Loading (50 kb)...'
(continued)
Title: Jane Doe vs. ABC Co Number: Alameda County No 3 76052
Title: Number:
Title: Number:
Title: Number:
Title: Number:
Title: Number:
Title: Number:
Title: Number:
Title: Number:
Title: Number:
Note: If there are more civil actions, attach additional sheets with the required information.
48. The number of injuries and illnesses reported in the previous calendar year on the United States Department of Labor OSHA Form No. 300 for those employees covered by the Section 3201.5 or 3201.7 provision:
49. The number of employees covered by the Section 3201.5 or 3201.7 provision who participated in vocational rehabilitation:
50. The number of employees covered by the Section 3201.5 or 3201.7 provision who participated in a light duty program or modified return to work programs established under Section 3201.5 or 3201.7:
51. For an employer, or group of employers, who is covered by a 3201.7 provision, please provide an employee survey that measures worker satisfaction with the applicable 3201.7 alternative dispute resolution procedures. The survey shall be designed and administered by agreement between the employer and the union.
52. Please attach any explanatory material, narrative account or comment that you believe would enable the Division to understand your response(s).
Programs are encouraged to submit updated information covering prior calendar year claims reported to Division of Workers' Compensation.
DWC Form GV-1 (012004)
Note: Authority cited: Sections 133 and 5307.3, Labor Code. Reference: Sections 3201.5, 3201.7 and 3201.9, Labor Code.
s 10203.2. Individual Employer Annual Report (DWC Form GV-2).
STATE OF CALIFORNIA Department of Industrial Relations Division of Workers'
Compensation Administrative Director Post Office Box 420603 San Francisco, CA
94142 Telephone: (415) 703-4600
Individual Employer Annual Report Labor Code ss 3201.5 and 3201.7;
Title 8, California Code of Regulations s 10203
For the 12 month period ending December 31, 20__.
The following information is being obtained by the Administrative Director pursuant to Labor Code ss 3201.5 and 3201.7, and Title 8, California Code of Regulations Section 10203. An individual employer who is participating in a Section 3201.5 or 3201.7 program with a group of employers shall provide the information requested in this form to the administrator of the Section 3201.5 or 3201.7 program, or the contact person or persons identified in Title 8, California Code of Regulations s 10201(a)(1)(D) and (2)(B) or s10202(d)(1)(C) or (2)(B). The information provided to the program shall be confidential and not subject to public disclosure under any law of this state. However, the Division of Workers' Compensation may create derivative works based on collective bargaining agreements and data. Those derivative works shall not be confidential, but shall be public. The information provided by the employer shall be maintained by the administrator of the program and is available for inspection by the Administrative Director upon reasonable written request.
Name of Program: Statute Authorizing Program (circle one): 3201.5 - Construction 3201.7 - Other
1. Employer Information. Name: FEIN: Principal business of employer (please circle one or more): 3201.5: construction construction maintenance rock, sand, gravel, cement and asphalt operations heavy-duty mechanics surveying construction inspection 3201.7: education and health services financial activities government information leisure and hospitality manufacturing natural resources and mining professional and business services transportation and utilities wholesale and retail trade other (specify)
2. Name of union participating in the Section 3201.5 or 3201.7 agreement:
3. Dates that the Section 3201.5 or 3201.7 provision was in effect during the previous calendar year: Beginning date: Ending date:
4. Name of insurer:
5. Insurance policy number:
5a. If an employer is legally self-insured under authority of the Department of Industrial Relations' Office of Self-Insurance Plans, list certificate number and name:
6. Attach payroll in accordance with the rules of the Workers' Compensation Insurance Rating Bureau (WCIRB). Payroll shall be reported by class code as set by the WCIRB and provided in table format.
7. Total person hours worked by covered employees, indicate by trade or craft:
Trade: Person Hours:
Trade: Person Hours:
Trade: Person Hours:
(Note: If there are more trades represented, attach additional sheets with the required information on person hours worked.)
DWC Form GV-2 (012004)
Questions 8 through 27 apply to claims filed in the previous calendar year pursuant to Labor Code ss 5401 or 5402. For claims with a date of injury on or after January 1, 2003, the information reported shall be for the year in which the claim was filed, and the subsequent calendar years until the claim is resolved. However, information from no more than four calendar years (including the year the claim was filed) shall be reported on each claim.
8. Number of claims that were medical only:
9. Total amount of paid costs for medical only claims:
10. Total amount of incurred costs for medical only claims:
11. Number of claims that included a claim for indemnity:
12. Total amount of paid temporary disability for indemnity claims:
13. Total amount of incurred temporary disability for indemnity claims:
14. Total amount of paid permanent disability for indemnity claims:
15. Total amount of incurred permanent disability for indemnity claims:
16. Total amount of paid life pensions for indemnity claims:
17. Total amount of incurred life pensions for indemnity claims:
18. Total amount of paid death benefits for indemnity claims:
19. Total amount of incurred death benefits for indemnity claims:
20. Total amount of paid vocational rehabilitation for indemnity claims:
21. Total amount of incurred vocational rehabilitation for indemnity claims:
22. Total amount of paid medical services for indemnity claims:
23. Total amount of incurred medical services for indemnity claims:
24. Total amount of paid medical legal expenses for indemnity claims:
25. Total amount of incurred medical legal expenses for indemnity claims:
26. Number of claims that were resolved (resolved means one in which ultimate liability has been determined, even though payments may be made beyond the reporting period):
27. Number of claims that remained unresolved: Note: The numbers in questions 26 and 27 added together should equal the summation of the number of medical only claims (question 8) and indemnity claims (question 11).
28. The number of claims that were resolved with a denial of compensability:
29. The number of claims that were resolved before mediation:
30. The number of claims that were resolved at or after mediation:
31. The number of claims that were resolved at or after arbitration. Note: For employers who utilize a alternative dispute resolution system that includes resolution procedures in addition to or in place of mediation and/or arbitration, please identify on an attachment each resolution procedure used and the number of claims that were resolved using that procedure.
32. The number of claims that were resolved at or after the Workers' Compensation Appeals Board (WCAB):
33. The number of claims that were resolved at or after the court of appeals:
34. Provide the title and number of every application filed with the WCAB during the previous calendar year concerning the claim alleged by any party to fall within the Section 3201.5 or 3201.7 provision, regardless of whether the employee had the right to file such a application (example in italics):
Title: Jane Doe vs. ABC Co Number: SFO 0123456
Title: Number:
If there are more applications, attach additional sheetswith the required information.
35. Provide the title and court number of every civil action, including petitions for writs and injunctions in any court, state or federal, filed in the previous calendar year, that concerned a claim alleged by any party to fall within the Section 3201.5 or 3201.7 provision (example in italics):
DWC Form GV-2 (012004)
Title: Jane Doe vs. ABC Co Number: Alameda County No 3 76052
Title: Number:
Note: If there are more civil actions, attach additional sheets with the required information.
36. The number of injuries and illnesses reported in the previous calendar year on the United States Department of Labor OSHA Form No. 300 for those employees covered by the Section 3201.5 or 3201.7 provision:
37. The number of employees covered by the Section 3201.5 or 3201.7 provision who participated in vocational rehabilitation:
38. The number of employees covered by the Section 3201.5 or 3201.7 provision who participated in a light duty program or modified return to work programs established under Section 3201.5 or 3201.7:
39. For an employer who is covered by a 3201.7 provision, please provide an employee survey that measures worker satisfaction with the applicable 3201.7 alternative dispute resolution procedures. The survey shall be designed and administered by agreement between the employer and the union.
40. Please attach any explanatory material, narrative account or comment that you believe would enable the Division to understand your response(s).
Programs are encouraged to submit updated information covering prior calendar year claims reported to Division of Workers' Compensation.
DWC Form GV-2 (012004)
Note: Authority cited: Sections 133 and 5307.3, Labor Code. Reference: Sections 3201.5, 3201.7 and 3201.9, Labor Code.
s 10204. Annual Reports.
(a) On or before March 31 of every year, the parties covered by the 3201.5 or 3201.7 provision shall submit updated copies of the documents and other evidence required by Section 10201 or Section 10202. However, if certain documents and other evidence are completely unchanged since the previous submission, the party responsible for submitting the annual update may instead submit a statement under penalty of perjury that there has been no change in the document or evidence since the previous submission. The Administrative Director may nonetheless require any party to submit the actual documents or evidence.
(b) If the parties have not submitted the updated documents required by this section, or if the employer has not timely submitted the data required by Section 10203 the Administrative Director may, after notice and an opportunity to respond, either: (1) revoke a letter of eligibility issued pursuant to Labor Code section 3201.5; (2) revoke the recognition given to the labor-management agreement negotiated pursuant to Labor Code section 3201.7; or (3) take such other steps as he or she deems necessary to secure the parties' compliance with reporting requirements.
Note: Authority cited: Sections 133, 3201.5 and 5307.3, Labor Code. Reference: Sections 3201.5, 3201.7 and 3201.9, Labor Code.
s 10250. Payment of Medical Provider and Medical-Legal Lien Claimant Initial Lien Filing Fees.
(a) At the time of filing of the initial lien in each case, every medical provider or medical-legal lien claimant, except the Veterans Administration, the Medi-Cal program, or a public hospital, shall be responsible for payment of the initial lien filing fee required of providers by Labor Code Section 4903.05. For purposes of this section, the term "initial lien" means any lien filed in a case on or after January 1, 2004 by a lien claimant who has not previously filed a lien in the same or in any related case. When the medical provider or medical-legal lien claimant files a single initial lien in more than one related case involving the same employee or dependent, only a single filing fee shall be required. For purposes of this section, a case shall be deemed related if the case alleges injury to the same or substantially same body parts.
(b) When filing the initial lien in writing, the medical provider or medical-legal lien claimant shall submit a check or money order in the amount of one hundred dollars ($100), made payable to "DWC Revolving Fund." The check or money order for the filing fee shall be attached to the front of the lien form and shall contain the words "lien filing fee" and the Workers' Compensation Appeals Board case number, if available, in the memo section of the check or money order.
(c) If no application exists for the employee at the time of the initial lien filing, the lien claimant must file any necessary application(s) together with the lien. When the medical provider or medical-legal lien claimant files the application, the filing fee required by Labor Code Section 4903.05 shall be submitted together with the application. In such cases, the WCAB case number shall be filled in by the WCAB on the check or money order at such time as the case number is assigned. If the lien claimant wishes to receive a conformed copy of the application, the lien claimant shall submit a postage paid, pre-addressed return envelope together with the application(s).
(d) When the medical provider or medical-legal lien claimant files liens in written form in more than one case at the same time, the filing fees for each lien may be paid with a single check or money order by attaching a list of the available WCAB case numbers for the cases in which the filing fees are paid to the check covering those cases. If the list includes cases in which the lien claimant is filing an application together with the lien, the lien claimant shall provide the name of the employee, the employee's social security number, and the date(s) of injury on the list instead of a WCAB case number. A single list may include existing cases and cases where the lien claimant is filing the application.
(e) No initial lien, filed in writing, shall be accepted for filing on or after January 1, 2004 unless accompanied by full payment for the filing fee required by Labor Code Section 4903.05. Any initial lien delivered for filing on or after January 1, 2004 without payment of the initial lien filing fee shall be discarded without notice to the party submitting it, unless a postage paid, pre-addressed return envelope is submitted with the lien. Until receipt of proper payment, the lien shall not be deemed to have been received or filed for any purpose.
(f) A medical provider or medical-legal lien claimant shall be billed on a monthly basis for all liens filed electronically through the EDEX system, or as otherwise designated by DWC, in the preceding month. Within 30 calendar days of receipt of the billing, the medical provider or medical-legal lien claimant shall submit a check or money order for the total filing fee billed. The check or money order, made payable to "DWC Revolving Fund," shall be submitted to:
lien filing fee payment unit division of workers' compensation p.o. box 420603 san francisco, ca 94142-0603
(g) The WCAB will not order or enforce payment of any medical treatment or medical-legal lien filed on or after January 1, 2004 without prior payment of the filing fee required by Labor Code Section 4903.05.
(h) When the attorney for the employee or dependent or any assignee of the lien claimant files the initial medical or medical-legal lien, that filing shall be deemed to have been made by an agent for the medical provider or medical-legal lien claimant and payment of the filing fee required by Labor Code Section 4903.05 shall be required of the filing party as if the lien had been filed directly by the medical provider or medical-legal lien claimant.
Note: Authority cited: Section 4903.05, Labor Code. Reference: Sections 4903.05 and 5307, Labor Code.
s 10300. Adoption, Amendment or Rescission of Rules.
Notices required by Labor Code Sections 5307 and 5307.4 shall be served by the Appeals Board by regular mail, fax, electronic mail or any similar technology, not less than thirty (30) days prior to the date of hearing on those who have on file with the Secretary of the Workers' Compensation Appeals Board in San Francisco a written request for notification. Notice of action taken shall be served on the same persons by regular mail within thirty (30) days following the filing of any order pertaining to the rules with the Secretary of State.
Note: Authority cited: Section 5307, Labor Code. Reference: Section 5307.4, Labor Code.
s 10301. Definitions.
As used in this chapter:
(a) "Administrative Director" means the Administrative Director of the Division of Workers' Compensation.
(b) "Appeals Board" means the commissioners and deputy commissioners of the Workers' Compensation Appeals Board acting en banc or in panels.
(c) "Applicant" means any person asserting a right to relief under the provisions of Labor Code Section 5300.
(d) "Application for Adjudication" or "application" means the initial pleading that asserts a right to relief under the provisions of Labor Code Section 5300.
(e) "Declaration of Readiness to Proceed" or "Declaration of Readiness" means a request for a proceeding before the Workers' Compensation Appeals Board.
(f) "Declaration of Readiness to Proceed to Expedited Hearing" means a request for a proceeding before the Workers' Compensation Appeals Board pursuant to Labor Code section 5502(b).
(g) "Defendant" means any person against whom a right to relief is claimed.
(h) To "file" a document means to deliver the document or cause it to be delivered to the Workers' Compensation Appeals Board district office with venue or to the Appeals Board for the purpose of having it included in the Workers' Compensation Appeals Board case file.
(i) "Hearing" means any trial, mandatory settlement conference, rating mandatory settlement conference, status conference, or priority conference.
(j) "Lien claimant" means any person claiming payment under the provisions of Labor Code section 4903 or 4903.1.
(k) "Mandatory settlement conference" means a proceeding before the Workers' Compensation Appeals Board to assist the parties in resolving their dispute or, if the dispute cannot be resolved, to frame the issues and stipulations in preparation for a trial.
(l) "Party" means an Applicant or Defendant, or a lien claimant where the applicant's case has been settled by way of a compromise and release, or where the applicant chooses not to proceed with his or her case.
(m) "Petition" means any request for action by the Workers' Compensation Appeals Board other than an Application for Adjudication, an Answer or a Declaration of Readiness to Proceed.
(n) "Priority conference" means a proceeding before the Workers' Compensation Appeals Board in which the applicant is represented by an attorney and the issues in dispute at the time of the proceeding include employment and/or injury arising out of and in the course of employment.
(o) "Rating mandatory settlement conference" means a mandatory settlement conference conducted to facilitate determination of the existence and extent of permanent disability through the use of informal ratings issued by the Disability Evaluation Unit, where the only unresolved issues are permanent disability and the need for future medical treatment.
(p) "Record of proceedings" means the pleadings, Declaration of Readiness to Proceed, minutes of hearings and summary of evidence, transcripts, if prepared and filed, proof of service, evidence received in the course of a proceeding, exhibits marked but not received into evidence, notices, petitions, briefs, findings, orders, decisions and awards, and arbitrator's file, if any.
(q) "Regular hearing" means a trial.
(r) To "serve" a document means to personally deliver a copy of the document, or send it in a manner permitted by these rules, to a party, lien claimant, or attorney who is entitled to a copy of the document.
(s) "Status conference" means a proceeding set for the purpose of ascertaining if there are genuine disputes requiring resolution by the Workers' Compensation Appeals Board, of providing assistance to the parties in resolving disputes, of narrowing the issues, and of facilitating preparation and trial if a trial is necessary. A status conference includes a lien conference.
(t) "Submission" means the closing of the record to the receipt of further evidence or argument.
(u) "Trial" means a proceeding set for the purpose of receiving evidence.
(v) "Workers' Compensation Appeals Board" means the Appeals Board, commissioners, deputy commissioners, presiding workers' compensation judges and workers' compensation judges.
Note: Authority cited: Sections 133 and 5307, Labor Code.
s 10302. Working Title of Referees and Referees in Charge.
The Appeals Board hereby declares its intent that the working or organization titles of "referee" and "referee in charge" shall be respectively "workers' compensation judge" and "presiding workers' compensation judge."
Note: Authority cited: Section 5307, Labor Code. Reference: Sections 123.5, 5309, 5310, 5312, Labor Code.
s 10304. Article and Section Headings.
Article and section headings shall not be deemed to limit or modify the meaning or intent of the provisions of any section hereof.
Note: Authority cited: Sections 133, 5307, Labor Code. Reference: Sections 133, 5307, Labor Code.
s 10306. Case Names.
Each case shall be filed in the database of the Division of Workers' Compensation under the name of the person claimed to have been injured, whether or not that person is an applicant. Reference to the case shall be by the name of the injured person and the Workers' Compensation Appeals Board case number.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 126, Labor Code.
s 10308. Official Address Record.
The Workers' Compensation Appeals Board shall maintain in each case file an official address record, which shall contain the names and addresses of all parties and lien claimants, and their attorneys or agents of record.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 126, Labor Code.
s 10322. Workers' Compensation Appeals Board Records Not Subject to Subpoena.
The records, files and proceedings of the Workers' Compensation Appeals Board shall not be taken from its offices either on informal request or in response to a subpoena duces tecum or any order issued out of any other court or tribunal. Except as precluded by Civil Code Section 1798.24, or Government Code Section 6254, certified copies of portions of the records desired by litigants shall be delivered upon payment of fees as provided in the Rules of the Administrative Director.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 127, 5811, Labor Code.
s 10324. Ex Parte Communications.
No document, including letters or other writings, shall be filed by a party or lien claimant with the Workers' Compensation Appeals Board unless service of a copy thereof is made on all parties together with the filing of proof of service as provided for in Rule 10514. No party or lien claimant shall discuss with the Appeals Board or a workers' compensation judge the merits of any case pending before the Appeals Board or that judge without the presence of all necessary parties to the proceeding, except as provided by these rules.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 5708, Labor Code.
s 10340. Appeals Board Decisions and Orders.
In accordance with Labor Code Section 115, the following orders, decisions and awards shall be issued only by the Appeals Board:
(a) All orders dismissing, denying and granting petitions for reconsideration and decisions thereon.
(b) All decisions that terminate proceedings on reconsideration, including, but not limited to, findings, orders, awards, orders approving or disapproving compromise and release, orders allowing or disallowing liens, and orders for dismissal.
(c) All orders, including interim and interlocutory orders, made after reconsideration has been granted and while proceedings are pending on reconsideration, including but not limited to, orders taking off calendar, orders joining or dismissing parties, and orders allowing or disallowing liens. Unless otherwise instructed by the Appeals Board, the authority of the workers' compensation judge to whom a case has been referred for proceedings on reconsideration is as set out in Section 10862 of these Rules.
(d) Except for sanctions and contempt, orders in disciplinary proceedings against attorneys or other agents.
(e) Decisions on remittitur.
(f) Orders disqualifying a workers' compensation judge under Labor Code Section 5311.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 115, 5311, Labor Code.
s 10341. En Banc Decisions.
En banc decisions of the Appeals Board are binding on panels of the Appeals Board and workers' compensation judges as legal precedent under the principle of stare decisis.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 115, Labor Code.
s 10342. Appeals Board, Member Orders.
The following orders may be issued only by the Appeals Board or a member thereof:
(a) approving undertakings on stays of proceedings on reconsideration and petitions for writ of review; and
(b) directing exhumation or autopsy.
Note: Authority cited: Sections 133, 5307, Labor Code. Reference: Sections 115, 5706, 5707 and 6002, Labor Code.
s 10344. Appeals Board, Commissioner, Deputy Commissioner and Presiding Workers' Compensation Judge Orders.
The following may be issued only by the Appeals Board, a commissioner, a deputy commissioner or a presiding workers' compensation judge:
(a) orders issuing certified copies of orders, decisions or awards except that a certified copy may be issued by a presiding workers' compensation judge only if the time for seeking reconsideration and judicial review has expired, and no proceedings are pending on reconsideration or judicial review;
(b) orders staying, quashing and recalling writs of execution and fixing and approving undertaking thereon;
(c) orders directing entry of satisfaction of judgment; and
(d) orders issuing, recalling, quashing, discharging and staying writs of attachment and fixing and approving undertakings thereon.
Note: Authority cited: Sections 133, 5307, Labor Code. Reference: Sections 6000, 6001 and 6002, Labor Code.
s 10346. Assignment or Transfer of Cases.
(a) The presiding workers' compensation judge has full responsibility for the assignment of cases to the workers' compensation judges of each office. The presiding workers' compensation judge shall transfer to another workers' compensation judge the proceedings on any case in the event of the death, extended absence, unavailability, or disqualification of the workers' compensation judge to whom it has been assigned, and may otherwise reassign those cases if no oral testimony has been received therein, or if the requirements of Labor Code Section 5700 have been waived. To the extent practicable and fair, supplemental proceedings shall be assigned to the workers' compensation judge who heard the original proceedings.
Any conflict that may arise between presiding workers' compensation judges of different offices respecting assignment of a case, venue, or priority of hearing where there is conflict in calendar settings will be resolved by a deputy commissioner of the Appeals Board.
(b) If a compromise and release or stipulations with request for award have not been approved, disapproved, or noticed for trial on the issue of adequacy and other disputed issues within 45 days after filing, the file shall be transferred to the presiding judge for review.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5309 and 5310, Labor Code.
s 10347. Assignment of Judges.
Where practicable, different judges shall be assigned to conduct the mandatory settlement conference or conference(s) pursuant to Labor Code section 5502(c) and the trial.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5309 and 5310, Labor Code.
s 10348. Authority of Workers' Compensation Judges.
In any case that has been regularly assigned to a workers' compensation judge, the judge shall have full power, jurisdiction and authority to hear and determine all issues of fact and law presented and to issue any interim, interlocutory and final orders, findings, decisions and awards as may be necessary to the full adjudication of the case, including the fixing of the amount of the bond required in Labor Code section 3715. Orders, findings, decisions and awards issued by a workers' compensation judge shall be the orders, findings, decisions and awards of the Workers' Compensation Appeals Board unless reconsideration is granted.
A workers' compensation judge or a deputy commissioner may issue writs or summons, warrants of attachment, warrants of commitment and all necessary process in proceedings for direct and hybrid contempt in a like manner and to the same extent as courts of record.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 121, 134, 5309 and 5310, Labor Code.
s 10349. Orders Equivalent to Notices of Intention.
An order with a clause rendering the order null and void if an objection showing good cause is filed within ten (10) days shall be deemed equivalent to a ten (10) day notice of intention.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section !, Labor Code.
s 10350. Trials: Appointment and Authority of Pro Tempore Workers' Compensation Judges.
A presiding workers' compensation judge may appoint and assign a pro tempore workers' compensation judge to conduct a trial on any issue in any proceeding before the Workers' Compensation Appeals Board and to make and file a finding, opinion, order, decision or award based thereon. Before assignment of a particular pro tempore workers' compensation judge, the parties or their representatives shall submit a request and written stipulation to the presiding workers' compensation judge. The request and written stipulation shall set out in full the name and the office address of the attorney agreed upon to conduct the trial as a pro tempore workers' compensation judge.
If a case is off calendar or has not before been set on the trial calendar, the request and written stipulation must be filed with a Declaration of Readiness to Proceed pursuant to Section 10414. The presiding workers' compensation judge, upon approval of the request for trial by a pro tempore workers' compensation judge, will assign the case to the trial calendar making appropriate arrangements to provide the pro tempore workers' compensation judge with facilities and staff at a time and place convenient to the Workers' Compensation Appeals Board and the pro tempore workers' compensation judge.
At the time of any conference hearing, the parties or their representatives may file the same request and written stipulation which will be submitted to the presiding workers' compensation judge who will assign the case to the trial calendar in the same manner as set forth above.
Pro tempore workers' compensation judges will have all the authority and powers of workers' compensation judges as set forth in the Labor Code and Rules of Practice and Procedure of the Workers' Compensation Appeals Board including inquiry into adequacy of and approval of compromise and release agreements and stipulated findings including the authority to issue appropriate findings, awards and orders. Pro tempore workers' compensation judges shall be bound by the Rules of Practice and Procedure of the Workers' Compensation Appeals Board (including Articles 6, 7 and 8).
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 123.7, 5309 and 5310, Labor Code.
s 10351. Conference Hearings: Appointment and Authority of Pro Tempore Workers' Compensation Judges.
A pro tempore workers' compensation judge shall in any case filed have the same power as a workers' compensation judge to conduct conference hearings, including mandatory settlement conferences, rating mandatory settlement conferences and status conferences; to inquire into the adequacy of and to approve compromise and release agreements; to approve stipulated findings and to issue appropriate awards based on the stipulations; to frame stipulations and issues and make interim and interlocutory orders at the conference hearing.
The presiding workers' compensation judge may assign a pro tempore workers' compensation judge to any conference hearing calendar including rating mandatory settlement conferences or status conferences. The name of the pro tempore workers' compensation judge shall appear on the notice of hearing. Failure to object to the assignment within five days of service of notice of conference hearing shall constitute a waiver of any objection to proceeding before the pro tempore workers' compensation judge assigned to the mandatory settlement conference hearing, rating mandatory settlement conference or status conference.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 123.7, 5309 and 5310, Labor Code.
s 10352. Reconsideration of Pro Tempore Workers' Compensation Judge's Orders, Decisions or Awards.
Any final order, decision or award filed by a pro tempore workers' compensation judge shall be subject to the reconsideration process as set forth in Labor Code Sections 5900 through 5911.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 121, 123.7, 5309, 5310 and 5900-5911, Labor Code.
s 10353. Settlement Conference Authority.
(a) In accordance with Labor Code section 5502, subdivision (e)(2), the workers' compensation judge shall have authority to inquire into the adequacy and completeness, including provision for lien claims, of compromise and release agreements or stipulations with request for award or orders, and to issue orders approving compromise and release agreements or awards or orders based upon approved stipulations. The workers' compensation judge may make orders and rulings regarding admission of evidence and discovery matters, including admission of offers of proof and stipulations of testimony where appropriate and necessary for resolution of the dispute(s) by the workers' compensation judge, and may submit and decide the dispute(s) on the record pursuant to the agreement of the parties. The workers' compensation judge shall not hear sworn testimony at any conference.
(b) The workers' compensation judge may temporarily adjourn a conference to a time certain to facilitate a specific resolution of the dispute(s) subject to Labor Code section 5502, subdivision (e)(1).
Subject to the provisions of Labor Code Section 5502.5 and Rule 10416, upon a showing of good cause, the workers' compensation judge may continue a mandatory settlement conference to a date certain, may continue it to a status conference on a date certain, or may take the case off calendar. In such a case, the workers' compensation judge shall note the reasons for the continuance or order taking off calendar in the minutes. The minutes shall be served on all parties and lien claimants, and their representatives.
(c) Absent resolution of the dispute(s), the parties shall file at the mandatory settlement conference a joint pre-trial statement setting forth the issues and stipulations for trial, witnesses, exhibits, and the proposed permanent disability rating as provided by Labor Code Section 4065. The parties may modify their proposed ratings only when evidence, relevant to the proposed ratings, and disclosed or obtained after the mandatory settlement conference, becomes admissible pursuant to Labor Code Section 5502, subdivision (e)(3).
A summary of conference proceedings including the joint pre-trial conference statement and the disposition shall be filed by the workers' compensation judge in the record of the proceedings on a form prescribed and approved by the Appeals Board and shall be served on the parties.
Note: Authority cited: Sections 133, 5307 and 5502, Labor Code. Reference: Sections 5502 and 5502.5, Labor Code.
s 10360. Necessary Parties.
Any applicant other than the injured employee shall join the injured employee as a party. In such instances the Application for Adjudication shall include the injured employee's address if known or, if not known, a statement of that fact.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 126, 5307.5 and 5503, Labor Code.
s 10364. Parties Applicant.
(a) Any person in whom any right to relief is alleged to exist may appear, or be joined, as an applicant in any case or controversy before the Workers' Compensation Appeals Board. A lien claimant may become a party where the applicant's case has been settled by way of a compromise and release, or where the applicant chooses not to proceed with his or her case.
(b) Any person against whom any right to relief is alleged to exist may be joined as a defendant.
(c) In death cases, all persons who may be dependents shall either join or be joined as applicants so that the entire liability of the employer or the insurer may be determined in one proceeding.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5300, 5303, 5307.5, 5500 and 5503, Labor Code.
s 10368. Parties Defendant.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5300, 5303, 5307.5, 5500 and 5503, Labor Code.
s 10372. Parties in Death Cases.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5300, 5303, 5307.5, 5500 and 5503, Labor Code.
s 10380. Joinder of Parties.
After filing of an Application for Adjudication, the Appeals Board, a workers' compensation judge may order the joinder of additional parties necessary for the full adjudication of the case. A party not present or represented at the time of joinder shall be served with copies of the order of joinder, the application, minutes of hearing and summary of evidence, medical reports and other documents, as directed in the order of joinder. The Workers' Compensation Appeals Board may designate the party or parties who are to make service.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5307.5 and 5316, Labor Code.
s 10390. Place and Time of Filing Documents.
After the filing and processing of the application for adjudication, all papers and documents required to be filed by the Rules of Practice and Procedure of the Workers' Compensation Appeals Board or which request action by the Workers' Compensation Appeals Board shall be filed with the office of the Workers' Compensation Appeals Board district office where the case has been assigned for hearing except where the case is pending before the Appeals Board in San Francisco for action on a petition for reconsideration or removal.
After a petition for reconsideration or petition for removal has been properly filed pursuant to Rule 10840 or 10843 and after the 15 days for amendment or correction allowed by Rule 10859 or 10843 and until the Appeals Board issues its decision on a petition for reconsideration or removal, all requests for action relating to the reconsideration process, requests for withdrawal of the petitions for reconsideration or petitions to remove or notifications of change of address from the parties or lien claimants shall be filed with the Appeals Board in San Francisco. All other mail unnecessary to the reconsideration or removal process shall be filed with the district office where the case was heard and from which the decision issued.
Documents received in any other district office or the office of the Appeals Board in San Francisco, except as provided in this rule, shall not be accepted for filing or deemed filed and shall not be acknowledged or returned to the filing party and may be discarded. Such document, however, may be returned where the filing party includes a self addressed envelope with sufficient return postage. The Workers' Compensation Appeals Board, in any proceeding, may excuse a failure to comply with this rule resulting from mistake inadvertence, surprise, or excusable neglect.
Except where the document is filed at the mandatory settlement conference or hearing, the person who received the document for filing shall affix on it an appropriate endorsement as evidence of the fact and date of receipt, which endorsement may be made by handwriting, by hand stamp, by electrical mail received time and date stamp, or by any other appropriate means. Documents filed by mail are deemed filed on the date they are received by the Workers' Compensation Appeals Board, not on the date of posting.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 126, Labor Code.
s 10391. Filing of Copies of Documents.
A document that has been sent directly to the Workers' Compensation Appeals Board by fax or e-mail will not be accepted for filing.
The Workers' Compensation Appeals Board will accept for filing a fax copy, photocopy, or other reproduction of a properly executed Application for Adjudication, Answer to an Application for Adjudication, Petition, Declaration of Readiness, Compromise and Release, or Stipulations with Request for Award.
Any reproduction of a document filed under this section is presumed to be an accurate representation of the original document. If a party alleges that a reproduction filed under this section is inaccurate or unreliable, the party filing the reproduction has the burden of proving by a preponderance of the evidence, that the reproduction is an accurate representation of the original document.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 126, Labor Code.
s 10392. Form and Size Requirements for Filed Documents.
All pleadings, letters, petitions, briefs and notices filed with the Workers' Compensation Appeals Board by any party or lien claimant shall be on 8 1/2 x 11 inch paper with two holes punched at the top and centered to fit the Workers' Compensation Appeals Board file. All documents shall include in the heading the name of the injured employee and the Workers' Compensation Appeals Board case number. All pleadings, petitions and briefs shall be double spaced, except that quotations may be single spaced.
Where, on the same day, a party files two or more medical reports in the same case, the party shall attach them to a transmittal letter that shall list each report by name of physician and date of report. The transmittal letter shall include the name of the injured employee and the Workers' Compensation Appeals Board case number.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 126, Labor Code.
s 10395. Improper Filing of Documents.
The following documents shall not be filed with or sent to the Workers' Compensation Appeals Board:
(a) Letters to opposing parties or counsel;
(b) Subpoenas;
(c) Notices of taking deposition;
(d) Medical appointment letters;
(e) Proofs of service ordered pursuant to Rule 10500;
(f) Medical reports, except as required by Rules 10608 and 10615;
(g) Any other document which is not required to be filed by the Rules of Practice and Procedure of the Workers' Compensation Appeals Board or which does not request action by the Workers' Compensation Appeals Board.
This rule shall not prevent admission into evidence of any document relevant to an issue pending before the Workers' Compensation Appeals Board.
Documents improperly filed pursuant to this rule and received in any district office or the office of the Appeals Board in San Francisco shall neither be accepted for filing nor deemed filed for any purpose and shall not be acknowledged or returned to the filing party, and may be discarded.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 126, Labor Code.
s 10396. Duty to Furnish Correct Address.
(a) Every party and lien claimant having an interest in an active case pending before the Workers' Compensation Appeals Board shall advise the Workers' Compensation Appeals Board and all other known interested parties of any change of address by promptly furnishing the correct and current mailing address.
Every lien claimant having an interest in an active case pending before the Workers' Compensation Appeals Board shall advise all known interested parties of any change in the identity or telephone number of the person with authority to resolve the lien by promptly furnishing the correct name and daytime telephone number of that person to the interested parties, and shall advise the Workers' Compensation Appeals Board of any such change after a Declaration of Readiness is filed.
(b) Every party and lien claimant having an interest in an inactive case shall advise all other known interested parties and known interested lien claimants of any change of address by promptly furnishing the correct and current mailing address.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 126, Labor Code.
s 10400. Applications.
Proceedings for adjudication of rights and liabilities before the Workers' Compensation Appeals Board shall be initiated by the filing of an Application for Adjudication, Compromise and Release Agreement or Stipulations with Request for Award.
Applications for Adjudication shall be filed with the Workers' Compensation Appeals Board office with the proper venue. Upon filing, the application shall be assigned a case number and placed in the case file. The person filing the application shall be notified that the application has been filed and shall be given a case number that he or she shall serve on all other parties and lien claimants.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 126, 5316 and 5500, Labor Code.
s 10401. Separate Application for Each Injury.
A separate Application for Adjudication shall be filed for each separate injury for which benefits are claimed even though the employer is the same in each case. Separate pleadings shall be filed in each case.
All claims of all persons arising out of the same injury to the same employee shall be filed in the same proceeding.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 3208.2 and 5500, Labor Code.
s 10402. Minors, Incompetents as Applicants.
If the Applicant is a minor or incompetent, the Application for Adjudication shall be accompanied by a Petition for Appointment of a Guardian ad Litem and Trustee. In those instances where the minor has the right of nomination, the nomination shall be included in the petition.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5307.5 and 5500, Labor Code.
s 10403. Venue.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 5300, 5310 and 5501.5, Labor Code.
s 10404. Labor Code Section 4906(g) Statement.
The employee, insurer, employer and the attorneys for each party shall comply with Labor Code Section 4906(g) by filing a statement under penalty of perjury wherein it is declared that the party on whose behalf the declaration is made has not violated Labor Code Section 139.3, has not offered, delivered, received, or accepted any unlawful rebate, refund, commission, preference, patronage dividend, discount or other consideration, whether in the form of money or otherwise, as compensation or inducement for any referred examination or evaluation by a physician. Except as otherwise provided herein, failure to comply with this rule shall result in refusal to file or process that party's application for adjudication or answer. If any of the above parties are not available, cannot be located or are unwilling to sign a declaration under penalty of perjury setting forth in specific detail the reasons that the party is not available, cannot be located or is unwilling to sign as well as good faith efforts to locate the party may be filed with the application or answer. If the presiding workers' compensation judge or designee determines from the facts set forth in the declaration that good cause has been established, he or she may accept the application or answer for filing. For the purpose of this rule, a compromise and release agreement or stipulations with request for award shall not be treated as an application for adjudication.
Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 4906(g), Labor Code.s 10405. Request for Findings of Fact. (continued)