CurrentDelaware Department of InsurancePolicy 159

Regulatory Expectations for Payroll Audit Practices (Bulletin No. 159)

Customize your policy alerts

Sign up for Delaware Department of Insurance Policy 159 alerts

Get alerted when Policy 159 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Sets the Delaware Department of Insurance's expectations for carriers' payroll audit documentation, online access, refund handling, agent access, payment timeframes, and dispute procedures affecting carriers authorized to write workers' compensation and employer liability in Delaware.

Policy Summary

PayerDelaware Department of Insurance

PolicyRegulatory Expectations for Payroll Audit Practices (Bulletin No. 159)

Policy CodePolicy 159

Change TypeRevision (no material coverage changes)

Effective DateOct 20, 2025

Last ReviewFeb 5, 2026

Next Review Date

Key ActionAllow licensed agents prompt access to audit documentation when designated by the insured; insured consent controls sharing.

SourceLink

POLICY UPDATE CHANGES

No material clinical or coverage changes in this revision.

30min days to pay audited premium

12 monthsappeal period after termination

same methodrefund method required

prohibitedPII in audit materials

Department Expectations for Payroll Audits

Payroll Audit Expectations and Minimum Standards

Department expectations and minimum standards for payroll audits and related practices.

Carriers must provide audit documentation that includes all calculations and supporting documentation necessary to justify the audited premium amount, presented so the insured can understand and verify the audit results without employee-level PII; full internal worksheets must be retained for regulatory review.

If a carrier maintains an online portal, audit-related documents (including historical audit records, billing notices, and correspondence) must be made securely accessible to the insured through the portal.

When an audit reduces the amount owed, carriers must issue a direct refund of any overpaid amount rather than automatically applying a credit to future billing cycles, unless the insured expressly requests otherwise.

Refunds must be issued using the same method as the original premium payment (the first payment method used for that policy term); if that method is unavailable, issue by check or another mutually agreed method between the insured and carrier.

Carriers should implement standardized processes to enable licensed insurance agents to promptly assist insureds with obtaining audited payroll documentation when the insured designates the agent; the insured’s consent controls sharing and prevails if withheld.

Portal access for agents or designated individuals must be limited and secure (e.g., unique usernames/passwords) and mailed documents should be sent only to individuals designated by the insured on a proprietary or confidential basis.

Carriers should provide at least 30 calendar days from the date the audited premium bill is issued for the insured to remit payment, unless a different timeframe is expressly established by contract and disclosed with justification.

Insureds who wish to challenge payroll audit results may appeal to the DCRB during the policy period or within 12 months after policy termination; carriers must include appeal information and a clearly labeled link (e.g., 'How to Appeal Your Audit Results') in audit communications and portals.

Carriers must review and, if necessary, adjust audit procedures to comply with this Bulletin, including submission of updated rule or form filings; the Bulletin is effective immediately until withdrawn or superseded.

Agent and Carrier Operational Requirements

Documentation Required

Permit agent access only with insured designation and consent

Allow licensed insurance agents prompt access to audit documentation when the insured designates them; insured consent controls whether agents receive portal access or mailed audit materials. Carriers must implement standardized processes to enable agents to assist insureds promptly, with portal access limited and secure (unique usernames/passwords) and mailed documents sent only to individuals designated by the insured. If the insured does not consent to sharing audit documents with an agent, the insured's decision prevails.

Carriers should implement a standardized process that allows licensed agents to promptly assist insureds in obtaining audited payroll documentation.
Insureds must be given the opportunity to designate who may access online portals or receive mailed audit information.
Portal access should be limited and secure through unique usernames and passwords; mailed documents should be sent on a proprietary or confidential basis only to individuals designated by the insured.
If an insured does not consent to sharing audit documents with an agent, the insured's decision must prevail.

Key Definitions, Refunds, and Online Access

Audit Documentation Transparency

DefinitionCarriers must include calculations and supporting documentation necessary to justify the audited premium amount in the audit bill or notice to the insured; materials must allow the insured to understand and verify results without employee-level PII.

PII handlingProvide clear, comprehensive, PII-free materials (aggregated payroll summaries, class codes applied, adjustments, narrative explanations) while retaining full audit worksheets internally for regulatory review.

Scope of materialsDocumentation should outline payroll reviewed, class codes, reclassifications or added exposures, and the complete premium calculation used to determine the final premium amount.

RetentionCarriers must retain full internal audit worksheets for regulatory review but not disclose employee-level data to insureds.

PurposeEnsure insureds can verify audit results and understand basis for any premium changes without exposing employee-level personal information.

Refund handling

Refund requirementWhen an audit reduces the amount owed, carriers must issue a direct refund of any overpaid amount rather than applying credit to future billing cycles, unless the insured expressly requests otherwise.

Method of refundPremium refunds must be issued using the same method as the original premium payment (the first method used by the insured for that policy term).

Multiple payment methodsIf multiple payment methods were used, refund must be issued using the first payment method type; if that method is unavailable, issue by check or another mutually agreed method.

Insured choiceInsured may expressly request credit to future billing cycles instead of a refund; otherwise direct refund is required.

Online Access to Audit Materials

Requirement for portalsIf a carrier maintains an online portal, all audit-related documents (historical records, billing notices, correspondence) must be accessible to the insured through secure digital access.

SecurityCarriers must ensure digital platforms support secure and continuous access to audit materials (secure login, controlled access).

ContinuityAccess must be continuous to allow insureds to review historical audit records and related communications as needed.

Agent access controlInsureds must be given the opportunity to designate who may access portals; portal access should be limited and secure through unique usernames and passwords.

Policy Summary

PayerDelaware Department of Insurance

PolicyRegulatory Expectations for Payroll Audit Practices (Bulletin No. 159)

Policy CodePolicy 159

Change TypeRevision (no material coverage changes)

Effective DateOct 20, 2025

Last ReviewFeb 5, 2026

Next Review Date

Key ActionAllow licensed agents prompt access to audit documentation when designated by the insured; insured consent controls sharing.

SourceLink

On This Page

OpenPayer is powered by Trek Health's payer performance platform. Trek continuously ingests, validates, and normalizes Transparency in Coverage data alongside payer policies and other commercial payer data to create a structured payer intelligence foundation. OpenPayer uses this foundation to deliver personalized search results, dynamically generated policy pages, and tailored policy monitoring based on each user's payers, specialties, billing codes, and areas of interest. The same intelligence powers broader payer performance workflows, including reimbursement benchmarking, contract evaluation, payer negotiations, and financial decision-making.

Regulatory Expectations for Payroll Audit Practices (Bulletin No. 159)

Customize your policy alerts

Sign up for Delaware Department of Insurance Policy 159 alerts

Get alerted when Policy 159 changes without checking for updates manually.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Department Expectations for Payroll Audits

Payroll Audit Expectations and Minimum Standards

Department expectations and minimum standards for payroll audits and related practices.

Agent and Carrier Operational Requirements

Documentation Required

Permit agent access only with insured designation and consent

Carriers should implement a standardized process that allows licensed agents to promptly assist insureds in obtaining audited payroll documentation.
Insureds must be given the opportunity to designate who may access online portals or receive mailed audit information.
Portal access should be limited and secure through unique usernames and passwords; mailed documents should be sent on a proprietary or confidential basis only to individuals designated by the insured.
If an insured does not consent to sharing audit documents with an agent, the insured's decision must prevail.

Key Definitions, Refunds, and Online Access

Audit Documentation Transparency

Scope of materialsDocumentation should outline payroll reviewed, class codes, reclassifications or added exposures, and the complete premium calculation used to determine the final premium amount.

RetentionCarriers must retain full internal audit worksheets for regulatory review but not disclose employee-level data to insureds.

PurposeEnsure insureds can verify audit results and understand basis for any premium changes without exposing employee-level personal information.

Refund handling

Method of refundPremium refunds must be issued using the same method as the original premium payment (the first method used by the insured for that policy term).

Insured choiceInsured may expressly request credit to future billing cycles instead of a refund; otherwise direct refund is required.

Online Access to Audit Materials

SecurityCarriers must ensure digital platforms support secure and continuous access to audit materials (secure login, controlled access).

ContinuityAccess must be continuous to allow insureds to review historical audit records and related communications as needed.

Agent access controlInsureds must be given the opportunity to designate who may access portals; portal access should be limited and secure through unique usernames and passwords.