DWC Releases Sample Benefit Notices in Spanish

The Division of Workers’ Compensation has developed Spanish versions of its sample benefit notices and posted them in a revised benefit notice manual on its website to help workers’ compensation claims operations comply with changes in the benefit notice regulations that took effect April 9, 2008.

DWC notes that as with the English versions of the sample notices, the Spanish-language notices are not intended to be used verbatim in lieu of individual notices tailored to the specific facts of each claim. Each benefit notice must contain all relevant elements mandated by statute or regulation, and claims organizations are required to draft notices that meet the regulations, as these will be reviewed by the DWC Audit Unit as part of their performance audits. Division auditors report that during recent reviews, they have found some claims organizations are sending notices that lack the necessary information and/or are sending the information beyond the required time frames.

The regulations that took effect in April require claims operations to send “DWC fact sheets” along with notice letters at various points in the life of a claim. These include fact sheets on TD, PD and on the AME/QME process. In its announcement, the DWC specifically cited failure to send Fact Sheet E on the AME/QME process as a problem that will affect a claims organization’s performance rating, which could lead to an expanded audit. DWC also issued a reminder that in claims where it is determined that there is no residual disability and the worker is not entitled to permanent disability, the claims administrators must advise the worker within 14 days of the determination.

The Division has posted its benefit notice manual and sample benefit notices in English and Spanish at http://www.dir.ca.gov/dwc/audit.html. . The revised benefit notice regs are posted at (www.dir.ca.gov/dwc/DWCPropRegs/BenefitNoticeRegulations/BNU_FinalRegulations.doc).
To access a Word or Adobe Acrobat file of a Spanish fact sheet (Hoja de información) go to: www.dir.ca.gov/dwc/iwguides_Spanish.html.

• The Spanish version of the Temporary Disability fact sheet is: Hoja de información C “Respuestas a sus preguntas sobre los beneficios de incapacidad temporal”

• The Spanish version of the Permanent Disability fact sheet is: Hoja de información D “Respuestas a sus preguntas sobre los beneficios de incapacidad permanente”

• The Spanish version of the AME/QME fact sheet is: Hoja de información E “Respuestas a sus preguntas sobre evaluadores médicos calificados y evaluadores médicos acordados”

BY/