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California Workers' Compensation Administrative Penalties for the 1994 (Part 1)

By Edited Jul 25, 2015 0 0

The following are the Workers Compensation Administrative Penalties for California for the year 1994.

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

The administrative penalties set forth in subsections (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 subsection (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 and 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 if $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 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 subsection 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 were 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, of the claim was denied.

[ii]  For each Notice of Benefits which was not issued timely as provided in Title 8, California Code of Regulations, Division 1, Chapter 4.5, Chapter 1.5, Article 7, beginning with Section 10122, unless penalties apply and are assessed under Section 10111.1 (b)(3), (b)(4),(b)(5),(b)(6),(b)(7) or (b)(8) of these Rules, the penalty is $100.

[iii]  For each Notice of Benefits which was not issued timely as provided in Title 8, California Code of Regulations, Division 1, Chapter 4.5 Subchapter 1, Article 8 beginning with Section 9810, or as provided in Title 8, Article 7, beginning with Section 10122, unless penalties apply and are assessed under Section 10111.1(b)(3),(b)(4),(b)(5),(b)(6),(b)(7) or (b)(8) of these Rules, 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 Title 8, California Code of Regulations, Division 1, Chapter 4.5, Subchapter 1, Article 8, beginning with Section 9810, (except an inaccurate denial notice assessed under Section 10111.1(b)(9)), or by Title 8, California Code of Regulations, Division 1, Chapter 4.5, Subchapter 1.5, Article 7 beginning with Section 10122, which is inaccurate, 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(b),(c),(d),(e),(f),(g),(h),(i),(j) of these Regulations, 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:

$50 for each bill which was paid more than 60 days from receipt with interest and a 10% increase;

$75 for each bill which was paid more than 60 days from receipt where either interest or a 10% increase was not included;

$100 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 where no timely objection was sent.

For more information on California Workers’ Compensation benefits, see the following articles:

California Workers' Compensation: What to Do If You are Injured at Work
California Workers' Compensation: Permanent Disability Benefits
California Workers' Compensation: Temporary Disability Benefits

 

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