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DWCNewsline 62-09: Division of Workers' Compensation posts revised benefit notice manual
December 17, 2009
The Division of Workers' Compensation (DWC) has posted a revised benefit notice manual and sample benefit notices to its Web site. The benefit notice manual offers guidance for claims administrators in providing injured workers with notices that comply with the benefit notice regulations found in Title 8, California Code of Regulations, sections 9810, 9811, 9812, 9813, 9813.1 and 9813.2.
California regulations provide that benefit notices, except those notices whose language or format is set forth in statute or those specific notice forms adopted by regulation, may be produced in any format developed by the claims administrator. The regulations require that each benefit notice contain all relevant elements required by either statute or regulation. They also require the DWC administrative director to make sample notices that comply with these requirements available on the DWC Web site.
The revised manual updates both the substance of benefit notice provisions and required attachments that must be enclosed with various notices:
• The revised QME/AME Fact Sheet, (I&A Fact Sheet E) posted November 9, 2009;
• The QME Panel Request Form for Unrepresented Workers, QME Form 105, with attachment;
• The Notice of Offer of Regular Work, (form 10118, renumbered from form 10003);
The revision also includes corrections to minor typographical errors.
The benefit notice regulations require the most recent revision of a given fact sheet to be enclosed with certain benefit notices (the notices and attachments are specified in the benefit notice regulations at section 9810, et seq). Sending out an outdated fact sheet is a basis for an audit penalty. In the case of the QME/AME sheet, this could affect the audit subject's performance rating.
The sample notices are not intended to be used verbatim in lieu of individual notices tailored to the specific facts of each claim. The revised benefit notice manual and sample benefit notices can be found on the DWC Web site at http://www.dir.ca.gov/dwc/BenefitiNoticeManual/BenefitNoticeManual.pdf
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