98 audit report - narrative

DEPARTMENT OF INDUSTRIAL RELATIONSDIVISION OF WORKERS’ COMPENSATION1998 AUDITS OF WORKERS’ COMPENSATIONINSURERS, SELF-INSURED EMPLOYERS, ANDTHIRD-PARTY ADMINISTRATORSApril 1, 1999California Department of Industrial RelationsDivision of Workers' Compensation1998 Audits of Workers' Compensation Insurers, Self-InsuredEmployers, and Third-Party AdministratorsApril 1, 19991998 Audit ResultsThis ninth annual workers' compensation audit report summarizes the accomplishments of theAudit Unit of the Division of Workers' Compensation during calendar year 1998. ScopeA total of 34 audits were completed by the Audit Unit of the Division of Workers' Compensationin 1998. Of these, 29 of the audits were randomly selected and the remaining 5 were non-random,or "targeted" audits. Non-random audits were selected either based upon results from prior auditsor following investigations resulting from complaints received by the Division of Workers'Compensation. The audit subjects included 11 insurance companies, 11 self-administered, self-insured employers, and 12 third-party administrators (TPAs). In addition to these 34 audits, the Audit Unit scheduled 16 investigations pursuant to Title 8,California Code of Regulations, Section 10106(d) in which claim files will be reviewed based onratios of points assigned to alleged violations in complaints received by the Division of Workers'Compensation compared to the numbers of claims reported at the adjusting locations. The ...