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 section 129(b) only if claims are administered under the same local management at that location. 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 claim log, or a claim chosen based on criteria relevant to a target audit but for which no specific complaint has been received. (c) Administrative Director. The Administrative Director of the Division of Workers' Compensation or the Director’s duly authorized representative, designee, or delegee. ...