Issue 117 - November 2021
2021 Workers’ Compensation Claims Audit
Each year, the Authority measures the claims handling performance of its workers’ compensation third-party administrator, Sedgwick, against performance standards set by the Authority with the assistance of its auditor.
For the fifth consecutive year, the Authority contracted with Jim Bankson to conduct the annual audit of its workers’ compensation program. Bankson is the president and founder of Northern Claims Management LLC, based in Santa Rosa, California. He has worked extensively with public agency clients. He has a comprehensive understanding of California’s complex workers’ compensation environment.
Bankson conducted the audit of the Sedgwick team by reviewing a random selection of 150 claims, including indemnity, future medical, and medical-only claims. The audit focused on key performance indicators established by the Authority, compliance with California’s statutory requirements, and industry best practices.
Bankson presented his findings to the Authority’s Executive Committee at its meeting on October 27, 2021. Bankson reported Sedgwick’s score of 90.96%, an increase over last year’s 90.45% score. This score is even more impressive considering the significant influx of COVID-19 claims the Sedgwick team handled during the audit period.
Some of this year’s highlights include the following:
|Key Performance Indicator||Rating|
|Compensability Determination||100% up from 82%|
|Timely Notice of Delay||100% up from 80%|
|Permanent Disability Reserves||91% up from 78%|
|Excess Insurance||100% up from 60%|
This marks the twelfth consecutive year the Authority’s dedicated team at Sedgwick has scored 90% or higher on the annual audit. Members are invited to share their feedback regarding the Authority’s workers’ compensation claims administration efforts at any time by contacting Workers’ Compensation Program Manager Jeff Rush.< Back to Full Issue Print Article