Member Alert: Check The Revision Date on Your AME/QME Fact Sheets

On December 17, 2009, the DWC issued Newsline 62-09 announcing revisions to its benefit notice manual & other forms, including the AME/QME Fact Sheet (I&A Fact Sheet E, Rev. 11/2009), which it had posted on its website. The Division noted that benefit notice regulations (CCR §9810, et seq, effective April 2008) require claims administrators to enclose the most recent revision of a fact sheet along with notice letters that must be sent at various points in the life of a claim, and specified that sending outdated Fact Sheets is a basis for an audit penalty, and in the case of the AME/QME Fact Sheet, could affect a claims operation’s performance rating, which in turn,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.

CWCI forwarded this information to members in our December 17, December 18 and January 4 newsclips, and in a December 17 email to committees, but given the holiday timing of the DWC announcement, some claims administrators may not have taken note. The Institute strongly recommends that all members check to make sure that their claims staff is sending the most recent fact sheets – especially the 11/2009 version of the AME/QME Fact Sheet.

DWC’s Newsline announcing the release of its Benefit Notice Manual and the revised forms and fact sheet is posted at http://www.dir.ca.gov/dwc/dwc_newslines/2009/Newsline_62-09.html .

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