| Monetary Determinations | |
|---|---|
| Initial and transitional claims | 10,606 |
| Sufficient wage credits | 9,401 |
| Insufficient wage credits | 1,204 |
| Proportion with insufficient wage credits | 0.114 |
| Separation Determinations | |
| Initial and reopened claims | 15,470 |
| No Issue | 12,063 |
| Issue/adjudicated | 3,407 |
| Approved | 1,550 |
| Denied | 1,857 |
| Proportion of initial and reopened claims adjudicated | 0.220 |
| Proportion of adjudicated claims denied | 0.545 |
| Proportion of initial and reopened claims denied | 0.120 |
| Nonseparations Determinations | |
| Total claimant contacts | 131,614 |
| Week paid/no issue | 127,282 |
| Issue/adjudicated | 4,332 |
| Approved | 1,969 |
| Denied | 2,363 |
| Proportion of claimant contacts adjudicated | 0.033 |
| Proportion of adjudicated contacts denied | 0.545 |
| Proportion of claimant contacts denied | 0.018 |
Sources:ETA 218 (monetary determinations);ETA 207 (separation and nonseparation determinations).
| Before Appeal or Redetermination (%) |
After Appeal or Redetermination (%) |
|||
| Type of Denial | Average | 5-State Range | Average | 5-State Range |
|---|---|---|---|---|
| Monetary | 23 | $13,424.000 | 16 | $12,236.000 |
| Separation | 15 | $37,770.000 | 9 | $37,677.000 |
| Nonseparation | 14 | $37,825.000 | 11 | $37,793.000 |
Source:Belle and Casey 1988,Table 3.
| Type of Denial | Average (%) | 5-State Range (%) |
|---|---|---|
| Monetary | 27 | 20-33 |
| Separation | 73 | 47-100 |
| Nonseparation | 71 | 48-93 |
Source:Belle and Casey 1988,Tables J.1 -J.5.
Table 1-7
Agency Actions in Erroneous Denials,by Type,1987 Denials Pilot Project
(percentage of erroneous denials for which each action taken,5-state average with 5-
state range in parentheses)
| Agency Action | Monetary Average (range) |
Separation Average (range) |
Nonseparation Average (range) |
|---|---|---|---|
| Issue undetectable with existing procedures |
25 (12-43) | 22 (0-54) | 28 (0-62) |
| Already resolving | 55 (29-82) | 31 (17-41) | 23 (8-33) |
| Took wrong action | 4 (0-10) | 32 (22-53) | 29 (15-61) |
| Insuffficient follow-through | 10 (0-27) | 7 (0-14) | 12 (0-47) |
| Issue not detected – procedures not used |
6 (0-16) | 7 (3-12) | 9 (5-15) |
Source:Belle and Casey 1988,Table 4.
| Characteristic | Nebraska | New Jersey | South Carolina | West Virginia | Wisconsin |
|---|---|---|---|---|---|
| Population (thousands) |
1,665 | 8,053 | 3,760 | 1,816 | 5,170 |
| Labor force (thousands) | 906 | 4,194 | 1,913 | 805 | 2,928 |
| Percentage growth (1990-97) |
5.0% | 3.9% | 7.9% | 1.2% | 5.7% |
| Land area (square miles) | 76,878 | 7,491 | 30,111 | 24,087 | 54,314 |
| Population per square mile | 21.3 | 1,070.9 | 122.0 | 75.9 | 94.3 |
| Average annual pay | $23,291 | $35,928 | $24,093 | $24,075 | $26,021 |
| Unemployment rate | 2.6% | 5.1% | 4.5% | 6.9% | 3.7% |
Sources:U.S.Bureau of Labor Statistics and Statistical Abstract of the United States.
Notes:The unemployment rate in 1997 for the United States was 4.9%.The U.S.population grew by
7.6%between 1990 and 1997).
| Eligibility Criteria | Nebraska | New Jersey | South Carolina | West Virginia | Wisconsin | |
|---|---|---|---|---|---|---|
| Monetary | ||||||
| Formula | Flat | 20 weeks | 1.5 x HQ | Flat | 30 x WBA | |
| Minimum earnings | $1,200 | $2,020 | $900 | $2,200 | $1,590 | |
| Distribution requirement |
>$400 outside HQ | 2Q | 2Q | 2Q | 8 x WBA outside HQ | |
| Seasonal restriction |
no | no | no | yes | yes | |
| Separation | ||||||
| Voluntary leaving: | ||||||
| Good cause restricted to work-related issues |
no | yes | no | yes | yes | |
| Number of inclusions | 0 | 0 | 0 | 2 | 4 | |
| Disqualification period |
7-10 weeks |
Duration | Duration | Duration | Duration | |
| Earnings to requalify |
-- | 6 WBA | 8 WBA | 30 days | 4 WBA | |
|  Misconduct: | ||||||
| Disqualification period (weeks) |
7-10 weeks | 5 | 5-26 | 6 | 7 | |
| Earnings to requalify |
-- | -- | -- | -- | 14 x WBA | |
| Benefits reduced | yes | no | yes | yes | yes | |
| Added penalty for gross misconduct |
yes | yes | yes | yes | no | |
| Nonseparation | ||||||
| Able and available for: | ||||||
| any work | yes | yes | no | no | yes | |
| Suitable work | no | no | no | no | no | |
| Usual work | no | no | yes | yes | no | |
| Refusing suitable work: | ||||||
| Disqualification period |
7-10 weeks | 3 weeks | Duration | 4 weeks | Duration | |
| Benefits reduced | yes | no | no | yes | no |
Note:See section 2.3 for discussion. Sources:U.S.Department of Labor,Comparison of State Unemployment Insurance Laws (1997); Advisory Council on Unemployment Insurance (1995,Chapters 7 and 8 ),Nicholson (1997),Anderson (1997),and the laws of each of the five pilot states.
| Week Ending | Counter Denials | Formal Monetary Denials |
|---|---|---|
| April 4 | 61 | 45 |
| April 10 | 105 | 107 |
| April 17 | 103 | 67 |
| April 24 | 92 | 60 |
| May 1 | 62 | 55 |
| May 8 | 82 | 54 |
| May 15 | 75 | 51 |
| May 12 | 83 | 55 |
| May 29 | 89 | 57 |
| Nine-week Total | 752 | 551 |
Source:West Virgina Bureau of Employment Programs.
| State | Monetary | Separation | Nonseparation |
|---|---|---|---|
| Nebraska | 10.1 (20/198) | 4.0 (8/200) |
14.0 (28/200) |
| New Jersey | 12.6 (23/182) |
11.3 (22/195) |
14.4 (28/195) |
| South Carolina | 23.4 (45/192) |
5.0 (10/200) |
18.5 (37/200) |
| West Virginia | 15.1 (19/126) |
3.4 (7/208) |
6.8 (14/206) |
| Wisconsin | 18.2 (37/203) |
19.7 (40/203) |
21.7 (44/203) |
| All Five Pilot States | 16.0 (144/901) |
8.7 (87/1,006) |
15.0 (151/1,004) |
Source:Tabulated from Denied Claims Accuracy Pilot records for September 1997 through September 1998.Missing cases excluded.
| A. All five pilot states | |||
|---|---|---|---|
| Reason | improper | proper | Total |
| Sufficient wages/hours/weeks/days | 0 (0) | 3 (100) | 3 (100) |
| Insufficient wages | 98 (14) | 585 (68) | 683 (100) |
| Insufficient hours/weeks/days | 1 (100) | 0 (0) | 1 (100) |
| Failure of high quarter wage test | 26 (17) | 125 (83) | 151 (100) |
| Failed transitional work requirement | 12 (27) | 32 (73) | 44 (100) |
| Other | 7 (37) | 12 (63) | 19 (100) |
| Total | 144 (16) | 757 (84) | 901 (100) |
| B. Nebraska | |||
| Reason | improper | proper | Total |
| Insufficient wages | 19 (10) | 173 (90) | 192 (100) |
| Insufficient hours/weeks/days | 1 (100) | 0 (0) | 1 (100) |
| Other | 0 (0) | 5 (100) | 5 (100) |
| Total | 20 (10) | 178 (90) | 198 (100) |
| C. New Jersey | |||
| Reason | improper | proper | Total |
| Sufficient wages/hours/weeks/days | 0 (0) | 2 (100) | 2 (100) |
| Insufficient wages | 21 (12) | 154 (88) | 175 (100) |
| Failed transitional work requirement | 0 (0) | 2 (100) | 2 (100) |
| Other | 2 (67) | 1 (33) | 3 (100) |
| Total | 23 (13) | 159 (87) | 182 (100) |
| D. South Carolina | |||
| Reason | improper | proper | Total |
| Insufficient wages | 22 (22) | 78 (78) | 100 (100) |
| Failure of high quarter wage test | 22 (25) | 66 (75) | 88 (100) |
| Failed transitional work requirement | 0 (0) | 1 (100) | 1 (100) |
| Other | 1 (33) | 2 (67) | 3 (100) |
| Total | 45 (23) | 147 (77) | 192 (100) |
| E. West Virginia | |||
| Reason | improper | proper | Total |
| Sufficient wages/hours/weeks/days | 0 (0) | 1 (100) | 1 (100) |
| Insufficient wages | 19 (18) | 89 (82) | 108 (100) |
| Failure of high quarter wage test | 0 (0) | 1 (100) | 1 (100) |
| Failed transitional work requirement | 0 (0) | 15 (100) | 15 (100) |
| Other | 0 (0) | 1 (100) | 1 (100) |
| Total | 19 (15) | 107 (85) | 126 (100) |
| F. Wisconsin | |||
| Reason | improper | proper | Total |
| Insufficient wages | 17 (16) | 91 (84) | 108 (100) |
| Failure of high quarter wage test | 4 (6) | 58 (94) | 62 (100) |
| Failed transitional work requirement | 12 (46) | 14 (54) | 26 (100) |
| Other | 4 (57) | 3 (43) | 7 (100) |
| Total | 37 (18) | 166 (82) | 203 (100) |
Source: Tabulated from Denied Claims Accuracy Pilot records for September 1997 through September
1998.
| A. All five pilot states | |||
|---|---|---|---|
| Reason | improper | proper | Total |
| No separation issue | 1 (100) | 0 (00) | 1 (100) |
| Lack of work | 1 (33) | 2 (67) | 3 (100) |
| Voluntary quit | 56 (9) | 548 (91) | 604 (100) |
| Discharge | 26 (7) | 362 (93) | 388 (100) |
| Not separated (e.g., job attached, leave of absence) |
3 (30) | 7 (70) | 10 (100) |
| Total | 87 (9) | 919 (91) | 1006 (100) |
| B. Nebraska | |||
| Reason | improper | proper | Total |
| Lack of work | 0 (0) | 2 (100) | 2 (100) |
| Voluntary quit | 7 (5) | 143 (95) | 150 (100) |
| Discharge | 1 (2) | 47 (98) | 48 (100) |
| Total | 8 (4) | 192 (96) | 200 (100) |
| C. New Jersey | |||
| Reason | improper | proper | Total |
| No separation issue | 1 (100) | 0 (00) | 1 (100) |
| Lack of work | 1 (100) | 0 (00) | 1 (100) |
| Voluntary quit | 12 (11) | 100 (89) | 112 (100) |
| Discharge | 7 (9) | 69 (91) | 76 (100) |
| Not separated (e.g., job attached, leave of absence) |
1 (20) | 4 (80) | 5 (100) |
| Total | 22 (1) | 173 (89) | 195 (100) |
| D. South Carolina | |||
| Reason | improper | proper | Total |
| Voluntary quit | 5 (6) | 77 (94) | 82 (100) |
| Discharge | 5 (4) | 113 (96) | 118 (100) |
| Total | 10 (5) | 190 (95) | 200 (100) |
| E. West Virginia | |||
| Reason | improper | proper | Total |
| Voluntary quit | 4 (3) | 119 (97) | 123 (100) |
| Discharge | 3 (4) | 82 (96) | 85 (100) |
| Total | 7 (3) | 201 (97) | 208 (100) |
| F. Wisconsin | |||
| Reason | improper | proper | Total |
| Voluntary quit | 28 (20) | 109 (80) | 137 (100) |
| Discharge | 10 (16) | 51 (84) | 61 (100) |
| Not separated (e.g., job attached, leave of absence) |
2 (40) | 3 (60) | 5 (100) |
| Total | 40 (20) | 163 (80) | 203 (100) |
Source: Tabulated from Denied Claims Accuracy Pilot records for September 1997 through September 1998.
| A. All five pilot states | |||
|---|---|---|---|
| Reason | improper | proper | Total |
| No nonseparation issue | 0 (0) | 2 (100) | 2 (100) |
| Able issue | 12 (10) | 108 (90) | 120 (100) |
| Available issue | 37 (16) | 199 (84) | 236 (100) |
| Work search issue | 7 (10) | 64 (90) | 71 (100) |
| Disqualifying/unreported income | 46 (25) | 139 (75) | 185 (100) |
| Refusal of work | 3 (17) | 15 (83) | 18 (100) |
| Reporting/registration violation | 36 (12) | 263 (88) | 299 (100) |
| Other | 10 (14) | 63 (86) | 73 (100) |
| Total | 151 (15) | 853 (85) | 1004 (100) |
| B. Nebraska | |||
| Reason | improper | proper | Total |
| No nonseparation issue | 0 (0) | 2 (100) | 2 (100) |
| Able issue | 1 (9) | 10 (91) | 11 (100) |
| Available issue | 2 (13) | 13 (87) | 15 (100) |
| Work search issue | 0 (0) | 10 (100) | 10 (100) |
| Disqualifying/unreported income | 18 (27) | 47 (72) | 65 (100) |
| Reporting/registration violation | 5 (6) | 78 (94) | 83 (100) |
| Other | 2 (14) | 12 (86) | 14 (100) |
| Total | 28 (14) | 172 (86) | 200 (100) |
| C. New Jersey | |||
| Reason | improper | proper | Total |
| Able issue | 2 (6) | 29 (94) | 31 (100) |
| Available issue | 9 (12) | 65 (88) | 74 (100) |
| Work search issue | 0 (0) | 5 (100) | 5 (100) |
| Disqualifying/unreported income | 1 (100) | 0 (0) | 1 (100) |
| Refusal of work | 0 (0) | 2 (100) | 2 (100) |
| Reporting/registration violation | 14 (19) | 61 (81) | 75 (100) |
| Other | 2 (29) | 5 (71) | 7 (100) |
| Total | 28 (14) | 167 (86) | 195 (100) |
| D. South Carolina | |||
| Reason | improper | proper | Total |
| Able issue | 4 (9) | 40 (91) | 42 (100) |
| Available issue | 4 (11) | 33 (89) | 37 (100) |
| Work search issue | 5 (17) | 24 (83) | 29 (100) |
| Disqualifying/unreported income | 15 (36) | 27 (64) | 42 (100) |
| Refusal of work | 1 (20) | 4 (80) | 5 (100) |
| Reporting/registration violation | 6 (16) | 31 (84) | 37 (100) |
| Other | 2 (33) | 4 (67) | 6 (100) |
| Total | 37 (19) | 163 (82) | 200 (100) |
| E. West Virginia | |||
| Reason | improper | proper | Total |
| Able issue | 1 (6) | 17 (94) | 18 (100) |
| Available issue | 3 (5) | 53 (95) | 56 (100) |
| Work search issue | 1 (8) | 11 (92) | 12 (100) |
| Disqualifying/unreported income | 2 (6) | 30 (94) | 32 (100) |
| Refusal of work | 1 (11) | 8 (89) | 9 (100) |
| Reporting/registration violation | 5 (9) | 53 (91) | 58 (100) |
| Other | 1 (5) | 20 (95) | 21 (100) |
| Total | 14 (7) | 192 (93) | 206 (100) |
| F. Wisconsin | |||
| Reason | improper | proper | Total |
| Able issue | 4 (25) | 12 (75) | 16 (100) |
| Available issue | 19 (35) | 35 (65) | 54 (100) |
| Work search issue | 1 (7) | 14 (93) | 15 (100) |
| Disqualifying/unreported income | 10 (22) | 35 (78) | 45 (100) |
| Refusal of work | 1 (50) | 1 (50) | 2 (100) |
| Reporting/registration violation | 6 (13) | 40 (87) | 46 (100) |
| Other | 3 (12) | 22 (88) | 25 (100) |
| Total | 44 (22) | 159 (78) | 203 (100) |
Source: Tabulated from Denied Claims Accuracy Pilot records for September 1997 through September 1998.
| Error Rate Adjusted for: | ||||
|---|---|---|---|---|
| (1) | (2) | (3) | (4) | |
| State | Error rate unadjusted |
Appeals & re- determinations |
Agency resolution |
All factors |
| Nebraska | 10 | 10 | 10 | 10 |
| (20/198) | (20/198) | (19/198) | (19/198) | |
| New Jersey | 13 | 13 | 8 | $8.200 |
| (23/182) | (23/182) | (15/182) | (15/182) | |
| South Carolina | 23 | 23 | 16 | 16 |
| (45/198) | (45/198) | (31/192) | (31/192) | |
| West Virginia | 15 | 15 | 14 | 14 |
| (19/126) | (19/126) | (17/126) | (17/126) | |
| Wisconsin | 18 | 18 | 9 | 9 |
| (37/203) | (37/203) | (19/203) | (19/203) | |
| All Five Pilot States | 16 | 16 | 11 | 11 |
| (144/901) | (144/901) | (101/901) | (101/901) | |
Source: Tabulated from Denied Claims Accuracy Pilot records for September 1997 through September 1998. Missing cases excluded.
| Error Rate Adjusted for: | ||||
|---|---|---|---|---|
| (1) | (2) | (3) | (4) | |
| State | Error rate unadjusted |
Appeals & re- determinations |
Agency resolution |
All factors |
| Nebraska | 4 | 4 | 4 | 4 |
| (8/200) | (7/200) | (8/200) | (7/200) | |
| New Jersey | 11 | 7 | 10 | $6.200 |
| (22/195) | (14/195) | (19/195) | (12/195) | |
| South Carolina | 05 | 3 | 4 | 3 |
| (10/200) | (6/200) | (8/200) | (6/200) | |
| West Virginia | 3 | 3 | 3 | 3 |
| (7/208) | (6/208) | (7/208) | (6/208) | |
| Wisconsin | 20 | 17 | 19 | 16 |
| (40/203) | (35/203) | (38/203) | (33/203) | |
| All Five Pilot States | 09 | 7 | 8 | 6 |
| (87/1,006) | (68/1,006) | (80/1,006) | (64/1,006) | |
Source: Tabulated from Denied Claims Accuracy Pilot records for September 1997 through September 1998. Missing cases excluded.
| Error Rate Adjusted for: | ||||
|---|---|---|---|---|
| (1) | (2) | (3) | (4) | |
| State | Error rate unadjusted |
Appeals & re- determinations |
Agency resolution |
All factors |
| Nebraska | 14 | 14 | 14 | 14 |
| (28/200) | (28/200) | (27/200) | (27/200) | |
| New Jersey | 14 | 12 | 14 | $11.800 |
| (28/195) | (24/195) | (27/195) | (23/195) | |
| South Carolina | 19 | 18 | 18 | 17 |
| (37/200) | (36/200) | (35/200) | (34/200) | |
| West Virginia | 7 | 6 | 6 | 6 |
| (14/206) | (13/206) | (13/206) | (12/206) | |
| Wisconsin | 22 | 20 | 18 | 16 |
| (44/203) | (41/203) | (36/203) | (33/203) | |
| All Five Pilot States | 15 | 14 | 14 | 13 |
| (151/1,004) | (142/1,004) | (138/1,004) | (129/1,004) | |
Source: Tabulated from Denied Claims Accuracy Pilot records for September 1997 through September 1998. Missing cases excluded.
| Number of Cases |
Percent CWC |
Error Rate (percent) | ||
|---|---|---|---|---|
| CWC | Non-CWC | |||
| Monetary Investigations | ||||
| Nebraska | 198 | 5.6 | 36.4 | 9 |
| New Jersey | 182 | 0 | -- | 12.6 |
| South Carolina | 192 | 2.1 | 25.0 | 23.4 |
| West Virginia | 126 | 13.5 | 76.5 | 5.5 |
| Wisconsin | 203 | 4.4 | 11.1 | 18.7 |
| All Five Pilot States | 901 | 4.6 | 46.3 | 14.5 |
| Separation Investigations | ||||
| Nebraska | 200 | 4.5 | 0.0 | 4.2 |
| New Jersey | 195 | 3.6 | 14.3 | 11.2 |
| South Carolina | 200 | 3.5 | 14.3 | 4.7 |
| West Virginia | 208 | 8.7 | 0.0 | 3.7 |
| Wisconsin | 203 | 2.0 | 25.0 | 19.6 |
| All Five Pilot States | 1,006 | 4.4 | 6.7 | 8.7 |
| Nonseparation Investigations | ||||
| Nebraska | 200 | 1.5 | 0.0 | 14.2 |
| New Jersey | 195 | 3.6 | 14.3 | 14.4 |
| South Carolina | 200 | 2.0 | 25.0 | 18.4 |
| West Virginia | 206 | 5.3 | 0.0 | 7.2 |
| Wisconsin | 203 | 1.0 | 0.0 | 21.9 |
| All Five Pilot States | 1,004 | 2.7 | 7.4 | 15.3 |
Source: Tabulations of variables for Combined Wage Claims in DCA subsystem data base.
| Method Used to Obtain information | ||||
|---|---|---|---|---|
| In-person | Telephone | Nonresponse | ||
| Monetary Investigations | ||||
| Nebraska | 4.0 | 48.0 | 12.6 | 35.4 |
| New Jersey | 7.7 | 13.7 | 21.4 | 57.1 |
| South Carolina | 46.9 | 50.0 | 0.5 | 2.6 |
| West Virginia | 0.8 | 31.0 | 46.8 | 21.4 |
| Wisconsin | 51.2 | 19.2 | 6.9 | 22.7 |
| Separation Investigations | ||||
| Nebraska | 8.0 | 55.0 | 13.5 | 23.5 |
| New Jersey | 28.2 | 31.8 | 18.5 | 21.5 |
| South Carolina | 67.0 | 30.0 | 0.0 | 3.0 |
| West Virginia | 2.9 | 31.7 | 42.3 | 23.1 |
| Wisconsin | 48.8 | 17.7 | 7.4 | 26.1 |
| Nonseparation Investigations | ||||
| Nebraska | 3.0 | 61.0 | 15.5 | 20.5 |
| New Jersey | 20.0 | 26.7 | 21.5 | 31.8 |
| South Carolina | 62.0 | 36.5 | 0.0 | 1.5 |
| West Virginia | 3.9 | 17.5 | 61.2 | 17.5 |
| Wisconsin | 51.2 | 23.2 | 8.4 | 17.2 |
Source: Tabulations of variable for "primary method claimant information obtained" in DCA subsystem data base.
| Information Obtained | No response | |
|---|---|---|
| Monetary Investigations | ||
| Nebraska | 10.9 (14/128) |
8.6 (6/70) |
| New Jersey | 18.0 (14/78) |
8.6 (9/104) |
| South Carolina | 24.1 (45/187) |
0.0 (0/5) |
| West Virginia | 15.2 (15/99) |
14.8 (4/27) |
| Wisconsin | 22.3 (35/157) |
4.4 (2/46) |
| Separation Investigations | ||
| Nebraska | 5.2 (8/153) |
0.0 (0/47) |
| New Jersey | 11.8 (18/153) |
9.5 (4/42) |
| South Carolina | 5.2 (10/194) |
0.0 (0/6) |
| West Virginia | 4.4 (7/160) |
0.0 (0/48) |
| Wisconsin | 20.7 (31/150) |
17.0 (9/53) |
| Nonseparation Investigations | ||
| Nebraska | 15.1 (24/159) |
9.8 (4/41) |
| New Jersey | 17.3 (23/133) |
8.1 (5/62) |
| South Carolina | 18.8 (37/197) |
0.0 (0/3) |
| West Virginia | 7.1 (12/170) |
5.6 (2/36) |
| Wisconsin | 20.8 (35/168) |
25.7 (9/35) |
Source: Tabulations of variable for "primary method claimant information obtained" and "action flag"in DCA subsystem data base.
| A. All five pilot states | |||
|---|---|---|---|
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 54 (67) | 27 (33) | 81 (100) |
| Proper denial | 233 (28) | 603 (72) | 836 (100) |
| Total | 287 (31) | 630 (69) | 917 (100) |
| B. Nebraska | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 7 (88) | 1 (13) | 8 (100) |
| Proper denial | 48 (25) | 141 (75) | 189 (100) |
| Total | 55 (28) | 142 (72) | 197 (100) |
| C. New Jersey | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 19 (95) | 1 (5) | 20 (100) |
| Proper denial | 100 (59) | 69 (41) | 169 (100) |
| Total | 119 (63) | 70 (37) | 189 (100) |
| D. South Carolina | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 5 (50) | 5 (50) | 10 (100) |
| Proper denial | 24 (13) | 166 (87) | 190 (100) |
| Total | 29 (15) | 171 (86) | 200 (100) |
| E. West Virginia | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 2 (40) | 3 (60) | 5 (100) |
| Proper denial | 22 (18) | 103 (82) | 125 (100) |
| Total | 24 (18) | 106 (82) | 130 (100) |
| F. Wisconsin | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 21 (55) | 17 (45) | 38 (100) |
| Proper denial | 39 (24) | 124 (76) | 163 (100) |
| Total | 60 (30) | 141 (70) | 201 (100) |
Source: Tabulated from Denied Claims Accuracy Pilot records.
| A. All five pilot states | |||
|---|---|---|---|
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 78 (55) | 65 (45) | 143 (100) |
| Proper denial | 161 (21) | 607 (79) | 768 (100) |
| Total | 239 (26) | 672 (74) | 911 (100) |
| B. Nebraska | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 20 (80) | 5 (20) | 25 (100) |
| Proper denial | 29 (17) | 139 (83) | 168 (100) |
| Total | 49 (25) | 144 (75) | 193 (100) |
| C. New Jersey | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 20 (71) | 8 (29) | 28 (100) |
| Proper denial | 50 (30) | 114 (70) | 164 (100) |
| Total | 70 (36) | 122 (64) | 192 (100) |
| D. South Carolina | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 16 (43) | 21 (57) | 37 (100) |
| Proper denial | 35 (21) | 128 (79) | 163 (100) |
| Total | 51 (26) | 149 (75) | 200 (100) |
| E. West Virginia | |||
| QPI score | |||
| DCA finding | fail | pass | Total |
| Improper denial | 3 (27) | 8 (73) | 11 (100) |
| Proper denial | 21 (18) |