Workers’ compensation claim data is central to the department’s regulatory functions. Claim information is used to track system performance and trends; monitor employer and insurer compliance; determine eligibility for department programs (Employer-at-Injury Program and Preferred Worker Program); and, to schedule Oregon-OSHA inspections. To support these purposes, it is essential that the data is accurate and received in a timely manner.
The division has an archaic computer system for claim data. Insurers submit claim documents primarily on paper forms (some as document images) and the division manually enters data from these documents into a Claims Information System. This database is over 30 years old and is inefficient, extensively bandaged, and full of workarounds in order to make the system work for the current needs.
Oregon is one of eleven states that do not allow electronic claim reporting. Electronic Data Interchange (EDI) is computer-to-computer communication that allows data to be passed quickly, efficiently, and cost-effectively. Electronic reporting minimizes error associated with a paper process and speeds up the transmission of information from insurers and self-insured employers to regulators. There is significant interest from both stakeholders and the division to move to electronic claim reporting, but the current system cannot accommodate this change.
Over the past year, the division has worked with the State Chief Information Office to determine readiness for electronic claim reporting. The analysis showed that the claim system is connected to a multitude of separate standalone programs. Thus a broader look at the division’s entire information system is more prudent than making a change to only one part. A project of this magnitude is expected to be a “stage gate” information technology project which requires an extensive process of planning, budget approval, and project implementation. The capacity to manage this type of project over the long term (five to ten years) does not currently exist in the division.
The division is requesting a budget package to hire five positions to build on the preliminary analysis, ensure that the stage gate process is followed, and develop the full plan for system modernization. The cost for this budget package will be approximately $1 million. The funding will come from premium assessments, and based on current projections this budget request will not measurably impact the assessment rate.
We expect the division will return to the legislature in 2021 with a budget request to start the first phases of the redesign process, including the statutory changes needed to implement electronic claim reporting.