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					 office   of the   new york state comptroLLer
                   D ivision of LocaL Government
                       & schooL accountabiLity




 Policies and Procedures of
    County Self-Insured
Workers’ Compensation Plans

                       2007-MR-3




               Thomas P. DiNapoli
                             Table of Contents


                                                                          Page

AUTHORITY LETTER                                                               3


EXECUTIVE SUMMARY                                                              5


INTRODUCTION                                                                    7
           Background                                                           7
           Objective                                                            8
           Scope and Methodology                                                8
           Comments of Local Officials and Corrective Action                    8


CLAIMS PROCESSING AND PAYMENT                                                  10
            Claims Processing                                                  10
            Claims Payment                                                     14
            Recommendations                                                    15


COST MINIMIZATION AND CONTAINMENT                                              16
            Cost Minimization Opportunities                                    16
            Cost Containment Opportunities: Best Practices                     19
            Recommendations                                                    20


SUBSEQUENT EVENTS TESTING                                                      21


APPENDIX A      Responses From Local Officials                                 23
APPENDIX B      OSC Comments to County Officials’ Response                     25
APPENDIX C      Audit Methodology and Standards                                26
APPENDIX D      Glossary of Workers’ Compensation Terms                        27
APPENDIX E      Workers’ Compensation Plan Case Review                         30
APPENDIX F      How to Obtain Additional Copies of the Report                  33
APPENDIX G      Local Regional Office Listing                                  34




                      Division of LocaL Government anD schooL accountabiLity        1
                                           State of New York
                             Office of the State Comptroller

Division of Local Government
and School Accountability

December 2007

Dear Local Officials:

A top priority of the Office of the State Comptroller is to help local government officials manage
government resources efficiently and effectively and, by so doing, provide accountability for
tax dollars spent to support government operations. The Comptroller oversees the fiscal affairs
of local governments statewide, as well as compliance with relevant statutes and observance of
good business practices. This fiscal oversight is accomplished through, among other functions,
our audits, which identify opportunities for improving operations and County Legislative Board
governance. Audits also can identify strategies to reduce costs and to strengthen controls intended
to safeguard local government assets.

Following is a report of our audit of Policies and Procedures of County Self-Insured Workers’
Compensation Plans. This audit was conducted pursuant to the State Comptroller’s authority under
Article V, Section 1 of the State Constitution, and Article 3 of the General Municipal Law.

This audit’s results and recommendations are resources for local government officials to use in
effectively managing operations and in meeting the expectations of their constituents. If you have
questions about this report, please feel free to contact the local regional office for your county, as
listed at the end of this report.

Respectfully submitted,


Office of the State Comptroller
Division of Local Government
and School Accountability




                           Division of LocaL Government anD schooL accountabiLity                3
                                                                        State of New York
                                                          Office of the State Comptroller
                                                            EXECUTIVE SUMMARY

Under the Workers’ Compensation Law (WCL), generally, workers injured on the job are entitled
to receive medical care for their work-related injuries or illnesses and may be entitled to receive
compensation, in the form of cash payments, usually until they return to work. The method for
determining the amount of compensation that an injured worker may be entitled to is set forth
in the Law. The Workers' Compensation Board (Board) administers the workers’ compensation
program Statewide. The Chair of the Board prescribes the various forms that are used for filing and
managing claims in compliance with the WCL, while the Board, among its functions, adjudicates
and resolves controversies, and makes awards and findings.

Counties are allowed to establish county-managed Workers’ Compensation Self-Insurance Plans
(Plans). The WCL makes counties responsible for managing their Plans and accounting for Plan
assets. Under the WCL, local governments and certain other entities located within a county
may elect to participate in a county's Plan. By creating their own Plans rather than paying for a
traditional workers’ compensation insurance policy, counties and other participants can realize
substantial cost savings. The Counties of Livingston, Ontario, Steuben, Wayne and Yates all
manage Plans that include coverage for participating units of government within the Counties.
All five Counties covered in this audit contracted with Third-Party Administrators (TPAs)1 to help
manage their Plans; three of the Counties hired new TPAs subsequent to our initial audit period.
TPAs typically review, investigate and make recommendations with respect to claims involving
the county’s or a participant’s employees; monitor case progress; and file all necessary paperwork
with the Board in a timely manner. When claims are not filed on time, counties may be subject to
fines and penalties established in the WCL and imposed by the Board.

During our audit period, expenditures of the Plans ranged from approximately $440,000 to $3.5
million for workers’ compensation claims.2 There were 1,435 new claims during our audit period
and 581 old claims for workers’ compensation benefits that were still open on September 30,
2004.3

Scope and Objective

The objective of our audit was to review the policies and procedures established for self-insured
workers’ compensation plans in the following five Counties: Livingston, Ontario, Steuben, Wayne


1
  The WCL authorizes Plans to “contract for necessary actuarial or other expert or professional services.”
2
  The average of the five Plans was $2.7 million.
3
  Details by County can be seen in Table 5 of Appendix E.

                               Division of LocaL Government anD schooL accountabiLity                        5
and Yates. Our audit was for the period January 1, 2003 through September 30, 2004. In Livingston,
Steuben and Wayne Counties, we conducted subsequent audit testing of the new TPAs for the
period January 1, 2005 through March 31, 2005. Our audit addressed the following question:

   •   Have County officials established adequate policies and procedures for processing workers’
       compensation claims to ensure that only legitimate claims are paid and that costs related to
       these claims are contained and minimized?

Audit Results

With the exception of Ontario, the Counties have not established adequate policies and procedures
for processing workers’ compensation claims. Although the Counties contracted with TPAs
to administer workers’ compensation self-insurance plans, they did not monitor their TPAs’
performance. In our review of individual workers’ compensation case files maintained by the
TPAs, we found missing, incomplete, or insufficient documentation, as well as late filings and
late payments. As a result, the Counties could spend more money than they should on Plan costs.
Late filing and/or late payment could result in Board-imposed fines, and lack of proper and timely
investigation makes it more likely that Counties could be paying for inappropriate claims. We
attribute the claims processing and payment problems found in four of the five Counties we visited
to a lack of County policies and procedures for properly managing their Plans, and to Counties’
failure to monitor TPA performance. In addition, with the exception of Ontario, the Counties did
not retain responsibility for the fiscal management of the Plan, as required by the WCL.

Our audit also found that four of the five Counties are not doing as much as they can — and
should — to minimize the costs of their Plans. If County Governing Boards develop and implement
procedures for verifying claimants’ eligibility for benefits, monitoring the status of claims, and
obtaining reimbursements when available, Counties can help reduce their Plans’ costs. Settling
old claims and adopting best practices can also save money for Plans and County taxpayers. We
provided a number of suggestions for improving the efficiency and effectiveness of workers’
compensation claims processing procedures.

Although three of the Counties contracted with a new TPA in January 2005, a review of a sample
of individual case files, as maintained by the new TPAs, identified continuing problems related to
incomplete or insufficient documentation and late filings. To obtain improved performance from
TPAs and to avoid unnecessary Plan costs, the Counties should adopt policies and procedures for
managing and monitoring their Plans.

Comments of Local Officials

The results of our audit and recommendations have been discussed with County officials and
excerpts from their comments, which appear in Appendix A, have been considered in preparing
this report. County officials generally agreed with our recommendations. Appendix B contains our
comment on an issue raised in one County’s response.




  6       office of the new york state comptroLLer
                        Introduction

Background          Under the Workers’ Compensation Law (WCL), generally,
                    workers injured on the job are entitled to receive medical care
                    for their work-related injuries or illnesses and may be entitled
                    to receive compensation, in the form of cash payments, usually
                    until they return to work. Workers’ compensation insurance
                    provides the cost of full medical treatment, which may include
                    rehabilitation, and, in certain cases, provides cash payments for
                    covered employees who become disabled as a result of a disease
                    or injury connected with their employment. It also provides
                    payments, known as death benefits, for qualified dependents of
                    a worker who dies from a compensable injury or illness. The
                    method for determining the amount of compensation that an
                    injured worker may be entitled to is set forth in the WCL.

                    The Workers’ Compensation Board (Board), which administers
                    the workers’ compensation program Statewide, among
                    other things, receives and processes the workers' claims for
                    compensation, employers' reports of accident, and medical
                    reports from physicians and other health care providers. These
                    forms, as well as various other forms that are used for filing and
                    managing claims in compliance with the WCL, are prescribed
                    by the Chair of the Board. The Board also adjudicates and
                    resolves controversies, and makes awards and findings.

                    Generally, employers must provide workers’ compensation
                    insurance for their employees. The WCL allows counties to
                    establish a county-managed Workers’ Compensation Self-
                    Insurance Plan (Plan). By creating their own Plans rather than
                    paying for a traditional workers’ compensation insurance policy,
                    counties and other participants can realize substantial cost
                    savings. The WCL also allows local governments and certain
                    other entities located within a county to elect to participate in
                    the Plan. The Counties of Livingston, Ontario, Steuben, Wayne
                    and Yates all manage Plans that include coverage for units of
                    government within the Counties. Participants of the Plans
                    include 85 towns, 38 villages, two cities, three public authorities
                    and five school districts.

                    The WCL assigns counties the responsibility of managing their
                    Plans and accounting for Plan assets. All five Counties covered
                    in this audit contracted with Third-Party Administrators (TPAs)


             Division of LocaL Government anD schooL accountabiLity               7
                                 to help manage their Plans; three of the Counties hired new
                                 TPAs subsequent to our initial audit period. The TPA is
                                 typically responsible for reviewing, investigating and making
                                 recommendations with respect to the approval of claims
                                 involving the county’s or a participant’s employees, as well as
                                 following up on the progress of the cases, and filing necessary
                                 paperwork with the Board in a timely manner. When claims
                                 are not filed on time, counties may be subject to fines and
                                 penalties established in the WCL and imposed by the Board.

                                 During our audit period, expenditures of the Plans ranged
                                 from approximately $440,000 to $3.5 million for workers’
                                 compensation claims.4 There were 1,435 new claims during
                                 our audit period and 581 old claims for workers’ compensation
                                 benefits that were still open on September 30, 2004.5

Objective                        The objective of our audit was to review the policies and
                                 procedures established for self-insured workers’ compensation
                                 plans in the Counties of Livingston, Ontario, Steuben, Wayne
                                 and Yates. Our audit addressed the following question:

                                        •   Have County officials established adequate policies
                                            and procedures for processing workers’ compensation
                                            claims to ensure that only legitimate claims are paid
                                            and that costs related to these claims are contained and
                                            minimized?

Scope and                        We examined self-insured workers’ compensation plans of
Methodology                      Livingston, Ontario, Steuben, Wayne and Yates Counties for
                                 the period January 1, 2003 through September 30, 2004. In
                                 Livingston, Steuben and Wayne Counties, we also conducted
                                 a subsequent audit test of the performance of the new TPAs
                                 for the period January 1, 2005 through March 31, 2005.

                                 We conducted our audit in accordance with generally accepted
                                 government auditing standards (GAGAS). More information
                                 on such standards and the methodology used in performing
                                 this audit are included in Appendix C of this report.

Comments of Local Officials      The results of our audit and recommendations have been
and Corrective Action            discussed with County officials and excerpts from their
                                 comments, which appear in Appendix A, have been considered
                                 in preparing this report. County officials generally agreed

                                 4
                                     The average of the five Plans was $2.7 million.
                                 5
                                     Details by County can be seen in Table 5 of Appendix E.

  8         office of the new york state comptroLLer
  with our recommendations. Appendix B contains our comment on an
  issue raised in one County’s response.

  The Governing Boards have the responsibility to initiate corrective
  action. Pursuant to Section 35 of the General Municipal Law, the
  Governing Board should prepare a plan of action that addresses the
  recommendations in this report and forward the plan to our office
  within 90 days. For guidance in preparing your plan of action, you
  may refer to applicable sections in the publication issued by the Office
  of the State Comptroller entitled Local Government Management
  Guide. We encourage the Governing Board in each County to make
  this plan available for public review in the offices of the Clerk of the
  Board.




Division of LocaL Government anD schooL accountabiLity               9
                    Claims Processing and Payment

                            Counties with their own Plans are required to manage the Plans
                            in compliance with the WCL and Board regulations to ensure
                            they obtain necessary claim-related information, file required
                            forms with the Board and investigate claims in a timely manner,
                            retain case documentation, and keep the compensation payment
                            function under the control and supervision of the County
                            Treasurer. However, we found that, with the exception of Ontario
                            County, the Counties, as well as the TPAs hired to manage the
                            Counties’ Plans, did not always perform the claims management
                            functions efficiently or effectively. As a result, the Counties
                            could spend more money than they should on Plan costs. Late
                            filing and/or late payment could result in Board-imposed fines,
                            and lack of proper and timely investigation makes it more likely
                            that Counties could be paying for inappropriate claims. We
                            attribute the claims processing and payment problems found in
                            four of the five Counties audited to a lack of County policies
                            and procedures for properly managing their Plans, and to the
                            Counties’ failure to monitor TPA performance.

Claims Processing           When a County employee or employee of a participant in the
                            Plan (including all volunteer firefighters and ambulance workers
                            of a political subdivision) sustains a work-related injury or an
                            occupational illness, the employee enters the area of workers’
                            compensation. When this occurs, the County must collect and file
                            relevant data with the Board according to specific timeframes.
                            Below is a list of some of the Board forms that may be required
                            to be filed, along with a brief description of their purpose.
                            Appendix D includes a more detailed description of some of
                            these Board forms, as well as a glossary of various Workers’
                            Compensation terms as defined on the Board’s website.

                               •   C-2: A report the employer must file that, generally,
                                   provides information regarding the injured employee,
                                   provides information regarding the injury or illness, and
                                   indicates whether any medical attention was provided.

                               •   C-7: A report the employer must file when it is
                                   controverting — or disputing — the employee’s right to
                                   compensation.




 10     office of the new york state comptroLLer
           •   C-669: A report the employer must file when it is
               accepting the workers’ compensation claim, which
               indicates whether payments have begun, and if not,
               why not.

           •   C-250: A form the employer should file, as necessary,
               to request reimbursement for compensation payments
               from the Special Disability Fund, which is established
               under the WCL.

        Within 10 days of an incident, a C-2 form, which is usually
        completed by the injured worker’s employer, must be filed with
        the Board. The completed C-2 is sent to the TPA for remittance
        to the Board from the County or participating municipality
        via fax or direct delivery. The TPA generally would open a
        case file for this claimant, and attempt to determine, based on
        the information provided on the C-2, whether the Plan should
        either accept or controvert the claim. There are three common
        reasons for controverting a claim: (1) the employer does not
        believe the injury or illness “arises out of and in the course
        of employment”; (2) there is a lack of medical evidence to
        sustain a claim for compensation; or (3) the employer did not
        receive notice of the injury or illness from the injured worker
        within the specified period of time.

        If the TPA cannot perform a reasonable assessment based
        on the information in the C-2, then the TPA usually would
        conduct an initial investigation, which involves contacting the
        supervisor or witnesses indicated. If necessary, the TPA can
        perform additional investigative work to complete the review
        and to provide a reasonable basis for the TPA’s recommended
        action on the claim. Upon completing the review, the TPA
        would notify a County official of its recommendation to
        accept or controvert the claim.

        Generally, the Plan must accept or controvert the claim within
        10 days of the date the employer first had knowledge of the
        alleged injury (or within 18 days of disability). The TPA
        generally would file form C-669 or form C-7 with the Board
        to indicate, respectively, that the claim has been accepted
        and benefit payments have or have not begun and why, or to
        controvert the claim. A C-7 form initiates a hearing, scheduled
        by the Board, before a Workers’ Compensation Law Judge who
        makes a determination of eligibility. With respect to injuries
        to certain body parts, if it is determined that the employee


Division of LocaL Government anD schooL accountabiLity            11
                         has a permanent partial disability, schedules established by the
                         WCL indicate the amount of compensation that a claimant may
                         be entitled to. In addition, with respect to injuries that result in
                         a claimant being classified, the Plan has the right to periodically
                         verify eligibility of the claimant.

                         Counties must ensure that they, and the TPAs that manage their
                         Plans, file required forms and pay claimants any benefits in
                         a timely manner to avoid significant penalties – up to $3,500
                         for each instance of late filing or payment – that could be
                         imposed by the Board. TPAs should maintain complete case
                         files, including documentation of any investigation performed
                         by the TPA or the employee’s supervisor, to make a competent
                         assessment of a claim’s legitimacy and to provide information
                         to use as evidence if a case goes before the Board.

                         Our review of claims processing disclosed the following:6

                             •    Of the 289 case files we selected for review, 32 files
                                  (11 percent) in three Counties could not be located by
                                  the TPA.7 The TPA stated that the case files may have
                                  been misfiled, at the County for review, or out for court
                                  hearings. However, the TPA did not maintain a log to
                                  document the location, removal, and return of the case
                                  files, so neither we nor the TPAs could locate the files.
                                  It is imperative that the TPA ensure that claimant case
                                  files are safeguarded at all times. The information in
                                  the case files is confidential and must be protected to
                                  preserve claimants’ privacy rights. Further, the Counties
                                  and TPAs must be able to track the status and location
                                  of every case file to properly manage claims processing
                                  and payment.

                             •    The Plans did not have a procedure in place to ensure that
                                  employers (i.e., the County or other Plan participants)
                                  promptly submitted completed C-2s to their TPAs. Of
                                  the 257 case files we tested, 12 (5 percent) were lacking
                                  C-2s and 27 (11 percent) contained C-2s that were
                                  incomplete. In addition, 63 files (25 percent) contained
                                  C-2s that were filed late. A C-2 provides information to
                                  the TPA as well as to the Board. If it is incomplete or

                         6
                           Details by County can be seen in Tables 1 and 2 of Appendix E.
                         7
                           The same TPA was used by the three counties. Individual rates for missing
                         files were: Livingston, 10 files (12 percent); Steuben, 3 files (5 percent); and
                         Wayne, 19 files (21 percent).


12   office of the new york state comptroLLer
                missing, the TPA does not have all the information it
                needs for proper management of the claim. Delayed
                transmittal to the TPA may result in the TPA filing
                the form late. Each instance of late filing and/or late
                payment could potentially result in a Board-imposed
                fine of up to $3,500.

            •   With the exception of Ontario County, the Plans did not
                require immediate supervisors of the injured workers
                to perform an initial investigation. Of the 257 files
                tested, 103 (40 percent) did not have evidence of an
                initial investigation. By not contacting the supervisor,
                the TPA may not get information that would identify
                a fraudulent claim. In addition, if this documentation
                is not available, the TPA cannot use the information to
                determine the reasonableness of the claim in making a
                recommendation to the County, or to use as evidence
                if the case goes to a hearing before a Workers’
                Compensation Law Judge.

            •   In Ontario County, a copy of the C-2 is sent to both the
                TPA and the County Safety Coordinator (Coordinator)
                for review. The Coordinator assesses and investigates
                the claim by speaking to the injured party, supervisor,
                and/or witnesses and gathering data. The Coordinator
                uses this information to evaluate the incident and decide
                whether the accident and/or the related injury appear
                to be valid or questionable, and whether the accident
                was potentially avoidable.8 Additional analysis at this
                point can help ensure that only legitimate claims are
                paid and can also reduce claims in the future.

            •   Of the 257 case files tested, 121 case files required a
                C-669 or C-7 to be on file. However, this form was
                missing from 53 case files (44 percent). The remaining
                68 case files contained one or the other required form,
                but 35 of those forms (51 percent) had been filed late.
                These forms provide important notice to the Board
                that a claim has been accepted or controverted. Not
                filing these forms or filing them late could result in
                fines and penalties being imposed by the Board or
                a Board determination in favor of the claimant on a
                controverted claim.
        8
          An avoidable accident is one that may not have occurred if safety
        procedures were followed, if additional training were given and/or if the
        safety of equipment or the area were improved.

Division of LocaL Government anD schooL accountabiLity                     13
Claims Payment              According to the Law,9 the County Treasurer (Treasurer) must
                            be the custodian of all moneys of the Plan, and the Treasurer is
                            required to account for such moneys in a separate fund known
                            as the county self-insurance fund. Since Plan compensation
                            payments are disbursements of Plan moneys, the disbursements
                            are required to be under the supervision and control of the
                            Treasurer. In Ontario County, the Treasurer maintains the Plan
                            accounts, writes the benefit payment checks and provides for
                            a reconciliation of the Plan account. However, the other four
                            Counties delegate this responsibility to the TPA, despite the lack
                            of authority to delegate this function. We noted the following
                            during our review of claims payments:10

                                •    With the exception of Ontario County, the contracts
                                     between the Counties and their TPA provide for the
                                     creation of an account funded with Plan money for
                                     distribution by the TPA. The TPA processes and pays all
                                     medical expenses and indemnity payments. The TPA
                                     also stores and writes the checks on this account to pay
                                     the Plan’s claims and expenses, and also reconciles the
                                     account. Once the TPA makes payment, the TPA faxes
                                     a check register to the Treasurer’s office and requests
                                     that the account be replenished. The TPA does not
                                     provide any additional supporting documentation with
                                     the check register for review by the County. Therefore,
                                     the responsible County official or body11 cannot perform
                                     a proper review and approval of claims.

                                •    Sufficient documentation was not always available to
                                     determine the timeliness of initial payments to claimants.
                                     Of the 128 cases requiring an initial payment, 55 (43
                                     percent) did not contain sufficient documentation to
                                     indicate the timeliness of the payment. We also found
                                     that, for 44 of the 73 cases (60 percent) that did contain
                                     such documentation, payments were made late. When
                                     the Plan makes late payments, the delays could result
                                     in both financial stress for the individual claimant and
                                     higher costs for the County if the Board imposes fines/
                                     penalties.

                            9
                               Note also that pursuant to County Law, the County Treasurer must be the
                            recipient and custodian of all money belonging to the county or in which the
                            county has an interest.
                            10
                               Details by County can be seen in Table 3 of Appendix E.
                            11
                               Generally the Governing Board or, where such offices have been established,
                            the County Auditor or County Comptroller, is responsible for auditing claims
                            against the county.

 14     office of the new york state comptroLLer
                          As the WCL requires the Treasurer to be the custodian of Plan
                          moneys, and there is no authority for a county to delegate this
                          function to a TPA, the Treasurer must maintain the Plan moneys
                          and must write the compensation payment checks on behalf of
                          the Plan. Furthermore, unless the Treasurer maintains control
                          over disbursement of funds from Plan accounts, counties
                          cannot properly account for these expenditures of county
                          funds, and are at risk of being penalized for noncompliance
                          with payment requirements.

Recommendations           1. The County Governing Boards should ensure that the
                             Plans have adequate policies and procedures to ensure
                             that:

                             •   Workers’ compensation incident report forms are
                                 received, reviewed, and filed timely.

                             •   TPAs maintain documentation of the location of case
                                 files at all times.

                             •   Claimants’ supervisors are contacted during the
                                 course of an initial investigation to help assess the
                                 circumstances of the incident and validity of the
                                 claim.

                             •   Forms indicating a claim’s payment status are filed
                                 with the Board in a timely manner.

                             •   Only legitimate claims are paid after audit and approval
                                 by the appropriate County official/body.

                          2. The County Governing Boards should monitor their
                             Plans’ performance to ensure statutory and contractual
                             requirements are met.

                          3. The Treasurer must maintain custody of all Plan moneys,
                             including storing and writing Plan checks and reconciling
                             the Plan bank account.




                  Division of LocaL Government anD schooL accountabiLity           15
                Cost Minimization and Containment

                            Counties elect to self-insure under their own Plans generally
                            as a means to save money. To make sure their Plans operate
                            as economically as possible, counties must avoid paying
                            inappropriate claims, seek reimbursement from other payers,
                            when possible, and actively pursue cost containment measures.
                            Our audit results showed that four of the five Counties we audited
                            are not doing as much as they can – and should – to minimize
                            the costs of their Plans. If County Governing Boards develop
                            and implement procedures for verifying claimants’ eligibility
                            for benefits, monitoring the status of claims, and obtaining
                            reimbursements when available, counties can help reduce their
                            Plans’ costs. Settling old claims and adopting best practices can
                            also save money for Plans and county taxpayers.

Cost Minimization           The Plan’s first opportunity to minimize costs is to determine
Opportunities               the validity of a workers’ compensation claim so the Plan can
                            avoid paying inappropriate claims. There are many possible
                            causes for inappropriate claims, including misunderstandings,
                            honest mistakes, cost shifting from non-occupational health
                            care, employee resentment, unscrupulous service providers,
                            and outright fraud. Therefore, sufficient, complete and timely
                            supporting documentation, such as C-2s and initial investigation
                            reports, are essential for determining validity. We noted that
                            the Plans, with the exception of Ontario County, do not require
                            immediate supervisors of the injured to perform an initial
                            investigation of the incident. If Plans do not require supervisors
                            to investigate the incident, and if TPAs do not contact supervisors
                            for information, as reported earlier, the Plans are much less
                            likely to discover a misstated or fraudulent claim.

                            We also determined that, except for Ontario County, the Counties
                            do not have a policy for controverting claims. The policies
                            should set criteria for the claims the Plans will dispute so TPAs
                            will recommend the denial of claims in a consistent manner.
                            Until Plans establish and follow a policy for controverting
                            claims, their costs may be higher than necessary because they
                            could be paying for inappropriate claims. Industry standards
                            set the claims denial rate between 15 percent and 20 percent.12


                            12
                              The Marsh & McLennan Companies Journal, Volume XXXIII No. 1
                            2004

 16     office of the new york state comptroLLer
        However, only 18 (7 percent)13 of the 257 claims we reviewed
        were controverted, which is below the industry standard. Only
        Ontario County’s performance was in line with the industry
        standard.

        Once a workers’ compensation claim is validated, the Plan
        may control costs by:

             •   Monitoring the claimant’s continuing eligibility for
                 benefits

             •   Creating a back-to-work (rehabilitation) plan for the
                 individual, which identifies the most appropriate way
                 to get the employee back into the workforce

             •   Seeking reimbursement of costs from other parties

             •   Reviewing older claims for settlement.14

        We found that most of the Counties could significantly
        improve their use of all the above cost-control measures.
        For example, periodic investigations are necessary to verify
        a claimant’s continuing eligibility for benefits, to track the
        employee’s progress, and to ensure the legitimacy of the
        claim. We determined that of the 98 claimants requiring
        periodic continuing eligibility verification to be completed,
        46 (47 percent) claimants’ case files had no evidence that the
        verifications were performed. In addition, 45 (38 percent) of
        the 120 claimants tested who could benefit from back-to-work
        plans did not have a plan in their file. Furthermore, 67 (34
        percent) of the 195 claims requiring additional investigation
        did not contain any evidence of them being performed.
        Additional investigations are also necessary for tracking
        employee progress and ensuring the legitimacy of the claim
        as well as to determine a claim’s eligibility for submittal for
        reimbursement to the Special Disability Fund (Fund), which
        reimburses insurers for benefits paid to disabled employees
        whose condition is determined to have worsened as a result of
        an additional injury.15

        We also found that none of the Plans had policies and procedures
        for determining if a claim is eligible for reimbursement from

        13
           Details by County can be seen in Table 1 of Appendix E.
        14
           Details by County can be seen in Tables 4 and 5 of Appendix E.
        15
           The Special Disability Fund is discussed in Appendix D.

Division of LocaL Government anD schooL accountabiLity                      17
                         the Fund. The Counties relied completely on the TPAs to
                         determine a claimant’s eligibility for payment from this Fund
                         and to send the required form (C-250) to the Board to request
                         reimbursement. However, we did note during our review of the
                         Ontario County insurance committee’s minutes brief discussions
                         about possible reimbursements for some claims.

                         In addition, TPAs did not report on, and Counties did not inquire
                         about, efforts to obtain Fund reimbursements. We determined that
                         80 (31 percent) of the 257 case files contained forms C-250 that
                         were filed with the Fund; however, only 54 (68 percent) claims
                         were determined by the Board to be eligible for reimbursement.
                         Three of the five Counties received and recognized $536,419
                         in Fund reimbursement for the period January 1, 2003 through
                         December 31, 2003. Since the TPAs do not report to Counties
                         about potential reimbursements from the Fund, which claims
                         they consider to be eligible, or how successful their efforts are,
                         neither we nor the Counties can determine if this was the full
                         amount due the Plans. Furthermore, in all the Counties except
                         Ontario, the TPA receives the reimbursement checks rather than
                         the Treasurer directly receiving these moneys from the Fund.

                         The Plan may also seek reimbursement from any moneys
                         received by or due to the claimant from any third-party
                         settlement. For example, if a workers’ compensation claim
                         arises from a motor vehicle accident where the claimant was
                         not at fault and the claimant receives a third-party settlement,
                         the Plan may be entitled to recoup a portion of its workers’
                         compensation payments from the claimant. We noted that
                         21 claims appeared eligible for reimbursement from a third
                         party. For two of these claims, the Counties involved sought
                         and received reimbursement for their Plans from third parties.
                         Yates County filed a lien for its one eligible claim and received
                         full reimbursement; Livingston County received a third-party
                         reimbursement of approximately $500,000 on behalf of its Plan.
                         Of the remaining 19 claims, 13 (68 percent) case files contained
                         no documentation that the TPAs sought reimbursement on
                         behalf of the Plans.

                         Finally, the Plans have no policy to periodically review older
                         workers’ compensation claims for settlement potential or
                         closure. A negotiated Board-approved agreement, termed a
                         “non-schedule adjustment,” between a claimant with a non-
                         schedule permanent partial disability and the Plan can provide
                         savings. According to the terms of the agreement, the claimant


18   office of the new york state comptroLLer
                                receives a sum of money representing all future compensation
                                for his or her disability and the case is considered closed.
                                Such agreements can provide timely resolution of claims and
                                overall cost savings.

                                As of September 30, 2004, the five Plans had 676 open claims
                                that were over a year old and 208 claims were over 10 years
                                old. During the period of our review of the 257 sampled
                                claims, we observed that only one Plan settled a claim (Wayne
                                County). However, we noted Yates County made two offers
                                to claimants that were rejected and settlement discussions
                                were in progress by the Ontario County insurance committee
                                for one claim.

Cost Containment                Ontario County works to contain costs by providing an
Opportunities: Best Practices   incentive to the TPA for verifying that claims were charged
                                the appropriate medical fee. For example, the TPA’s computer
                                system reviews each medical claim submitted for compliance
                                with the Official New York State Workers' Compensation
                                Medical Fee Schedule. During our audit period, the Plan was
                                billed $376,000 by medical providers. The TPA determined
                                that the providers should have charged the Plan $262,000. As
                                a result of identifying these errors, the TPA saved the Plan
                                $114,000 and received an incentive of $17,000 (15 percent of
                                the savings). Other Plans using outside contractors as TPAs
                                should consider providing for a similar TPA incentive program
                                the next time they solicit proposals for TPA services, both to
                                save money and to help ensure providers do not overcharge
                                for their services.

                                We further recognize Ontario County’s efforts to minimize
                                workers’ compensation claims by creating a safety committee
                                to oversee the implementation of a safety program, providing
                                safety training and rehabilitation services. According to
                                industry sources, a well-designed and administered safety
                                committee can help to reduce the burden of running a safety
                                program and increase the return on the investment.16 The
                                benefits to forming an effective safety committee include
                                increased employee involvement, increased productivity,
                                increased morale, decreased injuries and illnesses, decreased
                                waste of materials and decreased cost of insurance coverage.




                                16
                                     Source: Safety and Health, Inc. Safety Program Development

                       Division of LocaL Government anD schooL accountabiLity                     19
Recommendations          4. The County Governing Boards should ensure that the Plans
                            have adequate policies and procedures to ensure that:

                            •   Supervisors perform an initial investigation of any claims

                            •   Criteria are set for controverting claims

                            •   The Risk Manager or other appropriate County official
                                reviews the Plans’ rate of controverting claims; rates
                                below industry standards should be investigated to ensure
                                that only legitimate claims are accepted

                            •   Verification of continuing eligibility for benefits is
                                monitored and back-to-work plans are developed

                            •   All available avenues of reimbursement and cost effective
                                settlement are pursued.

                         5. The County Governing Boards should require the TPAs to
                            provide the Plans with monthly status reports detailing all
                            active claims, including potential reimbursement, to allow the
                            Plans to monitor the TPAs’ performance as well as the status
                            of Plan claims.

                         6. The Treasurer should be the direct recipient of reimbursements
                            made by the Special Disability Fund.

                         7. The Plans should consider implementing Ontario County’s
                            incentive and safety committee practices.




 20    office of the new york state comptroLLer
 Subsequent Events Testing

        In January 2005, three Counties17 each contracted with a new
        TPA. We determined that the Plans still had not established
        adequate policies and procedures for processing workers’
        compensation claims and still did not monitor the performance
        of their TPAs. The new TPAs also maintained bank accounts
        for the payment of Plan claims. Because of the continued
        internal control weaknesses in the operation of the Plans, we
        selected 43 case files from March 2005 for review to determine
        if the same exceptions still existed with the new TPAs. Our
        review of these individual case files, as maintained by the new
        TPAs, identified continuing problems related to incomplete or
        insufficient documentation and late filings.

               •   Of the 43 case files tested, three (7 percent) contained
                   an incomplete C-2 and the C-2 forms for four cases (9
                   percent) were filed late. The C-2 forms in two files (5
                   percent) had no date, so we could not determine if they
                   were filed on time.

               •   All 11 required C-669 forms were filed late in Steuben
                   and Wayne Counties.

               •   None of the claims were controverted in Steuben or
                   Wayne Counties. One claim was controverted in
                   Livingston, but it was filed late.

               •   Ten (23 percent) of the 43 case files tested could have
                   been eligible for Fund reimbursement, but only three
                   (30 percent) contained a submitted C-250 form to the
                   Board. The TPA for Steuben stated that they process
                   Fund reimbursements every 26 weeks and diary every
                   Fund claim for reimbursement every six months. The
                   TPA is currently creating a spreadsheet for the Risk
                   Manager to monitor. While creating this spreadsheet,
                   the current TPA identified over $180,000 in Fund
                   reimbursements that the previous TPA had missed, and
                   is now processing and submitting these reimbursement
                   requests.



        17
             Livingston, Steuben and Wayne Counties


Division of LocaL Government anD schooL accountabiLity               21
                         We recognize that the Counties have made efforts to improve
                         the operation of their individual Plans. However, the Treasurers
                         must maintain the moneys for the Plans. In addition, until they
                         develop policies and procedures for their Plans’ operations and
                         monitor their TPAs’ performance in administering the Plans, the
                         Counties may continue to pay higher costs than necessary, and
                         fail to maximize reimbursements from other payers.




22   office of the new york state comptroLLer
                                         APPENDIX A

                      RESPONSES FROM LOCAL OFFICIALS

A draft copy of this report was sent to each of the five Counties audited. The following comments
were excerpted from the four responses we received.

General Responses

Ontario County “strives to achieve excellence in all operational areas and appreciates the audit as an
opportunity to re-examine our efforts to provide benefits to eligible workers in an efficient manner
while minimizing the cost through accident prevention and appropriate program controls.”

Steuben County officials stated, “we appreciate the observations provided by your audit team and
will incorporate their recommendations into our plan.”

Yates County “finds the issues discussed in the report to be accurate as delineated.”

Livingston County officials stated, “we find that this report makes a number of suggestions
for changes in policies and procedures. While some of these suggestions are valid and will be
implemented, nowhere does it document that these changes will substantially improve the
performance of our plan. Exceptions to the plan's findings are continuously made for Ontario
County, yet there is no evidence of superior results. One can argue that Livingston County's current
procedures and controls identified the need to change third party administrators in 2005.”

Claims Processing

Steuben County officials stated, “A third party contractor has the technical expertise to effectively
perform the required claims management function to insure compliance with current law. They
also are better equipped to serve the injured worker in obtaining appropriate medical care. The
effectiveness of this service however, can only be measured by frequent oversight on the part of
the plan administrator.”

With regard to policy, Steuben County officials stated, “a review of County policy related to filing
of claims has been recently conducted and recommended changes have been approved by County
Legislators. Orientations at department level will be periodically conducted to insure adherence to
policy and procedures related to timeliness of filing.”

With regard to oversight, Livingston County officials stated, “any time a municipality contracts
for service they lose a certain amount of control to the independent contractor. However, in return
we receive a level of expertise that we might not acquire from County staff. Our third party
administrator acts on our behalf and under our control, not autonomously.”




                           Division of LocaL Government anD schooL accountabiLity               23
Claims Payment

Steuben County officials “recognize that responsibility for administration of public funds cannot
be transferred to a third party.”

Livingston County officials maintain that “the County Treasurer is the custodian of all moneys of       See
                                                                                                        Note 1
the Plan and does account for such moneys in a separate fund known as the county self-insurance
                                                                                                        Page 25
fund. Our Treasurer also signs all benefit checks and reconciles the Plan account.”

Subsequent Event Testing

Steuben County officials stated “we recognized the shortcomings of our previous third party
administrator and took action to replace them. As a result, aging claims have been closed, settlement
of other long-term claims has been initiated, and the County is already seeing results.

Livingston County officials stated, “we contend that the overall operation of our workers'
compensation fund has improved dramatically since the switch to our current third party
administrator in February 2005. Communication between the County and our TPA are greatly
improved. We are in contact with key staff members on a regular basis and have access to complete
file information through their website.”




  24      office of the new york state comptroLLer
                                       APPENDIX B

          OSC COMMENTS TO COUNTY OFFICIALS’ RESPONSES

In response to comments in the County response letters, we provide the following information:

Note 1:

Livingston County’s contract with the previous TPA provided for the creation of an account
funded with Plan money for distribution by the TPA. In addition to meeting with the TPA and
reviewing documents, we met with the County Treasurer twice during October 2004 to obtain an
understanding of the County’s policies and procedures that supported this contract provision.




                         Division of LocaL Government anD schooL accountabiLity           25
                                        APPENDIX C

                   AUDIT METHODOLOGY AND STANDARDS

We reviewed internal controls over the Plans. We obtained our understanding of these internal
controls by inquiry, observation, inspection of documents and records and reviewing policies and
procedures and other audit reports. Our audit also included reviews of individual claimant files
maintained by the TPA to determine if the TPA provided sufficient documentation, investigation,
and approval of the claims. We further reviewed the TPA files to determine if the TPA recouped
moneys from third party insurance providers and completed return to work evaluations or
schedules. We obtained a detailed listing of all cases opened and closed during the period January
1, 2003 and September 30, 2004. In addition, we obtained a detailed listing of all claims opened
prior to January 1, 2003 that were still open on September 30, 2004. For all these claims, we
identified certain aspects, such as the number of days of lost time, the amount paid, whether the
claim was controverted, if the claimant was a previous claimant, and if the claim was submitted
for reimbursement. Finally, we reviewed the Plans’ process for auditing and paying the workers’
compensation claims. We selected 30 of the TPA claim vouchers during our audit period to review
payments for services provided to the Plans.

In January 2005, Livingston, Steuben and Wayne Counties contracted with new TPAs. As a result
we performed subsequent event testing of the new TPAs. This testing was consistent with the
methodology described above and was performed on claims initiated in March 2005.

We conducted this performance audit in accordance with generally accepted government auditing
standards (GAGAS). Those standards require that we plan and perform the audit to obtain sufficient,
appropriate evidence to provide a reasonable basis for our findings and conclusions based on our
audit objectives. We believe that the evidence obtained provides a reasonable basis for our findings
and conclusions based on our audit objectives.




  26      office of the new york state comptroLLer
                                              APPENDIX D

             GLOSSARY OF WORKERS’ COMPENSATION TERMS18

C-2:
         This Board form, titled “Employer’s Report of Work-Related Accident or Occupational
         Disease,” must be filed by employers within 10 days after an accident occurs, as required
         by Workers’ Compensation Law (WCL). Failure to make timely C-2 filings subjects
         employers to potential administrative and criminal penalties.

C-7:
         This Board form, titled “Notice that Right to Compensation is Controverted,” must be filed
         by the carrier (as appropriate) or Plan within (1) 18 days of the date disability begins or (2)
         10 days of the date the employer first had knowledge of the alleged injury, whichever is
         later. Filing must occur within 25 days from the Board’s mailing of a notice of indexing in
         volunteer firefighter or volunteer ambulance worker cases.

C-250:
         This Board form, titled “Notice of Claim for Reimbursement Out of Special Disability
         Fund Under Section 15-8,” must be filed by the carrier or Plan to request reimbursement,
         if eligible, from the Special Disability Fund.

C-669:
         This Board form, titled “Notice to Chair of Carrier’s Action on Claim for Benefits,” must
         be filed by the carrier or Plan with the Board within (1) 10 days of the date the TPA first
         had knowledge of the alleged injury, or (2) 18 days of the date disability began, whichever
         is later. This form indicates either that payment has begun or why payments have not
         started.

Claim:
         A request, filed on a prescribed Form C-3, for workers’ compensation for work-connected
         injury, occupational disease, disablement, or death. A claimant must file a claim within a
         two-year period from the occurrence of the accidental injury, knowledge of occupational
         disablement, or death. Failure to file a claim may bar an award for compensation unless
         the employer has made advance benefit payment or fails to raise the issue, in which event
         the claim filing requirement is deemed waived.

Close (a Case):
       Closing a case removes it from further consideration. A decision to close a case is based on
       a judge’s determination that no further rulings by the Board will be necessary in the case.
       A case closing is effected by a statement on a Board decision.


18
  The definitions contained in this Glossary were obtained from the Board's website at http://www.wcb.state.ny.us,
with the exception of the definitions of “Special Disability Fund” and “Special Fund for Reopened Cases” which were
obtained from the Special Funds Conservation Committee’s website at http://www.specialfunds.org.

                              Division of LocaL Government anD schooL accountabiLity                         27
Controverted Claim:
      A claim challenged by the carrier or Plan on stated grounds. The Board sets a pre-hearing
      for the determination of the grounds and directs the parties to appear and present their
      case.

Indemnity Benefits:
      These benefits are compensation paid to the workers’ compensation claimants for non-
      medical loss resulting from an injury or illness. Six types of award are permitted by the
      WCL:

       •   temporary total disability benefits (for periods of total wage loss)

       •   temporary partial disability benefits (for periods of partial wage loss)

       •   facial disfigurement awards (at judge’s discretion but subject to a maximum, for
           cosmetic facial disfigurement resulting form the accident or exposure)

       •   permanent partial disability benefits (for loss of physical function or for periods of
           partial wage loss after a claimant has been classified as having a permanent partial
           disability)

       •   permanent total disability benefits (for loss of wage earning capacity after a claimant
           has been classified as having a permanent total disability)

       •   death benefits (compensation benefits awarded to spouse, children or, under certain
           circumstances, other family members following a work-related death).

Lost Time:
       Lost time is a period of total wage loss and loss of earning capacity, beyond the statutory
       waiting period, caused by the claimant’s work-connected disability. In workers’
       compensation cases only, if the disability period exceeds 14 days, compensation will be
       paid from the first day of disability. There is no waiting period for volunteer ambulance
       worker or volunteer firefighter cases.

Lump Sum Settlement:
      This settlement is a negotiated and Board-approved agreement, termed a “non-schedule
      adjustment,” between a claimant with a non-schedule permanent partial disability and the
      insurer(s). As a result of the agreement, the claimant receives a sum of money representing
      all future compensation for his/her disability, and the case is considered closed.

Medical Benefits:
      Medical benefits encompass all medical treatment provided under the WCL to injured
      workers as a result of injuries arising out of and in the course of employment.




  28       office of the new york state comptroLLer
Special Disability Fund:
       The Special Disability fund is responsible for reimbursing insurers for all payments properly
       paid pursuant to Section 15 (8) and Section 14 (6) of the Workers’ Compensation Law. With
       respect to Section 15 (8), if an employee with a “permanent physical impairment” incurs
       a subsequent disability because of a work-related injury or occupational disease, which
       results in a permanent disability caused by both conditions and the combined disability
       is greater than what would have resulted from the second injury or occupational disease
       alone, the insurer is reimbursed from the Special Disability Fund for all benefits after the
       first 260 weeks of disability. Concerning Section 14 (6), where an injured employee is
       concurrently engaged in more than one employment at the time of injury, the employer
       in whose employment the employee was injured pays the full compensation rate and is
       reimbursed by the Special Disability Fund for the additional benefits resulting from the
       employee’s increased average weekly wage due to concurrent employment.

Special Fund for Reopened Cases:
       The Special Fund for Reopened Cases, under Section 25-a of the Workers’ Compensation
       Law, provides:

           •   Direct payment to claimants and health care providers for cases reopened after
               seven years from the date of injury or death and three years from the date of the last
               payment of compensation

           •   Reimbursement to employers or carriers for supplemental benefits paid to increase
               old benefit rates made obsolete by inflation

           •   Reimbursement to employers or carrier for 1999 retroactive increases to volunteer
               firefighter and volunteer ambulance worker benefits.

Third-Party Action:
       This term refers to lawsuits against equipment manufacturers, facility owners and other
       non-employer parties whose products or services contributed to the occurrence of an
       accident.

Workers’ Compensation Board (Board):
      (a) The New York State agency charged with administering the Workers’ Compensation
      Law, the Volunteer Ambulance Workers’ Benefit Law, and the Volunteer Firefighters’
      Benefit Law and the Disability Benefits Law. (b) The 13-member Board is responsible for
      determining all issues involving claims under the WCL. Members are appointed to seven-
      year terms by the Governor, by and with the advice and consent of the Senate.




                          Division of LocaL Government anD schooL accountabiLity               29
                                               APPENDIX E

                  WORKERS’ COMPENSATION PLAN CASE REVIEW

                                      TABLE 1: Results of Sample Case Review
                   Livingston      Ontario        Steuben           Wayne          Yates            Total
                 Number Percent Number Percent Number Percent Number Percent   Number Percent   Number Percent
New claims
for Period
                  365    70%     290    69%     249     67%     455    75%       76     81%      1,435   71%
1/1/03-
9/30/04
Old claims
still Open on     157    30%     129    31%     125     33%     152    25%       18     19%      581     29%
9/30/04
  Total claims    522    100%    419    100%    374    100%     607    100%      94     100%     2,016   100%
Total claims
selected for       81    15%      42    10%      59     16%     90     15%       17     18%      289     14%
review
Case files
                   10    12%      0       0      3      5%      19     21%       0       0        32     11%
missing
  Total claims
                   71    100%     42    100%     56    100%     71     100%      17     100%     257     100%
      reviewed
Number
                   3      4%      6     14%      4      7%       3      4%       2      13%       18      7%
controverted
Lacking C-2s       4      6%      1      2%      2      4%       5      7%       0       0%       12      5%
Incomplete
                   8     11%      2      5%      9      16%      3      4%       5      29%       27     11%
C-2s
Late C-2s          24    34%      19    46%      7      13%      9     13%       4      24%       63     25%
No evidence
of initial         34    48%      23    55%      24     43%     12     17%       10     59%      103     40%
Investigation
No C-699 or
                   30    42%      0      0%      22     39%      8     11%       7      41%       67     26%
C-7 on File




 30         office of the new york state comptroLLer
                           TABLE 2: Cases With Missing or Late-filed Forms (C-7 OR C-669)
                 Livingston       Ontario          Steuben             Wayne            Yates Total
               Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent
Total number
of cases
                    43         100%      14        100%        34        100%      25        100%     5       100%        121         100%
requiring
C-699 or C-7
Cases with
missing             35         81%       0         0%          10        29%       8         32%      0       0%          53          44%
C-669 or C-7
C-699 or C-7
on file and         5          63%       6         43%         11        46%       10        41%      3       60%         35          51%
late




                               TABLE 3: Cases With Inadequately Supported or Late Initial Payments
                          Livingston      Ontario          Steuben            Wayne              Yates Total
                        Number Percent Number Percent Number Percent Number Percent Number Percent Number Percent
Total number of
cases requiring           43      100%        14        100%        41      100%        25     100%       5        100%         128        100%
initial payment
Cases with
insufficient              32      74%         0           0%        12      29%         11      44%       0          0%         55         43%
documentation
With sufficient
documentation and         5       45%         12         86%        17      59%         8       57%       2         40%         44         60%
untimely filed




                                      Division of LocaL Government anD schooL accountabiLity                                          31
                                    TABLE 4: Plans’ Cost Minimization and Containment Efforts
                         Livingston       Ontario           Steuben          Wayne            Yates     Total
                       Number Percent Number Percent Number Percent Numbers Percent Number Percent Number Percent
Total number of
cases requiring          38    100%     2     100%     31    100%     22     100%     5        100%      98   100%
verification
No verification
                         15    39%      1      50%     16     52%     10     45%      4        80%       46   47%
performed
Total cases that
would benefit from       34    100%     4     100%     31    100%     46     100%     5        100%     120   100%
back to work plans
Back to work plan
                         10    29%      4     100%     17     55%     10     22%      4        80%       45   38%
not on file
Total number of
cases requiring
                         38    100%     42    100%     48    100%     56     100%     11       100%     195   100%
additional
investigation
No evidence
investigation was        15    39%      20     48%     19     40%     11     16%      2        18%       67   34%
performed
Total cases eligible
for 3rd party            3     100%     5     100%      5    100%      7     100%     1        100%      21   100%
reimbursement
No documentation
filed for 3rd party      1     33%      3      60%      2     40%      7     100%     0         0        13   62%
reimbursement
Total number
                         16    100%     8     100%     23    100%     26     100%     7        100%      80   100%
C-250’s filed
Claims eligible for
                         9     56%      8     100%      9     39%     26     100%     2        29%       54   68%
reimbursement




                           TABLE 5: Cases That Could Potentially Be Settled
                             Livingston Ontario Steuben         Wayne                 Yates           Total
     New Claims for the         365        290        249         455                  76             1,435
     period 1/1/03-9/30/04
     Old claims still open      157        129        125         152                     18          581
     on 9/30/04
     Cases one year old         175        160        142         178                     21          676
     Cases 10 years old          47         40         57          56                      8          208
                       Total    222        200        199         234                     29          884




  32         office of the new york state comptroLLer
                                         APPENDIX F

         HOW TO OBTAIN ADDITIONAL COPIES OF THE REPORT


To obtain copies of this report, write or visit our web page:




                                   Office of the State Comptroller
                                   Public Information Office
                                   110 State Street, 15th Floor
                                   Albany, New York 12236
                                   (518) 474-4015
                                   http://www.osc.state.ny.us/localgov/




                           Division of LocaL Government anD schooL accountabiLity   33
                                                    APPENDIX G
                             OFFICE OF THE STATE COMPTROLLER
                              DIVISION OF LOCAL GOVERNMENT
                               AND SCHOOL ACCOUNTABILITY
                                            Steven J. Hancox, Deputy Comptroller
                                            John C. Traylor, Assistant Comptroller

                                      LOCAL REGIONAL OFFICE LISTING
BUFFALO REGIONAL OFFICE                                       GLENS FALLS REGIONAL OFFICE
Robert Meller, Chief Examiner                                 Karl Smoczynski, Chief Examiner
Office of the State Comptroller                               Office of the State Comptroller
295 Main Street, Room 1050                                    One Broad Street Plaza
Buffalo, New York 14203-2510                                  Glens Falls, New York 12801-4396
(716) 847-3647 Fax (716) 847-3643                             (518) 793-0057 Fax (518) 793-5797
Email: Muni-Buffalo@osc.state.ny.us                           Email: Muni-GlensFalls@osc.state.ny.us

Serving: Allegany, Cattaraugus, Chautauqua, Erie,             Serving: Clinton, Essex, Franklin, Fulton, Hamilton,
Genesee, Niagara, Orleans, Wyoming counties                   Montgomery, Rensselaer, Saratoga, Warren, Washington
                                                              counties

ROCHESTER REGIONAL OFFICE                                     ALBANY REGIONAL OFFICE
Edward V. Grant, Jr., Chief Examiner                          Kenneth Madej, Chief Examiner
Office of the State Comptroller                               Office of the State Comptroller
The Powers Building                                           22 Computer Drive West
16 West Main Street – Suite 522                               Albany, New York 12205-1695
Rochester, New York 14614-1608                                (518) 438-0093 Fax (518) 438-0367
(585) 454-2460 Fax (585) 454-3545                             Email: Muni-Albany@osc.state.ny.us
Email: Muni-Rochester@osc.state.ny.us
                                                              Serving: Albany, Columbia, Dutchess, Greene,
Serving: Cayuga, Chemung, Livingston, Monroe,                 Schenectady, Ulster counties
Ontario, Schuyler, Seneca, Steuben, Wayne, Yates
counties
                                                              HAUPPAUGE REGIONAL OFFICE
SYRACUSE REGIONAL OFFICE                                      Richard J. Rennard, Chief Examiner
Eugene A. Camp, Chief Examiner                                Office of the State Comptroller
Office of the State Comptroller                               NYS Office Building, Room 3A10
State Office Building, Room 409                               Veterans Memorial Highway
333 E. Washington Street                                      Hauppauge, New York 11788-5533
Syracuse, New York 13202-1428                                 (631) 952-6534 Fax (631) 952-6530
(315) 428-4192 Fax (315) 426-2119                             Email: Muni-Hauppauge@osc.state.ny.us
Email: Muni-Syracuse@osc.state.ny.us
                                                              Serving: Nassau, Suffolk counties
Serving: Herkimer, Jefferson, Lewis, Madison,
Oneida, Onondaga, Oswego, St. Lawrence counties

BINGHAMTON REGIONAL OFFICE                                    NEWBURGH REGIONAL OFFICE
Patrick Carbone, Chief Examiner                               Christopher Ellis, Chief Examiner
Office of the State Comptroller                               Office of the State Comptroller
State Office Building, Room 1702                              33 Airport Center Drive, Suite 103
44 Hawley Street                                              New Windsor, NY 12553-4725
Binghamton, New York 13901-4417                               (845) 567-0858 Fax (845) 567-0080
(607) 721-8306 Fax (607) 721-8313                             Email: Muni-Newburgh@osc.state.ny.us
Email: Muni-Binghamton@osc.state.ny.us
                                                              Serving: Orange, Putnam, Rockland, Westchester
Serving: Broome, Chenango, Cortland, Delaware,                counties
Otsego, Schoharie, Sullivan, Tioga, Tompkins
counties

  34         office of the new york state comptroLLer