reglab/statecodes huggingface dataset:
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 12 - Copy Service and Electronic Transaction Rates › Section 9985 - Disputes

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Disputes over the production of records may be resolved
						by filing a petition with the Workers' Compensation Appeals Board, or by filing
						a petition with a superior court pursuant to Labor Code section
						132.
1. New
						section filed 6-15-2022; operative 7-15-2022. Exempt from the APA and OAL
						review pursuant to Government Code section
						11340.9(g).
						Submitted to OAL for filing and printing only pursuant to Government Code
						section
						11343.8
						(Register 2022, No. 24).
Note: Authority cited: Sections
						  133 and
						  5307.9, Labor
						  Code. Reference: Sections
						  4453 and
						  5307.9, Labor
						  Code; and Section
						  1563,
						  Evidence Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 12 - Copy Service and Electronic Transaction Rates › Section 9990 - Division Fees for Transcripts; Copies of Documents; Certifications; Case File Inspection; Electronic Transactions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Division will charge and collect fees for copies of
						records or documents. For the purposes of this section, "records" includes any
						writing containing information relating to the conduct of the public's business
						which is prepared, owned, or used by the Division, regardless of the physical
						form or characteristics. "Writing" means handwriting, typewriting, printing,
						photostatting, photographing and every other means of recording any form of
						communication thereof, and all papers, maps, magnetic tapes, photographic films
						and prints, electronic facsimiles, any form of stored computer data, magnetic
						cards or disks, drums, and other documents.
Fees will be charged and collected by the Division as
						follows:
(a) For copies of papers,
					 records or documents, not certified or otherwise authenticated, one dollar
					 ($1.00) for the first copy and twenty cents ($0.20) for each additional copy of
					 the same page, except to the injured worker to whom the fee will be ten cents
					 ($.10) per page.
(1) State sales tax and
					 postage will be added to this fee.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 12 - Copy Service and Electronic Transaction Rates › Section 9991 - Payment of Fees in Advance to the Division

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Payment of fees in Section
						9990 must accompany the request,
						either in cash or by check or money order made payable to the Division of
						Workers' Compensation, except as otherwise provided in the establishment of
						payment accounts.
1.
						Renumbering of former section
						9992 to new section
						9991, including amendment of
						section heading, filed 4-30-2015; operative 7-1-2015 (Register 2015, No.
						18).
Note: Authority cited: Sections
						  127,
						  133 and
						  5307.3, Labor
						  Code. Reference: Section
						  127, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 12 - Copy Service and Electronic Transaction Rates › Section 9992 - Payment of Fees in Advance. [Renumbered]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Amendment filed 1-28-94; operative 1-28-94 (Register 94, No. 4). Submitted to
						OAL for printing only pursuant to Government Code section
						11351.
2.
						Renumbering of former section
						9992 to section
						9991 filed 4-30-2015; operative
						7-1-2015 (Register 2015, No. 18).
Note: Authority cited: Sections
						  127,
						  133 and
						  5307.3, Labor
						  Code. Reference: Section
						  127, Labor
						  Code.
California Code of Regulations › Title 8 - Industrial Relations › Division 1 - Department of Industrial Relations › Chapter 4.5 - Division of Workers' Compensation › Subchapter 1 - Administrative Director-Administrative Rules › Article 12 - Copy Service and Electronic Transaction Rates › Section 9994 - Payment for Transcripts. [Repealed]

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
1.
						Amendment of section heading and text filed 1-28-94; operative 1-28-94
						(Register 94, No. 4). Submitted to OAL for printing only pursuant to Government
						Code section
						11351.
2.
						Repealer filed 4-30-2015; operative 7-1-2015 (Register 2015, No.
						18).
Note: Authority cited: Sections
						  127,
						  133 and
						  5307.3, Labor
						  Code. Reference: Section
						  127, Labor
						  Code.
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 - Definitions-Prior to 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, 1990 and
						before 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 his/her
					 duly authorized representative.
(c)
					 Audit. Any audit performed by the Audit Unit of the Division of Workers'
					 Compensation pursuant to Labor Code Sections
					 129 and
					 129.5.
(d) Claims Administrator. A self-administered
					 insurer providing security for the payment of compensation required by
					 Divisions 4 and 4.5 of the Labor Code, a self-administered self-insured
					 employer, or a third-party claims administrator for a self-insured employer,
					 insurer, legally uninsured employer, or joint powers authority.
(e) Claim File. A record, either in legible
					 paper or electronic form which can be produced into legible paper, containing
					 all of the information specified in Section
					 10101 and related documents
					 pertaining to a given work-injury claim.
(f) Claim Log. A handwritten or printed
					 ledger maintained by the claims administrator listing each work injury case by
					 the date the injury was reported to the claims administrator and listing the
					 date of injury. The claim log contents are specified in Section
					 10103.
(g) Compensation. Compensation as defined in
					 Labor Code Section
					 3207.
(h) Duly Authorized Representative. A
					 designated employee or unit of the Department of Industrial
					 Relations.
(i) DWC. The Division of
					 Workers' Compensation of the Department of Industrial Relations.
(j) Employee. An employee, his or her
					 dependents or his agent.
(k)
					 Indemnity Case. A work-injury claim which has or may result in any of the
					 following benefits:
(1) Temporary
					 Disability
(2) Permanent
					 Disability
(3) Life
					 Pension
(4) Death
					 Benefits
(5) Vocational
					 Rehabilitation
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 10100.2 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following definitions apply in Articles 1 through 7
						of this Subchapter for audits conducted on or after January 1, 2003.
(a) Adjusting Location. The office where
					 claims are administered. Separate underwriting companies, self-administered,
					 self-insured employers, and/or third-party administrators operating at one
					 location shall be combined as one audit subject for the purposes of audits
					 conducted pursuant to Labor Code section
					 129(b)
					 only if claims are administered under the same local management at that
					 location.
For auditing purposes, any separate office or location
						whose staff includes local management may be considered a single adjusting
						location.
(b) Additional
					 claim file. A claim selected for audit in addition to the random sample of
					 claims selected. An additional claim file may include a companion claim file, a
					 file selected for audit because it was incorrectly designated on the claim log,
					 or a claim chosen based on criteria relevant to a target audit but for which no
					 specific complaint has been received.
(c) Administrative Director. The
					 Administrative Director of the Division of Workers' Compensation or the
					 Director's duly authorized representative, designee, or delegee.
(d) Audit. An audit performed under Labor
					 Code sections
					 129 and
					 129.5.
(e) 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
					 shall be considered as separate audit subjects for the purposes of implementing
					 Labor Code sections
					 129(a)
					 and
					 129(b).
					 However, the Audit Unit at its discretion may combine more than one adjusting
					 location of a claims administrator as a single targeted audit subject, or may
					 designate one insurer, insurer group, or self-insured employer at one or more
					 third-party administrator adjusting locations as a single targeted audit
					 subject.
(f) Audit Unit. The
					 organizational unit within the Division of Workers' Compensation which audits
					 and/or investigates insurers, self-insured employers and third-party
					 administrators pursuant to Labor Code sections
					 129 and
					 129.5.
(g) Carve-Out Program.
(1) An alternative dispute resolution (ADR)
					 system for employees and employers engaged in construction (or other enumerated
					 activities), established pursuant to Labor Code section
					 3201.5.
(2) An alternative dispute resolution (ADR)
					 system for any industry (other than construction), established pursuant to
					 Labor Code section
					 3201.7.
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 2 - Claims Administration and Recordkeeping › Section 10101 - Claim File-Contents

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This section applies to maintenance of claims files for
						injuries occurring before January 1, 1994.
Every claims administrator shall maintain a claim file of
						each work-injury claim including claims which were denied. All open claim files
						shall be kept at the adjusting location for the file. The file shall contain
						but not be limited to:
(a) An employer
					 date stamped copy of the Employee's Claim for Workers' Compensation Benefits,
					 DWC Form 1, or documentation of reasonable attempts to obtain the
					 form.
(b) Employers Report of
					 Occupational Injury or Illness, DLSR Form 5020, or documentation of reasonable
					 attempts to obtain it.
(c) Every
					 notice or report sent to the Division of Workers' Compensation.
(d) A copy of every Doctor's First Report of
					 Occupational Injury or Illness, DLSR Form 5021, or documentation of reasonable
					 attempts to obtain them.
(e) The
					 original or a copy of every medical report pertaining to the claim, or
					 documentation of reasonable attempts to obtain them.
(f) All orders or awards of the Workers'
					 Compensation Appeals Board pertaining to the claim.
(g) A record of payment of
					 compensation.
(h) A copy of the
					 application(s) for adjudication of claim filed with the Workers' Compensation
					 Appeals Board, if any.
(i) Copies
					 of all notices sent to the employee pursuant to the requirements of the Benefit
					 Notice Program established by Labor Code Section
					 138.4 and the
					 notices required by Article 2.6 of Chapter 2 of Part 2 of the Labor Code,
					 commencing with Section
					 4635.
1. New
						section filed 1-18-90; operative 1-18-90 (Register 90, No. 4). New section is
						exempt from review by OAL pursuant to Government Code Section
						11351.
2.
						Amendment of article heading, section heading, text and NOTE filed 1-28-94;
						operative 1-28-94. Submitted to OAL for printing only pursuant to Government
						Code section
						11351
						(Register 94, No. 4).
Note: Authority cited: Sections
						  59,
						  129.5,
						  133,
						  138.4,
						  4603.5 and
						  5307.3, Labor
						  Code. Reference: Sections
						  124,
						  129,
						  129.5,
						  138.3,
						  138.4,
						  139.5,
						  4061,
						  4453,
						  4454,
						  4600,
						  4603.2,
						  4621,
						  4622,
						  4636,
						  4637,
						  4641,
						  4643,
						  4644,
						  4650,
						  4701 through
						  4703.5,
						  5401,
						  6409 and
						  6409.1, Labor
						  Code.
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 2 - Claims Administration and Recordkeeping › Section 10102 - Retention of Claim Files

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) All claim files shall be maintained at
					 least until the latest of the following dates:
(1) five years from the date of
					 injury;
(2) one year from the date
					 compensation was last provided;
(3)
					 all compensation due or which may be due has been paid;
(4) if an audit has been conducted within the
					 time specified in (a)(1), until the findings of an audit of the file have
					 become final.
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 2 - Claims Administration and Recordkeeping › Section 10103 - Claim Log-Contents and Maintenance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This section shall govern claim log maintenance prior to
						January 1, 1994.
(a) Every claims
					 administrator shall produce a claim log of all work-injury claims maintained at
					 each adjusting location, prepared chronologically in alphanumeric or numeric
					 ascending order, or in a combination thereof.
(b) The claim log shall contain at least the
					 following information:
(1) Name of
					 injured.
(2) The claims
					 administrator's claim number.
(3)
					 Date of injury.
(4) An indication
					 as to whether the work-injury claim is an indemnity or medical-only
					 case.
(5) An entry if all liability
					 for a claim has been denied.
(6)
					 For self-insurer, when a Certificate of Consent to Self-Insure has been issued,
					 an entry identifying the corporation employing the injured.
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 2 - Claims Administration and Recordkeeping › Section 10103.1 - Claim Log-Contents and Maintenance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This section shall govern claim log maintenance on or
						after January 1, 1994.
(a) The claims
					 administrator shall maintain annual claim logs listing all work-injury claims,
					 open and closed. Each year's log shall be maintained for at least five years
					 from the end of the year covered. Separate claim logs shall be maintained for
					 each self-insured employer and each insurer for each adjusting
					 location.
(b) Each entry in the
					 claim log shall contain at least the following information:
(1) Name of injured worker.
(2) Claims administrator's claim
					 number.
(3) Date of
					 injury.
(4) An indication whether
					 the claim is an indemnity or medical-only claim.
(5) An entry if all liability for a claim has
					 been denied at any time. All liability is considered to have been denied even
					 if the administrator accepted liability for medical-legal expense.
(6) If the claim log is for a self-insured
					 employer and a Certificate of Consent to Self-Insure has been issued, the name
					 of the corporation employing the injured worker. If the claim log consists of
					 claims for two or more members of an insurer group, each entry on the log shall
					 identify the insurer.
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 2 - Claims Administration and Recordkeeping › Section 10103.2 - Claim Log-Contents and Maintenance

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
This section shall govern claim log maintenance on or
						after January 1, 2003.
(a) The claims
					 administrator shall maintain annual claim logs listing all work-injury claims,
					 open and closed. Each year's log shall be maintained for at least five years
					 from the end of the year covered. Separate claim logs shall be maintained for
					 each self-insured employer and each insurer for each adjusting
					 location.
(b) Each entry in the
					 claim log shall contain at least the following information:
(1) Name of injured worker.
(2) Claims administrator's claim
					 number.
(3) Date of
					 injury.
(4) An indication whether
					 the claim is an indemnity or medical-only claim. Indemnity claims shall be
					 differentiated from medical-only claims or any other claim where no indemnity
					 payment(s) has been made. Claims that only require the provision of first aid,
					 as defined by California Code of Regulations, title 8, section
					 9780(d), should
					 not be included in the claim log.
(5) An entry if all liability for a claim has
					 been denied at any time. All liability is considered to have been denied even
					 if the administrator accepted liability for medical-legal expense.
(6) If the claim log is for a self-insured
					 employer and a Certificate of Consent to Self-Insure has been issued, the name
					 of the corporation employing the injured worker. If the claim log consists of
					 claims for two or more members of an insurer group, the log shall identify the
					 insurer for each claim.
(7) If the
					 claim has been transferred from one adjusting location to another:
(A) The address of the new location shall be
					 identified on the initial adjusting location's log along with the date of
					 transfer.
(B) Claims that are
					 transferred from one adjusting location to another shall be listed on the claim
					 log of the new adjusting location for the year in which the claim was initially
					 reported, not for the year in which the claim was transferred. The claim log
					 shall also indicate the address of the old adjusting location along with the
					 date of transfer.
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 3 - Auditing › Section 10105 - Auditing, Discretion of the Administrative Director

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
To carry out the responsibility pursuant to Labor Code
						sections
						129 or
						129.5, the
						Administrative Director or his/her representative shall audit claims
						administrators' claim files and claim logs at such reasonable times as he/she
						deems necessary. The Administrative Director or his/her representative may also
						utilize the provisions of Government Code sections
						11180
						through
						11191.
1. New
						article 3 heading, repealer of former section
						10105 and renumbering and amendment
						of former section
						10104 to section
						10105 filed 1-28-94; operative
						1-28-94. Submitted to OAL for printing only pursuant to Government Code section
						11351
						(Register 94, No. 4). For prior history, see Register 90, No. 4.
2.
						Amendment filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
3. Amendment of section and NOTE filed
						4-20-2009; operative 5-20-2009 (Register 2009, No.
						17).
Note: Authority cited: Sections
						  59,
						  129,
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  129 and
						  129.5, Labor
						  Code.
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 3 - Auditing › Section 10106.1 - Routine and Targeted Audit Subject Selection; Complaint Tracking; Appeal of Targeted Audit Selection

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
For audits conducted on or after January 1, 2003:
(a) The Division of Workers' Compensation
					 shall maintain and update annually a list of known adjusting locations of
					 California workers' compensation claims. The list will be based on information
					 provided to the Division in Annual Reports of Inventory submitted pursuant to
					 California Code of Regulations, title 8, section
					 10104, data submitted to the
					 Division's Workers' Compensation Information System pursuant to Labor Code
					 section
					 138.6, and any
					 other sources of information available. The list shall include all known
					 adjusting locations, located in or out of California, of insurers,
					 self-administered self-insured employers, and third-party administrators that
					 administer California workers' compensation claims.
(b) The Audit Unit shall select each
					 adjusting location from the list of adjusting locations for routine profile
					 audit review pursuant to Labor Code section
					 129(b)(1)
					 at least once every five years. Audit subjects may be selected in any order,
					 and routine audits may be scheduled by the Audit Unit in a manner to best
					 minimize travel expenses and utilize audit personnel efficiently.
(1) For routine audit subject selection
					 pursuant to Labor Code section
					 129(b)(1),
					 if the adjusting location includes claims of more than one insurance
					 underwriting company, self-insured employer, or third-party administrator at
					 the location and all claims at that location share the same local management,
					 the location will be considered as one audit subject.
(2) Eligibility under this subsection for
					 removal from the pool for routine audit subject selection shall not bar the
					 targeted selection of the audit subject pursuant to subdivisions (c)(2),
					 (c)(3), (c)(4) of this section, Labor Code section
					 129(b)(3),
					 or for investigation and/or audit pursuant to California Code of Regulations,
					 title 8, section
					 10106.5.
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 3 - Auditing › Section 10106.5 - Civil Penalty Investigation

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
Notwithstanding California Code of Regulations, title 8,
						sections 10106.1 and
						10107.1, if the Audit Unit has
						information indicating the possible existence of claims handling practices
						which would be assessable as a civil penalty under Labor Code section
						129.5(e),
						it may conduct an investigation and/or audit pursuant to Labor Code sections
						129 and
						129.5. The
						Audit Unit may also utilize the provisions of Government Code sections
						11180
						through
						11191 as
						the delagee of the Administrative Director's powers as a department
						head.
The Audit Unit shall report any suspected fraudulent
						activity uncovered during an audit and/or investigation to the appropriate law
						enforcement agencies, including but not limited to the Department of Insurance
						Fraud Bureau and the appropriate District Attorney having jurisdiction over the
						audit subject.
1. New
						section filed 10-26-98; operative 11-25-98 (Register 98, No. 44).
2.
						Amendment filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
3. Amendment of first paragraph filed
						4-20-2009; operative 5-20-2009 (Register 2009, No.
						17).
Note: Authority cited: Sections
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  11180
						  through
						  11191,
						  Government Code; and Sections
						  59,
						  60,
						  111,
						  124,
						  129 and
						  129.5, Labor
						  Code.
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 3 - Auditing › Section 10108 - Audit Violations-General Rules

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The following general rules apply to audits and audit
						processes under Labor Code sections
						129 and
						129.5:
(a) If the date or deadline (including any
					 applicable extension) to perform any act falls on a weekend or holiday, the act
					 may be performed on the last business day before or the first business day
					 after the weekend or holiday. A payment date which is changed under this
					 provision shall not change the normal dates for later payments in an existing
					 two-week payment schedule.
(b) For
					 the purpose of imposing audit penalties, if the claims administrator does not
					 record the date it received a document, it shall be deemed received five days
					 after the latest date the sender wrote on the document.
(c) Audit penalties will be based on each
					 claim's status when the claim is audited.
(1)
					 If, at the time of the audit, the claims administrator has failed to perform a
					 required act, but remedies the failure prior to the receipt of the Notice of
					 Audit Commencement, when the claims administrator was notified that the claim
					 was selected for audit, the claims administrator will be accountable for the
					 violation. The penalty for an unlawful delay of more than 30 days in performing
					 an act is the same as the penalty for not performing the act unless these
					 regulations specifically provide otherwise. However the penalty will be
					 mitigated for good faith because the act, though late, was eventually
					 performed.
(2) If the claims
					 administrator remedies a failure to perform a required act only after receipt
					 of the Notice of Audit Commencement, the claims administrator will nonetheless
					 be accountable for the violation as a failure to act and audit findings related
					 to the violation will be based on the failure to perform the act. In cases
					 where there is an unlawful delay of more than 30 days in performing an act and
					 the act was performed only after the audit subject was notified that the claim
					 was selected for audit, penalties will be assessed as though there was a
					 failure to perform the act rather than late performance of the act. There will
					 be no mitigation for good faith if the act was performed after notification to
					 the audit subject that the claim was selected for audit.
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 3 - Auditing › Section 10109 - Duty to Conduct Investigation; Duty of Good Faith

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) To comply with the time requirements of
					 the Labor Code and the Administrative Director's regulations, a claims
					 administrator must conduct a reasonable and timely investigation upon receiving
					 notice or knowledge of an injury or claim for a workers' compensation
					 benefit.
(b) A reasonable
					 investigation must attempt to obtain the information needed to determine and
					 timely provide each benefit, if any, which may be due the employee.
(1) The administrator may not restrict its
					 investigation to preparing objections or defenses to a claim, but must fully
					 and fairly gather the pertinent information, whether that information requires
					 or excuses benefit payment. The investigation must supply the information
					 needed to provide timely benefits and to document for audit the administrator's
					 basis for its claims decisions. The claimant's burden of proof before the
					 Appeal Board does not excuse the administrator's duty to investigate the
					 claim.
(2) The claims administrator
					 may not restrict its investigation to the specific benefit claimed if the
					 nature of the claim suggests that other benefits might also be
					 due.
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 5 - Administrative Penalties › Section 10112 - Liability for Penalty Assessments

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The audit subject is liable for all penalty assessments,
						except that if the audit subject is acting as a third-party administrator, the
						client of that third-party administrator which secures the payment of
						compensation is jointly and severally liable with the administrator for all
						penalty assessments except civil penalties imposed under Labor Code section
						129.5(e).
						Without affecting DWC's rights, a third-party administrator and its client may
						agree how to allocate the audit penalty expense between them.
1.
						Renumbering of former section
						10112 to section
						10115 and new section filed
						1-28-94; operative 1-28-94. Submitted to OAL for printing only pursuant to
						Government Code section
						11351
						(Register 94, No. 4).
2. Amendment filed 4-20-2009; operative
						5-20-2009 (Register 2009, No. 17).
Note: Authority cited: Sections
						  59,
						  129.5, 133.
						  5307.3, Labor Code. Reference: Section
						  129,
						  129.5,
						  3200-
						  6002, Labor
						  Code.
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 5.5 - Administrative Penalties Pursuant to Labor Code Section 5814.6 › Section 10112.3 - Notice of Administrative Penalty Assessment, Appeal Hearing Procedures and Review

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 Pursuant to Labor Code section
					 5814.6, the
					 Administrative Director shall issue a Notice of Assessment when the
					 Administrative Director, or his or her designee (the investigating unit of the
					 Division of Workers Compensation), has evidence to support a finding that an
					 employer or insurer has knowingly violated section
					 5814 with a frequency that
					 indicates a general business practice.
(b) Successor liability may be imposed on a
					 corporation or other business entity that has merged with, consolidated with,
					 or otherwise continued the business of an employer or insurer that is subject
					 to penalties under Labor Code section
					 5814.6. The
					 surviving entity shall assume and be liable for all the liabilities,
					 obligations and penalties of the prior employer or insurer. Successor liability
					 will be imposed if there has been a substantial continuity of business
					 operations and/or the new business uses the same or substantially the same work
					 force.
(c) The Notice of Assessment
					 shall be in writing and shall contain all of the following:
(1) The basis for the penalty assessment,
					 including a statement of the alleged violations and the amount of each proposed
					 penalty;
(2) A description of the
					 methods for paying or appealing the penalty assessment.
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 6 - Civil Penalty › Section 10113 - Order to Show Cause RE: Assessment of Civil Penalty and Notice of Hearing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) If an audit
					 subject fails to meet the full compliance audit performance standards in two
					 consecutive full compliance audits, the Audit Unit shall refer the audit
					 subject to the Administrative Director for the possible assessment of a civil
					 penalty pursuant to Labor Code Section
					 129.5(e).
					 Nothing in these regulations shall prohibit the Audit Unit from referring any
					 audit subject to the Administrative Director for the possible assessment of a
					 civil penalty under Labor Code Section
					 129.5(e)
					 for any other reason. If the Administrative Director has reason to believe that
					 an employer, insurer, or third-party administrator has knowingly committed or
					 performed any of the practices set forth in Labor Code Section
					 129.5(e),
					 (s) he shall issue an Order to Show Cause Re:
					 Assessment of Civil Penalty and Notice of Hearing.
(b) The order shall be in writing and shall
					 contain all of the following:
(1) Notice that
					 a civil penalty not to exceed $100,000 per audit subject named in the order may
					 be assessed;
(2) The basis for the
					 assessment, including a statement of the alleged violations;
(3) Notice of the date, time and place of
					 hearing. Continuances will not be allowed without a showing of good
					 cause.
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 6 - Civil Penalty › Section 10113.1 - Answer to Order to Show Cause

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Within 30 days after service of the Order
					 to Show Cause Re Assessment of Civil Penalties the claims administrator may
					 file with the Administrative Director an Answer to the Order to Show Cause in
					 which the claims administrator may:
(1) Admit
					 or deny in whole or in part any of the allegations of set forth in the Order to
					 Show Cause;
(2) Set forth any
					 affirmative defenses.
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 6 - Civil Penalty › Section 10113.2 - Amended Complaint or Supplemental Order to Show Cause Before Submission of Case

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
At any time before the hearing, the Administrative
						Director may file or permit the filing of an amended complaint or supplemental
						Order to Show Cause. All parties shall be notified thereof. If the amended or
						supplemental Order to Show Cause presents new charges, the Administrative
						Director shall afford the claims administrator a reasonable opportunity to
						prepare its defense thereto, and it shall be entitled to file an amended
						Answer.
1. New
						section filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
Note: Authority cited: Sections
						  59,
						  129,
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  129 and
						  129.5, Labor
						  Code.
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 6 - Civil Penalty › Section 10113.3 - Administrative Director's Designation of Hearing Officer

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director may delegate authority to a
						Workers' Compensation Administrative Law Judge to act as the Hearing Officer.
						The delegation may include the following authority: to conduct a prehearing
						conference; to conduct the civil penalty hearing; to issue subpoenas for the
						attendance of witnesses at the conference; to issue subpoena duces tecum for
						the production of documents; and to prepare a Recommended
						Determination.
1. New
						section filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
Note: Authority cited: Sections
						  59,
						  129,
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  129 and
						  129.5, Labor
						  Code.
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 6 - Civil Penalty › Section 10113.4 - Written Statement and Supporting Evidence

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Not less than 30 calendar days prior to
					 the date of hearing, the claims administrator shall file and serve a written
					 statement with the Administrative Director specifying its legal and factual
					 bases for its Answer. The written statement shall also include copies of all
					 documents and all other evidence the claims administrator intends on
					 introducing into evidence at the hearing. If the written statement and
					 supporting evidence are not timely filed and served, the Administrative
					 Director shall dismiss the Answer and issue a written Determination. If the
					 written statement and supporting evidence are not timely filed and served, the
					 claims administrator may file a written request for leave to file a written
					 statement and supporting evidence. The written request for leave must be filed
					 and served no later than the date of the hearing. The Administrative Director
					 may grant the request for leave to file the written statement and supporting
					 evidence and continue the hearing, upon a showing of good cause.
(b) The claims administrator must file the
					 original and one copy of the written statement and all supporting evidence on
					 the Administrative Director and concurrently serve one copy of the written
					 statement and all supporting evidence on the Audit Unit. The original and all
					 copies of any filings shall have a proof of service.
1. New
						section filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
2. Amendment of subsection (a) filed
						4-20-2009; operative 5-20-2009 (Register 2009, No.
						17).
Note: Authority cited: Sections
						  59,
						  129,
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  129 and
						  129.5, Labor
						  Code.
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 6 - Civil Penalty › Section 10113.5 - Prehearing Conference; Subject Matter; Prehearing Order

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The Administrative Director or designee
					 shall set the time and place for the prehearing conference, and shall give
					 reasonable written notice to all parties.
(b) The prehearing conference may deal with
					 one or more of the following matters:
(1)
					 Exploration of settlement possibilities.
(2) Preparation of stipulations.
(3) Clarification of issues.
(4) Rulings on identity and limitation of the
					 number of witnesses.
(5) Objections
					 to proffers of evidence.
(6) Order
					 of presentation of evidence and cross-examination.
(7) Rulings regarding issuance of subpoenas
					 and protective orders.
(8) Exchange
					 of witness lists and of exhibits or documents to be offered in evidence at the
					 hearing.
(9) Schedules for the
					 submission of written briefs and schedules for the commencement and conduct of
					 the hearing.
(10) Any other matters
					 as shall promote the orderly and prompt conduct of the
					 hearing.
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 6 - Civil Penalty › Section 10113.6 - Subpoenas

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The Administrative Director or designee may issue
						subpoenas for the attendance of persons and the production of documents or
						other things, to compel the attendance of persons residing anywhere within the
						State.
1. New
						section filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
Note: Authority cited: Sections
						  59,
						  129,
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  129 and
						  129.5, Labor
						  Code.
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 6 - Civil Penalty › Section 10114 - Hearing

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) The hearing
					 shall be held at the place, time and date noticed, unless a continuance has
					 been granted for good cause.
(b) A
					 record of the hearing shall be made.
(c) Any claims administrator that fails to
					 meet the full compliance audit performance standards in two consecutive full
					 compliance audits shall be rebuttably presumed to have engaged in a general
					 business practice of discharging and administering its compensation obligations
					 in a manner causing injury to those dealing with it. With regard to any other
					 bases for the assessment of a civil penalty, the Audit Unit will have the
					 burden to prove a
prima facie
case that a violation of
					 129.5(e) occurred. The claims administrator may cross-examine the witnesses.
					 The claims administrator may then present any testimony to rebut the Audit
					 Unit's testimony, and the Audit Unit may cross-examine. The Designated Hearing
					 Officer may choose to ask questions for clarification of the record.
1. New
						section filed 1-18-90; operative 1-18-90 (Register 90, No. 4). New section is
						exempt from review by OAL pursuant to Government Code Section
						11351.
2.
						Renumbering of former section
						10114 to section
						10115.2 and renumbering and
						amendment of former sections
						10110 and
						10111 to section
						10114 filed 1-28-94; operative
						1-28-94. Submitted to OAL for printing only pursuant to Government Code section
						11351
						(Register 94, No. 4).
3. Amendment of section heading, repealer of
						subsections (a), (b), (d), (e), (g) and (h), subsection relettering and new
						subsection (c) filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
Note: Authority cited: Sections
						  59,
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  7,
						  124 and
						  129.5, Labor
						  Code.
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 6 - Civil Penalty › Section 10114.1 - Evidence; Examination of Witnesses

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Oral evidence shall be taken only on oath
					 or affirmation.
(b) Each party
					 shall have these rights: to call and examine witnesses, to introduce exhibits;
					 to cross-examine opposing witnesses on any matter relevant to the issues even
					 though that matter was not covered in the direct examination; to impeach any
					 witness regardless of which party first called him or her to testify; and to
					 rebut the evidence.
(c) In the
					 absence of a contrary order by the Hearing Officer, the Audit Unit shall
					 present its evidence first.
(d) The
					 hearing need not be conducted according to technical rules relating to evidence
					 and witnesses, except as hereinafter provided. Any relevant evidence shall be
					 admitted if it is the sort of evidence on which responsible persons are
					 accustomed to rely in the conduct of serious affairs, regardless of the
					 existence of any common law or statutory rule which might make improper the
					 admission of the evidence over objection in civil actions.
(e) Hearsay evidence may be used for the
					 purpose of supplementing or explaining other evidence but over timely objection
					 shall not be sufficient in itself to support a finding unless it would be
					 admissible over objection in civil actions. An objection is timely if made
					 before submission of the case or on reconsideration.
(f) The rules of privilege shall be effective
					 to the extent that they are otherwise required by statute to be recognized at
					 the hearing.
1. New
						section filed 12-30-2002; operative 1-1-2003 pursuant to Government Code
						section
						11343.4
						(Register 2003, No. 1).
Note: Authority cited: Sections
						  59,
						  129,
						  129.5,
						  133 and
						  5307.3, Labor
						  Code. Reference: Sections
						  7,
						  124 and
						  129.5, Labor
						  Code.