Information Requested on Written Communications to the Division

(a) Unless the division-prescribed form, format, or manner of a written communication specifies otherwise, all written communications to the division about an injured employee or claim for benefits must include the following information, if known:

(1) the injured employee's full name, date of injury, address, and Social Security number. If no Social Security number has been assigned, insert the numerical digits "999" followed by the claimant's birth date or if unknown, the claimant's date of injury listed by the month, day, and year (MMDDYY). Do not use "999" in place of a valid Social Security number to meet timeliness of reporting requirements;

(2) the name and address of the claimant, if other than the injured employee;

(3) the workers' compensation number assigned to the claim by the division;

(4) the employer's name and address;

(5) the employer's Federal Employer's Identification Number;

(6) the insurance carrier's name;

(7) the insurance carrier's policy number; and

(8) the insurance carrier's claim number.

(b) Written communications filed by claim EDI under §124.2 of this title (concerning Insurance Carrier Notification Requirements) must comply with the requirements of Chapter 124, Subchapter B of this title (concerning Insurance Carrier Claim Electronic Data Interchange Reporting to the Division).

(c) Subsection (a) is effective on adoption. Subsection (b) is effective July 26, 2023.