What triggers a UR investigation?
A. Claims administrators are subject to routine investigations once every five years. These routine investigations generally will be conducted as part of the existingDperformance audit review (PAR) process under Labor Code sections 129 and 129.5. UROs will be subject to routine investigation once every three years. Also, if the claims administrator or URO has failed a previous routine investigation, DWC can return for a target investigation. The DWC can also do a target investigation based on a credible complaint. Credible complaints will go to the claims administrator for their response prior to an investigation, unless the AD determines that advance notice will render the special target investigation less useful.
