Employer-at-Injury Program Audits 2013 Calendar Year

Total Dollar Accuracy of Audited Accuracy of Total # of EAIP Total EAIP Reimbursements Total Dollars Reimbursements Amounts Reimbursements Audited Dollars Insurer Name Location Reimbursements Reimbursed Audited Audited Adjusted Adjusted ABF Freight System, Inc. In-office 3 $3,007.14 3 $3,007.14 0 $0.00 100.0% 100.0% Ace American Insurance Company ESIS 5 $11,993.46 5 $11,993.46 2 $262.21 60.0% 97.8% Ace American Insurance Company Gallagher Bassett Services 39 $56,490.71 35 $49,707.88 2 $162.24 94.3% 99.7% Ace American Insurance Company Corvel Enterprises Comp, Inc. 22 $84,768.51 21 $80,927.21 2 $152.16 90.5% 99.8% ACIG Insurance Company Eberle Vivinan Incorporated 11 $14,716.09 11 $14,716.09 2 $1,488.94 81.8% 89.9% Advantage Workers’ Compensation Insurance Company Gallagher Bassett Services 7 $10,205.25 7 $10,205.24 1 $0.00 85.7% 100.0% Adventist Health System of the West Adventist Health System of the West 28 $72,069.15 26 $63,032.43 4 $5,910.02 84.6% 90.6% AIG Assurance Company AIG Claims, Inc 30 $152,546.87 28 $150,087.99 3 $3,704.90 89.3% 97.5% AIG Property Casualty Company Sedgwick CMS 8 $11,003.97 8 $11,003.97 1 $38.75 87.5% 99.6% American Economy Insurance Company American Economy Insurance Company 1 $293.38 1 $293.38 0 $0.00 100.0% 100.0% American Guarantee and Liability Insurance Co. Sedgwick CMS 3 $3,218.71 3 $3,218.71 0 $0.00 100.0% 100.0% American States Insurance Company American States Insurance Company 8 $10,788.21 8 $10,788.21 0 $0.00 100.0% 100.0% American Zurich Insurance company Sedgwick CMS 76 $145,444.77 58 $110,548.60 6 $1,234.72 89.7% 98.9% American Zurich Insurance Company ESIS 11 $49,719.23 1 $1,628.75 0 $0.00 100.0% 100.0% American Zurich Insurance Company Gallagher Bassett Services 12 $16,596.96 12 $16,596.96 1 $569.06 91.7% 96.6% Arch Insurance Company Sedgwick CMS 5 $6,559.53 5 $6,559.53 2 $188.79 60.0% 97.1% Argonaut Insurance Company Argonaut Claims Services LTD 5 $8,189.35 5 $8,189.35 0 $0.00 100.0% 100.0% Argonaut-Midwest Insurance Company Argonaut Claims Services LTD 20 $22,933.64 19 $22,543.56 1 $248.60 94.7% 98.9% Argonaut-Southwest Insurance Company Argonaut Claims Services LTD 1 $1,420.58 1 $1,420.58 0 $0.00 100.0% 100.0% Asante Matrix Absence Management, Inc. 39 $83,322.05 41 $87,239.16 3 $2,331.61 92.7% 97.3% Beaverton School District 48J Tristar Risk Management 15 $19,038.28 15 $19,038.28 0 $0.00 100.0% 100.0% Bi-Mart Corporation Sedgwick CMS 2 $2,960.63 2 $2,960.63 0 $0.00 100.0% 100.0% Boise Cascade Company Corvel Enterprises Comp, Inc. 21 $58,854.39 20 $58,471.61 4 $766.00 80.0% 98.7% Brookwood Insurance Company Intermountain Claims, Inc. 1 $2,547.85 1 $2,547.85 0 $0.00 100.0% 100.0% Charter Oak Fire Insurance Company Charter Oak Fire Insurance Company 72 $117,486.00 54 $92,009.17 12 $1,259.22 77.8% 98.6% CIS Workers Compensation Group CIS Workers Compensation Group 141 $674,369.64 94 $543,575.68 9 $2,160.67 90.4% 99.6% City of Ashland Tristar Risk Management 11 $35,459.95 11 $35,459.95 3 $0.00 72.7% 100.0% City of Beaverton Tristar Risk Management 14 $46,561.82 14 $46,562.02 1 $0.00 92.9% 100.0% City of Eugene CCMSI 21 $78,227.99 20 $71,568.21 2 $0.00 90.0% 100.0% City of Gresham CCMSI 8 $37,163.52 8 $36,203.52 0 $0.00 100.0% 100.0% City of Hillsboro Tristar Risk Management 16 $43,054.37 16 $43,054.34 0 $0.00 100.0% 100.0% City of PDX City of PDX 146 $431,960.76 121 $346,225.23 6 $1,024.73 95.0% 99.7% City of Salem Corvel Enterprises Comp, Inc. 44 $176,426.46 38 $157,806.11 0 $0.00 100.0% 100.0% Clackamas County Oregon Clackamas County Oregon 10 $34,504.39 10 $34,624.30 0 $0.00 100.0% 100.0% Commerce and Industry Insurance Company AIG Claims, Inc 18 $68,045.36 18 $68,045.34 3 $3,324.63 83.3% 95.1% ConAgra Foods, Inc. Sedgwick CMS 9 $16,548.04 9 $16,548.04 5 $8,720.99 44.4% 47.3% Continental Divide Insurance Company Intermountain Claims, Inc. 8 $15,619.50 8 $15,619.50 0 $0.00 100.0% 100.0% Costco Wholesale Corporation Helmsman Management Services, LLC 125 $271,050.03 86 $185,390.33 11 $4,687.89 87.2% 97.5% Daimler Trucks North America Sedgwick CMS 24 $68,487.28 23 $63,985.66 0 $0.00 100.0% 100.0% Deschutes County Matrix Absence Management, Inc. 9 $27,534.40 9 $27,534.40 0 $0.00 100.0% 100.0% Douglas County Corvel Enterprises Comp, Inc. 13 $21,136.20 13 $21,752.20 1 $105.27 92.3% 99.5% Employers Compensation Insurance Company Broadspire Services, Inc. 2 $5,190.68 2 $5,190.68 0 $0.00 100.0% 100.0% Employers Insurance Company of Wausau Employers Insurance Company of Wausau 1 $4,404.32 1 $4,404.32 0 $0.00 100.0% 100.0% Esco Corporation Sedgwick CMS 68 $145,243.03 55 $118,332.79 0 $0.00 100.0% 100.0% Farmington Casualty Company Farmington Casualty Company 3 $3,839.28 3 $3,839.28 0 $0.00 100.0% 100.0% Farmington Casualty Company Sedgwick CMS 7 $13,246.21 7 $13,246.21 1 $523.41 85.7% 96.0% Fireman's Fund Insurance Company Gallagher Bassett Services 1 $6,120.88 1 $6,120.90 0 $0.00 100.0% 100.0% Food Services of America, Inc. Intermountain Claims, Inc. 19 $36,421.59 18 $30,322.14 5 $3,416.84 72.2% 88.7% Fred Meyer Stores, Inc. Sedgwick CMS 275 $390,923.94 134 $192,587.14 9 $4,687.14 93.3% 97.6% Freestone Insurance Company Tristar Risk Management 1 $3,978.75 1 $3,978.75 1 $0.00 0.0% 100.0% Freres Lumber Co, Inc Empire Pacific Risk Management, Inc. 8 $26,012.37 8 $26,012.37 0 $0.00 100.0% 100.0% Granite State Insurance Company AIG Claims, Inc 1 $1,043.47 1 $1,043.47 0 $0.00 100.0% 100.0% Hartford Accident and Indemnity Company ESIS 7 $13,779.69 7 $13,779.68 2 $0.00 71.4% 100.0% Hartford Accident and Indemnity Company Gallagher Bassett Services 1 $6,309.21 1 $6,309.21 0 $0.00 100.0% 100.0% Healthcare for the Mid-Columbia Region Empire Pacific Risk Management, Inc. 10 $31,483.77 10 $31,483.77 1 $385.76 90.0% 98.8% Indemnity Insurance Company of North America Constitution State Services 9 $6,024.65 9 $6,024.65 0 $0.00 100.0% 100.0% Indemnity Insurance Company of North America Sedgwick CMS 68 $231,105.78 55 $187,697.72 20 $12,478.44 63.6% 93.4% Indemnity Insurance Company of North America ESIS 11 $38,639.84 11 $38,639.84 0 $0.00 100.0% 100.0% Indemnity Insurance Company of North America Gallagher Bassett Services 186 $57,962.86 29 $54,751.76 9 $9,480.66 69.0% 82.7% Insurance Company of the State of Pennsylvania AIG Claims, Inc 6 $24,911.38 6 $24,911.38 2 $259.78 66.7% 99.0% Insurance Company of the State of Pennsylvania Sedgwick CMS 27 $35,931.37 25 $32,892.77 1 $565.50 96.0% 98.3% Insurance Company of the State of Pennsylvania Gallagher Bassett Services 1 $4,045.22 1 $4,045.20 0 $0.00 100.0% 100.0% Jackson County CCMSI 9 $31,218.02 9 $30,138.02 0 $0.00 100.0% 100.0% Jeld-Wen, Inc. Broadspire Services, Inc. 13 $25,636.34 13 $25,636.34 2 $277.26 84.6% 98.9% Kaiser Foundation Sedgwick CMS 46 $176,634.20 40 $162,497.27 5 $3,673.62 87.5% 97.7% Klamath Care Services Inc. Empire Pacific Risk Management, Inc. 10 $15,093.87 10 $15,093.83 0 $0.00 100.0% 100.0% Lane County Corvel Enterprises Comp, Inc. 35 $62,745.88 32 $56,812.99 13 $2,399.52 59.4% 95.8% Legacy Health Legacy Health 64 $194,997.28 52 $177,032.65 0 $0.00 100.0% 100.0% Les Schwab Tire Centers of Oregon Inc. Sedgwick CMS 1 $569.36 1 $569.36 0 $0.00 100.0% 100.0% Les Schwab Warehouse Centers Sedgwick CMS 90 $195,063.36 68 $150,631.35 9 $6,513.67 86.8% 95.7% Liberty Insurance Corporation Gallagher Bassett Services 58 $114,928.22 48 $91,569.00 3 $0.00 93.8% 100.0% Liberty Insurance Corporation Liberty Insurance Corporation 24 $44,759.56 23 $43,856.55 0 $0.00 100.0% 100.0% Liberty Mutual Fire Insurance Company Liberty Mutual Fire Insurance Company 10 $11,280.23 10 $11,280.09 0 $0.00 100.0% 100.0% Liberty Mutual Insurance Company Liberty Mutual Insurance Company 14 $17,242.60 14 $17,243.15 0 $0.00 100.0% 100.0% Liberty Northwest Insurance Corporation Liberty Northwest Inurance Corporation 330 $545,796.98 148 $287,407.00 9 $2,602.89 93.9% 99.1% LM Insurance Corporation LM Insurance Corporation 12 $23,200.21 12 $23,110.21 0 $0.00 100.0% 100.0% Marion County Oregon CCMSI 47 $164,646.45 41 $124,974.46 1 $1,743.84 97.6% 98.6% Marion County School District #24J CCMSI 45 $107,887.78 39 $97,850.21 1 $0.00 97.4% 100.0% Marriott International, Inc In-office 9 $9,715.48 9 $9,715.48 2 $878.17 77.8% 91.0% Marvin Lumber and Cedar Company Broadspire Services, Inc. 8 $19,400.80 6 $19,400.79 0 $0.00 100.0% 100.0% Maryland Casualty Company Sedgwick CMS 5 $5,737.95 5 $5,737.95 0 $0.00 100.0% 100.0% May Trucking Company Corvel Enterprises Comp, Inc. 15 $29,015.87 15 $24,522.40 0 $0.00 100.0% 100.0% Multnomah County Oregon Corvel Enterprises Comp, Inc. 89 $294,993.98 68 $210,030.49 20 $8,377.92 70.6% 96.0% Multnomah County School District #1 Tristar Risk Management 32 $86,552.41 29 $70,081.16 1 $0.00 96.6% 100.0% National Frozen Foods Corporation Matrix Absence Management, Inc. 2 $1,641.18 2 $1,641.18 0 $0.00 100.0% 100.0% National Union Fire Insurance of Pittsburgh, PA AIG Claims, Inc 5 $23,115.73 5 $23,115.73 0 $0.00 100.0% 100.0% National Union Fire Insurance of Pittsburgh, PA Constitution State Services 8 $6,231.43 8 $6,231.43 0 $0.00 100.0% 100.0% National Union Fire Insurance of Pittsburgh, PA ESIS 1 $2,549.85 1 $2,549.85 0 $0.00 100.0% 100.0% New Albertson's, Inc. Sedgwick CMS 46 $73,546.72 40 $62,637.54 5 $1,790.03 87.5% 97.1% New Hampshire Insurance Company AIG Claims, Inc 12 $33,040.93 12 $33,040.93 2 $170.00 83.3% 99.5% New Hampshire Insurance Company Sedgwick CMS 42 $33,148.20 37 $30,089.43 0 $0.00 100.0% 100.0% New Hampshire Insurance Company Gallagher Bassett Services 41 $47,104.28 36 $43,508.00 1 $0.00 97.2% 100.0% Nike, Inc. ESIS 1 $720.20 1 $720.20 1 $720.20 0.0% 0.0% Nordstrom, Inc. In-office 1 $533.95 1 $533.95 0 $0.00 100.0% 100.0% Norpac Foods, Inc. Norpac Foods, Inc. 31 $34,908.44 28 $33,849.68 0 $0.00 100.0% 100.0% North Clackamas School District 12 Tristar Risk Management 3 $4,876.11 3 $4,876.11 0 $0.00 100.0% 100.0% Northern Insurance Company of New York Sedgwick CMS 1 $3,788.97 1 $3,788.97 0 $0.00 100.0% 100.0% NW Natural Gas Company Matrix Absence Management, Inc. 5 $14,880.86 5 $14,880.86 2 $343.16 60.0% 97.7% Old Republic Insurance Company Sedgwick CMS 3 $2,892.23 3 $2,892.23 0 $0.00 100.0% 100.0% Old Republic Insurance Company ESIS 2 $5,004.11 2 $5,004.11 2 $510.36 0.0% 89.8% Oregon Contractors Workers Compensation Trust Empire Pacific Risk Management, Inc. 2 $11,427.34 2 $11,427.34 0 $0.00 100.0% 100.0% Oregon Educational Employers Workers Compensation Empire Pacific Risk Management, Inc. 8 $16,167.78 8 $16,167.78 0 $0.00 100.0% 100.0% Oregon Employers Trust, Inc. Empire Pacific Risk Management, Inc. 163 $285,521.29 103 $204,905.16 1 $81.00 99.0% 100.0% Oregon Nonprofit Employers Trust Empire Pacific Risk Management, Inc. 32 $60,174.27 29 $54,428.19 1 $178.37 96.6% 99.7% Oregon Operators Self-Insurers Fund Tristar Risk Management 54 $50,601.77 46 $38,581.45 7 $2,689.91 84.8% 93.0% Owens-Illinois, Inc. Gallagher Bassett Services 5 $14,737.64 5 $14,738.00 2 $261.31 60.0% 98.2% Port of Portland Tristar Risk Management 9 $40,636.44 8 $36,446.37 0 $0.00 100.0% 100.0% Portland General Electric Portland General Electric 38 $168,916.03 32 $145,377.64 4 $4,856.48 87.5% 96.7% Precision Castparts Corp. ESIS 75 $284,419.08 60 $224,736.02 5 $4,840.46 91.7% 97.8% Providence Health & Services-Oregon Sedgwick CMS 341 $892,948.53 147 $440,745.89 21 $11,836.01 85.7% 97.3% QBE Insurance Corporation Sedgwick CMS 5 $7,317.04 5 $7,317.04 0 $0.00 100.0% 100.0% RLC Industries Co. CCMSI 8 $16,642.20 8 $15,682.20 0 $0.00 100.0% 100.0% Roman Catholic Archbishop of Portland in Oregon Tristar Risk Management 10 $30,936.82 10 $30,936.80 2 $2,197.80 80.0% 92.9% RSG Forest Products Tristar Risk Management 3 $8,288.09 3 $8,288.09 0 $0.00 100.0% 100.0% Safeway, Inc. Safeway, Inc. 127 $264,908.88 87 $167,051.37 5 $1,230.61 94.3% 99.3% SAIF Corporation SAIF Corporation 5562 $12,452,772.07 300 $877,394.62 13 $2,674.72 95.7% 99.7% Seabright Insurance Company Sedgwick CMS 31 $37,151.96 28 $34,264.10 5 $3,121.72 82.1% 90.9% Select Markets Insurance Company Argonaut Claims Services LTD 5 $9,226.29 5 $9,226.29 0 $0.00 100.0% 100.0% Seneca Sawmill Company Comp Source 8 $29,500.43 8 $29,500.43 1 $4,980.70 87.5% 83.1% Sentinel Insurance Company, LTD Gallagher Bassett Services 8 $12,413.55 8 $12,414.00 1 $235.88 87.5% 98.1% Sentry Insurance A Mutual Company Intermountain Claims, Inc. 8 $20,342.95 8 $20,342.95 0 $0.00 100.0% 100.0% Sherm's Thunderbird Market, Inc. Intermountain Claims, Inc. 23 $22,750.69 22 $21,908.35 5 $1,399.28 77.3% 93.6% Special Districts Association of Oregon Special Districts Association of Oregon 193 $440,321.74 116 $285,516.10 7 $19,684.25 94.0% 93.1% Technology Insurance Company Intermountain Claims, Inc. 3 $8,626.22 3 $8,626.22 1 $249.99 66.7% 97.1% Thrifty Payless, Inc. Constitution State Services 8 $22,273.85 8 $22,273.85 3 $538.61 62.5% 97.6% Tower Insurance Company of New York York Risk Services Group, Inc. 2 $1,100.04 1 $268.00 0 $0.00 100.0% 100.0% Travelers Indemnity Company of America Travelers Indemnity Company of America 4 $10,659.40 4 $10,659.40 1 $59.55 75.0% 99.4% Travelers Property Casualty Company of America Travelers Property Casualty Company of America 8 $13,143.10 8 $13,143.00 0 $0.00 100.0% 100.0% Travelers Property Casualty Company of America Sedgwick CMS 1 $2,642.27 1 $2,642.27 0 $0.00 100.0% 100.0% Tri-County Metroplitan Transportation District Corvel Enterprises Comp, Inc. 93 $206,875.86 69 $156,212.00 0 $0.00 100.0% 100.0% Trinity Health Corporation ESIS 11 $19,792.80 11 $19,790.84 0 $0.00 100.0% 100.0% Trumbull Insurance Company ESIS 1 $2,367.27 1 $2,367.27 0 $0.00 100.0% 100.0% Trumbull Insurance Company Broadspire Services, Inc. 4 $7,278.62 4 $7,278.66 0 $0.00 100.0% 100.0% Twin City Fire Insurance Company Hartford Fire & Casualty Company 2 $5,702.80 2 $5,702.80 1 $650.81 50.0% 88.6% United States Fidelity and Guaranty Company Sedgwick CMS 2 $16,961.72 2 $16,961.72 0 $0.00 100.0% 100.0% Wal-Mart Associates Inc Sedgwick CMS 237 $334,698.90 125 $176,307.36 2 $199.62 98.4% 99.9% Washington County Tristar Risk Management 23 $65,862.91 22 $63,072.46 2 $1,009.47 90.9% 98.4% Wausau General Insurance Company Wausau General Insurance Company 1 $552.72 1 $552.72 0 $0.00 100.0% 100.0% Wausau Underwriters Insurance Company Wausau Underwriters Insurance Company 17 $17,826.20 17 $17,946.20 0 $0.00 100.0% 100.0% Work First Casualty Company Broadspire Services, Inc. 9 $7,762.57 9 $7,762.68 5 $2,259.27 44.4% 70.9% XL Specialty Insurance Company Corvel Enterprises Comp, Inc. 24 $16,394.49 17 $16,394.49 0 $0.00 100.0% 100.0% XL Specialty Insurance Company Gallagher Bassett Services 7 $6,153.74 7 $6,154.00 0 $0.00 100.0% 100.0% YRC, Inc. Sedgwick CMS 8 $9,728.08 8 $9,728.08 1 $296.18 87.5% 97.0% Zurich American Insurance Sedgwick CMS 82 $167,152.02 63 $133,628.64 16 $11,163.04 74.6% 91.6% 2013 Reimbursement Totals 10209 $22,685,721.19 3581 $8,687,724.39 329 $176,834.61 90.8% 98.0%