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:

    1. Employers Report of Occupational Injury of 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 of 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) 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:

    1. Employers Report of Occupational Injury and Illness (Form 5020);
    2. Employee Claim Form (DWC Form 1);
    3. All notes (including computer notes);
    4. All bills (including medical, rehab, legal, investigative, and other expenses;
    5. All Explanation of Benefits (EOB's documenting any review and/or reduction);
    6. List of all payments including date, amount, payment code, payee, and address;
    7. List of all reserve worksheets and dated changes broken down by category;
    8. Benefit notices;
    9. Wage statements;
    10. All correspondence (including letters, forms, faxes, and e-mails);
    11. Medical statuses, releases and prescriptions;
    12. Medical reports;
    13. Medical management reports;
    14. Rehab reports and forms, including RU 94 and VR plan;
    15. Investigative reports and statements;
    16. Audio and video tapes;
    17. Legal correspondence and notices;
    18. Subpoenaed reports (including medical, personnel, and employment records);
    19. Filings, pleadings, applications, orders, liens, subpoenas, settlements, petitions, awards, and other legal documents);
    20. All ratings (formal, informal, advisory, etc.);
    21. All data submitted to Worker's Compensation Information System (WCIS) for Electronic Data Interchange (EDI), acknowledgements, error lists, and other correspondence from WCIS, dates and documentation of data exchange.

(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.