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 10111.2 - Full Compliance Audit Penalty Schedules; Target Audit Penalty Schedule

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a)
					 For full compliance audits conducted on or after January 1, 2003,
					 administrative penalties will be assessed pursuant to subdivision (a) for audit
					 subjects that fail to meet or exceed the profile audit review performance
					 standards calculated pursuant to California Code of Regulations, title 8,
					 section 10107.1(c)(3) but
					 meet or exceed the full compliance audit performance standards calculated
					 pursuant to section
					 10107.1(d)(3).
					 However, for violations in claims with dates of injury from January 1, 1990
					 through December 31, 1993, penalty amounts may not exceed the amounts that
					 would be assessed pursuant to California Code of Regulations, title 8, section
					 10111, and for violations in claims
					 with dates of injury from January 1, 1994 through December 31, 2002, penalty
					 amounts may not exceed the amounts that would be assessed pursuant to Section
					 10111.1:
(1) The penalty for each failure to pay the
					 10% self-imposed increase due because of a late indemnity payment is:
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:
$50 if the late-paid indemnity totals not more than 3
						days;
$100 if the late-paid indemnity totals more than 3 but
						not more than 7 days;
$150 if the late-paid indemnity totals more than 7 but
						not more than 14 days;
$200 if the late paid indemnity totals more than 14 but
						not more than 21 days;
$300 if the late paid indemnity totals more than 21 but
						not more than 28 days;
$500 if the late paid indemnity totals more than 28
						days.
(2) The penalty for
					 each failure to pay or denial of rehabilitation maintenance allowance,
					 temporary disability indemnity, or salary continuation in lieu of temporary
					 disability indemnity, without a factual, medical or legal basis for the failure
					 or denial, is:
$200 for the equivalent of 3 days or less of unpaid
						indemnity;
$400 for the equivalent of more than 3 but not more than
						7 days of unpaid indemnity;
$600 for the equivalent of more than 7 but not more than
						14 days of unpaid indemnity;
$1,000 for the equivalent of more than 14 but not more
						than 21 days of unpaid indemnity;
$1,500 for the equivalent of more than 21 but not more
						than 28 days of unpaid indemnity;
$2,000 for the equivalent of more than 28 but not more
						than 35 days of unpaid indemnity;
$3,000 for the equivalent of more than 35 but not more
						than 42 days of unpaid indemnity;
$5,000 for the equivalent of more than 42 days of unpaid
						indemnity.
(3) The penalty
					 for each failure to pay permanent disability indemnity based on a reasonable
					 estimate of permanent disability, or denial of permanent disability indemnity,
					 without a factual, medical or legal basis, is:
$400 for up to 6 weeks of unpaid indemnity;
$800 for more than 6 but not more than 15 weeks of unpaid
						indemnity;
$1,500 for more than 15 but not more than 30 weeks of
						unpaid indemnity;
$2,000 for more than 30 but not more than 50 weeks of
						unpaid indemnity;
$3,000 for more than 50 but not more than 95 weeks of
						unpaid indemnity;
$5,000 for more than 95 weeks of unpaid
						indemnity.
(4) The penalty
					 for each failure to pay death benefits pursuant to Labor Code section
					 4701 to any
					 claimant without a factual, medical or legal basis for the failure, is:
$200 for the equivalent of 3 days or less of unpaid
						indemnity or for no more than $300 of unpaid burial expenses;
$400 for the equivalent of more than 3 but not more than
						7 days of unpaid indemnity or for more than $300, but not more than $600, of
						unpaid burial expenses;
$600 for the equivalent of more than 7 but not more than
						14 days of unpaid indemnity or for more than $600, but no more than $900, of
						unpaid burial expenses;
$1,000 for the equivalent of more than 14 but not more
						than 21 days of unpaid indemnity or for more than $900, but no more than$1,500,
						of unpaid burial expenses;
$1,500 for the equivalent of more than 21 but not more
						than 28 days of unpaid indemnity or for more than $1,500, but no more than
						$2,000, of unpaid burial expenses;
$3,000 for the equivalent of more than 28 but not more
						than 42 days of unpaid indemnity or for more than $2,250 of unpaid burial
						expenses;
$5,000 for the equivalent of more than 42 days of unpaid
						indemnity.
The penalty for each failure to pay to any claimant
						compensation which was accrued and unpaid to the injured worker at the time of
						the worker's death is the same penalty which would apply for failure to pay
						that compensation to the injured worker.
(5) The penalty for each late first payment
					 of temporary disability indemnity is:
$100 if the first payment was made 1 to 3 days
						late
$200 if the first payment was made 4 to 7 days
						late
$250 if the first payment was made 8 to 14 days
						late;
$300 if the first payment was made 15 to 21 days
						late;
$400 if the first payment was made 22 to 30 days
						late.
Penalty amounts for payments made over 30 days late are
						assessed pursuant to California Code of Regulations, title 8, section
						10108(c) and
						subdivision (a)(2) of this section.
(6) The penalty for each late first payment
					 of permanent disability is:
$100 if the first payment was made 1 to 3 days
						late;
$200 if the first payment was made 4 to 7 days
						late
$250 if the first payment was made 8 to 14 days
						late;
$300 if the first payment was made 15 to 21 days
						late;
$400 if the first payment was made 22 to 30 days
						late.
Penalty amounts for payments made over 30 days late are
						assessed pursuant to section
						10108(c) and
						subdivision (a)(3) of this section.
For purposes of this subdivision, the first payment of
						permanent disability indemnity shall be considered late if not made within 14
						days after the last payment of temporary disability indemnity, or within 14
						days of knowledge of the existence of permanent disability, whichever last
						occurs.
(7) The penalty for
					 each late first payment of VRMA or death benefit is:
$100 if the first payment was made 1 to 3 days
						late;
$200 if the first payment was made 4 to 7 days
						late
$250 if the first payment was made 8 to 14 days
						late;
$300 if the first payment was made 15 to 21 days
						late;
$400 if the first payment was made 22 to 30 days
						late.
Penalty amounts for payments made over 30 days late are
						assessed pursuant to section
						10108(c) and
						subdivision (a)(2) of this section.
(8) The penalty for each underpayment of
					 temporary disability, permanent disability, death benefits, or VRMA, when the
					 balance of the indemnity was paid late, or late paid self-imposed increases,
					 not paid together with the late indemnity payment is:
$100 for late payment of the equivalent of 3 days of
						indemnity or less, except it is $25 for late paid self-imposed
						increases;
$200 for late payment of the equivalent of more than 3
						but no more than 7 days of indemnity, except it is $50 for late paid
						self-imposed increases;
$250 for late payment of the equivalent of more than 7
						but no more than 14 days of indemnity, except it is $75 for late paid
						self-imposed increases;
$300 for late payment of the equivalent of more than 14
						but no more than 21 days of indemnity, except it is $100 for late paid
						self-imposed increases;
$400 for the late payment of the equivalent of more than
						21 days of indemnity, except it is $125 for late paid self-imposed
						increases.
Penalty amounts for underpayments made more than 30 days
						late are governed by section
						10108(c).
(9) The penalty for each failure to make
					 temporary disability, permanent disability, death benefits or VRMA payments
					 according to the payment schedule defined by section
					 10100.2(jj) is:
$100 for each payment made 1 to 3 days late
$200 for each payment made 4 to 7 days late
$250 for each payment made 8 to 14 days late;
$300 for each payment made 15 to 21 days late;
$400 for each payment made 22 to 30 days late.
Penalty amounts for payments made more than 30 days late
						are governed by section
						10108(c).
(10) Penalty amounts assessed pursuant to
					 subdivisions (a)(1) through (a)(9) will be increased by 100%, but will not
					 exceed $5000 except as provided by Labor Code section
					 129.5(c)(3),
					 if the failure to pay or late payment was in violation of an award or order of
					 the Workers' Compensation Appeals Board, the Rehabilitation Unit, or the
					 Administrative Director. When the award or order is not specific to, but only
					 stated as a lump sum, of any benefit pursuant to subdivisions (a)(1) through
					 (a)(9) above, the increased penalty amount of 100% as specified above shall be
					 determined based on the equivalent amount of unpaid indemnity as assessed under
					 subdivision (a)(2), (a)(3), or (a)(4) of this section. Increased penalties
					 under this subdivision will be separately assessed for late compliance and/or
					 the failure to pay any portion of an award or order.
(11) Notwithstanding Labor Code section
					 129.5(c)(1)
					 and whether or not the audit subject has met or exceeded performance standards
					 calculated pursuant to California Code of Regulations, title 8, section
					 10107.1(c)(3),
					 penalties will be assessed for failure to pay, or late or partial payment of, a
					 Notice of Compensation Due issued as a result of an audit conducted pursuant to
					 Labor Code section
					 129(b).
					 Penalties will be assessed as follows:
A penalty in the same amount as the total of the
						penalties applicable under subdivisions (a)(1) through (a)(4) and (a)(10) will
						be assessed for any compensation paid more than 15 but not more than 30 days
						after receipt of the Notice of Compensation Due;
A penalty in the amount of 200% of the total of the
						penalties applicable under subdivisions (a)(1) through (a)(4) and (a)(10) will
						be assessed for any compensation paid more than 30 but not more than 60 days
						late;
A penalty in the amount of 300% of the total of the
						penalties applicable under subdivisions (a)(1) through (a)(4) and (a)(10) will
						be assessed for any compensation not paid within 60 days.
(12) Notwithstanding Labor Code section
					 129.5(c)(2)
					 and whether or not the audit subject has met or exceeded performance standards
					 calculated pursuant to section
					 10107.1(d)(3),
					 additional penalties will be assessed for late payment or failure of the audit
					 subject to pay any administrative penalties assessed pursuant to this section
					 that are not timely appealed pursuant to California Code of Regulations, title
					 8, section 10115.1. Penalties will be assessed
					 as follows:
An additional penalty of 50% of the amount of each late
						paid penalty will be assessed for each penalty paid more than 30 but not more
						than 60 days from receipt of the Notice of Penalty Assessments;
An additional penalty of 100% of the amount of each
						applicable penalty will be assessed for each penalty not paid within 60 days of
						receipt of the Notice of Penalty Assessments.