Indicator 2: Promptness of First Indemnity Payments
This indicator measures insurers promptness of payment of first indemnity TTD payments.
DWD 80.02(3)(a), Wis. Adm. Code, establishes a promptness standard of 80% or more for all first indemnity payments. To meet the standard, first payments must be mailed to the injured employee within 14 days or less following the date of injury or the last day worked after the injury before the first day of compensable lost time.
With 80% as the minimum, the standard allows for unavoidable delays resulting from legitimate litigation or claim investigations, and delays in notification of the injury from the employee to the employer. The standard was developed and set at 80% with consideration to these and other reasons for delayed payments made that were beyond the insurer's reasonable control. The WCD commends insurers for exploring ways to reduce these delays in an effort to move as far above the 80% standard as possible.
Standard or Benchmark:
The standard is the same as the compliance requirement above under DWD s. 80.02(3)(a), that 80% or more of first indemnity payments are to be made within 14 days of the date of injury or the last day worked.
Source of Indicator Data:
Temporary total disability (TTD) benefits payments are used to measure timeliness of first indemnity payments. "Salary Continued" payments are always considered TTD and, when made, are always considered as a prompt payment. First TTD payments made as a result of an order from a legal hearing or stipulation are included in the timeliness measurement. Payments made as a result of a compromise agreement are not included in the assessment of timeliness of first indemnity payments. All other types of payments, including permanent partial disability (PPD) and temporary partial disability (TPD) are excluded from the timeliness measurement.
For most claims, promptness of the first indemnity payment is measured by computing the number of days from the day following the date of injury or last day of work, whichever is later, to the day the first indemnity payment is made. For instance, if the injury occurred on December 1, the indemnity payment should be made by December 15 in order to be considered timely.
In cases in which the first period of lost time is 3 days or less, followed by a period of intervening work that is followed by another period of lost time, computation begins with the last day worked which triggered eligibility for payment for the first period of lost time. For example, an injury happened on December 1 but the worker was on the job December 3-6 and subsequently was not able to work from December 7-10; then, a first indemnity payment made by December 20 would be timely.
State of Wisconsin Average:
What This Indicator Measures:
This indicator measures promptness of Worker's Compensation first indemnity payments. The legal standard for insurers is to make 80% of first indemnity payments within 14 days of the date of injury or last day of work prior to the first compensable day of injury, whichever occurs later. This indicator summarizes data from about 180 large, medium-sized and small carriers and self-insured employers with the most claims, accounting for over 90% of all claims. This is a quarterly indicator with year-to-date and 12 quarter history data.
Explanatory Comments for Current Indicator:
Industry performance is 84% for the 2nd quarter of 2014. 12 quarter performance is at 85%, an excellent 5% above the statutory standard of 80%. This overall superb performance can be attributed to constant monitoring, counseling and enforcement actions on the part of the WC Division. It is also the result of industry concern to both make timely first indemnity payments and engage in informational outreach to employers regarding when the former should be reporting injuries to the latter.
Indicator 2: Promptness
of First Indemnity
Group A - Large Insurers (400 claims or more per year)
Group B - Medium Size Insurers (65-399 claims per year)
Group C - Small Size Insurers (equal to or greater than 65 claims every 3 years)
PLEASE NOTE: Quarterly summary reports are static, a snapshot of performance reflected by our database the day prior to the reports being run. As such, actual performance may be different due to changes to the claims for the given quarter after the reports are run than performance captured in the PDF.First Quarter 2014 Fourth Quarter 2013