The Administrative Director of the Division of Workers’ Compensation submitted the thirty-second annual workers’ compensation report summarizing the results of audits conducted by the DWC Audit & Enforcement Unit for 2021.
Congratulations to the 31 entities who met or exceeded the Profile Audit Review (PAR) standard, and the following were in the top five positions with the best audio scores.
1. Warner Bros. Studio Facilities – Burbank
2. Schools Insurance Authority – Sacramento
3. RICA & RICC – San Francisco
4. Zenith Insurance Co. – Los Angeles
5. Cherokee Insurance Company – Sterling Heights, MI
Labor Code sections 129 and 129.5 provide the framework for oversight and enforcement of the regulations of the Administrative Director for the prompt and accurate provision of workers’ compensation benefits.
The performance of any insurer, self-insurer, or third-party administrator is rated for action in specific areas of benefit provision. Of foremost importance is the payment of all indemnity owed to the injured worker for an industrial injury. The timeliness of all initial and subsequent indemnity payments and compliance with the regulations of the Administrative Director for provision of notice for a qualified or agreed medical evaluation are also measurable performance factors.
The Audit & Unit completed 40 audits, of which 37 were routinely selected for routine Profile Audit Review (PAR). In addition, another 3 audits were selected as target audits based on the failure of a prior audit. The PAR audit subjects consisted of 13 insurance companies, 4 self-administered/self-insured employers, 18 third-party administrators (TPA), and 5 insurance companies/third-party administrators that combined claims-adjusting locations. The Audit & Enforcement Civil Penalty Unit completed 1 Utilization Review Investigation based on a credible referral and complaint.
The Statewide 2021 Audit Ranking Report (Exhibit 4) ranks all insurers, self-insured employers, and TPA audited during 2021 according to their performance measured by the PAR and FCA performance standards. Low performance rating numbers reflect good claims-handling performance, and high performance rating numbers reflect poor performance. Rankings on Exhibit 4 are from the best to the worst performers.
The complete report for this audit shows the remaining scores of the audit participants for 2021.