Regulations for 2016

In 2015, the Office of Administrative Law or (“OAL”) approved the Division of Workers Compensation (“DWC”) regulations regarding benefit notices including the DWC-1 Form/NOPE and posting notices.  The amended regulations pertain to benefit notices under Title 8 of the California Code of Regulations, §§9810, 9811, 9812, 9813, 9814, 9881.1, and 10139.  These new regulations apply to all notices sent on or after January 1, 2016. (Section 9810(a)).

In the Initial Statement of Reasons, the DWC indicated that the objective of the amended regulations “is to provide injured workers with a clearer understanding of their rights and responsibilities in the workers’ compensation claims process and reduce litigation.”  While some of the amendments made only minor, and non-substantive numbering changes to accommodate newly added and re-ordered subdivisions, other changes are more substantive. ”

  • All benefit notices, regardless of letterhead, are required to identify the claims administrator’s name. (Section 9810)(c)(1).  However, the claims administrator may give an alternate claims department name and telephone number, if there is a documented reason to believe that disclosure of the claims examiner’s name presents a security concern towards his or her personal safety.  (Section 9810(c)(2))
  • 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. (Section 9810(f))
  • Upon the documented written agreement of the attorney, all benefit notices, including attachments, may be sent electronically in lieu of by mail. (Section 9810(i))
  • Section 9812 no longer requires that a copy of various DWC informative pamphlets be sent.
  • If the claims administrator’s determination is based on a medical report, a copy of the medical report(s) shall be provided with the notice, except for psychiatric reports that the psychiatrist has recommended not be provided to the employee. (Section 9812(a)(3), 9812(d), 9812(e)(2)(3), 9812(i).
  • Information on the employee poster will be updated to reflect the existing state of the law. (Section 9881.1)
  • “The Notice of Delay in Any Temporary Disability Indemnity Payment” is required if the employee’s entitlement to any period of TD indemnity cannot be determined within 14 days “after” the date of knowledge of injury and disability. (Section 9812(a)(2))
  • “The Notice of Changed Benefit Rate, Payment Amount or Schedule” must be given before or “at the same time” as the new payment. (Section 9812(c))
  • “The Notice that Benefits Are Ending” is required if the decision to end payment of indemnity was made after the last payment, the claims administrator must send the notice and accounting of benefits paid within 14 days “after” the last payment. (Section 9812(d))
  • “The Notice of Monitoring Until P&S Date” must be given at the “at the same time as” the last payment of TD indemnity. (Section 9812(e)(1))
  • “The Notice That Permanent Disability Exists” is it to be given “at the same time as” the last payment of TD indemnity or within 14 days of knowledge that the injury has caused PD. (Section 9812(e)2)

Workers’ Compensation Information System (WCIS)

The regulations pertaining to the Worker’s Compensation Information System (WCIS) under Title 8 of the California Code of Regulations, Sections 9701 and 9702, have also been amended and are effective April 6, 2016.

The Labor Code requires that the data collected electronically by the WCIS must be compatible with the Electronic Date Interchange (EDI) system of the International Association of Industrial Accident Boards and Commissions (IAIABC).  The IABIABC has updated its Medical Bill Data Reporting guidelines, moving from version 1.1 to Release 2.0.  Correspondingly, the California EDI Implementation Guide for Medical Bill Payment Records is being updated to be consistent with the IAIABIC’s Release 2.0.

It was therefore necessary to also revise Sections 9701 and 9702, concerning transmittal of EDI to WCIS so that these regulations will not be inconsistent with the revised California EDI Implementation Guide for Medial Bill Payment Records and the IAIABC’s Medical Bill Data Reporting guidelines, Release 2.0.