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Premium Audits and Bathroom Breaks – Revisited Once Again


Revisited – Premium Audits and Bathroom Breaks

The question on bathroom breaks and premium audit required a revisit.  I have received a large number of responses to the questions that I posed on this post. One of the independent auditors that I have known for quite some time added a comment to that post. I agree with it for the most part.

I think the main concern here is that at what point does one draw the line between “incidental duties” and a part of the job function. There may be other considerations that a premium auditor would take into account. That is why the audit work papers or auditor’s comments are so important. Always request a copy regardless of your premium audit looks to be OK or not.

Picture Of Man In Office Doing Papers Work No Bathroom Breaks At The Table

You can usually ask for them when the premium auditor is at your place of business or by writing the audit department that is listed on your audit report or premium bill. Even if you decide to have a consultant look at the audits for your company, this is a very important piece of information. It can be very difficult to obtain them from a few months or years in the past.

Asking for the work papers within two months after the audit should be good timing.

The one thing to make sure is that the premium auditor understands what every person does in your company – no more, no less. That is why I always recommend fully documented job descriptions for all employees.

Job descriptions can also come in handy when you are trying to return an injured employee to work. They are very tedious to pull together but will save your company $ in the long run.

The injured employee’s treating physician will appreciate having a full job duty listing for a successful return to work.

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One Response

  1. Lets set some more parameters to some of your examples from your first post.

    Parking in the towing company lot by a clerical employee and walking through the lot to get to the office and when leaving work. The key here is that you have yet to clock in to work when arriving, and you have clocked out when you leave. Therefore there is no WC exposure before starting work, or after leaving work.

    I did an audit years ago where clerical employees who only took phone orders during the lunch rush of a pizza joint worked in a physically separated office on the 2nd floor of the building. The restaurant operations were on the first floor.

    The auditor reassigned the clerical employees to the restaurant code because they walked in the front door of the restaurant to punch in to the time clock. From there they went up the stairs next to the clock to their second floor office.

    I reassigned them back to the clerical code, as they were not on the clock until they clocked in or clocked out. Anything done prior to starting work or after leaving work in not a legitimate basis for reassigning these clerical employees.


James J Moore - Workers Comp Expert

Raleigh, NC, United States

About The Author...

James founded a Workers’ Compensation consulting firm, J&L Risk Management 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:

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