California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1.5 - Injuries on or After January 1, 1990 › Article 2 - Claims Administration and Recordkeeping › Section 10104 - Annual Report of Inventory

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(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.