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 10101.1 - Claim File-Contents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This section applies to maintenance of claim files for
						injuries occurring on or after January 1, 1994.
Every claims administrator shall maintain a claim file of
						each work-injury claim including claims which were denied. For injuries
						reported on or after June 19, 2009 each claims administrator shall maintain a
						claim file for each indemnity and medical-only claim, including denied claims,
						and shall ensure that each file is complete and current for each claim.
						Contents of claim files may be in hard copy, in electronic form, or some
						combination of hard copy and electronic form. Files maintained in hard copy
						shall be in chronological order with the most recently dated documents on top,
						or subdivided into sections such as medical reports, benefit notices,
						correspondence, claim notes, and vocational rehabilitation. Files or portions
						of files maintained in electronic form shall be easily retrievable. All open
						claim files shall be maintained at the adjusting location responsible for
						administering the claim. The file shall contain but not be limited to:
(a) Either (1) a copy of the Employee's Claim
					 for Workers' Compensation Benefits, DWC Form 1, showing the employer's date of
					 knowledge of injury, the date the employer provided the form to the employee
					 and the date the employer received the completed form from the employee; or (2)
					 if the employee did not return the claim form, documentation of the date the
					 employer provided a claim form to the employee. If the administrator cannot
					 obtain the form or determine that the form was provided to the employee by the
					 employer, the file shall contain documentation that the administrator has
					 provided the claim form to the employee as required by Title 8, California Code
					 of Regulations section
					 10119.
(b) A copy of the Employer's Report of
					 Occupational Injury or Illness, DLSR Form 5020, or documentation of reasonable
					 attempts to obtain it;
(c) A copy
					 of every notice, correspondence either initiated or received by the claims
					 administrator, or report sent to the Division of Workers'
					 Compensation.
(d) A copy of every
					 Doctor's First Report of Occupational Injury or Illness, DLSR Form 5021, or
					 documentation of reasonable attempts to obtain them.
(e) The original or a copy of every medical
					 report pertaining to the claim, or documentation of reasonable attempts to
					 obtain them.
(f) All orders or
					 awards of the Workers' Compensation Appeals Board or the Rehabilitation Unit
					 pertaining to the claim.
(g) A
					 record of payment of compensation.
(h) A copy of the application(s) for
					 adjudication of claim filed with the Workers' Compensation Appeals Board, if
					 any.
(i) Copies of the following
					 notices sent to the employee:
(1) Benefit
					 notices, including vocational rehabilitation notices and supplemental job
					 displacement benefit notices, required by California Code of Regulations, title
					 8, section 9810, or by California Code of
					 Regulations, title 8, section
					 10122 through section
					 10133.60;
(2) Notices and forms related to the
					 Qualified Medical Evaluation or Agreed Medical Evaluator process required by
					 Labor Code sections
					 4060 et
					 seq.;