DEPARTMENT OF LABOR AND EMPLOYMENT
Division of Workers’ Compensation
7 CCR 1101-3
	WORKERS’ COMPENSATION RULES OF PROCEDURE
Rule 5	Claims Adjusting Requirements

5-14	SURVEYS

(A)	Within 30 days following closure of each claim that was reported to the Division, the insurer shall survey the claimant.  If the claimant is deceased the survey shall be presented to the claimant’s dependents, if there are such dependents.  If two or more claims have been merged or consolidated, one survey may be presented.
(B)	If the claimant has previously authorized the insurer to communicate through electronic transmission, the survey may be sent to the claimant electronically.  Otherwise, the survey shall be mailed to the claimant.  Along with the survey, the insurer shall provide a self-addressed, stamped envelope for the claimant to use when returning the survey.
(C)	The survey shall include the name of the insurer.  The survey shall also have a space for the claimant to sign and shall include the following language: “This survey relates to your recent workers’ compensation claim.  We would like to find out how satisfied you are with the way your claim was handled. Please complete the survey fully and return it in the enclosed envelope.”  In addition, the survey shall set forth the following questions:
(1)	On a scale from 1 to 5, with 1 being the least satisfied and 5 being the most satisfied, please describe your satisfaction with the level of courtesy shown to you in relation to your workers’ compensation claim. 	
           					1	2	3	4	5
(2)	On a scale from 1 to 5, with 1 being the least satisfied and 5 being the most satisfied, please describe your satisfaction with how promptly you received medical care.		
	1	2	3	4	5
(3)	On a scale from 1 to 5, with 1 being the least satisfied and 5 being the most satisfied, please describe your satisfaction with how promptly your claim was handled.
	1	2	3	4	5
(4)	On a scale from 1 to 5, with 1 being the least satisfied and 5 being the most satisfied, please describe your satisfaction with how quickly any disputes in your claim were resolved.  If you did not have any disputes, please mark NA.
	1	2	3	4	5	NA
(5)	On a scale from 1 to 5, with 1 being the least satisfied and 5 being the most satisfied, please describe your overall satisfaction with the way your claim was handled.
	1	2	3	4	5  
(6)	The name of the adjuster handling your claim, if known.
(D)	On or before the last day of January, 2011, and on or before the last day of January in each following year, the insurer shall report the survey results to the Division.  The report shall be based on all survey results actually received by the insurer during the preceding calendar year.  For the questions set out in (C)(1), (C)(2), (C)(3) and (C)(5) above, the insurer shall report the number of responses to the question and the average score based on those responses.  For question (C)(4), the insurer shall report the number of responses to the question, the number of responses that indicated NA, and the average of those responses that provided a numerical response.  The insurer shall maintain the survey responses for a minimum of six months after providing the results to the Division, and shall provide the survey results to the Division upon request.