The Division of Workers’ Compensation undertakes a rigorously detailed audit of third-party administrators, insurance carriers, and self-administered employers every five years in order to ensure that benefits are being paid timely and appropriately and that benefit notices are sufficient to inform the injured workers of their rights and benefits. The stakes are high for those being audited as the scores are published for review by the public.
The audit score was calculated following a review of 57 randomly selected indemnity files and is based on the frequency of unpaid compensation, frequency of claims with violations involving late disability payments, and the frequency of claims where there is a failure to advise injured employees of the right to select an Agreed Medical Examiner or a Panel Qualified Medical Examiner.
The goal is to obtain the lowest score possible, but to pass at the PAR level, a rating of 1.47885 or less must be obtained. A higher score will necessitate the administration of a Full Compliance Audit after which administrative penalties are assessed.
Athens Orange obtained a rating of .89923 which is well under the score required to pass at the PAR level, and it was in line with the audit results for our other offices in 2015, which were .90278 for Athens Sacramento and .90601 for Athens Concord.
Athens is committed to the highest quality claims handling for our clients and their employees, and the remarkable consistency between all offices’ scores, despite having different auditing teams, speaks to the integration of processes, procedures, oversight and internal auditing at Athens.