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California Workers' Compensation Administrative Penalties for the years 1990 - 1993 (Part 1)

By Edited Dec 28, 2013 0 0

The following are the Workers Compensation Administrative Penalties for California for the years 1990 – 1993.

§ 10111 Schedule of Administrative Penalties for injuries on or after January 1, 1990 but before 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, 1990, but before January 1, 1994, subject to any applicable mitigation or exacerbation under subsection (e) of this section.

(a) A penalty of up to $100.00 for each work-injury violation shall be assessed when there is:

(1) Failure to make full payment of 10% self-imposed increase when temporary disability indemnity or permanent disability indemnity is overdue.  The penalty for this violation 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 days 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)  Failure to provide first permanent disability payments when due and/or within 14 days after temporary disability payments are terminated.  The penalty for this violation 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) Failure to respond to a written request for medical treatment of injured worker within 20 days of the date of request.  The penalty for this violation is:

$25 for a response made from 1 to 7 days late;
$50 for a response made from 8 to 15 days late;
$75 for a response made from 16 to 34 days late'
$100 for failure to respond from more than 35 days.

(4)  Failure to provide, upon request, any transportation costs when due to injured worker for medical care.  The penalty for this violation is:

$25 for $10 or less in expense;
$50 for more than $10, to $20, in expense;
$75 for more than $20, to $40, in expense;
$100 for more than $40 in expense

(5)  Failure to document average weekly earnings if temporary disability indemnity is being paid at less than the maximum rate.  The penalty for this violation is $100.

(6)  Failure to make the first payment of temporary disability indemnity not later than 14 days after the date of the employer's knowledge of injury and disability pursuant to Labor Code Section 4650 (a).  The penalty for this violation 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, or if all indemnity than due was not paid but was paid with a subsequent payment;
$100 if the first payment was not made within 14 days of the employer date of knowledge of injury and disability, or if all indemnity then due was not paid with the first payment and remains unpaid at the time of audit.

(7)  Failure to follow the Rules and Regulations established by the Administrative Director for the purpose of carrying out the workers' compensation provisions in Labor Code Section 3200 through Section 6002.  The penalty for this violation 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, or if the claim was denied.

[ii] For each failure to issue a notice of benefits as required by Title 8 California Code of Regulations, Division 1, Chapter 4.5, Subchapter 1, Article 8 beginning with Section 9810, or by Title 8, California Code of Regulations, Division 1, Chapter 4.5, Subchapter 1.5, Article 7, beginning with Section 10122, 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 California Code of Regulations, Division 1, Chapter 4.5, Subchapter 1.5, Article 7, beginning with Section 10122, 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 or denial notice which was issued from 1 to 7 days late; $75 for each delay in decision notice or denial 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 7, beginning with Section 10122, which was inaccurate, except an inaccurate denial notice, the penalty is $25.  For an inaccurate denial notice the penalty is $100.

[v] For each failure to include in a claim file, or document attempts to obtain, any of the required contents specified in Section 10101, the penalty is $100.

[vi] For each failure to comply with any regulation of the Administrative Director, not otherwise assessed in these Regulations, the penalty is $100.

(8)  Failure to pay or object to all documented Medical-Legal expenses within 60 days of receipt of billing and any required reports as provided in Labor Code Section 4622.  The penalty for this violation 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.

(9)  Failure to pay or object to expenses for medical treatment within 60 days of receipt of the  bill and any required reports.  The penalty for this violation is:

$25 for each bill of $100 or less, excluding interest and penalty;
$50 for each bill of 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)  Failure to pay within ten days any indemnity due which is not specified in subsections (a) (1) through (a) (9).  The penalty for this violation is;

$25 for late payment of 3 days of indemnity or less;
$50 for late payment of more than 3 but no more than 7 days of indemnity;
$75 for late payment of more than 7 days of indemnity, or failure to pay 3 days of indemnity or less;
$100 for failure to pay more than 3 days of indemnity

(b)  A penalty of up to $500 for each violation shall be assessed when there is;

(1)  Failure to maintain and provide a written claim log as defined in Section 10100 (f) to the audit unit commencing July 1, 1990, and thereafter.  The claim log shall contain all claims received, whether liability has been accepted, and distinguish between Indemnity and Medical-only claims.  The penalty for this violations:

$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 employers on the log;
$100 for each failure to identify the underwriting insurance company or insurance group;
$100 for each failure to designate a denied claim 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 to the Audit Unit.

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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