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Chapter 4.5. Division of Workers' Compensation
Subchapter 1.5. Injuries on or After January 1, 1990
Article 2. Claims Administration and Recordkeeping
§10104. Annual Report of Inventory.
(a) Each claims administrator shall maintain, and shall file with the Administrative Director, an Annual Report of Inventory for each of its adjusting locations. The report shall be filed annually by April 1. It shall include the name, address, and telephone number of the adjusting location and the name and title of the person responsible for audit coordination. Claims administrators shall report, as of the preceding January 1, the numbers of indemnity, denied, and medical-only claims reported to each of its adjusting locations during the preceding calendar year for insurers and private self-
insured employers, or public self-insured employers. If the administrator adjusts for more than one entity at that location, the report shall give the total numbers of claims at that location and shall also identify the numbers of claims for each self-insured employer or insurer liable for the payment of compensation. Indemnity claims shall be differentiated on the Annual Report of Inventory from medical-only claims or any other claim where no indemnity payment(s) has been made.
(b) If a claims administrator relocates, opens a new adjusting location, closes an adjusting location, changes contact persons, changes the e-mail address, changes from third-party administered to self-administered or from self-administered to third-party administered, or changes from self-insured to insured, the claims administrator shall advise the Administrative Director by mailing written notice to the manager of the Audit Unit within 45 calendar days of the event.
(c) Adjusting locations that have no indemnity, denied, or medical-only claims reported during the preceding calendar year must file with the Administrative Director a statement indicating whether the location is actively adjusting workers' compensation claims. The statement, which shall be filed annually by April 1, shall contain the name, address, and telephone number of the adjusting
location and the name and title of the person responsible for audit coordination.
(d)(1) A claims administrator's obligation to submit an Annual Report of Inventory under subdivision (a) of this section is waived upon a determination by the Administrative Director that the claims administrator is in compliance with the electronic data reporting requirements of the Workers' Compensation Information System, as set forth in California Code of Regulations, title 8, section 9702.
||(2) Each claims administrator whose obligation to submit an Annual Report of Inventory is satisfied under subdivision (d)(1) of this section shall maintain and file with the Administrative Director an Annual Report of Adjusting Locations. This report shall be filed annually by April 1 of each calendar year and shall report, as of the preceding December 31, each of the claims administrator's adjusting locations. The report shall include the name, street and mailing address, physical zip code, e-mail address, fax number, and telephone number for each adjusting location and the name, title, e-mail address, fax number and telephone number of the person responsible for audit coordination.
||(3) The claims administrator shall notify the Administrative Director, by mailing written notice to the manager of the Audit Unit, of any change in the information provided in the Annual Report of Adjusting Locations. A reportable change shall include the relocation of the claims administrator or the opening or closing of an adjusting location. The notification shall be made within 45 calendar days after the effective date of the change.
||(4) The waiver granted to a claims administrator under subdivision (d)(1) of this section shall be rescinded if the total number of claims reported by the claims administrator to the Audit Unit in a claim log submitted pursuant to California Code of Regulations, title 8, section 10107.1(a) is not within one percent of the total number of claims electronically reported by the claims administrator to the Workers' Compensation Information System for the same period of time as covered in the submitted claim log.
|| Note: Authority cited: Sections 59, 129.5, 133 and 5307.3, Labor Code. Reference: Sections 129, 129.5 and 138.6, Labor Code.
1. Renumbering of former section 10104 to section 10105 and 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 filed 12-30-2002; operative 1-1-2003 pursuant to GovernmentCode section 11343.4 (Register 2003, No. 1).
3. Amendment filed 10-6-2003; operative 12-1-2003 (Register 2003, No. 41).
4. Amendment of section and Note filed 4-20-2009; operative 5-20-2009 (Register 2009, No. 17).
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