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Preface
Statement on Fair Use
10.0 Introduction to California Workers' Compensation Insurance Program
10.1.0 Purpose of Workers' Compensation
10.2.0 History of Workers' Compensation
10.2.1 Negligence
10.2.2 Contributory Negligence
10.2.3 Assumption of Risk Doctrine in Civil Actions
10.2.4 Fellow-Servant Rule
10.2.5 Dissatisfaction With the System
10.2.6 Legislative and Constitutional Enactments
10.2.6.1 Limitations on use of Assumption of Risk and Fellow-Servant Rule Doctrines
10.2.6.2 Roseberry Act
10.2.6.3 Voter Approval
10.2.6.4 Boynton Act-Workmen's Compensation Insurance and Safety Act
10.2.6.5 Amendment to Boynton Act
10.2.6.6 Revised Workmen's Compensation Insurance and Safety Act of 1917
10.2.6.7 Constitutional Provisions
10.2.6.8 Concerns About Federal Preemption
10.2.6.9 Compensation is not the Same as Damages in Civil Action
10.2.6.10 Every Employer Must Secure Workers' Compensation Insurance or be Permissibly Self-Insured
10.2.6.11 Employers Cannot Require Employees to Contribute to Workers' Compensation Costs
10.2.7 Advertising
10.2.7.1 Workers' Compensation Truth in Advertising
10.2.8 Carve out Programs—Construction Industry's Special Arbitration Program/Alternative Dispute Resolution
10.2.8.1 Special Labor - Management Agreements - Arbitration Program - Alternative Dispute Resolution - Expansion of Program
10.2.8.2 Collective Bargaining Agreements for Licensed Jockeys
10.2.8.3 Petition for Reconsideration From an Arbitration Decision
10.2.8.4 Board has Jurisdiction to Dismiss an Application for Adjudication of Claim if the Employee is Subject to Alternative Dispute Resolution Process
10.3.0 Organization and Administration of the Workers' Compensation Insurance Program
10.3.1 Department of Industrial Relations (DIR)
10.3.2 Division of Workers' Compensation (DWC)
10.3.3 Office of Benefit Assistance and Enforcement/Information and Assistance Officers
10.3.3.1 Information and Assistance Officers
10.3.4 Office of Benefit Determination
10.3.5 Workers' Compensation Appeals Board (WCAB)
10.3.5.1 Powers of the Appeals Board
10.3.5.2 En Banc Decisions of the Appeals Board
10.3.5.3 Appointments to the Board
10.3.5.4 Actions of the Board
10.3.5.4.1 Sanctions May Be Imposed by the Board
10.3.5.5 Uniform Rules and Forms That Must be Used by all Board Offices
10.3.5.6 Exclusive Jurisdiction of California Supreme Court and the Court of Appeals Over Actions of the Appeals Board
10.3.5.7 Location of the Appeals Board Headquarters
10.3.6 Deputy Commissioners
10.3.6.1 Court Administrator's Position Abolished in 2011
10.3.7 Presiding Workers' Compensation Judges
10.3.8 Workers' Compensation Administrative Law Judges (WCALJ)
10.3.8.1 Court Reporters
10.3.9 Arbitrators
10.3.10 Objection to a Judge to Hear Case
10.3.11 Pro Tempore Workers' Compensation Judge
10.3.12 Legal Office
10.3.13 Qualified Medical Evaluators (QMEs)
10.3.13.1 Specific Finding by a Judge or the Appeals Board, That Must be Made, if a Medical Legal Report is Rejected
10.3.13.2 Definitions of Terms Used by the Division
10.3.13.3 A Physician Must be a Qualified Medical Evaluator to Perform Certain Medical Evaluations
10.3.13.4 Unlawful Referrals and Practices by Physicians
10.3.13.4.1 Exceptions to Referrals Prohibition Under Labor Code Section 139.3
10.3.13.4.2 Division Review of Advertising, Disciplinary Actions and Proceedings; Adoption of Advertising Regulations and Report to Legislature
10.3.13.4.3 False or Misleading Advertising Prohibited
10.3.13.4.4 Description of False or Misleading Advertisements
10.3.14 Vocational Rehabilitation Program and Unit Abolished in 2004
10.3.15 State Compensation Insurance Fund (SCIF)
10.3.16 Department of Insurance
10.3.16.1 Minimum Standards for Claims Adjusters
10.3.17 Workers' Compensation Insurance Rating Bureau (WCIRB)
10.3.17.1 Yearly Reports to Governor and Legislature by WCIRB
10.3.17.2 Workers' Compensation Administration Revolving Fund
10.3.17.3 The Cal-OSHA Targeted Inspections and Consultation Fund
10.3.18 Commission on Health and Safety and Workers' Compensation (CHSWC)
10.3.19 Uninsured Employer's Benefits Trust Fund (UEBTF)
10.3.20 Subsequent Injuries Benefits Trust Fund (SIBTF)
20.0 Substantive Provisions
20.10.0 Guardian Ad Litem for Minors and/or Incompetents
20.20.0 Discrimination Against Workers who are Industrially Injured is Prohibited
20.10.1 Earnings of a Minor
20.10.2 Illegally Employed
20.12.24 Aggregate Permanent Disability Indemnity Charts
20.1.0 Compensable Industrial Injuries
20.1.1 Injury Defined
20.1.2 Specific and Cumulative Injuries
20.1.3 Injury to Health Care Worker From Preventive Care
20.1.4 Date of Injury in Cases of Occupational Disease or Cumulative Injury
20.1.5 Liberal Construction
20.1.6 Combined Injuries Require Separate Determinations
20.1.7 Health Care Workers' Reaction to Health Care Provided by Employers
20.1.8 Prophylactic Layoff From Work Because of Exposure to a Disease is not Considered an Injury if There is no Pathology
20.1.10 Special Rules for Occupational Disease or Cumulative Injury Cases
20.1.10.1 Time Limitations to File Application With the Appeals Board
20.1.10.2 What Does "Asserted" Mean?
20.1.10.3 Injurious Exposure Must Be Established to Trigger Liability
20.1.10.4 Last Date of Exposure may Trigger Liability if Injurious Exposure Period is Unclear
20.1.10.5 Liability is Based on Consecutive Calendar Years of Exposure
20.1.10.6 Time Limitation Limits Only Number of Employers Within one Year Preceding Date of Injury, Not Number of Years of Exposure
20.1.10.7 Filing of Cumulative Injury Claim may Toll Statute of Limitations as to Specific Injuries Contained Within a Cumulative Injury Time Period
20.1.10.8 Consequences if Last Employer Is Not Insured for Workers' Compensation Insurance
20.1.10.9 Apportionment of Disability to Prior or Subsequent Years may not be Allowed
20.1.10.10 Application Must State Names of all Employers Potentially Liable
20.1.10.11 Right to a Continuance if Application is not Prepared
20.1.10.12 Self-Employment is not Considered Employment Under Labor Code Section 5500.5
20.1.10.13 Liability is Based on Periods of Injurious Exposure and not on Exposure
20.1.10.14 Liability is Based on Periods of Stressful Employment and not the Degree of Stress
20.1.10.15 Right to Elect Against one or More Employers or Insurance Carriers
20.1.10.16 All Proper Parties Must be Joined
20.1.10.17 Employers Joined After First Hearing, or After Election, are not Entitled to Participate in Proceedings Prior to Board's Final Decision
20.1.10.18 Trial Judge may Refuse to Allow Election
20.1.10.19 Election may be Made Against a Carrier Where Only one Employer and Multiple Carriers Involved
20.1.10.20 Unelected Carrier may not Challenge Judge's Findings Until Contribution Proceedings Are Brought
20.1.10.21 Right to Contribution of Elected Carrier if Proceedings Instituted Within one Year of Award or Right to Reimbursement
20.1.10.22 Applicant may Have to be Subpoenaed to the Hearing
20.1.10.23 In Contribution Hearing, Nonelected Parties may Establish no Injurious Exposure
20.1.10.24 Formal Petition Must be Filed Requesting Contribution
20.1.10.24.1 Liability of Carriers in Continuous Trauma Claim, who do not Settle, may be Entitled to Credit Against Settlement
20.1.10.25 Determination of Rights and Interests of Employers in Silicosis Cases
20.1.10.26 Uninsured Employers' Fund not Liable for Contribution for an Uninsured Employer's Pro-Rata Share of Awarded Benefits
20.1.10.28 Employers or Employees in a Claim for Occupational Disease or Cumulative Injury may not Elect Against an Illegally Uninsured Employer
20.1.10.29 Settlement by one Carrier may Release Other Defendants from Liability
20.1.11 Date of Injury
20.1.11.1 Specific Injuries
20.1.11.2 Occupational Diseases or Cumulative Injuries
20.1.11.3 Specific and Cumulative Injuries Have Different Dates of Injury
20.1.11.4 Combined Injuries Require Seperate Determinations
20.1.11.5 Disability Rate in Effect on Date of Injury Control Employee's Weekly Indemnity Rate
20.1.12 Unique Injuries and Diseases That may Occur Without Visible Traumatic Effect
20.1.12.1 Cirrhosis of the Liver From a Needle Stick may be Industrial Injury
20.1.12.2 Parkinson's Disease may be Industrially Caused
20.1.12.3 Special Exposure to Contagious or Infectious Diseases may Have to be Established
20.1.12.4 Covid Presumption SB-1159
20.1.12.5 Notice Obligations for Covid-19 Exposures in Workplace
20.1.12.6 Covid-19 Paid Sick Leave
20.1.13 Degree of Proof Needed to Prove Industrial Causation
20.1.14 Compensability of Psychiatric Injuries Occurring Prior to July 16, 1991
20.1.14.1 Compensability of Psychiatric Injuries Occurring on or After July 16, 1991
20.1.15 Discovery Requirements in Proceedings Involving Injury Arising From Sexual Conduct; Non-Admissible Evidence
20.1.15.1 What Constitutes Pre-Termination Psychiatric Treatment?
20.1.16 Psychiatric Injuries Caused by Lawful, Nondiscriminatory, Good Faith Personnel Actions are not Compensable
20.1.17 Psychiatric Injuries That Arise out of Physical Injuries Still Require Higher Degree of Proof
20.1.17.1 Constitutionality of Labor Code Section 3208.3(B)(1) Imposing "Predominant" Test for Psychiatric Injuries
20.1.17.2 Public Employee's Retirement System (PERS) Employees - Psychiatric Injuries
20.1.18 Sudden and Extraordinary Events of Employment
20.1.19 Post-Termination Claims, Other Than Psychiatric Claims
20.1.20 Laid off on a Prophylactic Basis During the Incubation Period for a Communicable Disease
20.1.21 Disability Increased by Negligent Medical Provider, Consequence of?
20.1.22 Recurrence/Flare-Up (Exacerbation) Versus Aggravation/Lighting-Up (New Injury)
20.2.0 Hernias may be Compensable Injury
20.3.1 Employer Definition
20.3.2 Employee Definition
20.3.2.1 Domestic Service Referral Agencies may not be Employers for Workers' Compensation Purposes
20.3.3 Presumption of Employee Status
20.3.4 Job Applicant may be Considered an Employee in Unique Circumstances
20.3.4.1 Injury Sustained While Undergoing Pre-Employment Medical Examination may be Compensable
20.3.5 Effect of Falsification of Employment Application
20.3.6 Gratuitous Service-Volunteer may not be an Employee
20.3.7 Special Topics
20.3.7.1 Effect of Union Picketing and Injuries at Union Hall
20.3.7.2 Court Personnel
20.3.7.2.1 Judges of Superior Courts are Employees of the State
20.3.7.2.2 Reporters for Superior Courts are Employees of the County
20.3.7.2.3 Jurors may be Employees of County
20.3.8 Excluded Persons
20.3.8.1 Independent Contractors
20.3.8.1.1 Burden of Proof
20.3.8.1.1.1 An Unlicensed Contractor Cannot sue for Payment of Work Requiring a License
20.3.8.1.2 General Contractor not Responsible to Ensure That Independent Contractor Complies With all Safety Orders
20.3.8.1.3 Exception of Nonliability of Individuals or Other Entities who Engage the Service of an Independent Contractor Under the Peculiar Risk Doctrine
20.3.8.1.3.1 Property Owner may be Liable for Concealed Hazardous Condition
20.3.8.1.3.2 Subcontractors With no Workers' Compensation Insurance
20.3.8.1.3.3 Negligent Hiring Exception to Privette and Toland Holdings
20.3.8.1.3.4 Providing of Unsafe Equipment Exception to Privette and Toland
20.3.8.1.3.5 General Contractor not Liable to Subcontractor’s Injured Employee in a Third-Party Tort Action
20.3.8.1.3.6 Third Party Lawsuits Against Landowner by Injured Employees of an Independent Contractor on Theory of General Premises Liability
20.3.8.1.4 Legal Consequences of an Employer Electing to Include an Independent Contractor in its Insurance Policy
20.3.8.1.5 Contractors State License Board (CSLB)
20.3.8.2 Construction Permits - Certificate of Insurance
20.3.8.3 Parents, Spouses, or Children Employed by Such Owners or Occupants of Residential Dwellings
20.3.8.4 Casual Workers Employed by Owners or Occupants of Residential Dwellings
20.3.8.5 Workers for Charitable Organizations
20.3.8.6 Workers for a Public Agency or a Private Nonprofit Organization
20.3.8.7 Ski Patrollers
20.3.8.8 Ski-Lift Operator Employees Injured While Off-Duty but on Employer's Premises
20.3.8.9 Sports or Athletics Participants
20.3.8.10 Camp, hut, or Lodge Workers
20.3.8.11 Deputies Appointed for Their own Convenience
20.3.8.12 Persons Performing Officiating Services at Amateur Sporting Events, for Public or Nonprofit Organization
20.3.8.13 Students Participating as Athletes in Amateur Sporting Events Sponsored by any Public Agency or Private Nonprofit College, University, or School
20.3.8.14 Law Enforcement Officer Regularly Employed Outside of State
20.3.8.14.1 Outside of State Law Enforcement Officers
20.3.8.15 Watchpersons Working for Nonindustrial Establishments
20.3.9 Special Persons Including Volunteers
20.3.9.1 Trainees in Rehabilitation
20.3.9.2 Workers Associated Under a Partnership Agreement
20.3.9.3 Active Fire Fighters While Members of an Organized Volunteer Fire Department
20.3.9.4 Disaster Service Workers
20.3.9.5 Persons Working as Unpaid Volunteers for Recreation and Park Districts
20.3.9.6 Persons Registered as Active Police Workers
20.3.9.7 Persons Deputized by Proper Authority
20.3.9.8 Persons Registered with Department of Fish and Game as Active Reserve Members
20.3.9.9 Persons Working as Unpaid Volunteers for a Public Agency
20.3.9.10 Persons Working as Unpaid Volunteers for Private, Non-Profit Organization
20.3.9.11 Persons Working as Unpaid Volunteers for Sheriff's Reserve
20.3.9.12 Persons Working as Unpaid Volunteers for School Districts
20.3.9.13 Persons who are Wards of a Juvenile Court
20.3.9.14 Persons who are Juvenile Traffic Offenders or Juvenile Probationers
20.3.9.15 Persons who are Inmates of a State Penal or Correctional Institution
20.3.9.15.1 Determining Earning Capacity of State Prison Inmates
20.3.9.15.2 Attorney Referral for Inmates
20.3.9.16 Inmates of County or City Jails
20.3.9.17 Persons Engaged in Suppressing Fires
20.3.9.18 Persons Engaged as Part of a Posse
20.3.9.19 Persons Rendering Technical Assistance to a Public Entity to Prevent Fires, Explosions or Other Hazardous Occurrences
20.3.9.20 Persons Engaged in Work-Experience Education, Community Classroom, or Occupational Training Classes
20.3.9.21 California National Guard Members
20.3.9.22 Persons Performing Services for any Private, Nonprofit Organization
20.3.9.23 Undocumented Workers
20.3.10 Election to be Subject to the Code
20.3.11 A Finding of Employment by the Board Becomes Binding When Appeal Time Passes
20.3.12 Presumption of Compensability Under Labor Code Section 5402
20.3.13 Compensation Payable Directly to Injured Employee
20.4.1 Liability Falls on Employer who has Employee on Payroll
20.4.1.1 General and Special Employers' Liability
20.5.0 Statutory Defenses to Compensability of a Claim
20.5.1 Employee/Employer Relationship Must Exist
20.5.2 Intoxication Must not be a Substantial Factor in Causing the Injury
20.5.3 Injury Must not be Self-Inflicted
20.5.3.1 Negligence of an Employee
20.5.3.2 Suicide of Employee
20.5.3.3 Felony Convictions
20.5.4 Altercation/Initial Physical Aggressor
20.5.5 Injury Must Arise out of Employment (AOE) and Occur in Course of Employment (COE)
20.5.6 Proof by a Preponderance of the Evidence
20.5.7 Recreational, Social, or Athletic Activity not a Factor (Voluntary)
20.5.9 When Does an Injury Arise out of an Employee's Employment (AOE)?
20.5.9.1 Earthquake Injuries
20.5.9.2 Lightning Strike Injuries
20.5.9.3 Normal Bodily Movement Injuries-Idiopathic Condition Injuries
20.5.9.3.1 If Industrial Knee Surgery Triggers Multiple Sclerosis and Psychiatric Condition, These Conditions may be Compensable
20.5.9.4 AIDS Arising out of Employment by Exposure to Contaminated Fluids
20.5.9.4.1 Addiction Arising out of Employment May Be Compensable
20.5.10 When is an Employee Acting in the Course of Employment (COE)?
20.5.10.1 Course of Employment Test v. Scope of Employment Test (Respondeat Superior) (Vicarious Liability of Employer)
20.5.10.2 Injured Going to or From Work (Going and Coming Rule)
20.5.10.3 Injured While on a Special Mission (Special Mission Exception to the Going and Coming Rule)
20.5.10.3.1 Traveling to or From Work Without a Particular Place of Employment
20.5.10.3.2 Peace Officers
20.5.10.4 Injured During a Deviation While on a Special Mission
20.5.10.5 Injured While Riding a bus or Carpooling to Work at Employer's Request
20.5.10.5.1 Employee Voluntarily Participates in an Alternative Commute Program
20.5.10.6 Injured While Using own Vehicle for Employer's Benefit
20.5.10.6.1 Injured While Riding in Co-Employee's car at Request of Employer
20.5.10.6.2 Employee who Quits in the Middle of the Work day and is Injured on way Home
20.5.10.7 Employee's Home Used as a Second job Site-Telecommuting
20.5.10.8 Local bar Used as Second job Site
20.5.10.9 Injured While Attending Educational or Other Special Activities Directly Related to the Employee's Work Duties
20.5.10.10 Injured While on a Trip for the Employer (Commerical Traveler Doctrine)
20.5.10.10.1 Social, Athletic, and Recreational Activity Limitation Applies to Commercial Traveler
20.5.10.11 Injured on Work Premises While Using Employer's Equipment, for Personal Reasons or While Remaining on Work Premises After Work, for Personal Reasons
20.5.10.12 Injured While Taking Advantage of Employee Discount Provided by Employer
20.5.10.13 Injured While Engaged in a Recreational, Athletic, or Social Activity
20.5.10.13.1 Commercial Traveler Exception
20.5.10.14 Sexual Activity Injury at Work or While a Commercial Traveler
20.5.10.15 Injured in Vehicular Accident Traveling Home, After Work, due to Drowsiness, Caused by Work
20.5.10.16 Injured While Performing Duties for Which not Hired
20.5.10.17 Injured While Engaged in Criminal (Illegal) Activity and/or While on an Unauthorized Departure From Duty or While Performing Work in an Unauthorized Manner
20.5.10.18 Injured After Separation or Other Termination From Work but While Still on Work Premises
20.5.10.19 Injured During act of Personal Comfort and Convenience
20.5.10.19.1 Injured While Walking on Public Walkway During Uncompensated Lunch Break
20.5.10.20 Salaried Employees Injured During Lunch Breaks
20.5.10.21 Injured Because of Personal Smoking Habit
20.5.10.22 Injured Because of Consuming Alcohol due to Work Stress or Because of Pain and/or Depression From an Industrial Injury
20.5.10.23 Injured as a Result of Dissatisfaction With Work Demotion
20.5.10.24 Injured Because of Work Criticism and/or Harassment at Work
20.5.10.25 Injured While Picking up a Paycheck on day off
20.5.10.26 Injured While off Duty During an Emergency to aid an Employer
20.5.10.26.1 Injured While Combining a Personal act Outside of Regular Working Hours With an act in Furtherance of Employer's Business
20.5.10.27 Injured Assisting the Public in Exercise of Common Decency
20.5.10.28 Injured as a Result of a Personal Grievance Against a Co-Employee or Because of the Behavior of a Co-Employee
20.5.10.29 Injured Because of Bias Against an Employee as a Result of the Employee's Race, Religious Creed, Color, National Origin, age, Gender, Disability, or Sexual Orientation
20.5.10.30 Injured From Gossip in the Workplace
20.5.10.31 Injured Because of Rejection of Romantic Overtures of Co-Employee
20.5.10.32 Injured While Engaged in Horseplay or Skylarking
20.5.10.32.1 Condonation of Horseplay or Skylarking by Employer
20.5.10.33 Injured Upon or Near the Employer's Parking Area-Premises Line Rule
20.5.10.34 Injured in a Special Risk Zone
20.5.10.35 Injured While Living on Work Premises—Bunkhouse Rule
20.5.10.35.1 Ski-Lift Operator Employees who Reside on Work Premises
20.5.10.37 Loss of Employment Resulting in Injury—Not Compensable
20.5.10.38 Injured While Traveling to or From Medical Facility for Treament-Compensable Consequences Doctrine
20.5.10.39 Injured From Medical Treatment That was Rendered for an Industrial Injury
20.5.10.40 Injured While at Medical Facilities for Treatment
20.5.10.41 Injured as a Result of Inoculation and/or Vaccination or Examinations Required by Employer
20.5.10.42 Injured as a Result of Employer Required Medical Treatment
20.5.10.43 Injured in Accident While Traveling to a Workers' Compensation Hearing
20.5.10.44 Injured While Reporting for Employer Required Yearly Physical Examination
20.5.10.45 Laid-Off on Prophylactic Basis During the Incubation Period for a Communicable Disease Because of Exposure to Such a Disease at Work
20.5.10.46 Mysterious Circumstances Surrounding Death at Work
20.5.10.47 Injured in a Nonindustrial Accident as a Result of a Prior Industrial Injury - Compensable Consequence Doctrine
20.5.10.47.1 Date of Injury for Compensable Consequence Injuries
20.5.10.48 Fireman Injured off Duty Anywhere in California While Performing Fire Fighting Work, but not Under Employer's Immediate Direction
20.5.10.49 Peace Officers Injured off Duty Anywhere in California While Performing Peace Work, but not Under Employer's Immediate Direction
20.5.10.49.1 Off Duty Firefighters Injured While not Acting Under Employer's Immediate Direction, but While Performing Duties Somewhere in This State to Protect Life or Property
20.5.10.50 Injury Arising From Litigation Process
20.5.10.51 Injured While Undergoing a Defense Medical Examination
20.5.11 Presumptions That Certain Diseases or Other Medical Conditions That Arise out of Employment, in Favor of Certain Public Employees
20.5.11.1 Cities, Counties, Districts, or Other Public Entities, Sheriff, Police, or Fire Depts.; Division of Forestry of the State Dept. of Natural Resources; Wildlife Protection Branch or the Dept. of Fish and Game; Employees of (Labor Code Section 3212
20.5.11.2 Firefighting Members of Fire Departments of Cities, Counties, Cities and Counties, Districts, or Other Public or Municipal Corporations or Political Subdivisions, and Active Firefighting Members of the Fire Departments of The University of Calif
20.5.11.2.1 Appeals Board may, Upon Request, Determine Disability of Public Employees' Retirement System Members as well as City or County Employees
20.5.11.3 Dept. of Corrections; Dept. of Youth Authority; Atascadero State Hospital; Employees of (Labor Code Section 3212.2)
20.5.11.4 California State Police; Employees of (Labor Code Section 3212.3)
20.5.11.4.1 Injury to Peace Officers of Department of California Highway Patrol
20.5.11.5 University of California Fire Dept.; Employees of (Labor Code Section 3212.4)
20.5.11.6 City Or Municipal Police Dept.; State Highway Patrol; Employees of (Labor Code Section 3212.5)
20.5.11.7 City or County Police Dept.; Employees of (Labor Code Section 3212.6)
20.5.11.8 Department of Justice; Employees Within "State Safety" Class (Labor Code Section 3212.7)
20.5.11.8.1 Peace Officers and Firefighters - Blood Borne Infectious Diseases
20.5.11.9 University of Calif. Police Dept.; Employees of (Labor Code Section 3213)
20.5.11.9.1 Injuries Include Lower Back Impairment to Certain law Enforcement Employees From Duty Belt
20.5.11.10 What is "Heart Trouble"?
20.5.11.11 What do the Words "Develops or Manifests Itself" Mean?
20.5.11.12 Hypertension
20.5.11.13 Peace Officers, Definition of
20.5.11.14 Early Intervention Program
20.6.0 Basic Benefit Scheme
20.6.1 Medical, Surgical, Hospital and Dental Treatment
20.6.1.1 Transportation Expenses (Mileage Rate Reimbursement)
20.6.2 Temporary Disability Indemnity
20.6.3 Permanent Disability Indemnity
20.6.4 Life Pension
20.6.5 Death Payments
20.6.6 Burial Expenses
20.6.7 Discrimination Benefits
20.6.8 Penalties and Fines for Unreasonable Delay in Providing Benefits
20.6.9 Sanctions for Bad-Faith Actions or Tactics That are Frivolous
20.6.10 Reasonable Attorney Fees When Compensation is Unreasonably Delayed or Refused
20.6.11 Supplemental Job Displacement Benefit Vouchers
20.6.12 Serious and Willful Misconduct Benefits by Employer or Employee
20.6.13 Subsequent Injuries Benefit Trust Fund (SIBTF)
20.6.14 Asbestos Workers' Benefits
20.7.0 Medical Benefits
20.7.1 Medical and Hospital Treatment
20.7.2.1 Prohibition Against Rescinding Authorization for Medical Treatment
20.7.3 Limitations on Chiropractic, Occupational and Therapy and Physical Therapy Visits
20.7.4 Nursing Care, Medications, Medical Supplies, Braces, Eyeglasses and Other Medical Aids
20.7.5 Housekeeping Services - Home Health Care
20.7.6 Erectile Dysfunction Medication
20.7.7 Physician, Surgeon, Chiropractic, Acupuncturist, Orthopedic, Podiatrist, Dentist, Optometrist, or Psychiatric Care
20.7.7.1 Physician Assistants and/or Nurse Practitioners
20.7.7.2 Right of Medical Assistants to Render Adjunct Services Involving Concepts of Physical Therapy
20.7.7.3 Physician's Right to sell and Dispense Drugs to Patients
20.7.7.4 Generic Drug Equivalent, When Available, Must be Dispensed Absent Special Circumstances
20.7.7.5 Chiropractor/Acupuncturist
20.7.8 Marriage, Family, Child Counselors, and Clinical Social Workers Services
20.7.8.1 In Vitro Fertilization
20.7.9 Hospital or Similar Care Facility
20.7.10 Medical-Legal Expense-Laboratory, X-Ray, and Medical Reports
20.7.10.1 Nurse Case Manager
20.7.10.2 Drugs not Approved by the Food and Drug Administration
20.7.12 Living Expenses While Seeking Treatment Away From Home
20.7.12.1 Treatment From Original Physician who has Moved to Distant Location—Right to
20.7.12.2 Prohibition for Referral for Physical Therapy, MRIs and Psychometric Testing
20.7.13 Other Forms of Treatment may be Agreed Upon
20.7.14 Pain Patient's Bill of Rights
20.7.15 Private Medical Policy Must Provide Benefits While Workers' Compensation Liability is Being Litigated
20.7.15.1 Industrial Medical Council (IMC) Abolished
20.7.16 Medical Examinations
20.7.16.1 Limitation of Labor Code Section 4050 Exam to Rebut a QME if Applicant is Unrepresented
20.7.17 Employee Notice to Employer of Injury
20.7.17.1 Medical Report Requirements to be Admissable at the Appeals Board
20.7.17.2 Referrals Allowed
20.7.17.3 Medical Reports (First Report of Injury) - Duty to File
20.7.17.4 Duty of the Employer to Give Notice to its Insurer of Injury Sustained by an Employee
20.7.17.4.1 [Reserved]
20.7.17.5 [Reserved]
20.7.17.6 Duty of the Attending Physician
20.7.17.6.1 Reproduction of the Doctor's First Report—Labor Code Section 14007
20.7.17.6.2 Attestation in Body of Medical Reports
20.7.17.7 Medical Treatment Utilization Schedule (MTUS)
20.7.17.7.1 Utilization Review Process That all Employers Must Follow, Substantially Changed, Effective January 1, 2013
20.7.17.7.2 Utilization Review Deadlines are Mandatory
20.7.17.7.3 [Reserved]
20.7.17.7.4 A Utilization Review Physician Cannot be Deposed nor Submit a Supplemental Report
20.7.17.7.5 Unreasonable Delay for Providing Medical Treatment for Periods of Time Necessary to Complete the Utilization Review Process may not Justify a Penalty
20.7.17.7.6 [Reserved]
20.7.17.8 Confidentiality of Employer's Report and Physician's First Report of Injury
20.7.18 Medical Treatment Control
20.7.18.1 Reasonable Geographic Area
20.7.18.1.1 How Often can an Injured Employee Change Treating Physicians if his or her Employer has not Established a Medical Provider Network or a Health Care Organization?
20.7.18.2 Personal Physician
20.7.18.2.1 Primary Treating Physician
20.7.18.3 Employee-Selected Physician Fails to Provide Reports or Respond to Reasonable Requests by Defense, Where Employer has not Established an MPN or HCO, Consequences if
20.7.18.3.1 Procedure for Employee to Take Over Medical Care if the Employer has not Established an MPN or HCO
20.7.18.3.2 Penalty for Delay in Authorizing Treatment, Tests, and/or Consultations
20.7.18.4 Payment of Employee-Selected Physician Bills as well as Employer Designated Physician Bills Prior to July 1, 2013
20.7.18.4.1 Electronic Medical Billing
20.7.18.4.2 Payment for Medical Treatment - Official Medical Fee Schedule (OMFS) Effective July1, 2013
20.7.18.4.3 Extraordinary Circumstances may Justify a fee Higher Than the OMFS
20.7.18.4.4 Right of Medical Provider to Collect Money From Employee
20.7.18.5 Change of Physician Request if the Employer has not Established an MPN or HCO
20.7.18.5.1 Employee's Request to Change Physician if the Employer has not Established an MPN or HCO
20.7.18.6 Duty of Employer to Advise Injured Employee of Right to Select own Physician Where Employer has not Established an MPN or HCO
20.7.18.7 Right to Consulting Physician in a Serious Case
20.7.18.8 Right to Consulting Physician or Attending Physician in any Case but Such Physicians' Reports may not be the Sole Basis of Compensation Award
20.7.18.8.1 Personal Physician or Chiropractor Presumption of Correctness Repealed for all Claims Regardless of Date of Injury
20.7.18.9 Right of Injured Employee to Refuse Surgery
20.7.18.10 Right to Disability Benefits is Barred if Employee Refuses to Submit to Medical Examination or Obstructs the Examination After Being Directed to Report for Examination by the Board
20.7.18.11 Consequences if Refusal of Carrier to Provide Medical Care Prolongs Disability Period
20.7.18.12 Consequences of Defective Treatment That Increases Disability - Medical Malpractice
20.7.18.13 Injured in Accident While Traveling to or From Treatment or Medical Examination
20.7.18.13.1 Consequences if Nonindustrial Accident Aggravates Industrial Treatment
20.7.18.14 Loss of Medical Control by Carrier – Consequences
20.7.18.15 Treatment for Family Members of Injured Employee
20.7.19 Limit of Medical Award
20.7.19.1 A Precautionary or Provisional Medical Award may not be Terminated More Than Five (5) Years After an Injury
20.7.20 Self-Procured Medical Treatment - Official Medical Fee Schedule may not Control
20.7.20.1 [Reserved]
20.7.20.2 Self-Procured Medical Treatment Obtained in a Foreign Country
20.7.20.3 Must Prove Self-Procured Treatment was Reasonably Necessary
20.7.20.4 Treatment Secured From Private Sources at no Cost to Employee
20.7.20.5 Expenses Incurred at Distant Locations
20.7.20.5.1 Outpatient Surgical Center Facility Fees
20.7.21 Medical-Legal Reports and Expenses
20.7.22 Official Medical Fee Schedule
20.7.23 [Reserved]
20.7.23.1 Effects of Medical Treatment Fee Schedule on Self-Procured Medical Expenses
20.7.23.2 Medical-Legal Fee Schedule Regulations - Extraordinary Circumstances may Justify Higher fee
20.7.23.2.1 Time to Submit Supplemental Reports
20.7.23.3 Clerical Cost of Producing Medical-Legal Report
20.7.24 Sleep Apnea
20.7.25 Compound Drugs (Drugs Made to Order)
20.7.26 Treatment of Nonindustrial Conditions
20.7.26.1 Right of Medical Provider and an Employer to Agree on Medical fee Arrangement
20.7.26.1.1 Fees for Medical Experts, or Others, in Other Than Workers' Compensation Matters
20.7.27 First aid and/or Emergency Treatment
20.7.28 Duty to Report Fraudulent Medical Care Claims
20.7.28.1 The Appeals Board may Resolve Medical Liens by Arbitration if the Parties Agree
20.7.29 Controlling Medical Care if Employer or Insurer Contract With two or More Health Care Organizations, Certified to Provide Care
20.7.30 Reporting of Defective Medical Reports to Administrative Director and Licensing Body by the Appelas Board
20.7.31 [Reserved]
20.7.32 Medical Benefits Provided to all Industrially Injured Employees, Regardless of Date of Injury, Effective January 1, 2013—Medical Treatment Utilization Schedule (MTUS)
20.7.32.1 Limitations of Occupational Therapy
20.7.32.2 Determining Whether Medical Expense is Medical-Legal or Medical Treatment
20.7.32.3 [Reserved]
20.7.32.3.1 Interpreter Services
20.7.32.4 [Reserved]
20.7.32.5 Limitations of Occupational Therapy
20.7.32.6 National Medical Community Guidelines
20.7.32.7 Medical Provider Network (MPN)
20.7.32.8 Highlights of the "Medical Provider Network" (MPN)
20.7.32.9 Continuity of Care
20.7.32.10 How an Injured Employee Enters the "Medical Provider Network"
20.7.32.11 Second Opinion
20.7.32.12 Third Opinion
20.7.32.13 If a Dispute Still Exists Over Treatment or Diagnosis, how is it Resolved?
20.7.32.14 The Independent Medical Reviewer's (IMR's) Role
20.7.32.15 How Does the Administrative Director Select the Independent Medical Reviewer?
20.7.32.16 [Reserved]
20.7.32.17 Nurse Case Manager
20.7.32.18 Employees Right to Immediate Medical Treatment
20.7.32.19 Consequences of an Employer Failing to Comply With Medical Provider Regulations Notices
20.7.32.20 Doctor's Right to Admission to an MPN
20.7.32.21 Explanation of Benefits (EOBs)
20.8.0 Earnings
20.8.1 Computing Average Annual Earnings
20.8.2 [Reserved]
20.8.3 Minimum Rate
20.8.4 Effect of State and Federal Income Taxes on Benefits
20.8.5 Undocumented Workers
20.8.6 Agriculture Workers
20.9.0 Cost of Living Adjustment
20.11.0 Temporary Disability Benefits
20.11.1 Pregnancy During a Period of Temporary Disability
20.11.2 Wage Loss - Only Partially Temporarily Disabled
20.11.3 Injured Employee is not Entitled to Temporary Disability Indemnity to Reimburse for Wages Lost While Pursuing Medical Treatment Once Found Permanent and Stationary
20.11.4 Determining an Employee's Weekly Indemnity Rate
20.11.5 If Temporary Total Disability Indemnity is Paid for Disability two or More Years After the Injury, Payment Must be Based on Current Rates (Applies to Death Benefits Payments)
20.11.6 To Whom Paid?
20.11.7 Compensation Benefits are not Subject to Other Debts
20.11.8 Notices and Advice to Injured Employees
20.11.9 [Reserved]
20.11.10 [Reserved]
20.11.11 [Reserved]
20.11.12 [Reserved]
20.11.13 Partial Loss of Earnings
20.11.14 [Reserved]
20.11.15 [Reserved]
20.11.16 Between January 1, 1979 and April 19, 2004
20.11.17 Consequence of Intervening Events
20.11.18 Special Payments for Certain Classes of Employees
20.11.19 Special Payments to Highway Patrol Members, Department of Justice, and San Francisco Port Commission Employees
20.11.20 Special Payments to University of California Fire Department Employees
20.11.21 Special Payments to University of California Police Department Employees
20.11.22 Special Payments to Policepersons, Firepersons, Sheriffs, Lifeguards, and Others (Labor Code Section 4850 Benefits)
20.11.23 [Reserved]
20.11.24 Special Payments to Other State Employees
20.11.25 Public Entity Employees Must Comply With Claim Presentation Requirements
20.11.26 Legal Limbo Between Ending of Temporary Disability Benefit and Commencement of Permanent Disability
20.11.27 [Reserved]
20.11.28 [Reserved]
20.11.29 [Reserved]
20.11.30 Temporary Disability Indemnity Limits for Injuries Sustained on or After April 19, 2004
20.11.31 Determination of Compensability, Temporary Disability, Permanent Disability, Need for Medical Care and Other Issues
20.11.31.1 Procedure to Determine Compensability of an Alleged Injury: Unrepresented Injured Worker (Effective April 19, 2004)
20.11.31.2 Procedure to Determine Compensability of an Alleged Injury: Represented Injured Worker (Effective January 1, 2005)
20.11.31.3 Labor Code Section 4061 Procedure to Determine Permanent Disability Rating: Unrepresented Injured Worker (Effective April 19, 2004)
20.11.31.5 Procedure to Object to a Medical Determination Made by the Treating Physician Concerning Medical Issues not Covered by Section 4060 or 4061 and not Subject to Utilization Review Under Section 4610: Unrepresented Employee (Effective April 19, 20
20.11.31.6 Procedure to Object to a Medical Determination Made by the Treating Physician Concerning Medical Issues not Covered by Section 4060 or 4061 and not Subject to Utilization Review Under Section 4610: Represented Employee (Effective January 1, 201
20.11.31.7 Defendant is not Entitled to Rebut an Opinion by a QME Selected From a Panel by Securing a Section 4050 Exam in Unrepresented Cases
20.12.0 Permanent Disability Benefits for Injuries Occuring Prior to January 1, 2005
20.12.1 Determining Percentage of Permanent Disability for Compensable Claims Arising Before January 1, 2005
20.12.2 When is Permanent Disability Payable?
20.12.3 [Reserved]
20.12.4 Rehabilitation Benefits may be a Factor in Determining Permanent Disability (LeBoeuf)
20.12.5 Progressive Diseases - Insidious Diseases
20.12.6 Apportionment
20.12.7 Cosmetic Disfigurement
20.12.8 [Reserved]
20.12.9 Disabilities Conclusively Presumed 100 Percent
20.12.10 Sensitivity to Substances (Chemicals)
20.12.11 Two or More Separate and Independent Injuries (Avoiding Overlap)
20.12.12 Multiple Injuries Suffered Contemporaneously (Avoiding Overlap)-Combined Values Chart (CVC)
20.12.13 Determining Extent of Permanent Disability for Compensable Claims Arising on or After January 1, 2005 but Before January 1, 2013
20.12.14 Totally Disabled Employee Prior to Injury, but Still Working, may Recover Permanent Disability Indemnity
20.12.15 Schedule for Rating Permanent Disabilities
20.12.16 [Reserved]
20.12.17 Formal Ratings
20.12.18 Calculating Weekly Permanent Disability Payments
20.12.19 Proper Rate if Several Injuries Straddle a Rate Change and Different Carriers Involved
20.12.20 How to Determine the Compensable Permanent Disability Award if the Overall Disability is Composed of Industrial and Nonindustrial Factors, After April 1, 1972
20.12.21 How to Determine the Permanent Disability Award if two or More Injuries to the Same Part of the Body Become Permanent and Stationary at the Same Time, and Similar or Different Employers are Involved
20.12.22 Permanent Disability Indemnity Cannot be Paid Until the Right to all Temporary Disability Resulting From all Injuries has Expired
20.12.23 Nominal Disability Indemnity
20.12.25 Supplemental Job Displacement Benefits
20.12.26 Determining Percentage of Permanent Disability for Compensable Claims Arising on or After January 1, 2005, but Prior to January 1, 2013
20.12.26.1 Determining Permanent Disabilty for Injuries Occurring on or After January 1, 2013
20.12.26.2 Return to Work - Permanent Disability Increase or Decrease by 15% for Injuries Sustained Prior to January 1, 2013
20.13.0 Permanent Disability Benefits After Senate Bill 899 Enacted 2004
20.13.1 Effect of Senate Bill 899 on Permanent Disability
20.13.2 Application to Injuries Occurring Before January 1, 2005
20.13.3 Rebutting the AMA Guides
20.13.4 Future Earning Capacity (FEC)
20.13.5 Rebutting the FEC for Injuries Occurring Prior to January 1, 2013
20.14.0 Apportionment
20.14.1 Cumulative Injury Situations
20.14.2 Medical Treatment
20.14.3 Temporary Disability Indemnity
20.14.4 Between Employers/Insurance Carriers
20.14.5 Permanent Disability
20.14.6 Prophylactic Work Restriction
20.14.7 Psychiatric Disability
20.14.8 Between an Industrial Injury and Subsequent Unrelated Noncompensable Injury
20.14.9 Between Industrial Injuries
20.14.10 Between Insurance Carriers
20.14.11 [Reserved]
20.14.12 Effect of Prior Apportionment on Award to Reopen for Increased Disability
20.14.13 [Reserved]
20.14.14 Death Benefits
20.14.15 Apportionment of Permanent Disability on or After April 19, 2004
20.14.16 Calculation of Apportionment Before April 19, 2004
20.14.17 Determining Permanent Disability Apportionment as of April 19, 2004
20.15.0 Life Pensions
20.16.0 Death Benefits
20.16.1 Total and Partial Dependents
20.16.2 [Reserved]
20.16.3 [Reserved]
20.16.4 [Reserved]
20.16.5 Burial Expense
20.16.6 Injury Date Used as Determining Death Benefit
20.16.7 Who Qualifies as a Dependent?
20.16.8 Total Dependents
20.16.9 Wholly Dependent Child
20.16.10 Putative Wife as a Surviving Widow - Meretricious Relationship
20.16.11 Partial Dependents
20.16.12 How are Benefits Distributed between Total and Partial Dependents
20.16.13 Board has Power to Determine Paternity of a Child
20.16.14 For Deaths Resulting From Injuries Sustained on or After January 1, 1981
20.16.15 Apportionment of Death Benefits
20.16.16 How are Death Benefits Paid?
20.16.17 Deceased Employee or Beneficiary Leaves Accrued Benefits
20.16.18 Deceased Employee Leaves no Dependents or Leaves Dependents That are not Entitled to the full Amount of the Total Death Benefits That Would be Payable to a Surviving Spouse With no Dependent Children
20.16.18.1 Reimbursement
20.16.19 Hearing Locations
20.16.20 Death Occurs Under Mysterious Circumstances-Inferences
20.16.21 Special Death Benefit for Dependents of Assassinated Public Officials
20.16.22 Autopsy and Exhumation may be Ordered by Board
20.16.23 Special Benefit for Dependents of Peace Officers Killed or Totally Disabled in the Performance of Duty
20.16.24 Death of a Member of the Public Employees' Retirement System
20.16.25 Limitation on Time to File Application for Death Benefits
20.16.26 Deceased Employee Previously Litigated Issue
20.16.27 Department of Transportation Employees
20.17.0 Supplemental Job Displacement Benefits Prior to July 1, 2013
20.17.1 Overview of New Supplemental Job Displacement Benefit Regulations
20.17.2 Return to Work Program
20.18.0 Serious and Willful Misconduct Benefits
20.18.1 Misconduct by Employee
20.18.2 The Following Circumstances Have Been Held to Constitute Serious and Willful Misconduct on the Part of an Employee Which Proximately Caused Injury to the Employee, Thereby Justifying Reducing the Employee's Compensation Award by One-Half
20.18.3 Misconduct by Employer
20.18.4 Serious and Wilfull Misconduct Based Upon Violation of a Safety Order
20.18.5 The Following Circumstances Have Been Held to Have Constituted Serious and Willful Misconduct on the Part of an Employer Which Proximately Caused Injury to the Employee, Thereby Justifying an Award for Such Benefits Against the Employer
20.18.6 The Following Circumstances Have Been Held not to Have Constituted Serious and Willful Misconduct on the Part of the Employer
20.18.6.1 An "Insurer" is not Included Within the Meaning of "Employer"
20.18.7 Right of Opposing Party to Inspect Premises
20.18.7.1 Employer Not Bound by Earlier Proceedings
20.18.8 What the Additional Compensation is Based Upon
20.18.9 May be Awarded Against Governmental Agencies
20.18.10 Employer may not Insure Against Serious and Willful Misconduct Liability
20.18.11 Claim Must be Filed Within Twelve Months of Alleged Misconduct
20.18.12 All Allegations of Misconduct Must be Pleaded Separately
20.18.13 Settlement of a Claim for Normal Workers' Compensation Benefits by Compromise and Release Does not Settle Serious and Willful Misconduct Claim Unless Clear Language to That Effect in the Settlement Papers
20.18.14 Right to Bring Civil Action Against Employer for Removal or Failure to Install a Point of Operation Guard on a Power Press
20.19.0 Subsequent Injuries Benefit Trust Fund (SIBTF)
20.19.1 Liability of the Fund Must be Reduced by Certain Money Payments Received by the Applicant
20.19.2 When do Fund Payments Commence?
20.19.3 Fund is not Required to Provide Medical Care but Must pay Reasonable Medical Costs Incurred in Making the Claim
20.19.3.1 Commutations
20.19.4 Fund not Bound by Prior Settlement or Litigation Results
20.19.5 Application Procedure
20.19.6 When Claim Must be Filed
20.19.7 Compromise and Release of a SIBTF Claim
20.19.8 Who Pays Cost of Fund Liability?
20.19.9 Who Defends the Fund?
20.19.10 [Reserved]
20.19.10.1 Liability for Unreasonable Delay in Providing Benefits
20.19.11 Special Hearing Locations
20.20.1 Appeals Board may Interpret Collective Bargaining Agreement to Rule on Discrimination
20.20.2 Casual or As-Needed Employees
20.20.3 If Employee is Unable to Return to Work, Claim may be Premature
20.20.4 A Disability Benefit Plan Must be Applied in Non-Discriminatory Manner
20.20.5 ERISA Preempts Pension Benefits
20.20.6 The Exclusive Remedy Rule Does not Preclude an Americans With Disabilities (ADA) Claim and/or a Fair Employment Housing Act (FEHA) Claim as well as a Labor Code Section 132(a) Claim
20.20.7 Safety Bonus Denial
20.20.8 Must Have an Employer-Employee Relationship
20.20.9 Laid-Off Status Entitles Employee to Protection
20.20.10 Salary Reduction or Denial of Merit/Salary Increase as Basis of Disability Discrimination
20.20.11 Testifying for Co-Employee
20.20.12 Reinstatement to Permanent Position
20.20.13 Duty to Mitigate Damages
20.20.14 Any Judge may Hear a 132a Claim
20.20.15 Issue may not be Subject of Arbitration
20.20.16 Civil Action Including FEHC Claims
20.20.17 Res Judicata
20.20.18 Credit Against Third-Party Recovery
20.20.19 Compromise and Release of Benefits
20.20.20 Mandatory Drug Test
20.20.21 [Reserved]
20.20.21.1 Malicious Prosecution
20.20.21.2 Alternative Resolution Dispute Programs
20.21.0 Retroactive Operation of Compensation Laws
20.22.0 Fraud
30.0 Claims Process
30.1.0 Notice by Employer to Employee of Possible Benefits
30.2.0 Notice by Employee to Employer of Injury
30.3.0 How to Apply for Normal Benefits
30.3.1 Claim Form
30.3.2 Presumption of Compensability-Labor Code Section 5402
30.3.3 Dismissal of Claim Form
30.3.4 Administrative Assistance
30.3.5 Direct Informal Adjustment
30.3.6 Rights of Employer to Notification of Claim From Insurance Carrier and Right to Objection to Settlements - Employer's Bill of Rights
30.3.7 Employer's Right to Access Claim Documents, Right to Discuss Claim With Insurer - Employer's Bill of Rights
30.3.8 Right to Reserve Information
30.4.0 Payment of Disability Indemnity
30.5.0 Medical Confidentiality Act of 1928
30.5.1 Purpose
30.5.2 Two Groups Covered
30.5.3 Definition of Terms
30.5.4 Providers of Health Care
30.5.5 Authorization
30.5.6 Employers
30.5.7 Authorization
30.5.8 Exceptions to the Act
30.5.9 Violations
30.5.10 Patient-Litigant Exception
30.5.11 Workers' Compensation Identifiable Information Protected
30.5.12 Psycotherapist Threat
40.0 Litigation Process
40.10.0 Arbitration
40.20.0 Petition for Writ of Review-District Court of Appeal
40.1.0 Attorneys
40.1.1 Attorney Fees
40.1.2 Attorney or Law Firm may Divide Fees With Other Lawyers and may Give Incidental Nonmonetary Gifts for Recommendations; Employees may be Paid for Recommendation
40.1.3 Substitution of Attorney
40.1.4 Representatives who are not Attorneys may not Charge an Injured Worker
40.1.5 Runners or Cappers
40.1.6 Prohibition of Various Statements
40.1.7 Malpractice
40.2.0 Employer Law Suit Against Carrier for Bad Faith
40.2.2 Silberg Case (Refusal to Provide Medical Care Under a Private Policy While Workers' Compensation Claim is Being Litigated)
40.2.1 Crisci Case (Refusal to Accept Reasonable Offer Within Policy Limits)
40.2.3 Egan Case (Failure to Properly Investigate a Claim)
40.2.4 Types of Cases
40.2.5 Parties
40.2.6 Assignment of Rights
40.2.7 Defenses to a Bad Faith Claim
40.2.8 Statute of Limitations (Time Limitations)
40.2.9 Damages
40.2.10 Compensatory Damages
40.2.11 Punitive (Exemplary) Damages
40.2.12 Right of Employer to Bring Civil Action Against Insurer for Negligent Claims Handling
40.2.13 Right of Employer to Bring Civil Action Against Insurer for Breach of Implied Covenant of Good Faith and Fair Dealing and Negligence, Based on Claim of Insurer's Misconduct in Analyzing and Reporting Financial Data to Rating Bureau That Results in
40.2.14 Settlement of a Subrogation Claim in a Third-Party Suit for Less Than the Workers' Compensation Insurance Benefits Paid, Where the Settlement Will Result in a Loss to the Insured, may Constitute "Bad Faith"
40.2.15 Duty to Defend
40.3.0 Jurisdiction of the Appeals Board-Exclusivity
40.3.1 Hired or Regularly Employed in California and Injured in or Outside of California
40.3.2 Injuries Occuring Upon Navigable Waters and Adjoining Areas
40.3.2.1 Credit Between California Workers' Compensation Act and Longshore and Harbor Workers' Compensation Act
40.3.2.2 Jones Act
40.3.2.3 Defense Base Act
40.3.2.4 Outer Continental Shelf Lands Act
40.3.3 Hired Outside of California and Injured in California
40.3.4 Concurrent Jurisdiction With Superior Court
40.3.5 Over Insurance Carriers
40.3.5.1 Hired Outside of California and Injured Outside of California
40.3.6 Unfair Competition Law
40.3.7 When is an Appeals Board's Decision Binding?
40.3.8 Small Claims Actions/Court
40.3.9 Full Faith and Credit
40.4.0 Conflicts between the State Laws and Laws of Other Entities
40.5.0 Time Limitations/Statute of Limitations
40.5.1 Normal Injury Benefits
40.5.2 Occupational Disease or Cumulative Injury Benefits
40.5.3 Death Benefits
40.5.4 Serious and Willful Misconduct by Employer
40.5.5 Serious and Willful Misconduct by Employee
40.5.6 Discrimination Under Section 132a
40.5.7 Subsequent Injuries Fund
40.5.8 Minors
40.5.9 Disability Has Either Recurred, Increased, Diminished, or Terminated
40.5.10 New and Further Disability
40.5.11 Estoppel to Raise Defense of Statute of Limitations
40.5.12 Employee Notices
40.5.13 Collateral Estoppel
40.5.13.1 Finding of Fact by a Worker's Compensation Judge has no Collateral Estoppel Effect on a Subsequent Criminal Prosecution
40.5.14 Credit for Third-Party Recovery
40.5.15 Doctrine of Equitable Tolling of Statute of Limitations
40.5.16 Medical Malpractice
40.6.0 Laches
40.7.0 Filing an Application for Adjudication of Claim
40.7.1 Normal Benefits
40.7.2 Application for Normal Benefits on or After January 1, 1994
40.7.3 Representation
40.7.4 Prerequisite to the Filing of an Application
40.7.5 Service
40.7.6 Fee Disclosure Statement
40.7.7 Information Request and Response Forms
40.7.8 Death Benefits
40.7.9 Serious and Willful Misconduct Benefits
40.7.10 Subsequent Injuries Benefits Trust Fund
40.7.11 Petitions and Answers
40.7.12 Where to File
40.7.13 Special Hearing Locations
40.7.14 Board Procedure if Applicant Files at Improper Office
40.7.15 Petition for Change of Venue
40.7.16 Board's Policy and Procedural Manual
40.7.17 Expedited Hearing and Decision
40.7.18 Venue
40.7.19 Minors and Incompetents
40.7.20 Amending Pleadings to Conform to Proof
40.7.21 Answer
40.7.22 Dismissal of an Application for Adjudication of Claim
40.8.0 Discovery
40.8.1 Depositions
40.8.1.1 Contempt for Refusing to Appear or be Sworn
40.8.1.2 Exclusion of Employer at a Deposition
40.8.1.3 Subsequent Deposition
40.8.2 Interrogatories
40.8.3 Videotaping a Deposition
40.8.4 Sexual Harassment, Sexual Assault, or Sexual Battery
40.9.0 Declaration of Readiness to Proceed (DOR)
40.9.1 Walk-Through Calendar
40.9.2 Computer Printout of Benefits Paid
40.9.3 Medical Reports, Medical-Legal Reports, and Medical Records
40.11.0 Mandatory Settlement Conferences
40.12.0 Stipulated Award
40.12.1 Collateral Estoppel Effect of Stipulations Made at the Appeals Board in Other Civil Actions
40.13.0 Compromise and Release Agreements
40.13.1 Discrimination Cases (Labor Code Section 132a)
40.13.2 Occupational Disease or Cumulative Injury Cases
40.13.3 Rehabilitation Cases - Thomas Finding
40.13.4 Effect of an Earlier Compromise and Release on a Subsequent Claim of Injury to the Same Part of an Employee's Body
40.13.5 Subsequent Injury Fund or Serious and Willful Misconduct Cases
40.13.6 Approval and Setting Aside of a Compromise and Release Agreement (Rescission)
40.13.7 Offset of Social Security or Pension Plan Benefits
40.13.8 Procedure in Filing the Compromise Release
40.13.9 May Constitute Filing of a Claim
40.13.10 Public Employees Retirement System; Effect of Settlement on
40.13.11 Right to Petition
40.13.12 Structured Settlements
40.13.12.1 Life Care Plan
40.14.0 Hearing Procedure
40.14.1 Judicial Disqualification
40.14.2 Petition to Disqualify a Judge
40.14.3 Automatic Reassignment Based on the Belief Unable to Get a Fair Hearing from Judge Assigned to the Case
40.14.4 Consolidation of Cases for Hearing
40.14.5 Written Nonmedical Evidence
40.14.6 Written Medical and Other Evidence
40.14.7 Letters of Appointment for Medical-Legal Evaluations
40.14.8 Treating Physician Findings
40.14.9 Agreed or Qualified Medical Evaluator Must Not Accept Referral Gifts and Must Disclose Any Significant Interest in Entities to Whom He or She Refers Patients
40.14.10 X-Rays
40.14.11 Duty to Disclose All Medical Reports
40.14.12 Hospital or Dispensary Records
40.14.13 Patient Access to Health Records
40.14.14 Vocational Experts
40.14.15 Right of the Appeals Board and Judges to Order Employee to Be Examined by a Physician
40.14.16 [Reserved]
40.14.17 Agreed Medical Evaluator (AME)
40.14.18 Subpoenas
40.14.19 Rules of Evidence - Hearsay
40.14.20 Binding Authority of En Banc Decisions and Significant Panel Decisions
40.14.21 Liberal Construction
40.14.22 Providing Benefits Not Due is Not an Admission of Liability
40.14.23 Immigration Status
40.14.24 Presumptions
40.14.25 Compensability of Claim
40.14.26 Rehabilitation
40.14.27 Diseases Incurred by Safety Employees
40.14.28 Permanent Disability
40.14.29 Person Rendering Service
40.14.30 Rendering Service for Which a License Is Required
40.14.31 Physician and Surgeon
40.14.32 Minors
40.14.33 Spouse
40.14.34 Appeals Board Orders
40.14.35 State, Counties, and Cities
40.14.36 Continuing Temporary Disability
40.14.37 Insurance Contracts
40.14.38 Treating Physicians Findings
40.14.39 Burden of Proof
40.14.40 Collateral Estoppel
40.14.41 Judicial Estoppel/Collateral Estoppel/Equitable Estoppel
40.14.42 Res Judicata
40.14.43 Hearing Procedure
40.14.44 [Reserved]
40.14.45 Waiving Right to Appeal
40.14.46 Judge's Decision
40.14.46.1 Common Sense
40.14.47 Judge Has 15 Days to Reconsider Decision
40.14.48 Sanctions for Bad-Faith Actions or Tactics
40.14.48.1 Uninsured Employers Benefits Trust Fund (EUBTF)
40.14.49 Collateral Estoppel
40.14.49.2 Vexatious Litigants
40.14.49.1 Other Requests for Action by the Appeals Board
40.15.0 Costs
40.15.1 Answer to Petition for Writ of Review
40.15.2 Expert Witness
40.15.3 Attorney Fees
40.15.4 Sanctions, Costs and Attorney Fees for Frivolous Actions
40.15.5 Copying Records - Fee Schedule
40.15.6 Copying Board Records - Case File Inspection
40.15.7 Disability Evaluator's Testimony
40.15.8 Interpreter Fees
40.15.9 Medical-Legal Expenses
40.15.10 Notification of Medical-Legal Appointment
40.15.11 Lien Claimant's Right to Due Process
40.15.12 Transcripts
40.15.13 Witness Fees
40.15.14 Peace Officers or Firefighters
40.15.15 Medical Examiners
40.15.16 Deposition Costs
40.15.17 Subpoena Costs
40.15.18 No Employer-Employee Relationship
40.16.0 Appeal a Judge's Decision
40.16.1 Amendment of Judge's Award to Correct Clerical or Mathematical Error
40.16.2 Petition for Reconsideration
40.16.3 Answer to Petition for Reconsideration
40.16.4 Judge or Referee Has 15 Days to Amend, Modify, or Rescind Decision
40.16.5 Petition for Removal of Case from Judge to Appeals Board
40.17.0 Appeals Board's Decision
40.17.1 Sanctions for Bad-Faith Actions or Tactics That are Frivolous
40.18.0 Appeal of an Appeals' Board Decision
40.19.0 Transcript of Testimony
40.20.1 When Does Statutory Time to File Commence to run?
40.20.2 Failure to Attach Exhibits Will Result in Denial of Writ
40.20.3 Must Fairly and Accurately State All Material Evidence on Issues Under Appeal
40.20.4 Must Be Verified
40.20.5 Unpublished Opinions
40.20.6 Written Undertaking Must Be Executed
40.20.7 Substantial Evidence Needed to Support Award
40.21.0 Petition for Hearing at the California Supreme Court
40.22.0 Petition to Reopen Subsequent to a Findings and Award or Order
40.22.1 Remittitur
40.23.0 Awards
40.23.1 Bankruptcy or Insolvency of Employer
40.23.2 Child Support
40.23.3 Community Property Aspect of an Award
40.24.0 Commutation of an Award
40.24.1 Procedure to Request for Commutation
40.24.2 Uninsured Employer
40.24.3 Commutation of Subsequent Injuries Fund Benefits
40.24.4 Reserved
40.25.0 Interest on Awards
40.25.1 Joint Venture
40.26.0 Survival of an Award After Employee's or Dependent's Death
40.27.0 Attachments
40.28.0 Liens
40.28.1 Attorney Fees
40.28.2 Medical Treatment for Injury
40.28.3 Proposal to Reduce Lien Under Labor Code Section 4903.1
40.28.4 Government Agencies' Right to File a Lien
40.28.5 May Be Assigned
40.28.6 Representation of Lien Claimant by Applicant's Attorney
40.28.7 Living Expenses/Temporary Disability Income
40.28.8 Gifts
40.28.9 Burial Expenses of Employee
40.28.9.1 Living Expenses of Family if Employee Deserts Family
40.28.10 Unemployment Compensation Benefits
40.28.11 Unemployment Compensation Disability Benefits
40.28.11.1 Proposal to Reduce Lien of Employment Development Department
40.28.12 Indemnification to Victims of Crimes
40.28.13 Uninsured Employers Benefit Trust Fund
40.28.14 Medi-Cal
40.28.15 Notice Requirement if Medi-Cal Benefits Provided
40.28.16 Contents of Notice
40.28.16.1 First Lien of Medi-Cal
40.28.17 Effect of Settlement without Notice to Director of Health Services
40.28.18 Compromises
40.28.19 Attorney Fees - Medi-Cal Liens
40.28.20 Right to Notice of ADA and FEHA Benefits
50.0 Penalties and Extraordinary Remedies
50.1.0 Increased Compensation for Delay in Providing Benefits - Penalty
50.1.1 Guidelines for Determining Penalties 1779
50.1.2 Burden of Proof 1779
50.1.3 What Constitutes Reasonable Delay - Genuine Doubt from Legal or Medical Point of View as to Liability
50.1.4 Board is Bound by Court of Appeal Finding of No Reasonable Basis for Writ
50.1.5 [Reserved]
50.1.6 [Reserved]
50.1.7 [Reserved]
50.1.8 Delay in Authorization of Treatment, Tests, and/or Consultations
50.1.9 Medical Treatment Payment Delay and/or Failure to Authorize Treatment
50.1.10 Penalty Payable to Employee
50.1.11 Crediting Overpayment Against Award
50.1.12 Credit for Third-Party Recovery Against Benefits Due
50.1.13 Taking Credit for Overpayment of Temporary Disability Against Liability for Permanent Disability
50.1.14 Interest Delay
50.1.15 [Reserved]
50.1.16 Travel Expenses Incurred for Medical Care
50.1.17 Attorney Fees
50.1.18 [Reserved]
50.1.18.1 Delay Due to Failure of Employer to Submit Claim to Insurer
50.1.19 Delay in Paying Compromise and Release Agreement
50.1.20 [Reserved]
50.1.21 Failure to Promptly Pay Death Benefits
50.1.22 Benefits Must be Paid Without Waiting for a Board Award in Most Cases
50.1.22.1 Continuing Jurisdiction of Board to Assess a Penalty
50.1.23 Temporary Disability or Permanent Disability Checks Not Issued on Time
50.1.24 Failure to Pay Permanent Disability Indemnity to Unrepresented Applicant Pursuant to Labor Code Sections 4061 and 4063
50.1.25 Applicant Caused Delay
50.1.26 Failure to Include Temporary Disability in Computing Serious and Willful Misconduct Award Justifies a Penalty
50.1.27 Failure to Pay Correct Temporary Disability Indemnity Rate
50.1.28 Failure to Pay Portion of Death Award
50.1.29 Payment During Pendency of an Appeal - Stay of Execution
50.1.30 Credit Against Third-Party Recoveries
50.1.31 Carrier Ordered to Pay Award Solely Liable for Delay Penalty
50.1.32 Penalty for Paying Indemnity by Means of a Check That is not Immediately Negotiable and Payable Cash
50.1.33 Penalty for Failure to Promptly pay Medical Expenses Necessary to Prove a Contested Claim
50.1.34 Withholding Potential Attorney Fees
50.1.35 California Insurance Guarantee Association Liability (CIGA) - Penalty
50.1.36 [Reserved]
50.1.37 Uninsured Employers Fund
50.1.37.1 Individual Members of Public Agency or Members of a Private Nonprofit Organization
50.1.38 Between Insurers
50.1.39 Penalty Under Labor Code Section 5814 as Amended Effective July 1, 2004
50.1.40 Sanction and Fine for Bad-Faith Actions or Tactics
50.1.40.1 Rehabilitation Program Outside of Workers' Compensation
50.1.40.2 Privileged Communications—Litigation Privilege
50.2.0 Reopening a Case After an Order or Findings and Award has Been Issued by the Appeals Board
50.2.1 On Grounds That the Disability has Recurred, Increased, Diminished, or Terminated
50.2.2 On Grounds That There is Newly Discovered Evidence Showing That a Findings and Award was Inequitable due to an Unavoidable Error of Fac
50.2.3 On Grounds That a Findings and Award was Inequitable due to an Unavoidable Error of Law
50.2.4 To Correct a Clerical Error in an Order or Findings and Award
50.2.5 Petition to Reopen Filed by Unrepresented Employee who was Previously Evaluated by a Panel Evaluator
50.3.0 Additional Actions Against Employer, Co-Employee, or Others
50.3.1 Employer Relieved of Liability if Insurance Carrier Assumes Responsibility for Claim
50.3.2 Co-Employee
50.3.3 Employer Intentionally Inflicts Injury on Employee
50.3.4 False Imprisonment of Employee by Employer
50.3.5 Discrimination on Basis of Sexual Orientation
50.3.6 Disability Discrimination (FEHA) and Americans with Disabilities Act (ADA)
50.3.7 Age Discrimination
50.3.8 Spoliation of Evidence
50.3.9 Tort Claim for Damages Incurred by Fraudulent Inducement of Employee to Relocate, not Within Exclusivity of Workers' Compensation Act
50.3.10 Persons Other Than the Employer or Co-Employees
50.3.11 Employer Removes or Fails to Install a Point of Operation Guard on a Power Press
50.3.12 Who is a Manufacturer?
50.3.13 Discrimination Discharge Under Labor Code Section 132a
50.3.14 Employer Acting in a Dual Capacity
50.3.15 Insurance Carrier Acting in a Dual Capacity
50.3.16 Nonperformance of a Statutory Duty
50.3.17 Action Against an Independent Claims Administrator of a Self-Insured Employer
50.3.18 Actions Against Insurer Under Cartwright Act and/or RICO Act
50.3.19 Action Against Insurer for Malicious Prosecution
50.3.20 Injuries to Unborn Baby as a Result of Injury to Female Employee
50.3.21 Advances on Permanent Disability Indemnity
50.3.22 Aggravation of Disability by Unreasonable Conduct of Injured Employee
50.3.23 Initial Physical Aggressor
50.3.24 Assumption of Risk
50.4.0 Asbestosis
50.4.1 Reserved
50.5.0 Loss of Consortium
60.0 Credits, Offsets and Third Party Recoveries
60.1.0 Credit for Having Advanced Benefits
60.1.1 Temporary Disability Indemnity
60.1.1.1 Determination of Liens for Reimbursement for Benefits Paid or Services Provided - Credit
60.1.2 Permanent Disability Indemnity
60.1.3 Offsets - Setoffs
60.1.3.1 Vacation pay, Sick Leave, Wages, and Fringe Benefits
60.2.0 Recoupment of Overpayments
60.3.0 Offset
60.3.1 Private Disability or Retirement Pension Benefits Against Workers' Compensation Benefits
60.3.2 Social Security Disability Payment Offset
60.4.0 Subrogation
60.4.1 Admissibility of Evidence of Immigration Status in Civil Actions
60.4.2 Non-Negligent Employer
60.4.3 Negligent Employer
60.4.4 Delegation of Duty to Maintain Safe Workplace
60.4.5 Comparative Negligence
60.4.6 No Prohibition against Consideration of Cal-OSHA Regulations in Tort Actions
60.4.7 Interest on Judgment
60.4.8 Credit to Employer Against an Employee's Third-Party Recovery
60.4.9 Injured Employee may Purchase Employer's Lien
60.4.9.1 Loss of Consortium
60.4.10 Negligent Third-Party Cann ot Recover From Employer Absent Written Agreement
60.4.11 Bad-Faith Recovery
60.4.12 Recovery Against Co-Employee
60.4.13 Attorney Fees and Expenses
60.4.14 Credit against Discrimination Liability Under Labor Code Section 132a
60.4.15 Serious and Willful Misconduct
60.4.16 Penalty for Unreasonable Delay in Paying Benefits
60.4.17 Permanent Partial Disability against Permanent Total Disability
60.4.18 Medical Malpractice
60.4.18.1 Offer to Settle
60.4.19 Right of Third Party to Bring an Employer Into an Action by Filing a Cross-Complaint Where the 1944 Employer has Provided Benefits to an Injured Employee but Does not Seek Reimbursement From the Third Party
60.4.20 Liability of a Third Party to Injured Employee and the Workers' Compensation Insurance Carrier if the Third Party Aggravates the Industrial Injury
60.4.21 Right of Insurance Carrier to sue Third Party in Small Claims Court
60.4.22 Liability of Third Party for Noneconomic Damages Attributable to Fault of Employer: Proposition 51
60.4.23 Malpractice Recoveries
60.4.24 Uninsured Motorist Coverage
60.4.25 Fireman's Rule
60.4.26 Vicarious Liability
60.4.27 Liability of Owner of a Vehicle for Negligence of Permissive User
70.0 Insurance, Self-Insurance and Securing Payment for Compensation
70.1.0 Posting Notice of Insurance
70.2.0 Informing Employees of Benefits
70.3.0 Insurance
70.3.1 Workers' Compensation Insurance is Mandatory for all Employers
70.3.2 Restrictions on Power of Insurance Carriers to Cancel an Insurance Policy
70.3.3 Loss Control Consultation Services Must Be Provided Free, by Insurers, to High Risk Employers
70.3.4 Insurers Duty to Conduct a Review of Certain Employer's Injury and Illness Prevention Program
70.3.5 Insurance Commissioner Must Establish and Maintain an Internet Website Showing Rates of top Fifty Insurers
70.3.6 Insurers Must Advise Policyholders of Rating Laws
70.3.6.1 Fair Procedure Doctrine
70.3.7 Audits and Penalties
70.3.8 Certification of Claim Adjusting Personnel
70.3.9 Civil Penalties
70.3.10 Coverage for Owners of a Business
70.3.11 Employers Cannot Pass Costs of Insurance on to Employees
70.3.12 Self-Insurance
70.3.13 Claim File Maintenance
70.3.14 Duty to Disclose Insurance Status
70.3.15 Excess Insurance
70.4.0 Uninsured Employers, Consequences of?
70.4.1 Uninsured Employers Benefits Trust Fund (UEBTF)
70.4.1.1 Legal Representative for the Director is the Attorney General
70.4.1.2 Service of Process
70.4.1.3 Employer Identification
70.4.1.4 Cooperation of the Uninsured Employers Benefit Trust Fund
70.4.1.4.1 Failure to Comply
70.4.2 Special Hearing Locations
70.4.3 Bankruptcy of Employer
70.4.3.1 Award of Reasonable Attorney Fees
70.4.4 Liability for Penalty and/or Interest
70.4.4.1 Not Liable for Penalties
70.5.0 Means of Securing Payment of Compensation
70.5.1 Deductible Policies
70.5.2 Non-Renewal of Policies
70.5.3 Election to be Subject to Compensation Liability
70.5.4 Appeals
70.5.4.1 Failure to Insure
70.5.5 Employer Cannot Require Employees to Contribute to Workers' Compensation Cost
70.5.6 Whistleblower Hotline
70.6.0 Safety Programs for High Hazardous Industries
70.7.0 Injury Prevention Program
70.8.0 California Insurance Guarantee Association (CIGA)
70.8.1 General Obligations and Liability of California Insurance Guarantee Association
70.8.3 Liability of California Insurance Guarantee Association for Specific Injuries
70.8.3.1 Multiple and Successive Specific Injuries
70.8.3.2 General-Special Employment Relationship That May Involve CIGA
70.8.3.3 Other Forms of Insurance Available to the Injured Worker
70.8.3.3.1 Uninsured Motorist Insurance
70.8.3.4 CIGA Liability for and Liens of Employment Development Department (EDD)
70.8.3.5 Liability of CIGA for Reimbursement to a Solvent Insurer
70.8.3.6 Contribution
70.8.3.7 Credit
70.8.3.8 Assigned Liens Not Covered Unless Only for Collection Purposes
70.8.3.9 Time Limitations to Seek Reimbursement/Contribution
70.8.3.10 Penalties
70.8.3.10.1 Duty to Defend an Employee's Civil Action
70.8.3.10.2 Longshore and Harbor Workers' Compensation Act Claim
70.8.3.10.3 Changing Administrators
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Preface

Category: 1. California Workers' Compensation Claims and Benefits
Last Updated on 03 August 2020
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The state of California has, over the years, enacted laws establishing programs designed to alleviate the hardships experienced by workers of this state in times of distress. These programs are structured in such a way as to render assistance expeditiously, inexpensively, and without encumbrance of any nature, with the goal of reducing to a minimum the suffering caused to workers in certain situations.

The distress toward which a certain body of these laws is directed is that which may be visited upon a worker and, in many cases, upon his or her family, when he or she becomes unable to work and needs an income and/or is in need of medical care due to an on-the-job injury. Assistance for such a worker or his or her family comes from the Workers’ Compensation Insurance Program.

This book is a concise and realistic explanation of the Workers’ Compensation Insurance Program and designed in such a way as to introduce the reader to the basic provisions of the program by use of extensive quotes from the Labor Code, Regulations and Case Law.

To more readily assist our readers, we have produced a separate book for the State Disability Insurance program, the Unemployment Insurance program, and the Paid Family Leave.

Case citations have been carefully selected and those that are given are not always intended to constitute authority for, or against, the conclusions drawn or the analysis given, but may be intended to refer the reader to an authority that discusses the general subject matter or the specific subject of analysis in more detail.

If the reader is using cases cited in this book to support a Petition for a Writ of Review, or Petition to the Supreme Court, it is important to check the official cases to be certain that they are still “published”. “Unpublished” California Court of Appeal cases cited in this book may not be cited in any action or proceeding before an Appellate Court, except where the opinion is relevant under the doctrines of "law of the case", "res judicata", or "collateral estoppel" or where the opinion is relevant to a criminal or disciplinary action because it states reasons for a decision affecting the same defendant or respondent in another such action. Cases cited as published, unpublished, or writ denied in this book may be changed by subsequent actions and therefore it is imperative that the reader shepardize before citing.

In explaining when an unpublished California case may be cited, the Appeals Court, Second District in Reynaud et al., v. Technicolor Creative Services, USA, Inc. (2020) 85 Cal.Comp.Cases 281 (Published), stated, in part:
Although we may not rely on unpublished California cases, the California Rules of Court do not prohibit citation to unpublished federal cases, which may properly be cited as persuasive, although not binding, authority. [Citations.] (Airline Pilots Assn. Internat. v. United Airlines, Inc. (2014) 223 Cal.App.4th 706, 724, fn. 7 [167 Cal.Rptr.3d 467]; see also Cal. Rules of Court, rule 8.1115(a); Fed. Rules App.Proc., rule 32.1(a), 28 U.S.C.; U.S. Cir. Ct. Rules (10th Cir.), rule 32.1(b)(A).)....

In 1964, the California Supreme Court ordered Courts of Appeal to designate which of its opinions were to be deemed "published" and which were to be deemed "unpublished". This rule was intended to relieve attorneys from the burden of researching thousands of Appellate Court decisions each year that neither interpreted new law nor involved legal issues of continuing public interest.

Then effective January 1, 1974, the California Supreme Court and the State Judicial Council ruled that "unpublished" opinions of the Courts of Appeal or opinions of a Department of a Superior Court could not be cited in Court proceedings, by a Court or a party in any other action or proceeding except when the opinion was relevant under the doctrine of the case, res judicata, or collateral estoppel, or in a criminal action or proceeding involving the same defendant or a disciplinary action or proceeding involving the same respondent.

California Rules of Court, section 8.1115(a)-(d) provides:

Rule 8.1115. Citation of opinions

(a) Unpublished opinion

Except as provided in (b), an opinion of a California Court of Appeal or superior court appellate division that is not certified for publication or ordered published must not be cited or relied on by a court or a party in any other action.

(b) Exceptions

An unpublished opinion may be cited or relied on:

(1) When the opinion is relevant under the doctrines of law of the case, res judicata, or collateral estoppel; or

(2) When the opinion is relevant to a criminal or disciplinary action because it states reasons for a decision affecting the same defendant or respondent in another such action.

(Subd (b) amended effective January 1, 2007.)

(c) Citation procedure

On request of the court or a party, a copy of an opinion citable under (b) must be promptly furnished to the court or the requesting party.

(Subd (c) amended effective July 1, 2016.)

(d) When a published opinion may be cited

 A published California opinion may be cited or relied on as soon as it is certified for publication or ordered published. See also 40.14.43 of this book for further discussion.

This prohibition applies even though the cases may be available in print in LexisNexis California Workers' Compensation Cases. See California Rules of Court, above. However, although cases denied Writ of Review, as well as Board En Banc, and Panel decisions, have no "stare decisis" effect at Appellate Courts, they are, in very limited circumstances, citable authority as to the holding of the Appeals Board. This is consistent with the well-established principle that "contemporaneous administrative construction" of a statute by the agency charged with its enforcement and interpretation, while not necessarily controlling, is of great weight, and Courts will not depart from such an Appeals Board construction unless it is clearly erroneous or unauthorized. (Smith v. W.C.A.B (2000) 65 Cal.Comp.Cases 277 (Published), First District; Ralph’s Grocery Co. v. W.C.A.B. (1995) 60 Cal.Comp.Cases 840 (Published); and Tenet/Centinela Hospital Center v. W.C.A.B. (Rushing) (2000) 65 Cal.Comp.Cases 477 (Published).) However, when cited to a Court, they are of limited value and the reader should advise the court as to the reason for the citation.

In Smith, supra, the Court stated, in part:

In this case the parties rely on an unpublished, hence not citable, court decision from Division Four of this court and a 30-year-old divided Board panel decision, Paul v. Glidden-Durkee, supra, 35 Cal.Comp.Cases 273. These two cases, the parties assert, come to opposite conclusions on the self-inflicted injury issue. We note that Court of Appeal opinions which are not published in the official reports, even though available in print in the California Compensation Cases (Cal.Comp.Cases), may not be cited or relied upon in the reviewing court. (Cal. Rules of Court, rule 977 Deering's].) On the other hand, Board panel decisions and denials of petitions for writ of review reported in the California Compensation Cases and in the California Workers' Compensation Reporter (Cal. Workers'Comp.Rptr.), along with occasional Board denials of petitions for reconsideration also reported periodically in the latter publication, are properly citable authority, but only to the extent that they point out the contemporaneous interpretation and -- application of the workers' compensation laws by the Board. (Ralphs Grocery Co. v. Workers' Comp. Appeals Bd (1995) 38 Cal.App.4th 820, 827, fn. 7 [45 Cal. Rptr. 2d 197, 60 Cal. Comp. Cases 840].) This is consistent with "the well-established principle that contemporaneous administrative construction of a statute by the agency charged with its enforcement and interpretation, while not necessarily controlling, is of great weight and courts will not depart from such construction unless it is clearly erroneous or unauthorized." (Industrial Indemnity Co. v. Workers' Comp. Appeals Bd. (1985) 165 Cal.App.3d 633, 638 [211 Cal. Rptr. 683, 50 Cal. Comp. Cases 171] accord, Griffith v. Workers' Comp. Appeals Bd (1989) 209 Cal.App.3d 1260, 1264 & fn. 2 [257 Cal. Rptr. 813, 54 Cal. Comp. Cases 145].) Although we encourage citation of these cases, we emphasize that they are of limited precedential value and unquestionably have no stare decisis effect in an appellate court (Ralphs Grocery Co., supra, 38 Cal.App.4th at p. 827, fn. 7.)...

The above rules in no way limits the citing of any decision to a Workers' Compensation Judge or the Appeals Board.

However, in Woodward v. Tri Corp. Construction (2014) 2014 Cal.Wrk.Comp. P.D. LEXIS 104 (Panel Decision), the Board panel observed that although parties generally should not cite an unpublished Court of Appeal decision in a Petition for Reconsideration or Answer or other communications with the Judge or Board, counsel may cite such decisions if they indicate they are not citing the case as authority. Counsel may inform a Jude or Board panel that while counsel acknowledges that unpublished decisions are not binding on anyone, other than the parties in that case, counsel is offering the unpublished decision for consideration of the argument made by the successful counsel in the unpublished decision.

In Cubeudo v. Leemar Enterprises, Inc. et al,. 2011.Cal.Wrk.Comp.P.D. Lexis 356 (Panel Decision), the three Commissioners reprimanded the Workers Compensation Administrative Law Judge for supporting his decision by relying upon an unpublished Court of Appeal case.

California Rules of Court, Rule 8.1115 provides that a published California opinion may be cited or relied upon as soon as it is certified for publication or ordered published.

Almost all Appeals Board "En Banc" decisions are cited throughout this book. Once the Board, by majority vote, declares a decision "En Banc", that decision is binding on panels of the Appeals Board and Workers' Compensation Judges as legal precedent under "stare decisis." See Title 8 of the California Code of Regulations, section 10341 and Labor code sections 133 and 5307.

In July 1997, the Appeals Board created a "hybrid" decision called a Significant Panel Decision (SPD). The Board's Chairperson, at that time, stated that the Board was designating certain cases as SPDs because they deal with significant legal issues about which there is little or no published case law. This concept was further explained in Larch v. W.C.A.B (1999) 64 Cal.Comp.Cases 1098 (Writ Denied), where the Court, stated, in part:

Although each significant panel decision is signed by its three panel members, each significant panel decision must be reviewed by all Board members and all Board members must concur that the decision is significant and that it merits general dissemination to the workers' compensation community. Finally, the Board and its staff make a particular effort to ensure that its significant panel decisions are thoroughly deliberated and carefully researched....

However, SPD decisions are not binding precedent as are Board "En Banc" decisions on panels of the Appeals Board and Workers' Compensation Judges.

Citations from the California Workers’ Compensation Reporter are now included inasmuch as the Reporter is a properly citable authority, especially as an indication of contemporaneous interpretation and application of workers’ compensation law by the Appeals Board and any of it's three panel Commissioners. See Griffith v. W.C.A.B. (1989) 54 Cal.Comp.Cases 145, Second District (Published).

Persons citing the above sources should be careful to check to make certain that a particular case being cited has not been reversed or amended on higher appeal.

Further, LexisNexis now publishes what it calls "Noteworthy Panel Decisions" which are other panel decisions it feels makes a contribution to the body of law available to attorneys, claims personnel, Judges and the Appeals Board, and others seeking to understand the Workers' Compensation laws of California. Many of these cases are cited throughout the book. Do not confuse these "Noteworthy Panel Decisions" with cases with "Significant Panel Decisions" or the cases reported in the "California Workers' Compensation Reporter."

The reader should be aware that ever since this program was enacted in 1917 the Legislator has time and again changed the law in various ways and attention must be paid as to whether a particular change applies to all claims regardless of date of injury or only to claims filed after the particular change was made by the Legislator.

For example, effective 1/1/2013 the Legislators made massive changes in this law when they enacted Senate Bill 863.

In Section 84 of SB 863 the Legislator stated, "This act shall apply to all pending matters, regardless of date of injury, unless otherwise specified in this act, but shall not be a basis to rescind, alter, amend, or reopen any final award of workers' compensation benefits."

I have continued my initial goal, in this thirteenth edition of setting forth sufficient facts and language used in leading cases from the California Supreme Court, Court of Appeals, and Workers’ Compensation Appeals Board, so that rarely will the reader have to seek out the case itself to fully understand the reasoning of the Court or Board.

Realizing that in certain instances the reader must have the precise language of a Labor Code Section or Regulation at hand, we have added throughout this book direct quotes from these sources. Further, we have added for the convenience of the reader, the complete Labor Code sections pertaining to Workers’ Compensation, the Regulations adopted by the Division of Workers’ Compensation, and the Workers’ Compensation Appeals Board in the Appendix.

Finally, I hope I have succeeded in my goal of sorting out and bringing to our readers’ attention those endless laws, regulations and cases of which we all must be aware in the field of Workers’ Compensation.

To sort out is not enough. I hope I have placed the cases, codes and regulations in those places you will logically look to see if there is law on the issue under study.

-David W. O’Brien, Esq.

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California Workers' Compensation Claims and Benefits