WC Insurers Claims Handling Performance Indicator Reports

General Description and Purpose of the Report:

The claims handling Performance Reports are intended to promote excellence in claims handling practices and provide insurers as well as the general public with both benchmark and quarterly performance data related to claims handling performance under the Wisconsin Worker’s Compensation program. This performance data is intended to be used for the purposes of education and training by insurers and the Division and to thereby improve claims handling performance. It may also be used by the Division to ensure compliance with Worker’s Compensation statutes and Administrative code.

While the focus of Wisconsin's Worker's Compensation Law is primarily on individual claim situations the Administrative Code, DWD 80.02, does create some standards of expected performance. DWD 80.02 (3) reads:

EVALUATION. In evaluating whether payments of compensation and reports made by insurance carriers and self-insured employers were prompt and proper under the provisions of ss. 102.28(2) and 102.31(3), Stats., and before undertaking to revoke the exemption from insurance under s. 102.28 (2) , Stats., or before recommending under s. 102.31(3), Stats., to the commissioner of insurance that enforcement proceedings under s. 601.64, Stats., be invoked the department will consider all of the following performance standards together with all other factors bearing on the performance and activities of the insurance carrier or self-insured employer:

  1. Payment of first indemnity
    Whether 80% or more of first indemnity payments are mailed to the injured employee in 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.
  2. First report of injury
    Whether 70% or more of reports required under sub. (2)(a) are received by the department within 14 days of the date of injury or the last day worked after injury before the first day of compensable lost time.
  3. Correct and complete names
    Names of self-insured employers on reports filed with the department must be correct and complete. The name of an insurance group is not a substitute for the name of the individual company insuring the risk. The name of an insurance service company is not a substitute.
  4. Penalty frequency and severity
    The number and amount of penalties assessed for violations of ss. 102.18(1)(bp), 102.22(1), 102.57, and 102.60, Stats.

The standards, not cited in the above rule, listed in the Performance Reports were created by the Division as reasonable expectations of industry performance. They are intended as objectives and a means by which insurers can assess and modify their claims handling practices.

The Performance Reports are published for insurers of Wisconsin Worker’s Compensation claims with significant annual claim volume. It includes quarterly, year-to-date and 3-year performance data for several key performance indicators beginning with data from 2008.

Data used in the Performance Reports are derived from information recorded in the Wisconsin Worker’s Compensation automated Information Claims Management System (ICMS). ICMS is used to input the information provided by insurers from hard copy (rare instances), Electronic Data Interchange (EDI) and the Pending Reports Internet application. Information is accurate as of the date it was taken from ICMS, although the information may contain a small percentage of reporting or recording errors.

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