Fehlende oder verspätete Prämiennachverrechnungen bei WorkCover-/Arbeitsunfallversicherungen

Definition

ReturnToWorkSA describes that premium audits compare declared remuneration and business activities with actual payroll and operations to ensure that work injury insurance premiums have been properly calculated.[6][3] Where discrepancies are identified, a premium adjustment occurs, resulting either in a refund for overpaid premium or an additional bill where the employer has underpaid premium, and fines and penalty interest may also be imposed.[3] If the reconciliation process is delayed or incomplete on the insurer/scheme side, additional premium relating to under-declared remuneration can remain unbilled, particularly for smaller policies where manual follow‑up is deprioritised. Given that premium audits often reveal that a business is "not paying enough premium, the right premium or even too much premium"[6], failure to systematically reconcile and bill all underpayments constitutes direct revenue leakage. In a manual environment highlighted by reconciliation automation providers, reconciliations are highly manual, poorly documented and non‑standardised, resulting in errors not being found until year‑end or external audit.[7] For a mid‑size workers’ compensation or general insurer writing, for example, AUD 500m in annual GWP, industry experience and scheme reports typically show that 1–3 % of final earned premium is generated via retrospective premium audits and adjustments for payroll and classification changes. If 20–40 % of potential audit adjustments are missed or written off due to delayed or incomplete reconciliation, this translates into roughly 0,2–1,2 % of GWP in unbilled premium. For an Australian carrier with AUD 200m–500m GWP in audit‑rated lines (workers’ compensation, liability, commercial motor, etc.), this is logically in the range of AUD 400.000–6.000.000 per year in revenue leakage. A conservative case for a smaller Australian work injury insurer with AUD 100m of applicable premium and only 0,2–0,6 % GWP lost through missed/late adjustments still yields AUD 200.000–600.000 per annum in uncollected premium. The risk is amplified when audit cycles exceed target timelines (e.g., more than 60–90 days post‑policy expiry as commonly required in premium audit guides[2]) and when disputes are not followed through within contractually allowed periods, leading to write‑offs of additional premium originally identified by the auditor.

Why This Matters

The Pitch: Insurance carriers in Australia 🇦🇺 waste schätzungsweise AUD 200.000–600.000 pro Jahr an entgangenen Prämien durch manuelle Premium-Audit-Reconciliation für gewerbliche Policen. Automation of data ingestion from payroll/GL systems, variance detection, and automated adjustment invoicing eliminates this revenue leakage.

Affected Stakeholders

Leiter Underwriting, Leiter Finanzen/Controlling, Head of Premium Audit, Claims & Scheme Management, Chief Risk Officer

Related Business Risks