Indicator 8: Promptness of Responding to Claims Correspondence
This indicator measures compliance with 102.31(3), Wis. Stats., which requires a 30 day response time to Department claims correspondence.
Insurers are required to comply with 102.31(3), Wis. Stats., and to thereby respond to Department claims correspondence within 30 days.
Standard or Benchmark:
While there is no performance standard set by statute or rule the benchmark used for training purposes is that at least 85% of Department claims correspondence is responded to timely. This benchmark will be used when considering referrals to the Office of the Commissioner of Insurance for enforcement purposes under s.102.31(3) and s.601.64 Wis. Stats.
Source of Indicator Data:
The source of the data is the date received for 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 surcharges, OCI referral letters, individualized letters to insurance carriers, balance due letters and letters sent as follow-ups, with a 30 day response date, for required reports. The data detail 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 is computed by dividing the number of replies received within 30 days in a given quarter by all replies and failures to reply promptly within at least 60 days in a given quarter. For a given quarter this establishes the percentage of timely responses vis-à-vis all responses and 60 day non-responses.
State of Wisconsin Averages:
What This Indicator Measures:
This indicator reflects the individual and combined performance of about 180 insurers with respect to the timeliness of responding to Division claims correspondence. These insurers account for over 90% of the claims submitted. The benchmark for training purposes is set at an 85% timely response rate to Department claims correspondence. Data is updated quarterly.
Explanatory Comments for Current Indicator:
Publication of the industry wide performance for this indicator has been temporarily suspended due to the WC Division 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. As such they are a snapshot of performance reflected by our database on the 14th day of every new quarter. As such, actual performance may be different due to changes to the claims for the given quarter after the reports are run.
Due to the WC Division backlog in processing supplemental reports, the Indicator 8 detail level data will not be published until further notice.