CWCI Member Alert: Update Your Fact Sheets

Last Friday, the DWC issued Newsline 67-10 announcing that it has posted revised versions of its Facts Sheets on its website, including those on TD benefits (Fact Sheet C), PD benefits (Fact Sheet D), and QMEs/AMEs (Fact Sheet E). Benefit notice regulations that took effect in April 2008 (CCR §9810, et seq) require that these 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.

While the DWC Newsline noted that the revised fact sheets "are available to employers and insurers who are required to comply with benefit notice regulations," "are available for immediate use in English and Spanish" and "can be found at http://www.dir.ca.gov/dwc/iwguides.html," it did not mention two requirements included in the benefit notice regs that could potentially trip up claims administrators:

1) workers’ compensation claims administrators must enclose the most recent revision of a fact sheet along with the benefit notice letters; and

2) sending outdated Fact Sheets is a basis for an audit penalty, and in the case of the QME/AME Fact Sheet, could affect a claims operation’s performance rating, which could lead to an expanded audit.

Given that there was no advanced notice that these mandatory Fact Sheets were about to change, that this is the second time that the QME/AME Fact Sheet has been revised this year, and that DWC made no mention of a grace period for implementing the changes, CWCI strongly recommends that all members check to make sure that their claims staff is aware of the November 2010 revisions and that their systems are reprogrammed to send the most recent fact sheets – especially the November 2010 version of the QME/AME Fact Sheet. The Newsline on the revised Fact Sheets is posted at http://www.dir.ca.gov/dwc/dwc_newslines/2010/Newsline_67-10.html.

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