Hey there! Dealing with a workers' compensation audit can sometimes lead to disagreements. It's totally normal to have questions or feel like something isn't quite right. That's where a well-written dispute letter comes in handy. This article will walk you through what a Workers Compensation Audit Dispute Letter Sample looks like and how to use it effectively to get your concerns addressed.
Why Sending a Dispute Letter Matters
So, what exactly is a Workers Compensation Audit Dispute Letter Sample, and why is it important? Think of it as your official way of telling your insurance company, "Hold on a second, I think there's a mistake here." This letter is your formal communication to dispute specific findings in your audit. Sending this letter is crucial because it opens a dialogue and allows you to present your side of the story, potentially correcting errors that could lead to higher premiums or incorrect classifications.
When you receive your audit results, you'll want to review them carefully. Look for things like:
- Incorrect employee classifications
- Miscalculated payroll figures
- Inclusion of employees who shouldn't be covered
- Discrepancies in your reported work activities
If you find something that doesn't add up, it's time to start thinking about a dispute. You'll typically have a certain timeframe to submit your dispute, so don't delay!
Here’s a quick breakdown of what typically happens:
| Step | What Happens |
|---|---|
| 1. Audit Review | You get your audit results. |
| 2. Identify Discrepancies | You find errors or points of contention. |
| 3. Write Dispute Letter | You officially communicate your disagreement. |
| 4. Insurance Company Review | They investigate your claims. |
| 5. Resolution | The issue is resolved, or further steps are taken. |
Dispute Letter Example: Incorrect Employee Classification
Example: Incorrect Employee Classification
[Your Company Letterhead]
[Your Company Name]
[Your Company Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Dispute Regarding Workers' Compensation Audit - Policy Number [Your Policy Number] - Incorrect Employee Classification
Dear [Insurance Company Contact Person or Department Name],
I am writing to dispute a specific finding in the recent workers' compensation audit for policy number [Your Policy Number], covering the period from [Audit Period Start Date] to [Audit Period End Date].
During the audit, it was determined that [Employee Name/Job Title] was classified under code [Incorrect NCCI Code]. We believe this classification is incorrect. Based on the actual duties performed by this employee, they should be classified under code [Correct NCCI Code]. [Employee Name] primarily [briefly describe their actual duties] and does not perform any tasks associated with the [Incorrect NCCI Code] classification. Supporting documentation, such as [mention supporting documents like job descriptions, payroll records, or employee affidavits], is attached for your review.
We kindly request that you re-evaluate this classification and adjust our audit accordingly. Please let us know if you require any further information from our end.
Thank you for your time and attention to this matter.
Sincerely,
[Your Name]
[Your Title]
Example: Disputed Payroll Figures
[Your Company Letterhead]
[Your Company Name]
[Your Company Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Dispute Regarding Workers' Compensation Audit - Policy Number [Your Policy Number] - Disputed Payroll Figures
Dear [Insurance Company Contact Person or Department Name],
This letter serves as a formal dispute regarding the reported payroll figures for the period [Audit Period Start Date] to [Audit Period End Date] as reflected in our recent workers' compensation audit for policy number [Your Policy Number].
We have reviewed the audit findings and noticed that the total payroll reported for [Specific Department/Employee Group] appears to be higher than what was actually paid. Specifically, the audit states a payroll of $[Audit Payroll Amount], whereas our records indicate the correct payroll for this group during the audit period was $[Correct Payroll Amount]. This discrepancy may be due to [explain the potential reason for discrepancy, e.g., accounting errors, inclusion of uncashed checks, etc.]. We have attached [mention attached documentation, e.g., detailed payroll summaries, P&L statements, etc.] to substantiate our claim.
We request a thorough review of the payroll records and an adjustment to reflect the accurate payroll amounts. Please advise on the next steps required to resolve this matter.
Thank you for your prompt attention.
Sincerely,
[Your Name]
[Your Title]
Example: Excluding Out-of-State Workers
[Your Company Letterhead]
[Your Company Name]
[Your Company Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Dispute Regarding Workers' Compensation Audit - Policy Number [Your Policy Number] - Exclusion of Out-of-State Workers
Dear [Insurance Company Contact Person or Department Name],
I am writing to dispute the inclusion of payroll for employees who worked exclusively outside of [Your State] during the audit period of [Audit Period Start Date] to [Audit Period End Date] for policy number [Your Policy Number].
Our audit report includes payroll for certain employees who were on assignment or temporarily working in [Other State(s)] during the entire audit period. As per our understanding and the terms of our policy, payroll for employees working exclusively outside of [Your State] should not be subject to this state's workers' compensation rates. We have attached payroll records and travel documentation that clearly show these employees' work locations during the audit period.
We request that the payroll for these specific out-of-state workers be removed from the audit calculation for [Your State]. Please review the attached documentation and confirm the adjustment.
We appreciate your understanding and assistance.
Sincerely,
[Your Name]
[Your Title]
Example: Disputing Exposure Calculations (for specific industries)
[Your Company Letterhead]
[Your Company Name]
[Your Company Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Dispute Regarding Workers' Compensation Audit - Policy Number [Your Policy Number] - Disputed Exposure Calculations
Dear [Insurance Company Contact Person or Department Name],
This letter outlines our dispute regarding the exposure calculations for the [Specific Operation/Department] during the workers' compensation audit for policy number [Your Policy Number], covering [Audit Period Start Date] to [Audit Period End Date].
The audit report reflects an exposure calculation of [Audit Exposure Calculation] based on [Method Used by Auditor]. However, we believe this calculation does not accurately represent our actual risk profile or the nature of the work performed. Our industry often uses alternative exposure metrics, and we propose that a more accurate calculation would be [Your Proposed Exposure Calculation Method] which results in an exposure of [Your Proposed Exposure Calculation]. We have provided detailed operational reports and industry standard documentation to support our proposed method.
We request a reconsideration of the exposure calculation for [Specific Operation/Department] and an adjustment to our audit based on the more appropriate methodology. Please let us know if you need further clarification or additional supporting materials.
Thank you for your diligence.
Sincerely,
[Your Name]
[Your Title]
Example: Missing or Incorrectly Applied Credits/Discounts
[Your Company Letterhead]
[Your Company Name]
[Your Company Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Dispute Regarding Workers' Compensation Audit - Policy Number [Your Policy Number] - Missing Credits/Discounts
Dear [Insurance Company Contact Person or Department Name],
I am writing to dispute our recent workers' compensation audit for policy number [Your Policy Number] concerning the period [Audit Period Start Date] to [Audit Period End Date]. We believe there are eligible credits or discounts that were not applied to our audit.
Specifically, we have identified that we should be eligible for [Mention specific credit/discount, e.g., a safety program credit, a dividend program credit, etc.]. We have previously [or are providing now] documentation supporting our eligibility for this credit, such as [mention documentation, e.g., safety program certificates, dividend statements, etc.]. The absence of this credit has resulted in an inflated premium.
We kindly request a review of our account for the application of the aforementioned credit/discount and an adjustment to our audit. Please inform us of any additional documentation required.
We look forward to your favorable review.
Sincerely,
[Your Name]
[Your Title]
Example: Incorrect Date Range for Audit
[Your Company Letterhead]
[Your Company Name]
[Your Company Address]
[Your Phone Number]
[Your Email Address]
[Date]
[Insurance Company Name]
[Insurance Company Address]
Subject: Dispute Regarding Workers' Compensation Audit - Policy Number [Your Policy Number] - Incorrect Audit Date Range
Dear [Insurance Company Contact Person or Department Name],
I am writing to formally dispute the date range used for the workers' compensation audit for policy number [Your Policy Number]. The audit report indicates the period from [Audit Period Start Date in Report] to [Audit Period End Date in Report].
However, our policy was effective from [Correct Policy Start Date] to [Correct Policy End Date]. We believe the audit has been conducted for an incorrect or overlapping period. This discrepancy affects the accuracy of the payroll and exposure calculations. We have attached a copy of our policy declaration pages for your reference.
We request that the audit be recalculated based on the correct policy period of [Correct Policy Start Date] to [Correct Policy End Date]. Please confirm receipt of this dispute and advise on the timeframe for re-evaluation.
Thank you for your cooperation.
Sincerely,
[Your Name]
[Your Title]
Writing a Workers Compensation Audit Dispute Letter Sample might seem a bit daunting, but it's a necessary tool for ensuring fairness and accuracy in your insurance coverage. By clearly stating your concerns, providing supporting evidence, and maintaining a professional tone, you can effectively address any issues that arise. Remember to always review your audit results thoroughly and act promptly if you believe there are errors. This proactive approach will help you maintain the correct premium and ensure your business is properly protected.