California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1.5 - Injuries on or After January 1, 1990 › Article 1 - Audit, General Definitions › Section 10100.1 - Definitions-on or After January 1, 1994

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following definitions apply in Articles 1 through 7
						of this Subchapter for injuries occurring on or after January 1, 1994.
(a) Adjusting Location. The office where
					 claims are administered.
(b)
					 Administrative Director. The Administrative Director of the Division of
					 Workers' Compensation or the Director's duly authorized representative,
					 designee, or delegee.
(c) Audit. An
					 audit performed under Labor Code Sections
					 129 and
					 129.5.
(d) Audit Subject. A single adjusting
					 location of a claims administrator which has been selected for audit. If a
					 claims administrator has more than one adjusting location, other locations may
					 be selected as separate audit subjects. In its discretion, the Audit Unit may
					 combine more than one adjusting location of a claims administrator as a single
					 non-random audit subject.
(e) Audit
					 Unit. The organizational unit within the Division of Workers' Compensation
					 which audits insurers, self-insured employers and third-party administrators
					 pursuant to Labor Code Sections
					 129 and
					 129.5.
(f) Claim. A request for compensation for an
					 injury arising out of and in the course of employment, whether disputed or not,
					 or notice or knowledge that such an injury has occurred or is alleged to have
					 occurred.
(g) Claim File. A record
					 in paper or electronic form, or a combination, containing all of the
					 information specified in Section
					 10101.1 of these Regulations and
					 all documents or entries related to the provision or denial of
					 benefits.
(h) Claim Log. A
					 handwritten or printed ledger maintained by the claims administrator listing
					 each work-injury claim as specified in Section
					 10103.1 of these
					 Regulations.
(i) Claims
					 Administrator or Administrator. A self-administered workers' compensation
					 insurer, a self-administered self-insured employer, a self-administered legally
					 uninsured employer, a self-administered joint powers authority, or a
					 third-party claims administrator for an insurer, a self-insured employer, a
					 legally-uninsured employer or a joint powers authority.
(j) Closed Claim. A work-injury claim in
					 which future payment of compensation cannot be reasonably expected to be
					 due.
(k) Compensation. Every
					 benefit or payment, including vocational rehabilitation, medical, and
					 medical-legal expenses, conferred by Divisions 1 and 4 of the Labor Code on an
					 injured employee or the employee's dependents.
(l) Date of Knowledge of Injury and
					 Disability. The date the employer had knowledge or reasonably can be expected
					 to have had knowledge of (1) a worker's injury or claim for injury, and (2) the
					 worker's inability or claimed inability to work because of the
					 injury.
(m) Denied Claim. A claim
					 for which all liability has been denied at any time, even if the claim was
					 accepted before or after the denial. A claim which otherwise meets this
					 definition is a denied claim even if medical-legal expenses were
					 paid.
(n) Employee. An employee, or
					 in the case of the employee's death, his or her dependent, as each is defined
					 in Division 4 of the Labor Code, or the employee's or dependent's
					 agent.
(o) First Payment of
					 Temporary Disability Indemnity.
(1) The first
					 payment of temporary disability indemnity made to an injured worker for a work
					 injury; or
(2) the first resumed
					 payment of temporary disability indemnity following any period of one or more
					 days for which no temporary disability indemnity was payable for that work
					 injury; or
(3) the first resumed
					 payment of temporary disability indemnity following issuance of a lawful notice
					 that temporary disability benefits were ending.