Section R20-5-118. Effective Date of Notices of Claim Status and Other Determinations; Attachments to Notices of Claim Status; Form of Notices of Claim Status

A.      If a notice of claim status accepting a claim for benefits is final, any subsequent notice of claim status that changes a claimant’s amount of, or entitlement to, compensation or med- ical, surgical, or hospital benefits shall not have a retroactive effect for more than 30 days from the date a carrier or self- insured employer issues the subsequent notice of claim status. This subsection does not apply to a subsequent notice that affects the entitlement to or amount of death benefits. The Commission may for good cause relieve a carrier or self- insured employer of the effect of this subsection.

B.       If a notice of claim status or other determination issued by a carrier, self-insured employer, or special fund division, is based upon a physician’s report:

1.        The carrier or self-insured employer shall attach a copy of the physician’s complete report to the notice of claim sta- tus or other determination sent to the Commission; and

2.        The carrier, self-insured employer, or special fund divi- sion shall attach a copy of the physician’s complete report to the notice of claim status or other determination served on a party, except as provided in R20-5-114(D).

C.      If a carrier, self-insured employer, or special fund division pays compensation to a claimant:

1.        The carrier or self-insured employer shall close the claim by issuing a notice of claim status; and

2.        The special fund division shall close the claim by issuing a notice of determination.

D.      The inadvertent failure of a carrier, self-insured employer, or special fund division to comply with subsection (B) shall not affect the validity of a notice or determination if the carrier, self-insured employer, or special fund division issuing the notice or determination had in its possession at the time the notice or determination is issued a medical report consistent with the notice or determination.

Historical Note

Former Rule 18. Amended effective March 1, 1987, filed

February 26, 1987 (Supp. 87-1). Amended effective

August 28, 1992 (Supp. 92-3). R20-5-118 recodified from R4-13-118 (Supp. 95-1). Amended by final rulemaking at 7 A.A.R. 3966 and 7 A.A.R. 4995, effec-

tive August 17, 2001 (Supp. 01-3).