Reformulated Fraud Assessment Commission

The California Department of Insurance’s Fraud Assessment Commission is holding a special meeting tomorrow to consider a major shift in where and how the dollars are distributed in the state’s fight against workers’ comp fraud (see related item on page 1). Five commissioners reviewed the proposal at the Commission’s January 10th meeting, but it is … Read More »

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SIU Fraud Reporting Rollback

The California Department of Insurance is floating the idea of undoing a change to the reporting rules for special investigations units (SIUs) amid concerns that the current standard undermines some prosecutions. The Department backed a change to the insurance code to get more complete reports of suspected fraudulent activity, but there are now new issues. … Read More »

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DWC Says Two Claims Shops Failed Audits In 2022

The Division of Workers’ Compensation’s annual report about its audits of workers’ compensation claims adjusting locations shows it inspected 48 shops and that 46 were able to pass the audit at the initial stage. Of the two shops that failed to meet the Profile Audit Review (PAR) standard, one passed a more in-depth Full Compliance … Read More »

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Bureau Targeting Restaurants for Inspection Audits

The Workers’ Compensation Insurance Rating Bureau will conduct targeted inspection audits on the food and beverage service industry next year. The audits will target many of the 16,000 experience-rated risks currently in the 9079 classification. That, as it prepares to deconstruct the 9079 Restaurants or Taverns classification into six new classes effective this year on … Read More »

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Fraud Assessment Climbs to $90M In 2024

The California Department of Insurance’s Fraud Assessment Commission voted 3-2 to increase the workers’ comp fraud assessment on California employers by 5% next year to $89,985,405. The two commissioners who voted against the proposal wanted an increase closer to the 16% that the District Attorneys requested and would have boosted the total bill to nearly … Read More »

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Finger Pointing Amid the Fight Against Workers’ Comp Fraud

District Attorneys around the state are decrying a sharp drop in the number of suspected fraud referrals over the past few years and complain that pandemic-induced changes to carrier operations are sabotaging the prosecution of cases. But employers and insurance carriers say that many DAs are unresponsive when fraud cases are brought to their attention, … Read More »

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Fraud Assessment Commission Losing Decades of Experience

The Fraud Assessment Commission is heading into 2024 with two of its seven commissioner positions vacant, and now the two longest-serving members on the commission have announced that the January meeting will be their last. FAC chairman Don Marshall of Zenith Insurance and self-insured representative John Riggs of Disney are stepping down after each has … Read More »

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Employers To Pay More To Fight Workers’ Comp Fraud

The California Department of Insurance Fraud Assessment Commission members will reconvene this morning to decide how much employers will pay next year to fight workers’ comp fraud. It is a foregone conclusion it will be more than this year. A majority of the members already expressed support for an increase at a meeting of the … Read More »

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