Loss Control Program Compliance Audits

An overview of the purpose and procedures of program auditing

Audit Purpose

Measure the degree of program compliance as required by the insurance carrier

Identify opportunities for improvement in the existing company program

Provide a structure to the risk management process for your branch staff

Opportunity for training of new staff members relative to your program

“Level of Compliance” Definition

RCS is hired by the insurance carrier to evaluate your level of compliance with their adopted standards for managing risk.

– These adopted standards are the elements of the audit format - differing to some degree with the various programs.

Carriers develop minimum standards of compliance, usually a minimum audit score.

– This provides them with a level of confidence that your company is actively working to control risk.

Audit Process

The audit is designed to follow the path of risk management-based business concepts:

– Facilities

– Risk management-based hiring

– Orientation

– Risk management-based sales and client site safety

– OSHA compliance

– Accident and injury procedures

– Modified duty

– Managing claims

Audit Training Opportunities

Involve various staff members in the process

Work with schedulers and auditors prior to the audit visit to establish goals and expectations for the session

– This will help RCS to select the right auditor and help you maximize the value of the service visit

Preparing for the Audit

You have the advantage of “having a copy of the test” before the test day.

Auditor Expectations

This will depend to some degree on your business model and mix, but some things are consistent across the board

– Facility visuals as outlined in the audit

– Hiring documents that are completed in the branch

– Orientation materials and safety communication materials used by the branch

Client-Specific Materials

Client files for clients serviced by the branch will be reviewed and must be available for the auditor either in electronic or paper format

– Safety evaluations that include the information specified in the RCS sample forms:

Ergonomics

Safety Program and training information

OSHA information

Hold Harmless Agreements

Safety partnership letters or contracts containing similar provisions.

Training records specific to the client and/or employees assigned to the client site.

What We Need From You

The auditor will need access to “job orders by NCCI code”

– Accomplished with payroll runs or any other internal tool that lists your clients by NCCI or class codes

Length of Audit Process

Depends on the nature of the operation and the amount of files that the auditor will need to review

Operating standard is 10 employee files, 10 client files, and 10 Workers Comp Claims files

The auditor must be the person who selects the files for review

With the auditor reviewing 30 files for content and conducting the audit interview with the branch staff, the audits will take from 120 to 150 minutes (2 to 2 ½ hours)

Electronic Files

Acceptable in some cases

– Scanned forms with signatures

– Electronic signature systems for online applications

Some forms that require a signature may be a problem in electronic format

Scanned or electronic client site evaluations are acceptable if they are comparable to the RCS sample form in content (i.e. ergonomic information, PPE assessment, safety training information, etc.)

What We Need From You

The consultant will need a copy of your:

– Application packet

– Orientation materials (tests, etc.)

– Client site evaluation forms (initial and follow-up)

– Hold harmless agreements, partnership letters, etc.

– Accident packet forms as specified in the RCS audit

– Your accident log, either on screen or in printed format. The log must either by sorted by branch location (if a central log) or a branch-specific document.

Audit Results

It is RCS policy to review the audits for content and quality prior to publishing for client viewing.

Scores may be adjusted based on auditor notes and reviewer comments.

The audit will be posted for viewing on your password-protected area of the RCS website within 5 - 7 business days.

– If you have not received notification of the posting, contact us at 800.807.7475 for assistance.

Summary

RCS provides the audit as a service primarily to the insurance carrier as a measure of compliance.

Offices being audited have opportunities for consulting and training associated with the process.

Allow 2 ½ hours for the entire process.

– About 1 hour will be an interview with office staff.

Summary

To assure full credit and timely completion and posting of the audit:

– Have the required paperwork available for the auditor to review

– Work with clients ahead of time to assure that site-specific training, partnership letters, or other documents from clients are in your office and available for review