DWC audit regulations

TITLE 8. INDUSTRIAL RELATIONS DIVISION 1. DEPARTMENT OF INDUSTRIAL RELATIONS CHAPTER 4.5. DIVISION OF WORKERS' COMPENSATION SUBCHAPTER 1.5 INJURIES ON OR AFTER JANUARY 1, 1990 ARTICLE 1 AUDIT, GENERAL DEFINITIONS §10100.2. Definitions. The following definitions apply in Articles 1 through 7 of this Subchapter for audits conducted on or after January 1, 2003. (a) Adjusting Location. The office where claims are administered. Separate underwriting companies, self-administered, self-insured employers, and/or third-party administrators operating at one location shall be combined as one audit subject for the purposes of audits conducted pursuant to Labor Code Ssection 129(b) only if claims are administered under the same local management at that location. Where claims are administered from an office that includes a satellite office at another location, claims administered at the satellite office(s) will be considered as part of the single adjusting location for auditing purposes when demonstrated that the claims are under the same immediate management. For auditing purposes, any separate office or location whose staff includes local management may be considered a single adjusting location. (b) Additional claim file. A claim selected for audit in addition to the random sample of claims selected. An additional claim file may include a companion claim file, a file selected for audit because it was incorrectly designated on the ...