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Chapter 8. Office of the Director
Subchapter 2. Administration of Self-Insurance Plans
Article 9. Recordkeeping and Audits

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§15400. Claim File.

(a) Every self-insurer or its administrative agency shall keep a claim file of each indemnity and 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:

(1) Employers Report of Occupational Injury or Illness, Form No. 5020;

(2) Every report made to the Administrative Director of the Division of Industrial Accidents; including but not limited to the letter of denial to the employee;

(3) Doctor's First Report of Occupational Injury or Illness, Form No. 5021;

(4) Every subsequent relevant medical report;

(5) All applicable orders of the Workers' Compensation Appeals Board and reports relating thereto;

(6) A record of payment of compensation benefits as compensation is defined in Section 3207 of the Labor Code, together with a record of the periods covered by disability payments, including a copy of DIA Form 500, Notice of Termination of Benefits;

(c) For injuries reported on or after January 1, 2006, each self administering self insurer and claims administrative agency shall maintain a claim file for each indemnity and medical-only claim, including denied claims, and shall ensure that each file is complete and current for each claim. Contents of claim files may be in hard copy, in electronic form, or some combination of hard copy and electronic form. Files maintained in hard copy shall be in chronological order with the most recently dated documents on top, or subdivided into sections such as medical reports, benefit notices, correspondence, claim notes, and vocational rehabilitation. In addition to the contents specified in Title 8, California Code of Regulations, Section 10101.1, each indemnity file shall contain itemized written documentation showing the basis for the calculation of estimated future liability and for each change in estimated future liability for the claim. Files or portions of files maintained in electronic form shall be easily retrievable.


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, 3704 and 3705, Labor Code.


HISTORY

1. Amendment filed 12-3-69; effective thirtieth day thereafter (Register 69, No. 49).

2. Amendment filed 11-19-75; effective thirtieth day thereafter (Register 75, No. 47).

3. New subsection (g) filed 11-21-78; effective thirtieth day thereafter (Register 78, No. 47).

4. Amendment filed 2-19-92; operative 3-20-92 (Register 92, No. 13).

5. Change without regulatory effect amending subsection (a) filed 11-3-96 pursuant to section 100, title 1, California Code of Regulations (Register 96, No. 46).

6. Repealer and new subsection (c) filed 2-9-2006; operative 3-11-2006 (Register 2006, No. 6).

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