Report: County Risk Department Rejects Push for Quarterly Updates

Wednesday, July 1, 2020 | 0

The risk department for a county in Northern California rejected an auditor’s recommendation to consider sending quarterly newsletters about its work comp program to managers and supervisors, according to a report by the Daily Republic.

The Solano County Risk Management Department also disagreed with an auditor’s recommendation to stop paying injured workers in advance for attending medical-legal appointments to avoid double payments when the worker cancels the appointment and reports to work.

An audit report presented to supervisors during a June 23 meeting found eight county departments did not submit “Report of Work-Related Injury” forms on 20 of 60 claims that were reviewed. The Risk Management Department said supervisors and managers might not be aware of the requirement to use the forms.

However, the risk department rejected the suggestion of sending a quarterly newsletter covering proper work comp processes to supervisors and managers. The department said it will consider other ways to “reiterate the importance of following the mandated process for reporting.”

A review of 27 cases found the county’s third-party administrator, Athens, twice made payments to injured workers for med-legal appointments that they didn’t attend. As a result, the workers received both the advance pay for the appointment as well as their wages for the day.

The county's auditor said the Labor Code requires that injured workers receive one day of temporary disability benefits for each day of wages that are lost as a result of having to submit to a med-legal appointment, but nothing requires the payments be made in advance. The auditor suggested the county stop the practice of paying workers in advance for attending QME appointments.

The Risk Management Department said, “this is a typical practice throughout the industry” and it plans to continue making advance payments to workers who have scheduled medical-legal exams.

The department acknowledged that the county should try to recover payments made to injured workers who subsequently cancel an appointment. This, however, is feasible only during settlement negotiations.

“Without an actual approval order from the Workers’ Compensation Appeals Board to compel the employee to pay the county, there is no mechanism to collect the overpayment,” the county’s department said. “The legal expenses that the county would incur would far outweigh recovery. The most cost-effective way is to have the WCAB approve a petition for credit for overpayment at settlement.”

The audit also uncovered evidence that some county departments were not reporting workplace injuries on time and that the TPA didn’t always make initial contact with an injured worker within 24 hours of receiving an injury report.

The Risk Management Department agreed with related recommendations to stress the importance of reporting deadlines and reminding the TPA to contact injured workers within 24 hours.

A copy of the audit is here.