What is the Audit Team?
The Workers’ Compensation Division Audit Team develops and conducts performance audits of insurance companies and self-insured employers for the following reasons:
- To ensure compliance with claim processing statutes and rules
- To gather data on industry performance
- To provide industry training in low-performing claim processing areas
These audits include the annual audits of claims processing and benefits payment timeliness and the focused audits on specific claims processing performance areas.
The Audit Team also develops and conducts audits of records of insurance companies, self-insured employers, and assigned claims processing agents. The team does this to validate expenditures from the Workers’ Benefit Fund and require necessary monetary adjustments associated with the fund's programs that help injured workers.
Tips on claim processing
The Audit Team has developed the following tip sheets to help insurers comply with Oregon’s claim processing standards:
Temporary Disability Checklist
Timely First Payment of Temporary Disability
Prior audit results
All insurer audits include all Oregon insurers with auditable activity.
Selected insurer audits are primarily re-audits of insurers with performance below standards in the prior audit year. Other insurers may be selected, such as those new to Oregon, or those with other performance issues.
COVID-19 Denied Claims Audit
2004-2006 compliance audit
2007-2010 compliance audit summary
Vocational rehabilitation eligibility evaluation pilot audit
self-reported quarterly claims processing performance for information provided by insurers and self-insured employers.