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 10111.1 - Schedule of Administrative Penalties for Injuries on or After January 1, 1994

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
The administrative penalties set forth in subdivisions
						(a) through (d) of this section will be imposed for injuries occurring on or
						after January 1, 1994, subject to any applicable mitigation or exacerbation
						under subdivision (e) of this section. Penalties will not be assessed for
						violations occurring during the period January 1, 1994 through March 31, 1994
						for acts or omissions for which there previously existed no audit
						penalties.
(a) The following Group A
					 violations carry penalties of up to $100:
(1)
					 The penalty for each failure to pay the 10% self-imposed increase with a late
					 indemnity payment in accordance with Labor Code section
					 4650(d)
					 is:
$25 if the self-imposed increase was paid after the late
						indemnity payment;
If the self-imposed increase was not paid or was only
						partially paid, the audit penalty is based on the amount of the underlying
						indemnity and is as follows:
$25 if the late-paid indemnity totals not more than 3
						days;
$50 if the late-paid indemnity totals more than 3 but not
						more than 7 days;
$75 if the late-paid indemnity totals more than 7 but not
						more than 14 days;
$100 if the late paid indemnity totals more than 14
						days.
(2) The penalty for
					 each failure to make the first payment of permanent disability indemnity within
					 14 days after the last payment of temporary disability indemnity, or within 14
					 days of knowledge of the existence of permanent disability when there is no
					 temporary disability, is:
$25 if the first payment was made 1 to 2 days
						late;
$50 if the first payment was made 3 to 7 days
						late;
$75 if the first payment was made 8 to 14 days
						late;
$100 if the first payment was made more than 14 days
						late;
(3) The penalty for
					 each failure to object or pay to the injured worker, within 60 days of
					 receiving a request, reimbursement for the reasonable expense incurred for
					 self-procured medical treatment in accordance with Labor Code section
					 4600, is:
$25 for $100 or less in expense;
$50 for more than $100, to $200, in expense;
$75 for more than $200, to $400, in expense;
$100 for more than $400 in expense.
(4) The penalty for each failure to pay
					 mileage fees and bridge tolls when notifying the employee of a medical
					 evaluation scheduled by the claims administrator, in accordance with Labor Code
					 sections
					 4600 through
					 4621; or to pay
					 mileage fees and bridge tolls within 14 days of receiving notice of a medical
					 evaluation scheduled by the administrative director or the appeals board; or to
					 object or pay the injured worker for any other transportation, temporary
					 disability, meal or lodging expense incurred to obtain medical treatment or
					 evaluation, within 60 days of receiving a request, is:
$25 for $10 or less in expense;
$50 for more than $10, to $50, in expense;
$75 for more than $50, to $100, in expense;
$100 for more than $100 in expense.
(5) The penalty for each failure to document
					 a factual basis for paying less than the maximum indemnity rate is
					 $100.
(6) The penalty for each
					 failure to make temporary disability, permanent disability, death benefits or
					 VRMA payments according to the payment schedule defined by California Code of
					 Regulations, title 8, section
					 10100.1(x) of
					 these regulations is:
$25 for each payment made 1 to 2 days late;
$50 for each payment made 3 to 7 days late;
$75 for each payment made 8 to 14 days late;
$100 for each payment made more than 14 days
						late.
(7) The penalty for
					 each failure to comply with any regulation of the Administrative Director
					 specified in this subdivision is:
[i] For each
					 failure to include in a claim file a copy of the Employee's Claim for Worker's
					 Compensation Benefits, DWC Form 1, showing the date the form was provided to
					 and received from the employee, or documentation of the date the claim form was
					 provided to the employee if the employee did not return the form, the penalty
					 is:
$100 if there was any late indemnity payments, or if
						notice of acceptance of the claim was not issued within 90 days after the
						employer's date of knowledge of injury and disability, or if the claim was
						denied.
[ii] For each failure
					 to issue a notice of benefits as required by California Code of Regulations,
					 title 8, beginning with section
					 9810, or by California Code of
					 Regulations, title 8, beginning with section
					 10122, unless penalties apply and
					 are assessed under section
					 10111.1 subdivisions (b)(2),
					 (b)(3), (b)(4), (b)(5), (b)(6), (b)(7) or (b)(8), the penalty is
					 $100.
[iii] For each Notice of
					 Benefits which was not issued timely as provided in California Code of
					 Regulations, title 8, beginning with section
					 9810, or as provided in California
					 Code of Regulations, title 8, beginning with section
					 10122, unless penalties apply and
					 are assessed under section
					 10111.1 subdivisions (b)(2),
					 (b)(3), (b)(4), (b)(5), (b)(6), (b)(7) or (b)(8), the penalty is:
$25 for each notice of first, resumed, changed or final
						payment of temporary disability indemnity, wage continuation, death benefits,
						permanent disability indemnity, or VRMA which was issued from 1 to 7 days
						late;
$50 for each notice of first, resumed, changed or final
						payment of temporary disability indemnity, wage continuation, death benefits,
						permanent disability indemnity, or VRMA which was issued more than 7 days late,
						and for each delay in decision notice which was issued from 1 to 7 days
						late;
$75 for each delay in decision notice which was issued
						more than 7 days late.
[iv]
					 For each notice of benefits required by California Code of Regulations, title
					 8, beginning with section
					 9810, (except a materially
					 misleading denial notice assessed under section
					 10111.1(b)(9)), or
					 by California Code of Regulations, title 8, beginning with section
					 10122, which is materially
					 inaccurate or incomplete, the penalty is $25.
[v] For each failure to include in a claim
					 file, or document attempts to obtain, any of the required contents specified in
					 section 10101.1 subdivisions (b), (c), (d),
					 (e), (f), (g), (h), (i), (j), the penalty is $100.
[vi] For each failure to comply with any
					 regulation of the Administrative Director, not otherwise assessed in this
					 subchapter, the penalty is $100.
(8) The penalty for each failure to pay or
					 object to a billing for a medical-legal expense, in the manner required by
					 section 9794, within 60 days of receiving
					 the bill and all reports and documents required by the Administrative Director
					 incident to the services, is:
$25 for each bill which was paid more than 60 days from
						receipt with interest and a 10% increase;
$50 for each bill which was paid more than 60 days from
						receipt where either interest or a 10% increase was not included;
$75 for each bill which was paid more than 60 days from
						receipt where neither interest nor a 10% increase was paid.
$100 for each bill which was not paid at the time the
						audit subject was notified the claim was selected for audit where no timely
						objection was sent.
(9) The
					 penalty for each failure to pay or object to, in the manner required by Labor
					 Code section
					 4603.2, a bill
					 for medical treatment provided or authorized by the treating physician, is as
					 follows when the bill remains unpaid at the time the audit subject is notified
					 that the claim was selected for audit. For the purpose of this penalty the
					 treating physician will be presumed chosen by the employee unless the claims
					 administrator demonstrates otherwise:
$25 for each bill of $100 or less, excluding interest and
						penalty;
$50 for each bill of more than $100, but no more than
						$200 excluding interest and penalty;
$75 for each bill of more than $200, but no more than
						$300, excluding interest and penalty;
$100 for each bill of more than $300, excluding interest
						and penalty.
(10) The
					 penalty for each failure to pay or object to, in the manner required by Labor
					 Code section
					 4603.2, a bill
					 for medical treatment provided or authorized by the treating physician, is as
					 follows when the bill was paid before the audit subject was notified that the
					 claim was selected for audit:
$25 for each bill which included an increase and interest
						with the late payment of any uncontested amount of the bill, in accordance with
						Labor Code Section
						4603.2;
$50 for each bill which included either the increase or
						interest with the late payment of any uncontested amount of the bill, in
						accordance with Labor Code Section
						4603.2;
$75 for any bill which included neither the increase nor
						interest with the late payment of any uncontested amount of the bill, in
						accordance with Labor Code Section
						4603.2.
(11) The penalty for each failure to pay or
					 object to a vocational rehabilitation bill within 60 days of receipt, as
					 required by California Code of Regulations, title 8, sections
					 10132 and
					 10132.1, is:
$25 for each bill of $100 or less;
$50 for each bill of more than $100, but no more than
						$200;
$75 for each bill of more than $200, but no more than
						$300;
$100 for each bill of more than $300.
(12) The penalty for each failure to make a
					 required first payment of temporary disability indemnity within 14 days after
					 the employer's date of knowledge of injury and disability is:
$25 if the first payment was made 1 to 7 days
						late;
$50 if the first payment was made 8 to 14 days
						late;
$75 if the first payment was made 15 to 21 days
						late;
$100 if the first payment was made more than 21 days
						late.
(13) The penalty for
					 each underpayment of an indemnity payment (including death benefits and VRMA),
					 when the balance of the indemnity was paid late, is:
$25 for late payment of the equivalent of 3 days of
						indemnity or less;
$50 for late payment of the equivalent of more than 3 but
						no more than 7 days of indemnity;
$75 for late payment of the equivalent of more than 7 but
						no more than 14 days of indemnity;
$100 for the late payment of the equivalent of more than
						14 days of indemnity.
(14)
					 The penalty for each failure to make a first payment of VRMA or death benefit
					 when due is:
$25 if the first payment was made 1 to 7 days
						late;
$50 if the first payment was made 8 to 14 days
						late;
$75 if the first payment was made 15 to 21 days
						late;
$100 if the first payment was made more than 21 days
						late.