Questions & Answers
The following is the most common questions that are asked about our service and the value we bring.
1. Doesn’t My Insurance Agent Already Do This?
Insurance agents are valuable partners in securing coverage for your business, they have different skillsets and focuses compared to forensic auditors specializing in worker's comp. Here are some points to consider:
Insurance agents are valuable partners who help businesses evaluate risks, obtain appropriate coverage, and navigate the insurance marketplace. CIV provides a different, highly specialized service that complements the agent’s work.
An agent generally relies on information supplied by employers, carriers, claims administrators, and rating bureaus. CIV independently examines the current and historical information used to calculate workers’ compensation premiums and experience modification factors.
Our review may include:
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Experience rating worksheets
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Claims and loss information
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Payroll reporting
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Employee classifications
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Premium audits
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Policy records
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Carrier and rating-bureau data
When discrepancies are identified and corrected, the agent may have more accurate information to use when marketing coverage, communicating with underwriters, and advising the client.
CIV does not sell insurance, place coverage, or replace your agent. We provide an additional level of verification that supports your agent’s efforts.
2. Isn’t the Insurance Industry Regulated?
Yes. Workers’ compensation insurance is governed by state regulations, rating-bureau rules, and other requirements. However, regulation does not prevent reporting, classification, calculation, or administrative errors from occurring.
Workers’ compensation data may pass through employers, agents, carriers, claims administrators, auditors, and rating bureaus. With so many parties and systems involved, even an unintentional error can affect an experience modification factor or premium.
CIV independently reviews the underlying information to determine whether it appears accurate and compliant with the applicable rules.
3. What Happens to Overpaid Premiums on Expired Policies?
Potential overpayments on expired policies may remain undiscovered unless the historical policies and supporting records are reviewed.
Depending on the state, circumstances, and applicable filing deadlines, it may be possible to correct historical information and pursue an eligible refund or premium credit. CIV reviews available records to determine whether correctable issues exist and whether recovery may still be available.
4. I Receive a Refund Every Year. Why Would I Need a Review?
An annual premium audit refund typically results when actual payroll is lower than the estimated payroll used at the beginning of the policy period. Receiving that refund does not necessarily confirm that every part of the premium calculation was correct.
Other issues may still exist involving:
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Employee classifications
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Claims and loss information
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Experience modification calculations
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Payroll allocation
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Premium-audit treatment
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Rating-bureau or carrier reporting
CIV looks beyond the routine payroll adjustment to verify the other information used to calculate your premiums.
5. Is My Agent at Fault if CIV Finds Errors?
Not necessarily. Workers’ compensation policies and experience modification factors are based on information supplied and maintained by several different parties.
Agents generally rely on information provided by the employer, carrier, claims administrator, auditor, and rating bureau. An agent may have no practical way to identify an error contained within historical claims data or another party’s records.
CIV’s purpose is not to assign blame. Our role is to identify discrepancies, document the relevant facts, and pursue eligible corrections while supporting your existing agent's work.
Your agent's role:
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Insurance agents typically specialize in finding the right coverage for your business's needs based on the information you provide.
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They may not have the specialized expertise in workers' comp complexities and regulations that forensic auditors like CIV Inc. do.
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Agents might also be limited by the data you, insurance companies, and rating bureaus provide, which may be incomplete or inaccurate.
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Agents present you policies written by your insurance company. The agent should not be held liable if the insurance company has written a policy that is not in compliance with your state's regulations.
6. Is My Controller or Internal Team at Fault if CIV Finds Errors?
Not necessarily. Controllers and accounting teams play an important role in maintaining payroll and financial records, but workers’ compensation is a specialized system involving information controlled by multiple outside parties.
Errors can result from:
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Incorrect or incomplete reporting
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Data-entry mistakes
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Misclassifications
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Misapplied rating rules
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Claims-status errors
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Communication breakdowns
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Information transferred incorrectly between systems
Even when your internal team, agent, and safety professionals perform their responsibilities correctly, an outside reporting or administrative error may still affect your premiums.
CIV has encountered situations in which a single data-entry error created a substantial financial impact.
7. What Will My Insurance Company Think About the Review?
A professional review should not be viewed as an adversarial action. Employers have a legitimate interest in verifying that their policies, claims data, experience modification factors, and premiums are accurate.
CIV presents potential discrepancies, supported by documentation and applicable rules. When carrier or rating-bureau communication is required, we follow the authorization and communication procedures established for the engagement.
8. How Much of My Time Will Be Required?
CIV performs most of the review remotely. A typical client may spend approximately 30 to 45 minutes providing information and responding to occasional questions during an eight to twelve-week review period.
The actual time and duration depend on the number of policies reviewed, the availability of records, and the complexity of any issues discovered.
9. What Is the Probability of a Recovery?
According to CIV’s internal review data, more than 91% of qualified clients have had potentially correctable issues identified. Among qualifying companies that pay more than $100,000 annually in workers’ compensation premiums, CIV reports an average recovery of $42,000.
Every company is different, and past results do not guarantee a future recovery. The outcome depends on the accuracy of the existing records, applicable regulations, filing deadlines, policy terms, and carrier or rating-bureau determinations.
10. How Much Does the Forensic Review Cost?
Qualified clients may be eligible for CIV’s contingency-based No Recovery, No Fee program. Under this arrangement, CIV earns a fee only when a qualifying financial recovery is obtained, as defined in the client agreement.
Hourly and fixed-fee arrangements may also be available for organizations that do not qualify for the contingency program, including certain self-insured employers, group plans, agreed-rate policies, and Professional Employer Organization arrangements.
All fees and engagement terms are explained in writing before the review begins.