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California Workers' Compensation Administrative Penalties for the years 1990 - 1993 (Part 2)

By Edited Apr 16, 2014 0 0

This is part two of the Workers Compensation Administrative Penalties for California for the years 1990 through 1993.

§ 10111 Schedule of Administrative Penalties for injuries on or after January 1, 1990 but before January 1, 1994

(2)  Failure to comply with Labor Code Sections 4636, 4637, and 4644, the penalty for this violation is:

[i] The penalty for each failure to assign a qualified rehabilitation representative immediately after 90 days of aggregate temporary disability indemnity is $100 if the assignment was made 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 not more than 10 days, to a maximum penalty of $500.

[ii] 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 not more than 10 days, to a maximum penalty of $500.

[iii]  The penalty for each failure to notify an injured employee for 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, 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.

(c)  A penalty of up to $1,000 for each violation shall be assessed when there is:

(1) Failure to pay or appeal penalties provided for in the Notice of Compensation Due within 15 days of the date of receipt of the Notice.  The penalty for this violation is;

$250 for each assessment paid more than 15 but not more than 30 days after receipt
$500 for each assessment paid more than 30 but not more than 45 days after receipt
$1,000 for each assessment not paid within 45 days after receipt

(2)  Failure to comply with or appeal any final order of the Workers' Compensation Appeals Board within 30 days of service. 

The penalty for this violation is:

$250 for full compliance in more than 30 but not more than 45 days from the date of service, or for any late payment or failure to pay interest due;

$500 for full compliance (other than a late interest payment) in more than 45 but not more than 60 days from the date of service;

$750 for full compliance (other than a late interest payment in more than 60 but not more than 75 days from the date of service; $1,000 if there was not full compliance (other than failure to pay interest) within 75 days of the date of service.

(d)  A penalty of up to $5,000 for each violation shall be assessed when there is;

(1)  Failure to produce, on a second request, a legible paper copy of a claim file within 5 days of written notice by the Administrative Director or his representatives.  The penalty for this violation is:

$100 if the file was produced not more than 3 days late
$250 if the file was produced more than 3 but not more than 14 days late
$500 if the file was produced more than 14 but nor more than 29 days late
$1,000 if the file was produced more than 29 days late but not more than 40 days late
$2,500 if the file was produced more than 40 days late but not more than 90 days late
$5,000 if the file was produced more than 90 days late or was not produced

(2)  Denial of liability for a claim without supporting documentation.

The total penalty shall be determined by applying the penalty assessment amount listed in [i] for gravity, subtracting the amount listed [ii] for good faith if applicable, and increasing or decreasing eh penalty as applicable for history and frequency as set forth in [iii] and [iv];

[i] For a claim involving potential for medical treatment only the penalty is $3,500;

For a claim involving potential for medical treatment and either temporary or permanent disability the penalty is $4,000

For a claim involving potential for medical treatment and both temporary and permanent disability the penalty is $4,500;

For a claim involving potential for medical treatment, temporary disability, permanent disability and vocational rehabilitation the penalty is $5000

For a claim involving potential for death benefits the penalty is $5000

[ii] The penalty will be reduced by $1,000 for good faith if there was a reasonable attempt to investigate the claim.

[iii] Reduction or increase of the penalty for history shall be based on the following:

An audit subject having no prior Audit Unit history will receive a $500 reduction;

An audit subject having a prior Audit Unit history of no more than one audited unsupported denial will receive a $500 reduction;

An audit subject having a prior Audit Unit history of more than one audited unsupported denial but no more than 5% of audited denials as unsupported will receive no reduction or increase for history;

An audit subject having a prior Audit Unit history or more than one audited unsupported denial and more than 5% of audited denials as unsupported will receive a $500 increase.

[iv] Reduction or increase of the penalty for frequency shall be based on the following;

An audit subject having no more than one audited unsupported denial will receive a $500 reduction;

An audit subject having more than one audited unsupported denial but no more than 5% of audited denials which are unsupported will receive no reduction or increase for frequency;

An audit subject having more than one audited unsupported denial and more than 5% of audited denials which are unsupported will receive an increase of $500

[v] The total amount assessed for a denial shall be reduced by 50% if the claim was accepted after the denial without evidence that the acceptance was the result of litigation or of the claim's selection for audit.

(3) Except as provided in subsection (d) (1) of this section, failure to comply with or appeal any lawful written request or order of the Administrative Director regarding a claim filed within 30 days.  The penalty for this violation is:

$500 if there was compliance in more than 30 but not more than 40 days from receipt of the request or order;

$1000 if there was compliance in more than 40 but not more than 60 days from receipt of the request or order;

$2,500 if there was compliance in more than 60 but not more than 90 days of receipt of the request or order.

$5000 for failure to comply within 90 days or receipt of the request or order.

(4) Failure by a claims administrator. to provide a claim form within 24 hours upon request of an injured worker or his/her agent. The penalty for this violation is:

$500 if the claim form was provided in more than 1 but not more than 5 working days from receipt of the request, if benefits were being provided to the employee at the time of the request;

$1000 if the claim form was not provided within 5 working days of receipt of the request, if benefits were being provided to the employee at the time of the request;

$3000 if the claim form was provided in more than 1 but not more than 5 working days from receipt of the request, if benefits were not being provided to the employee at the time of the request;

$5000 if the claim form was not provided within 5 working days of receipt of the request, if benefits were not being provided to the employee at the time of the request.

(e)  The penalties otherwise applicable under subsections (a) through (d) of this section shall be modified, if warranted, for good faith, history, and frequency in the same manner as penalties are modified for acts or omissions occurring on or after January 1, 1994 by Section 10111.1 (e) of this Article.

Note:  Authority cited:  Sections 59, 129.5, 133, 138.3, 138.4, 139.5, 4603.5, 4627, 5307.3, Labor Code Reference: Sections 124, 129, 129.5, 4061, 4453, 4454, 4550, 4600, 4603.2, 4621, 4622, 4625, 4636 through 4638, 4639, 4641, 4642, 4650, 4651, 4701 through 4703.5, 4706.5, 5401, 5401.6, 5402, 5800, 5814, Labor Code; Section 2629.1 (e), (f), Unemployment Insurance Code.

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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