Division of Workers' Compensation

Workers' Compensation Statistics

Bureau of Monitoring and Audit

Mission Statement:

The missions of the Bureau of Monitoring and Audit serves to ensure that the payments of benefits are paid timely and accurate to injured workers as well as medical bills and required forms are filed timely and accurately to the division. In addition, verify that the self-insured employers have sufficient resources to pay outstanding liabilities.

The mission of the bureau is achieved through four sections:

Audit Section
The Audit Section examines insurer claims handling practices pursuant to Chapter 440.20, 440.185, 440.525, F.S., and Administrative Rules enacted by the Division. The examinations or investigations conducted by the audit section address patterns or practices of unreasonable delay in claims handling; timely and accurate payment of benefits to injured workers; timely filing and payment of medical bills; accurate and timely filing of required reports; and inspection and enforcement of compliance with compensation orders of Judges of Compensation Claims.

Penalty Section
The Penalty Section evaluates and assesses insurer performance with respect to the timely payment of initial indemnity benefits and medical bills and the timely filing of First Reports of Injury and medical bills. Performance is monitored via the Centralized Performance System (CPS), an interactive web-based system that allows insurers to access their performance information and respond to the division in real-time. There are separate CPS Medical and CPS Indemnity Modules.

Permanent Total Section
The Permanent Total Section ensures the accuracy and timeliness of the payment of permanent total benefits and permanent total supplemental benefits. In addition to reviewing/auditing forms filed with the division, the section participates in hearings, depositions, and mediations to assist in resolving disputes, and performs audits of carriers and self-insured employers.

Self-Insurance Section
The Self-Insurance Section monitors the self-insurance programs of governmental and public entities, calculates experience modification factors, and certifies third-party administrators.

Fiscal Year 2010/2011 Accomplishments

The Bureau of Monitoring and Audit

• Conducted and completed 64 audits of insurer claim files. The insurer claim file contains all records, medical reports and benefit information relative to a particular worker’s injury or illness.
• Reviewed 4,340 claim files on audit for accuracy and timeliness and revealed 605 files with underpayments. The identification of these underpayments resulted in the additional payment of $163,314 in indemnity benefits and $127,582 in penalties and interest, for a total of $290,896 paid to injured workers.
• Evaluated and monitored the accuracy and timeliness of 53,285 First Reports of Injury or Illness filed by employers, insurers and claims-handling entities through CPS. This evaluation resulted in a combined total $891,802 of penalties assessed against employers and insurers due to late payments and a combined total of $938,475 of assessed penalties due to late filings.
• Evaluated and monitored insurer performance for timely disposition and timely filing of medical bills through CPS. 3,861,864 medical bills were evaluated for compliance with the Division’s timely disposition and timely filing standards and resulted in $390,150 in late disposition assessed penalties and $819,915 in late filing assessed penalties.
• Audited 43,281 claim documents filed by insurers with the Division to ensure payment of accurate permanent total and permanent total supplement benefits.
• Determined and authorized reimbursement payments to injured workers in the amount of $5,895,567 due to underpayments by insurers.
• Calculated and approved payment of $18,028,738 in permanent total supplemental benefits to 1,486 eligible injured workers.
• Promulgated 410 experience modification factors for active self-insurers.
• Approved four new service companies and recertified 96.
• Approved four new self-insurance entities.
• Audited payroll records of 27 self-insurers and 59,758 payroll records. The audits resulted in the identification of $33,604,166 in underreported payroll and $769,770 in underreported premium.
  

Fiscal Year 2010/2011 Insurer Performance Charts

Click on each to review charts.

CHART 1	First Report of Injury or Illness Reviewed
CHART 2	First Report of Injury or Illness Timely Forms Timely Filing by Insurers
CHART 3	Medical Bills Reviewed for Timely Filing and Payment
CHART 4	Timely Medical Bill Filing
CHART 5	Medical Bill Late Filing Penalties
CHART 6	Timely Medical Bill Payments
CHART 7	Timely Initial Indemnity Benefit Payments
CHART 8	Underpaid Indemnity Benefits Identified During Audits