DWC Agrees to 30-Day Grace Period to Update "Fact Sheets" and Allows Text-Only Versions

CWCI’s December 7 Executive Memo noted that the DWC announced two weeks ago that it had posted revised versions of its Facts Sheets on its website, including those on TD benefits (Fact Sheet C), PD benefits (Fact Sheet D), and AMEs/QMEs (Fact Sheet E), all of which are required along with benefit notice letters at specific points in the life of the claim (per CCR 9812).

Because there was no advance notice that these required publications were changing, this created an issue for claims operations as the state’s benefit notice regulations specify that: 1) claims administrators must enclose the most recent revision of a Fact Sheet along with their notice letters; and 2) sending outdated Fact Sheets is a basis for an audit penalty, which in the case of the AME/QME Fact Sheet, could affect a claims operation’s performance rating, which in turn, could lead to an expanded audit. In addition, the revised Fact Sheets included graphics that made it difficult for companies to program the Fact Sheet text into their systems.

Last week, the Institute contacted the DWC and requested a grace period to allow claims operations time to reprogram the revised Fact Sheets into their systems, and to allow them to simply incorporate the revised text (sans the graphics) of the revised Fact Sheets. The Division has now agreed to a 30-day grace period and has specified that claims administrators only need to use the revised text and not the graphics in generating these new notices. The DWC has posted text-only versions of the revised Facts Sheets in English and Spanish on its Information & Assistance Unit web page http://www.dir.ca.gov/dwc/IandA.html and yesterday’s Newsline announcing these clarifications is posted at http://www.dir.ca.gov/dwc/dwc_newslines/2010/Newsline_70-10.html.

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