December 17, 2017

IL Auditor General Releases Report on State Employee Workers’ Comp Program

Springfield, IL – The Illinois Auditor General’s Office has recently released their audit of the Workers’ Compensation Program as it applies to State employees, identifying what the auditor referred to as “numerous shortcomings in both the structure and operations” of the workers’ compensation program.

The Workers’ Compensation Program as it applies to State employees involves three State agencies: the Department of Central Management Services (CMS), the Illinois Workers’ Compensation Commission, and the Illinois Attorney General. According to data received from CMS, for the four-year period January 1, 2007,through December 31, 2010, State employees filed a total of 26,101 workers’ compensation claims. As of July 2011, over $295 million was paid in workers’ compensation for State employees on claims filed during the four year period.

Our review of the workers’ compensation program found that CMS:

  • Data was incomplete, inaccurate, and inconsistent.
  • Adjusted claims and made decisions regarding compensability without appropriate forms being submitted.
  • Did not have caseload standards and could not always provide Adjuster caseloads.
  • Needed to establish clearer policies regarding settlement contracts and approval limits.
  • Negotiated settlement contract terms directly with the injured employee’s legal counsel.
  • Did not have formal policies for conflicts of interest for Adjusters or other employees who process workers’ compensation claims.

Our review of the workers’ compensation program found that the Workers’ Compensation Commission:

  • Data was incomplete, inaccurate, and inconsistent.
  • Did not conduct annual reviews to evaluate Arbitrator performance.
  • Did not have guidelines for Arbitrators regarding awards. We reviewed awards and found that many were inconsistent for the same type of injury to the same body part.
  • Review Board responsible for conducting investigations of complaints against Arbitrators and Commissioners did not meet for 3 ½ years (February 11, 2008-September 9, 2011).
  • Did not have a formal policy or specific procedures to identify fraud.

Our review of the workers’ compensation program found that the Attorney General:

  • Did not have specific policies or procedures to identify or control fraud for workers’ compensation cases referred to them.

Throughout this audit we identified numerous shortcomings in both the structure and operations of the workers’ compensation program as it applies to State employees. These problems have led to a program that is ill designed to protect the State’s best interests as it relates to processing and adjudicating workers’ compensation claims for State employees. Because of the extensive problems that permeate the workers’ compensation program as it applies to State employees, the General Assembly may wish to consider further changes to the structure and operations of the Workers’ Compensation Program as it applies to State employees.

The complete report and synopsis reports are available here: Illinois Auditor General – Workers’ Compensation Program as it Applies to State Employees

Source: IL Auditor General

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