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 10112.2 - Schedule of Administrative Penalties Pursuant to Labor Code Section 5814.6

Current through Register 2024 Notice Reg. No. 28, July 12, 2024
(a) Administrative
					 penalties shall only be imposed under this section based on violations of Labor
					 Code section
					 5814, after
					 more than one penalty award has been issued by the Workers' Compensation
					 Appeals Board on or after June 1, 2004 based on conduct occurring on or after
					 April 19, 2004 for unreasonable delay or refusal to pay compensation within a
					 five year time period. The five year period of time shall begin on the date of
					 issuance of any penalty award not previously subject to an administrative
					 penalty assessment pursuant to Labor Code section
					 5814.6.
(b) The Division of Workers' Compensation
					 shall at least monthly submit copies of WCAB decisions, findings, and/or awards
					 issued pursuant to Labor Code section
					 5814 to the
					 Audit Unit.
(c) The Audit Unit
					 shall obtain monthly Labor Code section
					 5814 activity
					 reports and shall determine if the decisions, findings, and/or awards are
					 final. If more than one final penalty award has been issued on or after June 1,
					 2004 against a claims administrator at a single adjusting location, the Audit
					 Unit may proceed with an investigation.
(d) To determine whether a violation
					 described in Labor Code section
					 5814.6 has
					 occurred, and notwithstanding Labor Code section
					 129(a) through
					 (d) and section
					 129.5
					 subdivisions (a) through (c) and sections
					 10106,
					 10106.1,
					 10107 and
					 10107.1 of Title 8 of the
					 California Code of Regulations, the Administrative Director, or his or her
					 designee, may conduct an investigation, which may include but is not limited to
					 an audit of claims and/or utilization review files. The investigation may be
					 independent of, or may be conducted concurrently with, an audit conducted
					 pursuant to Labor Code section
					 129 and
					 129.5.
(e) The Administrative Director, or his or
					 her designee, may also utilize the provisions of Government Code sections
					 11180
					 through
					 11191 to
					 carry out the responsibilities mandated by Labor Code section
					 5814.6.
(f) The Administrative Director may issue a
					 Notice of Assessment under this article in conjunction with an order to show
					 cause pursuant to section
					 10113 of Title 8 of the California
					 Code of Regulations, charging both an administrative penalty under this section
					 and a civil penalty under subdivision (e) of Labor Code section
					 129.5 in the
					 same pleading, however only one penalty may be imposed by the Administrative
					 Director following the hearing on such charges.
(g) Pursuant to Labor Code section
					 5814.6, the
					 Administrative Director, or his or her designee, shall issue a Notice of
					 Assessment for administrative penalties against an employer and/or insurer as
					 follows:
(1) $ 100,000 for when the
					 Administrative Director, or his or her designee, has evidence to support a
					 finding that an employer or insurer knowingly violated Labor Code section
					 5814 with a
					 frequency that indicates a general business practice, and additionally for each
					 applicable penalty award, the following;
(2) $ 30,000 for each penalty award by the
					 Workers' Compensation Appeals Board for a violation of Labor Code section
					 5814 for an
					 unreasonable delay or refusal to comply with an existing compensation
					 order;
(3) For each penalty award
					 by the Workers' Compensation Appeals Board for a violation of Labor Code
					 section
					 5814 for an
					 unreasonable delay or refusal to make a payment of temporary disability
					 benefits or salary continuation payments in lieu of temporary disability;
					 vocational rehabilitation maintenance allowance, life pension, or death
					 benefits:
(A) $ 5,000 for 14 days or less of
					 indemnity benefits;
(B) $ 10,000
					 for 15 days through 42 days of indemnity benefits;
(C) $ 15,000 for more than 42 days of
					 indemnity benefits.
(4)
					 For each penalty award by the Workers' Compensation Appeals Board for a
					 violation of Labor Code section
					 5814 for an
					 unreasonable delay or refusal to provide authorization for medical treatment:
(A) $ 1,000 for retrospective medical
					 treatment authorization;
(B) $
					 5,000 for prospective or concurrent medical treatment authorization;
(C) $15,000 for prospective or concurrent
					 medical treatment authorization when the employee's condition is such that the
					 employee faces an imminent and serious threat to his or her
					 health.
(5) For each
					 penalty award by the Workers' Compensation Appeals Board for a violation of
					 Labor Code section
					 5814 for an
					 unreasonable delay or refusal to reimburse an employee for self-procured
					 medical treatment costs:
(A) $ 1,000 for
					 medical treatment costs of $100 or less, excluding interest and
					 penalty;
(B) $ 2,000 for medical
					 treatment costs of more than $100 to $300, excluding interest and
					 penalty;
(C) $ 3,000 for medical
					 treatment costs of more than $300 to $500, excluding interest and
					 penalty;
(D) $ 5,000 for medical
					 treatment costs of more than $500, excluding interest and
					 penalty.
(6) $ 2,500 for
					 each penalty award by the Workers' Compensation Appeals Board for a violation
					 of Labor Code section
					 5814 for an
					 unreasonable delay or refusal to provide the supplemental job displacement
					 benefit, as required by section
					 10133.51(b) and
					 section 10133.56(c),
					 respectively, of Title 8 of the California Code of Regulations.
(7) $ 2,500 for each penalty award by the
					 Workers' Compensation Appeals Board for a violation of Labor Code section
					 5814 for an
					 unreasonable delay or refusal to make payment to an injured worker as
					 reimbursement for payment for services provided for a supplemental job
					 displacement benefit voucher, or where the unreasonable delay or refusal to pay
					 the training provider causes an interruption in the employee's
					 retraining.
(8) For each penalty
					 award by the Workers' Compensation Appeals Board for a violation of Labor Code
					 section
					 5814 for an
					 unreasonable delay or refusal to make a payment of permanent disability
					 indemnity benefits:
(A) $ 1,000 for 15 weeks
					 or less of indemnity benefits;
(B)
					 $ 5,000 for more than 15 but not more than 50 weeks of indemnity
					 benefits;
(C) $ 7,500 for more than
					 50 but not more than 95 weeks of indemnity benefits;
(D) $ 15,000 for more than 95 weeks of
					 indemnity benefits.
(9) $
					 2,500 for any other penalty award by the Workers' Compensation Appeals Board
					 pursuant to Labor Code section
					 5814 not
					 otherwise specified in this section.