Indicator 8: Promptness of Responding to Claims Correspondence
This report measures compliance with s. 102.31(3) of the Wis. Statutes relating to responsiveness to from the Division for claim information, some of which are for missing required reports.
Insurers are required under s. 102.31(3) to respond to correspondence within 30 days.
Standard or Benchmark:
There is no legal standard set by statute or rule for compliance. The benchmark we use for training, evaluation and enforcement purposes is that at least 85% of claims correspondence is responded to timely. This benchmark will be used when considering referrals to OCI for enforcement purposes under s.102.31(3) and s.601.64.
Source of Indicator Data:
The source of the data is the received date of replies to a large amount of departmental correspondence including dictated letters. The replies used for measuring this indicator are replies to many of the standard letters including forfeitures, "OCI referral letters", individualized letters to insurance carriers, balance due letters and letters sent in as follow-ups for required reports asking for a reply within 30 days. The "detail" part of the report available on the secured site will reflect the number of days for each reply received late or will show "none" if no reply was received within 60 days after the correspondence was mailed to the insurer.
Promptness percentage is computed by dividing the number of replies received within 30 days of the by all replies and failures to reply promptly during the quarter within at least 60 days of the mailing. This establishes a ratio of timely responses to untimely and no responses. This methodology was formerly changed in January 2002, retroactive through 1999 and again changed in the 2nd quarter of 2003.
State of Wisconsin Averages:
What This Indicator Measures:
This indicator measures timeliness of responding to Division claims correspondence by looking at the date of replies to written for information via form letters from the Division. The percentage reflects the percent of replies received within the 30-day due dates on the letters. The benchmark is set at 85%. Timely responses indicate lower overhead costs and less friction in the system.
Explanatory Comments for Current Indicator:
Publication of the industry wide performance for this indicator has been temporarily suspended due to the WC Divisionâ€™s backlog in processing supplemental reports (responses to claims correspondence). This backlog makes it seem as if industry wide performance has plummeted when in fact the measured drop is actually due to the backlog and not industry performance.
Indicator 8: Promptness to Claims
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.
Due to the WC Division backlog in processing supplemental reports, the Indicator 8 detail level data will not be published until further notice.