Workers compensation penalties accessed by compliance

Transcription

1 Wkers compensation penalties accessed by compliance Violations Statutes violated Applicable rules Assessment statutes Paid to Fmula and dollar amount Late First Rept of Injury fm s s10 Based on number of violations in past 12 months pri to assessment Against IR Late first-payment of benefits s st = warning 2nd = $125 3rd = $250 4th = $375 5th+ = $500 dues, subject to maximums Against IR selfinsured Days late % $ due Maximum % $5,000 Late denial of liability s5 25% of amount found to be delayed s a Based on number of days late Against IR selfinsured Frivolous denial of liability Against IR selfinsured s a s = $ = $ = $1,000 Based on number of violations in past two-year period pri to the assessment Violations/$ penalty 1-5 = $1, = $2,000 Up to 30 percent of amount found to be delayed Nonspecific NOID denial of liability Against IE selfinsured This penalty may be assessed in addition to penalties f late nonspecifi c denial s s2 Based on set dollar amount $500 This penalty may be issued in addition to penalties f late frivolous denial. Page 1

2 Prohibited practices Against IR, self-insured, TPA adjuster s3 None s4 Based on number of violations in past 12 months Violations of: Violation Sub. 3 (1-6 9) Sub. 3 (7-8) 1-5 Warning $3,000 each 6-10 $3,000 each $6,000 each $6,000 each $6,000 each 31+ $6,000 each f sub. 3 (1-9); in addition, may refer to Department of Commerce f license review Late improper payment of permanent partial disability s3/3a / due, subject to maximums Against IR selfinsured / s s5 = fail to pay 25 percent of amount found to be delayed s 1 = late pay Page 2

3 Late payment of der award Against IR selfinsured s due, subject to maximums based on set amount a (used when $ amount owed isn t clear) 1-15 = $ = $1, = $1, s1 Page 3

4 Improper discontinuance of benefits s10 = if $ amount owed is unclear Based on number of violations in past year and days late s 10 = fi rst violation in one year = warning Against IR selfinsured If not crected in 10 days from warning, apply following: days late = $ days late = $ days late = $ days late = $1,000 Second + violation in a year, then the following applies: 1-10 days late = $ days late = $ days late = $ days late = $1,000 = if $ amount owed is clear Late payment of ongoing benefits s1 None set s1 = only if additional benefi ts clearly due a due, subject to maximum Against IR selfinsured s1 = based on length of delay Up to $2,000 (no set rules) s5 25 percent of amount found to be delayed Page 4

5 Failure to notify of time limit to request retraining Against IR selfinsured Late payment denial of medical bills Against IR selfinsured Failure to release existing medical data Any party to a claim that is holding existing medical data relating to the claim Refusal to file failure to file required repts other than FROI in a timely manner Against IR, self-insured, TPA HCP Late payment of rehabilitation Against IR selfinsured s11 None s11 Based on number of days late $25 a day, up to $2,000 maximum Note: Applies only to dates of injury Oct. 1, 1995 later a Based on number of days late, set amount 1-15 = $ = $1, = $1, Based on number of days late > 7 days without response = $300 > 30 days without response = $450 > 60 days without response = $ s3, 4, 6, 7, s10 Based on number of days late s9, s19? None? s 3 3a? Not fi led within 21 days of written request = $125 Not fi led after second request = $375 Subsequent failure to fi le = $500 Not fi led within 30 days of due date = $125 Not fi led within 90 days of due date = $375 Not fi led within 180 days of due date = $500 No clear rules regarding penalties Note: Rules pending Page 5