SELECTED INDICATORS IN WORKERS’ COMPENSATION: A REPORT CARD FOR CALIFORNIANS
Audits by Type of Audit Subject
The following graph depicts the total number of audit subjects each year with a breakdown by whether the subject is an insurer, a self-insured employer, or a third-party administrator.
Selection of Files to be Audited
The majority of claim files are selected for audit on a random basis, with the number of indemnity and denied cases being selected based on the numbers of claims in each of those populations of the audit subject:
Targeted files are selected because they have attributes that the audits are focusing on.
Additional files include claims chosen based on criteria relevant to a target audit but for which no specific complaints had been received.
The number of claims audited is based upon the total number of claims at the adjusting location and the number of complaints received by the DWC related to claims-handling practices. Types of claims include indemnity, medical only, denied, complaint and additional.