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BenefitNoticeManual.doc - Division of Workers Compensation...

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Division of Workers' Compensation BENEFIT NOTICE INSTRUCTION MANUAL Title 8, California Code of Regulations, Sections 9810 through 9815 (Revisions effective January 1, 2016) January 2016
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BENEFIT NOTICE INSTRUCTION MANUAL CONTENTS PAGES Englis h INTRODUCTION 4 Instructions for Notices Regarding Temporary Disability & Salary Continuation 8 Notice Temporary Disability / Salary Continuation Start / Resume 11 Notice Temporary Disability / Salary Continuation Delay 15 Notice Temporary Disability / Salary Continuation Denial 18 Instructions for Benefit Notices for Resumption, Change, & Termination 22 Notice Resumed Benefit Payment 26 Notice Change in Rate, Amount or Payment Schedule 30 Notice Termination of Benefit Payment 33 Instructions for Notices Regarding Permanent Disability 37 Notice Permanent Disability Monitor 43 Notice Permanent Disability Advice 47 Notice Permanent Disability Denial 51 Notice Permanent Disability Start / Resume 55 Instructions for Notice of Denial & Delay of All Workers’ Compensation Benefits 58 Notice Denial of Workers' Compensation Benefits 62 Notice Delay of Workers' Compensation Benefits 66 Instructions for Notices Regarding Dependency (Death) Benefits 70 Notice Dependency Payment Start 74 Notice Dependency Payment Change or End 77 Notice Dependency Payment Delay 80 Notice Dependency Payment Denial 83 Benefit Notices-Revised 1/1/16 Page 2
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BENEFIT NOTICE INSTRUCTION MANUAL Engli sh Instructions for Notices to Provide Panel QME 86 Request For QME panel under Labor Code Section 4062.1 - unrepresented (QME Form 105) 87 Benefit Notices-Revised 1/1/16 Page 3
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BENEFIT NOTICE INSTRUCTION MANUAL INTRODUCTION The purpose of this manual is to present advice for accurate and timely completion of benefit notices and mandatory forms that meet the requirements of the Administrative Director's regulations. The regulations which govern the requirements for these notices are in Title 8, California Code of Regulations, Chapter 4.5--Division of Workers' Compensation, Subchapter 1--Administrative Director Administrative Rules, Article 8, “Benefit Notices; Claims Administrator’s Duties and Responsibilities; Claim Form and Notice of Potential Eligibility for Benefits; Regulatory Authority of the Administrative Director” Sections 9810-9815 (abbreviated 8, CCR §§9810-9815). These regulations are effective as of January 1, 2016. The regulations apply to all workers' compensation dates of injury, except as otherwise noted. When references to the regulations are made, they are by section and subdivision [for example, § 9812 (a)(1) ]. The model notices presented in this manual are in English and Spanish and are the result of a combined effort of workers' compensation professionals from insurers, self-insured employers, third-party administrators, and employer and employee representative groups working together with the Division of Workers' Compensation. The intent of this effort is to provide forms which, if used in conjunction with the instructions provided, will improve communication with the injured worker and make it easier for the
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