The Division of Workers’ Compensation has developed Spanish versions of its sample benefit notices and posted them in a revised benefit notice manual on its website to help workers’ compensation claims organizations comply with changes in the benefit notice regulations that took effect April 9, 2008.
The state requires workers’ compensation claims operations to draft notices that meet the new regulations, and these notices will be reviewed by the Division’s Audit Unit when they conduct their regular performance audits. Although each of the dozens of notices must contain all of the relevant elements mandated by statute or in the new regulations (www.dir.ca.gov/dwc/DWCPropRegs/BenefitNoticeRegulations/BNU_FinalRegulations.doc), DWC notes that as with the English versions of the sample notices, the sample Spanish-language notices are not intended to be used verbatim in lieu of individual notices tailored to the specific facts of each claim. DWC auditors report that during recent reviews, they found that some claims administrators are sending notices that lack the necessary information and/or are sending the information beyond the required time frames.
The regulations that took effect in April also require claims operations to send “DWC fact sheets” along with notice letters at various points in the life of a claim. These include fact sheets on TD, PD and on the AME/QME process. The DWC has specifically cited failure to send Fact Sheet E on the AME/QME process as a problem that will affect a claims organization’s performance rating, which could lead to an expanded audit. DWC also issued a reminder that in claims where it is determined that there is no residual disability and the worker is not entitled to permanent disability, the claims administrators must advise the worker within 14 days of the determination.
DWC has posted its benefit notice manual with sample notices in English and Spanish at http://www.dir.ca.gov/dwc/audit.html, and Word or Adobe Acrobat files of the Spanish fact sheets (Hojas de información) at www.dir.ca.gov/dwc/iwguides_Spanish.html.
• The Temporary Disability fact sheet in Spanish is: Hoja de información C “Respuestas a sus preguntas sobre los beneficios de incapacidad temporal.”
• The Permanent Disability fact sheet in Spanish is: Hoja de información D “Respuestas a sus preguntas sobre los beneficios de incapacidad permanente.”
• The AME/QME fact sheet in Spanish is: Hoja de información E
“Respuestas a sus preguntas sobre evaluadores médicos calificados y evaluadores médicos acordados.”