Benefit Printouts: A Sixty-Second Seminar in Workers’ Compensation Claims Handling

Today’s blog focuses on a topic seldom discussed in workers’ compensation. It concerns benefit printouts. Rule 10635 places a duty on the claims administrator to serve a benefit printout within 20 days upon request and no later than the date of a Mandatory Settlement Conference. Service of a printout has become so routine that it is viewed as just another ordinary clerical function.

Many applicant’s attorneys submit multiple requests for benefit printouts at frequent intervals. Rule 10635 clearly states requests can be issued “once every 120 days, unless there is a change in indemnity payments or a new dispute develops requiring updated payment periods.” Because most adjusters are unfamiliar with the 120-day limitation, they dutifully comply with such requests.

Most claims professionals are also unfamiliar with the information that must be contained in a benefit printout. Rule 10635(b) states:

The printout shall include the date and amount of each payment of temporary disability indemnity, permanent disability indemnity, the period covered by each payment, and the date, payee and amount of each payment for medical treatment.

Note the regulation does not require itemization or identification of total payout sums, nor does it mandate the printout be in a specific format. A few years ago, a judge in northern California unsuccessfully tried to hold a TPA in contempt simply because the appearance of the printout was not to his liking, despite there being no rules governing format structure.

By now many readers may be asking, “What’s the big deal and why are we even bothering with this subject?” Allow us to relay a true story which will influence that opinion.

In this anecdote the insurer never provided education on benefit printouts to its adjusters as it was assumed that no training was needed. In response to a request from an applicant’s attorney for a benefit printout, a claims supervisor served a printout identifying all payments issued in a file, including indemnity, medical and expenses. Wait a minute … expenses? The law does not require that disclosure! Upon review of the printout, applicant’s attorney was able to discover that surveillance activity had occurred; the identity of the investigator; and the dates surveillance had been conducted, information very useful to preparing the injured worker for an upcoming deposition! In addition to containing information about surveillance performed, the expense printout also identified expert witnesses the employer hired, alerting applicant’s attorney to the insurer’s defense strategy. With this foreknowledge AA was able to retain rebuttal experts, turning the tables on the employer and catching them completely by surprise. Lastly, applicant’s attorney knew to the penny how much the defense experts had been paid, thus enabling the rebuttal witnesses to charge a comparable fee, even though those hourly rates were greater than the rates that they typically charged!

What’s the take-away here? Demonstrate caution when producing a “benefit” printout! Don’t inadvertently disclose claim expenses to an AA!