UPDATE: Grace Period Extended for New AME/QME "Fact Sheet" Compliance

Benefit notice regulations (CCR §9810, et seq) require that 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. Furthermore, in the case of the AME/QME Fact Sheet (Fact Sheet E), sending an outdated version can result in audit penalties and affect a claims operation’s performance rating, which could lead to an expanded audit.

DWC Newsline 29-12 issued by the Division of Workers’ Compensation on June 15, announced that a revised version of the AME/QME Fact Sheet in English and Spanish had been posted on the DWC website in April. That information, however, was incorrect, as the Spanish version had not been posted. According to the June 15 Newsline, claims organizations had until July 15 to update their systems and implement the changes to the notice.

The Institute alerted the Division that the Spanish version had not been posted and requested that the grace period for claims administrators to begin providing the revised notice be extended until at least 30 days after both the English and Spanish versions were made available. Late yesterday, the DWC issued Newsline 32-12 announcing that the Spanish version of the revised QME/AME Fact Sheet, dated April 2012, has now been posted on its website, and that claims operations have until August 1 to begin providing the new English and Spanish versions.

According to yesterday’s Newsline, the updated Fact Sheet E has revised information on the need to fill out and file the claim form and a reformatted explanation of treatment within an MPN intended to "better clarify questions for potential use of a QME/AME." The updated fact sheet, including the text only version, in English and Spanish can now be found under the Fact sheets and guides for injured workers link on the I & A Unit web page, http://www.dir.ca.gov/dwc/iwguides.html. Please note, claims organizations are allowed to simply incorporate the revised text into their systems and are not required to include the graphics from the version posted by DWC.

CWCI strongly recommends that all members check to make sure that their claims staff is aware of the revised English and Spanish versions of the AME/QME fact sheet, both of which have April 2012 revision dates, and that their systems are reprogrammed by August 1 to send the most recent version. The Newsline on the revised Fact Sheets is posted at http://www.dir.ca.gov/dwc/dwc_newslines/2012/Newsline_32-12.html.

BY/