Chapter 4.5. Division of Workers' Compensation
Subchapter 1.5. Injuries on or After January 1, 1990
Article 1. Audit, General Definitions

§10103.2. Claim Log--Contents and Maintenance

This section shall govern claim log maintenance on or after January 1, 2003.

(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. Indemnity claims shall be differentiated from medical-only claims or any other claim where no indemnity payment(s) has been made. Claims that only require the provision of first aid, as defined by California Code of Regulations, title 8, section 9780(d), should not be included in the claim log.

(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, the log shall identify the insurer for each claim.

(7) If the claim has been transferred from one adjusting location to another:

(A) The address of the new location shall be identified on the initial adjusting location's log along with the date of transfer.

(B) Claims that are transferred from one adjusting location to another shall be listed on the claim log of the new adjusting location for the year in which the claim was initially reported, not for the year in which the claim was transferred. The claim log shall also indicate the address of the old adjusting location along with the date of transfer.

(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 that 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 12-30-2002; operative 1-1-2003 pursuant to  GovernmentCode section 11343.4 (Register 2003, No. 1).

2. Amendment of subsections (b)(4) and (b)(7), including redesignation and amendment of portions of subsection (b)(7) as new subsections (b)(7)(A)-(B), filed 4-20-2009; operative 5-20-2009 (Register 2009, No. 17).