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