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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 8. Benefit Notices; Claims Administrator’s Duties and Responsibilities; Claim Form and Notice of Potential Eligibility for Benefits; Regulatory Authority of the Administrative Director.
§9810. General Provisions.
(a) This Article applies to benefit notices prepared on or after its effective date. Amendments to this Article filed with the Secretary of State on December 11, 2007 shall become effective for notices required to be sent on or after April 9, 2008.
(b) The Administrative Director may issue and revise from time to time a
Benefit Notice Instruction Manual as a guide for completing and serving the notices required by this Article.
(c) Benefit notice letters, excepting those notices whose language or format are set forth in statute or where a specific notice form has been adopted as a regulation, may be produced on the claims administrator's letterhead. Unless sent on the claims administrator's letterhead, all notice letters shall identify the claims administrator's name, mailing address and telephone number, the employee's name, employer's name, the claim number, the date the notice was sent to the employee, and the date of injury. All notices shall clearly identify the name and telephone number and mailing address of the individual claims examiner responsible for the payment and adjusting of the claim, and shall include a notation if one or more attachments are being sent with the notice and shall clearly state that additional information may be obtained from an Information and Assistance officer with the Division of Workers' Compensation. If the employer offers additional disability benefits in addition to those provided by law under workers' compensation, the claims administrator may incorporate the information within the notices required by these regulations. A single benefit notice may encompass multiple events.
(d) Benefit notices, excepting those notices whose language or format are set
forth in statute or specific notice forms adopted by regulation, may be produced in any format developed by the claims administrator. Each such benefit notice shall contain all relevant notice elements required by either statute or regulation. The Administrative Director shall make sample notices that comply with these requirements available on the DWC website.
(e) The claims administrator shall provide copies to the employee, upon request, of all medical reports, relevant to any benefit notice issued, or which are not required to be provided along with a notice and have not yet been provided to the employee other than psychiatric reports which the physician has recommended not be provided to the employee.
(f) The claims administrator shall send a copy of each benefit notice, and any enclosures not previously served on the attorney, concurrently to the attorney of any represented employee.
(g) Any deadline for reply which is measured from the date a notice is sent, and all rights protected within the deadline, are extended if the notice is sent by mail, as follows: by 5 days if the place of mailing and the place of address are in the same state of the United States; by 10 days if the place of mailing and the place of address are in different states of the United States;
by 20 days if the place of mailing is in and the place of address is outside the United States. All notices shall be mailed from the United States.
(h) Copies of all benefit notices sent to injured workers shall be maintained by the claims administrator in the claims file. In lieu of retaining a copy of any attachments to the notice, the claims administrator may identify the attachments by name and revision date on the notice. These copies may be maintained in paper or electronic form.
(i) All benefit notices shall be made available in English and Spanish, as appropriate.
|| Note: Authority cited: Sections 59, 124, 133, 138.3, 138.4, 139.5(a)(2), 4061(a), (b), (d) and 5307.3, Labor Code. Reference: Sections 138.4, 139.5(a)(3), 4061 and 4650(a)-(d), Labor Code.
1. Repealer of article 8 (sections 9810-9878, not consecutive) and new article
8 (sections 9810-9817) filed 7-15-83; effective thirtieth day thereafter (Register 83, No. 30). For prior history, see Registers 81, No. 42; 79, No. 30; 78, No. 45; 73, Nos. 51 and 38; 72, No. 51; and 66, No. 20.
2. Editorial correction of 7-15-83 order redesignating effective date to 8-1-83 pursuant to Government Code section 11346.2(d) filed 7-19-83 (Register 83, No. 30).
3. Editorial correction of 7-15-83 order filed 8-11-83 (Register 83, No.33).
4. Amendment of article heading, section and Notefiled 1-7-94; operative 1-7-94. Submitted to OAL for printing only pursuant to Government Code section11351 (Register 94, No. 1).
5. Repealer of subsection (d) and subsection relettering filed 7-7-2004; operative 8-1-2004 pursuant to Government Code section 11343.4 (Register 2004, No. 28).
6. Repealer and new article heading and amendment of section andNote filed 12-11-2007; operative 4-9-2008 (Register 2007, No. 50).
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