COMPENSATION ADVISORY ORGANIZATION OF MICHIGAN

P. O. BOX 3337   •    LIVONIA, MI   48151-3337

PHONE (734) 462-9600    •    FAX (734) 462-9721

Internet WEB Site:  www.caom.com  • E-Mail:  caom@caom.com

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   September 6, 2001

            CIRCULAR LETTER #166 TO ALL MEMBERS

RE: BWC 400 FORM

Dear Member:

The Compensation Advisory Organization of Michigan receives numerous BWC 400 forms on a daily basis. This is the form the Bureau of Workers= Disability Compensation requires for notice of policy issuance and reinstatement of a policy. Information that must be reported to Compensation Advisory Organization of Michigan includes policy information page, renewal certificate, cancellation notice and reinstatement notice.

Unless there is some indication these 400 forms are for CAOM=s use, for reinstatement purposes, they are sent to the Bureau of Workers= Disability Compensation. The Bureau has recently contacted some carriers and asked them to stop submitting duplicate information (the 400 forms CAOM has forwarded to them).

CAOM is to receive a copy of all new and renewal policies. The 400 form is not to be sent to CAOM for new issuance. For reinstatements, carriers that send paper transactions should provide a duplicate copy of the reinstatement notice or letter which is sent to the insured. If this is not possible, the 400 form being sent to CAOM for reinstatement purposes must clearly indicate that it is for CAOM=s use. Carriers that report data electronically need not send the paper transactions.

CAOM will no longer forward BWC 400 forms to the Bureau. If the forms do not indicate that they are for CAOM=s use (for reinstatement purposes) they will be returned to the carrier.

    Very truly yours,

    Gary L. Thompson