RFP_5800_SLW3033_ATT_2_v1.xlsx
XLSX spreadsheet 334 KB Posted
- Solicitation number
- RFP 5800 SLW3033
- Issued by
- Texas
About this file
Summary
This is a workers' compensation overpayment tracking log for the City of Austin's Third Party Administrator (TPA) services, documenting claims processed by Sedgwick and York Risk Services Group. The document contains detailed records of overpayments identified across multiple workers' compensation claims, spanning from 2017 through 2023. Each entry documents the claim number, date of injury, overpayment amount, amount collected, amount outstanding, the reason for overpayment, recovery methods attempted, and whether overpayments were attributable to Sedgwick errors or other causes. Overpayments primarily result from delayed receipt or processing of Return to Work (DWC-6) forms, Maximum Medical Improvement (DWC-69) designations, and miscalculations of temporary income benefits (TIBS), impairment income benefits (IIBS), and partial temporary income benefits (PTIBS). The log tracks recovery strategies including offsetting future indemnity benefits, deducting percentages from ongoing weekly payments, voiding uncashed checks, and pursuing subrogation claims.
The total overpayments documented in this tracking log represent significant exposure for the City of Austin, with individual claims ranging from less than $10 to over $39,000. Recovery rates vary substantially, with many overpayments fully recouped through future benefit offsets or check voidance, while others remain outstanding. The log identifies recurring systemic issues, including TPA failures to timely request Designated Doctor evaluations, inadequate review windows for work status documents before check issuance, and calculation errors in benefit rates. Multiple entries note instances where adjusters had sufficient time to prevent or reduce overpayments but failed to take corrective action, attributing errors to TPA negligence. The City has documented cases where it is pursuing reimbursement from Sedgwick for overpayments deemed TPA-error-related, and notes indicate the City's expectation that Sedgwick implement comprehensive and timely Designated Doctor requests going forward.
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Other files
| File | Type | Posted |
|---|---|---|
| RFP_5800_SLW3033_PAC1_v1.pdf | ||
| RFP_5800_SLW3033_ATT_8_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_0600_v2.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_4_v1.docx | DOCX document | |
| CSP_6100_CLMB344_BID_DOC_5_v1.pdf | ||
| RFP_5800_SLW3033_0600_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_9_v1.pdf | ||
| RFP_5800_SLW3033_ATT_3_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_PAC2_v1.docx | DOCX document | |
| RFP_5800_SLW3033_ATT_10_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_12_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_6_v1.xls | XLS spreadsheet | |
| RFP_5800_SLW3033_ATT_11_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_5_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ADD_1_v1.pdf | ||
| RFP_5800_SLW3033_ATT_7_v1.xlsx | XLSX spreadsheet | |
| RFP_5800_SLW3033_ATT_1_v1.docx | DOCX document | |
| RFP_5800_SLW3033_PAC1_v2.pdf |
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Overpayments
| DEPT | DATE ENTERED | Claim # | Claimant | Date of injury | Claim Status | COVID? | Overpayment amount | Overpayment collected | Total Outstanding | Overpaid Details | Future Opportunities to Recover Overpayment/resolve Leakage | Leakage due to Sedgwick error | SEDGWICK'S RESPONSE TO ERROR | Not due to Sedgwick or COA | Reimbursement date to COA | Overpayment due to COA | $$$ Loss | Remedial Measures by COA (RM) | Notes | Sedgwick response: | |
| 83 | 9/15/24 | 4A23079R56G | 6/20/23 | O | $ 794.29 | $ - 0 | $ 794.29 | Sedgwick on behalf of the City of Austin advises that based on a report from Dr. Breazle stating you were released to return to work full duty as of 07-24-24. TIBS were paid thru 07-28-24 leaving an overpayment on your claim of 5 days of TIBS which equals $794.29 which will be credited to future indemnity payments. | Will attempt to recover from future benefits | No | Correction is being done to show the new overpayment amount, $158.86. This is due to 3 days lost time in 2023. | ||||||||||
| 81 | 9/15/24 | 4A2406TSMB5 | 6/24/24 | O | $ 1,592.46 | $ - 0 | $ 1,592.46 | Sedgwick, Third-Party Administrator for the City of Austin received a DWC-69 on 08/30/2024 notifying that you reached Maximum Medical Improvement (MMI) on 08/19/2024. Benefits were paid from 08/20/2024-09/02/2024 resulting in an overpayment of $1,592.46. We will reduce the overpayment from any future income benefits you may become entitled to. | IW at MMI - 0% no opportunity to recover | NoYES-PARTIALLY $796.23 , THE CHECK FOR DATES 8/27 THRU 9/02/2024 CLEARED THE BANK ON 9/6/2024. THERE WAS SUFFICIENT TIME FOR ADJUSTER TO CANCEL /STOP THE PROCESSING OF THE CHECK SINCE IT DID NOT CLEAR THE BANK UNTIL 9/06/2024 AND CLAIMANT WAS OT ENTITLED TO THE ENTIRE AMOUNT. | Move to no opt to recoup tab - The DWC69 was received on Friday 8/30/24 and the check was issued on Monday 9/2/24 which was Labor day-for benefits through 9/2/24 – When the examiner reviewed the 69 the check had cleared. | ||||||||||
| 83 | 9/15/24 | 4A240871HR1-AFD | 8/3/24 | O | $ 1,006.29 | $ - 0 | $ 1,006.29 | Sedgwick on behalf of the City of Austin received a DWC 69 received 09-17-24 advising you reached Maximum Medical Improvement as of 08-28-24 with a 0% impairment to your body as a whole. Based on the report, no impairment income benefits are owed. There is an overpayment of $1006.29 for benefits paid from 08-29-24 to 09-03-24 on your claim. This amount will be credited to any future indemnity benefits owed. | No Opportunity to recover - unless IW disputes MMI/IR | NoYES-The DWC6 was received on 8/29/2024 advising of RTW full duty on 8/29/2024. The document was imaged /read into the system on 8/29/2024. The check was issued on 9/03/2024 which was sufficient time to cancel the check and reissue for one day. The check had not been mailed until 9/03/2024 and document imaged into the claim file on 8/29/2024. | Monitor for 30 days for disputes - This was also he labor day holiday and the check was already commited on 9/3 when we returned from the holiday. | ||||||||||
| 83 | 9/15/24 | 4A2401X9NXM | 1/28/24 | O | $ 1,006.29 | $ - 0 | $ 1,006.29 | Sedgwick on behalf of the City of Austin received a DWC 6 dated 09-17-24 advising you returned to work full time with full pay as of 09-17-24. | |||||||||||||
| Benefits were paid to 9/17/24 to 9/22/24 resulting in an overpayment in the amount of $1,006.29. We will reduce this from future income benefits you become entitled to. | Will attempt to recover from future benefits | No YES--THE DOCUMENT IS IMAGED INTO THE SYSTEM ON 9/17/2024 AND :READ" BY ADJUSTER. THE ADJUSTER HAD SUFFICIENT TIME TO CANCEL THE CHECK BEFORE IT PROCESSED AND REISSUE FOR THE CORRECT AMOUNT. | This was a direct deposit and committed on 9/19/24 – we are unable to pull a direct deposit after 10:30am as it is already committed, 9/17/24 was a Friday |
70 8/15/24 4A2312CVKM2 12/10/23 O $ 29,606.48 $ - 0 $ 29,606.48 Sedgwick, Third Party Administrator of City of Austin, received a DWC-69 from the Designated Doctor on 08/12/2024 stating you reached MMI on 04/02/2024 and have a 0% impairment as a result of this injury.
The Designated Doctor also submitted a DWC73 indicating you could return to full duty on 02/08/2024.
| Benefits were paid in the form of Temporary Income Benefits (TIBS) from 02/08/2024-08/18/2024, therefore impairment income benefits are not owed. There is an overpayment on file of $29,606.48 that we will reduce from any future benefits you may become entitled to. | No opportunity to recovery unless IW disputes the DD and is successful for SIF. Possible subro | No | |||||||
| 60 | 8/15/24 | 4A23120J4T8 | 12/1/23 | O | $ 6,266.39 | $ - 0 | $ 6,266.39 | The reason for the change in amount is: Sedgwick, on behalf of the City of Austin, received notice that you signed an offer of limited duty on 5/26/24 and resigned on 5/31/24. Based on the fact the limited duty assignment and wages are still available to you, and the fact that you voluntarily removed yourself from the available wages, we are taking credit for the wages that were available to you beginning on 5/26/24. | |
| We paid benefits at the full rate of $1104.77 from 5/31/24 to 8/1/24 which resulted in an overpayment in the amount of $6,266.39 which we are reducing 25% of your weekly benefit until such time it is recovered. Should you qualify for any future income benefits in the future, we will reduce the overpayment from future income benefits as allowed by Texas rules and regulations. | Will attempt to recover from future benefits | 9/25/2024: No/Awaiting FOL opinion and will share | DDE 10/18/24 | ||||||
| 15 | 7/15/24 | 4A2209P413T | 9/21/22 | O | $ 39,217.23 | $ - 0 | $ 39,217.23 | Sedgwick, Third Party Administrator of City of Austin, received a DWC-69 on 07/09/2024 stating you reached MMI on 11/23/2022 and have a 5% impairment as a result of this injury. | |
| Benefits were paid from 11/24/2022-07/03/2024 resulting in an overpayment of $39,217.13. We will reduce the overpayment from any future income benefits you may become entitled to. | We will attempt to recover from future income benefits - IW may dispute the DD/ Possible subro | No | CCH 10/14/24 | ||||||
| 81 | 7/15/24 | 4A2405MQK88 | 5/18/24 | O | $ 758.16 | $ - 0 | $ 758.16 | Sedgwick, on behalf of the City of Austin, received form DWC6 on 7/8/24 notifying us that you returned to full duty on 6/28/24. | |
| Benefits were paid to you through 7/6/24 resulting in an overpayment from 6/28/24 to 7/6/24 in the amount of $758.16. We will reduce the overpayment from any future income benefits you become entitled to. | MMI 6/27/24 with no impairment | yes - DWC73 received 6/27/24 with full duty 6/27/24 | Move to check owed to the City | ||||||
| 60 | 6/15/24 | 4A2307CTSTW | 7/11/23 | O | $ 23,795.31 | $ - 0 | $ 23,795.31 | Sedgwick, Third Party Administrator of City of Austin, received a DWC-69 from the Designated Doctor on 06/20/2024 from Designated Doctor Judith-Ann Knowles, DC stating you reached MMI on 11/07/2023 and have a 0% impairment as a result of this injury. | |
| Benefits were paid from 11/07/2023 to 06/25/2024 resulting in an overpayment of $23,795.31. We will reduce the overpayment from any future income benefits you may become entitled to. | No opportunity to recover unless IW successfully disputes MMI date/IR | No7/16/2024SEDGWICK MAY BE RESPONSIBLE FOR THIS OVERPAYMENT. PLEASE REFER TO EMAIL SENT 7/16/2024 AS IT HAS EXTENSIVE INFORMATION. Based on further internal emails and discussion, the City will not be requesting/pursing any recovery of overpayments on the below files, except for Wallendael which was agreed upon already. The City does expect that going forward Sedgwick request DD’s on a timely basis and that all DD requests be comprehensive based on the claim situation. |
| 85 | 6/15/24 | 4A2305977L2 | 5/9/23 | O | $ 21,579.92 | $ - 0 | $ 21,579.92 | Sedgwick, Third Party Administrator of City of Austin, received a DWC-69 on 06/11/2024 stating you reached MMI on 11/07/2023, and have a 0% impairment as a result of this injury. | ||||
| Benefits were paid from 11/21/2023-06/10/2024 resulting in an overpayment of $21,579.92 which includes attorney fees paid from your weekly benefits. We will reduce the overpayment from any future income benefits you may become entitled to. | No opportunity to recover unless IW successfully disputes MMI date/IR | No7/16/2024SEDGWICK MAY BE RESPONSIBLE FOR THIS OVERPAYMENT. PLEASE REFER TO EMAIL SENT 7/16/2024 AS IT HAS EXTENSIVE INFORMATION. Based on further internal emails and discussion, the City will not be requesting/pursing any recovery of overpayments on the below files, except for Wallendael which was agreed upon already. The City does expect that going forward Sedgwick request DD’s on a timely basis and that all DD requests be comprehensive based on the claim situation. | ||||||||||
| 83 | 6/15/24 | 4A210929705 | 9/21/21 | O | $ 1,217.02 | $ - 0 | $ 1,217.02 | Sedgwick on behalf of the City of Austin advises that the Designated Doctor amended the previous MMI date he gave of 07-25-23 to 06-05-24. Based on this, Temporary Income Benefits paid from 06-06-23 to 07-25-23 were converted to Impairment Income Benefits. Due to the change in rate from TIBS to IIBS ($1007.00 to $705.00) there was an overpayment on the file which was credited to the remaining 3 weeks of IIBs owed which left a remaining overpayment on the claim of $1217.02. At this time, no further indemnity benefits are owed. | No opportunity to recover unless IW successfully disputes MMI date/IR | No | IW is appealing the D&O | |
| 83 | 6/15/24 | 4A2310D69H1 | 10/9/23 | O | $ 766.31 | $ 766.31 | $ - 0 | The reason for the change in amount is: Sedgwick on behalf of the City of Austin received a DWC 6 form stating that you returned to work modified duty 53 hours a week making $1872.57/weeks. Based on this report, you will receive temporary partial benefits in the amount of $78.14/week. There is an over payment of $766.31 on your claim which will be taken out of future indemnity benefits. | Recovered in full | no | Move to resolved tab. | |
| 83 | 5/15/24 | 4A24035HK5F | 3/5/24 | O | $ 1,289.51 | $ 1,289.51 | $ - 0 | Sedgwick, on behalf of the City of Austin received form DWC6 on 5/1/24 notifying us that you returned to full duty on 5/1/24. |
Sedgwick received form DWC6 on 5/1/24 notifying us that you returned to limited duty earning reduced wages on 4/22/24.
Benefits paid at $1174.00 per week for 4/22 to 5/2/24.
Benefits due from 4/22/24 to 4/30/24 at $431.91 per week – OP for 9 days $954.04 Benefits paid from 5/1/24 to 5/2/24 @1174.00 per week – OP for 2 days 335.42 Total overpayment of benefits $1289.51
| We will reduce the overpayment from any future income benefits you become entitled to. | Recovered in full | No | Move to resolved tab. | |||||||||
| 70 | 5/15/24 | 4A23064X7NN | 6/2/23 | O | $ 953.14 | $ 953.14 | $ - 0 | Sedgwick, Third Party Administrator for City of Austin, received a DWC-6 on 05/14/2024 reporting you returned to work at full duty on 05/14/2024. Benefits were paid 05/14/2024-05/19/2024 resulting in an overpayment of $953.14. We will reduce the overpayment from any future income benefits you may become entitled to. | Recovered in full | No | Move to resolved tab. | |
| 87 | 4/15/24 | 4A23044C3FR | 4/5/23 | O | $ 6,288.00 | $ 194.50 | $ 6,033.50 | Sedgwick, on behalf of the City of Austin, received notice via DWC73 from the Designated Doctor Mead that you were released to work full duty on 5/31/23. |
Temporary income benefits were paid for 7/6/23 to 7/12/23 as well as 10/17/23 to 11/13/23 resulting in an overpayment of benefits for 5 weeks or $5,560.00.
The overpayment of IIB based on TIB paid after your date of MMI 11/13/23 is $473.50.
| The total overpayment amount based on the Designated Doctor report is $6,033.50. | IW is currently disputing mmi/impairment. Possible Subro recovery. | No | CCH 11/26/24 | ||||||
| 87 | 4/15/24 | 4A23064X821 | 6/4/23 | O | $ 10,565.09 | $ 6,109.69 | $ 4,563.38 | Sedgwick-Third Party Administrator for the City of Austin received form DWC69 on 04/18/24 from Designated Doctor Brent D. Dreier, DC stating that you reached MMI on 02/26/24 and have 10% Impairment. |
Per Decision and Order, the employee had disability 6/4/2023 through 11/13/2023 and as a result, there was a prior overpayment on file due to previously issued TIBS and IIBS. The prior TIBS overpayment is $8,430.27 and the prior IIBS overpayment of $2,134.82 for a total overpayment on file of $10,565.09. We are reducing on-going IIBS weekly payments at a rate of 25% or by $194.50 to recoup the prior overpayment of Indemnity Benefits on file. The remaining overpayment at this time is $7152.13.
| The first benefits for 03/15/24 to 04/22/24 was reduced by $1083.64 of the prior overpayment. | We are reducing ongoing IIB 25% per week | No | |||||||
| 15 | 12/15/23 | 4A2307R2GFQ | 7/19/23 | O | $ 750.48 | $ - 0 | $ 750.48 | Sedgwick received form DWC6 on 12/14/23 notifying us that you returned to limited duty work earning full wages as of 12/15/23. | |
| Benefits were paid through 12/20/23 resulting in an overpayment in the amount of $750.48 which we will reduce from future income benefits. | We will attempt to recover from future benefits WHAT ARE THE OPPORTUNITIES TO RECOUP | No | DDE 2/28/24 - Not at MMI, MMI expected 5/28/24. Treating doctor placed the iw at MMI as of 6/4/24 with no impairment. DDE 9/18/24. BRC reset 10/22/24. | ||||||
| 90 | 11/15/23 | 4A22081P47K | 8/2/22 | O | $ 5,928.00 | $ - 0 | $ 5,928.00 | Initial DWC69 was received 8/10/23 stating MMI 8/2/23 10% - IIB Initiated |
IRR requested Amended PLN3 was filed 10/2/23 assessing 1% based on IRR DD requested and finds IW at MMI 10/4/22 0%
Resultant overpayment of IIB's 5,928.00 for IIB from 8/3 to 9/27/23 Possible SIF recovery. IW is also appealing decision and order. Yes - 4/1/2024: PER SEDGWICK THIS OVERPAYMENT IS DUE TO ITS ERROR. Not moved to check due to the City due to iw dispute. Payment history sent to FOL on 6/12/24. Decision and order final. Sending SIF request.
| No opportunity to recoup |
| Check owed to the City |
| Overpayment to discuss in monthly meeting |
| Recouped in full |
E&O requests
| DEPT | DATE ENTERED | Claim # | Claimant | Date of injury | Claim Status | COVID? | Overpayment amount | Overpayment collected | Total Outstanding | Overpaid Details | Date sent to Legal: | Date file credited: |
| 93 | 10/15/24 | 4A2310MCT4X-0001 | 10/18/23 | O | N | $2,397.63 | $0 | $2,397.69 | We have an accepted diagnosis on this file for thoracic strain (S29.012) and lumbar strain (S39.012) only. All other diagnosis should be disputed based on the PLN11 on file dated 2/22/24. The examiner paid bills after this date. | 10/15/24 | ||
| 86 | 10/15/24 | 4A2403T23D6-0001 | 3/25/24 | C | N | $1,982.44 | 0 | $1,982.44 | Examiner paid medical bills after the claim was denied in it's entirety. | 10/2/24 |
Resolved
| DEPT | DATE ENTERED | Claim # | Claimant | Date of injury | Claim Status | Overpayment amount | Overpayment collected | Total Outstanding | Overpaid Details | Future Opportunities to Recover Overpayment/resolve Leakage | Leakage due to York error | Reimbursement date to COA | Overpayment due to COA | $$$ Loss | Remedial Measures by COA (RM) | Notes | Sedgwick response: | Date credit applied to file: |
| 44 | 5/17/21 | 7162593 | 3/20/21 | O | $ 575.44 | $ 575.44 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin |
received notice from your employer on 4/19/2021 via a DWC 6 that advised that you returned to full duty on 4/19/2021. Resulting in four days overpayment of $575.44 for 4/19-4/22/202, which will
| applied to future income benefits, if any. | Will attempt to take credit from future benefits. | No | There is no over payment on the file. Check pulled for 4/16-4/22/21 & S/P pay on check for 3/26-4/1/21. Recommending we move to resolved tab | ||||||||||
| 15 | 5/17/21 | 7112642 | 8/20/20 | O | $ 1,531.20 | $ 1,531.20 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin received a DWC 73 on 4/7/2021. Claimant was released to full duty on 3/26/2021. Benefits were paid thru 4/14/2021 which resulted in a overpayment in the amount of $1,531.20. A stop payment was issued on the check#: 0000417211 for pay period of 4/8/21-4/14/21 @274. Leaving a overpayment balance of $1,257.20 for an overpayment. Credit will be taken from future benefits, if any. | |||||
| Will attempt to take credit from future benefits. | yes | Overpayment taken credit for in the payment of IIB. No overpayment on file. Recommending we move to the resolved tab. | |||||||||||
| 15 | 7005483 | 10/2/19 | O | $ 199.40 | $ 199.40 | $ - 0 | Sedgwick – The Third Party Administrator for The City of Austin received noticed from your employer via a DWC6 on 01/28/2020 that injured worker has returned to work limited duty/full pay on 01/29/2020. You were over paid Temporary Income Benefits (TIBs) from 01/29-01/30/2020 (2 days) in the amount of $199.40. There is currently a total overpayment of $199.40 on file which will be recouped from any future indemnity benefits. | Possible recoupment from future indemnity benefits. DD requested. | No | Sticky note placed on file. | Overpayment recouped in full. Move to resolve tab. | ||
| 15 | 6/25/21 | 7005483 | 10/2/19 | O | $ 997.01 | $ 997.01 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin | |||||
| received a DWC 6 from your employer on 6/24/2021. The DWC 6 advised that you returned to work, light duty/full pay on 6/14/2021. Benefits were paid thru 6/23/2021 which resulted in an overpayment in the amount of $997.01. Credit will be taken from future benefits, if any. WHAT ATTEMPTS ARE BEING MADE TO RECOVER FROM FUTURE BENEFITS | Recouped in full | No | Check was issued prior to DWC6. Move to resolved tab | ||||||||||
| 87 | 10/15/21 | 7158674 | 3/10/21 | O | $ 1,123.52 | $ 1,123.53 | $ - 0 | $1,123.52 overpayment for 06/14/21 - 06/21/21. | Overpayment recouped | No | Move to resolved tab | ||
| 22 | 7076913 | 6/8/20 | O | $ 6.62 | $ - 0 | $ - 0 | NA - Sedgwick, Third Party Administrator for the City of Austin received a DWC 6 on 06/18/20 that you returned to work full duty full pay on 06/17/2020. This resulted in an overpayment in the amount of $6.62 to be taken credit against any future income benefits. | Claim Closed with no DWC69 | City is waiving this overpayment due to amount and possibility of receiving 0% if impairment rating | ||||
| 78 | 10/15/21 | 4A210734F3C-0001 | 7/19/21 | O | $ 1,340.22 | $ 1,340.22 | $ - 0 | DWC3 and DWC6 received by email on 8/17/21 -LD RP 8/2 earning $1,532.40 weekly - PTIB rate 99.72 weekly or $14.25 daily |
DWC6 received by email and not yet in SIR - Additional Lost time 9/24/21 WP paid by COA 7/20 to 7/26 $1,532.40
AWW $1,674.85
We owe $99.72 to IW for Wait PeriodWe overpaid $1,814.56 for 8/2 to 8/15 due to late receipt of DWC6 (Guillermo was having Viaone issues submitting) We owe $374.61 for 9/24 to 9/26 at TIB and not PTIB
| Total Overpayment currently is $1,340.22 | Recouped in full | Yes | Move to the resolved tab. | ||||||||||||||
| 22 | 11/15/21 | 7005646 | 10/7/19 | O | $ 1,692.18 | $ 1,692.18 | $ - 0 | DD placed iw at MMI as of 6/18/20 w/14% impairment. TIBS were paid from 8/22/20-11/8/20 at the TIBS rate but should have been paid at the IIB rate causing the overpayment. OP recouped in full in IIBS | Recouped in full | ||||||||
| 15 | 5/17/21 | 7083790 | 7/1/20 | O | $ 368.43 | $ 368.43 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin received notice from your employer on 3/8/2021 via a DWC 6 which indicated that you returned to work at full duty on 3/5/2021. The overpayment of 3 days from 3/5/2021 to 3/7/2021 in the amount of $368.43 will be applied to future income benefits, if any. | Overpayment recouped in full. | Move to resolved tab | |||||||
| 87 | 8/15/21 | 4A21079C600-0001 | 7/5/21 | O | $ 270.32 | $ - 0 | $ 270.32 | DWC73 received on 7/29 releasing the clmt to full duty as of 7/23/21. Benefits were paid through 7/29 causing an overpayment in the amount of $270.32 | Potential subrogation/ will attempt to take credit from future benefits | No | No Overpayment. Check paying from 7/23-7/29 received and voided. Moving to resolved tab. | ||||||
| 70 | 7033791 | 12/20/19 | O | $ 4,362.39 | $ 4,362.39 | $ - 0 | Sedgwick – The Third-Party Administrator for The City of Austin received noticed from your employer via a DWC6 on 03/23/2020 that injured worker has returned to work limited duty/full pay on 02/18/2020. You were over paid Temporary Income Benefits (TIBs) from 02/18-03/22/2020 (4 weeks 6 days) in the amount of $4362.39. There is currently a total overpayment of $4362.39 on file which will be recouped from any future indemnity benefits. | TIBs were reduced and then IIBs for 8%. Full recovery received. | |||||||||
| 87 | 12/1/20 | 6876114 | 6/12/19 | O | $ 163.98 | $ 163.98 | $ - 0 | N/A-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer on 11/03/2020 via a DWC 6 that advised that you had returned to full duty on 11/2/2020. The overpayment of $163.98 for the period of 11/2/2020 to 11/4/2020 will be recouped from future income benefits, if any. | Possible recoupment from future indemnity benefits. | Overpayment recovered in full. | City of Austin received a DWC 51 from the injured worker on 2/12/2021 and she did qualify to commute her Impairment Income Benefits and they were commuted and paid in a lump sum minus the prior overpayment of $163.98. | ||||||
| 86 | 12/15/21 | 4A21092G772-0001 | 09/21/2021 | O | $ 429.27 | $ 429.27 | $ - 0 | DWC6 received 12/13/21 FULL DUTY/FULL PAY AS OF 11/18/21. Causing an overpayment in the amount of $429.27. MMI 11/11/21 1% impairment. Overpayment credit taken. MOVE TO RECOUPED TAB | Recouped in full | N | Move to resolved tab | ||||||
| DEPT | DATE ENTERED | Claim # | Date of injury | Claim Status | Overpayment amount | Overpayment collected | Total Outstanding | Overpaid Details | Future Opportunities to Recover Overpayment/resolve Leakage | Leakage due to York error | Reimbursement date to COA | Overpayment due to COA | $$$ Loss | Remedial Measures by COA (RM) | Notes | X | |
| 87 | 6795730 | 10/31/18 | O | $ 393.43 | $ 393.43 | $ - 0 | TOTAL OP - $393.43 |
Prior OP $ 125.43 New OP $268.00 for 2 days ( 3/13 & 3/14) IW RTW LD/FP on 3/13/19 $938/7 days= $134 X 2 days= $268
| TOTAL OP $125.43 + $268 = $393.43 | IW rec'vd 4%. OP recouped | |||||||||
| 83 | 7090940 | 7/9/20 | O | $ 1,434.11 | $ 1,434.11 | $ - 0 | Sedgwick- RTW LD/RP on 10/10/2020. Post Injury Earnings are $2242.97. OP of $1269.83 will be applied to future income benefits. Sedgwick-Third Party Administrator for the City of Austin received notice from your employer on 11/09/2020 via a DWC 6 that advised that you returned to full duty on 11/9/2020. The overpayment of $164.28 will be recouped from future income benefits, if any. Total OP - $1434.11 | Recouped OP from IIBs | ||
| 83 | 6/21/21 | 7174721 | 5/6/21 | O | $ 614.47 | $ 73.38 | $ 541.09 | Previous PLN8 filed in error - NO overpayment - DWC6 received 6/1 - LD RP 6/1 - no overpayment , first PLN8 was in error - new weekly amount $146.75. Checks voided |
The reason for the chance in amount is: Sedgwick-Third Party Administrator for the City of Austin received a DWC 6 from your employer on 6/1/2021. The DWC 6 advised that you returned to work, light duty/reduced pay on 6/1/2021. Temporary Income Benefits were paid thru 6/5/2021 which resulted
| in an overpayment in the amount of $614.47. | Will attempt to take credit from future benefits. | No | PLN8 stated overpayment in error. NO overpayment on file. Recommend we move to the resolved tab. | ||||||||||
| 83 | 9/15/21 | 7174721 | 5/6/21 | O | Check # 124968603 for dates 06/06 – 06/12/21 and 12968654 for dates 06/13 – 06/19/21 are only for $110.06 vs PTIBs amount $146.75- The overpayment was being taken from the weekly PIB’s. Clmt RTW, light duty/reduced wages on 6/1/2021. Full TIB's were paid thru 6/5/2021 which resulted in an overpayment in the amount of $614.47. An OP credit of $36.69 will be taken from PIB’s weekly rate. The new PIB’s wkly rate: $110.06. Check # 419262 for dates 06/20 – 06/26/21 was VOID but we cannot tell if this check was issued for the correct amount. Not sure why the check then not released. A check will be issued today. Check # 125450963 for dates 07/11 – 07/17/21 is for PTIBs at a reduced rate vs the full TIBs amount. Yes, an overpayment in the amount of $36.69 was been taken from the weekly benefits. TIBs checks as of 07/18/21 are being reduced, we are assuming for an Overpayment but cannot make out why? Yes, that is correct. A credit of $36.69 is being deducted from weekly TIB’s until the OP has been recovered in full. | ||||||||
| 60 | 3/31/21 | 5844981 | $ 5,577.01 | Adjuster failed to review SIBs file--employee died on 11/30/2020, Paid several quarters without follow-up | |||||||||
| 81 | 5/17/21 | 7156781 | 2/16/21 | O | $ 251.71 | $ 251.71 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin received a DWC 6 from your employer on 4/21/2021. The DWC 6 stated the claimant returned to work, full duty on 4/19/2021. Benefits were paid thru 4/20/2021 which resulted in an overpayment in the amount of $251.71. Credit will be taken from future benefits, if any. | Will attempt to take credit from future benefits. | No | Overpayment recouped in full. Move to resolved tab. | ||
| 60 | 7032692 | 12/17/19 | R | $ 138.57 | $ - 0 | $ 138.57 | Sedgwick – The Third-Party Administrator for The City of Austin received noticed from your employer via a DWC6 on 03/24/2020 that injured worker has returned to work full duty/full pay on 03/24/2020. You were over paid Temporary Income Benefits (TIBs) on 03/24/2020 (1 day) in the amount of $138.57. There is currently a total overpayment of $138.57 on file which will be recouped from any future indemnity benefits. | IW rec'vd 7%. Does not appear OP taken. | Yes | Claim Closed. Confirm if OP was recouped to update OP screen. | |||
| 60 | 7032692 | 12/17/19 | R | $ 138.57 | $ - 0 | $ 138.57 | Sedgwick – The Third-Party Administrator for The City of Austin received noticed from your employer via a DWC6 on 03/24/2020 that injured worker has returned to work full duty/full pay on 03/24/2020. You were over paid Temporary Income Benefits (TIBs) on 03/24/2020 (1 day) in the amount of $138.57. There is currently a total overpayment of $138.57 on file which will be recouped from any future indemnity benefits. | IW rec'vd 7%. Does not appear OP taken. | Yes | Claim Closed. Confirm if OP was recouped to update OP screen. | |||
| 11 | 3/31/21 | 5828906 | $ 524.32 | Adjuster paid reimbursement in excess of one year | |||||||||
| 87 | 10/15/21 | 7077545 | 6/11/20 | O | $ 297.63 | $ 297.63 | $ - 0 | Updated DWC6 received from employer 09/22/21, shows weekly PIE as of 08/02/21 = $1,994.43. $2,455.38 AWW - $1,994.43 PIE = $460.95 Difference x 70% = $322.67 TP Rate. 08/02/21 – 10/03/21 (9 weeks) = $3,201.66 TP Paid. $322.67 x 9 weeks = $2,904.03 TP Owed. $3,201.66 TP Paid - $2,904.03 TP Owed = $297.63 Overpayment for period of 08/02/21-10/03/21. $322.67 x 25% = $80.67 Weekly Recoup Rate |
| Overpayment recouped | No | Recommend we move to the resolved tab. | ||||||||||
| 87 | 10/15/21 | 4A21082DF83-0001 | 8/23/21 | O | $ 473.15 | $ 473.15 | $ - 0 | DWC6 received on 9/3/21 stating that iw RTW on 9/2/21 LDRP. Benefits were paid from 9/2/21-9/6/21 causing a $473.15 overpayment. | Recouped in full | No | Move to resolved tab | |
| 87 | 6839345 | 2/23/19 | O | $ 14,782.61 | $ 10,276.96 | $ 4,505.65 | York Risk Services Group - Third Party Administrator for City of Austin received DWC 69 on 10/23/2019 from John Skyler, MD, who found claimant at maximum medical improvement on 5/17/2019 and 0% impairment rating. Based on the attached Designated Doctor exam with John Skyler, MD, on 10/16/2019 the injured worker could return to work full duty for the compensable injuries on 2/28/2019. Temporary Income Benefits (TIBs) were paid to the injured worker from 2/24-2/25/19 $$268.00; 6/15-10/23/2019 $14,514.61 = $14,782.61. There is currently a total overpayment of $14,782.61 on file which will be recouped from any future indemnity benefits. Subrogation case settled and City recovered $10,000 from the third party action. This included most of the overpayment and therefore the balance is owed back to the City. | $10,000 recovered through subrogation .Balance added to pending check reimbursement to City | Yes | Check requested to reimburse COA | ||
| 11 | 11/15/21 | 4A21088F7DG-0001 | 8/3/21 | O | $ 98.60 | $ 98.60 | $ - 0 | MMI Evaluation completed 11/08/21 placing claimant at MMI as of 10/29/21 with a 3% IR, report received 11/16/21. |
Claimant owed IIBS starting 10/30/21.
Claimant previously paid TP benefits through to 10/31/21.
Total TP paid for 10/30/21-10/31/21 = $98.60 (overpayment).
IIBS Rate-$705.00
| First week of IIBS issued for 10/30/21-11/05/21 for $705.00 - $98.60 recoup = $606.40 total IIBS issued with overpayment recovered. | Recouped in full | Move to resolved tab | ||||||||
| 15 | 7007221 | 10/10/19 | R | $ 256.35 | $ 256.35 | $ - 0 | N/A-York Risk Services Group-Third Party Administrator for the City of Austin received notice from your employer on 10/30/2019 via a DWC 6 that advised that you returned to light duty, full pay on 10/30/2019. The overpayment for the period of 10/30/2019 to 11/1/12019 in the amount of $256.35 will be applied to future income benefits, if any. | Recouped OP from IIBs | ||
| 60 | 12/15/21 | 4A21072B5CF-0001 | 7/20/21 | O | $ 139.71 | $ 139.71 | $ - 0 | TP Overpayment - $139.71 |
Period: 12/03/21 - 12/06/21
Claimant confirmed to RTW FD as of 12/03/21 via DWC6.
TP paid for DOS 11/30/21 - 12/06/21 for $244.50
$244.50 / 7 days = $34.93 x 3 days = $104.79 TP owed 11/30/21 - 12/02/21.
| $244.50 TP Paid - $104.79 TP Owed = $139.71 TP Overpayment. | Recouped in full | No | Move to resolved tab | ||||||
| 83 | 6833876 | 1/30/19 | O | $ 3,092.58 | $ - 0 | $ 3,092.58 | Per DWC 24, MMI= 7/16/20 with 5% IR |
Additional Disability from 12/2/19 to 2/12/20 TIB Rate= $938.00 IIB Rate= $656.00 Total TIBS Owed:
2/22/19 to 2/12/2020 $938.00 x 50 6/7= $47,704.00 Total IIBS Owed:
7/17/2020 to 10/29/20 $656.00 x 15 = $ 9,850.00 Total TIBS & IIBS owed = $57,544.00 Total TIBS & IIBS paid: $60,636.58 Total TIBS & IIBS owed: $57,544.00 $3092.58 OP for the period of 2/13/20- 3/16/20.
| Adjuster failed to take credit from IIIBs. | XXX | Seeking reimbursement from TPA | Check requested to reimburse COA | ||||||
| 87 | 10/15/21 | 6983068 | 9/1/19 | O | $ 1,289.14 | $ 1,289.14 | $ - 0 | Clmt reached MMI on 9/1/2021 w/15% IR.IIB Rate: $656.00 |
IIB's owed from 9/2/2021-7/13/2022 TIB'S were paid from 9/2/21-10/3/2021(4 wks)4 days@4,288.00 IIB's would have been owed for 9/2/21-10/3/21 @2,998.86 We are taking credit for TIB's that was paid.
$4,288.00-$2,998.86=$1,289.14 OP BALANCE
IIB'S INITIAL CHECK: 10/4/21-10/24/21(3 WKS)@1,968.00-25% OP CREDIT(492.00)=$1,476.00 OWED TO EEOP BALNACE: $797.14
| Recouped in full | No | ||||||||||||
| 34 | 7031275 | 12/13/19 | O | $ 441.16 | $ - 0 | $ 441.16 | Sedgwick-Third Party Administrator for the City of Austin received notice via DWC 6 from your employer that you returned to work on05/05/20 full pay with restrictions. This resulted in an overpayment of TIB which will be taken against any future income benefits: Paid = $15,517.11Due = $15,075.95OP $441.16Due periods12/14/19-12/20/19 at reduced rate of $76.5112/21/19-05/01/20 Full TIBs $772.0305/02/20-05/04/20 3 days at full rate $110.29 per day This is a Sedgwick error in missing the opportunity to recoup the overpayment. This is also an MVA case, so not sure if we wish to wait to recover from third party action. However, clearly the adjuster had ample opportunity to recoup the overpayment from IIBs and failed to do so. | IIBs paid. Have examiner review recoupment. | XXX | Examiner failed to recoup from IIBS. Reimbursement needed. | |||
| 83 | 5/17/21 | 7077979 | 6/12/20 | O | $ 277.43 | $ 277.43 | $ - 0 | Sedgwick, Third Party Administrator for the City of Austin received a DWC 73 from Dr. Welch on 06/26/2020 releasing you to return to work full duty full pay on 06/26/2020. This resulted in a one day overpayment of TIBs of $138.71 that will be recouped against any future income benefits. OP of TIBS from 11/23/2020 to 11/25/2020 added $319.20 to the total. New Total is $457.91. Overpayment recouped in full on 2/15/2021. | Overpayment recouped in full. | Move to resolved tab | |||
| 83 | 7077979 | 6/12/20 | O | $ 457.91 | $ 457.91 | $ - 0 | Sedgwick received a DWC 6 from your employer on 06/26/2020 releasing you to return to work full duty full pay on 06/26/2020. This resulted in a one day overpayment of TIBs of $138.71 that will be recouped against any future income benefits. OP of TIBS from 11/23/2020 to 11/25/2020 added $319.20 to the total. New Total is $457.91. | Possible recoupment from future indemnity benefits. MMI and IR need to be addressed. | Yes | Overpayment recovered in full. | Check from 2/1/2020 was issued at full TIB rate of $971.00 as she began losing time completely again on 1/28/2020. $971.00 was issued in two checks: $744.81 and $226.19 for a Total of $971.00 | ||
| 83 | 11/15/21 | 7077979 | 6/12/20 | O | $ 678.54 | $ 678.54 | $ - 0 | PIB'S WERE PAID FROM 7/6/21 TO 7/26/21. THIS RESULTED IN AN OVERPAYMENT IN THE AMOUNT OF $678.54. | Recouped in full from IIBS | Yes | Recommend we move to the resolved tab. | ||
| 83 | 5/15/21 | 7152532 | 1/23/21 | O | $ 353.01 | $ 353.01 | $ - 0 | Received DWC 6 on 3/24/2021. Clmt RTW, FD(FP) on 3/25/2021. Benefits were paid thru 3/28/2021 which resulted in an OP in the amount of $78.57. | |||||
| Prior Overpayment was $353.01-$91.66(OP Credit recvd)=$261.35 Op balance+$78.57(New OP)=$339.92 WHAT STEPS HAVE BEEN TAKEN TO RECOUP OVERPAYMENT | Recouped in full | No | DDE with Dr. Kevin McAlpin on 12/21/21 and was assigned a 5% IR. | ||||||||||
| 11 | 12/15/21 | 7172420 | 4/22/21 | O | $ 221.60 | $ - 0 | $ 221.60 | 221.60 TIBS Overpayment Calculations |
Updated DWC6 showing PIE received 10/18/21 showing LD earnings as of 10/11/21 of $1,108.40.
$927.59 TT / 7 days = $132.47 x 2 days = $264.94 Paid for 10/11/21 – 10/12/21 $151.71 TP / 7 days = $21.67 x 2 days = $43.34 Owed for 10/11/21 – 10/12/21
| $264.94 Paid - $43.34 Owed = $221.60 TIBS Overpayment for 10/11/21 – 10/12/21 | Recouped in full | No | Move to resolved tab | ||||||
| 11 | 11/15/21 | 7172420 | 4/22/21 | O | $ 221.60 | $ 221.60 | $ - 0 | Updated DWC6 showing PIE received 10/18/21 showing LD earnings as of 10/11/21 of $1,108.40. |
$927.59 TT / 7 days = $132.47 x 2 days = $264.94 Paid for 10/11/21 – 10/12/21 $151.71 TP / 7 days = $21.67 x 2 days = $43.34 Owed for 10/11/21 – 10/12/21
| $264.94 Paid - $43.34 Owed = $221.60 TIBS Overpayment for 10/11/21 – 10/12/21 | Recouped in full | No | Recommend we move to the resolved tab. | |||||
| 87 | 5/17/21 | 7130507 | 11/6/20 | $ 365.56 | $ 365.56 | $ - 0 | Sedgwick, Third Party Administrator for City of Austin, |
received a form DWC-6 on 01/12/2021 reporting a change in post injury earnings resulting in an overpayment of $365.56. Recouping $158.58 from this pay period. Current overpayment is currently
| $206.98. | Will attempt to take credit from future benefits. | Yes | Sticky note placed on file. | Overpayment recouped in full. Move to resolved tab | ||||||||||
| 87 | 7049884 | 2/12/20 | O | $ 1,803.29 | $ 1,803.29 | $ - 0 | COA-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer via a DWC 6 on 3/2/2020 that advised that you returned to full duty on 2/25/2020. The overpayment of $1803.29 will be applied to future income benefits, if any. The overpayment is due to TPA error. The DWC 6 was received on 2/18/2020 advising that LTB on 2/17/2020. The WP would have been 2/17 thru 2/23/2020 and first check and WP due 3/3/2020. Instead adjuster paid the WP extremely early on 2/27/2020 when notice was received in advance that LTB on 2/17/2020. Also RRTW FD was received on 2/27/2020, the same date that a check was issued. | Possible recoupment from future indemnity benefits. MMI and IR need to be addressed. | Yes | MMI 3/18/21 4% - Does not appear any credit was taken for overpayment. Email sent to handler to confirm. | Move to resolved tab | |||
| 87 | 7049884 | 2/12/20 | O | $ 1,803.29 | $ 1,803.29 | $ - 0 | COA-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer via a DWC 6 on 3/2/2020 that advised that you returned to full duty on 2/25/2020. The overpayment of $1803.29 will be applied to future income benefits, if any. The overpayment is due to TPA error. The DWC 6 was received on 2/18/2020 advising that LTB on 2/17/2020. The WP would have been 2/17 thru 2/23/2020 and first check and WP due 3/3/2020. Instead adjuster paid the WP extremely early on 2/27/2020 when notice was received in advance that LTB on 2/17/2020. Also RRTW FD was received on 2/27/2020, the same date that a check was issued. | Possible recoupment from future indemnity benefits. MMI and IR need to be addressed. | Yes | MMI 3/18/21 4% - Does not appear any credit was taken for overpayment. Email sent to handler to confirm. | Move to resolved tab | |||
| 81 | 6840967 | 2/27/19 | R | $ 10,536.54 | $ - 0 | $ - 0 | Sedgwick – The Third Party Administrator for The City of Austin received noticed from the Designated Doctor, Poorvi Sandesara, DC, via a DWC73 (see attached report) on 1/30/2020 that injured worker could have returned to work full duty on 09/07/2019. You were overpaid Temporary Income Benefits (TIBs) from 09/07/2019-01/31/2020 (21 weeks) in the amount of $10,536.54. There is currently a total overpayment of $10,536.54 on file which will be recouped from any future indemnity benefits. | this has been resolved and City agreed to accept compromise of the balance. We also recouped from the 4% | ||||||
| 83 | 12/1/20 | 7081803 | 6/26/20 | O | $ 416.13 | $ 416.13 | $ - 0 | N/A-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer on 11/12/2020 via a DWC 6 that advised that you returned to work light duty on 11/12/2020 but you were earning more than your average weekly wage while on light duty. Your pre injury average weekly wages was $1703.92 and your post injury earnings are $1726.08. Overpayment was $416.13 for 11/12/2020 to 11/14/2020.Update needed | Currently receiving TIBs. Checking recoupment status with examiner. | No | FD 2/2/21 - We will purse MMI/impairment at this time. | |||
| 87 | 11/15/21 | 4A21110N6H0-0001 | 11/8/21 | C | $ 453.12 | $ 453.12 | $ - 0 | Sedgwick, Third Party Administrator for City of Austin, received a DWC-6 on 11/22/2021 reporting you returned to work full duty on 11/22/2021. Waiting period not owed. Overpayment of $453.42 exists as 3 days TIBs owed at 151.14. | WP check was able to be voided. No overpayment on file. | No | Move to resolved tab | |||
| 83 | 12/1/20 | 7127015 | 10/21/20 | O | $ 700.92 | $ 700.92 | $ - 0 | Reduced from $1081.39 when it was discovered that he should have been paid $1007.00 instead of $971.00 OP reduced to $700.92 and is scheduled to be recouped within 2 weeks. | Currently receiving TIBs. Checking recoupment status with examiner. | XXX | final overpayment deduction on 2/9/2021. The Overpayment has now been recouped in full. | |||
| 83 | 7052866 | 1/20/20 | O | $ 284.31 | $ 284.31 | $ - 0 | City of Austin received notice from your employer on 04/29/2020 via a DWC 6 that advised that you returned to light duty, reduced pay on 4/27/2020. You are now being paid 70% of the difference between your pre injury average weekly wage and your post injury earnings. The overpayment of Full Temporary Income Benefits from 4/27/2020 to 4/28/2020 in the amount of $269.56 will be recouped from future income benefits. The City of Austin received notice from your employer on 11/20/2020 via a DWC 6 that advised that you returned to full duty work on 11/20/2020. The overpayment of $14.75 will be applied to future income benefits, if any. TOTAL OVERPAYMENT:$284.31 | Not at MMI. Additional recoupment from future income benefits. | Sticky note placed on file. | |||||
| 83 | 7064116 | 4/8/20 | O | $ 138.71 | $ 138.71 | $ - 0 | N/A-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer via a DWC 6 on 5/27/2020 that advised that you returned to full duty on 5/27/2020. One day overpayment of $138.71 for 5/27/2020 will be applied to future income benefits, if any. | Overpayment recouped | ||||||
| 22 | 9/15/21 | 6872615 | 6/4/19 | R | $ 114.98 | $ 114.98 | $ - 0 | DWC 6 received on 5/20/20 but box 18 incomplete. 5/27/20 email received confirming RTW FD 2/26/20 causing a one day overpayment in the amount of $114.98 | Possible recoupment from future indemnity benefits. DWC32 will be refiled to address MMI and IR. | No | Overpayment recouped in full | |||
| 87 | 12/1/20 | 7114401 | 9/28/20 | O | $ 489.19 | $ 489.19 | $ - 0 | N/A-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer on 11/16/2020 via a DWC 6 that advised that you returned to full duty on 11/16/2020. The overpayment of $489.19 from 11/16/2020 to 11/22/2020 will be applied to future income benefits, if any. | Possible recoupment from future indemnity benefits. MMI and IR need to be addressed. | Sticky note placed on file. | Injured worker mailed the check back. File credited. | |||
| 83 | 2/12/21 | 7034134 | 12/22/12019 | O | $ 458.86 | $ 458.86 | $ - 0 | MMI 12/3/20 8% impairment which caused an overpayment in TIBS in the amount of $458.86. We took credit for TIBS in IIBS. | We did take a TIB for IIB credit – there is no additional overpayment of benefits | |||||
| 87 | 6843055 | 3/7/19 | O | $ 1,146.41 | $ - 0 | $ 1,146.41 | Sedgwick - Third Party Administrator for the City of Austin received DWC 69 on 11/21/2019 from Ted Allen, DC, who found claimant at maximum medical improvement on 7/29/2019 and 0% impairment rating. You were overpaid Temporary Income Benefits (TIBs) from 7/30/2019 – 10/3/2019 (9 weeks 3 days) in the amount of $610.41. |
| There was a previous overpayment of Temporary Income Benefits (TIBs) from 7/8-7/11/2019 (4 days) at a daily rate of $134.00, in the total amount of $536.00. There is currently a total overpayment of $1146.41 on file which will be recouped from any future indemnity benefit This has been added to the Tracking Log seeking reimbursement from Sedgwick. | Possible recoupment from future indemnity benefits. Pending alternate rating and rescheduled BRC. Status of DWC24? | Check requested to reimburse COA | ||||||
| 87 | 6843055 | 3/7/19 | O | $ 1,146.41 | $ - 0 | $ 1,146.41 | Sedgwick - Third Party Administrator for the City of Austin received DWC 69 on 11/21/2019 from Ted Allen, DC, who found claimant at maximum medical improvement on 7/29/2019 and 0% impairment rating. You were overpaid Temporary Income Benefits (TIBs) from 7/30/2019 – 10/3/2019 (9 weeks 3 days) in the amount of $610.41. |
There was a previous overpayment of Temporary Income Benefits (TIBs) from 7/8-7/11/2019 (4 days) at a daily rate of $134.00, in the total amount of $536.00. There is currently a total overpayment of $1146.41 on file which will be recouped from any future indemnity benefit This has been added to the Tracking Log seeking reimbursement from Sedgwick. Possible recoupment from future indemnity benefits. Pending alternate rating and rescheduled BRC. Status of DWC24? The prior overpayment of $536.00 for the period of 7/8/2019 to 7/11/2019 was not correctly calculated by the prior adjuster. TIBS paid: 7/8/2019 to 7/11/2019 4 days x $134.00= $536.00 TIBS owed: 7/8/2019 to 7/11/2019 4 days x $ 12.33= $ 49.32 Total OP= $486.68 In agreement with this amount?
| 60 | 9/15/21 | 7175398 | 5/10/21 | O | $ 625.57 | $ - 0 | $ 623.57 | AWW $1,127.86 - PIE $1052.80 = $75.06 x 70% = $52.54 | No-- | Remove from the report | When the PLN9 was filed accordingly on 09/13/21, we documented the overpayment calculated at that time. It was later learned that this was a misunderstanding between the claimants supervisor and the claimant. The employer confirmed with me that the claimant did not in fact voluntarily resign. As such, it was determined that the claimant was still owed on-going TIBS benefits through to the date of their LOV noted as 09/27/21 in which they were released from care and noted as being at MMI. With the back pay of owed TIBS there was no longer any overpayment on the file. |
| 15 | 4/20/21 | 7134855 | $ 861.36 | DWC3 not recd until 1/11 - so 1 week of OP due to Sedgwick error in amount of 189.83. OP due to no DWC3 786.44. Total overpayment 976.27 MMI/3/24/21 0% |
| 83 | 11/15/21 | 4A21100DC3A-0001 | 10/14/21 | C | $ 836.78 | $ 836.78 | $ - 0 | Sedgwick, Third Party Administrator for City of Austin, received a DWC-6 on 11/01/2021 reporting you returned to work full duty 10/25/2021. You were therefore not owed for the waiting period in the amount of $532.50 and pain in excess from 10/25/2021 – 10/28/2021. Total overpayment of $836.78 | Checks were not cashed so we were able to void. Overpayment recouped in full. | No | Move to the resolved tab |
| 83 | 6/15/21 | 7161358 | 3/25/21 | O | $ 107.07 | $ 107.07 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin |
received a DWC 6 from your employer on 5/11/2021. The DWC 6 advised that you returned to work, light duty(reduced wages) on 5/12/2021. Benefits were paid thru 5/12/2021 which resulted in an
| overpayment in the amount of $107.07. Credit will be taken from future benefits. | Will attempt to take credit from future benefits. | No | Move to resolved tab | ||||||||||
| 83 | 3/1/21 | 7141865 | 12/29/20 | 0 | $ 501.91 | $ - 0 | $ 501.91 | CS not paid per order due to 2 claims open for Adrian Martinez, COVID claims, AFD and APD - wrong file had CS order uploaded - 1/25/21 to 2/22/21 | Check has been requested | ||||
| 15 | Feb-21 | 7037411 | 1/6/20 | O | $ 109.41 | $ - 0 | $ 109.41 | N/A-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer on 6/09/2020 via a DWC 6 that advised that you returned to light duty, full pay on 6/09/2020. The one day overpayment of 6/09/2020 in the amount of $109.41 will be applied to future income benefits, if any. | Possible recoupment from future indemnity benefits. MMI and IR need to be addressed. | No | IIB;s owed to date: $679.00 x 3=$2,037.00-$109.41(TIB's OP)= $1,927.59 (owed to date) | ||
| 87 | 5/17/21 | 7061918 | 3/28/20 | O | $ 693.70 | $ 693.70 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin received notice from Dr. Garcia via a DWC |
69 on 4/19/2021 which advised that you reached Maximum Medical Improvement on 2/1/2021 with an
| 8% Impairment Rating. The prior overpayment of $693.70 was applied to the first payment. | Overpayment recouped in full. | Move to Resolved tab | |||||||||||
| 87 | 7061918 | 3/28/20 | O | $ 693.70 | $ 693.70 | $ - 0 | N/A-Sedgwick-Third Party Administrator for the City of Austin received notice from your employer on 11/9/2020 via a DWC 6 that advised that you returned to full duty on 11/6/2020. The overpayment for the period of 11/6/2020 to 11/10/2020 in the amount of $693.70 will be applied to future income benefits, if any. | Possible recoupment from future indemnity benefits. MMI and IR need to be addressed. | XXX | Sticky note placed on file. Email sent to handler to request DD. | IR exam 3/8/20 | ||
| 93 | 8/15/21 | 7171378 | 4/16/21 | C | $ 1,464.00 | $ 1,464.00 | $ - 0 | DWC-6 received 07.28.2021 reporting IW rtw light duty, full pay on 07.15.2021. |
| TIBs paid from 07.15.2021 - 07.30.2021 resulting in overpayment of $1464.00. | Recouped in full | Move to resolved tab | ||||||
| 87 | 5/17/21 | 7133647 | 11/22/20 | $ 67.88 | $ 67.88 | $ - 0 | Sedgwick, Third Party Administrator for City of Austin, |
received a DWC-6 on 01/13/2021 reporting an increase in the post injury earnings resulting in an
| overpayment of $67.88. Overpayment is being recouped from this pay period. | Overpayment recouped in full. | Move to resolved tab | |||||||
| 87 | 6/15/21 | 7158251 | 3/7/21 | O | $ 97.28 | $ 97.28 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin |
received notice from your employer on 5/5/2021 via a DWC 6 advising that you returned to work on 5/5/2021 at light duty, reduced pay. The overpayment of $97.28 for the period of 5/5/2021 through
| 5/6/2021 will be applied to future income benefits, if any. | Will attempt to take credit from future benefits. | No | Check issued prior to receiving DWC6/ Recommend we move to the resolved tab, overpayment resolved. | ||||||
| 87 | 6/15/21 | 7158251 | 3/7/21 | O | $ 97.28 | $ 97.28 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin |
received notice from your employer on 5/5/2021 via a DWC 6 advising that you returned to work on 5/5/2021 at light duty, reduced pay. The overpayment of $97.28 for the period of 5/5/2021 through
| 5/6/2021 will be applied to future income benefits, if any. | Will attempt to take credit from future benefits. | No | Check issued prior to receiving DWC6/ Recommend we move to the resolved tab, overpayment resolved. | ||||||
| 87 | 7007174 | 10/10/19 | O | $ 554.87 | $ 554.87 | $ - 0 | Sedgwick, Third Party Administrator for the City of Austin received |
via a DWC 6 on 06/01/2020 that you returned to work on 06/01/2020 limited duty, reduced pay.
$2012.23 Pre-Injury AWW $1717.79 Post-Injury AWW $294.44 PTIBs AWW @ 70% = $206.11 / 7 = $29.44 per day You were overpaid for week 05/29/2020-06/04/2020 Full TIBs due 05/29/20-05/31/20= 3 days ($138.71 per day) $416.13, resulting in an overpayment of $554.87. Your new TIBs rate of $206.11 is being reduced by 25% until this amount had been
| completely recouped | recouped OP from TIBs | ||||||||
| 87 | 6/15/21 | 6971006 | 8/8/19 | O | $ 400.69 | $ 400.69 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin has |
completed the payment of Impairment Income Benefits on 5/10/2021. Your prior overpayment of
| $400.69 was applied to this payment. | Overpayment recouped in full. | Move to resolved tab | |||||||
| 83 | 5/17/21 | 7138186 | 12/14/20 | O | $ 38.58 | $ 38.58 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin |
received a DWC 6 from your employer on 4/5/2021. The DWC 6 states the claimant returned to work, full duty/full pay on 4/6/2021. Benefits were paid thru 4/6/2021 which resulted in a overpayment in the
| amount of $38.58. | Will attempt to take credit from future benefits. | No | Check issued prior to DWC6 being received. Overpayment recouped in full. Recommending we move to the resolved tab. | ||||||
| 93 | 10/15/21 | 7159115 | 2/18/21 | O | $ 1,148.04 | $ 1,148.04 | $ - 0 | CLMT RTW FD ON 8/2/21 |
TIB’S WERE PAID FROM 8/2/21 to 8/8/21 $1007.00 Overpayment CLMT RTW LD/RP on 8/9/21 @$1577.67 PTIB Rate= AWW ($1605.86) - PIE ($1577.67)= $28.19 x .70= $19.73 FULL TIB’S WERE PAID FOR DATE OF 8/9/21@143.86. PIB’S SHOULD HAVE BEEN PAID @2.82.
| 143.86-2.82=$141.04 OP AMOUNT FOR 8/9/2021, ONLY OP TOTAL: $1,148.04 ADDTL LT as of 8/17/2021 to present. Clmt was paid TIB’s from 8/17/2021-9/27/2021 at the incorrect TIB rate of $960.12. The correct TIB rate is $1007.00. ADDTL TIB’S OWED TO EMPLOYEE FROM 8/17/21-9/27/2021 IS $281.28. NEW OP TOTAL: $1,148.04-281.28(ADDTL TIB’S OWED)=$866.76 NEW OP AMOUNT. OP CREDIT OF $251.75 WILL BE TAKEN FROM CURRENT TIB’S WKLY UNTIL OP HAS BEEN RECOVERED IN FULL | Recouped in full | No | |||||||
| 11 | 5/17/21 | 7073490 | 5/23/20 | O | $ 31.74 | $ 31.74 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin |
began the overpayment recoupment process on 4/15/2021. $15.87 will be deducted weekly until the
| $31.74 overpayment is recouped. | Overpayment recouped in full. | Move to resolved tab | |||||||
| 15 | 5/17/21 | 7164344 | 4/9/21 | O | $ 511.36 | $ 511.36 | $ - 0 | Sedgwick-Third Party Administrator for the City of Austin received a DWC 6 from your employer on |
4/26/2021. The DWC 6 stated that you returned to light duty/full pay on 4/21/2021. Benefits were paid thru 4/25/2021 which resulted in an overpayment in the amount of $511.36. However, a stop pay was
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