The Workers’ Compensation Division may require self-insured employers to complete a claims reserve audit on their annual report of losses. The purpose of the claims reserve audit is to ensure each self-insurer’s claims are valued appropriately for use in deposit, experience rating, and retrospective rating calculations used to secure claim liabilities in the event of a default or insolvency.
The claims reserve audit methodology includes:
- Auditing each valuation year
- Reviewing all claims over the NCCI threshold
- Sampling all claims under the threshold
- Auditors schedule claims reserve audits from March 1 through mid-December of each year
- Auditors send a schedule confirmation letter to the self-insured employer:
- Requesting preparation of claim files and specific financial information summaries for the audit
- Records may be provided via physical or electronic records, but must adhere to the requirements of the audit
- Auditors review the following claims information:
- Acceptances, denials, and orders
- Any other information related to the ultimate cost of a claim (litigation, comorbidities, and potential recovery sources)
- Indemnity payments
- Medical payments
- Excess insurance information (including excess levels and notification letters)
- Outstanding reserves
- Auditors determine what reserves would be sufficient for the ultimate probable cost of the claim
- A results letter is provided to the self-insured employer and third-party administrator, along with copies of worksheets for significant claims reserve differences