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Florida insurers see rising fines for late comp payments, reports


Insurers and other claims-handling entities operating in Florida experienced increasing penalties for late indemnity payments and injury and illness reports, according to a report by the Florida Division of Workers Compensation released on Thursday.

The division’s audit section discovered 17.5% of reviewed indemnity claim files contained underpayments, resulting in $337,727 of additional injured worker payments for indemnity benefits, penalties, and interest, according to the report. The audit section is responsible for examining and investigating patterns and practices of unreasonable delays in claims handling, untimely and inaccurate payment of benefits to injured workers, untimely and inaccurate filing of required forms and reports, and to enforce compliance with compensation orders of Florida Judges of Compensation Claims.

The total number of late indemnity payments for the 2015-16 fiscal year was 2,771 compared with 2,013 for the 2014-15 fiscal year, resulting in an increase in penalties for the late payments to $99,400 from $83,300, according to the report. The total number of late first reports of injury or illness climbed to 558 in the 2015-16 fiscal year from 359 reports in 2014-15, with the fines also increasing to $78,900 from $60,300.

Non-willful pattern and practice penalties rose to $392,500 in fiscal year 2015-16, up significantly from both the $202,500 in penalties assessed during fiscal year 2014-15 and the five-year penalty average of $222,500. The report attributed the increase to the fact that 2015-16 was the first year the Florida Bureau of Monitoring and Audit began assessing pattern and practice penalties for untimely notices of action or change, according to the report.

On the medical side of the equation, total charges for hospital inpatient services was $571.9 million and total paid was $284.2 million in 2015, compared with 2014 when total charges were $503.1 million and total paid were $251.6 million, according to the report. For hospital outpatient services, total charges for 2015 was $617.1 million and total paid was $301.3 million. In 2014, total charges were $559.4 million and total paid were $308.3 million.

Lost-time claims declined to 54,564 at a rate of 6.9 per 1,000 employees in 2015, down from 58,031 at a rate of 7.5 per 1,000 employees in 2014, according to the report. The top industrial category for lost-time claims in Florida last year was administrative, support, waste management and remediation with 8,018 claims, followed by retail trade at 6,080 claims and construction at 5,540 claims.

In 2015, medical costs for Florida lost-time claims totaled $639 million, indemnity costs were $182 million and settlement costs were $130 million, according to the report. 




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