Chapter 4.5. Division of Workers' Compensation
Subchapter 1.5. Injuries on or After January 1, 1990
Article 2. Claims Administration and Recordkeeping

§10103.1. Claim Log--Contents and Maintenance.

This section shall govern claim log maintenance on or after January 1, 1994.
(a) The claims administrator shall maintain annual claim logs listing all work-injury claims, open and closed. Each year's log shall be maintained for at least five years from the end of the year covered. Separate claim logs shall be maintained for each self-insured employer and each insurer for each adjusting location.

(b) Each entry in the claim log shall contain at least the following information:

(1) Name of injured worker.

(2) Claims administrator's claim number.

(3) Date of injury.

(4) An indication whether the claim is an indemnity or medical-only claim.

(5) An entry if all liability for a claim has been denied at any time. All liability is considered to have been denied even if the administrator accepted liability for medical-legal expense.

(6) If the claim log is for a self-insured employer and a Certificate of Consent to Self-Insure has been issued, the name of the corporation employing the injured worker. If the claim log consists of claims for two or more members of an insurer group, each entry on the log shall identify the insurer.

(c) The entries on a log provided to the Administrative Director shall reflect current information, to show at least any changes in status of a claim which occurred 45 days or more before the claim log was provided. However, once all liability for a claim has been denied the log shall designate the claim as a denial, even if the claim was later accepted.

(d) The claim log of each former self-insured employer and each self-insured employer which changes or terminates the use of a third-party administrator shall be maintained by that self-insured employer as required by subsection (a).

(e) A claims administrator shall provide a copy of a claim log within 14 days of receiving a written request from the Administrative Director.

   Note: Authority cited: Sections 59, 129.5, 133 and 5307.3, Labor Code. Reference: Sections 124, 129, 129.5, 138.4, 3702.8 and 5401, Labor Code.

 HISTORY 

   

1. New section filed 1-28-94; operative 1-28-94.  Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 94, No. 4).

2. Amendment of subsection (b)(6) filed 2-14-96; operative 2-14-96. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 96, No. 7).