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California Workers’ Compensation Practice

Handle workers' compensation matters with ease using this essential, practice-oriented guide.

“The keystone to any workers' compensation practitioner's library. It provides a thorough list of cases, statutes, and forms and is my go-to guide for the daily issues that come up in practice. I have visited and revisited its chapters often and don't doubt that I will continue to do so.”
Gregory Grinberg, Law Office of Gregory Grinberg, San Mateo

Handle workers’ compensation matters with ease using this essential, practice-oriented guide.

  • Includes changes enacted by SB 863 and its implementing regulations
  • Covers matters on behalf of applicants, employers, and insurers
  • Comprehensive discussion of temporary and permanent disability
  • Complete coverage from medical treatment through filing and review
  • Multiple time-saving forms and checklists
Print WC33150

4th edition, 2 looseleaf volumes, updated March 2023

$ 633.00
Add Forms CD to Print WC23152
$ 99.00
  • Overview
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“The keystone to any workers' compensation practitioner's library. It provides a thorough list of cases, statutes, and forms and is my go-to guide for the daily issues that come up in practice. I have visited and revisited its chapters often and don't doubt that I will continue to do so.”
Gregory Grinberg, Law Office of Gregory Grinberg, San Mateo

Handle workers’ compensation matters with ease using this essential, practice-oriented guide.

  • Includes changes enacted by SB 863 and its implementing regulations
  • Covers matters on behalf of applicants, employers, and insurers
  • Comprehensive discussion of temporary and permanent disability
  • Complete coverage from medical treatment through filing and review
  • Multiple time-saving forms and checklists

1

Workers’ Compensation and Other Remedies

Charles Lawrence Swezey

  • I.  INTRODUCTION
    • A.  Scope of Chapter  1.1
    • B.  Historical Background of Workers’ Compensation Laws  1.2
  • II.  CALIFORNIA’S WORKERS’ COMPENSATION SYSTEM
    • A.  How the System Differs From Tort Law  1.3
      • 1.  Liability Without Fault  1.4
      • 2.  Compulsory Insurance  1.5
      • 3.  Automatic Payment; Notice  1.6
      • 4.  Limited Benefits  1.7
      • 5.  Expeditious Machinery for Resolving Disputes  1.8
        • a.  Mandatory Dispute Resolution Procedures
          • (1)  Compensability, Permanent Disability, and Medical Treatment  1.9
          • (2)  Supplemental Job Displacement Benefit  1.10
          • (3)  Arbitration  1.11
          • (4)  Negotiated Resolutions  1.12
        • b.  Information and Assistance Officers  1.13
          • (1)  Available Services  1.14
          • (2)  Tolling of Limitations Periods  1.15
        • c.  Dispute Resolution By WCAB  1.16
          • (1)  Board Proceedings Not Bound by Rules of Evidence or Procedure  1.17
          • (2)  Representation at Board Proceedings  1.18
          • (3)  Full Disclosure  1.19
    • B.  Antifraud Provisions  1.20
      • 1.  Activities Subject to Criminal or Civil Penalties  1.21
      • 2.  Effects of Fraud Violation  1.22
      • 3.  Reporting Fraud  1.23
    • C.  Employer’s Obligations
      • 1.  Duty to Give Notice  1.24
        • a.  Notices Before Injury  1.25
        • b.  Claim Form and Notice After Injury  1.26
        • c.  Continuing Duty to Give Notices  1.27
      • 2.  Duty to Respond to Claim Form
        • a.  Employee Files Claim Form  1.28
        • b.  Employer Response to Filing  1.29
        • c.  Acceptance or Rejection of Claim  1.30
      • 3.  First Payment of Temporary Disability Indemnity or Delay Notice  1.31
      • 4.  Additional Notices  1.32
      • 5.  Duty to Transmit Claims Data  1.33
  • III.  CIVIL DAMAGES
    • A.  Both Workers’ Compensation Benefits and Civil Damages May Be Available  1.34
    • B.  Workers’ Lawsuits
      • 1.  Lawsuits Against Third Parties  1.35
      • 2.  Lawsuits Against Employers
        • a.  Exclusive Remedy Rule  1.36
        • b.  Civil Damages or Workers’ Compensation?  1.37
        • c.  Uninsured Employer  1.38
        • d.  Statutory and Other Exceptions  1.39
      • 3.  Lawsuit Against Coemployees  1.40
      • 4.  Lawsuit Against Compensation Insurers  1.41
      • 5.  Lawsuit Against Independent Adjusting Agents  1.42
    • C.  Employer’s Reimbursement and Credit Rights  1.43
  • IV.  COLLATERAL BENEFITS
    • A.  State Disability Benefits
      • 1.  Unemployment Disability Compensation  1.44
      • 2.  Paid Family Leave Benefits  1.45
    • B.  Other Disability Insurance  1.46
    • C.  Unemployment Insurance  1.47
    • D.  Sick Leave, Vacation Pay, Wages, and Fringe Benefits  1.48
    • E.  Leave Acts  1.49
    • F.  Medical Insurance  1.50
    • G.  Protection for Disabled Workers  1.51
      • 1.  Americans with Disabilities Act  1.52
      • 2.  California Fair Employment and Housing Act  1.53
      • 3.  Further Information  1.54
    • H.  Social Security  1.55
    • I.  Veterans’ Benefits  1.56
    • J.  Uninsured Motorist Insurance  1.57
    • K.  Victim of Violent Crime Indemnification  1.58
    • L.  Welfare  1.59
  • V.  FEDERAL REMEDIES
    • A.  Longshore and Harbor Workers’ Compensation Act
      • 1.  Coverage
        • a.  Injured Worker Must Meet Both Status and Situs Tests  1.60
        • b.  State Law May Also Apply  1.61
      • 2.  Procedure  1.62
      • 3.  Third Party Suits  1.63
    • B.  Other Federal Compensation Acts
      • 1.  Federal Employees’ Compensation Act  1.64
      • 2.  Defense Base Act  1.65
      • 3.  Outer Continental Shelf Lands Act  1.66
      • 4.  Private Employees on Federal Lands and Buildings  1.67
    • C.  Seamen’s Remedies
      • 1.  Maintenance, Cure, and Wages  1.68
      • 2.  Unseaworthiness  1.69
      • 3.  Jones Act  1.70
        • a.  Jones Act Coverage  1.71
        • b.  Where to File; State Law May Also Apply  1.72
      • 4.  Death on the High Seas Act  1.73
    • D.  Federal Employers’ Liability Act  1.74

2

Jurisdiction

Colleen S. Casey

  • I.  WORKERS’ COMPENSATION APPEALS BOARD
    • A.  Constitutional and Legislative Authority  2.1
    • B.  Composition  2.2
    • C.  Jurisdiction and Judicial Powers  2.3
    • D.  Basic Jurisdictional Limits
      • 1.  Compensable Injury Required  2.4
      • 2.  Jurisdiction Must Be Established  2.5
      • 3.  Limited Jurisdiction  2.6
      • 4.  Personal Jurisdiction Required  2.7
      • 5.  Cannot Declare Statute Unconstitutional  2.8
      • 6.  Termination and Reservation of Jurisdiction  2.9
      • 7.  Continuing Jurisdiction  2.10
      • 8.  Fraud Conviction  2.11
      • 9.  Carve-Out Programs  2.12
    • E.  Exclusive Jurisdiction  2.13
    • F.  Exclusive Remedy Rule  2.14
      • 1.  Acts Outside Normal Employment Relationship  2.15
      • 2.  Violation of Public Policy  2.15A
      • 3.  Discrimination Claims  2.15B
      • 4.  Statutory Exceptions  2.15C
      • 5.  Administrative Director’s Powers  2.16
  • II.  PREREQUISITES FOR RECOVERY  2.17
    • A.  Specific Conditions of Compensability  2.18
      • 1.  Subject to Workers’ Compensation Laws  2.19
      • 2.  Performing Services Related to Employment  2.20
        • a.  Personal Comfort and Convenience  2.21
        • b.  Lunch and Coffee Breaks  2.22
        • c.  Bunkhouse Rule  2.23
      • 3.  Proximate Cause
        • a.  General Rules  2.24
        • b.  Examples of Injuries or Conditions Caused by Employment  2.24A
      • 4.  Intoxication  2.25
      • 5.  Self-lnflicted Injuries  2.26
      • 6.  Suicide  2.27
      • 7.  Initial Physical Aggressor  2.28
      • 8.  Felony Convictions  2.29
      • 9.  Restriction for Recreational, Social, and Athletic Activity  2.30
      • 10.  Posttermination or Layoff Claims
        • a.  Physical Injuries  2.31
        • b.  Posttermination Psychiatric Injuries  2.32
    • B.  Arising Out of Employment  2.33
      • 1.  Condition of Employer’s Premises or Equipment  2.34
      • 2.  Extraneous or Unknown Source: Positional Risk or Zone of Danger Rule  2.35
      • 3.  Employment Risks Versus Personal Risks  2.36
        • a.  Personal Risk  2.37
        • b.  Mixed Risk  2.38
        • c.  Neutral Risk  2.39
      • 4.  Employee’s Preexisting Conditions; Normal Bodily Movements  2.40
      • 5.  Horseplay  2.41
    • C.  Occurring in Course of Employment  2.42
      • 1.  Unauthorized or Forbidden Activities  2.43
      • 2.  Commercial Travelers; Travel Between Worksites  2.44
      • 3.  Dual Purpose Rule  2.44A
      • 4.  Before and After Work Hours  2.45
      • 5.  Going and Coming Rule  2.46
        • a.  Employer-Provided Transportation  2.47
        • b.  Special Mission or Errand Doctrine  2.48
        • c.  Special Risk Exception  2.49
        • d.  Restatement of Going and Coming Rule  2.50
      • 6.  Telecommuting  2.50A
      • 7.  Traveling to or From Medical Appointments  2.50B
    • D.  “Injury” Defined
      • 1.  Injury Versus Disability  2.51
      • 2.  Disease  2.52
      • 3.  Psychiatric Injury
        • a.  General Criteria (Lab C §3208.3)  2.53
          • (1)  6-Month Requirement  2.54
          • (2)  “Sudden and Extraordinary” Exception  2.54A
          • (3)  Physical-Mental Injuries  2.55
        • b.  Good Faith Personnel Action Defense  2.56
        • c.  Posttermination Psychiatric Injury Claims  2.57
        • d.  State Prison Inmates and Persons Committed to a State Hospital  2.58
      • 4.  Blood-Borne Disease or Illness  2.58A
      • 5.  Other Compensable Injuries  2.59
  • III.  ESTABLISHING EMPLOYMENT RELATIONSHIP
    • A.  “Employer” Defined; Exclusions  2.60
    • B.  “Employee” Defined  2.61
      • 1.  Presumption of Employee Status  2.62
      • 2.  Employees Included by Statute  2.63
      • 3.  Judicial Inclusions  2.64
      • 4.  Inclusion by Election  2.64A
    • C.  Excluded Persons and Occupations
      • 1.  Employees Excluded by Statute  2.65
        • a.  Residential and Personal Employees
          • (1)  Time and Salary Limitation (Lab C §3352(a)(8))  2.66
          • (2)  Family Member Limitation (Lab C §3352(a)(1))  2.67
          • (3)  Exception From Exclusion for Residential Worker Whose Employer Is Uninsured  2.68
        • b.  Athletic Activities: Participants and Officials  2.69
        • c.  Services for Charities  2.70
        • d.  Ski Resort and Recreational Camp Workers  2.71
        • e.  Deputies  2.72
        • f.  Disaster Workers  2.73
        • g.  Other Excluded Employees  2.74
        • h.  Employees Temporarily Working in California
          • (1)  General Rules  2.74A
          • (2)  Rules Applicable to Professional Athletes
            • (a)  Claims Filed on or After 9/15/2013  2.74B
            • (b)  Claims Filed Before 9/15/2013  2.74C
      • 2.  Independent Contractors
        • a.  Definition; Right to Control  2.75
        • b.  General Factors  2.76
        • c.  Rebuttable Presumptions  2.77
      • 3.  Volunteers  2.78
      • 4.  Employees Under Federal or Tribal Jurisdiction  2.79
    • D.  General and Special Employment  2.80
      • 1.  Evidence of Special Employment  2.81
      • 2.  Joint and Several Liability  2.82
      • 3.  Temporary Employees Assigned by Agency  2.83
      • 4.  Jurisdiction Over Workers’ Compensation Insurers  2.84
  • IV.  CONCURRENT JURISDICTION
    • A.  Uninsured Employer  2.85
    • B.  Jurisdiction to Determine Jurisdiction  2.86
      • 1.  Res Judicata  2.87
      • 2.  Collateral Estoppel  2.88
      • 3.  Forum Selection Clause  2.88A
  • V.  EXTRATERRITORIAL JURISDICTION
    • A.  Contract of Hire Made in California  2.89
    • B.  Contract of Hire Made Outside California  2.90
    • C.  Serious and Willful Violation  2.91
    • D.  Choice of Law  2.92
    • E.  Full Faith and Credit  2.93
    • F.  Ceding Jurisdiction
      • 1.  Statutory Reciprocal Cession  2.94
      • 2.  Inconvenient Forum  2.95
  • VI.  INCIDENTAL POWERS AND JURISDICTION
    • A.  General Powers  2.96
      • 1.  Contempt  2.97
      • 2.  Sanctions  2.98
      • 3.  Service of Process  2.99
    • B.  Subpoena Power  2.100
    • C.  Rule-Making Power  2.101
    • D.  Employers’ Injury Reports  2.102
    • E.  Guardians, Trustees, and Conservators; Payments to Minors  2.103
      • 1.  Appointment of Guardian  2.104
      • 2.  Appointment of Conservator  2.105
      • 3.  Appointment of Trustee  2.106
      • 4.  Supervision of Trusts  2.107
    • F.  City, County, and State Employees  2.108
      • 1.  Jurisdiction Regarding Leave-of-Absence Benefit  2.109
      • 2.  Industrial Disability Leave Jurisdiction  2.110
      • 3.  Lab C §§4850–4850.7 Jurisdiction [Deleted]  2.111
      • 4.  Expansion of WCAB’s Jurisdiction  2.112
    • G.  Compromises and Releases  2.113
    • H.  Liens on Compensation  2.114
    • I.  Restitution of Overpayment  2.115
    • J.  Payment for Subsequent Injuries  2.116
    • K.  Contribution Among Employers or Insurers
      • 1.  Cumulative Injury; Occupational Disease  2.117
      • 2.  General and Special Employment  2.118
    • L.  Arbitrating Insurance Controversies  2.119
    • M.  Discrimination; Reinstatement With Back Pay  2.120
    • N.  Jurisdiction Over Representatives  2.121
    • O.  Administrative Appeals  2.122
    • P.  Longshore Act Disputes  2.123
    • Q.  Pension Plans; Labor Agreements  2.124
    • R.  Negligence and Damages Findings  2.125
    • S.  Other Powers and Restrictions  2.126
  • VII.  EQUITY JURISDICTION
    • A.  Reformation: Compromises, Insurance Policies  2.127
    • B.  Death Benefit Distribution  2.128
    • C.  General Principles; Laches  2.129

3

Medical Treatment

Colleen S. Casey

  • I.  MEDICAL TREATMENT BENEFITS
    • A.  All “Reasonably Required” Medical Services  3.1
    • B.  Medical Treatment May Be Unlimited  3.2
    • C.  Scope of Medical Treatment
      • 1.  Treating “Physicians”  3.3
      • 2.  Physician Assistants and Nurse Practitioners  3.4
      • 3.  Psychologists, MFTs, Clinical Counselors, and LCSWs  3.5
      • 4.  Home Health Care Services  3.6
        • a.  Who May Prescribe Services  3.7
        • b.  How Services May Be “Prescribed”  3.8
        • c.  Limits on Employer’s Liability for Home Health Care Services  3.9
        • d.  Services May Be Provided by Family Member  3.10
        • e.  Attorney Fees Available  3.10A
      • 5.  Housekeeping Services  3.11
      • 6.  Medical Rehabilitation  3.12
      • 7.  First Aid and Emergency Medical Treatment  3.12A
      • 8.  Interpreter Services  3.12B
        • a.  Required Qualifications  3.12C
        • b.  Standards for Recovery of Interpreter Fees  3.12D
    • D.  Expenses Related to Medical Treatment
      • 1.  Transportation Expenses  3.13
      • 2.  Expenses for Requested Medical-Legal Examinations  3.14
  • II.  PROVISION OF MEDICAL TREATMENT
    • A.  Employer Obligated to Provide All Required Treatment  3.15
    • B.  Control of Medical Treatment
      • 1.  Employer Makes Initial Choice of Treating Physician  3.16
      • 2.  When Employee May Choose Treating Physician  3.17
        • a.  Must Be Within Reasonable Geographic Area  3.18
        • b.  Procedure for Choosing Treating Physician  3.19
        • c.  Not Limited to One Choice  3.20
      • 3.  Right to Request Change of Employer-Selected Physician  3.21
      • 4.  Predesignation of Personal Physician  3.22
        • a.  Conditions Under Which Employee Can Predesignate Physician  3.23
        • b.  Who Is Eligible to Be Designated as Personal Physician  3.24
        • c.  Employer Must Provide Notice of Right to Predesignate  3.24A
        • d.  Procedure for Predesignation  3.25
        • e.  If Employer Has a Medical Provider Network (MPN)  3.26
        • f.  Claims Administrator’s Duties  3.27
        • g.  Provision of Emergency Medical Treatment  3.28
        • h.  No Prior Employer Contact With Predesignated Physician  3.29
        • i.  Resolution of Disputes  3.30
        • j.  When Predesignated Physician Is Unable to Provide Treatment  3.31
      • 5.  Changing Physician at Employer’s Request
        • a.  Must File Petition to Change Primary Treating Physician  3.32
        • b.  Must Show Good Cause  3.33
        • c.  Form and Contents of Petition  3.34
        • d.  Response to Petition  3.35
        • e.  Administrative Director’s Decision  3.36
        • f.  Review of Administrative Director’s Order  3.37
      • 6.  Transfer Into Newly Established MPN  3.38
      • 7.  Loss or Relinquishment of Medical Control  3.39
    • C.  Role of Primary Treating Physician
      • 1.  Primarily Responsible for Care of Injured Employee  3.40
      • 2.  Limitation on Chiropractor as Primary Treating Physician  3.41
      • 3.  Reporting Duties  3.42
        • a.  First Report of Injury (Form 5021)  3.43
        • b.  Progress Reports
          • (1)  When Required  3.44
          • (2)  Form and Contents  3.45
        • c.  Permanent and Stationary Reports
          • (1)  Existence and Extent of Permanent Disability  3.46
          • (2)  Return-to-Work and Voucher Report  3.47
    • D.  Secondary Physicians  3.48
    • E.  Medical Treatment Utilization Schedule (MTUS)
      • 1.  Medical Treatment Must Be Based on MTUS  3.49
      • 2.  Contents of MTUS
        • a.  ACOEM Guidelines  3.50
          • (1)  General Approaches  3.51
          • (2)  Clinical Topics  3.52
        • b.  AD’s Treatment Guidelines for Special Topics  3.53
        • c.  Drug Formulary  3.53A
      • 3.  Rebuttable Presumption That MTUS Is Correct  3.54
      • 4.  If MTUS Does Not Address Condition or Injury  3.55
      • 5.  Medical Evidence Search Sequence  3.56
        • a.  When MTUS Does Address Condition or Injury  3.57
        • b.  When Rebutting MTUS  3.58
        • c.  Format of Citations  3.59
    • F.  Utilization Review (UR)
      • 1.  Mandatory Process to Review Medical Treatment Requests  3.60
      • 2.  Establishing UR Process  3.61
        • a.  Written Policies and Procedures to Ensure Compliance With MTUS  3.62
        • b.  Description of UR Process  3.63
        • c.  Review and Approval by Administrative Director  3.64
        • d.  Active Accreditation Required  3.64A
        • e.  Modifications to UR Process  3.65
        • f.  Process Must Be Publicly Available  3.66
        • g.  Restrictions on Financial Interests  3.66A
      • 3.  Request for Authorization  3.67
        • a.  When Employer May Defer Submitting Request to UR  3.68
        • b.  Employer May Request Reasonably Necessary Additional Information  3.69
        • c.  When Treatment Is Automatically Approved
          • (1)  Required Conditions  3.69A
          • (2)  Physician Reporting Requirements  3.69B
          • (3)  Exceptions to Automatic-Approval Rule  3.69C
          • (4)  Retrospective UR to Ensure Compliance With MTUS  3.69D
      • 4.  Who May Make UR Decision  3.70
      • 5.  Deadlines for Making UR Decision  3.71
        • a.  Determining Date of Receipt  3.72
        • b.  Prospective or Concurrent Review
          • (1)  Definitions  3.73
          • (2)  General Rule: 5 Days/14 Days  3.74
          • (3)  Deadline Extensions
            • (a)  Additional Information Needed  3.75
            • (b)  Additional Examination, Test, or Consultation Needed  3.76
          • (4)  Expedited Review  3.77
        • c.  Retrospective Review  3.78
      • 6.  Deadlines for Communicating UR Decision  3.79
        • a.  When Request for Authorization Is Approved  3.80
        • b.  When Request for Authorization Is Not Approved in Full  3.81
      • 7.  Procedure When UR Decision Is Untimely  3.82
      • 8.  Required Form and Contents of UR Decision
        • a.  When Request for Authorization Is Approved  3.83
        • b.  When Request for Authorization Is Not Approved in Full  3.84
      • 9.  Duration of UR Decisions  3.85
      • 10.  Violations and Penalties  3.86
    • G.  Disputes Regarding UR Decision or Provision of Medical Treatment  3.87
  • III.  MEDICAL PROVIDER NETWORKS (MPNs)  3.88
    • A.  MPN Approval  3.89
    • B.  Access Standards for Medical Treatment  3.90
      • 1.  MPN Must Propose Alternative When Standards Cannot Be Met  3.91
      • 2.  Treatment Outside MPN When Standards Are Not Met  3.92
      • 3.  Policy for Employees Outside Service Area  3.93
      • 4.  When Emergency Medical Treatment Is Needed  3.94
      • 5.  Referrals to Specialists  3.95
      • 6.  Availability of Medical Access Assistants  3.96
    • C.  Probation, Suspension, or Revocation of MPN
      • 1.  Grounds  3.97
      • 2.  Opportunity to Cure Violation; Notice of Action  3.98
      • 3.  Request for Reevaluation  3.99
      • 4.  Administrative Director’s Decision  3.100
      • 5.  Appeal of Decision  3.101
    • D.  MPN Complaints and Petitions for Suspension or Revocation
      • 1.  Complaint Procedures  3.102
        • a.  Required Contents of Complaint  3.103
        • b.  MPN Response to Complaint  3.104
        • c.  When MPN Fails to Remedy Violation or Disputes Complaint  3.105
          • (1)  Investigation by Administrative Director  3.106
          • (2)  Procedure If Violation Is Found  3.107
      • 2.  Petition for Suspension or Revocation
        • a.  Grounds for Petition  3.108
        • b.  Form and Contents of Petition  3.109
        • c.  MPN Response to Petition  3.110
        • d.  Administrative Director’s Request for Information or Evidence  3.111
        • e.  Administrative Director’s Decision  3.112
    • E.  Administrative Penalties  3.113
      • 1.  Schedule of Penalties
        • a.  Violations of MPN Filing Requirements  3.114
        • b.  Violations of MPN Access Requirements  3.115
        • c.  Failure to Respond to DWC Requests  3.116
        • d.  Notice Violations  3.117
      • 2.  Procedures for Imposition of Penalty
        • a.  Notice of Action and Opportunity to Correct  3.118
        • b.  Mitigation of Penalty  3.119
        • c.  Request for Reevaluation  3.120
        • d.  Appeal of Notice of Action  3.121
    • F.  Notice Requirements
      • 1.  When Industrial Injury Occurs  3.122
      • 2.  When MPN Coverage Ends  3.123
      • 3.  Failure to Provide Required Notices  3.124
    • G.  Medical Treatment Within MPN  3.125
      • 1.  Employer Arranges Initial Evaluation  3.126
      • 2.  Employee’s Right to Change Physician  3.127
      • 3.  When Employee Has Predesignated Personal Physician  3.128
      • 4.  Treatment by Non-MPN Specialist  3.129
  • IV.  HEALTH CARE ORGANIZATIONS  3.130
  • V.  SELF-PROCURED MEDICAL TREATMENT  3.131
    • A.  Reimbursability for Self-Procured Treatment  3.132
    • B.  Notice to Employer  3.133
    • C.  When Failure to Give Notice Is Excusable  3.134
    • D.  Reasonable Value of Services  3.135
      • 1.  Effect of Fee Schedule  3.136
      • 2.  When Services Not Covered by Fee Schedule  3.137
      • 3.  Lien Claims  3.138
      • 4.  Finance Charges  3.139
  • VI.  REFUSAL TO SUBMIT TO TREATMENT OR SURGERY  3.140
  • VII.  PAYMENT OF MEDICAL TREATMENT EXPENSES
    • A.  Jurisdiction  3.141
    • B.  Billing and Payment/Explanation of Review  3.142
    • C.  Contesting Billings  3.143
    • D.  Second Bill Review  3.144
    • E.  Independent Bill Review (IBR)  3.145
      • 1.  When IBR Is Appropriate  3.146
      • 2.  Consolidation of IBR Requests  3.147
      • 3.  Deadline to Request IBR  3.148
      • 4.  How to Make IBR Request  3.149
      • 5.  Preliminary Review and Assignment to IBR Organization  3.150
      • 6.  Withdrawal of IBR Request  3.151
      • 7.  Review and Determination  3.152
      • 8.  Appeal  3.153
      • 9.  Petition to Enforce IBR Decision  3.154
    • F.  Official Medical Fee Schedule  3.155
    • G.  Physicians Barred From Collecting Fees From Injured Workers  3.156
    • H.  Effect of Accepting Medi-Cal Payments  3.157
  • VIII.  NO APPORTIONMENT OF LIABILITY FOR MEDICAL TREATMENT
    • A.  Combined Industrial and Nonindustrial Causes  3.158
    • B.  Out-of-State Injury  3.159
    • C.  Apportionment Among Carriers  3.160

4

Temporary Disability

Andrew K. Shaffer

Brett A. Borah

  • I.  INTRODUCTION  4.1
    • A.  Temporary Disability May Be Total or Partial  4.2
    • B.  Availability of Alternative Work and the “Odd Lot” Doctrine  4.3
    • C.  No Apportionment of Temporary Disability  4.4
    • D.  Subsequent Nonindustrial Injury  4.5
  • II.  PROCEDURE
    • A.  Entitlement to Temporary Disability Indemnity  4.6
    • B.  When Liability for Temporary Disability Payments Begins
      • 1.  General Rule: 3-Day Waiting Period  4.7
      • 2.  Exceptions to 3-Day Waiting Period  4.8
    • C.  When Liability for Disability Payments Ends
      • 1.  Statutory Time Limits  4.9
        • a.  Effect of Payments Under Lab C §4850  4.10
        • b.  Longer Period for Certain Serious Injuries or Conditions  4.11
      • 2.  Employee Returns to Work, Is Cleared to Return to Work, or Condition Becomes Permanent and Stationary  4.12
      • 3.  Employee Dies or Retires  4.13
    • D.  Timing of Temporary Disability Payments
      • 1.  First Payment Within 14 Days  4.14
      • 2.  Subsequent Payments; Penalty for Late Payment  4.15
      • 3.  If Employer Denies Liability  4.16
        • a.  Unrepresented Employee  4.17
        • b.  Represented Employee  4.18
      • 4.  If Liability Determination Is Delayed  4.19
        • a.  Unrepresented Employees  4.20
        • b.  Represented Employee  4.21
    • E.  Manner of Payment  4.22
    • F.  To Whom Payment Is Made  4.22A
    • G.  When WCAB Loses Jurisdiction  4.23
  • III.  CALCULATING AVERAGE WEEKLY EARNINGS (AWE)
    • A.  Importance of AWE  4.24
    • B.  Chart: Minimum and Maximum AWE  4.25
    • C.  What Constitutes Earnings
      • 1.  Allowable Items
        • a.  Wages or Salary, and Overtime  4.26
        • b.  Board, Lodging, and Fuel as Remuneration  4.27
        • c.  “Other Advantages”  4.28
      • 2.  Excluded Items
        • a.  Special Expenses  4.29
        • b.  Other Exclusions  4.30
    • D.  Four Methods of Calculating AWE  4.31
      • 1.  Method Used Must Reflect Employee’s Earning Capacity  4.32
      • 2.  Method #1: Full-Time Work (Lab C §4453(c)(1))  4.33
        • a.  Earnings at Time of Injury  4.34
        • b.  Inclusion of Overtime  4.35
        • c.  New or Seasonal Employment  4.36
      • 3.  Method #2: Two or More Employers (Lab C §4453(c)(2))  4.37
      • 4.  Method #3: Earnings at Irregular Rate (Lab C §4453(c)(3))  4.38
      • 5.  Method #4: Part-Time Work or When Other Methods Do Not Produce Fair and Reasonable Result (Lab C §4453(c)(4))  4.39
        • a.  Factors for Determining Earning Capacity  4.40
        • b.  Postinjury Earnings  4.41
        • c.  Effect of Postinjury Education or Training on Earning Capacity  4.41A
        • d.  Part-Time Employees  4.42
        • e.  Seasonal Employees  4.43
        • f.  Intermittent Employment  4.43A
    • E.  Calculating AWE for Special Classes
      • 1.  Retired Public Safety Employees  4.44
      • 2.  Minors  4.44A
      • 3.  Other Special Classes  4.45
  • IV.  CALCULATING TEMPORARY DISABILITY PAYMENTS
    • A.  Rate on Date of Injury Controls  4.46
    • B.  Exception: TTD Payments Made More Than 2 Years From Date of Injury  4.47
    • C.  TTD Payments = 2/3 of Injured Worker’s AWE  4.48
    • D.  TPD Payments = 2/3 of Loss in Injured Worker’s AWE  4.49
      • 1.  Maximum Partial Disability Payment  4.50
      • 2.  Obtaining New Employment During Temporary Disability  4.51
    • E.  When Temporary Disability Is Both Partial and Total  4.52
  • V.  SPECIAL PAYMENTS
    • A.  Voluntary Continuation of Regular Wages or Salary  4.53
    • B.  State Disability Indemnity  4.54
    • C.  Leave-of-Absence Benefit for Certain Public Safety Employees  4.55
      • 1.  Eligible Public Safety Employees  4.55A
      • 2.  Excluded Employees  4.55B
      • 3.  Resolving Disputes Regarding Eligibility  4.56
        • a.  Cases Finding Employee Eligible for Benefit  4.56A
        • b.  Cases Finding Employee Ineligible for Benefit  4.56B
      • 4.  Extent of Leave-of-Absence Benefit  4.57
        • a.  One-Year Leave Need Not Be Continuous  4.57A
        • b.  When Employee Sustains Multiple Injuries or Cumulative Trauma  4.57B
        • c.  “Without Loss of Salary"  4.57C
      • 5.  Concurrent Payment of Disability Indemnity  4.57D
      • 6.  WCAB’s Jurisdiction
        • a.  Determination of Industrial Causation  4.57E
        • b.  Determination of Employee Eligibility  4.57F
        • c.  Determination of When Disability Ceases  4.57G
      • 7.  Leave-of-Absence Benefit After Retirement, Resignation, or Termination  4.58
    • D.  Paid Leave for School Employees  4.59
    • E.  Benefits for California State University Personnel  4.60
    • F.  Industrial Disability Leave for State Officers and Employees  4.61
  • VI.  INDEMNITY RATE ADJUSTMENTS
    • A.  Adjustments for Injuries Before 1/1/1990  4.62
    • B.  Adjustments for Injuries Occurring on or After 1/1/1990  4.63
    • C.  Procedure for Resolving Disputes  4.64
  • VII.  TERMINATION OF TEMPORARY DISABILITY BENEFITS
    • A.  Termination Procedure
      • 1.  Petition to Terminate Liability for Temporary Disability Indemnity  4.65
      • 2.  Content of Petition  4.66
      • 3.  Objection to Petition  4.67
    • B.  Notice of Termination  4.68
      • 1.  Unrepresented Employee  4.69
      • 2.  Represented Employee  4.70
    • C.  Resumption of Temporary Disability Indemnity Payments  4.71

5

Permanent Disability

Charles Lawrence Swezey

  • I.  OVERVIEW OF PERMANENT DISABILITY
    • A.  Definition of Permanent Disability  5.1
    • B.  Disability Considered Permanent and Stationary
      • 1.  No Major Changes Expected  5.2
      • 2.  When Disease Is Progressive  5.3
      • 3.  How Permanency Is Established  5.4
    • C.  Permanent Disability May Be Total or Partial  5.5
      • 1.  Impairments Conclusively Presumed to Be Totally Disabling  5.6
      • 2.  Proving Permanent Total Disability Based on Facts  5.7
  • II.  RATING PERMANENT DISABILITY
    • A.  Disability Evaluation Schedules
      • 1.  Nature and Function of Schedules in General  5.8
      • 2.  California’s Schedules
        • a.  Historical Development  5.9
        • b.  Adoption and Amendment by Administrative Director  5.10
        • c.  Adjustments for Occupation and Age  5.11
      • 3.  Schedule as Prima Facie Evidence  5.12
      • 4.  Determining Which Schedule Applies  5.13
        • a.  Use of Age and Occupational Modifiers in 2005 Schedule for Injuries Occurring On or After January 1, 2013  5.14
        • b.  When 2005 Schedule Applies to Compensable Claims Arising Before January 1, 2005  5.15
    • B.  Rating Permanent Disability Using 1997 Schedule
      • 1.  Identifying Factors of Disability
        • a.  Ratable Factors  5.16
        • b.  Objective Factors  5.17
        • c.  Subjective Factors; Permanent Rating Schedule Adopted Before January 1, 2005  5.18
        • d.  Work Limitations  5.19
        • e.  Cosmetic Defects  5.20
        • f.  Psychiatric Factors  5.21
      • 2.  Applying the 1997 Schedule to Disability Factors
        • a.  Scheduled Ratings  5.22
          • (1)  Formula for Determining Percentages  5.23
          • (2)  Examples of Formulas  5.24
      • 3.  Multiple Disabilities and Avoiding Pyramiding  5.25
    • C.  Rating Permanent Disability Using 2005 Schedule
      • 1.  Overview of Procedures  5.26
      • 2.  Determining Impairment Number and Whole Person Impairment Rating
        • a.  Use of AMA Guides  5.27
        • b.  Impairment Number  5.28
        • c.  Whole Person Impairment (WPI) Rating  5.29
          • (1)  Combining Multiple Impairments
            • (a)  Rules for Combining  5.30
            • (b)  Use of Combined Values Chart Versus Adding Multiple Impairments  5.31
          • (2)  Increase in WPI for Pain  5.32
          • (3)  Psychiatric Impairments  5.33
          • (4)  Unlisted Impairments  5.34
      • 3.  Adjustment for Diminished Future Earning Capacity (DFEC)  5.35
      • 4.  Adjustment for Employee's Occupation  5.36
        • a.  Occupational Group Number  5.37
          • (1)  Unlisted Occupations  5.38
          • (2)  Multiple Employers With Differing Duties  5.39
          • (3)  Cumulative Trauma  5.40
        • b.  Occupational Variant  5.41
        • c.  Occupational Adjustment  5.42
      • 5.  Adjustment for Employee's Age  5.43
      • 6.  Combining Multiple Permanent Disabilities  5.44
      • 7.  Example of Rating String  5.45
      • 8.  Step-by-Step Calculation of Rating  5.46
    • D.  Rating Permanent Disability for Injuries Occurring on or After 1/1/2013
      • 1.  Administrative Director May Formulate New Schedule of Occupation and Age Modifiers  5.47
      • 2.  Elements of Rating  5.48
        • a.  Elimination of DFEC Component  5.49
        • b.  Continued Use of 2005 Schedule’s Occupation and Age Modifiers   5.50
        • c.  Elimination of Increases for Sleep, Sexual Dysfunction, and Psychiatric Disorders  5.51
      • 3.  Steps for Rating Permanent Disability for Injuries Occurring on or After 1/1/2013  5.52
  • III.  REBUTTING A PERMANENT DISABILITY RATING  5.53
    • A.  Rebutting the Diminished Future Earning Capacity (DFEC) Component  5.54
      • 1.  Method One  5.55
      • 2.  Method Two  5.56
      • 3.  Method Three  5.57
    • B.  Rebutting the Whole Person Impairment (WPI) Rating  5.58
  • IV.  CALCULATING AND PAYING PERMANENT DISABILITY INDEMNITY
    • A.  Permanent Partial Disability  5.59
      • 1.  Compensation Rate
        • a.  Two-Thirds of Injured Employee’s AWE  5.60
        • b.  Chart: Statutory Minimum and Maximum AWE  5.61
      • 2.  Duration of Payments  5.62
        • a.  Injuries Occurring From January 1, 1992, to December 31, 2003  5.63
        • b.  Injuries Occurring From January 1, 2004, to December 31, 2004  5.64
        • c.  Injuries Occurring From January 1, 2005, to December 31, 2012  5.65
        • d.  Injuries Occurring On or After January 1, 2013  5.66
        • e.   Calculating Number of Weeks of Payments That Are Due  5.67
      • 3.  Increase or Reduction in Amount of Payments Based on Offer of Work  5.68
        • a.  15 Percent Increase  5.69
        • b.  15 Percent Reduction  5.70
          • (1)  What Constitutes Regular, Modified, or Alternative Work  5.71
          • (2)  Offer of Seasonal Work  5.72
        • c.  Procedures Relating to Offers of Work  5.73
        • d.  When the Parties Dispute Employee’s Permanent and Stationary Status  5.74
      • 4.  Life Pension for Serious Permanent Partial Disabilities
        • a.  When Life Pension Begins; Rate of Compensation  5.75
        • b.  When Life Pension Rate May Be Increased (COLAs)  5.76
    • B.  Permanent Total Disability
      • 1.  Duration and Rate of Compensation  5.77
      • 2.  Chart: Minimum and Maximum AWE  5.78
      • 3.  When Compensation Rate May Be Modified
        • a.  Cost of Living Adjustments (COLAs)  5.79
        • b.  No Increase Under Lab C §4661.5  5.80
    • C.  Payment of Permanent Disability Indemnity
      • 1.  Timing and Manner of Payment  5.81
      • 2.  If Injury Causes No Permanent Disability  5.82
      • 3.  If Employee Dies  5.83
      • 4.  When Extent of Permanent Disability Remains Undetermined  5.84
      • 5.  Delay in Payment on Offer of Employment  5.85
      • 6.  Commutation of Award of Permanent Disability  5.86
      • 7.  When Employee Self-Procures Medical Treatment  5.87
    • D.  Apportionment of Permanent Disability
      • 1.  Definition and Nature of Concept  5.88
      • 2.  History of Apportionment Law  5.89
      • 3.  Apportionment Standards
        • a.  SB 899 Applies to All Pending Cases  5.90
        • b.  Apportionment Analysis Involves Causation of Disability, Not Causation of Injury  5.91
        • c.  Allocation of Burdens  5.92
        • d.  Physician and WCAB Must Make Apportionment Determination  5.93
        • e.  Sufficiency of Medical Evidence  5.94
      • 4.  Benefits for Which No Apportionment Is Permitted  5.95
      • 5.  Preexisting Permanent Disability
        • a.  Issue of Overlap  5.96
        • b.  When There Is a Prior Award of Permanent Disability
          • (1)  Conclusive Presumption of Continued Existence of Prior Permanent Disability  5.97
          • (2)  If Prior Permanent Disability Was Rated Under Different Schedule  5.98
          • (3)  Permanent Disability Awards May Not Exceed 100 Percent for Any One Body Region  5.99
        • c.  When There Is Preexisting Permanent Disability, But No Prior Award  5.100
      • 6.  Preexisting Disease or Condition
        • a.  Pre-SB 899 Rules  5.101
        • b.  Post-SB 899 Rules  5.102
        • c.  No Apportionment When Disease Is Presumed Compensable  5.103
      • 7.  Cumulative Injury and Occupational Disease Cases  5.104
      • 8.  Successive Industrial Injuries That Become Permanent and Stationary at Same Time  5.105
      • 9.  Effect of Later Nonindustrial Injuries  5.106
      • 10.  Calculating Compensation in Apportioned Cases (Fuentes Rule)  5.107
    • E.  Payment for Subsequent Injuries
      • 1.  Subsequent Injuries Benefits Trust Fund (SIBTF)  5.108
      • 2.  Eligibility Requirements  5.109
        • a.  Prior Disability Must Have Been Labor Disabling (Ratable)  5.110
        • b.  When Prior Disability Is Total  5.111
        • c.  Combined Disabilities Must Be Greater Than Subsequent Disability Alone  5.112
        • d.  Combined Effect of Disabilities Must Be 70 Percent or More  5.113
        • e.  Subsequent Injury Must Meet 5 or 35 Percent Threshold  5.114
      • 3.  Compensation Payments  5.115
      • 4.  Reduction for Other Benefits  5.116
      • 5.  Procedures
        • a.  File Written Application With WCAB  5.117
        • b.  Deadline to File Application  5.118
        • c.  Joining the SIBTF
          • (1)  When Existence of Prior Disability Becomes Apparent  5.119
          • (2)  When the SIBTF Is Not Joined  5.120
        • d.  Hearing  5.121
      • 6.  Compromise  5.122
  • V.  PERMANENT DISABILITY RATING PROCEDURES
    • A.  Disability Evaluation Unit (DEU) Raters  5.123
    • B.  Formal Rating Determinations  5.124
      • 1.  Requesting a Formal Rating (Rating Instructions)  5.125
      • 2.  Preparation and Service of Formal Rating  5.126
      • 3.  Objection to Formal Rating  5.127
      • 4.  Cross-Examination of Rater  5.128
    • C.  Summary Rating Determinations  5.129
      • 1.  Summary Rating Based on Physician’s Evaluation  5.130
      • 2.  Summary Rating Based on QME Evaluation  5.131
        • a.  Components of Request for Summary Rating  5.132
        • b.  Request for Rating of Supplemental QME Evaluation  5.133
        • c.  Consideration of Corrected Evaluation  5.134
        • d.  If Evaluation Indicates That Apportionment May Be Appropriate  5.135
        • e.  Service of Summary Rating and Notice of Options  5.136
      • 3.  Reconsideration of Summary Rating  5.137
    • D.  Consultative Rating Determinations  5.138
    • E.  Pretrial Evaluations  5.139
    • F.  Informal Ratings  5.140
    • G.  Other Services  5.141

6

Supplemental Job Displacement Benefit and Return-to-Work Supplement Program

Sally M. Harms

Deborah Lieberman

  • I.  BENEFIT FOR RETRAINING AND SKILLS ENHANCEMENT  6.1
  • II.  REPEAL OF VOCATIONAL REHABILITATION BENEFIT  6.2
  • III.  SJDB FOR INJURIES OCCURRING ON OR AFTER 1/1/2004 AND BEFORE 1/1/2013
    • A.  Requirements for Receipt of Benefit  6.3
    • B.  When Employer Is Not Liable for SJDB  6.4
      • 1.  Definitions of “Modified” and “Alternative” Work  6.5
      • 2.  Waiver of Objection to Work’s Location  6.6
      • 3.  Seasonal Employees  6.7
    • C.  Notice of Right to SJDB  6.8
    • D.  Amount of Voucher  6.9
    • E.  Permissible Uses, Approved Schools, and VRTWCs  6.10
    • F.  Procedure for Delivery and Use of Voucher  6.11
    • G.  Deadline to Use Voucher  6.12
  • IV.  SJDB FOR INJURIES OCCURRING ON OR AFTER 1/1/2013
    • A.  Requirements for Receipt of Benefit  6.13
      • 1.  When No Time Has Been Lost or Employee Returns to Same Job  6.14
      • 2.  Equivalency of Wages and Compensation  6.15
      • 3.  Waiver of Objection to Work’s Location  6.16
      • 4.  Offer of Seasonal Work  6.17
      • 5.  Employer Liability for Injuries While Using Voucher  6.17A
      • 6.  Employee Not Limited to One SJDB  6.17B
    • B.  Notice of Right to SJDB  6.18
    • C.  Deadline to Offer SJDB  6.19
    • D.  Amount of Voucher; Permissible Uses  6.20
    • E.  Procedure for Delivery and Use of Voucher  6.21
    • F.  Deadline to Use Voucher  6.22
    • G.  Dispute Resolution  6.23
    • H.  Prohibition on Settling or Commuting Claim for SJDB  6.23A
  • V.  ATTORNEY FEES MAY BE AWARDED BASED ON SJDB  6.24
  • VI.  RETURN-TO-WORK SUPPLEMENT PROGRAM  6.25
    • A.  Eligibility to Receive Supplemental Payment  6.26
    • B.  Notice of Eligibility  6.27
    • C.  Amount  6.28
    • D.  Procedures for Applying for Supplemental Payment
      • 1.  Deadline for Application  6.29
      • 2.  Application Must Be Submitted Electronically; Contents  6.30
      • 3.  Decision on Application  6.31
      • 4.  Appeal to WCAB  6.32

7

Death Benefits, Dependency, and Burial Expenses

Dennis J. Hannigan

  • I.  INTRODUCTION AND GENERAL CONCEPTS  7.1
    • A.  Death Resulting From Suicide  7.1A
    • B.  Death Resulting From Mysterious Circumstances  7.1B
    • C.  Autopsy and Exhumation  7.1C
    • D.  Time Limitations  7.1D
  • II.  DETERMINING DEPENDENCY
    • A.  Dependency Determined at Time of Injury  7.2
    • B.  Individuals Who Can Qualify As Dependents  7.3
      • 1.  Good Faith Member of Household  7.4
      • 2.  Spouse  7.4A
    • C.  Dependents May Be Total or Partial  7.4B
      • 1.  Who Are Total Dependents?
        • a.  Conclusive Presumption of Total Dependency  7.5
          • (1)  Child  7.6
          • (2)  Spouse  7.7
        • b.  Factual Total Dependency Determination  7.8
      • 2.  Who Are Partial Dependents?  7.9
        • a.  Without Decedent, Can Claimant Maintain Living Standard?  7.10
        • b.  What Amount Did Decedent Devote Annually to Applicant’s Support?  7.11
    • D.  Employer Notice Requirements
      • 1.  Claim Form; Notice of Status of Benefits  7.11A
      • 2.  Notice of Denial of Benefits  7.11B
      • 3.  Notice Regarding Delay in Determining Benefits  7.11C
      • 4.  Notice of Change in Benefits  7.11D
  • III.  IF NO DEPENDENTS
    • A.  Payment to Department of Industrial Relations  7.12
    • B.  Payment to Estate No Longer Required  7.12A
    • C.  Employer Notice Requirements  7.13
    • D.  Payment Procedures and Reimbursement  7.14
    • E.  Disputes Regarding Existence or Extent of Dependency  7.15
  • IV.  METHOD OF PAYMENT AND AMOUNT OF DEATH BENEFIT
    • A.  Benefit Paid in Same Manner and Amounts as Temporary Total Disability Benefits  7.16
    • B.  Amount Depends on Date of Injury  7.17
      • 1.  One Total Dependent and No Partial Dependents  7.18
      • 2.  One Total Dependent and One or More Partial Dependents  7.19
      • 3.  Two Total Dependents  7.20
      • 4.  Three or More Total Dependents  7.21
      • 5.  No Total But One or More Partial Dependents  7.22
      • 6.  Special Death Benefits to Totally Dependent Children  7.23
      • 7.  No Dependents  7.24
      • 8.  Table of Death Benefits  7.25
    • C.  Distribution of Death Benefit Among Dependents
      • 1.  Dependents’ Right to Death Benefits  7.26
      • 2.  Workers’ Compensation Appeals Board May Assign Benefits Equitably  7.27
      • 3.  If a Dependent Dies  7.28
    • D.  No Apportionment of Death Benefits  7.29
    • E.  Increase in Death Benefit Due to Unreasonable Delay; Penalties  7.29A
  • V.  SPECIAL PUBLIC EMPLOYEE DEATH BENEFITS
    • A.  Assassinated Public Officials  7.30
    • B.  Certain Members of California Public Employees’ Retirement System (CalPERS)
      • 1.  Members Entitled to Special Death Benefit  7.31
      • 2.  Persons Entitled to Receive Special Death Benefit  7.31A
      • 3.  Role of the WCAB  7.31B
      • 4.  Coordination of Benefits  7.31C
      • 5.  Coordination of Proceedings  7.31D
    • C.  Educational Scholarship for Dependents of Certain Public Safety Employees  7.31E
    • D.  Continuation of Health Benefits for Survivors of Certain Deceased Public Safety Employees  7.31F
  • VI.  BURIAL EXPENSES  7.32

8

Penalties

Sally M. Harms

Deborah Lieberman

  • I.  OVERVIEW
    • A.  Penalties and Other Remedies  8.1
    • B.  Who Can Claim a WCAB Penalty  8.2
  • II.  STRICT LIABILITY PENALTIES FOR LATE PAYMENT OF COMPENSATION (LAB C §4650)  8.3
    • A.  Penalty Applies Only to Periodic and Accrued Disability Payments  8.4
    • B.  Statutory Exceptions to Imposition of Lab C §4650 Penalty
      • 1.  No Penalty When Employer Continues to Pay Wages  8.5
      • 2.  No Penalty for Payment Due Before Submission of Claim Form  8.6
      • 3.  No Penalty While Employer Determines Compensability  8.7
    • C.  When Liability for Injury, Disability, or Indemnity Rate Is Disputed  8.8
    • D.  When No Temporary Disability Has Been Paid  8.9
    • E.  Interaction With Lab C §5814 Penalties for Unreasonable Delay  8.10
  • III.  UNREASONABLE DELAY OR REFUSAL TO PROVIDE BENEFITS (LAB C §5814)  8.11
    • A.  Determining Whether Refusal or Delay Was Unreasonable
      • 1.  Allocation of Burdens of Proof  8.12
      • 2.  Considerations in Making Reasonableness Determination  8.13
        • a.  Genuine Doubt Regarding Liability  8.14
        • b.  Defendant Acted With Due Diligence  8.15
    • B.  Calculation of Penalty Amount
      • 1.  Amount Is Discretionary  8.16
      • 2.  Factors Considered in Determining Penalty Amount  8.17
      • 3.  Credit for Amount Paid Under Lab C §4650(d)  8.18
    • C.  Safe-Harbor Provision  8.19
    • D.  Conclusive Presumption That Accrued Lab C §5814 Penalties Have Been Resolved  8.20
    • E.  Statute of Limitations  8.21
    • F.  Attorney Fees Under Lab C §5814.5  8.22
    • G.  Types of Benefits Affected
      • 1.  Temporary Disability  8.23
      • 2.  Permanent Disability  8.24
      • 3.  Supplemental Job Displacement Benefit; Return-to-Work Supplement Payment  8.25
      • 4.  Interest  8.26
      • 5.  Medical Expenses  8.27
      • 6.  Payment of Penalties  8.28
      • 7.  Postsettlement Benefits  8.29
      • 8.  Immediately Negotiable Written Instrument  8.30
      • 9.  Death Benefits  8.31
    • H.  Parties Liable Under Lab C §5814  8.32
    • I.  Jointly Liable Employers  8.33
    • J.  Multiple Penalties Under Lab C §5814  8.34
      • 1.  Example of Legally Significant Acts  8.35
      • 2.  Examples of Legally Insignificant Acts  8.36
  • IV.  UNREASONABLE DELAY OR REFUSAL UNDER LAB C §§5414.3, 5814.1, AND 5814.6  8.37
  • V.  EMPLOYER’S SERIOUS AND WILLFUL MISCONDUCT UNDER LAB C §4553
    • A.  Increased Compensation  8.38
    • B.  Types of Benefits Affected  8.39
    • C.  Determining Serious and Willful Misconduct
      • 1.  Definition  8.40
      • 2.  Burden of Proof, Proximate Cause, and Procedure  8.41
      • 3.  Statute of Limitations  8.42
    • D.  Whose Misconduct Results in Increased Compensation Under Lab C §4553?  8.43
    • E.  Common Allegations of Serious and Willful Misconduct  8.44
      • 1.  Failure to Provide Safe Place to Work  8.45
        • a.  Knowledge of Dangerous Condition  8.46
        • b.  Knowledge of Probable Consequence  8.47
        • c.  Employer’s Action or Inaction  8.48
      • 2.  Failure to Comply With Safety Order
        • a.  Nature of Safety Order  8.49
        • b.  Required Elements  8.50
          • (1)  Knowledge of Safety Order and Its Applicability  8.51
          • (2)  Obvious Condition Made Safety Order Applicable  8.52
    • F.  Defenses
      • 1.  Proximate Cause  8.53
      • 2.  Good Faith Attempt to Abate Danger  8.54
      • 3.  Vague and Ambiguous Safety Order; Alternative Methods of Complying  8.55
      • 4.  Defective Pleading  8.56
      • 5.  Other  8.57
  • VI.  EMPLOYEE’S SERIOUS AND WILLFUL MISCONDUCT (LAB C §4551)  8.58
  • VII.  DISCRIMINATION AGAINST INJURED WORKER (LAB C §132a)  8.59
    • A.  Prohibited Acts
      • 1.  Violation of Express Lab C §132a Provisions  8.60
      • 2.  Penalizing Worker for Work Injury  8.61
    • B.  Determining Discrimination Under Lab C §132a  8.62
      • 1.  Employee’s Burden of Proof  8.63
      • 2.  Detrimental Conduct Justified by Business Realities  8.64
      • 3.  Examples
        • a.  Lab C §132a Violations Found  8.65
        • b.  No Lab C §132a Violation Found  8.66
      • 4.  Procedure; Statute of Limitations  8.67
    • C.  Parties Liable Under Lab C §132a  8.68
    • D.  Remedies  8.69
      • 1.  Reinstatement  8.70
      • 2.  Reimbursement for Lost Wages and Work Benefits  8.71
      • 3.  Misdemeanor Charge  8.72
  • VIII.  EMPLOYER’S FAILURE TO INSURE
    • A.  Duty to Insure  8.73
    • B.  Penalties
      • 1.  Increased Compensation Award and Attorney Fees (Lab C §§4554–4555)  8.74
      • 2.  Criminal Penalties (Lab C §3700.5)  8.75
      • 3.  Stop Orders (Lab C §§3710.1–3710.3)  8.76
      • 4.  Civil Penalties (Lab C §3722)  8.77
      • 5.  Exception: Residential Owners and Occupants  8.78
    • C.  Procedure  8.79
  • IX.  AUDITS AND PENALTIES UNDER LAB C §§129, 129.5  8.80
  • X.  ILLEGALLY EMPLOYING MINOR UNDER 16 YEARS OF AGE  8.81
  • XI.  ATTORNEY AND PARTY SANCTIONS UNDER LAB C §5813  8.82
    • A.  Who Is Subject to Sanctions  8.83
    • B.  Grounds for Sanctions in 8 Cal Code Regs §10421(b)  8.84
    • C.  Additional Regulatory Grounds for Sanctions  8.85
    • D.  Examples of Actions That Resulted in Imposition of Sanctions  8.86
    • E.  Procedures for Requesting Sanctions  8.87
  • XII.  PHYSICIAN’S FAILURE TO MEET MEDICAL-LEGAL REPORTING REQUIREMENTS  8.88
  • XIII.  REMEDIES OUTSIDE WORKERS’ COMPENSATION SYSTEM
    • A.  Peculiar Risk of Harm; Retained Control  8.89
    • B.  Intentional Torts  8.90
    • C.  State Claims  8.91
    • D.  Federal Claims  8.92

9

Dispute Resolution Procedures

Charles Lawrence Swezey

  • I.  INTRODUCTION  9.1
  • II.  DISPUTE RESOLUTION PROCEDURES
    • A.  Disputes Regarding Compensability of Injury (Lab C §4060)  9.2
      • 1.  When Medical Evaluation Is Needed to Determine Compensability  9.3
      • 2.  Liability for Evaluations Not Obtained Under Lab C §4060  9.4
      • 3.  Self-Procured Compensability Evaluations Are Inadmissible  9.5
    • B.  Disputes Regarding Permanent Disability or Need for Future Medical Care (Lab C §4061)
      • 1.  Represented Employees  9.6
      • 2.  Unrepresented Employees  9.7
        • a.  Request for Correction of Factual Errors  9.8
        • b.  Summary Rating  9.9
      • 3.  Rebuttal Evaluation From Privately Retained Expert Is Inadmissible  9.10
    • C.  Disputes Regarding Medical Treatment
      • 1.  For Injuries Occurring On or After 1/1/2013 or When UR Decision Is Communicated After 7/1/2013
        • a.  Mandatory Independent Medical Review (IMR) Process  9.11
          • (1)  Disputes Not Subject to IMR [Deleted]  9.12
          • (2)  Who May Request IMR  9.13
          • (3)  Deadline to Request IMR  9.14
          • (4)  Fees  9.15
          • (5)  Initial Eligibility Review  9.16
          • (6)  Notice of Assignment to IMR Organization  9.17
          • (7)  Document Production  9.18
          • (8)  Standards of Review; Deadline for Decision  9.19
          • (9)  Format of Decision; Implementation  9.20
          • (10)  Appeal of IMR Decision  9.21
          • (11)  Penalties  9.22
        • b.  Spinal Surgery Disputes Now Handled Through IMR  9.23
        • c.  When UR Decision Is Untimely or Otherwise Procedurally Deficient  9.24
      • 2.  Labor Code §4062 Governs All Other Medical Disputes  9.25
    • D.  Carve-Outs  9.26
  • III.  OBTAINING AME/QME EVALUATIONS
    • A.  When Used  9.27
    • B.  Definitions  9.28
    • C.  Selecting an AME  9.29
    • D.  Selecting a QME
      • 1.  Represented Employee Injured On or After January 1, 2005 (Lab C §4062.2)  9.30
        • a.  When QME Panel May Be Requested  9.31
        • b.  Procedure for Requesting QME Panel  9.32
        • c.  Panel Assigned Automatically; Time for Service of Assignment  9.33
        • d.  Resolution of QME Panel Selection Disputes  9.34
        • e.  Deadline to Strike Names  9.35
      • 2.  Represented Employee Injured Before January 1, 2005  9.36
      • 3.  Unrepresented Employee (Lab C §4062.1)
        • a.  Procedure for Requesting QME Panel
          • (1)  Mandatory Use of QME Form 105  9.37
          • (2)  Additional Documents  9.38
          • (3)  Incomplete Form  9.39
        • b.  Deadlines for Assignment of Panel and Selection of Evaluator  9.40
        • c.  Referral When Employee Selects Acupuncturist as QME  9.41
      • 4.  QME Replacement Requests  9.42
    • E.  Information Provided to QME or AME
      • 1.  Required Information  9.43
      • 2.  Information That Must Not Be Provided  9.44
      • 3.  Service on Opposing Party  9.45
      • 4.  Objecting to Proposed Information  9.46
      • 5.  Remedy for Violation of Lab C §4062.3(b)  9.46A
    • F.  Communications With QME or AME  9.47
    • G.  Appointments
      • 1.  Making the Appointment; Location of Examination  9.48
      • 2.  Appointment Notification and Cancellation
        • a.  QME Must Send Appointment Notification Form  9.49
        • b.  Time Limits for Cancellations and Rescheduled Appointments  9.50
      • 3.  Before the Appointment  9.51
      • 4.  At the Appointment
        • a.  Required Disclosures and Opportunity to Ask Questions  9.52
        • b.  Minimum Examination Times  9.53
        • c.  Restrictions on Who Can Examine Injured Employee  9.54
    • H.  QME/AME Reporting Requirements
      • 1.  Time Limits for Preparing and Submitting Report  9.55
      • 2.  Required Contents and Form  9.56
      • 3.  Consultation With Treating Physician  9.57
      • 4.  When There Are Issues Outside Evaluator’s Area of Expertise  9.58
      • 5.  When Evaluator Determines That Employee Is Permanently Disabled  9.59
      • 6.  Service of Report
        • a.  General Rules  9.60
        • b.  Electronic Service  9.60A
        • c.  Service of Report Involving Claimed or Disputed Injury to Psyche  9.61
    • I.  Correction of Factual Errors in Unrepresented Cases  9.62
    • J.  Supplemental Reports in Unrepresented Cases
      • 1.  When Report Finds That Injury Has Not Become Permanent and Stationary  9.63
      • 2.  When Report Finds Permanent Disability  9.64
    • K.  Use of Same Evaluator When New Medical Issue Arises  9.65
    • L.  Panel QME in Second Medical Specialty  9.66
    • M.  Cross-Examination of Evaluator by Deposition  9.67
    • N.  Effect of Evaluation  9.68
    • O.  Ethical Requirements for QMEs  9.68A
    • P.  Unavailability of QME  9.68B
  • IV.  DISPUTE RESOLUTION IN MEDICAL PROVIDER NETWORKS
    • A.  When Employee Disputes Treating Physician’s Diagnosis or Treatment Recommendation
      • 1.  Requesting Second and Third Opinions  9.69
        • a.  Procedures for Obtaining Second Opinion  9.70
        • b.  Procedure for Obtaining Third Opinion  9.71
        • c.  If Second or Third Opinion Physician Determines That Injury Is Outside Scope of Practice  9.72
        • d.  Contents of Second and Third Opinion  9.73
        • e.  If Employee Accepts Second or Third Opinion  9.74
      • 2.  Requesting MPN Independent Medical Review  9.75
    • B.  When Employee or Employer Disputes UR Decision  9.75A
  • V.  MEDICAL-LEGAL EXPENSES  9.76
    • A.  Costs Must Be Reasonable and Necessary  9.77
    • B.  Showing of Employment Prerequisite  9.78
    • C.  Expenses Must Be for Contested Claim  9.79
    • D.  Reports Must Meet Legal Requirements  9.80
      • 1.  Complete History  9.81
      • 2.  Review of Medical Records  9.82
      • 3.  Appropriate Conclusions  9.83
    • E.  Reports From Multiple Specialists  9.84
    • F.  Interpreter Fees  9.85
    • G.  Copying and Related Services  9.86
      • 1.  Allowable and Nonallowable Services  9.87
      • 2.  Rates for Copy and Related Services  9.88
        • a.  When Services Are Rendered Before 7/15/2022  9.88A
        • b.  When Services Are Rendered on or After 7/15/2022  9.88B
        • c.  Resolution of Disputes  9.88C
    • H.  Nonmedical Expert Witnesses [Deleted]  9.89
    • I.  Recovery of Medical-Legal Expenses  9.90
      • 1.  60 Days to Pay or Contest the Bill  9.91
      • 2.  Second Review; Independent Bill Review  9.92
      • 3.  When Bill Is Denied for Reasons Other Than Amount Billed  9.93
      • 4.  Waiver of Medical-Legal Expense Issue  9.94
      • 5.  Penalty on Unpaid Portion of Bill  9.95
      • 6.  Bad Faith Actions or Tactics  9.96
    • J.  WCAB Hearing for Reimbursement  9.97
    • K.  Expenses for Copying Medical Records [Deleted]  9.98
    • L.  Reimbursement for Medical Testimony  9.99

10

Representing Injured Workers

Frank D. Russo

  • I.  OVERVIEW
    • A.  Challenges of Workers’ Compensation Practice  10.1
    • B.  Is Worker’s Injury Compensable?  10.2
    • C.  What Benefits Should Worker Pursue?  10.3
    • D.  Duty to Advise  10.4
    • E.  Resources  10.5
  • II.  INTAKE
    • A.  Interacting With Potential Clients  10.6
      • 1.  Form: Potential New Client Questionnaire  10.7
      • 2.  Form: Letter Confirming Appointment  10.8
      • 3.  Form: Nonengagement Letter  10.9
    • B.  Initial Office Interview
      • 1.  Objectives  10.10
      • 2.  Documents Client Should Bring  10.11
      • 3.  Scope of Interview  10.12
    • C.  Necessary Forms and Releases  10.13
      • 1.  Fee Disclosure
        • a.  Preparation of Fee Disclosure Statement  10.14
        • b.  Form: Fee Disclosure Statement (DWC Form 3)  10.15
        • c.  Supplementary Disclosure Statement  10.16
        • d.  Form: Supplementary Fee Disclosure Statement  10.17
      • 2.  Declaration of Nonviolation of Lab C §139.3 (Declaration Under Lab C §4906(h))  10.18
      • 3.  Venue Authorization
        • a.  When Venue Authorization Is Required  10.19
        • b.  Form: Venue Authorization  10.20
      • 4.  Form: Authorization for Release of Medical Information  10.21
      • 5.  Form: Authorization for Release of Psychiatric, Drug, and Alcohol Treatment Records  10.22
      • 6.  Form: Authorization for Release of Employment and School Records  10.23
      • 7.  Form: Letter to Workers’ Compensation Insurance Rating Bureau Requesting Compensation Coverage Information [Deleted]  10.24
    • D.  Checklist: Information Necessary to Pursue State Workers’ Compensation Claim  10.25
      • 1.  Checklist: Injured Employee and Dependents  10.26
      • 2.  Checklist: Employment Status  10.27
      • 3.  Checklist: Earnings  10.28
      • 4.  Checklist: Employer’s Insurance  10.29
      • 5.  Checklist: Injury  10.30
        • a.  Checklist: Injuries Resulting in Death  10.31
        • b.  Checklist: Prior Injuries or Disabilities  10.32
      • 6.  Checklist: Medical Treatment and Expenses  10.33
      • 7.  Checklist: Compensation to Date  10.34
      • 8.  Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After 1/1/2004 and Before 1/1/2013)  10.35
      • 9.  Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After January 1, 2013)  10.35A
      • 10.  Checklist: Claim Form; Procedural Information  10.36
  • III.  REPRESENTING THE CLIENT  10.37
    • A.  Form: Letter of Representation to New Client  10.38
    • B.  Filing Application With Workers’ Compensation Appeals Board; Venue  10.39
    • C.  Serving Claim Form on Employer; Notice of Representation  10.40
    • D.  Form: Notice of Representation to Employer  10.41
    • E.  Notice of Representation to Insurer or Adjusting Agency
      • 1.  Informing Insurer or Adjusting Agency of Representation  10.42
      • 2.  Form: Letter to Insurer or Adjusting Agency  10.43
    • F.  Serving Lien Claimants and Others  10.44
    • G.  Send Other Letters at Outset or When Necessary  10.45
      • 1.  Form: Letter Requesting Vocational Rehabilitation [Deleted]  10.46
      • 2.  Form: Letter Designating Primary Treating Physician  10.47
      • 3.  Form: Letter Regarding Medical Bills Received by Applicant  10.48
    • H.  Documenting the Client’s File  10.49
    • I.  Discovery
      • 1.  Expenses  10.50
      • 2.  Sources of Discovery  10.51
      • 3.  Limits on Discovery  10.51A
      • 4.  Deposition of Injured Worker
        • a.  Generally  10.52
        • b.  Preparing Worker  10.53
        • c.  Attorney Fees and Other Expenses  10.54
        • d.  After Deposition Is Scheduled
          • (1)  Send Letter to Worker  10.55
          • (2)  Form: Letter to Worker Regarding Deposition  10.56
        • e.  Form: Letter Requesting Payment for Fees and Costs Associated With Injured Worker’s Deposition  10.57
        • f.  Form: Petition for Attorney Fees and Expenses for Injured Worker’s Deposition  10.58
        • g.  Form: Letter Requesting Worker to Review Deposition Transcript  10.59
    • J.  Medical Evaluations
      • 1.  Generally  10.60
      • 2.  Form: Letter to Worker Regarding Medical Evaluation  10.61
    • K.  Delays in Obtaining Medical and Disability Benefits
      • 1.  Generally  10.62
      • 2.  Form: Letter to Doctor to File Lien  10.63
    • L.  Hearing; Mandatory Settlement Conference
      • 1.  Form: Letter Notifying Worker of Hearing Request  10.64
      • 2.  Form: Letter Notifying Worker of Settlement Conference Date  10.65
    • M.  Settlement  10.66
      • 1.  Effect on Other Benefits  10.67
      • 2.  Stipulations With Request for Award or Compromise and Release  10.68
    • N.  Closing the File
      • 1.  Generally  10.69
      • 2.  Form: Letter Notifying Worker of Closed Case File  10.70

11

Representing Defendants

Glen J. Grossman

  • I.  BASIC ETHICAL CONSIDERATIONS  11.1
    • A.  Conflicts of Interest and Duty of Loyalty
      • 1.  California Rules of Professional Conduct; Bus & P C §6068(e)  11.2
      • 2.  State Bar Formal Opinion 1995–139  11.3
      • 3.  Other State Bar Formal Opinions Impacting the Defense Attorney  11.3A
      • 4.  Applicability to Workers’ Compensation  11.4
    • B.  Protecting Employer’s Interests (Tricor)  11.5
      • 1.  Understanding Tricor’s Importance [Deleted]  11.6
      • 2.  Determining Whether Employer Has a Tricor Interest in the Claim  11.7
        • a.  Experience Rating  11.8
        • b.  Experience Modification  11.9
          • (1)  Experience Period  11.10
          • (2)  Statistical Reporting and Claim Valuation  11.11
        • c.  Example of Tricor-Recognized Interest  11.12
  • II.  GATHERING INFORMATION
    • A.  Getting the Big Picture  11.13
      • 1.  First 75/90 Days  11.14
      • 2.  Employer’s Report of Occupational Injury or Illness (Form 5020)  11.15
        • a.  When Employer Must File  11.16
        • b.  Using Form 5020  11.17
      • 3.  Doctor’s First Report of Occupational Injury or Illness (Form 5021)  11.18
        • a.  Admissibility  11.19
        • b.  Pesticide Poisoning  11.20
        • c.  Using Form 5021  11.21
      • 4.  Form: Statement of Employee’s Gross Earnings  11.22
      • 5.  Benefit Notices  11.23
        • a.  Mandatory Information  11.23A
        • b.  Mandatory Statements  11.23B
        • c.  Attachments and Medical Reports  11.23C
        • d.  Service of Notices  11.23D
        • e.  Retention of Notices by Claims Administrator  11.23E
        • f.  Temporary Disability Notices  11.24
        • g.  Permanent Disability Notices  11.25
          • (1)  Condition Not Permanent and Stationary But Injury May Cause Permanent Disability  11.25A
          • (2)  Injury Has Caused Permanent Disability  11.26
            • (a)  Additional Requirements to Unrepresented Employees  11.26A
            • (b)  Additional Requirements for Represented Employees  11.27
          • (3)  Injury Has Not Caused Permanent Disability  11.27A
            • (a)  Additional Requirements for Unrepresented Employees  11.27B
            • (b)  Additional Requirements for Represented Employees  11.27C
          • (4)  Notice of Payment of Permanent Disability  11.27D
        • h.  Notices to Dependents in Death Cases  11.27E
        • i.  Notice of Delay in Determining Liability  11.27F
        • j.  Provision of QME Panel Request Form  11.27G
        • k.  Notice Denying Liability for All Compensation Benefits  11.27H
        • l.  Notice of Right to Supplemental Job Displacement Benefit  11.28
        • m.  Return to Work Notices  11.28A
        • n.  Corrected Notices  11.28B
      • 6.  Form: Compensation Litigation Transmittal Note  11.29
    • B.  Contacting the Employer  11.30
    • C.  Notice of Representation  11.31
    • D.  Obtaining Information From Employment Development Department  11.32
      • 1.  Examine Any Employment Development Department Lien or Notice  11.33
      • 2.  Form: Letter to Employment Development Department  11.34
    • E.  Social Security Earnings Information  11.35
      • 1.  If Injured Worker Will Not Sign Release  11.36
      • 2.  Form: Letter Requesting Signed Social Security Earnings Release  11.37
    • F.  Applicant’s Deposition
      • 1.  Deposition Goals
        • a.  Gather Information  11.38
        • b.  Assess How Claim Will Proceed  11.39
        • c.  Influence Medical Treatment [Deleted]  11.40
        • d.  Understand Worker’s Goal  11.41
      • 2.  Form: Applicant’s Deposition Worksheet  11.42
      • 3.  Form: Petition to Compel Answers to Questions and Production of Documents at Deposition  11.43
    • G.  Applicant’s Deposition—Psychiatric Injury  11.44
      • 1.  Areas to Explore  11.45
      • 2.  Form: Petition for Order Compelling Production of Psychiatric Records; Order  11.46
    • H.  Primary Treating Physician’s Deposition  11.47
      • 1.  Form: Deposition Letter to Primary Treating Physician  11.48
      • 2.  Form: Petition to Compel Attendance at Medical Evaluation  11.49
  • III.  ANALYZING THE INFORMATION
    • A.  Denying or Shifting Liability  11.50
    • B.  Specific Injury Claims  11.51
    • C.  Cumulative Injury Claims  11.52
      • 1.  Compromise and Release (Lab C §5005)  11.53
      • 2.  Joinder; Election  11.54
      • 3.  Form: Petition for Joinder  11.55
    • D.  Coverage  11.56
      • 1.  Form: Letter to Employer Re: Lack of Coverage  11.57
      • 2.  Form: Letter to Applicant or Codefendant Re: Lack of Coverage  11.58
      • 3.  Form: Petition to Dismiss for Lack of Coverage; Order  11.59
  • IV.  TAKING THE OFFENSIVE
    • A.  Attacking the Pleadings  11.60
      • 1.  Form: Petition to Strike Application (Lab C §4906(h), Declaration Missing); Order  11.61
      • 2.  Form: Petition to Dismiss—No Employment Within Last Year of Injurious Exposure  11.62
      • 3.  Form: Petition to Dismiss—No Coverage Within Last Year of Injurious Exposure  11.63
      • 4.  Form: Petition to Dismiss—Statute of Limitations  11.64
      • 5.  Form: Petition to Dismiss—Failure to Prosecute  11.65
    • B.  Lien Claims  11.66
      • 1.  Employment Development Department  11.67
      • 2.  Medical-Legal Expense  11.68
        • a.  Penalties (Lab C §4622(a))  11.69
        • b.  Other Demands for Payment  11.70
          • (1)  Lab C §4060  11.71
          • (2)  Lab C §4061  11.72
          • (3)  Lab C §4062  11.73
          • (4)  Lab C §4062.5  11.74
          • (5)  Lab C §4064  11.75
          • (6)  Lab C §4620  11.76
          • (7)  Lab C §4621  11.77
          • (8)  Lab C §4622  11.78
          • (9)  Lab C §4628  11.79
          • (10)  8 Cal Code Regs §§9794–9795  11.80
        • c.  Form: Objection to Medical-Legal Expense  11.81
      • 3.  Reimbursement From Medical-Legal Providers  11.82
      • 4.  Medical Treatment Liens  11.83
      • 5.  Penalties and Interest  11.84
      • 6.  Form: Objection to Medical Treatment Expense  11.85
      • 7.  Other Lien Claimants  11.86
  • V.  COMPENSATION RECOVERY  11.87
    • A.  Form: Petition for Credit for Third Party Recovery  11.88
    • B.  Form: Petition for Restitution From Injured Worker  11.89
    • C.  Form: Petition for Reimbursement From Codefendant  11.90
    • D.  Petition for Contribution (Lab C §5500.5)  11.91
    • E.  Form: Petition for Reimbursement of Paid Medical-Legal Expense  11.92
  • VI.  COLLATERAL ISSUES
    • A.  Penalty Petitions  11.93
    • B.  Serious and Willful Misconduct Petitions  11.94
    • C.  Form: Letter From Insurer’s Attorney Advising Employer of Serious and Willful Misconduct Petition  11.95
    • D.  Discrimination Petitions  11.96
    • E.  Form: Letter Advising Insured Employer of Petition Alleging Discrimination  11.97
    • F.  Employer’s Bill of Rights (Lab C §3761 Proceedings)  11.98
  • VII.  ALTERNATIVE DISPUTE RESOLUTION  11.99

12

Time Limitations

Paul Peyrat

  • I.  INTRODUCTION
    • A.  Need for Timely Notices, Claims, and Applications  12.1
    • B.  Determining Date of Injury
      • 1.  Specific Injury  12.2
      • 2.  Cumulative Injury  12.3
        • a.  Compensable Disability  12.4
        • b.  Employee’s Knowledge of Industrial Cause  12.5
        • c.  Occupational Disease  12.6
      • 3.  Latent Injury  12.7
  • II.  ASSERTING AND RESPONDING TO INDUSTRIAL INJURY CLAIMS
    • A.  Employee: Give Employer Notice of Injury
      • 1.  Ascertaining and Ensuring Employer’s Knowledge  12.8
      • 2.  Serving Written Notice; Alternatives
        • a.  30-Day Notice and Its Equivalents  12.9
        • b.  Form: Notice of Injury  12.10
      • 3.  Showing Employer’s Knowledge of Injury  12.11
      • 4.  Meeting Absent or Defective Notice Defense
        • a.  Employer’s Need to Show Prejudice  12.12
        • b.  Effect of Notice to Employer’s Insurer  12.13
      • 5.  Prenotice Medical Treatment  12.14
    • B.  Employer: Provide Claim Form, Notice of Eligibility, and Advice
      • 1.  Claim Form and Notice of Eligibility
        • a.  Use DWC-Approved Claim and Notice Form  12.15
        • b.  Provide Claim and Notice Form as Soon as Possible  12.16
        • c.  Form: Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility  12.17
      • 2.  Printed Advice to Employee  12.18
        • a.  Notice to Employees Poster  12.18A
        • b.  Form: Notice to Employees—Injuries Caused By Work (DWC 7)  12.18B
    • C.  Employee: Complete Claim Form and File With Employer
      • 1.  Reasons to File Claim Form  12.19
      • 2.  Filling in Blanks  12.20
      • 3.  Filing Form With Employer  12.21
    • D.  Employer: Respond to Filed Claim Form
      • 1.  Completing and Distributing Claim Form  12.22
      • 2.  Accepting the Claim  12.23
      • 3.  Denying (Rejecting) the Claim
        • a.  Restarting Limitations Periods  12.24
        • b.  Avoiding Presumption of Compensability  12.25
    • E.  Employee: File Application With Workers’ Compensation Appeals Board
      • 1.  If Employer Has Rejected Claim  12.26
      • 2.  If Employer Has Paid Compensation  12.27
    • F.  Employer: Notify Claims Administrator of Positive COVID-19 Test  12.27A
  • III.  ASCERTAINING APPLICABLE LIMITATIONS
    • A.  Preliminary Considerations
      • 1.  Liberal Construction  12.28
      • 2.  One Cause of Action  12.29
      • 3.  Table of Limitations  12.30
    • B.  Disability Indemnity and Medical Treatment
      • 1.  1-Year Limit  12.31
      • 2.  5-Year Limit for New and Further Disability  12.32
        • a.  Meaning of “New and Further Disability”  12.33
        • b.  When WCAB Loses Jurisdiction Over “New and Further Disability”  12.34
      • 3.  Medical Treatment as “Furnishing of Benefits”  12.35
        • a.  When Medical Treatment Is Furnished  12.36
        • b.  When Medical Treatment Is Not Furnished  12.37
        • c.  Lien Claims
          • (1)  Labor Code §4903.5  12.37A
          • (2)  Labor Code §4903.6  12.37B
    • C.  Death Benefits and Burial Expenses
      • 1.  General Rule: 1-Year/240-Week Limit  12.38
      • 2.  Limitations Period When Death Is Caused by Asbestosis or HIV-Related Disease  12.39
    • D.  Serious and Willful Misconduct
      • 1.  Employee’s Claim  12.40
      • 2.  Employer’s Claim  12.41
    • E.  Unreasonable Delay or Refusal to Pay Compensation  12.41A
    • F.  Employer Discrimination  12.42
    • G.  Subsequent Injuries Benefits Trust Fund  12.43
    • H.  Vocational Rehabilitation for Injuries Occurring Before January 1, 2004
      • 1.  1-Year Limit [Deleted]  12.44
      • 2.  5-Year Limit [Deleted]  12.45
    • I.  Claims by Asbestos Workers’ Account  12.46
    • J.  Contribution  12.47
    • K.  Reopening Orders and Awards  12.48
  • IV.  SUSPENSION OF LIMITATIONS PERIODS
    • A.  Minority  12.49
    • B.  Incompetence
      • 1.  Tolling for Incompetence  12.50
      • 2.  Allegations of Incompetence, Competence Regained  12.51
    • C.  Imprisonment  12.52
    • D.  Servicemembers’ Civil Relief Act  12.53
    • E.  Request for Administrative Assistance  12.54
    • F.  Filing Civil Action  12.55
  • V.  ASSERTING THE DEFENSE
    • A.  Burden of Proof  12.56
    • B.  Waiver
      • 1.  Failure to Assert Before Submission  12.57
      • 2.  Agreement  12.58
    • C.  Estoppel
      • 1.  Active Conduct  12.59
      • 2.  Failure to Notify Employee  12.60
      • 3.  Pleading and Procedure  12.61

13

Filing With the Workers’ Compensation Appeals Board

Colleen S. Casey

  • I.  WORKERS’ COMPENSATION APPEALS BOARD FILING PROCEDURES  13.1
    • A.  Invoking the WCAB’s Jurisdiction  13.2
    • B.  Required Pleadings and Papers  13.3
      • 1.  Liberal Construction of Pleadings  13.4
    • C.  Filing Procedures
      • 1.  Electronic Adjudication Management System (EAMS)  13.5
      • 2.  Filing Methods In EAMS  13.6
        • a.  OCR Forms  13.7
        • b.  E-Forms  13.8
        • c.  JET File  13.9
      • 3.  Form and Size Requirements for Filed Documents
        • a.  General Requirements  13.10
        • b.  Requirements for OCR Forms  13.11
        • c.  Document Cover and Separator Sheets  13.12
          • (1)  Document Cover Sheets  13.13
          • (2)  Document Separator Sheets  13.14
          • (3)  Use by Unrepresented Parties  13.15
        • d.  Oversized Documents  13.16
        • e.  Requirements for Electronically Filed Documents  13.17
      • 4.  Documents That Should Not Be Filed  13.18
      • 5.  Failure to Comply With EAMS Rules  13.19
    • D.  Exhaust Other Required Remedies  13.20
  • II.  PARTIES TO BOARD PROCEEDINGS  13.21
    • A.  Injured Employees and Dependents of Deceased Employees  13.22
    • B.  Employers and Insurance Carriers  13.23
      • 1.  Insured Employers  13.24
      • 2.  Self-Insured Private Employers  13.25
      • 3.  Unlawfully Uninsured Employers  13.26
      • 4.  Governmental Entities  13.27
    • C.  Lien Claimants  13.28
    • D.  Department of Industrial Relations  13.29
    • E.  Asbestos Workers’ Account  13.30
    • F.  Joinder of Injured Employee and Others  13.31
    • G.  Parties Checklist  13.32
  • III.  APPLICATIONS FOR ADJUDICATION OF CLAIMS
    • A.  General Rules and Effect  13.33
    • B.  Separate Application Required for Each Injury; Consolidating Claims  13.34
    • C.  Preparing DWC/WCAB Form 1A  13.35
      • 1.  Case Number  13.36
      • 2.  Applicant’s Social Security Number  13.37
      • 3.  Venue  13.38
      • 4.  Names and Addresses
        • a.  Injured Worker  13.39
        • b.  Other Applicant  13.40
        • c.  Employer Information  13.41
          • (1)  Corporations  13.42
          • (2)  Partnerships and Unincorporated Associations  13.43
          • (3)  Fictitious Names  13.44
          • (4)  Governmental Entities  13.45
      • 5.  Insurance Carriers and Adjusting Agents  13.46
      • 6.  Item 1: Jurisdictional Facts
        • a.  Date of Birth  13.47
        • b.  Employee’s Occupation; Type of Injury; Date(s) of Injury  13.48
        • c.  Place of Injury  13.49
        • d.  Parts of Body Injured  13.50
      • 7.  Item 2: How Injury Occurred  13.51
      • 8.  Item 3: Earnings  13.52
      • 9.  Item 4: Period of Disability  13.53
      • 10.  Item 5: Payment of Compensation  13.54
      • 11.  Item 6: Unemployment or Disability Benefits Received  13.55
      • 12.  Item 7: Medical Treatment  13.56
      • 13.  Item 8: Other Applications  13.57
      • 14.  Item 9: Disputed Issue(s) or Requested Relief  13.58
      • 15.  Representation; Date and Signature  13.59
    • D.  Preparing DIA WCAB Form 2  13.60
      • 1.  Case Number  13.61
      • 2.  Applicant and Other Parties  13.62
      • 3.  Claims
        • a.  Items 1–6  13.63
        • b.  Item 7: Burial Expenses  13.64
        • c.  Item 8: Dependents  13.65
      • 4.  Request for Hearing and Award; Date and Signature  13.66
    • E.  Preparing Applications Alleging Occupational Disease and Cumulative Injury
      • 1.  Definitions  13.67
      • 2.  Form of Application  13.68
      • 3.  Which Employers Are Liable  13.69
      • 4.  Naming Employers and Carriers  13.70
      • 5.  Alleging Cumulative Injury and Exposure  13.71
      • 6.  Form: Sample Allegations of Cumulative Injury and Exposure  13.72
      • 7.  Separate Injuries; Antimerger Doctrine  13.73
      • 8.  Electing Defendants  13.74
    • F.  Applications Naming the Uninsured Employers Benefits Trust Fund (UEBTF)  13.75
      • 1.  Joining the UEBTF  13.76
      • 2.  Serving the Uninsured Employer and the UEBTF  13.77
  • IV.  PETITIONS
    • A.  Preparing Petition for Serious and Willful Misconduct
      • 1.  Basis of Serious and Willful Misconduct Petition Against Employer or Insurer  13.78
      • 2.  How to Claim Increased Benefits for Employer’s Serious and Willful Misconduct  13.79
      • 3.  Pleading Employee’s Serious and Willful Misconduct  13.80
      • 4.  Form: Petition for Award for Employer’s Serious and Willful Misconduct  13.81
      • 5.  Form: Petition for Award for Employer’s Serious and Willful Misconduct—Violation of Safety Order (Lab C §4553.1)  13.81A
        • a.  Caption  13.82
        • b.  First Cause of Action  13.83
        • c.  Verification  13.84
        • d.  Service  13.85
      • 6.  Sample Allegation: Violation of Safety Order  13.86
        • a.  Cite or Refer Correctly to Safety Order or Statute  13.87
        • b.  State How Safety Order or Statute Was Violated  13.88
      • 7.  Sample Allegation: General Misconduct  13.89
    • B.  Preparing Petition for Increased Benefits Based on Discriminatory Conduct by Employer or Insurer  13.90
      • 1.  Form: Petition for Award Under Lab C §132a  13.91
      • 2.  Prepare and File Within 1 Year  13.92
    • C.  Petition for Guardian Ad Litem and Trustee
      • 1.  Need for Guardian and Trustee; Powers  13.93
      • 2.  Procedure  13.94
      • 3.  Bonds  13.95
  • V.  APPLICATION ATTACHMENTS AND ACCOMPANYING PAPERS
    • A.  In General  13.96
    • B.  Lab C §4906(h) Declaration
      • 1.  Mandatory Accompaniment to Application or Answer  13.97
      • 2.  Form: Declaration Under Lab C §4906(h)  13.98
    • C.  Claim Form  13.99
    • D.  Declaration of Readiness to Proceed (DWC-CA Form 10250.1)  13.100
    • E.  Proof of Service  13.101
    • F.  Consent to Venue  13.102
    • G.  Election of Defendants  13.103
    • H.  Request for Benefits From Subsequent Injuries Benefits Trust Fund (SIBTF)
      • 1.  Availability of Benefits for Previous Disability  13.104
      • 2.  Making Application Against the SIBTF  13.105
      • 3.  Filing and Serving Separate SIBTF Application  13.106
    • I.  Arbitration Submittal Form  13.107
  • VI.  FILING AND SERVING APPLICATIONS AND PETITIONS
    • A.  Filing Mechanics  13.108
    • B.  Place of Filing—Venue  13.109
      • 1.  Venue Options  13.110
      • 2.  Incorrect Venue  13.111
      • 3.  Objection to Venue  13.112
      • 4.  Change of Venue  13.113
    • C.  Serve Application
      • 1.  Ordinary Service  13.114
      • 2.  Service on Uninsured Employer and on UEBTF  13.115
  • VII.  ANSWERS
    • A.  Answers to Applications for Adjudication of Claim
      • 1.  Preparing the Answer  13.116
        • a.  Caption  13.117
        • b.  Denials  13.118
        • c.  Affirmative Defenses  13.119
        • d.  Attachments and Accompanying Documents  13.120
      • 2.  Time to File Answer  13.121
      • 3.  Filing and Service of Answer  13.122
      • 4.  Amending the Answer  13.123
      • 5.  Effect of Failure to File Answer  13.124
    • B.  Answer to Petitions  13.125
    • C.  Requesting Dismissal of Application
      • 1.  Applications Subject to Dismissal  13.126
        • a.  Insufficient Detail  13.127
        • b.  More Than One Injury Alleged  13.128
        • c.  Dismissal or Joinder of Parties Required  13.129
        • d.  Improper Venue or Jurisdiction  13.130
      • 2.  Form: Answer to Petition and Request for Dismissal or Continuance  13.131
  • VIII.  ATTORNEYS’ APPEARANCE AND SUBSTITUTION
    • A.  Initial Appearance  13.132
    • B.  Substitution and Dismissal  13.133
      • 1.  Mutual Consent  13.134
      • 2.  Attorney Withdraws  13.135
      • 3.  Notice of Dismissal  13.136
      • 4.  Disqualification of Attorney  13.137

14

Gathering Evidence

Barry M. Lesch

James P. Pettibone

  • I.  INFORMATION GATHERING DURING FIRST 75 OR 90 DAYS (LAB C §5402)
    • A.  Initial Investigation by Claims Administrator  14.1
      • 1.  Information Gathered During Initial Investigation  14.2
      • 2.  Conducting the Investigation  14.3
    • B.  Evidence From Employee  14.4
    • C.  Evidence From Employer  14.5
      • 1.  Form 5020 Information  14.6
      • 2.  Form: Employer’s Report of Occupational Injury or Illness (Form 5020)  14.7
    • D.  Evidence From Medical Providers
      • 1.  Primary Treating Physicians; Form 5021  14.8
      • 2.  Obtaining Medical Reports  14.9
      • 3.  Obtaining Additional Records by Use of a Medical Release  14.10
      • 4.  Form: Authorization for Medical Information  14.11
      • 5.  Limits on Medical Discovery  14.12
    • E.  Additional Information
      • 1.  Form: Request for Social Security Earning Information (SSA-7050-F4)  14.13
      • 2.  Miscellaneous Information  14.14
  • II.  ATTORNEY ROLES AT EARLY STAGES
    • A.  Defense Attorney  14.15
    • B.  Employee’s Attorney
      • 1.  Instructing the Employee Concerning Medical Examinations  14.16
      • 2.  Finding Lay Witnesses  14.17
      • 3.  Establishing Serious and Willful Misconduct  14.18
        • a.  Safety Orders; Safety Standards  14.19
        • b.  Proving Knowledge  14.20
  • III.  REBUTTABLE PRESUMPTION OF COMPENSABILITY IF CLAIM NOT DENIED WITHIN FIRST 75 OR 90 DAYS  14.21
    • A.  Rebutting the Presumption  14.22
    • B.  Discovery Allowed on Other Issues  14.23
  • IV.  OBTAINING MEDICAL EVIDENCE IN GENERAL  14.24
    • A.  Medical-Legal Expenses  14.25
    • B.  Types of Physicians  14.26
    • C.  Selecting Examining Physicians  14.27
      • 1.  Is Physician Qualified to Report?  14.28
      • 2.  Arranging the Examination  14.29
      • 3.  Communicating With Physicians  14.30
      • 4.  Requesting Medical-Legal Report  14.31
    • D.  Contents of Medical-Legal Report  14.32
      • 1.  Lab C §4628 Requirements  14.33
      • 2.  Form: Declaration by Signing Physician  14.34
      • 3.  If Report Violates Lab C §4628  14.35
      • 4.  If Report Violates 8 Cal Code Regs §10682  14.36
      • 5.  On Receiving Report  14.37
  • V.  OBTAINING MEDICAL EVIDENCE ON SPECIFIC MEDICAL ISSUES AFTER THE FIRST 90 DAYS
    • A.  Compensability Evaluations (Lab C §4060)  14.38
      • 1.  If Employee Is Not Represented by an Attorney  14.39
      • 2.  If Employee Is Represented by an Attorney  14.40
    • B.  Primary Treating Physician Reports  14.41
      • 1.  Ongoing Reports From Primary Treating Physician  14.42
      • 2.  Primary Treating Physician’s Report Concerning Permanent Disability  14.43
      • 3.  Presumption of Correctness of Treating Physician’s Findings Repealed  14.44
        • a.  Rebutting the Presumption  14.45
        • b.  Defeating the Presumption  14.46
      • 4.  Rebuttable Presumption of Percentage of Permanent Disability Attributed to Each Injury Covered by 2005 Permanent Disability Rating Schedule  14.46A
      • 5.  Rebuttable Presumption of Correctness of Medical Treatment Utilization Schedule  14.46B
    • C.  Medical-Legal Evaluations Under Lab C §§4060–4068  14.47
      • 1.  Disputes Under Lab C §4062  14.48
        • a.  Procedure for Objecting  14.49
        • b.  Contents of Evaluation  14.50
      • 2.  Disputes Under Lab C §4061  14.51
        • a.  Procedure Under Lab C §4061  14.52
        • b.  Contents and Service of Evaluation  14.53
      • 3.  After the Comprehensive Medical Examination: Payment or Hearing  14.54
    • D.  Medical Provider Networks  14.54A
    • E.  Production of Medical Reports  14.55
  • VI.  OBTAINING EVIDENCE IN DEATH CASES  14.56
    • A.  Autopsy  14.57
    • B.  Nonmedical Evidence  14.58
  • VII.  DEFENDANT’S SURVEILLANCE AND FILMING OF EMPLOYEE  14.59
    • A.  When Surveillance May Be Beneficial  14.60
    • B.  Limits on Filming
      • 1.  No Entrapment, Fraud, or Deceit  14.61
      • 2.  Liability Under CC §1708.8 for Invasion of Privacy  14.62
    • C.  Use of Film  14.63
      • 1.  Determine Value  14.64
      • 2.  Discrediting Film  14.65
      • 3.  Presenting Film to Physicians  14.66
        • a.  Panel Qualified Medical Evaluator  14.67
        • b.  Medical Evaluators  14.68
        • c.  Agreed Medical Evaluators  14.69
      • 4.  Use for Impeachment of Employee  14.70
    • D.  Disclosing Film During Discovery  14.71
      • 1.  Until Employee’s Deposition  14.72
      • 2.  Until Mandatory Settlement Conference or Trial  14.73
  • VIII.  DEPOSITIONS AND WITNESS STATEMENTS
    • A.  Generally; Interpreter Services  14.74
    • B.  Employee’s Deposition  14.75
      • 1.  Information From and Attendance of Employer  14.76
      • 2.  Employee’s Deposition Rights  14.77
      • 3.  Limitation on Questions Concerning Medical History  14.78
      • 4.  Checklist: Deposition Information From Employee  14.79
    • C.  Depositions Taken by Employee
      • 1.  Purpose of Depositions  14.80
      • 2.  Obtaining Deposition of Employer or Defense Witness  14.81
    • D.  Depositions of Physicians
      • 1.  To Obtain Evidence, Not Only Discovery  14.82
        • a.  Balance Risks and Benefits of Cross-Examination  14.83
        • b.  Whether to Cross-Examine Treating Physician, AME, or Panel QME  14.84
      • 2.  Costs of Medical Depositions  14.85
    • E.  Third Party Witnesses
      • 1.  Witness Statements  14.86
        • a.  Written or Recorded Statements  14.87
        • b.  Statements Are Discoverable  14.88
      • 2.  Deposition of Witnesses  14.89
    • F.  Testimony of Judicial or Quasi-Judicial Officers  14.89A
    • G.  Subpoenas  14.90
    • H.  Failure to Appear or Answer  14.91
  • IX.  NONMEDICAL EXPERT EVIDENCE  14.91A
    • A.  Continued Use of Vocational Experts  14.91B
    • B.  Functional Capacity Evaluation  14.91C
  • X.  OBTAINING RECORDS
    • A.  Medical Records  14.92
    • B.  X Rays  14.92A
    • C.  Production of Documents by Opposing Party  14.93
    • D.  By Subpoena  14.94
    • E.  Enforcing Subpoena  14.95
  • XI.  OTHER DISCOVERY METHODS  14.96
  • XII.  DISCOVERY CUTOFF  14.97
  • XIII.  LIMITATIONS ON GATHERING AND USING EVIDENCE
    • A.  Injury Arising From Sexual Conduct  14.98
    • B.  HIV/AIDS Cases  14.99
    • C.  Privilege Statutes Apply in Workers’ Compensation Proceedings  14.99A

15

Lien Claims

Hon. Pamela W. Foust

  • I.  OVERVIEW
    • A.  Restrictions on Disbursement of Benefits to Claimant  15.1
    • B.  Nature of Lien  15.2
    • C.  Statutory Classes
      • 1.  Permissive Liens  15.3
      • 2.  Mandatory Liens  15.4
    • D.  Compensation Subject to Liens  15.5
    • E.  Assignment of Liens  15.5A
    • F.  WCAB’s Jurisdiction to Allow Liens Is Exclusive  15.6
      • 1.  Support for Deserted or Neglected Dependents  15.7
      • 2.  Attorney Fees  15.8
      • 3.  Medical Treatment Liens  15.8A
  • II.  ALLOWABLE LIENS
    • A.  Chart: Liens Allowable and Not Allowable  15.9
    • B.  Attorney Fees and Disbursements  15.10
      • 1.  Determining Attorney Fee Amount
        • a.  Factors Board Considers  15.11
        • b.  Life Pension Cases  15.12
        • c.  Complexity of Case  15.13
        • d.  Lack of Care and Skill  15.14
        • e.  Vocational Rehabilitation Claims (Injuries Before January 1, 2004)  15.15
      • 2.  Deposition Attorney Fees  15.16
      • 3.  Attorney Fees Payable by Defendant  15.17
        • a.  Permissive Fee Awards  15.18
        • b.  Attorney Fees Payable as Sanction  15.18A
        • c.  Mandatory Fee Awards  15.19
      • 4.  Allocation of Fees Between Successive Attorneys  15.20
      • 5.  Disbursements  15.21
    • C.  Medical Treatment
      • 1.  Items Subject to Lien  15.22
      • 2.  Time Limit for Filing Lien Claim
        • a.  Labor Code §4903.5  15.22A
        • b.  Other Limitations on Filing  15.22B
        • c.  Labor Code §4903.6  15.22C
      • 3.  Dismissal of Applicant’s Case  15.22D
      • 4.  Substantive Matters
        • a.  Disputes About Threshold Issues  15.22E
        • b.  Medical Control  15.22F
      • 5.  Limited to Cure or Relief of Industrial Injury [Deleted]  15.23
      • 6.  Qualifications of Medical Providers  15.24
      • 7.  Reasonable Medical Necessity  15.24A
      • 8.  Timing of Treatment and Lien Filing [Deleted]  15.25
      • 9.  When Lien Claimant Disputes Settlement Allocation [Deleted]  15.26
      • 10.  Dismissal of Applicant’s Case [Deleted]  15.27
      • 11.  Reasonable Value  15.28
      • 12.  Insurers’ Medical Treatment Liens  15.29
    • D.  Medical-Legal Expenses
      • 1.  Recoverable as Lien  15.30
      • 2.  When Costs Not Allowable: Examples  15.31
      • 3.  Worker’s Claim Must Be Contested; Timing and Notice Issues  15.32
      • 4.  Defendant’s Obligation to Pay or Object  15.33
      • 5.  No Cost Claim for Unnecessary Reports  15.34
      • 6.  Who May Write Medical-Legal Reports  15.35
      • 7.  Antifraud Provisions  15.36
        • a.  Duties of Physician  15.37
        • b.  Contents of Medical Report  15.38
      • 8.  Medical Report Must Be Capable of Proving or Disproving Essential Disputed Medical Facts  15.39
      • 9.  Fee Schedule; Interpreter Rates  15.40
    • E.  Employee and Dependent Living Expenses  15.41
      • 1.  Included, Excluded Expenses  15.42
      • 2.  Unrelated Medical Expenses  15.43
      • 3.  Compensation Paid by Mistake  15.44
      • 4.  Loss of Income Benefits  15.45
    • F.  Burial Expense  15.46
    • G.  Living Expenses of Deserted or Neglected Spouse or Minor Children  15.47
    • H.  Employment Development Department Benefits  15.48
      • 1.  Disability  15.49
      • 2.  Unemployment Insurance  15.50
    • I.  Victim of Violent Crime Indemnification  15.51
    • J.  Family Temporary Disability Insurance Benefits (Paid Family Leave)  15.51A
    • K.  Asbestos Workers’ Benefits [Deleted]  15.52
    • L.  Nonmedical Litigation Costs  15.53
      • 1.  Interpreter Services  15.54
      • 2.  Costs Under Lab C §5811
        • a.  Post-SB 863 Costs  15.55
        • b.  Pre-SB 863 Costs  15.55A
    • M.  Uninsured Employers Benefits Trust Fund Payments  15.56
    • N.  Tax Liens  15.57
  • III.  ELECTRONIC ADJUDICATION MANAGEMENT SYSTEM (EAMS)  15.57A
  • IV.  LIEN PROCEDURE
    • A.  Preliminary Steps  15.58
    • B.  Notices of Representation  15.58A
      • 1.  Required Contents of Notice; Verification  15.58B
      • 2.  Time for Filing and Service  15.58C
      • 3.  Additional Requirements for Nonattorney Representatives [Deleted]  15.58D
      • 4.  Notice of Nonrepresentation [Deleted]  15.58E
    • C.  Fees
      • 1.  Filing Fee for Medical Treatment Lien and Cost Claim (Filed After 1/1/2013)  15.58F
      • 2.  Activation Fee for Medical Treatment Lien (Filed Before 1/1/2013)  15.58G
      • 3.  Reimbursement  15.58H
    • D.  Time to File
      • 1.  Lab C §§4903.5 and 4903.6  15.59
      • 2.  Laches  15.60
    • E.  Who May File  15.61
    • F.  Completing, Filing, and Serving Lien Claims
      • 1.  When Lien Claim Must Be Filed Electronically  15.62
      • 2.  When OCR Form Permitted  15.62A
      • 3.  When Lien Claim May Be Filed on Non-OCR Form [Deleted]  15.63
      • 4.  Requirements for Filing Lien Claims
        • a.  Case Number; Party Names and Addresses  15.64
        • b.  Claims  15.65
        • c.  Signature  15.66
      • 5.  Supporting Documents  15.67
      • 6.  Filing  15.68
      • 7.  Proof of Service  15.68A
      • 8.  Verification to Filing of Lien Claim or Application by Lien Claimant  15.68B
      • 9.  Verification to Filing of Declaration of Readiness to Proceed by or on Behalf of Lien Claimant  15.68C
      • 10.  Service  15.69
      • 11.  Amendments  15.70
      • 12.  Duty to Notify Parties of Changes in Contact Information  15.70A
      • 13.  Notification of Hearing  15.70B
      • 14.  Notice After Resolution or Withdrawal  15.70C
    • G.  Defendants’ Obligations  15.71
      • 1.  Withhold Funds in Anticipation of Lien  15.72
      • 2.  Notify Employment Development Department  15.73
      • 3.  Disclose All Liens [Deleted]  15.74
    • H.  Service of Medical Reports
      • 1.  On Party or Physician Lien Claimant  15.75
      • 2.  On Nonphysician Lien Claimant  15.75A
      • 3.  Manner of Service  15.75B
    • I.  Hearings and Dismissal of Liens
      • 1.  When Case in Chief Is Resolved by Compromise and Release or Stipulated Award [Deleted]  15.76
      • 2.  Lien Conferences
        • a.  How Lien Conference Is Set  15.76A
        • b.  Proof of Payment of Lien Filing or Activation Fee Required  15.76B
        • c.  When and Where Lien Conference Is Set  15.76C
        • d.  Required Appearances at Lien Conference; Possible WCJ Actions  15.76D
        • e.  Pre-Trial Conference Statement  15.76E
        • f.  Submission at Lien Conference  15.76F
        • g.  When Lien Conference Has Been Ordered Off Calendar  15.76G
        • h.  Consequence for Violation of Lien Conference Rules  15.76H
      • 3.  Lien Trials  15.76I
      • 4.  Dismissal of Lien for Lack of Prosecution
        • a.  When Petition for Dismissal May Be Filed  15.77
        • b.  Required Documents [Deleted]  15.77A
        • c.  Service [Deleted]  15.77B
        • d.  Notice of Intention to Dismiss  15.77C
      • 5.  Dismissal for Failure to Appear  15.77D
      • 6.  Summary Lien Claim Procedure [Deleted]  15.78
      • 7.  Arbitration  15.79
    • J.  Lien Claimant’s Rights and Obligations
      • 1.  “Right to Relief” or “Party in Interest”  15.80
      • 2.  Due Process  15.81
    • K.  Burden of Proof  15.82
    • L.  Sanctions  15.82A
    • M.  Attorney Fees and Costs  15.83
      • 1.  Procedure  15.84
      • 2.  Request for Fee Increase  15.85
    • N.  Medical-Legal Costs  15.86
    • O.  Settled Claims  15.87
  • V.  WORKERS’ COMPENSATION APPEALS BOARD’S DISCRETION
    • A.  Limits  15.88
    • B.  Determining Reasonableness  15.89
    • C.  Payment Priorities  15.90
    • D.  Payment Method  15.91
    • E.  Allowance on Workers’ Compensation Appeals Board’s Own Motion  15.92
    • F.  Need for Opportunity to Be Heard  15.93
    • G.  Settled Claims  15.94
  • VI.  LIEN CLAIMANT’S LIABILITY FOR ATTORNEY FEES
    • A.  Statutory Provisions  15.95
    • B.  Common Fund Principle [Deleted]  15.96
    • C.  Procedure  15.97

16

Settlement

Raymond E. Frost

  • I.  ADVANTAGES AND TYPES OF SETTLEMENT  16.1
  • II.  COMPROMISE AND RELEASE AGREEMENT  16.2
    • A.  Advantages  16.3
    • B.  Primary Issues to Resolve
      • 1.  Permanent Disability  16.4
      • 2.  Temporary Disability  16.5
      • 3.  Future Medical Care  16.6
      • 4.  Other Issues  16.7
    • C.  Types of Compromise and Releases
      • 1.  Full or Partial Release  16.8
      • 2.  Claims Against Subsequent Injuries Benefits Trust Fund  16.9
      • 3.  Claims for Vocational Rehabilitation (Injuries Occurring Before January 1, 2004) [Deleted]  16.10
        • a.  Thomas Finding [Deleted]  16.10A
        • b.  One-Time Payment [Deleted]  16.10B
        • c.  Form: RU-122 [Deleted]  16.10C
      • 4.  Serious and Willful Misconduct of Employer or Employee  16.11
      • 5.  Third Party Settlement  16.12
    • D.  Circumstances Justifying Settlement
      • 1.  General Policy  16.13
      • 2.  Worker’s Considerations  16.14
      • 3.  Defense Considerations  16.15
    • E.  Negotiation
      • 1.  Evaluating Case Value  16.16
      • 2.  Negotiating Techniques  16.17
        • a.  On Behalf of Worker  16.18
        • b.  On Behalf of Defense  16.19
      • 3.  Specific Types of Cases  16.20
      • 4.  Lien Claims  16.21
    • F.  Drafting, Service, and Filing
      • 1.  Requirements; Using WCAB C&R Forms  16.22
      • 2.  Separate Forms for Separate Injuries Not Required  16.23
      • 3.  Form: Compromise and Release Agreement (DWC-CA Form 10214(c))  16.24
      • 4.  Completing DWC-CA Form 10214(c)
        • a.  Case Number(s); Venue; Parties  16.25
        • b.  Description of Injury and Claim  16.26
        • c.  Scope of Release  16.27
        • d.  Compensation Paid and Claimed  16.28
        • e.  Amount of Compromise and Deductions  16.29
        • f.  Liens to Be Disallowed or Reduced  16.30
        • g.  Attorney Fees  16.31
        • h.  Reason for Compromise  16.32
          • (1)  Special Provisions  16.33
          • (2)  Form: Addendum to Compromise and Release  16.34
        • i.  Provision for Hearing  16.35
        • j.  Execution  16.36
      • 5.  Accompanying Papers  16.37
      • 6.  Reducing Lien Claims
        • a.  Statutory Authority
          • (1)  Unemployment Compensation Liens  16.38
          • (2)  Certain Medical and Group Disability Liens  16.39
        • b.  Allocation by Formula
          • (1)  Unemployment Compensation Liens (Baird Formula)  16.40
          • (2)  Medical and Group Disability Liens  16.41
        • c.  Procedure  16.42
        • d.  Form: Sample Computation of Fair Allocation to Unemployment Compensation Disability Lien Claim (Baird Formula)  16.43
        • e.  Form: Sample Computation of Lien Reduction Under Lab C §4903.1(a)(4)  16.44
      • 7.  Service and Filing  16.45
      • 8.  “Walk-Through” Filing  16.46
      • 9.  Form: Compromise and Release Agreement—Dependency Claim (DWC-CA Form 10214(d))  16.47
      • 10.  Form: Compromise and Release Agreement—Third Party (DWC-CA Form 10214(e))  16.48
    • G.  Status of Executed Compromise and Release Before Approval  16.49
      • 1.  Effect of Worker’s Death  16.50
      • 2.  Effect of Party’s Repudiation  16.51
      • 3.  Effect of Disapproval [Deleted]  16.52
    • H.  Approval of Agreement
      • 1.  WCAB’s Responsibility  16.53
      • 2.  Informal Discussion With Workers’ Compensation Judge  16.54
      • 3.  Employers’ Objections  16.55
      • 4.  Hearing  16.56
      • 5.  Workers’ Compensation Appeals Board’s Authority  16.57
      • 6.  Effect of Approval
        • a.  On Parties  16.58
        • b.  On Dependents  16.59
        • c.  On Right to Vocational Rehabilitation Services (Injuries Occurring Before January 1, 2004) [Deleted]  16.60
    • I.  Effect of Disapproval  16.60A
    • J.  Procedures to Reconsider, Review, or Set Aside Approval
      • 1.  Petitions for Reconsideration and Review  16.61
      • 2.  Setting Aside
        • a.  Petition to Reopen  16.62
        • b.  Restitution Ordinarily Not Condition Precedent  16.63
        • c.  Grounds for Reopening  16.64
          • (1)  Fraud, Duress, or Undue Influence  16.65
          • (2)  Mutual Mistake of Fact  16.66
          • (3)  Mistake of Law  16.67
          • (4)  Invalidity of Execution  16.68
          • (5)  Incompetency or Minority at Time of Execution  16.69
  • III.  STIPULATIONS WITH REQUEST FOR AWARD
    • A.  Legal Effect  16.70
    • B.  Strategic Considerations  16.71
    • C.  Components
      • 1.  Permanent Disability  16.72
      • 2.  Temporary Disability  16.73
      • 3.  Lien Claims  16.74
    • D.  Negotiation  16.75
    • E.  Deciding Whether to Execute Stipulations  16.76
    • F.  Stipulations Form
      • 1.  Preparation  16.77
      • 2.  Form: Stipulations With Request for Award (DWC-WCAB Form 10214(a))  16.78
      • 3.  Filing, Service, and Attachments  16.79
      • 4.  Lien Claims  16.80
      • 5.  Death Case
        • a.  Preparation  16.81
        • b.  Form: Stipulations With Request for Award (Death Case) (DWC-CA Form 10214(b))  16.82
        • c.  Filing, Service, and Attachments  16.83
        • d.  Form: Sample Letter Requesting Fee (To Accompany WCAB Form 4)  16.84
    • G.  Ruling on Stipulations  16.85

17

Preparing for Trial

Yale I. Jones

Robert E. Buch

  • I.  WORKERS’ COMPENSATION APPEALS BOARD HEARINGS IN GENERAL
    • A.  Continuing Implementation of EAMS  17.1
    • B.  Need for Hearing  17.1A
    • C.  Setting Case for Hearing  17.2
    • D.  Electronic Hearings, Appearances, and Testimony  17.2A
  • II.  TYPES OF HEARINGS  17.3
    • A.  Regular Hearing (Trial Calendar)  17.4
    • B.  Mandatory Settlement Conference  17.5
      • 1.  Conduct of Conference  17.6
        • a.  Continuance  17.7
        • b.  Failure to Appear  17.8
        • c.  Consolidation  17.8A
      • 2.  Effect of Mandatory Settlement Conference  17.9
        • a.  Listing Witnesses and Disclosing Evidence  17.10
        • b.  Raising Issues  17.11
      • 3.  Form: Pretrial Conference Statement §5502(d)(3) (WCAB Form 24)  17.12
    • C.  Consultative Disability Evaluations at Mandatory Settlement Conference  17.13
    • D.  Hearing by Pro Tempore Judge  17.14
    • E.  Emergency Hearings  17.15
    • F.  Expedited Hearings
      • 1.  When Appropriate  17.16
      • 2.  How to Request an Expedited Hearing  17.17
      • 3.  Form: Declaration of Readiness to Proceed to Expedited Hearing (Trial) (DWC-CA Form 10208.3)  17.18
    • G.  Rating Mandatory Settlement Conference  17.18A
    • H.  Status Conference  17.18B
    • I.  Priority Conference  17.18C
    • J.  Walk-Through Procedure
      • 1.  In General  17.18D
      • 2.  Emergency Petition for Stay  17.18E
  • III.  SETTING FOR HEARING
    • A.  Declaration of Readiness to Proceed
      • 1.  Need to File  17.19
      • 2.  Content  17.20
      • 3.  Requesting Specific Date  17.21
      • 4.  Form: Declaration of Readiness to Proceed (DWC-CA Form 10250.1)  17.22
    • B.  Objection to Declaration  17.23
    • C.  Screening by Presiding Judge  17.24
      • 1.  Ordinary and Death Benefits  17.25
      • 2.  Serious and Willful Misconduct  17.26
      • 3.  Subsequent Injuries Benefits Trust Fund Benefits  17.27
      • 4.  Petition to Reopen Prior Decision  17.28
      • 5.  Arbitration  17.29
    • D.  Judge’s Calendaring Discretion  17.30
    • E.  Priorities in Setting  17.31
    • F.  Medical and Vocational Rehabilitation Testimony Disfavored  17.32
    • G.  Notice of Hearing  17.33
      • 1.  Notice to Lien Claimants  17.34
      • 2.  Notice to Uninsured Employers  17.35
      • 3.  Waiver of Notice  17.36
    • H.  Obtaining Continuance  17.37
    • I.  Changing the Judge  17.38
      • 1.  Petition for Automatic Reassignment of Trial or Expedited Hearing
        • a.  When to File  17.39
        • b.  Form: Petition for Automatic Reassignment to Another Workers’ Compensation Judge  17.40
      • 2.  Petition for Disqualification
        • a.  When to File  17.41
        • b.  Form: Petition to Disqualify Assigned Workers’ Compensation Judge  17.42
    • J.  Removal of Case From Calendar  17.43
    • K.  Dismissal of Off-Calendar Cases  17.44
  • IV.  APPLICANT’S PREPARATION
    • A.  Differences From Civil Practice  17.45
    • B.  Raising Issues  17.46
    • C.  Checklist: Refining Issues  17.47
    • D.  Compelling Attendance of Witnesses
      • 1.  Interviewing Witnesses; Securing Attendance  17.48
        • a.  Subpoenas  17.49
        • b.  Form: Subpoena (WCAB Form 30)  17.50
        • c.  Form: Subpoena Duces Tecum (WCAB Form 32)  17.51
      • 2.  Safety Officers and State Employees  17.52
      • 3.  Failure of Witnesses to Appear  17.53
    • E.  Proving Earnings and Other Sums  17.54
    • F.  Preparing Medical Evidence  17.55
      • 1.  Need for Narrative Medical Reports  17.56
      • 2.  Need for Expert Testimony  17.57
    • G.  Medical Testimony  17.58
      • 1.  Direct Examination of Physician  17.59
      • 2.  Cross-Examination of Physician  17.60
      • 3.  Cross-Examination Tactics
        • a.  General Strategy  17.61
        • b.  Flaws in Medical History  17.62
        • c.  Flaws in Reasoning  17.63
        • d.  Ambiguous Conclusions  17.64
    • H.  Petitions and Motions Before Trial  17.65
    • I.  Preparing the Applicant to Testify  17.66
      • 1.  Discuss Case Issues; Go Over Questions  17.67
      • 2.  When Extent of Permanent Disability Is at Issue  17.68
      • 3.  Activities and Surveillance Videotapes or Films to Impeach Applicant  17.69
    • J.  Dealing With the Apportionment Issue  17.70
    • K.  Preparing Proposed Permanent Disability Rating—“Baseball Arbitration” [Deleted]  17.71
  • V.  DEFENDANT’S PREPARATION
    • A.  Differences From Civil Practice  17.72
    • B.  Ascertaining Issues  17.73
      • 1.  Prerequisites to Formal Litigation (Injuries Occurring After 1990)  17.74
      • 2.  Application  17.75
      • 3.  Employer or Insurer  17.76
        • a.  Compensation Litigation Transmittal Note  17.77
        • b.  Employer’s Report of Occupational Injury or Illness  17.78
        • c.  Form: Additions to Employer’s Report of Occupational Injury or Illness  17.79
        • d.  Doctor’s First Report of Occupational Injury or Illness  17.80
      • 4.  Statement of Employee’s Gross Earnings  17.81
    • C.  Identifying Affirmative Defenses  17.82
      • 1.  Injured Worker’s Status as Independent Contractor  17.83
      • 2.  Intoxication  17.84
        • a.  Proof of Intoxication  17.85
        • b.  Proximate Cause of Injury  17.86
        • c.  Estoppel From Asserting Defense  17.87
      • 3.  Employee’s Serious and Willful Misconduct  17.88
      • 4.  Aggravation of Disability by Employee’s Unreasonable Conduct  17.89
      • 5.  Prejudice From Lack of Notice  17.90
      • 6.  Apportionment of Permanent Disability  17.91
      • 7.  Reasonableness of Delay or Refusal to Pay Benefits Under Lab C §5814  17.91A
      • 8.  Statutes of Limitations  17.92
      • 9.  Fraud  17.93
    • D.  Employer’s Insurance Coverage  17.94
    • E.  Marshaling Evidence
      • 1.  Time Available  17.95
      • 2.  Reviewing Discovery; Medical Testimony  17.96
      • 3.  Witness Preparation  17.97
      • 4.  Earnings Records  17.98
      • 5.  Form: Letter to Applicant’s Attorney Requesting Earnings Information  17.99
      • 6.  Surveillance Videotapes and Films
        • a.  Admissibility  17.100
        • b.  Authentication  17.101
        • c.  Relevance  17.102
        • d.  Impeachment Value  17.103
        • e.  Meeting Applicant’s Rebuttal  17.104
    • F.  Medical Preparation  17.105
    • G.  Petitions and Motions Before Trial  17.106
      • 1.  Form: Petition to Dismiss Application  17.107
      • 2.  Petition to Dismiss for Lack of Prosecution  17.108
      • 3.  Dismissal for Want of Prosecution (Injuries Occurring On or After January 1, 1990, and Before January 1, 1994) [Deleted]  17.109
      • 4.  Form: Petition to Dismiss Improperly Joined Insurer  17.110
      • 5.  Form: Petition to Join Additional Employers and Insurers  17.111
      • 6.  Form: Petition for Order Directing Exhumation and Autopsy  17.112
      • 7.  Form: Petition to Suspend Proceedings and to Compel Medical Examination  17.113
      • 8.  Form: Petition to Bar Applicant’s Right to Disability Payments  17.114
    • H.  Preparing Proposed Permanent Disability Rating  17.115

18

Trial

Yale I. Jones

  • I.  REGULAR HEARING PROCEDURE (TRIAL)  18.1
    • A.  Trial Briefs and Oral Statements  18.2
    • B.  Persuasion  18.3
    • C.  Time Limitations and Narrowing Issues
      • 1.  Time Limitations  18.4
      • 2.  Narrowing Issues  18.5
      • 3.  Collateral Issues  18.6
      • 4.  Economy of Proof; Frivolous Delay  18.7
    • D.  Review of Issues and Stipulations
      • 1.  Confirm Issues and Stipulations  18.8
      • 2.  Raise Issue or Risk Waiver
        • a.  Rule  18.9
        • b.  Exceptions  18.10
    • E.  Admitting Documents Into Evidence  18.11
    • F.  Order of Proof  18.12
    • G.  How Workers’ Compensation Judge Weighs Evidence  18.13
    • H.  Continuances  18.14
    • I.  Failure to Appear  18.15
      • 1.  Dismissal  18.16
      • 2.  Order Off Calendar  18.17
      • 3.  Submit and Decide  18.18
      • 4.  Continuance  18.19
      • 5.  Sanctions  18.19A
  • II.  BURDENS OF PROOF AND PRESUMPTIONS  18.20
    • A.  Applicant’s Burden of Proof  18.21
      • 1.  Proving Cause of Physical Injury  18.22
      • 2.  Proving Cause of Psychiatric Injury  18.23
    • B.  Defense Burden of Proof
      • 1.  Affirmative Defenses  18.24
      • 2.  Assertion of Issue  18.25
      • 3.  Burden Shifts During Trial  18.26
    • C.  Presumptions in General  18.27
    • D.  Conclusive Presumptions
      • 1.  Dependency  18.28
      • 2.  Total Disability  18.29
      • 3.  Other Conclusive Presumptions  18.30
    • E.  Rebuttable Presumptions
      • 1.  Employee Status  18.31
        • a.  Independent Contractors Excluded  18.32
        • b.  Licensed/Unlicensed Contractors  18.33
      • 2.  Failure to Deny Liability Within Statutory Time Period (Lab C §5402(b))  18.34
        • a.  Counting 75 or 90 Days  18.35
        • b.  Employer’s Duty to Provide Claim Form  18.36
        • c.  Rebutting Presumption  18.37
        • d.  Form and Notice of Denial  18.38
      • 3.  Findings of Treating Physician [Deleted]  18.39
        • a.  When Former Presumption Inapplicable [Deleted]  18.40
        • b.  Rebutting Former Presumption [Deleted]  18.41
      • 4.  Duration of Temporary Disability  18.42
      • 5.  Presumption of Correctness Regarding Extent and Scope of Medical Treatment  18.42A
      • 6.  Other Rebuttable Presumptions
        • a.  Certain Diseases or Conditions of Public Safety Employees  18.43
          • (1)  Length-of-Service Requirements  18.43A
          • (2)  Covered Employees Entitled to Full Range of Benefits  18.43B
          • (3)  Extension of Presumption Following Termination of Service  18.43C
          • (4)  Antiattribution Provisions  18.43D
          • (5)  Enumerated Diseases and Conditions
            • (a)  Hernia  18.43E
            • (b)  Cancer  18.43F
            • (c)  Skin Cancer  18.43G
            • (d)  Heart Trouble  18.43H
            • (e)  Pneumonia  18.43I
            • (f)  Tuberculosis  18.43J
            • (g)  Blood-Borne Infectious Disease or Staphylococcus Aureus  18.43K
            • (h)  Illness Resulting From Exposure to Biochemical Substance  18.43L
            • (i)  Meningitis  18.43M
            • (j)  Lyme Disease  18.43N
            • (k)  Lower Back Impairments  18.43O
            • (l)  Post-Traumatic Stress Disorder  18.43P
        • b.  Unlawfully Uninsured Employers  18.43Q
        • c.  Unemployment Compensation Disability Liens  18.43R
        • d.  Refusal to Permit Autopsy  18.43S
        • e.  Presumptions Related to COVID-19  18.43T
    • F.  “Quasi-Presumptions”  18.44
    • G.  Inferences  18.45
    • H.  Effect of Stipulations
      • 1.  Parties Bound  18.46
      • 2.  Workers’ Compensation Appeals Board Not Bound  18.47
  • III.  EVIDENCE
    • A.  General Evidentiary Policies and Rules  18.48
      • 1.  Hearsay  18.49
      • 2.  Full Disclosure Requirement  18.50
      • 3.  Objections to Evidence  18.51
    • B.  Documentary Evidence
      • 1.  Admitting Documents in Evidence  18.52
      • 2.  Objections to Admission of Document  18.53
    • C.  Evidentiary Privileges
      • 1.  Applicability of Privileges  18.54
      • 2.  Medical Information  18.55
      • 3.  Self-Incrimination  18.56
      • 4.  Attorney-Client Privilege; Work Product Doctrine  18.57
      • 5.  Inadvertent Receipt of Privileged Information  18.58
      • 6.  Sexual Conduct  18.59
      • 7.  Other Privileges  18.60
  • IV.  WITNESSES  18.61
    • A.  Witness Preparation and Direct Examination  18.62
    • B.  Cross-Examination  18.63
    • C.  Offers of Proof  18.64
    • D.  Testimony of Judicial or Quasi-Judicial Officers  18.64A
  • V.  RECORDING OF PROCEEDINGS  18.64B
  • VI.  DEVELOPMENT AND PROTECTION OF THE RECORD
    • A.  Preserving the Record  18.65
    • B.  Form: Minutes of Hearing (DWC-CA Form 10245) [Deleted]  18.66
    • C.  Workers’ Compensation Judges’ Obligation to Develop Record  18.67
    • D.  Use of Record on Reconsideration  18.68
  • VII.  POSTHEARING PROCEDURES
    • A.  Closing the Record; Disposition Orders  18.69
    • B.  Petition to Vacate Submission  18.70
    • C.  Attorney Fees  18.71
      • 1.  Defendant’s Liability for Applicant’s Attorney Fees  18.71A
      • 2.  Only Licensed Attorneys May Receive Fee  18.71B
      • 3.  Declaration of Readiness to Proceed Filed by Defendant  18.71C
      • 4.  Calculating Attorney Fees  18.71D
      • 5.  Appropriate Withholding of Attorney Fees  18.71E
    • D.  Costs  18.71F
      • 1.  Deposition Fees and Costs  18.71G
      • 2.  Appellate Costs  18.71H
      • 3.  Bad Faith Actions  18.71I
      • 4.  Effect of Third Party Recovery  18.71J
      • 5.  When Costs May Be Denied  18.71K
    • E.  Service of Formal Rating  18.72
    • F.  Methods of Objecting to Rating  18.73
      • 1.  Obvious Errors  18.74
      • 2.  Motion to Strike  18.75
      • 3.  Cross-Examination of Disability Evaluation Unit Rater  18.76
      • 4.  Rebuttal Evidence  18.77

19

Arbitration

Dennis J. Hannigan

  • I.  GOVERNING PROVISIONS  19.1
  • II.  EMPLOYEE OR DEPENDENT MUST BE REPRESENTED BY COUNSEL  19.2
  • III.  WHEN ARBITRATION IS MANDATORY  19.3
    • A.  Insurance Coverage  19.4
    • B.  Right of Contribution Under Lab C §5500.5  19.5
    • C.  Permanent Disability  19.6
    • D.  Vocational Rehabilitation Issues  19.7
  • IV.  WHEN VOLUNTARY  19.8
  • V.  FORMS
    • A.  Form: Arbitration Submittal Form (DWC-CA Form 10297)  19.9
    • B.  Form: Arbitration Submittal Orders (WCAB Form 33)  19.10
    • C.  Form: Arbitrator Application  19.10A
  • VI.  ARBITRATORS
    • A.  Eligibility  19.11
    • B.  Selection  19.12
    • C.  Powers  19.13
  • VII.  PROCEEDINGS
    • A.  Time and Place  19.14
    • B.  Record of Proceeding  19.14A
    • C.  Filing and Service of Documents  19.15
    • D.  Ex Parte Communications and Disclosure of Settlement Offers Prohibited  19.16
    • E.  Other Ground Rules  19.17
    • F.  Decision  19.18
    • G.  Payment of Costs; Dispute Resolution  19.19
    • H.  Reconsideration  19.20
  • VIII.  CARVE-OUTS  19.20A
    • A.  Construction Industry Carve-Outs  19.21
    • B.  General Industry Carve-Outs  19.21A
  • IX.  INSURANCE CONTROVERSIES  19.22

20

Decisions, Awards, and Judgments

  • I.  DECISIONS
    • A.  Terminology  20.1
    • B.  When Issued  20.2
    • C.  Components
      • 1.  Summary of Evidence  20.3
      • 2.  Opinion on Decision  20.4
      • 3.  Findings of Fact  20.5
        • a.  Specific Findings  20.6
        • b.  Amendment to Conform to Proof  20.7
      • 4.  Award  20.8
      • 5.  WCAB File  20.8A
      • 6.  Retention and Destruction of Case Files  20.8B
    • D.  Types of Awards
      • 1.  Provision for Adjustment by Parties  20.9
      • 2.  Continuing Awards  20.10
      • 3.  Separate, Joint, and Several Awards
        • a.  Cases Consolidated for Hearing  20.11
        • b.  Multiple Defendants  20.12
        • c.  Cumulative Injuries and Occupational Diseases  20.13
    • E.  Unresolved and Deferred Issues  20.14
    • F.  Penalties, Costs, Fees, and Interest
      • 1.  Penalties, Costs, and Fees  20.15
      • 2.  Interest  20.16
      • 3.  Prejudgment Interest on Lab C §132a Award  20.16A
      • 4.  Interest Rate  20.17
      • 5.  Interest on Medical-Legal and Medical Treatment Expenses  20.18
      • 6.  Interest Payable to Employment Development Department  20.19
    • G.  Service
      • 1.  Service by Board and Parties  20.20
      • 2.  Extension of Time for Responding  20.20A
      • 3.  Proof of Service  20.21
      • 4.  Defective Service  20.22
  • II.  COLLECTING AWARDS
    • A.  Alternative Methods  20.23
    • B.  Uninsured Employers Benefits Trust Fund
      • 1.  Nature of Fund  20.24
      • 2.  Demand on Fund  20.25
      • 3.  Fund Liability  20.26
      • 4.  Fund’s Recovery From Uninsured Employer
        • a.  In General  20.27
        • b.  Civil Penalty Assessments  20.28
        • c.  Lien Against Property  20.29
        • d.  Liquidated Damages, Judgment, and Civil Foreclosure  20.30
        • e.  Judgment Against Entities Regulated by Public Utilities Commission or Department of Motor Vehicles  20.31
      • 5.  Fund’s Recovery From Third Party  20.32
    • C.  Assignment to Labor Commissioner  20.33
    • D.  Judgment; Execution
      • 1.  Converting Award Into Judgment  20.34
        • a.  Obtain Certified Copy of Decision  20.35
        • b.  Superior Court Clerk Enters Judgment  20.36
      • 2.  Writ of Execution  20.37
      • 3.  Stay of Execution
        • a.  Authority  20.38
        • b.  Automatic 10-Day Stay  20.39
        • c.  Stay Before Entry of Judgment; Withholding Certified Copy of Award  20.40
        • d.  Stay After Entry of Judgment  20.41
        • e.  Procedure  20.42
      • 4.  Supplemental Proceedings on Execution  20.43
      • 5.  Satisfaction of Judgment  20.44
  • III.  PRIORITY; INSOLVENCY
    • A.  Priority of Compensation Claims  20.45
    • B.  Bankruptcy or Insolvency of Employer or Insurer
      • 1.  In General  20.46
      • 2.  California Insurance Guarantee Association  20.47
      • 3.  Self-Insurers’ Security Fund  20.48
      • 4.  Bankruptcy  20.49

21

Reconsideration

Dennis J. Hannigan

  • I.  INTRODUCTION
    • A.  Overview of Reconsideration Procedure  21.1
    • B.  Review of Arbitrator’s Decision  21.2
    • C.  Review of Contempt Finding  21.3
    • D.  Reopening and Removal Distinguished
      • 1.  Reopening  21.4
      • 2.  Removal  21.5
    • E.  Orders, Decisions, and Awards Issued Only by Appeals Board  21.5A
  • II.  BEFORE PETITIONING FOR RECONSIDERATION
    • A.  Understand Reasons to Petition for Reconsideration  21.6
    • B.  Assess Prospects for Success  21.7
  • III.  PREREQUISITES TO RECONSIDERATION
    • A.  Final Order, Decision, or Award  21.8
      • 1.  Orders That Are Not Final  21.9
      • 2.  Threshold Issues  21.10
      • 3.  Finality for Some Parties, But Not Others  21.11
    • B.  Petitioner Is Person Aggrieved  21.12
    • C.  Statutory Grounds  21.13
      • 1.  Workers’ Compensation Appeals Board Exceeded Powers  21.14
      • 2.  Decision Procured by Fraud  21.15
      • 3.  Findings Not Justified by Evidence  21.16
      • 4.  Newly Discovered Evidence  21.17
      • 5.  Findings Do Not Support Order or Award  21.18
      • 6.  Change in the Law  21.18A
      • 7.  Preserving Grounds at Trial; Waiver  21.19
    • D.  Timely Filing  21.20
      • 1.  If Order, Decision, or Award Served by Mail  21.21
      • 2.  If Order, Decision, or Award Served by Fax or Email  21.21A
      • 3.  If Order, Decision, or Award Is Served Via District Office Mail Box  21.21B
      • 4.  If Order, Decision, or Award Defectively Served  21.22
      • 5.  Filing Supplemental Reconsideration Petitions  21.23
      • 6.  Arbitrator’s Decisions Under Lab C §§3201.5, 3201.7  21.24
  • IV.  FILING PETITION FOR RECONSIDERATION
    • A.  Content; Specificity  21.25
    • B.  Waiver of Unstated Grounds  21.26
    • C.  Drafting the Petition
      • 1.  Format Requirements; Page Limitation  21.27
      • 2.  Caption; Introduction  21.28
      • 3.  Preliminary Statement; Grounds  21.29
      • 4.  Statement of Contentions  21.30
      • 5.  Summary of Material Facts  21.31
      • 6.  Argument  21.32
      • 7.  Request for Transcript  21.33
      • 8.  Prayer  21.34
      • 9.  Signature; Verification  21.35
      • 10.  Form: Petition for Reconsideration (WCAB Form 45)  21.36
    • D.  Exhibits  21.37
    • E.  Service  21.38
    • F.  Proof of Service  21.39
      • 1.  Declaration of Service  21.40
      • 2.  When Serving Separately Represented Parties  21.41
      • 3.  Notice of Failure of Service  21.42
    • G.  Filing: How and Where  21.43
  • V.  ANSWERS AND REPLIES
    • A.  Answer to Petition for Reconsideration  21.44
    • B.  Reply to Answer  21.45
    • C.  Reply to Workers’ Compensation Judge’s Report  21.46
  • VI.  DISPOSITION OF PETITION
    • A.  Workers’ Compensation Judge’s or Arbitrator’s Actions and Reports  21.47
      • 1.  Workers’ Compensation Judge Actions  21.48
      • 2.  Workers’ Compensation Judge Report  21.49
      • 3.  Arbitrator Report  21.50
      • 4.  Settlement Conference Referee Report [Deleted]  21.51
    • B.  Board’s Authority  21.52
    • C.  Board’s Action on Petition
      • 1.  Procedure  21.53
      • 2.  Adequacy of Board Decision on Reconsideration (Lab C §5908.5)  21.54
      • 3.  Time to Grant or Deny  21.55
      • 4.  Permissible Actions
        • a.  Dismissal  21.56
        • b.  Denial  21.57
        • c.  Grant: Options  21.58
          • (1)  Immediate Decision on the Record  21.59
          • (2)  Grant for Study, Transcript, or Supplemental Report  21.60
          • (3)  Grant to Take Additional Evidence  21.61
          • (4)  Grant to Rescind and Return to Workers’ Compensation Judge for Further Proceedings  21.62
    • D.  Successive Petitions for Reconsideration  21.63
    • E.  Effects on Order, Decision, or Award (of Filing Petitions for Reconsideration)
      • 1.  Enforcement; Stay  21.64
      • 2.  Interest  21.65
      • 3.  Nonpetitioning Parties  21.66
  • VII.  RECONSIDERATION ON BOARD’S OWN MOTION  21.67

22

Judicial Review

Peter Ray

Patricia S. Stephens

  • I.  MECHANISMS FOR JUDICIAL REVIEW
    • A.  Statutory Review
      • 1.  Writ of Review  22.1
      • 2.  Writ of Mandate  22.2
      • 3.  Writ of Prohibition  22.3
    • B.  Common Law Review: Habeas Corpus and Restraint of Execution  22.4
  • II.  TABLE: TIME LIMITS FOR JUDICIAL REVIEW  22.5
  • III.  CONSIDERATIONS BEFORE SEEKING REVIEW
    • A.  Difficulty of Overturning Board’s Decision  22.6
    • B.  Grounds for Review
      • 1.  Action Without or in Excess of Powers  22.7
      • 2.  Decision Procured by Fraud  22.8
      • 3.  Unreasonable Decision  22.9
      • 4.  Decision Not Supported by Substantial Evidence
        • a.  What Is “Substantial Evidence”?  22.10
        • b.  Board’s Fact-Finding Powers  22.11
        • c.  Power to Base Award on Hearsay Evidence  22.12
      • 5.  Failure of Findings to Support Decision
        • a.  Attacking Board Findings  22.13
        • b.  Typical Jurisdictional Facts on Which Findings Must Be Made  22.14
    • C.  Potential for Attorney Fees for Answering Petition Lacking Reasonable Basis  22.15
  • IV.  PLEADINGS AND PROCEDURES
    • A.  Petition for Writ of Review
      • 1.  Prerequisites
        • a.  Prior Petition for Reconsideration  22.16
        • b.  Final Decision  22.17
      • 2.  Procedural Requirements
        • a.  Time to File  22.18
        • b.  Where to File  22.19
        • c.  Method of Reproduction; Length  22.20
        • d.  Number of Copies  22.21
        • e.  Other Essential Requirements  22.22
      • 3.  Content and Format
        • a.  Components  22.23
        • b.  Cover  22.24
        • c.  Topical Index  22.25
        • d.  Table of Authorities Cited  22.26
        • e.  Title of Court and Cause  22.27
        • f.  Formal Address  22.28
        • g.  Opening Paragraph  22.29
        • h.  Allegations Identifying Parties and History of Claim
          • (1)  When Petitioner Is Employee  22.30
          • (2)  When Petitioner Is Dependent  22.31
          • (3)  When Petitioners Are Defendants  22.32
        • i.  Proceedings Before Board  22.33
        • j.  Grounds for Review Raised in Reconsideration Petition  22.34
        • k.  Questions Presented  22.35
        • l.  Incorporation of Points and Authorities  22.36
        • m.  Allegations Supporting Right to Petition
          • (1)  Petition Timely and Proper  22.37
          • (2)  No Right to Appeal  22.38
          • (3)  Residence and Beneficial Interest  22.39
        • n.  Prayer; Signature  22.40
        • o.  Verification
          • (1)  By Affidavit  22.41
          • (2)  By Declaration  22.42
          • (3)  Importance of Verification  22.43
        • p.  Exhibits  22.44
        • q.  Points and Authorities  22.45
          • (1)  Questions Presented  22.46
          • (2)  Statement of Material Facts  22.47
          • (3)  Argument and Authorities  22.48
          • (4)  Conclusion  22.49
      • 4.  Filing and Service
        • a.  Filing  22.50
        • b.  Service  22.51
      • 5.  Stay of Decision Pending Appellate Review  22.52
    • B.  Answer
      • 1.  Not Required But Always Filed  22.53
      • 2.  Who May File  22.54
      • 3.  Procedural Requirements
        • a.  Time to File; Copies  22.55
        • b.  Extension of Time
          • (1)  Stipulation Extending Time to File Answer  22.56
          • (2)  Application for Extension of Time to Answer  22.57
          • (3)  Order Extending Time to File Answer  22.58
      • 4.  Content and Format
        • a.  Same General Format as Petition  22.59
        • b.  Title When Attorney Fee Requested Under Lab C §5801  22.60
        • c.  Opening Paragraph  22.61
        • d.  Identification of Respondent; Denial of Allegations in Petition  22.62
        • e.  Allegation of Lack of Reasonable Basis for Petition  22.63
        • f.  Questions Presented  22.64
        • g.  Statement of Material Facts  22.65
        • h.  Argument and Authorities  22.66
        • i.  Conclusion  22.67
        • j.  Verification and Exhibits  22.68
      • 5.  Filing and Service  22.69
    • C.  Reply to Answer
      • 1.  Should Reply Be Made?  22.70
      • 2.  Time to File; Copies  22.71
      • 3.  Content and Format
        • a.  Same General Format as Petition; Exceptions  22.72
        • b.  Argument and Authorities  22.73
        • c.  Conclusion  22.74
      • 4.  Filing and Service  22.75
    • D.  Citation to New Authorities  22.75A
  • V.  DISPOSITION OF PETITION FOR WRIT OF REVIEW
    • A.  When Denied Without Hearing  22.76
    • B.  When Hearing Granted
      • 1.  Issuance of Writ of Review  22.77
      • 2.  Oral Argument
        • a.  Date  22.78
        • b.  Time Estimates  22.79
        • c.  Waiver  22.80
        • d.  Sequence of Presentations  22.81
      • 3.  Submission  22.82
      • 4.  Decision  22.83
    • C.  Appellate Costs  22.84
  • VI.  SUBSEQUENT PROCEEDINGS
    • A.  Petition for Rehearing in Court of Appeal
      • 1.  Not Available When Review Denied Without Opinion  22.85
      • 2.  When Review Granted  22.86
        • a.  Time to File; Copies  22.87
        • b.  Content and Format
          • (1)  Same General Format as Original Petition  22.88
          • (2)  Opening Paragraph  22.89
          • (3)  Questions Presented; Argument and Authorities  22.90
          • (4)  Prayer  22.91
      • 3.  Answer  22.92
      • 4.  Disposition  22.93
    • B.  Petition for Review by Supreme Court
      • 1.  Grounds  22.94
      • 2.  Time to File; Copies  22.95
      • 3.  Content and Format
        • a.  General Format; Page Limitation  22.96
        • b.  Caption, Formal Address, and Opening Paragraph  22.97
        • c.  Exhibits  22.98
      • 4.  Filing and Service  22.99
      • 5.  Answer  22.100
      • 6.  Reply to Answer  22.101
      • 7.  Petition May Be Denied Without Hearing  22.102
      • 8.  If Petition Is Granted  22.103
      • 9.  Oral Argument  22.104
      • 10.  Decision  22.105
    • C.  Petition for Rehearing in Supreme Court; Answer  22.106
  • VII.  REMITTITUR
    • A.  Nature  22.107
    • B.  Action of Board on Remittitur  22.108

23

Supplemental Proceedings

  • I.  BASES FOR CONTINUING JURISDICTION
    • A.  Statutory Authority  23.1
    • B.  Continuing Awards  23.2
    • C.  Issues Undecided in Original Proceedings  23.3
    • D.  Clerical Errors  23.4
    • E.  Enforcement of Award  23.5
  • II.  PETITIONS TO REOPEN
    • A.  Based on Good Cause (Lab C §5803)
      • 1.  Generally  23.6
      • 2.  Defendant’s Petition to Reopen  23.7
      • 3.  Time Limits
        • a.  Jurisdiction  23.8
        • b.  After Dismissal of Application  23.9
      • 4.  Condition Precedent  23.10
      • 5.  Good Cause
        • a.  Required Showing  23.11
        • b.  Examples  23.12
    • B.  Based on New and Further Disability (Lab C §5410)
      • 1.  Generally  23.13
      • 2.  Time Limits  23.14
      • 3.  Conditions Precedent  23.15
      • 4.  New and Further Disability Defined  23.16
    • C.  Procedure
      • 1.  Drafting the Petition  23.17
      • 2.  Response to Petition  23.18
      • 3.  Board Action on Petition to Reopen  23.19
      • 4.  Attorney Fees  23.20
    • D.  Table of Comparisons  23.21
    • E.  Form: Petition to Reopen (WCAB Form 42)  23.22
  • III.  TERMINATION OF LIABILITY
    • A.  Temporary Disability
      • 1.  Continuing Awards  23.23
      • 2.  Procedure for Terminating Liability  23.24
      • 3.  Effect of Vocational Rehabilitation on Petition to Terminate (Injuries Before January 1, 2004)  23.25
      • 4.  Form: Petition to Terminate Liability for Temporary Disability Indemnity (DWC/WCAB Form 46)  23.26
      • 5.  Objection to Petition to Terminate  23.27
    • B.  Further Medical Treatment  23.28
    • C.  Attorney Fees for Resisting Termination of Liability  23.29
    • D.  Automatic Termination of Liability  23.30
      • 1.  Statutory Limitations  23.31
      • 2.  Death  23.32
  • IV.  CREDIT FOR THIRD PARTY RECOVERY
    • A.  Right to Credit  23.33
    • B.  Amount of Credit  23.34
    • C.  Against Malpractice Recovery  23.35
    • D.  Against Attorney Fees; Against Other Recovery  23.36
  • V.  PROCEEDINGS TO EVALUATE PERMANENT DISABILITY
    • A.  Permanent Disability  23.37
    • B.  Petition for Permanent Disability Rating  23.38
  • VI.  CREDIT FOR OVERPAYMENT, RESTITUTION, AND LIENS
    • A.  Credit for Overpayment
      • 1.  Lab C §4909  23.39
      • 2.  Availability of Credit for Specific Types of Benefit Overpayments
        • a.  Temporary Disability  23.40
        • b.  Wage Payments  23.41
        • c.  Private Disability Plans  23.42
        • d.  Medical Expenses; Overpayment of Temporary Disability Indemnity and Permanent Disability Indemnity  23.43
        • e.  Labor Code §5814 Penalty  23.43A
        • f.  Social Security Disability Benefits  23.44
        • g.  Lab C §4850 Benefits  23.45
        • h.  Longshore and Harbor Workers’ Benefits  23.46
        • i.  Jurisdiction and Waiver  23.47
        • j.  Unilateral Credit  23.48
    • B.  Restitution
      • 1.  By Employee  23.49
      • 2.  By Lien Claimant  23.50
      • 3.  Examples of Restitution Orders  23.51
      • 4.  Restitution Under Ins C §§1871.4–1871.5  23.52
    • C.  Lien  23.53
  • VII.  CONTRIBUTION
    • A.  Nature of Proceeding  23.54
    • B.  Rights and Liabilities of Multiple Defendants  23.55
    • C.  Which Employers Are Liable  23.56
    • D.  Apportionment of Liability  23.57
    • E.  Time Limit for Filing Petitions for Contribution  23.58
    • F.  Form: Petition for Contribution Under Lab C §5500.5  23.59
    • G.  Contribution Proceedings  23.60
  • VIII.  COMMUTATION OF PAYMENTS TO LUMP SUM  23.60A
    • A.  Statutory Grounds; Timing  23.61
    • B.  Examples of Specific Instances  23.62
    • C.  Procedure
      • 1.  File Petition for Commutation of Future Payments  23.63
      • 2.  Request for Attorney Fees  23.64
      • 3.  Objection  23.65
      • 4.  Notice and Hearing  23.66
      • 5.  Determination
        • a.  WCAB’s Discretion  23.67
        • b.  Calculating Amount of Lump Sum
          • (1)  Temporary Disability Indemnity  23.68
          • (2)  Permanent Disability Indemnity and Death Benefits  23.68A
      • 6.  Order
        • a.  Full or Partial Commutation  23.69
        • b.  Commutation to Pay Attorney Fees and Lien Claims  23.70
        • c.  Prohibited Commutations  23.71
        • d.  Payment Methods  23.72
  • IX.  OTHER SUPPLEMENTAL PROCEEDINGS
    • A.  Petition for Relief From Failure to Appear  23.73
    • B.  Correction of Clerical Errors  23.74

CALIFORNIA WORKERS' COMPENSATION PRACTICE

(4th Edition)

March 2023

TABLE OF CONTENTS

 

File Name

Book Section

Title

CH10

Chapter 10

Representing Injured Workers

10-007

§10.7

Potential New Client Questionnaire

10-008

§10.8

Letter Confirming Appointment

10-009

§10.9

Nonengagement Letter

10-017

§10.17

Supplementary Fee Disclosure Statement

10-020

§10.20

Venue Authorization

10-021

§10.21

Authorization for Release of Medical Information

10-022

§10.22

Authorization for Release of Psychiatric, Drug, and Alcohol Treatment Records

10-023

§10.23

Authorization for Release of Employment and School Records

10-026

§§10.26-10.30

Checklist: Injured Employee and Dependents

 

§10.27

Checklist: Employment Status

 

§10.28

Checklist: Earnings

 

§10.29

Checklist: Employer’s Insurance

 

§10.30

Checklist: Injury

10-031

§§10.31-10.34

Checklist: Injuries Resulting in Death

 

§10.32

Checklist: Prior Injuries or Disabilities

 

§10.33

Checklist: Medical Treatment and Expenses

 

§10.34

Checklist: Compensation to Date

10-035

§10.35

Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After 1/1/2004 and Before 1/1/2013)

10-035A

§10.35A

Checklist: Notice of Supplemental Job Displacement Benefit (Voucher) (Injuries Occurring On or After January 1, 2013)

10-036

§10.36

Checklist: Claim Form; Procedural Information

10-038

§10.38

Letter of Representation to New Client

10-041

§10.41

Notice of Representation to Employer

10-043

§10.43

Letter to Insurer or Adjusting Agency

10-047

§10.47

Letter Designating Primary Treating Physician

10-048

§10.48

Letter Regarding Medical Bills Received by Applicant

10-056

§10.56

Letter to Worker Regarding Deposition

10-057

§10.57

Letter Requesting Payment for Fees and Costs Associated With Injured Worker’s Deposition

10-058

§10.58

Petition for Attorney Fees and Expenses for Injured Worker’s Deposition

10-059

§10.59

Letter Requesting Worker to Review Deposition Transcript

10-061

§10.61

Letter to Worker Regarding Medical Evaluation

10-063

§10.63

Letter to Doctor to File Lien

10-064

§10.64

Letter Notifying Worker of Hearing Request

10-065

§10.65

Letter Notifying Worker of Settlement Conference Date

10-070

§10.70

Letter Notifying Worker of Closed Case File

CH11

Chapter 11

Representing Defendants

11-022

§11.22

Statement of Employee’s Gross Earnings

11-029

§11.29

Compensation Litigation Transmittal Note

11-034

§11.34

Letter to Employment Development Department

11-037

§11.37

Letter Requesting Signed Social Security Earnings Release

11-042

§11.42

Applicant’s Deposition Worksheet

11-043

§11.43

Petition to Compel Answers to Questions and Production of Documents at Deposition

11-046

§11.46

Petition for Order Compelling Production of Psychiatric Records; Order

11-048

§11.48

Deposition Letter to Primary Treating Physician

11-049

§11.49

Petition to Compel Attendance at Medical Evaluation

11-055

§11.55

Petition for Joinder

11-057

§11.57

Letter to Employer Re: Lack of Coverage

11-058

§11.58

Letter to Applicant or Codefendant Re: Lack of Coverage

11-059

§11.59

Petition to Dismiss for Lack of Coverage; Order

11-061

§11.61

Petition to Strike Application (Lab C §4906(h), Declaration Missing); Order

11-062

§11.62

Petition to Dismiss—No Employment Within Last Year of Injurious Exposure

11-063

§11.63

Petition to Dismiss—No Coverage Within Last Year of Injurious Exposure

11-064

§11.64

Petition to Dismiss—Statute of Limitations

11-065

§11.65

Petition to Dismiss—Failure to Prosecute

11-081

§11.81

Objection to Medical-Legal Expense

11-085

§11.85

Objection to Medical Treatment Expense

11-088

§11.88

Petition for Credit for Third Party Recovery

11-089

§11.89

Petition for Restitution From Injured Worker

11-090

§11.90

Petition for Reimbursement From Codefendant

11-092

§11.92

Petition for Reimbursement of Paid Medical-Legal Expense

11-095

§11.95

Letter From Insurer’s Attorney Advising Employer of Serious and Willful Misconduct Petition

11-097

§11.97

Letter Advising Insured Employer of Petition Alleging Discrimination

CH12

Chapter 12

Time Limitations

12-010

§12.10

Notice of Injury

12-051

§12.51

Allegations of Incompetence, Competence Regained

CH13

Chapter 13

Filing With the Workers’ Compensation Appeals Board

13-032

§13.32

Parties Checklist

13-072

§13.72

Sample Allegations of Cumulative Injury and Exposure

13-081

§13.81

Petition for Award for Employer’s Serious and Willful Misconduct

13-081A

§13.81A

Petition for Award for Employer’s Serious and Willful Misconduct—Violation of Safety Order (Lab C §4553.1)

13-087

§13.87

Cite or Refer Correctly to Safety Order or Statute

13-088

§13.88

State How Safety Order or Statute Was Violated

13-089

§13.89

Sample Allegation: General Misconduct

13-091

§13.91

Petition for Award Under Lab C §132a

13-098

§13.98

Declaration Under Lab C §4906(h)

13-131

§13.131

Answer to Petition and Request for Dismissal or Continuance

CH14

Chapter 14

Gathering Evidence

14-011

§14.11

Authorization for Medical Information

14-034

§14.34

Declaration by Signing Physician

14-079

§14.79

Checklist: Deposition Information From Employee

CH16

Chapter 16

Settlement

16-034

§16.34

Addendum to Compromise and Release

16-043

§16.43

Sample Computation of Fair Allocation to Unemployment Compensation Disability Lien Claim (Baird Formula)

16-044

§16.44

Sample Computation of Lien Reduction Under Lab C §4903.1(a)(4)

16-077

§16.77

Preparation

16-084

§16.84

Sample Letter Requesting Fee (To Accompany WCAB Form 4)

CH17

Chapter 17

Preparing for Trial

17-040

§17.40

Petition for Automatic Reassignment to Another Workers’ Compensation Judge

17-042

§17.42

Petition to Disqualify Assigned Workers’ Compensation Judge

17-047

§17.47

Checklist: Refining Issues

17-079

§17.79

Additions to Employer’s Report of Occupational Injury or Illness

17-099

§17.99

Letter to Applicant’s Attorney Requesting Earnings Information

17-107

§17.107

Petition to Dismiss Application

17-108

§17.108

Petition to Dismiss for Lack of Prosecution

17-110

§17.110

Petition to Dismiss Improperly Joined Insurer

17-111

§17.111

Petition to Join Additional Employers and Insurers

17-112

§17.112

Petition for Order Directing Exhumation and Autopsy

17-113

§17.113

Petition to Suspend Proceedings and to Compel Medical Examination

17-114

§17.114

Petition to Bar Applicant’s Right to Disability Payments

CH21

Chapter 21

Reconsideration

21-028

§§21.28-21.35

Caption; Introduction

 

§21.29

Preliminary Statement; Grounds

 

§21.30

Statement of Contentions

 

§21.31

Summary of Material Facts

 

§21.32

Argument

 

§21.33

Request for Transcript

 

§21.34

Prayer

 

§21.35

Signature; Verification

21-040

§21.40

Declaration of Service

CH22

Chapter 22

Judicial Review

22-024

§§22.24-22.26

Cover

 

§22.25

Topical Index

 

§22.26

Table of Authorities Cited

22-028

§§22.28-22.42

Formal Address

 

§22.29

Opening Paragraph

 

§22.30

When Petitioner Is Employee

 

§22.31

When Petitioner Is Dependent

 

§22.32

When Petitioners Are Defendants

 

§22.33

Proceedings Before Board

 

§22.34

Grounds for Review Raised in Reconsideration Petition

 

§22.35

Questions Presented

 

§22.36

Incorporation of Points and Authorities

 

§22.37

Petition Timely and Proper

 

§22.38

No Right to Appeal

 

§22.39

Residence and Beneficial Interest

 

§22.40

Prayer; Signature

 

§22.41

By Affidavit

 

§22.42

By Declaration

22-047

§22.47

Statement of Material Facts

22-056

§22.56

Stipulation Extending Time to File Answer

22-057

§22.57

Application for Extension of Time to Answer

22-058

§22.58

Order Extending Time to File Answer

22-060

§22.60

Title When Attorney Fee Requested Under Lab C §5801

22-061

§22.61

Opening Paragraph

22-062

§22.62

Identification of Respondent; Denial of Allegations in Petition

22-063

§22.63

Allegation of Lack of Reasonable Basis for Petition

22-064

§22.64

Questions Presented

22-065

§22.65

Statement of Material Facts

22-067

§22.67

Conclusion

22-074

§22.74

Conclusion

22-089

§22.89

Opening Paragraph

22-091

§22.91

Prayer

22-097

§22.97

Caption, Formal Address, and Opening Paragraph

22-098

§22.98

Exhibits

CH23

Chapter 23

Supplemental Proceedings

23-059

§23.59

Petition for Contribution Under Lab C §5500.5

 

Selected Developments

March 2023 Update

Chapter 1 (Workers’ Compensation and Other Remedies)

  • Concurrent federal-state compensation jurisdiction applied to a ferry captain injured while working on the engine of a ferry that was tied to a pier in Fisherman’s Wharf in San Francisco Bay. See Blue & Gold Fleet v WCAB (Brazil) (2022) 87 CCC 498 (writ denied) in §§1.61, 1.72.

Chapter 2 (Jurisdiction)

  • Although the general rule is that nonoccupational diseases do not “arise out of” employment, an exception is made if the employment subjects the employee to an increased risk compared to that of the general public. See State v WCAB (Shuere) (2022) 87 CCC 506 (writ denied; in split panel decision, Board majority affirmed WCJ’s decision that applicant’s valley fever was compensable based on layout of applicant’s workplace and its parking lot, which caused him to spend significant time outdoors exposed to soil and dust from nearby farmland, and on medical reporting that it was more probable applicant was exposed at work than elsewhere given proportion of time he spent outdoors while at work as compared to his nonindustrial time outdoors) in §2.33.

  • The risk is considered personal when an employee is assaulted and injured by a third party with a purely personal grievance, even though the employee’s presence at the jobsite made it possible for the assailant to find the victim. See Dacumos v Pete’s Home (Oct. 10, 2022, ADJ14393426) 2022 Cal Wrk Comp P.D. Lexis 274 (employee killed by coworker over alleged affair between employee and coworker’s wife, who was also coworker, was sufficiently connected with decedent’s employment to be compensable) in §2.37.

  • The 6-month employment requirement for claims of industrial psychiatric injury need not be 6 months of wage-earning services. See Express Employment Profs. v WCAB (Becerra) (2022) 87 CCC 299 (writ denied) in §2.54.

Chapter 3 (Medical Treatment)

  • Effective January 1, 2023, Lab C §3209.11(a)–(b) provides that an employer, workers’ compensation insurer, or self-insured employer may provide an employee with access to the services of a licensed clinical social worker (LCSW) acting within their scope of practice, and medical provider networks may add LCSWs to their physician providers listing. See §3.5.

  • Effective January 1, 2023, the mileage reimbursement rate has been raised to 65.5 cents per mile. See §3.14.

  • An employee’s attempted predesignation of personal physician was invalid because record did not establish that the physician had agreed to the predesignation. See Lazcano v Lutheran High Sch. Ass’n (Apr. 11, 2022, ADJ13514659) 2022 Cal Wrk Comp P.D. Lexis 99 in §3.24.

  • The defendant bears the burden of establishing that it provided the appropriate notice to the applicant of their right to predesignate a personal physician. See Lazcano v Lutheran High Sch. Ass’n, supra, in §3.24A.

Chapter 4 (Temporary Disability)

  • Aggregate payments for temporary disability for a single injury occurring on or after January 1, 2023, causing temporary disability for employees suffering from an injury or condition defined in Lab C §3212.1 (i.e., the Williams Dallas Jones Cancer Presumption Act of 2010) cannot extend for more than 240 compensable weeks. See Lab C §4656(d) in §4.9.

  • The statutory minimum and maximum average weekly earnings (AWE) for dates of injury in 2023 have increased to $364.29 and $2,428.72, respectively. See §4.25.

Chapter 5 (Permanent Disability)

  • The statutory minimum and maximum average weekly earnings (AWE) for dates of injury in 2023 have increased to $364.29 and $2,428.72, respectively. See §5.78.

  • A medical evaluator’s opinion does not constitute substantial evidence on the issue of apportionment unless it discusses “how and why” the preexisting condition was a cause of the employee’s permanent disability. See City of San Jose Human Resources Dep’t v WCAB (Junge) (2022) 87 CCC 502 (writ denied; medical reporting did not constitute substantial evidence when, instead of providing analysis of how and why nonindustrial factors were responsible for specific portion of applicant’s current disability, report simply repeated physician’s causation analysis without distinguishing between two and did not provide any reasoning for conclusion that preexisting depression and chronic pain caused attributed level of apportionment) in §5.94.

  • Labor Code §4663(e) provides that apportionment based on causation does not apply to injuries or illnesses covered by the various presumption statutes. See City of Irvine v WCAB (Giannini) (2013) 78 CCC 157 (writ denied; apportionment of police officer’s cumulative injuries impermissible under Lab C §4663(e) despite absence of express anti-attribution clause in Labor Code section on which officer based compensation (Lab C §3213.2)). The prohibition on apportionment in Lab C §4663(e) includes a prior permanent disability award. See California Highway Patrol v WCAB (Santigo) (2022) 87 CCC 1011 (writ denied) in §5.103.

Chapter 7 (Death Benefits, Dependency, and Burial Expenses)

  • That dependency is to be determined at the time of injury is strictly construed. In Carpet Land Mills v WCAB (Manzur) (2021) 86 CCC 1113 (writ denied), for example, a Board panel reversed the WCJ’s finding of partial dependency when the decedent’s son was not attending college at the time of injury and was wholly dependent on father for support, despite the fact that he became a full-time student 1 month later and began receiving financial aid for tuition and living expenses. See §7.2.

  • In cases in which the WCAB later finds that there are dependents to whom benefits are payable, the dependents are not entitled to interest on the delayed death benefits. See Velasquez v WCAB (2022) 87 CCC 899 (writ denied; because Lab C §4706.5(g) requires DWDU to reimburse employer or insurance carrier and not dependents and Lab C §5800 awards interest for delayed payment of “compensation” and “death benefits,” there was no legal basis to award interest to dependents for DWDU’s delayed reimbursement to insurer) in §7.14.

Chapter 8 (Penalties)

  • When the WCAB determines that the employer has unreasonably rejected liability for claims of injury or illness as defined in Lab C §§3212–3213.2, the penalty amount is five times the amount of the benefits unreasonably delayed, up to $50,000. See Lab C §5414.3(a) in §8.37.

Chapter 9 (Dispute Resolution Procedures)

  • An applicant need not wait until an employer has accepted or denied the claim before initiating the QME panel process. See County of Fresno v WCAB (Brar) (2022) 87 CCC 415 (writ denied) in §9.31.

  • If there has been an agreement to an AME, a QME panel will not be issued unless the parties mutually consent in writing to cancel the AME agreement. See Dzambik v WCAB (2022) 87 CCC 773 (writ denied) in §9.31.

  • A party has 10 days from service of list plus any additional time under 8 Cal Code Regs §10605 to strike one name from the QME panel list. See Barba v La Venadita Meat Mkt. (Oct. 6, 2022, ADJ14819466) 2022 Cal Wrk Comp P.D. Lexis 271 in §9.35.

  • The appropriate remedy for a violation of the parties’ agreement on additional information to be provided to the AME should be determined using the same factors as for a violation of Lab C §4062.3(b). See Sigurdson v Woodstove & Son Contractor Direct (Oct. 10, 2022, ADJ14365786) 2022 Cal Wrk Comp P.D. Lexis 275 in §9.43.

  • A letter to the AME was “information” under Lab C §4062.3(c) because it discussed both medical and nonmedical records relevant to the determination of medical issues. See Sigurdson v Woodstove & Son Contractor Direct (Oct. 10, 2022, ADJ14365786) 2022 Cal Wrk Comp P.D. Lexis 275 in §9.47.

  • Electronic service of medical-legal reports is provided for in new 8 Cal Code Regs §36.7. See §9.60A.

  • The appropriateness of additional QME panels was discussed in Bautista v The Beauty Box (Sept. 29, 2022, ADJ13487168) 2022 Cal Wrk Comp P.D. Lexis 268 (WCJ determined that additional panels were appropriate when orthopedic QME indicated he would defer evaluation in neurology and psychology to appropriate specialists, noting that WCJs have various tools to guard against abuse). See §9.66.

  • New and amended regulations regarding copying and related services have been integrated into §§9.86–9.88C.

Chapter 11 (Representing Defendants)

  • Effective January 1, 2023, for injuries or illnesses defined in Lab C §§3212–3212.85 and §§3212.9–3213.2, if liability is not rejected within 75 days after the claim form is filed, the injury will be presumed compensable, and this presumption can only be rebutted by evidence that was discovered after the 75-day period. See Lab C §5402(b)(2) in §§11.14, 14.21–14.23, 18.34–18.38.

Chapter 20 (Decisions, Awards, and Judgments)

  • For certain judgments entered on or after January 1, 2023, or when an application for renewal of judgment is filed on or after January 1, 2023, the interest rate is 5 percent per year. See CCP §685.010(a)(2)(A) in §20.17.

About the Authors

BRETT A. BORAH received his B.A. in 1972 from the University of California, Berkeley, and his J.D. in 1979 from the University of California, Hastings College of the Law. He is a partner in the firm of Scher & Bassett, specializing in workers’ compensation law. Mr. Borah is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization. Mr. Borah has served as vice-chair of the State Bar Workers’ Compensation Law Advisory Commission and as chair of the Executive Committee of the Workers’ Compensation Section of the State Bar. He is presently on the Board of Governors of the California Applicants’ Attorneys Association.

ROBERT E. BUCH received his B.A. in 1969 and his M.S. in 1970 from the University of Southern California and his J.D. in 1973 from Loyola University School of Law. He is a partner in the firm of Seyfarth, Shaw, Fairweather & Geraldson, specializing in workers’ compensation law. Mr. Buch is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization. He is a former chairman of the Workers’ Compensation Law Advisory Commission and is presently on the State Bar Board of Legal Specialization.

COLLEEN S. CASEY received her B.A. from the University of California, Berkeley, and her J.D. from Golden Gate University School of Law. She is a commissioner for the Workers’ Compensation Appeals Board in San Francisco.

FREDERICK T. DIETRICH, JR., received his B.S. in 1970 from the University of San Francisco, his Master’s of Industrial and Labor Relations in 1972 from Cornell University, and his J.D. in 1978 from San Francisco Law School. He is an assistant secretary and deputy commissioner for the Workers’ Compensation Appeals Board. Mr. Dietrich is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

HON. PAMELA W. FOUST received her B.A. in 1966 from the University of California, Los Angeles, and her J.D. from the University of West Los Angeles, where she graduated cum laude in 1978. Judge Foust is with the Workers’ Compensation Appeals Board in Santa Monica.

RAYMOND E. FROST received his B.A. in 1972 from San Jose State University and his J.D. in 1977 from the University of La Verne College of Law. He is in private practice in Fremont, specializing in workers’ compensation law. In addition, he serves regularly as a judge pro tem and as an arbitrator for the Alameda County Superior Court. Mr. Frost is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

GLEN J. GROSSMAN received his B.A. in 1977 from State University College of New York at Geneseo and his J.D. in 1980 from the New England School of Law. He is a staff counsel for the State Compensation Insurance Fund in Salinas, specializing in workers’ compensation defense. Mr. Grossman is a past member of the Executive Committee of the Workers’ Compensation Section of the State Bar (1996–1999) and is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

DENNIS J. HANNIGAN received his B.A. in 1968 from the University of California, Davis, and his J.D. in 1971 from the University of California, Hastings College of the Law. He is a secretary and deputy commissioner for the Workers’ Compensation Appeals Board. Mr. Hannigan was co-author of the California Workers’ Compensation Practice Update from 1992 through 1999.

SALLY M. HARMS attended University of California, Berkeley, and received her J.D. in 1986 from New College of California, School of Law. Ms. Harms, a partner in the San Francisco firm of Lieberman & Harms, specializes in workers’ compensation, representing longshore and harbor workers. She is past chair of the Executive Committee of the Workers’ Compensation Section of the State Bar and is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

YALE I. JONES received his B.A. in 1963 from Stanford University and his J.D. in 1966 from the University of California, Los Angeles, School of Law. He is a partner in the San Francisco firm of Jones, Clifford, McDevitt & Johnson, specializing in workers’ compensation law. Mr. Jones is the past chair of the Board of Legal Specialization of the State Bar and past chair of the State Bar Committee on Workers’ Compensation (1985–1986). He is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization and is a frequent speaker at seminars on workers’ compensation law.

BARRY M. LESCH received his B.A. in 1965 from the University of Pennsylvania, his M.A. in 1971 from Indiana University, and his J.D. in 1975 from the University of California, Berkeley, School of Law. He is the managing partner with Laughlin, Falbo, Levy & Moresi in Sacramento, specializing in workers’ compensation law. He is also the legal editor of the California Workers’ Compensation Reporter. Mr. Lesch is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

DEBORAH LIEBERMAN attended the Hebrew University of Jerusalem and received her J.D. in 1986 from New College of California, School of Law. She is a partner in the San Francisco firm of Lieberman & Harms, specializing in workers’ compensation law. Ms. Lieberman is a current member of Executive Committee of the Workers’ Compensation Section of the State Bar and a past member of the Workers’ Compensation Advisory Commission to the California Board of Legal Specialization (1995–1998). She was a contributing editor for California Compensation Cases (1990–1994). Ms. Lieberman is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

JAMES P. PETTIBONE received his B.A. in 1981 and his J.D. in 1987 from the University of San Francisco. He is a partner in the firm of Laughlin, Falbo, Levy & Moresi in Sacramento, specializing in workers’ compensation law.

PAUL PEYRAT received his B.A. in 1955 and his J.D. in 1958 at the University of Minnesota. He was a legal editor for the third edition of California Workers’ Compensation Practice and is the author of California Workers’ Damages Practice and a contributing editor for the California Workers’ Compensation Reporter.

FRANK D. RUSSO received his B.A. in 1973 from Yale University and his J.D. in 1976 from the University of California, Berkeley, School of Law. He is a partner in the firm of Russo, Uriarte & Carr in Oakland, specializing in workers’ compensation law. Mr. Russo is a member and past president (1997–1998) of the California Applicants’ Attorneys Association. He is a frequent lecturer at seminars on workers’ compensation law and is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

ANDREW K. SHAFFER received his B.A. in 1989 from Brown University and his J.D. in 1995 from Santa Clara University. He is an associate with the firm of Scher & Bassett specializing in workers’ compensation and Social Security disability. He is certified as a specialist in workers’ compensation law by the State Bar Board of Legal Specialization.

PATRICIA S. STEPHENS received her B.A. in 1977 from California State University, Dominguez Hills, and her J.D. in 1987 from the University of California, Hastings College of the Law. She is a senior judicial attorney, workers’ compensation specialist, at the Court of Appeal, Second Appellate District, Los Angeles.

CHARLES LAWRENCE SWEZEY received his A.B. in 1943 from Cornell University and his LL.B. in 1948 from Stanford University. He was a member of the California Workers’ Compensation Appeals Board from 1974 to 1975 and from 1979 until his retirement in 1988. Currently, he is a legal consultant for the Commission on Health and Safety and Workers’ Compensation and a contributing editor for the California Workers’ Compensation Reporter.

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