RFIs, responses and prohibited practice penalties
The Department of Labor and Industry's (DLI's) Compliance, Records and Training (CRT) unit sends requests for information (RFI) seeking information or correction of payments on workers' compensation claims. CRT has not been receiving timely responses -- or, in many cases, any response -- to RFIs, requiring second or third requests be sent on many claims.
Requests for information are sent via Work Comp Campus email with a link or a one-time-use security code. The link is the preferred method to access the request. If the adjuster assigned to the claim has permission to receive RFIs, the RFI is sent to them. Otherwise, if the claim adjuster does not have access or permission, the RFI is sent to a group administrator. The expectation is a response will be made to DLI within 30 days of when the RFI is sent to the insurer or a third-party administrator.
Penalties may be applied
Minnesota Statutes § 176.194, subdivision 6 provides for prohibited practices penalties for "failing to respond to the department within 30 calendar days after receipt of a written inquiry from the department about a matter related to benefits. Responses must be substantive and address the question."
Penalties for failing to respond within 30 days can be up to $6,000 for each violation.
Prohibited practice penalties assessed under Minn. Stat. § 176.194, subd. 6, are assessed against the parent entity rather than individual offices. For example, Company XYZ has offices in five locations (A, B, C, D and E). RFIs were sent to adjusters in each office and the adjusters from offices A, B and E responded timely, but there was no response from offices C and D. An initial penalty would be assessed against Company XYZ for office C's failure to respond and a second penalty would be assessed against Company XYZ for office D's failure to respond.
More intensive review begins
Beginning in March 2022, CRT will begin more intensive review of the timeliness of RFI responses and take the appropriate actions. DLI is notifying insurers, third-party administrators and claim representatives now to allow enough time to become current with their RFI responses and refine any internal procedures. By taking these actions, parties can ensure future timely RFI responses and avoid a prohibited practices penalty.
Review final medical reports
One common issue with RFIs that CRT suggests you review is final medical reports. Many RFIs ask for a final medical report. The FN (final) is used to indicate you believe your file is closed and you do not anticipate further payments of any kind.
Upon receipt of an FN, CRT reviews the Campus file. At the time of this review, a final medical report should have been received about injuries where there may be a minimum ascertainable permanent partial disability rating, if the injury involves the eyes or if it is a minor injury that causes more than a minimal amount of lost time. If the Campus file does not contain this medical report, an additional inquiry will be submitted to the claim administrator.
Additional information, further assistance
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