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

FAX: 262-796-4400