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SELECTED INDICATORS IN WORKERS’ COMPENSATION:  A REPORT CARD FOR CALIFORNIANS

2003 35 Audits passing the PAR standard:27.78%

2003   8 Audits passing the FCA standard:39.87%

2003   2 Audit failing all standards:            20.00%

Performance Ratings

Each audit subject’s performance rating is calculated following a review of a sample of randomly selected indemnity claims and is a composite score based on performance in specific key areas.  

Ratings are based on the frequency and severity of violations, with a weighting factor emphasizing the gravity of violations involving the failure-to-pay compensation.  The higher the rating of an audit subject the worse the performance.

Ratings are calculated based on the frequency of claims with:

Unpaid compensation and the amounts of unpaid compensation found in the sample of randomly selected undisputed claims.

Violations involving late first TD payments or first notices of salary continuation.

Violations involving late first payments of PD, vocational rehabilitation maintenance allowance, and death benefits.

Violations involving late subsequent (scheduled) indemnity payments.

Violations involving the failure to timely issue Notices of Potential Eligibility for Vocational Rehabilitation and Notices Advising Injured Workers of their Rights for Qualified Medical Examinations to determine PD.

If the audit subject's performance rating meets or exceeds (i.e., is lower than) the worst 20 percent of performance ratings for all final audit reports issued over the three calendar years before the year preceding the current audit, the Audit Unit will issue Notices of Compensation Due pursuant to Section 10110 but will assess no administrative penalties for violations found in that audit.

If the audit subject's performance rating is higher than the worst 20 percent of performance ratings as calculated based on all final audit findings as published in the Annual DWC Audit Reports over the three calendar years before the year preceding the current audit, the Audit Unit will conduct an additional audit by randomly selecting and auditing an additional sample of indemnity claims.

Specific findings for all audit subjects may be found in the DWC Audit Unit Annual Reports, available at http://www.dir.ca.gov/dwc/audit.html.

For further information…

DWC Annual Audit Reports may be accessed at http://www.dir.ca.gov/dwc/audit.html

CHSWC Report on the Division of Workers’ Compensation Audit Function (1998) - available at www.dir.ca.gov/chswc

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