|
Industry
Averages — Insurer and Self-Insured Employer Claims Performance
In 1992 the Oregon Workers’ Compensation Division (WCD) instituted the Quarterly Claims Processing Performance (QCPP) Audit.
It is a computer-generated summary of reports submitted to WCD by insurers and self-insured employers and entered in the division’s claims information system (CIS).
The QCPP audit monitors workers’ compensation insurers and self-insured employers based on timely performance of three basic claims-processing requirements. All insurers filing applicable reports in the quarter receive an audit summary. They may contest the audit findings and request adjustment before the information is published at this site.
Insurers are subject to civil penalties if they have quarterly activity of five or more claims and their percentage of timeliness falls below the standard in any of the following three areas:
|
|
|
|
Filing of claims
— 80% timeliness standard - Initial and aggravation claims for disabling
injuries and denied claims are to be reported to WCD within 14 days of the acceptance
or denial date.
|
|
|
|
|
First payment
of compensation for temporary disability (TD) - 90% timeliness standard - Payment
must be made within 14 days of whichever of the following applies:
|
|
|
|
the date the employer
knows of the claim, if TD is authorized within 14 days of the employer's
knowledge date
|
|
|
|
the date the attending
physician or authorized nurse practitioner authorizes, if TD is authorized
more than 14 days after the employer's knowledge date
|
|
|
|
Under OAR
436-060-0020, the date authorization is received, if insurer requested
verification and did not receive verification during first 14 days.
|
|
|
|
Examples
|
|
|
|
|
Acceptance or
denial of claims - 90% timeliness standard - Claims must be accepted or denied
within 60 days of the date the employer knows of the claim.
|
Industry
averages for initial claims processing is the total number of claims reports submitted
each quarter for the above three claims-processing areas, and the totals by year.
Insurer Performance
Statistics (IPS) criteria developed by the department’s Information
Management Division is used to evaluate the data extracted from the CIS to generate
this report.
|
