in the Audited Payroll?

  • Wages or salaries including retroactive wages or salaries
  • Commissions: If the employee is on a draw, and the draw is greater than commissions earned — use the entire amount of the draw;
  • Bonuses, included stock bonus plans - unless the bonus is awarded for individual invention or discovery;
  • Overtime: One-third of amount is subtracted from the total amount (one-half is subtracted if the employee earned double-time pay);
  • Davis-Bacon wages or wages from a similar prevailing wage law;
  • Pay for holidays, vacations, or periods of sickness;
  • Pay for time not worked (i.e., paid for an 8-hour day when only 7 hours worked);
  • Pay for travel time to or from work or specific job site;
  • Employer payments of amounts otherwise required by law (i.e., Statutory insurance, Social Security, etc.);
  • Contributions to a savings plan or vacation fund required by a union contract;
  • IRS Qualified Salary Reduction Plan (i.e. 401K) (refers to the employee's contribution and any qualified agreement between the employer and the employee to pay into a retirement plan in lieu of direct wages);
  • Employee Savings Plans: Only the amount put in by the employee, not the employer's match, (includes contributions to an IRA) if any;
  • Payment on any basis other than time worked such as piecework, incentive plans or profit sharing plans;
  • Payment or allowance for hand tools or power tools used by hand provided by employees either directly or through a third party and used in their work or operations for the insured;
  • Car allowance (not a company car, a car allowance);
  • The rental value of an apartment or house provided for an employee based on comparable accommodations, along with utilities paid by the employer on behalf of the employee;
  • The value of lodging other than an apartment or house received by employees as part of their pay to the extent shown on the insured's records;
  • The value of meals received by employees as part of their pay to the extent shown on the insured's record;
  • Substitutes for money such as the value of store certificates, merchandise, credits or any other substitute for money received by employees as part of their pay or in lieu of pay;
  • Expense reimbursements to employees to the extent that an employer's records do not substantiate that the expense was incurred as a valid business expense; and
  • Payment for filming of commercials, but this EXCLUDES subsequent residuals, which are earned by the commercial's participants each time the commercial appears in print or is broadcast.

Basically, what could the employee possibly lose if he or she can't work? That amount is included in the audit. 

But more important than knowing what payroll is included is knowing what payroll is excluded; so…

What remuneration is EXCLUDED from the audit?

  • Tips & other gratuities (subject to minimum wage exceptions – meaning if hourly pay plus tips do not equal minimum wage, the amount to make up the difference is included as remuneration in the audit);
  • Group Insurance/Pension Plan contributions made by employer;
  • Special rewards for individual invention or discovery;
  • Severance pay;
  • Pay for those on active military duty;
  • Employee discounts;
  • Expense reimbursements – if substantiated by the employer's records;
  • Money for meals for overtime work;
  • Work uniform allowance;
  • Sick pay paid by a third party (can't you just hear the duck – Aflac);
  • Employer-provided perks (company autos, incentive vacations, memberships); and
  • Employer contributions to salary reduction, employee savings plans, retirement or cafeteria plans.

More mistakes are made including payroll which should be excluded. Keep both lists handy, but commit the payroll exclusions to memory (well, just be able to recognize them).

First Published: January 20, 2017


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