Purpose

The objectives of our examination were to determine whether payments were appropriate and: (i) complied with the New York State Workers’ Compensation Law, (ii) were consistent with applicable fee schedules, and (iii) complied with the Board’s policies and procedures.

Background

The Board processed more than 580,000 claims totaling nearly $732 million from its four special funds in 2019 - the Uninsured Employers Fund, the Special Fund for Disability Benefits, the Second Injury Fund, and the Fund for Reopened Cases. The Board completed its transition from its Financial Management Information System to the Statewide Financial System in April 2018 and processed all claim payments in the SFS for all of 2019.

Key Findings

Our Office identified 1,208 errors totaling more than $4.28 million as part of our daily audit. In addition, we identified 917 product code errors totaling nearly $3.85 million.

Key Recommendations

• Take necessary steps to ensure the Board and the TPAs accurately process claims and recover monies as appropriate.
• Provide electronic access to data fields (e.g., Social Security Number, Date of Birth, Claimant Address, and Payment Address) in a more accessible format and TPA subcontracts, as requested by this Office.
• Continue to coordinate with this Office to identify areas of improvement in claims processing.