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 8 - Benefit Notices; Claims Administrator's Duties and Responsibilities; Claim Form and Notice of Potential Eligibility for Benefits; Regulatory Authority of the Administrative Director › Section 9811 - Definitions

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
As used in this Article:
(a) "Claims Administrator" means 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, a self-administered joint powers authority, a
					 self-administered legally uninsured employer, a third-party claims
					 administrator for a self-insured employer, insurer, legally uninsured employer,
					 or joint powers authority, or an administrator for an alternative dispute
					 resolution (ADR) program established under Labor Code section
					 3201.5 or
					 3201.7.
(b) "Date of knowledge of injury" means the
					 date the employer had knowledge of a worker's injury or claim of
					 injury.
(c) "Date of knowledge of
					 injury and disability" means the date the employer had knowledge of (1) a
					 worker's injury or claim of injury, and (2) the worker's inability or claimed
					 inability to work because of the injury.
(d) "Dependent" means any person who may be
					 or is claimed to be entitled to workers' compensation benefits as a result of
					 an employee's death (including compensation which was accrued and unpaid to an
					 injured employee before his or her death), and includes the parent or legal
					 guardian of a minor dependent child.
(e) "Duration" means any known period of time
					 for which benefits are to be paid, or, where benefits will continue for an
					 unknown period of time the event that will occur which will determine when
					 benefits will terminate.
(f)
					 "Employee" includes dependent(s) in the event of any injury which results in
					 death.
(g) "Employee's (or
					 claimant's) remedies" means the statement of the employee's rights, as set
					 forth in subdivision (e) of section
					 9810, of which an employee or
					 claimant shall be informed in benefit notices when specified in these
					 regulations.
(h) "Employer" means
					 any person or entity defined as an employer by Labor Code section
					 3300.
(i) "Injury" means any injury as defined in
					 Labor Code section
					 3208 which
					 results in medical treatment beyond first aid, lost time beyond the date of
					 injury, or death.
(j) "Medical
					 issue" means a dispute or question that is subject to Labor Code section
					 4060,
					 4061, or
					 4062, and does
					 not include a medical treatment issue that is subject to Labor Code section
					 4610,
					 4610.5, and
					 4610.6.
(k) "Permanent and stationary status" means
					 the point when the employee has reached maximal medical improvement his or her
					 condition is well stabilized and unlikely to change substantially in the next
					 year with or without medical treatment.
(l) "Salary continuation" means payments made
					 to an employee pursuant to a plan that meets the criteria specified in Labor
					 Code section
					 4650(g).
(m) "Temporary disability payment" includes
					 salary continuation as defined in subdivision (
l
) of this
					 section.
1.
						Amendment of section and NOTE filed 1-7-94; operative 1-7-94. Submitted to OAL
						for printing only pursuant to Government Code section
						11351
						(Register 94, No. 1).
2. Amendment of section and NOTE filed
						12-11-2007; operative 4-9-2008 (Register 2007, No. 50).
3. Amendment
						of section and NOTE filed 8-24-2015; operative 1-1-2016 (Register 2015, No.
						35).
Note: Authority cited: Sections
						  59,
						  133,
						  138.3,
						  138.4 and
						  5307.3, Labor
						  Code. Reference: Sections
						  138.4,
						  3201.5,
						  3201.7,
						  3208,
						  3300,
						  3351,
						  3351.5,
						  3700,
						  3753,
						  4060,
						  4061,
						  4062,
						  4062.2,
						  4610,
						  4610.5,
						  4610.6,
						  4650(a)-(d),
						  4653,
						  4654,
						  4700,
						  4701 and
						  4850, Labor
						  Code; Sections
						  11651 and
						  11652,
						  Insurance Code; Section
						  19871,
						  Government Code; Section
						  89529.03,
						  Education Code; and Sections
						  2330 and
						  2332, Civil
						  Code.