Member Alert: DWC Fact Sheet Revised Again Benefit notice regs

Benefit notice regs (CCR §9810, et seq) require claims administrators to include "Fact Sheets" developed by the DWC as enclosures along with benefit notice letters that must be sent to injured workers at various points within the life of a claim. Claims administrators are allowed to incorporate fact sheet text into their systems without the graphics from the version posted on the DWC website, but otherwise may not alter the Fact Sheet copy, even if it is incorrect, and failure to provide the most recent revision of a fact sheet could result in an audit penalty.

Yesterday, DWC issued a Newsline announcing it has revised the Fact Sheets — including the mandatory enclosures on TD (Fact Sheet C), PD (Fact Sheet D) and the AME/QME process (Fact Sheet E), which are now on DWC’s website. Unfortunately, the Division failed to note that the new PD fact sheets (in English and Spanish), dated March 2013, are corrected versions of the ones it released Feb. 7 (DWC Newsline 06-13) with instructions to claims operations that they had to begin distributing them by March 18. Thus, anyone who followed that directive is now using an incorrect & outdated PD Fact Sheets.

CWCI recommends that you check to make sure that your claims staff is aware of the latest revision to the PD fact sheet and that your systems are programmed to send the March 2013 rather than the February 2013 version, and that you check to see that the March 2013 versions of the TD and AME/QME fact sheets are being used.

An attorney for the Division did suggest at last month’s DWC Conference that revisions to benefit notice regs which are scheduled for later this year may eliminate the fact sheet requirements, however, as noted in yesterday’s Newsline, for the time being they are still required enclosures. The latest DWC Newsline on Fact Sheets, which includes a link to the latest versions, is at DWC NewsLine19-13.

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