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California Workers' Compensation Administrative Penalties for the 1994 (Part 2)

By Edited Nov 11, 2016 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

(9)  The penalty for each failure to pay or object to, within 60 days of receipt, in the manner required by law or regulation, a bill for medical treatment provided or authorized by the treating physician, is as follows. 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 or 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 include a 10% increase or interest with a late payment of any uncontested amount of a bill for medical treatment provided or authorized by the treating physician, in accordance with Labor Code Section 4603.2 is:

$25 for each late payment made without either the 10% increase or interest
$50 for each late payment made with neither the 10% increase nor interest

(11)  The penalty for each failure to pay or object to a vocational rehabilitation bill within 60 days of receipt, as required by Title 8 California Code of Regulations, 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

(b)  The following Group B violations carry penalties of up to $500:

(1)  The penalty for each failure to maintain or provide to the Audit Unit a claim log which complies with these Regulations is:

$25 for each failure to list on a claim log one or more of the following: employee's name; claim number; date of injury;

$25 for each misdesignation of an indemnity file as a medical-only file on the claim log;

$100 for each failure to identify subsidiary self-insured employer on the log as required by Section 10102.3(b)(6) of these Regulations;

$100 for each failure to identify the underwriting insurance company of an insurance group;

$100 for each failure to designate a denied claim on the log;

$100 for each claim not listed on the log;

$250 for each failure to provide the claim log to the Audit Unit within 14 days of receipt of a written request if the claim log was provided more than 14 but no more than 30 days from receipt of the request;

$500 for each failure for more than 30 days from receipt of a written request, to provide the claim log the Audit Unit.

(2)  The penalty for each failure to provide information regarding the  Americans with Disabilities Act, the Fair Employment and Housing Act, and workers' compensation vocational rehabilitation as required by Labor Code Section 4636(a) immediately after 90 days of aggregate temporary disability indemnity if $100 if the information was provided or the employee returned to his or her usual and customary occupation more than 10 but not more than 20 days after 90 days of aggregate total disability, and an additional $100 for each additional delay of no more than 10 days, to a maximum penalty of $500.

(3) The penalty for each failure to issue notice of medical eligibility for vocational rehabilitation services (if not previously issued) within 10 days after knowledge of a physician's opinion that the employee is medically eligible, or for failure to issue notice within 10 days after 366 days of aggregate total temporary disability, is $100 if the notice was issued not more than 10 days late, and an additional $100 for each additional delay of no more than 10 days, to a maximum penalty of $500.

(4) The penalty for each failure to provide the employee with a copy of the treating physician's final report together with notice of the procedure to contest the treating physician's determination, in accordance with Labor Code Section 4636(d), immediately upon receipt of that report, is $100 for compliance more than 10 but not more than 20 days after receipt of the  treating physician's final report, and an additional $100 for each additional delay of not more than 10 days, to a maximum penalty of $500.

(5)  The penalty for each failure to notify an injured employee of the reasons he or she is not entitled to any, or to any further, vocational rehabilitation services, and the procedure for contesting the determination of non-eligibility, as required by Sections 9813(a)(3) and 10131, is $100 if notification was issued more than 10 but not more than 20 days after the determination, and an additional $100 for each additional delay of not more than 10 days, to a maximum penalty of $500.

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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