A Performance Audit
An Audit Report on The Ombudsman Program at the Office of Injured Employee Counsel
The Office of Injured Employee Counsel (Office) had processes and related controls for its Ombudsman Program; however, it did not always ensure that it administered the program in accordance with applicable requirements. While the Office has implemented an ombudsman training program, the lack of consistent and accurate (1) monitoring and (2) documentation of activities performed increases the risk that that the Office is not effectively providing assistance to injured employees to help them protect their rights within the workers’ compensation system. Specifically, the Office did not:
- Monitor its Ombudsman Program in accordance with Office policies.
- Ensure that staff accurately and completely captured information about the assistance provided to injured employees in the Dispute Resolution Information System (DRIS).
- Maintain consistent documentation supporting that it provided assistance to injured employees in accordance with statutes, rules, and policies.
The Office complied with requirements for handling complaints and training ombudsmen. Specifically, the Office:
- Implemented a process for tracking and acting on complaints and followed its process for most complaints tested.
- Implemented an ombudsman training program that includes the key elements required by Texas Labor Code. It also ensured that participants completed most key elements of the program.
The Office Had Monitoring Processes for Its Ombudsman Program; However, It Did Not Ensure That Policies Were Followed
The Office had processes in place for evaluating ombudsmen’s performance and compliance with Office policies. However, the Office did not always ensure that those processes were performed in accordance with Office policies. Specifically, the Office did not ensure (1) that regional managers conducted required technical observations of ombudsmen or (2) that the Quality Assurance (QA) team accurately completed and compiled the results of the workers’ compensation case reviews that it performed.
The Office has implemented a process for tracking and acting on complaints that it receives as required by Texas Labor Code, Section 404.008.
The Office Did Not Accurately and Completely Capture Information in DRIS About the Assistance It Provided to Injured Employees
The Office did not ensure that the information it captured in the Dispute Resolution Information System (DRIS), which it uses to document the assistance provided to injured employees, was accurate or complete. Auditors identified inaccurate and missing information, such as staff activities that were not captured, duplicate records, records entered in error, and staff activities that were not coded correctly.
The Office Did Not Always Have Documentation to Support that It Provided Certain Types of Assistance to Injured Employees as Required
The Office did not always have documentation in DRIS or workers’ compensation case files to support that it provided certain types of assistance to injured employees as required. Based on the testing performed, staff did not always request and frequently did not exchange documentary evidence timely or at all, and staff did not consistently schedule or hold required preparation appointments within required time frames.
In addition, while there was documentation that ombudsmen helped injured employees develop their cases timely and held required preparation appointments with them for most cases analyzed, compliance with those requirements could be improved.
The Office Has Implemented an Ombudsman Training Program and Ensured That New Ombudsmen Completed Most Key Requirements
The Office has adopted training guidelines for ombudsmen and implemented an ombudsman training program that includes the key elements required by Texas Labor Code, Section 404.152, and Texas Administrative Code, Chapter 276.
In addition, the five participants in the program scheduled for November 2018 through March 2019 completed most required key elements of the program.
Graphics, Media, Supporting documents