ࡱ> '` /bjbj{P{P p::΁+    R R R $v ZZZP6v ohrx(T,nnnnnnn$$qhspnR n  voEEE* 8R nEnEE H: R =M p˓Z+KF?Qlo0oKBs=s=M=M&sR cM3CE`333nn^333ov v v Zv v v Zv v v         COMPLIANCE AUDIT REPORT STATE OF MAINE WORKERS COMPENSATION BOARD  MAINE INSURANCE GUARANTY ASSOCIATION August 30, 2007 Office of Monitoring, Audit & Enforcement Paul R. Dionne Steven P. Minkowsky Executive Director/Chair Deputy Director of Benefits Administration CONTENTS  TOC \o "1-3" \h \z \u  HYPERLINK \l "_Toc162070025" SUMMARY  PAGEREF _Toc162070025 \h 1  HYPERLINK \l "_Toc162070026"  Form filing  PAGEREF _Toc162070026 \h 2  HYPERLINK \l "_Toc162070027"  Timeliness of benefit payments  PAGEREF _Toc162070027 \h 4  HYPERLINK \l "_Toc162070028"  Accuracy of indemnity payments  PAGEREF _Toc162070028 \h 6  HYPERLINK \l "_Toc162070029"  Other significant issues  PAGEREF _Toc162070029 \h 7  HYPERLINK \l "_Toc162070030"  Complaint(s) for Audit  PAGEREF _Toc162070030 \h 8  HYPERLINK \l "_Toc162070031" PENALTIES  PAGEREF _Toc162070031 \h 9  HYPERLINK \l "_Toc162070032"  Penalties payable to injured employees  PAGEREF _Toc162070032 \h 9  HYPERLINK \l "_Toc162070033" Title 39-A M.R.S.A. Section 205(3)  PAGEREF _Toc162070033 \h 9  HYPERLINK \l "_Toc162070034"  Penalties payable to injured employees and the Workers Compensation Board  PAGEREF _Toc162070034 \h 12  HYPERLINK \l "_Toc162070035" Title 39-A M.R.S.A. Section 324(2)  PAGEREF _Toc162070035 \h 12  HYPERLINK \l "_Toc162070036"  Penalties payable to the Workers Compensation Board  PAGEREF _Toc162070036 \h 14  HYPERLINK \l "_Toc162070038" Title 39-A M.R.S.A. Section 359(2)  PAGEREF _Toc162070038 \h 14  HYPERLINK \l "_Toc162070039" Title 39-A M.R.S.A. Section 360(1)(A)  PAGEREF _Toc162070039 \h 15  HYPERLINK \l "_Toc162070040" Title 39-A M.R.S.A. Section 360(1)(B)  PAGEREF _Toc162070040 \h 17  HYPERLINK \l "_Toc162070041" Title 39-A M.R.S.A. Section 360(2)  PAGEREF _Toc162070041 \h 18  HYPERLINK \l "_Toc162070042" COMPLIANCE TABLES  PAGEREF _Toc162070042 \h 19  HYPERLINK \l "_Toc162070043"  Form Filing  PAGEREF _Toc162070043 \h 19  HYPERLINK \l "_Toc162070047" A. Memorandum of Payment (WCB-3 or WCB-4A)  PAGEREF _Toc162070047 \h 19  HYPERLINK \l "_Toc162070048" B. Discontinuance or Modification of Compensation (WCB-4 or WCB-4A)  PAGEREF _Toc162070048 \h 19  HYPERLINK \l "_Toc162070049" C. (21 Day) Certificate of Discontinuance or Reduction of Compensation (WCB-8)  PAGEREF _Toc162070049 \h 19  HYPERLINK \l "_Toc162070050" D. Notice of Controversy (WCB-9)  PAGEREF _Toc162070050 \h 19  HYPERLINK \l "_Toc162070051" E. Statement of Compensation Paid (WCB-11)  PAGEREF _Toc162070051 \h 19  HYPERLINK \l "_Toc162070052"  Timeliness of Benefit Payments  PAGEREF _Toc162070052 \h 20  HYPERLINK \l "_Toc162070053" F. Initial Payment of Indemnity Benefits  PAGEREF _Toc162070053 \h 20  HYPERLINK \l "_Toc162070054" G. Subsequent Payment of Indemnity Benefits  PAGEREF _Toc162070054 \h 20  HYPERLINK \l "_Toc162070055" H. Payment of Medical Bills  PAGEREF _Toc162070055 \h 20  HYPERLINK \l "_Toc162070056" I. Payment of Approved Agreements, Orders, Decisions  PAGEREF _Toc162070056 \h 20  HYPERLINK \l "_Toc162070057"  Accuracy of Indemnity Payments  PAGEREF _Toc162070057 \h 21  HYPERLINK \l "_Toc162070060" J. Partial Benefits  PAGEREF _Toc162070060 \h 21  HYPERLINK \l "_Toc162070061" K. Indemnity Paid  PAGEREF _Toc162070061 \h 21  SUMMARY The Maine Insurance Guaranty Association (MIGA) was created as a nonprofit unincorporated legal entity to provide a mechanism for the payment of covered claims under certain insurance policies to avoid excessive delay in payment and to avoid financial loss to claimants or policyholders because of the insolvency of an insurer, to assist in the detection and prevention of insurer insolvencies, and to provide an association to assess the cost of such protection among insurers. The Audit Division of the fb88 Workers Compensation Board (Board) examined all forty-eight (48) open workers compensation claims as of June 30, 2006 to determine compliance with statutory and regulatory requirements in the following areas: Form filing Timeliness of benefit payments Accuracy of indemnity payments Of the claim files audited, there were thirty-five (35) lost time claims, eleven (11) medical only claims and two (2) claims where the claimant was a resident of fb88 at the time of the injury but the claimant was not receiving workers compensation benefits under fb88statute. This audit was also expanded to include a review of issues raised in one (1) Complaint for Audit (CFA) form. Several other CFAs that named MIGA as the Claims Administrator were filed with the Board, but all issues raised by those documents had been addressed and resolved by MIGA prior to the audit engagement. Therefore, those other CFAs were not included in this audit. Guaranty Fund Management Services (GFMS) handles MIGAs workers compensation claims in Boston, MA. The on-site audit work was conducted at GFMS from January 22 through January 26, 2007. The compliance tables found on pages 19 through 21 of this report are representative of Board findings as of January 26, 2007. Since that time, the Audit Division has requested and received additional information. Following is a discussion of the aforementioned compliance tables and of the steps taken since January 26, 2007 to rectify identified noncompliance issues. This discussion also includes other significant issues identified by the audit. Form filing Title 39-A M.R.S.A and the Board Rules and Regulations provide the requirements for reports to the Board: WCB-3, Memorandum of Payment (MOP)Rules & Regs, Ch 1 Section 1.1, Rules & Regs, Ch 1 Section 1.3, 39-A M.R.S.A. Section 205(7), Rules & Regs, Ch 8 Section 12WCB-4, Discontinuance or Modification of CompensationRules & Regs, Ch 8 Section 11, Rules & Regs, Ch 8 Section 12WCB-4A, Consent Between Employer and EmployeeRules & Regs, Ch 8 Section 18WCB-8, (21 Day) Certificate of Discontinuance or Reduction of Compensation39-A M.R.S.A. Section 205(9)WCB-9, Notice of Controversy (NOC)Rules & Regs, Ch 1 Section 1.1, Rules & Regs, Ch 3 Section 4WCB-11, Statement of Compensation Paid Rules & Regs, Ch 8 Section 1, Rules & Regs, Ch 8 Section 12 Failure to file any Board form within established time frames is a violation of Title 39-A M.R.S.A Section 360(1) (A) or (B). Memorandum of Payment (WCB-3 or WCB-4A) and Notice of Controversy (WCB-9): Four (4) Memorandum of Payment forms and six (6) Notice of Controversy (lost time) forms were filed in accordance with the above requirements. MIGAs compliance rate for Memorandum of Payment filings is 29%, which is below the Boards performance benchmark of 75%. Ten (10) Memorandum of Payment forms and two (2) Notice of Controversy (lost time) forms were required, but not filed. Discontinuance or Modification of Compensation (WCB-4 or WCB-4A): Seven (7) Discontinuance or Modification of Compensation forms were filed in accordance with the above requirement. Seventeen (17) Discontinuance or Modification of Compensation forms were required, but not filed. (21 Day) Certificate of Discontinuance or Reduction of Compensation (WCB-8): Five (5) (21 Day) Certificate of Discontinuance or Reduction of Compensation forms were filed in accordance with the above requirement. Two (2) (21 Day) Certificate of Discontinuance or Reduction of Compensation forms were required, but not filed. Statement of Compensation Paid (WCB11): Nineteen (19) Statement of Compensation Paid forms were filed in accordance with the above requirements. Three (3) Statement of Compensation Paid forms were filed late. Sixty-six (66) Statement of Compensation Paid forms were required, but not filed. In response to notice of this problem area, MIGA is implementing procedures designed to hereafter timely file all reports specified in the fb88 Workers' Compensation Act and applicable rules. Timeliness of benefit payments Title 39-A M.R.S.A Section 205(2) provides the time requirements for indemnity payments. When there is not an ongoing dispute, failure to pay weekly compensation benefits or accrued weekly benefits within 30 days after becoming due and payable is a violation of Title 39-A M.R.S.A Section 205(2) and subject to penalty under Section 205(3). Initial Indemnity Payments: Thirteen (13) initial indemnity payments were paid timely. MIGAs compliance rate for initial indemnity payments is 59%, which is below the Boards performance benchmark of 80%. Nine (9) initial indemnity payments were paid late. Three (3) late initial payments were paid later than 30 days after they became due and payable, in violation of Section 205(2) and subject to penalty under Section 205(3). Subsequent Indemnity Payments: Three thousand five hundred fifty-two (3,552) subsequent payments were paid timely. One hundred forty-six (146) subsequent payments were paid late. Three (3) late subsequent payments were paid later than 30 days after they became due and payable in violation of Section205(2), and subject to penalty under Section205(3). Board Rules and Regulations Chapter 5, Section 7 states in part, The employer/insurer shall pay the health care provider's charge or the maximum allowable payment under this fee schedule, whichever is less, within 30 days of receipt of a bill unless the bill or previous bills from the same provider or the underlying injury has been controverted or denied. If an employer/insurer controverts whether a health care providers bill is reasonable and proper under 206 of the Act, the employer/insurer shall send a copy of the notice of controversy to the health care provider. Two hundred seventy-eight (278) medical bills were paid timely. One hundred thirty-two (132) were paid late. Two hundred thirty-one (231) medical payments could not be measured as the auditor could not locate corresponding medical bills or the corresponding medical bills were not date-stamped when received. In September 2006 MIGA implemented a new imaging system to address this issue. According to the Senior Vice President of Claims, Every scanned document has a date stamp on it and the stamp is on every page of that document. Once the date stamp is on, it is permanent. Title 39-A M.R.S.A Section 324(1) provides the requirements for benefit payments per an approved agreement, order or decision. Eight (8) Lump Sum Settlement(s), two (2) provisional orders, one (1) mediation agreement, four (4) Consent Decree(s) and one (1) decree were paid timely. One (1) Lump Sum Settlement, one (1) provisional order, three (3) mediation agreements, one (1) Consent Between Employer and Employee, one (1) Consent Decree, and three (3) decrees were paid late in violation of Section324(1) and subject to penalty under Section324(2). The timeliness of one (1) mediation agreement is unknown as the corresponding medical bill was not date-stamped when received. With the implementation of staff changes and the new imaging system, MIGA believes that late payments (if any) in MIGAs ongoing operations are likely to occur infrequently. Accuracy of indemnity payments Title 39-A M.R.S.A Sections 212 and 213 provide the requirements for compensation for total incapacity and partial incapacity. Twenty-five (25) claims were compensated. Partial Benefits: Partial benefits were calculated correctly for two (2) claims. Partial benefits were calculated incorrectly for three (3) claims. Indemnity Paid: Six (6) claims were compensated correctly. Seven (7) claims were underpaid ($9,396.82 aggregately). Twelve (12) claims were overpaid ($9,226.14 aggregately). Collectively, the aforementioned errors resulted in a net underpayment of $170.68. Other significant issues When indemnity payments have been made, a WCB11, Statement of Compensation Paid form (Interim Report) must be filed within 195 days of the date of injury (Rule8.1). A subsequent WCB11 form must be filed within 15 days of the anniversary date of the injury when payments (of any type) have been made since the previous WCB11 form was filed (Rule8.1). A WCB11, Final Report must be filed when no further payments are anticipated (Rule8.1). When an employer or insurer makes payments of compensation pursuant to an agreement by the parties or a decision of the Board, the employee or insurer shall document such payments by completing the appropriate sections of Form WCB11 (Rule8.12). Currently, the Board is unable to enter the WCB-11's filed by MIGA as the amounts are less than the WCB-11's on file from the previous insurer/TPA. According to the Senior Vice President of Claims, MIGA can legally only certify amounts it has paid. In response to notice of this problem area, MIGA has designed a new WCB-11 form approved by the Board for use. The new form contains three cumulative total sections. Historical data from the Board will be used to report amounts "PAID PRIOR TO INSOLVENCY" and add these to the amounts "PAID BY MIGA" for a "TOTAL" amount paid that can be entered into the Boards database. Eleven (11) claims had expense, interest and/or medical payments incorrectly coded as indemnity. In response to notice of this issue, MIGA has reclassified expense and medical payments incorrectly coded as indemnity. Further, MIGA is in the process of petitioning the UDS Committee of the National Conference of Insurance Guaranty Funds working under the auspices of the National Association of Insurance Commissioners for an additional code which will allow for loss payments to be coded separately from interest payments. Board Rules and Regulations, Chapter8, Section7 states, Interest on awards of compensation must be calculated by the employer and paid to the employee pursuant to 39AM.R.S.A. 205(6). Interest must be paid to the employee even if there is no express language in the decision of the mediator or hearing officer ordering such payment. Interest must be calculated using the formulae and Table contained in Appendix I. Unpaid interest arising from an award of compensation is subject to penalty under Section324(2). See Law Court decisions Guiggey v. Great Northern Paper Co., 1997 ME 232 and Jasch v. The Anchorage Inn, 2002 ME 106. Interest was not paid on one (1) claim in violation of Section324(1) and subject to penalty under Section324(2). The fb88 Workers Compensation Act provides no vehicle for the unilateral recovery of benefit overpayment(s). Recoveries under Section324 and Section360(2) fall under Board jurisdiction. See Board decision Pritchard v. S.D. Warren Co. and Law Court decision Bureau v. Staffing Network. Evidence ofunlawful benefit reimbursement request(s) and/or evidence of improperly recovered benefits was found in three (3) claims. Complaint(s) for Audit A Complaint For Audit was filed 3/27/07 regarding John P. Riordans 1/30/02 injury. Following is an outline of the issues and our findings, as it pertains to each issue: Unpaid medical bills (fb88 Medical Center) According to MIGA, the bill from fb88 Medical Center was received on 3/1/07 and payment was issued on 3/28/07 in violation of Section 324(1) and subject to penalty under Section 324(2). According to MIGA, the second bill from fb88 Medical Center was received on 4/13/07 and payment was issued on 4/25/07 in violation of Section 324(1) and subject to penalty under Section 324(2). Unpaid mileage reimbursement According to documentation provided by MIGA, the issue of mileage was part of the negotiated settlement. PENALTIES Penalties payable to injured employees Title 39-A M.R.S.A. Section 205(3) When there is not an ongoing dispute, if weekly compensation benefits or accrued weekly benefits are not paid within thirty (30) days after becoming due and payable, $50 per day must be added and paid to the worker for each day over thirty (30) days in which the benefits are not paid. Not more than $1,500 in total may be added pursuant to this subsection. For purposes of ratemaking, daily charges paid under this subsection do not constitute elements of loss. Delays of initial indemnity payments, subject to penalty under Section 205(3), were found on the following claims: CLAIM PENALTY JUSTIFICATIONPENALTY EXPOSURESally Eagar vs. America Service Group Inc. Date of Injury: 10/19/98 Date ER Notified of Incapacity: 10/20/98 Claim # 207044 Board # 98018598MIGAs initial indemnity payment (1/8/04) was made one hundred eighty-two (182) days after the receipt of the file (7/10/03).$0.00*Tommy Kincaid vs. Steven A McGee Date of Injury: 5/1/00 Date ER Notified of Incapacity: 5/1/00 Claim # 139567 Board # 00005471MIGAs initial indemnity payment (1/15/02) was made seventy-four (74) days after the receipt of the file (11/2/01).$1,500.00Richard Lagueux vs. Morrissey Enterprises Co. Inc. Date of Injury: 7/9/98 Date ER Notified of Incapacity: 4/12/99 Claim # 139572 Board # 98018403MIGAs initial indemnity payment (1/11/02) was made seventy-one (71) days after the receipt of the file (11/1/01).$1,350.00Total Penalties to Injured Employees for Delays of Initial Indemnity Payments$2,850.00 * This claim has been settled by Lump Sum and the Board is not pursuing penalties arising from the violation cited. Delays of subsequent indemnity payments, subject to penalty under Section 205(3), were found on the following claims: CLAIM PENALTY JUSTIFICATIONPENALTY EXPOSUREKenneth Ciliberti vs. Philip Services Corp. Date of Injury: 5/27/98 Date ER Notified of Incapacity: 5/27/98 Claim #139544 Board # 98017846The subsequent indemnity payment (5/3/05) was made seventy-six (76) days after the previous indemnity payment (2/16/05).$1,500.00Kenneth Ciliberti vs. Philip Services Corp. Date of Injury: 5/27/98 Date ER Notified of Incapacity: 5/27/98 Claim #139544 Board # 98017846The subsequent indemnity payment (6/13/05) was made forty (40) days after the previous indemnity payment (5/4/05).$150.00Wendell Grant vs. United Steel & Aluminum Corporation Date of Injury: 3/9/99 Date ER Notified of Incapacity: 3/11/99 Claim # 139578 Board # 99004883The subsequent indemnity payment (8/9/04) was made sixty-eight (68) days after the previous indemnity payment (6/2/04).$1,500.00Total Penalties to Injured Employees for Delays of Subsequent Indemnity Payments$3,150.00 Delays of other indemnity payments, subject to penalty under Section 205(3), were found on the following claims: CLAIM PENALTY JUSTIFICATIONPENALTY EXPOSUREWayne Butterfield vs. Filter Belts, Inc. Date of Injury: 9/1/99 Date ER Notified of Incapacity: 9/2/99 Claim #155464 Board # 99022535Mr. Butterfield was entitled to specific loss benefits. Payment of those benefits was made one thousand two hundred eight (1,208) days after compensation became due and payable (11/6/03).$1,500.00Ronald Cole vs. Town of Paris Date of Injury: 3/21/02 Date ER Notified of Incapacity: 3/22/02 Claim #211071 Board # 2006124Mr. Coles benefits were reduced prior to the effective date of the WCB-8. In addition, the value of Mr. Coles fringe benefits were not considered when determining his fixed partial rate.$0.00*Bibianne Couturier vs. The Proctor & Gamble Date of Injury: 4/15/98 Date ER Notified of Incapacity: 10/2/99 Claim # 211054 Board # 98019176Ms. Couturier was incapacitated fifteen (15) days between 4/3/05 and 4/17/05. Payment for one (1) of those days was made (6/22/07) seven hundred eighty-two (782) days after compensation became due and payable (5/1/05).$1,500.00Jason Dunn vs. Guild Drilling, Inc. Date of Injury: 7/28/99 Date ER Notified of Incapacity: 8/21/99 Claim # 139565 Board # 99012819Benefits were not increased from partial to total until thirty-five (35) days after compensation became due and payable (1/11/02).$0.00*Wendell Grant vs. United Steel & Aluminum Corporation Date of Injury: 3/9/99 Date ER Notified of Incapacity: 3/11/99 Claim # 139578 Board # 99004883An incorrect WCR was used to pay this claim resulting in accrued benefits that were not paid until 6/22/07.$1,500.00John Riordan vs. Poland Springs Date of Injury: 1/30/02 Date ER Notified of Incapacity: 1/30/02 Claim # 228346 Board # 2019395Benefits were not increased to the maximum weekly benefit rate effective 11/7/03, 7/1/04 and 7/1/05.$0.00*Total Penalties to Injured Employees for Delays of Other Indemnity Payments$4,500.00 * This claim has been settled by Lump Sum and the Board is not pursuing penalties arising from the violation cited. Penalties payable to injured employees and the Workers Compensation Board Title 39-A M.R.S.A. Section 324(2) Except as otherwise provided by Section 205, if an employer or insurance carrier fails to pay compensation as provided in this section, the Board may assess against the employer or insurance carrier a forfeiture of up to $200 for each day of noncompliance. The audit revealed violations subject to penalty under Section 324(2) in the claims listed below. MIGA contends that the Board does not have the authority to assess forfeitures against it pursuant to Section 324(2). CLAIM PENALTY JUSTIFICATIONPENALTY EXPOSUREKenneth Ciliberti vs. Philip Services Corp. Date of Injury: 5/27/98 Date ER Notified of Incapacity: 5/27/98 Claim #139544 Board # 98017846Partial workers compensation benefits were paid to Mr. Ciliberti sixty-four (64) days after a decree ordering such benefits was issued (12/14/04).$10,200.00Jason Dunn vs. Guild Drilling, Inc. Date of Injury: 7/28/99 Date ER Notified of Incapacity: 8/21/99 Claim # 139565 Board # 99012819Partial incapacity benefits were reinstated forty-one (41) days after an order was issued (10/16/01).$4,200.00*Jason Dunn vs. Guild Drilling, Inc. Date of Injury: 7/28/99 Date ER Notified of Incapacity: 8/21/99 Claim # 139565 Board # 99012819Total incapacity benefits were paid thirteen (13) days after a Consent Between Employer and Employee agreeing to such benefits was signed (3/26/02).$450.00*Jason Dunn vs. Guild Drilling, Inc. Date of Injury: 7/28/99 Date ER Notified of Incapacity: 8/21/99 Claim # 139565 Board # 99012819Partial incapacity benefits were paid fifteen (15) days after a decree ordering such benefits was issued (3/17/05).$300.00*Wayne Gagnon vs. Northland Frozen Foods Inc. Date of Injury: 1/14/00 Date ER Notified of Incapacity: unknown Claim # 157738 Board # 20986Total incapacity benefits were paid eighty-six (86) days after a decree ordering such benefits was issued (1/26/05).$10,950.00*Deborah Hartley vs. America Service Group Inc. Date of Injury: 1/24/01 Date ER Notified of Incapacity: 7/2/01 Claim # 211058 Board # 1000963Retroactive benefits were paid twenty-one (21) days after the parties signed the corresponding Mediation Agreement (11/17/04). Interest was paid (6/22/07) nine hundred forty-seven (947) days after the date the parties signed the corresponding Mediation Agreement. $187,400.00 CLAIM PENALTY JUSTIFICATIONPENALTY EXPOSUREHarold Marshall vs. AMCARE Medical Services, Inc. Date of Injury: 6/16/99 Date ER Notified of Incapacity: 6/25/99 Claim # 139151 Board # 99009823Prescriptions and mileage were paid three hundred fifty-two (352) days after the after the date the parties signed the corresponding Consent Decree (11/22/04).$68,400.00Harold Marshall vs. AMCARE Medical Services, Inc. Date of Injury: 6/16/99 Date ER Notified of Incapacity: 6/25/99 Claim # 139151 Board # 99009823Prescriptions were paid forty-one (41) days after the date the parties signed the corresponding Mediation Agreement (1/29/04).$6,200.00Eric Moran vs. ESOCO Orrington, Inc. Date of Injury: 9/30/99 Date ER Notified of Incapacity: 10/4/99 Claim # 211078 Board # 99015474Indemnity benefits were increased fifty-one (51) days after the recovery of overpayment (pursuant to the Mediation Agreement signed 4/30/04) was complete (9/12/06).$8,200.00John Riordan vs. Poland Springs Date of Injury: 1/30/02 Date ER Notified of Incapacity: 1/30/02 Claim # 228346 Board # 2019395Medical bills were paid twenty-seven and twelve (27 and 12) days after the date the medical bills were received (3/1/07 and 4/13/07).$2,550.00*Paul Tyner vs. US AIR, Inc. Date of Injury: 10/14/96 Date ER Notified of Incapacity: 10/15/96 Claim # 139539 Board # 96014204A Lump Sum Settlement was paid to Ms. Tyner thirteen (13) days after it was approved (8/31/06). A LSS was paid to Verrill & Dana fifteen (15) days after it was approved (8/31/06).$750.00*Total $299,600.00 * This claim has been settled by Lump Sum and the Board is not pursuing penalties (on behalf of the corresponding employee) arising from the violation cited. Penalties payable to the Workers Compensation Board Title 39-A M.R.S.A. Section 359(2) In addition to any other penalty assessment permitted under this Act, the Board may assess civil penalties not to exceed $25,000 upon finding, after hearing, that an employer, insurer or 3rdparty administrator for an employer has engaged in a pattern of questionable claims-handling techniques or repeated unreasonably contested claims. The Board shall certify its findings to the Superintendent of Insurance, who shall take appropriate action so as to bring any such practices to a halt. This certification by the Board is exempt from the provisions of the fb88 Administrative Procedure Act. The amount of any penalty assessed pursuant to this subsection must be directly related to the severity of the pattern of questionable claims-handling techniques or repeated unreasonably contested claims. All penalties collected pursuant to this subsection shall inure to the benefit of the General Fund. An insurance carriers payment of any penalty assessed under this section may not be considered an element of loss for the purpose of establishing rates for workers' compensation insurance. MIGA is not liable for the imposition of civil penalties under Section 359(2), therefore no action will be taken. If MIGA were liable for the imposition of penalties, a referral to the Abuse Investigation Unit would have been appropriate for the following reasons (including, but not limited to): Failure to file or timely file forms with the Board Failure to pay benefits timely Failure to pay claims accurately Title 39-A M.R.S.A. Section 360(1)(A) The Board may assess a civil penalty not to exceed $100 for each violation on any person: Who fails to file or complete any report or form required by this Act or rules adopted under this Act. The audit revealed violations subject to penalty under Section 360(1)(A) in the claims listed below. MIGA contends that the Board does not have the authority to assess forfeitures against it pursuant to Section 360(1)(A). EmployeeDate of InjuryForms Not FiledPenalty Exposure7/10/99WCB-3, Memorandum of Payment$200.00WCB-4, Discontinuance or Modification of Compensation$200.00WCB-8, (21-Day) Certificate of Discontinuance$200.00WCB-11, Statement of Compensation Paid$200.009/1/99WCB-3, Memorandum of Payment$100.00WCB-4, Discontinuance or Modification of Compensation$100.00WCB-11, Statement of Compensation Paid$100.004/12/00WCB-4, Discontinuance or Modification of Compensation$100.00WCB-11, Statement of Compensation Paid$400.002/1/00WCB-11, Statement of Compensation Paid$400.005/27/98; 8/9/98 WCB-3, Memorandum of Payment$100.00WCB-11, Statement of Compensation Paid$200.003/21/02WCB-11, Statement of Compensation Paid$200.001/1/00WCB-9, Notice of Controversy$100.0010/17/01WCB-11, Statement of Compensation Paid$300.007/28/99WCB-3, Memorandum of Payment$300.00WCB-11, Statement of Compensation Paid$500.0010/19/98WCB-4, Discontinuance or Modification of Compensation$200.00WCB-11, Statement of Compensation Paid$200.006/14/99WCB-11, Statement of Compensation Paid$400.001/14/00WCB-3, Memorandum of Payment$100.00WCB-4, Discontinuance or Modification of Compensation$100.00WCB-9, Notice of Controversy$100.00EmployeeDate of InjuryForms Not FiledPenalty Exposure3/9/99WCB-4, Discontinuance or Modification of Compensation$300.00WCB-11, Statement of Compensation Paid$400.001/24/01WCB-4, Discontinuance or Modification of Compensation$100.00WCB-11, Statement of Compensation Paid$200.005/1/00WCB-3, Memorandum of Payment$100.00WCB-4, Discontinuance or Modification of Compensation$200.00WCB-11, Statement of Compensation Paid$300.007/9/98WCB-11, Statement of Compensation Paid$300.006/16/99WCB-11, Statement of Compensation Paid$400.009/30/99WCB-4, Discontinuance or Modification of Compensation$200.00WCB-11, Statement of Compensation Paid$300.007/8/97WCB-11, Statement of Compensation Paid$300.001/30/02WCB-4, Discontinuance or Modification of Compensation$200.00WCB-11, Statement of Compensation Paid$200.004/26/96WCB-11, Statement of Compensation Paid$400.008/30/02WCB-11, Statement of Compensation Paid$100.001/19/00WCB-11, Statement of Compensation Paid$400.002/28/00WCB-3, Memorandum of Payment$100.00WCB-11, Statement of Compensation Paid$400.00Total$9,700.00 Title 39-A M.R.S.A. Section 360(1)(B) The Board may assess a civil penalty not to exceed $100 for each violation on any person: Who fails to file or complete such a report or form within the time limits specified in this Act or rules adopted under this Act. The audit revealed violations subject to penalty under Section 360(1)(B) in the claims listed below. MIGA contends that the Board does not have the authority to assess forfeitures against it pursuant to Section 360(1)(B). EmployeeDate of InjuryForms Filed LatePenalty Exposure4/16/98WCB-11, Statement of Compensation Paid$100.00 5/1/00WCB-11, Statement of Compensation Paid$100.00 7/9/98WCB-11, Statement of Compensation Paid$100.00Total$300.00 Title 39-A M.R.S.A. Section 360(2) The Board may assess, after hearing, a civil penalty in an amount not to exceed $1,000 for an individual and $10,000 for a corporation, partnership or other legal entity for any willful violation of this Act, fraud or intentional misrepresentation. The Board may also require that person to repay any compensation received through a violation of this Act, fraud or intentional misrepresentation or to pay any compensation withheld through a violation of this Act, fraud or misrepresentation, with interest at the rate of 10% per year. No action will be taken at this time. To avoid future penalty referral(s) under this Section, MIGA must take corrective measures to address the following inadequacies: Failure to file or timely file forms with the Board HIJMr = > ? 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the Board:Filed Compliant429%Not Filed1071%Total 14100% Discontinuance or Modification of Compensation (WCB-4 or WCB-4A) Open ClaimsNumberPercentReceived at the Board:Filed Compliant729%Not Filed1771%Total 24100% (21 Day) Certificate of Discontinuance or Reduction of Compensation (WCB-8) Open ClaimsNumberPercentReceived at the Board:Filed Compliant571%Not Filed229%Total 7100% Notice of Controversy (WCB-9) Open ClaimsNumberPercentReceived at the Board:Filed Compliant675%Not Filed225%Total 8100% Statement of Compensation Paid (WCB-11) Open ClaimsNumberPercentReceived at the Board:Filed Compliant1922%Late33%Not Filed6675%Total 88100% Timeliness of Benefit Payments Initial Payment of Indemnity Benefits Open ClaimsNumberPercentCheck Issued Within:0-14DaysCompliant1359%15-44Days627%45+Days314%Total22100% Subsequent Payment of Indemnity Benefits Open ClaimsNumberPercentCheck Issued Within:0-7DaysCompliant355296.05%8-37Days1433.87%38+Days3.08%Total3698100% Payment of Medical Bills Open 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