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Common Premium and Audit Questions

How is my premium set?

There are three primary variables that determine your premium:

  1. The type of business you're in;

  2. Your payroll; and

  3. Your experience modification, if applicable.

Different types of businesses have different kinds of risks. For each role your employees play in your business, Zenith assigns a rating for the risk of job-related injuries. For example, clerical workers are much less likely to be seriously injured on the job than a roofer—so a roofer has a higher rate. We multiply each rate by your corresponding payroll to calculate your premium.

The experience modification for your business, if you have one, will also adjust your premium. Click here to find out more about experience modifications.

In addition, several states offer premium credits for safe and drug-free workplaces to those employers that qualify.

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What should I do if I don't agree with my Final Audit results?

You need to submit a written dispute to one of our two processing centers.  This can be sent via e-mail or faxed to:

California Policies --> PremiumDisputes-WHL@thezenith.com  or fax to 818-587-5373

All Other States ----> PremiumDisputes-SRQ@thezenith.com  or fax to 941-906-4395

Note: Submit a written request for a copy of our auditor’s worksheets for your review, if a physical audit was completed.

 

What information do you need me to include in my dispute letter?

We will need a signed letter stating the following:

  • The name of your business
  • Your Zenith policy number (starts with a “C” or “Z”)
  • The best phone number and e-mail address to reach you with any questions we may have
  • ** And most importantly, we need a written description detailing specifically what it is you are disputing.  The more information you can provide, the less
    likely it is we will have to contact you for additional information.  Simply stating "I do not agree with my bill" or "A mistake has been made in my premium audit billing" without elaborating on the reasons for your disagreement is not considered a valid dispute. 
  • If your account was physically audited, it is most helpful for you and us if you have requested a copy of the auditor's worksheets prior to sending in your dispute letter.  This will enable you to see exactly where the differences are, and pinpoint that in your letter to us. 

 

How soon before I hear back from you on the status of my dispute?

We do our best to review and respond to all disputes within 14 days of receipt.  Depending on the nature of the dispute, we may need to refer it back to the Field Auditor who completed your original audit in which case it may take longer to resolve.

 

Do I have to pay my balance due while I am waiting for my dispute to be resolved?

We require that you pay only the "undisputed portion" of your outstanding balance.  For example, if you owe $10,000, but you are claiming two employees were misclassified, that would reduce your premium owed by $4,000. In that case we would require you to pay the $6,000 that you are in agreement with, while the remaining $4,000 in question would be put on hold, pending the outcome of your dispute.

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I've heard premium audits can lead to extra charges or increases in my premium. Is this true?

It's possible. An audit can either lead to an increase or decrease in your premium—it's entirely based on the accuracy of the information you provide to us, and on changes in your business. If you provide accurate information about the number, job types and salary of your employees, it's likely that your premium won't change at all.

It's important to let us know about changes in your business when they occur. For example, many companies today are unfortunately having to layoff employees. If this happens to you, it will also reduce your workers' compensation costs.

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What payroll is included in calculating premium?

Any information you report to the IRS in a W-2 form is a good place to start when reporting payroll to us. Zenith representatives can provide specific details on what to include and what to exclude. Call your nearest Zenith office, or the Premium Audit Department at 800-440-5020.

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How do I calculate overtime pay?

The premium or excess portion of overtime wages may be deducted from gross wages to determine your workers compensation insurance premium. Below is an example to help illustrate this point.

EXAMPLE:

Daisy Dentist's regular hourly rate of pay is $10.00 per hour. She receives time-and-a-half or $15.00 per hour for hours worked in excess of eight hours a day or forty hours a week. Last week she worked forty-five hours.

40 hours@10.00=$400.00 (regular wages)
5 hours@15.00=$75.00  (total overtime wages)
    ________________________
    $475.00 (gross wages)
Less: 1/3 excess ($75.00/3)=$(25.00) (excess overtime)
  ________________________
 =$450.00 is total chargeable wages for w/c premium

Deducting the excess overtime may result in sizable savings for your business.

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What kind of records does the auditor need?

Required records include all your payroll bookkeeping records (anything your accountant would prepare to document your payroll).

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What's the best way to organize my payroll records?

Track each employee's actual job duties and keep payroll records that reflect how many hours an employee works on different activities. For example, if an employee spends 20 hours of his time installing and repairing plumbing and 20 hours a week pouring and finishing concrete slabs for residences, record this information and keep it on file. In insurance lingo, this is called "payroll segregation." It helps premium auditors ensure that your workers' compensation cost is accurate.

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My employees use timecards. Can timecards serve as a record of my payroll?

No. Timecards only show hours worked. Your payroll records must include wages earned as well as each employee's job duties.

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How do I make a premium payment?

Zenith offers several ways to pay your premium, including automatic bill pay, one time payment by check, payment by mail, and payment online with a credit/debit card.  Learn more.

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How can I confirm that my payment has been received?

You can call 1-800-440-5020 to verify that your payment has been received or to ask other premium related questions.

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I've heard premium audits referred to as "payroll audits." Are they the same thing?

Yes. Sometimes workers' compensation audits are called payroll audits.

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What types of audits are there?

There are physical audits and voluntary audits. In a voluntary audit (also known as a mail-in audit), we send you a payroll information form that you fill out and mail back to us. In a physical audit, a Zenith premium auditor tours your workplace and gathers information from your payroll records to calculate your premium.

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What's a "checking audit"?

If your payroll does not fluctuate, we can bill you in installments with monthly payments based on estimated premiums. We can help you set up what we call a "checking audit" to avoid surprises when the policy expires.

If your payroll fluctuates, you may prefer monthly reporting, which means we send you a payroll report each month to complete and return to us.

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What is minimum premium?

It is the lowest amount for which a policy will be issued. In the states that have expense constants, the minimum premium includes the expense constant. Minimum premium is not subject to experience modification. If the minimum premium on your policy is $1,000 and you had no employees during the policy period, your premium would be $1,000. The minimum premium for your policy is shown at the bottom of the Workers' Compensation and Employers Liability Insurance Policy Information Page.

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Can I exclude anything else from my payroll besides premium overtime?

In the State of California only, if you have an IRS approved Section 125 (Cafeteria) plan, you may exclude the pre-tax deductions set aside for such items as medical, dental and vision premiums and related out-of-pocket expenses, including money set aside for dependent care obligations.

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Why do I need to have a physical audit?

Insurance carriers are obligated in many states to physically audit accounts above a certain premium threshold. At its discretion, a carrier may also randomly select other policies to audit as they deem appropriate. This is done for several reasons which include making sure your competitors are paying their fair share in premiums. In addition, a physical audit visit allows you to receive all the premium credits you are entitled to and might not be aware of. Moreover, this should be viewed as an opportunity to ask a representative of the company about any other general questions you might have relating to your policy.

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Must I provide workers' compensation coverage for independent contractors?

If you pay a contractor who is required to have a license and the contractor is not licensed, he is your employee.

If you hire an independent contractor to provide other services, review the following questions to determine whether he should be treated as an employee:

Who supplies the tools and where is the work performed?

If you supply the tools and the work is performed on your premises at your direction, this person is an employee. Include payments as payroll.

Are the services provided an integral part of your business?

If so, the person is likely an employee. Include payments as payroll.

How do you pay the person?

Commissions, piecework or by the hour possibly indicate an employee/employer relationship. If paid by the job, this is likely an independent contractor and payments should not be included.

Does this person work for other businesses in the same capacity?

If so, this is probably an independent contractor and should not be included.

Is there a written contract?

If you follow the contract in principle, you may want to refer to the company for review to determine whether it indicates an employee/employer relationship or an independent contractor relationship.

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Can I pay employees in cash, materials, parts or other substitutes for payroll to avoid paying workers' compensation premiums?

In California, pay is defined as all amounts paid (whether through payroll, in cash or any form of substitutes for money) or given to an individual for services performed.

Permanent records should reflect any and all cash payments or the retail value of materials and/or parts given to one who provides services in your day-to-day business operations.

These amounts and/or values should be reported as if they were payroll for workers' compensation purposes.

Items to be included or added to payroll:

  • Bonuses
  • Retail value of any parts or materials
  • Gifts
  • Auto Allowances paid at a flat amount
  • Lodging value, if lodging is provided instead of pay (some classes of business require lodging value always be added – e.g. property management classifications or farm classifications)

Items excluded or not added to payroll:

  • Employer contributions to a 401(k) plan
  • Value of meals provided to employees if added to payroll only for tax purposes
  • Value of lodging, only if you would not pay the employee more if lodging were not provided (some classifications require all lodging values be reported)
  • Personal use of a company provided vehicle if added to payroll only for tax purposes
  • Declared tips

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