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YELLOW SHEET Office of the State Auditor of Missouri |
September 26, 2002
Report No. 2002-95
State officials have not required employers/insurers to report injuries within required timeframes resulting in delayed payments to employees
This audit evaluated if the management of the state's workers' compensation program ensures the timely payment of benefits to employees with work-related injuries and illnesses.� State law requires employers/insurers to report these injuries to the state workers' compensation division within 10 days of learning of an accident.
Vast majority of injuries reported late or not at all
During the 4-year period reviewed, auditors found employers/insurers failed to report 93 percent of employees' injuries within the prescribed 10 day period, which delayed employee benefit payouts and increased case costs by nearly $300 million.� In addition, 249,238 of the 428,495 delayed cases were not reported within 30 days and 14,660 were never reported.� (See page 2)
Division officials have not enforced state workers' compensation laws
State law allows fines and penalties for employers/insurers who report injuries late, but division officials did not have authority to use these sanctions to improve reporting compliance except through prosecution.� However, officials did not send warning letters to persistent violators as some states do, and did not refer these violators to the Attorney General's office for prosecution.� Division officials said they could be more effective if they had the authority to penalize entities without going through the Attorney General's office, as is done in other states.� Current law only allows the Attorney General to prosecute and assess penalties. �(See page 4)
Delays in medical benefit payments resulted in significant hardships
Some employees did not receive timely medical or lost wage benefits after incurring injuries, because their employers/insurers disputed their claims.� State law does not provide protection for injured employees when employers/insurers deny or dispute claims. When employers/insurers dispute claims, employees may have to wait several months or years for a binding ruling by a division judge to receive benefits. �(See page 8)
Administrative improvements needed in the workers' compensation program
While visiting regional adjudication offices, auditors noted claimants without attorneys did not always know why they were invited to conferences in which critical decisions may be made about their benefits.� Although division staff send each claimant a "Notice of Conference" letter, the letter did not inform the claimant of the nature or reason for the conference. �The letter also failed to inform claimants of their rights under state workers' compensation laws.� Without this information, claimants may make decisions that could negate their ability to obtain further medical or other benefits. �(See page 11)