US Appeals Court Rules On Premium Dispute

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US Appeals Court Sides With Employer On Premium Audit Dispute

Gravel in US Appeals Court room
StockUnlimited

An employer disputed the premium audit properly was the US appeals court ruling from last week. I was reading an article earlier this week in The Workers Comp Forum concerning an employer in South Carolina that disputed their Workers Comp insurance premiums. The insurance carrier, Companion Insurance, canceled a second policy as the employer did not pay the insurance premium demanded on an audit billing for the first policy.

The employer sued Companion Insurance for breach of contract as they had paid all undisputed premiums. The employer lost the case on summary judgment but the Court of Appeals overturned the lower court. The reason the employer brought suit was that one of their employees was seriously injured in an accident and was denied benefits/coverage. 

Oral US Appeals Court appeals argument
Wikimedia Commons – tracy collins

The employer disputed the premium audit increase and forwarded its payroll information to dispute the audit’s accuracy. The court found such that a bona-fide dispute existed because the employer disputed the premium by refusing to pay, submitted its payroll data, and informed an insurance agent that it believed it had paid the amount owed on the first policy. The court stated it was “at a loss as to what more [the carrier] could reasonably expect of [the employer] when attempting to dispute the premium charge.”

 Check out my last post as this is all somewhat related. How is it all related? The employer prevailed as they disputed the audit timely. That is why I have posted very often to not let a premium audit statement or billing just sit in the inbox. The employer prevailed as they disputed the audit timely and forwarded the proper information to the carrier and agent. We will have to see how this all turns out as the case now goes back to the lower level court. The case is Triple H Debris Removal, Inc. v. Companion Property and Casualty Insurance Co., No. 08-1137 (8th Cir. 03/30/09)

 

Next Up – Question From A Blog Reader – How Can I Tell If The Workers Compensation Reserves On A File Are Correct?

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James Moore

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Mgmt Consultants, Inc. in 1996. J&L’s mission is to reduce our clients’ Workers Compensation premiums by using time-tested techniques. J&L’s claims, premium, reserve and Experience Mod reviews have saved employers over $9.8 million in earned premiums over the last three years. J&L has saved numerous companies from bankruptcy proceedings as a result of insurance overpayments.

James has over 27 years of experience in insurance claims, audit, and underwriting, specializing in Workers’ Compensation. He has supervised, and managed the administration of Workers’ Compensation claims, and underwriting in over 45 states. His professional experience includes being the Director of Risk Management for the North Carolina School Boards Association. He created a very successful Workers’ Compensation Injury Rehabilitation Unit for school personnel.

James’s educational background, which centered on computer technology, culminated in earning a Masters of Business Administration (MBA); an Associate in Claims designation (AIC); and an Associate in Risk Management designation (ARM). He is a Chartered Financial Consultant (ChFC) and a licensed financial advisor. The NC Department of Insurance has certified him as an insurance instructor. He also possesses a Bachelors’ Degree in Actuarial Science.

LexisNexis has twice recognized his blog as one of the Top 25 Blogs on Workers’ Compensation. J&L has been listed in AM Best’s Preferred Providers Directory for Insurance Experts – Workers Compensation for over eight years. He recently won the prestigious Baucom Shine Lifetime Achievement Award for his volunteer contributions to the area of risk management and safety. James was recently named as an instructor for the prestigious Insurance Academy.

James is on the Board of Directors and Treasurer of the North Carolina Mid-State Safety Council. He has published two manuals on Workers’ Compensation and three different claims processing manuals. He has also written and has been quoted in numerous articles on reducing Workers’ Compensation costs for public and private employers. James publishes a weekly newsletter with 7,000 readers.

He currently possess press credentials and am invited to various national Workers Compensation conferences as a reporter.

James’s articles or interviews on Workers’ Compensation have appeared in the following publications or websites:

  • Risk and Insurance Management Society (RIMS)
  • Entrepreneur Magazine
  • Bloomberg Business News
  • WorkCompCentral.com
  • Claims Magazine
  • Risk & Insurance Magazine
  • Insurance Journal
  • Workers Compensation.com
  • LinkedIn, Twitter, Facebook and other social media sites
  • Various trade publications

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