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Sally Coen
503-947-7687
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Field Audit Unit
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Purpose
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To effect insurer and
self-insured employers' compliance with claims processing rules, validate expenditures
from the Workers' Benefit Fund, and ensure employers' compliance with rules governing
self-insurance.
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Responsibilities
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Insurer
compliance with claim processing rules: The team collects data
from insurers and self-insured employers to determine if they are
in compliance with claim processing rules and statutes, and issues
penalties for performance falling below a standard threshold. Annual
audits of self-reported data and focused audits on specific issues
are designed to capture a current picture of how the industry is performing.
Expenditures from the Workers' Benefit Fund: Validate from
insurer records that expenditures meet eligibility requirements. Require
monetary adjustments as necessary.
Employer compliance with rules governing self-insurance: The
team conducts claims reserve audits to ensure that self-insured employers
are valuing claims appropriately and reporting accurate and complete
loss data that the division uses to establish experience-rating modifications
and security deposits. Also conducts on-site audits of bankrupt self-insured
employers' claims to ensure adequate funding in the Self-Insured Employer
Adjustment Reserve (SIEAR). And, the team conducts reviews to help
ensure that self-insured employers accurately report and pay premium
assessment monies, as well as help resolve instances where employers
are delinquent in paying WBF assessment monies. |
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Functions
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Field
auditors conduct various auditing activities, including self-reported
claims processing performance audits of insurers and self-insured
employers as well as auditing expenditures from the Workers' Benefit
Fund. Conducts annual audits for nine specific categories, as well
as focused audits on varying categories, topics selected quarterly.
Audits are also currently performed on the following programs funded
by the Workers' Benefit Fund: Workers with Disabilities Program, Reopened
Claims Program, Preferred Worker Program (claim costs), Employer-at-Injury
Program, the Non-complying Employer Program, and Supplemental Disability
Benefits. |
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Primary
governing rules
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WCD rules are involved in the work of the Field Audit Unit. |
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For
more information contact:
Field
Audit Unit: 503-947-7687
FAX: 503-947-7725 |
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If you have questions about this webpage, please contact Sally Coen, 503-947-7687.
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