IDES Quality Assurance & Compliance 2 — Questions and Answers
Question 1: An IDES claims examiner discovers that a claimant submitted falsified wage records to inflate their Weekly Benefit Amount. What is the appropriate compliance action?
- Issue a warning and correct the benefit amount going forward
- Refer the case to the IDES fraud investigation unit and issue an overpayment determination (Correct answer)
- Allow the inflated amount since the error was the employer's fault
- Close the claim without further action to avoid backlog
Correct answer: Refer the case to the IDES fraud investigation unit and issue an overpayment determination
Falsified wage records constitute fraud and must be referred to the fraud investigation unit, with an overpayment determination issued for benefits received in excess.
Question 2: Under Illinois UI law, what is the maximum percentage of a claimant's Weekly Benefit Amount that can be deducted per week to recover a non-fraud overpayment?
- 25%
- 50% (Correct answer)
- 100%
- 75%
Correct answer: 50%
IDES may withhold up to 50% of the Weekly Benefit Amount per week to recoup non-fraud overpayments.
Question 3: A Quality Assurance reviewer finds that an adjudicator consistently misclassifies 'lack of work' separations as 'voluntary quit' without evidence. This represents:
- Acceptable variation in adjudicator judgment
- A systemic accuracy error requiring targeted retraining and supervisory review (Correct answer)
- A minor issue correctable only at the appeal stage
- Evidence the employer is committing fraud
Correct answer: A systemic accuracy error requiring targeted retraining and supervisory review
Consistent misclassification of separation reasons is a systemic accuracy error that requires QA intervention, retraining, and supervisory oversight.
Question 4: The Benefit Payment Control (BPC) unit uses cross-matching with which federal database to detect claimants who return to work without reporting earnings?
- Social Security Administration Death Master File
- National Directory of New Hires (NDNH) (Correct answer)
- Department of Homeland Security E-Verify
- IRS Individual Master File
Correct answer: National Directory of New Hires (NDNH)
The NDNH, maintained by the federal Office of Child Support Enforcement, reports new hire data that BPC cross-matches against active UI claims.
Question 5: An employer submits a late response to a separation questionnaire 35 days after the due date. Under standard IDES QA policy, what typically happens?
- The response is accepted with a penalty fee applied
- The response is accepted and the determination is reopened
- The late response is generally not accepted and the determination stands (Correct answer)
- The employer is automatically disqualified from future protests
Correct answer: The late response is generally not accepted and the determination stands
IDES generally does not accept employer responses submitted after the established deadline, and the original determination remains in effect.
Question 6: Which IDES quality metric measures the percentage of monetary determinations issued within the federally required timeframe?
- Nonmonetary Timeliness Rate
- First Payment Promptness Rate
- Monetary Determination Timeliness Rate (Correct answer)
- Appeals Reversal Rate
Correct answer: Monetary Determination Timeliness Rate
The Monetary Determination Timeliness Rate tracks whether IDES issues monetary determinations within the federally mandated timeframe.
Question 7: A claimant certifies they were 'able and available' for work during a week when medical records show they were hospitalized and unable to work. This is an example of:
- A clerical error that does not affect eligibility
- A potential fraudulent misrepresentation requiring investigation (Correct answer)
- An employer reporting error
- An acceptable claim since hospitalization is involuntary
Correct answer: A potential fraudulent misrepresentation requiring investigation
Certifying availability while hospitalized and unable to work is a misrepresentation of eligibility, which constitutes potential fraud and requires investigation.
IDES Quality Assurance & Compliance 2
An IDES claims examiner discovers that a claimant submitted falsified wage records to inflate their Weekly Benefit Amount.
What is the appropriate compliance action?