What Is the Audit Unit in a California Workers’ Compensation Case?
The Audit Unit is a division of the California Division of Workers’ Compensation (DWC) that monitors how insurance companies, self-insured employers, and third-party administrators handle workers’ compensation claims. Its goal is to ensure that claims are processed correctly, benefits are paid on time, and injured workers are treated fairly under California law.
What Does the Audit Unit Do?
The Audit Unit conducts routine and targeted audits to evaluate whether claims administrators are complying with workers’ compensation laws and regulations. This includes:
- Reviewing files to ensure timely payment of benefits
- Checking for accurate and complete medical and legal documentation
- Identifying patterns of delays, underpayments, or denials of benefits
- Imposing penalties and fines for repeated or willful violations
Audits are based on performance standards set forth in the Administrative Director’s Audit Regulations.
What Triggers an Audit?
An audit may be triggered by:
- A random selection of claims administrators
- A high number of complaints from injured workers or attorneys
- A history of noncompliance or prior audit violations
- Poor performance based on annual profile audit review (PAR) scores
If a company or insurer performs poorly on a PAR, the Audit Unit may follow up with a full compliance audit.
Why the Audit Unit Matters to Injured Workers
The Audit Unit helps protect injured workers by holding insurers and employers accountable for:
- Delays in temporary or permanent disability payments
- Improperly denied medical treatment
- Failing to respond to requests for authorization or medical reports
- Missing legal deadlines that affect a worker’s benefits
By enforcing these standards, the Audit Unit helps ensure that workers receive the care and compensation they are legally entitled to.
Can Injured Workers Report a Problem?
Yes. Injured workers who believe their benefits are being mishandled can file a complaint with the DWC. While the Audit Unit does not investigate individual cases, repeated complaints can lead to a broader audit of a claims administrator’s practices.
Need Help With a Problematic Workers’ Compensation Claim?
If your benefits are being delayed, denied, or mishandled, you do not have to navigate the process alone. The Law Offices of Norman J. Homen can help you understand your rights and take action if your claim is not being handled properly. Contact us today for a free consultation.
