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Filing Audit Complaints for Penalty and Interest in Work Comp

August 25, 2015 by Catherine Montgomery

Here at DaisyBill we see almost a million California workers’ comp bills a year.

Our technology automatically calculates the payment due date for each of those million bills. Using the effective date of the payment, DaisyBill knows exactly which bills were paid late and which bills were paid on time.

We also know that the vast majority of claims administrators treat penalty and interest for untimely payments as though the increased payment is optional, instead of mandatory.

How do penalty and interest work?

If a claims administrator fails to process a bill in a timely manner, then the claims administrator owes the provider penalty and interest on the unpaid amount of the bill, retroactive to the date of receipt of the bill (NOT retroactive to the due date!).

NON Medical-Legal services penalty and interest:

  • Penalty: 15% increase for services neither timely paid nor objected to.
  • Interest: 10% per annum accruing retroactive to date of receipt of bill.
  • Payment Due Date:
  • Non-government employers - 45 days from date of receipt of the bill
  • Government employers - 60 days from date of receipt of the bill

Medical-Legal services penalty and interest:

  • Penalty: 10% increase for services untimely paid.
  • Interest: 7% per annum accruing retroactive to the date of receipt of bill
  • Payment Due Date:
  • All employers - 60 days from date of receipt of the bill.

How do I ask for those penalty and interest payments?

Penalties and interest are self-executing, which means that penalty and interest should be added automatically to your payment, with no need to present a bill or an invoice. Every time a claims administrators makes an untimely payment, the regulations mandate that the payment amount must be increased by the appropriate penalty amount along with accrued interest.

If DaisyBill knows the payment is late, so does the claims administrator. Penalty and interest are not optional!

What will filing an Audit Complaint do?

The DWC can only fix problems that it knows about. By filing an Audit Complaint for lack of payment of self-executing penalty and interest:

  1. The DWC will have lots of ammunition (your audit complaints) to enforce the mandatory payment by claims administrators.
  2. Service providers will eventually receive more money, as claims administrators start paying penalty and interest.
  3. Claims administrators will start paying bills in a timely manner once they realize that service providers, acting together, can effect change in the system.

Do you have a sample Audit Complaint?

DaisyBillers, we’ve made it super-easy for you to send an Audit Complaints in 5 seconds. Non-DaisyBillers, the following is a link which you can download:

Sample DaisyBill Audit Complaint for failure to pay penalty and interest.

Where can I find more information on Audit Complaints?

Watch the FREE Audit Complaints Webinar:

WATCH + VIEW

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About Us

DaisyBill is a trusted authority on workers’ comp billing. Thousands of work comp professionals attend our webinars and state agencies and professional organizations turn to us for our expertise. We created this blog to help everyone involved in workers’ compensation; sharing news, tips, and data of interest to the community.

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