Audit Complaint Form Updated in California

Recently the California Division of Workers Compensation (DWC) updated the Audit Complaint form used by providers to report claims administrator non-compliance.

The update includes a more prominent confidentiality box that allows the provider to submit a complaint without the DWC revealing the identity of the provider to the offending claims administrator.

STRONG Warning to Providers

DaisyBill knows from first-hand experience that the DWC contacts the claims administrator and investigates complaints filed against claims administrators. Audit Complaints definitely work!!!

Because MPNs can kick a provider off of an MPN for any reason, or for NO reason, DaisyBill strongly recommends that providers always check the confidentiality box to keep the audit complaint form anonymous.

Audit Complaints EASILY Submitted by DaisyBillers

When a claims administrator fails to compliantly adhere to California workers’ comp laws or regulations, DaisyBill always encourages providers to submit an Audit Complaint to the DWC.

DaisyBill makes submitting an Audit Complaint to the DWC easy by automatically completing the form and automatically submitting all documents that prove the non-compliance. In the last 365 days, DaisyBillers submitted 1,755 Audit Complaints to the DWC.

Claims Administrators - Top 10 Complaints by Count of Audit Complaints

Audit Complaint Count in the Last 365 Days

York Risk Services Group

261

Sedgwick Claims Management Services

160

Tristar Risk Management

89

Intercare Holdings Insurance, Inc.

87

AmTrust North America

72

Gallagher Bassett

69

Liberty Mutual Insurance

62

Zurich Insurance North America

59

County of San Diego (CA)

45

ESIS, Inc.

44

Athens Audit Complaint Example

To help make the complaint as easy as possible for the DWC to investigate, DaisyBill generates Audit Complaints that are not only compliant but that also cite relevant regulation sections. In this example of an Audit Complaint filed against Athens Administrators, DaisyBill automatically populated the Audit Referral Form with required information, such as specific details of the complaint, and also included the specific regulations that Athens failed to follow.

DaisyBill’s software also automatically populates the second page of the Audit Complaint with a Bill History. In this example, the Bill History shows Athens’ failure to follow the regulations that we had cited on the first page.

Audit Complaints Benefit Everyone

Submitting Audit Complaints is a benefit to the entire workers’ comp community, as each and every complaint filed:

  1. Alerts the DWC to possible wrong-doing.
  2. Warns claims administrators that their actions and inactions are noted and that they will be held accountable.
  3. Allows individual providers to air and share their experiences with no fear of retaliation (as long as those confidentiality boxes are checked).

To see more information on Audit Complaints, head over to the DWC’s annual reports page[a], although note that the most recent report only covers 2017.


DaisyBill is tailor-made to address work comp’s unique challenges using all the advantages of today’s tech. From authorization to billing to Audit Complaints, we’ve got providers covered. Schedule a free demonstration, and see what DaisyBill can do for your office.

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[a]A blog post that breaks down the insights from the annual report might be good for Ann or Tim to do.

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