Florida Regulations 69L-24.022

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§ 69L-24.022 Auditing.

(1) The audits by the Division will encompass all indicators covered by the Division�s Automated Carrier Performance System as provided in Rule 69L- 24.0211, F.A.C. However, carriers, self-insurers or servicing agents shall not be penalized for performance below 90 percent based on the following Automated Carrier Performance System indicators:

(a) Volume and cost of litigation in processing initial claims;

(b) Effectiveness in returning employees to work;

(c) Employee customer service ratings;

(d) Employer customer service ratings;

(e) Amount of average medical costs and average total costs per claim; and

(f) Volume and nature of employee complaints regarding the workers� compensation injury. The Division will make recommendations to assist these entities to improve performance in the aforementioned areas for the specific purpose of rendering the Workers� Compensation system more effective and efficient.

(2) The Automated Carrier Performance System indicators and the other sources identified in this rule shall be reviewed by the Division to determine whether and how often to conduct audits of each carrier, self-insurer or servicing agent�s practices. For purposes of this determination, substandard performance on any category outlined in Rule 69L- 24.021, F.A.C., shall subject the entity to consideration for audit. No prior notice is required if the Division determines an audit is necessary. However, nothing set forth in these rules shall prohibit the Division from auditing all carriers, self-insurers and servicing agents at least once every three

(3) years. Audits conducted under the three (3) year requirement shall cover the preceding three (3) fiscal years of the carrier, self-insurer or servicing agent's operation and must commence within twelve (12) months after the end of the most recent fiscal year being covered by the audit. The audit may cover any period of the entity's operations since the Division�s last audit.

(3) If the Division conducts an on-site audit of any carrier's, self-insurer's or servicing agent�s practices, the audit report shall be utilized to recommend changes in such entity's behavior and to ensure its continuing compliance with the minimum performance standards set forth in this rule.

(4) For purposes of this rule:

(a) On-Site audits will be conducted at the physical location of the entity being audited. The Division shall issue a written audit report within thirty (30) days after conclusion of an on-site audit conducted pursuant to this rule. This report shall include the Division�s recommendations for improving the entity�s overall performance in all categories as specified by the Automated Carrier Performance System.

(b) Desk audits will be conducted at the Division�s office based on data reported to the Division. A written audit report shall be issued at any time the entity�s performance is below the minimum performance standard.

(5) All carriers, self-insurers or servicing agents shall provide the Division with all information relevant to each case file and the Automated Carrier Performance System indicators, as needed, to permit a complete review of the entity�s operations and processes during an audit. Such information may be furnished through hard copy or through a computerized format, as long as the information is made available to the Division at the time of the audit. In the event the information is kept in a format other than hard copy, such format shall be accessible by the Division without unreasonable delay caused by access codes or the programming of access codes for entry into the entity's database by the Division.

Specific Authority 440.13(11)(b), 440.20(8)(c), (17), 440.591 FS. Law Implemented 440.13(11), 440.20 FS. History-New 8-29-94, Amended 5-14-95, Formerly 38F-24.022, 4L-24.022.