CIRCULAR LETTER #2819 – January 7, 1999
TO: MEMBERS OF THE BUREAU
SUBJECT: WISCONSIN
CONTRACTOR’S PREMIUM ADJUSTMENT
PROGRAM (WCPAP)
The State of Wisconsin, Office of the Commissioner of Insurance has approved the filing of the attached form. This form was developed to assist carriers, (at the time of audit) in reporting discrepancies (if any) of the WCPAP policy credit factor.
Upon audit the carrier shall verify the accuracy of the payroll figures used to promulgate the policy credit factor. If discrepancies are found, the carrier shall inform the employer in writing and copy the WCRB. The carrier will defer its audit for no more than thirty (30) days, giving the employer an opportunity to reapply. If the carrier has not received a revised policy credit worksheet from the WCRB within thirty days, then the carrier shall complete the audit excluding the credit.
Because of the significant implications of this Program, it is strongly suggested that each carrier share the content of this Circular with those employees responsible for premium audits of Worker’s Compensation policies.
Additional information on the WCPAP is also available by writing the WCRB at the above PO BOX or by calling (414) 479-2661.
Thank you in advance for disseminating this important information.
L.N. Hannes,
President
SAMPLE OF COMPLETED FORM
December 11, 1998
ABC CONTRACTING CORPORATION POLICY#: WC456789112
123 CEMENT WORK DRIVE EFFECTIVE: 7/1/97
CONCRETE, WI 55566 REPLY DUE: JANUARY 11, 1998
Your company has qualified for a Contractor’s Premium Adjustment Credit effective 7/1/97. Our audit of your payroll records has developed some payroll discrepancies. The payroll information you provided to the WCRB differs from the information we have to compose your audit. In order for us to properly adjust the policy credit for this policy period, we need you to provide the WCRB the following information in order to recalculate your credit:
1. 1996 third quarter base wages paid and regular hours worked for each employee, officer, sole proprietor, or partner covered under the worker’s compensation insurance policy. The reported payroll and hours worked must exclude overtime, vacation, holiday and sick pay. It does include wages, commissions, salaries and bonuses.
2. Each covered executive officer’s, sole proprietor’s or partner’s wages must be limited as written in the policy and divided by the four quarters of the year (i.e., executive officers = $39,000/4 = $9,750 per quarter and sole proprietors = $25,700/4 = $6,425).
Please complete and return this form within 30 days to our office. Again, in order for your company to take advantage of this Program, you must comply with the guidelines set by the Wisconsin Compensation Rating Bureau. If this form is not received within 30 days, the final audit will be prepared excluding the credit.
Non-Contracting Classifications (1996 third quarter only)
| WC Codes | Payroll | Hours Worked |
| 8810 | $3,500 | 520 |
| 8742 | $7,500 | 520 |
| 9015 | $2,300 | 300 |
Contracting Classifications (1996 third quarter only)
| WC Codes | Payroll | Hours Worked |
| 5190 | $9,750 | 520 |
| 5221 | $17,250 | 520 |
| 8227 | $2,300 | 300 |
We certify this report represents a true and complete statement of all monies paid during the policy period listed above according to the Program guidelines. We understand a company representative will verify this statement.
SIGNED: ____John
Dempsey___________________________ TITLE: Owner
DATE: _______1/8/99__________AGENT: D & E Insurance Associates
WCPAP-ED12/98
Mail to: Wisconsin Compensation Rating Bureau
ATTN: WCPAP
PO BOX 3080
MILWAUKEE, WI 53201-3080
OR FAX: (414) 476-0024
_________________________________________________________________________________
Your company has qualified for a Contractor’s Premium Adjustment Policy Credit effective ________. Our audit of your payroll records has developed some payroll discrepancies. The payroll information you provided to the WCRB differs from the information we have to compose your audit. In order for us to properly adjust the policy credit for this policy period, we need you to provide the WCRB the following information in order to recalculate your credit:
1. ______ Third quarter base wages paid and regular hours worked for each employee, officer, sole proprietor, or partner covered under the worker’s compensation insurance policy. The reported payroll and hours worked must exclude overtime, vacation, holiday and sick pay. It does include wages, commissions, salaries and bonuses.
2. Each covered executive officer’s, sole proprietor’s or partner’s wages must be limited as written in the policy and divided by the four quarters of the year (i.e., executive officers = _________________________per quarter and sole proprietors = __________________).
Please complete and return this form within 30 days to our office. Again, in order for your company to take advantage of this Program, you must comply with the guidelines set by the Wisconsin Compensation Rating Bureau. If this form is not received within 30 days, the final audit will be prepared excluding the credit.
Non-Contracting Classifications (_____third quarter only)
|
WC
Codes
|
Payroll
|
Hours
Worked
|
Contracting Classifications (______third quarter only)
|
WC
Codes
|
Payroll
|
Hours
Worked
|
We certify this report represents a true and complete statement of all monies paid during the policy period listed above according to the Program guidelines. We understand a company representative will verify this statement.
SIGNED: _______________________TITLE: ____________________________
DATE: _________________ AGENT: ________________________________
WCPAP-ED12/98
Mail
to: Wisconsin Compensation Rating Bureau
ATTN: WCPAP
PO BOX 3080
MILWAUKEE, WI 53201-3080