Amend Section 15400. Claim File to read:
(a) Every self administering self-insurer or its administrative agency shall keep a claim file of each self insured indemnity and or medical-only work-injury occurring on or after January 1, 1990, in accordance with Title 8, Section 10101 and Section 10101.1.
(b) For work injuries occurring prior to January 1, 1990, every self insurer shall keep a claim file including those claims which were denied. Said claim file shall contain, but not be limited to, a copy of:
(c) Every self administering self insurer or its claims administrative agency maintaining a claim file pursuant to subsection (a), shall insure that the file is complete and up-to-date for each self insured indemnity or medical-only injury occurring after January 1, 2004. A complete file shall include the following and be in chronological order, with the most recent date on top:
(c) (d) The administrator shall set a realistic estimate of incurred liability for each claim and shall adjust the estimate upon receipt of medical reports, orders of the Appeals Board, or upon the administrator's own evaluation of the claim based on other relevant information, that indicate the current estimate of future liability needs to be adjusted. The estimate shall be noted in the claim file or identified with the claim file.
(e) Claim files not in compliance with subsection (c) with dates of injury after January 1, 2004 is prohibited.
(f) Contents of claim files maybe in hard copy or electronic forms, or some combination of hard copy and electronic form. However, regardless of the forms, the content of the files shall contain all items required by subsection (c) and must be easily visible or retrievable.
(g) Each claims administrator shall provide the complete contents set forth in subsection (c) above to any subsequent claims administrator designated by the self insurer. Failure to maintain complete claims files and/or failure to provide complete claim files to the subsequent claims administrator shall be good cause for revocation of the administrative agencies Certificate of Administer.
NOTE: The use of a "Reserve Worksheet" developed by the administrator to document initial estimates of incurred liability and subsequent adjustments to the estimate is recommended.
Note: Authority cited: Sections 54, 55, 59 and 3702.10, Labor Code. Reference: Sections 59, 129, 3700, 3700(b), 3701, 3702, 3702.1, 3702.5, 3702.6, 3703, and 3705, Labor Code.