Policy
Name:
|
Premium
Audits
|
Policy #:
|
EP-16-07
|
Code/Rule
Reference
|
Ohio
Administrative Code (OAC) 4123-17-04, 4123-17-08, and 4123-17-17.
|
Effective
Date:
|
January 4,
2023
|
Approved:
|
Rex
Blateri, Chief of Employer Services
|
Origin:
|
Employer
Policy
|
Supersedes:
|
Audit
Protest policy dated October 17, 2011.
|
History:
|
New policy
issued January 4, 2023.
|
Review
Date:
|
January 4,
2028
|
I. Policy Purpose
The
Ohio Bureau of Workers' Compensation (BWC) conducts premium audits of employers
to verify the accuracy of payroll reporting and the appropriate use of National
Council on Compensation Insurance (NCCI) classification codes applicable to Ohio.
II. Applicability
This
policy applies to BWC Underwriting and Premium Audit, private employers (PA
employers), public employer taxing districts (PEC employers), and their
authorized representatives.
III. Definitions
There are no policy-specific definitions.
IV. Policy
A.
BWC rights.
1.
BWC has the right to
audit an employer to verify the correctness of reports made by the employer as
required by law.
2.
BWC has the right to
adjust classification codes, allocation of wage expenditures to classification
codes, amount of wage expenditures, premium rates, and amount of premium.
B.
Employer
responsibilities.
1.
Every employer
amenable under Ohio workers’ compensation law must maintain complete records
showing in detail all expenditures for payroll reportable to Ohio and the
division of such payroll to the various classification codes of an employer’s
business.
2.
An employer, who
elects to obtain other-states coverage pursuant to ORC 4123.292, must keep records of all payroll
reported to the other-states insurer for work performed outside of Ohio.
3.
An employer who
covers employees with an insurer providing federal Longshore and Harbor
Workers’ Compensation Act coverage must:
a.
Report payroll to
BWC for work the employees performed in Ohio for which they are eligible to
receive Ohio workers’ compensation benefits; and
b.
Keep records of all
payroll reported to the insurer providing the federal Longshore and Harbor
Workers’ Compensation Act coverage.
4.
The employer must
preserve all payroll records for at least five years after the respective time
of the transaction upon which such records are based.
5.
The employer must
keep available for inspection by BWC all books, records, and documents
reflecting the amount and classification codes of the employer’s payroll
expenditures.
6.
If BWC assigned two
or more classification codes to an employer's operations, the employer must
keep a record showing a correct and verifiable allocation of all payroll into
each classification code. If the employer failed to keep such record, the part
of payroll which cannot be reasonably determined by BWC will be assigned to the
classification code having the highest rate, and the employer will be assessed
premium accordingly.
7.
An employer must
make available to BWC payroll records, state and federal tax forms and
schedules, Ohio Department of Jobs and Family Services quarterly tax filings,
and federal unemployment forms 940 and 941.
8.
BWC may request the
employer provide other records, such as corporate minutes, business contracts,
and invoices.
C.
BWC premium audits.
1.
BWC audits employers
to verify the proper classification of business operations and ensure accurate
payroll reporting,
2.
An employer who may
have overreported payroll, or believes its operations are misclassified, may
request an audit.
3.
Generally, BWC
follows the guidelines of Medicare wage reporting, with exceptions involving
the construction industry and corporate officers. Information regarding what
items BWC considers payroll and who is reportable can be found on BWC’s website.
4.
BWC reviews employer
records to confirm the employer accurately reported all payroll to the proper
classification code(s). BWC will:
a.
Review the
employer’s financial records to confirm all wages were correctly reported to
the proper classification codes;
b.
Verify the duties of
the employees;
c.
Compare what the
employer reported to other state and federal reporting agencies to what the
employer reported to BWC;
d.
Review claims
assigned to the employer; and
e.
Verify anyone paid
as an independent contractor is an independent business and not an employee.
Issuing an IRS form 1099 does not necessarily mean the recipient is an
independent contractor for workers’ compensation payroll reporting purposes.
5.
BWC will share
findings with the employer at the end of the audit.
a.
BWC will provide the
employer with instructions for proper payroll reporting and a letter of
instruction for future reporting.
b. BWC will have the person who supplied
the information for the audit sign the audit findings letter confirming that
the description of the employer’s operations are accurate and complete. The
signer will also acknowledge receipt of the audit findings letter and
understanding of its content and purpose. The signature does not mean the
employer agrees or disagrees with the audit findings.
c.
BWC does not
finalize the audit findings at the time of the audit. BWC conducts a quality
review process after the audit to ensure consistency with BWC policies and
procedures. The employer’s monthly invoice will indicate when BWC processed the
audit and the financial results of the audit.
6.
BWC may modify an employer’s
estimated annual premium (EAP) based on an audit.
D.
Resolution of
complaints.
1.
An employer who
disagrees with the results of a BWC audit must file a complaint within two
years of the date the employer received the audit findings.
2.
BWC has identified
certain scenarios that are common to the audit process.
3.
BWC will review the
employer’s complaint and make a determination using the scenarios outlined in
section IV.E of this policy.
4.
BWC will approve or
deny the employer’s complaint. If the employer’s complaint is granted, BWC will
revise the audit as appropriate.
5.
BWC staff who
process an employer’s complaint must obtain management level sign-off on each
recommendation to approve or deny the employer’s request for relief.
E.
Scenarios.
1.
If the complaint is
related to the classification codes assigned to the employer, BWC will:
a.
Verify the
appropriate classification codes were assigned by using the NCCI categories
that are applicable to the state of Ohio. See the Classification Assignments policy for additional information.
b.
Revise the audit and
approve the employer’s complaint if the employer’s complaint has merit.
2.
If the complaint
involves finding independent contractors are actually employees, BWC will use
the following steps.
a.
BWC will determine if
the reasons for finding the workers as employees is well documented in the
audit and the audit shows direction and control of the workers resided with the
employer.
b.
BWC will use the
criteria set forth in ORC 4123.01(A)(1)(c) and the Independent Contractor/Employee
Questionnaire (UA-2) as a tool when a construction contract is at issue.
Documentation must show the factors on the UA-2 which demonstrate the workers
were employees and not independent contractors.
c.
For non-construction
industries, BWC considers an independent contractor an employer, and not an
employee, when the independent contractor controls the means and methods of the
work. Factors BWC will consider, include, but are not limited to:
i.
Work hours;
ii.
Work processes and
procedures;
iii. The entity furnishing material and goods:
iv.
Method of payment
for the work, and whether payment is by the hour, day, or job;
v.
Whether the work was
performed outside the employer’s regular business;
vi.
Whether the
contractor had expenses and can incur a profit or loss; and
vii. Whether the contractor has an investment
in the business and is not merely providing labor.
d.
BWC will review claims
filed, but no payroll reported for an injured worker (IW), and use the
following guidelines.
i.
If the employer has
certified the claim, the IW’s wages are reportable.
ii.
If the Industrial
Commission of Ohio (IC) rules the IW is an employee, BWC is bound by this order.
The IW’s wages are reportable. However, BWC will make an independent
determination whether other contractors are employees.
iii. If the employer does not appeal a claim
allowance for an independent contractor and the claim subsequently becomes
allowed, the IW’s wages are reportable.
iv.
If the employer
rejects a claim and the claim is denied by the IC, BWC is bound by this order.
The IW’s wages are not reportable. However, BWC will make an independent
determination whether other contractors are employees.
3.
If the complaint
involves wage allocation, or a dispute over a classification code assigned to certain
employees, BWC will review the employer’s position and based on this
information, the audit may be wholly or partially revised.
4.
If the complaint
involves the application of a procedure, for example, ordinary income for the
officer of an S corporation, BWC will:
a.
Ensure the audit followed
the procedure appropriately.
b.
Use Ohio
Labor Market Information
if, in the example above, there is doubt about a reasonable wage for the
officer of an S corporation.
5.
If the complaint
involves a policy, for example, the minimum payroll reporting requirement for a
sole proprietor who has elected coverage, BWC will ensure the policy has been
applied correctly. See the Minimum and Maximum Private Sate Fund
Payroll Limitations
policy for additional information.
6.
If the complaint
involves a request for premium relief from the financial burden of the audit,
BWC will:
a.
Communicate to the
employer the audit followed applicable rules and policies; and
b.
Refer the employer
to the Premium Relief Request policy.
7.
If the complaint
involves a sole proprietor, partner, or individual incorporated as a
corporation with no employees (ICORP) who has reported wages, but not elected
coverage, BWC will:
a.
Advise the sole
proprietor, partner, or ICORP there was an intent for coverage and BWC will not
refund premiums in this situation; and
b.
Refer the employer
to the Elective Coverage and Minimum and Maximum Private Sate Fund
Payroll Limitations
policies.
8.
If the complaint
involves a temporary labor services agency (temp agency) and the proper classification
code of temp agency employees assigned to clients, or the proper payroll
reporting and record keeping for a BWC premium audit, BWC will ensure the temp
agency and the audit followed the guidelines in the Temporary Labor Services (Temp or
Staffing) Agency policy.