DWC Announces 2016 PAR and FCA Audit Standards
State law (Labor Code §§129 and 129.5) requires DWC to conduct profile audit reviews (PARs) of all workers’ compensation adjusting locations at least once every five years. Each year the Division calculates overall claim operation performance ratings based on composite scores for such measures as payment of accrued and undisputed indemnity; late first payment of temporary disability and first notice of salary continuation; late first payment of permanent disability and death benefits; late subsequent indemnity payments; and provision of notices with qualified medical evaluator and agreed medical evaluator advice. The Division then uses the ratings from the last three years to set standards for upcoming audits.
On Tuesday of this week, DWC announced that the 2016 ratings, based on 2012-2014 audit results, will be lower than they were in 2015. The 2016 PAR standard will be 1.51082; the full compliance audit standard will be 1.67880.
What do these numbers mean to you?
- Audited adjusting locations receiving a PAR rating of 1.51082 or lower must pay any unpaid compensation, but no penalties; while those with a PAR performance rating of 1.51083 or higher face a full compliance audit (FCA) and an additional sample of indemnity claims will be audited.
- Full Compliance Audit subjects with an FCA performance rating of 1.67880 or less must pay any unpaid compensation plus penalties for all violations involving unpaid & late paid compensation. If an FCA subject’s FCA performance rating is 1.67881or higher, an additional sample of denied claims and the expanded sample of indemnity claims will be audited. The DWC will assess penalties for all violations per 8CCR §10111 – 10111.2.
More details on the performance standards that the DWC will use in 2016 profile audit reviews and full compliance audits are on the Audit Unit web site, www.dir.ca.gov/dwc/audit.html.
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