The Board is changing the process used to update claimants’ information and has created a new form, Claimant Name and Address Form (Form OC-966), to facilitate these requests and ensure the timely delivery of benefits to claimants.
Form OC-966 should be submitted directly to the insurance carrier, insurer's third-party administrator (TPA), or self-insured employer. Claimants’ addresses are automatically updated in eCase when payers submit eClaims filings. These filings will overwrite any address update already processed by the Board. Submitting an OC-966 form directly to the payer will ensure the claimant’s most current information is always in the case file and is accurately reflected on future case documentation.
Claimant attorneys
A copy of Form OC-966 does not need to be filed with the Board. However, attorneys and licensed representatives should keep a copy for their records. In the event the claimant’s information is not updated, the claimant's attorney or licensed representative can produce a copy of this form as proof that the updated name or new address was provided to the insurance carrier, insurer's TPA, or self-insured employer. Claimant attorneys should no longer send claimant name and address changes using the Request for Further Action by Legal Counsel (Form RFA-1LC) or other attorney correspondence.
Payers
When a payer receives a Form OC-966, the appropriate eClaims filings must be submitted to the Board to update the claimant's address in the case file. Failure to promptly update this information may subject the payer to a penalty.
More information
If you have any questions, contact Customer Service at (877) 632-4996.
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