Oakland, CA – In August, California amended its workers’ compensation benefit notice regulations that govern the DWC-1 claim form/Notice of Potential Eligibility (NOPE), posting notices and other notices that employers and claims administrators use to inform employees of their rights and obligations under state law. The regulations address statutory changes enacted in 2012, and require additions to notices including Medical Provider Network (MPN) information that replaces the requirement for employers to post a separate MPN poster, new language on electronic service of notices, advice that medical services are subject to approval, a revised permanent disability description and new language on timely reporting.
The state made the regulations effective January 1, 2016 to allow claims operations and employers time to obtain and distribute revised notices, so they may continue to use current versions until the end of 2015, after which they should begin using updated materials. With the January 1 effective date less than 3 months away, the community must gear up quickly as failure to provide current information can result in a number of penalties:
- civil penalties of up to $7,000 for each violation of the posting requirement (LC §6431);
- potential loss of employer medical control [LC §3550 (e) subject to LC §4616.3];
- a tolling of the statute of limitations for filing claims [LC §5405 and 5412, and case law (Galloway v. WCAB)]; and
- $100 penalties for each failure to provide the correct claim form [CCR §10111.2 (b)(25)], which also could result in the claims administrator being subjected to a Division of Workers’ Compensation Full Compliance Audit rather than a Profile Audit Review audit.
Private entities may publish the required workers’ compensation posting notices and new hire pamphlets if they are approved by the state, and many insurers and employers rely on the California Workers’ Compensation Institute (CWCI) to produce these materials and keep them up to date. After the state amended the regulations in August, CWCI updated its new hire pamphlet and posting notice, obtained state approvals, translated them into Spanish and printed them along with the new DWC-1/NOPE, which as of January 1 will consist of a 3-page Notice of Potential Eligibility attached to four copies of the claim form, which CWCI has produced on NCR paper to eliminate the need for employers to photocopy.
In addition to the changes adopted in August, CWCI added information to its pamphlet and posting notice on the state’s $120 million Return to Work Supplement Program to reflect regulations adopted in April, and updated its “Facts For Injured Workers” pamphlet, which many claims administrators use to provide information to injured workers early in the life of a claim, and to meet the notice requirement about fraudulent receipt of temporary disability and the notice requirement for victims of workplace crime.
CWCI now has the revised materials in stock and ready to ship. Claims operations or employers that wish to obtain revised notices so they can update their claim kits before the January 1 deadline, or who need more details, can visit www.cwci.org/store.html or call (510) 251-9470.
Source: CWCI