CWCI Member Alert: Update Your AME/QME "Fact Sheets"

The DWC today issued Newsline 29-12 announcing that it has posted a revised version of its QME/AME Fact Sheet (Fact Sheet E) on its website. Benefit notice regulations (CCR §9810, et seq) require that Fact Sheets be included as enclosures along with benefit notice letters that must be sent to injured workers at several different points within the life of a claim.

The DWC Newsline notes that the revised AME/QME fact sheet is available in English and Spanish to employers and insurers who are required to comply with benefit notice regulations, and can be found at http://www.dir.ca.gov/dwc/iwguides.html.

Please note that the benefit notice regulations require that claims administrators provide the most recent revision of a fact sheet along with the benefit notice letters and sending outdated Fact Sheets is a basis for an audit penalty. Furthermore, in the case of the QME/AME Fact Sheet, failure to supply the correct version could affect a claims operation’s performance rating, which could lead to an expanded audit.

The DWC notes that it posted the revised AME/QME Fact Sheet on its website in April of this year, though it made no announcement at the time, so today’s Newsline was the first notification to the claims community that the mandatory notice has changed. DWC has announced a 30-day grace period, so claims operations have until July 15 to implement the changes. Claims organizations are allowed to simply incorporate the revised text into their systems and are not required to include the graphics from the version posted by DWC.

CWCI strongly recommends that all members check to make sure that their claims staff is aware of the latest revision to the AME/QME fact sheet and that their systems are reprogrammed to send the most recent version. The Newsline on the revised Fact Sheets is posted at http://www.dir.ca.gov/dwc/dwc_newslines/2012/Newsline_29-12.html.

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