The Division of Workers’ Compensation (DWC) has posted the 2020 DWC Audit Unit annual report. The report provides information on how claims administrators performed during the 2020 audit year and includes a ranking report for the audits conducted.

The DWC Audit & Enforcement Unit conducts a Profile Audit Review (PAR) of all claims administrators every five years and rates each claim audited for performance in specific areas of benefit provision. This is important to ensure payments of all indemnity benefits owed to injured workers are paid accurately and timely. A performance rating is calculated for the sample of randomly selected claims and given a composite score based on the following:

  • Claims with unpaid indemnity
  • Claims with late first temporary disability payments or failure to comply with the regulations for the provision of the first notice of salary continuation in lieu of temporary disability
  • Claims with late permanent disability or death benefits
  • Claims with late subsequent payments
  • Claims with violations involving failure to comply with the provision of notices to advise injured workers of the process for selecting Agreed Medical Examiners (AME) or Qualified Medical Examiners (QME)

Each year, the Audit & Enforcement Unit establishes a target score for audits to be conducted in that year, and each administrator who scores below the target score passes the initial phase of the audit. Lower PAR audit scores indicate better performance. Audit fines are waived for those who pass the first phase of the audit.

If a claims administrator does not meet performance standards for a PAR audit, a Full Compliance Audit (FCA) will be conducted with penalties assessed.  If a claims administrator is subsequently identified for a return target audit due to failing a PAR/FCA audit, they may also be subject to civil penalties up to $100,000.

We are happy to report that Athens passed again in 2020, scoring the 8th best performance ranking in California. Athens Administrators has passed the first PAR audit level for every audit since it was established in 1976.

 

Athens Administrators has been a recognized leader in third-party claims administration services for over four decades. Providing prompt and accurate benefits to injured employees reduces litigation, promotes a swift recovery and reduces claims costs. Our consistently high audit scores reflect our technical expertise, effective claims handling, and dedication to taking care of our clients and their injured employees.

 

Learn more about Athens Administrators at www.athensadmin.com.