Fact Sheet Issues

To: Principal/Claims/Legal Executives February 13, 2008

From: Bob Young

DWC Fact Sheet Issues

The new benefit notice regs adopted by the Division of Workers’ Compensation in December (www.dir.ca.gov/dwc/DWCPropRegs/BenefitNoticeRegulations/BNU_FinalRegulations.doc ) take effect April 9.

Some of the changes reflect ‘02-‘04 reforms, but the regulations also include new requirements that claims administrators send "DWC fact sheets" along with notice letters that go out at various points in the life of a claim. Requirements include fact sheets on TD, PD, and on the AME/QME process. Currently, fact sheets are not required on all indemnity claims, but instead are posted on the DWC website (http://www.dir.ca.gov/dwc/iwguides.html), and until now it has been DWC’s job to distribute them upon request to inquiring injured workers and interested parties, per LC 139.6(c)(3).

Throughout the regulatory approval process, CWCI testified against requiring claims administrators to send the fact sheets, citing not only the added expense and additional paperwork, but the difficulty of keeping the information accurate and current. With less than 2 months to go until claims administrators must begin distributing the fact sheets, that challenge is becoming more apparent. At this point, the DWC has posted a revised TD Fact Sheet (revision date 2/08) that includes information on the 2-year TD cap that took effect for injuries on or after 1/1/08, though other deficiencies remain. The PD and AME/QME fact sheets posted on the DWC website are still the 12/05 versions, and the Institute believes the Division should make sure all of the fact sheets are up to date and accurate before requiring claims administrators to send them to injured workers.

The Institute has contacted the Administrative Director asking for her help in updating and correcting the fact sheets, as well as the DWC’s posting notice, as soon as possible. We will keep you posted on her response.

BY/