The Audit Unit of the Division of Workers’ Compensation (DWC) has posted draft revisions to the Benefit Notice Manual and sample benefit notices to the DWC forums for public comment. The Division welcomes suggestions from the workers’ compensation community to improve the quality and clarity of the draft notices.
The purpose of this manual is to present advice for accurate and timely completion of benefit notices and mandatory forms that meet the requirements of the Administrative Director’s regulations.The “safe harbor” provision of Title 8, Cal. Code of Regulations, section 9810(f) provides that “Benefit notices using the sample notices devised by the Administrative Director and available on the Division’s website are presumed to be adequate notice to the employee and, unless modified, shall not be subject to audit penalties.”
Various events in the life of a workers’ compensation claim trigger the requirement to issue a notice to the employee or claimant. There are required contents for each notice.
These regulations are effective as of January 1, 2016 The regulations apply to all workers’ compensation dates of injury, except as otherwise noted. The Division cautions the claims community that the revised notices may not be used until the regulations take effect on January 1.
The model notices presented in this 85 page manual are in English and Spanish and are the result of a combined effort of workers’ compensation professionals from insurers, self-insured employers, third-party administrators, and employer and employee representative groups working together with the Division of Workers’ Compensation. The intent of this effort is to provide forms which, if used in conjunction with the instructions provided, will improve communication with the injured worker and make it easier for the claims administrator to comply with the regulations governing the issuance of benefit notices.The Division anticipates posting the final revised Benefit Notice Manual and sample benefits notices to the Division’s website on or about October 15, 2015.
Ultimately, the claims administrator is responsible for compliance with the regulations governing the issuance of benefit notices, regardless of whether these model notices are used. Failure to provide a correct and timely notice is one of the most often cited offense in the audit report prepared following the mandatory routine claim audit process. Adherence to the guidance in the Manual would likely result in a much improved audit score.