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A requirement that the California Division of Workers’ Compensation revise its existing data collection processes to capture the date an injured worker is notified of a liability determination would be contingent on a legislative appropriation, under a recently amended bill.
Senate President Toni Atkins, D-San Diego, on Tuesday added the appropriation language to S.B.1127, which would require employers to accept or deny liability within 75 days for certain injuries that are presumed compensable.
Employers are currently given 90 days to make a liability determination on most claims. For example, claims for COVID-19 are presumed compensable for first responders if not rejected within 30 days, while claims for other workers are presumed compensable when not denied within 45 days.
S.B. 1127 would also create a new penalty for the unreasonable denial of any claim identified in Labor Code Sections 3212 through 3213.2 that would be equal to five times the amount of benefits unreasonably delayed and capped at $50,000.
The bill does not define an unreasonable denial and directs the Workers’ Compensation Appeals Board to assess the reasonableness of a claim denial in accordance with the facts of the case.
Finally, the bill would allow firefighters and peace officers to receive up to 240 weeks of temporary disability benefits for presumptive cancer claims, rather than the 104 weeks of TD available to other injured workers.
Ms. Atkins said the bill creates an opportunity to make fair and positive changes to the workers compensation system in which injured workers continue to experience delays and denials that prevent their claims and access to medical care from moving forward in a timely manner.
The California Professional Firefighters, which is sponsoring the bill, said the measure strikes a balance between providing a remedy for injured workers facing unreasonable denials and employers facing additional costs to backfill positions for injured firefighters.
The California Workers’ Compensation Institute in July released an analysis stating the bill would likely have no effect on most claims and could lead to more conditional denials and litigation on complex claims. More than 90% of accepted claims have a liability decision within 75 days, CWCI said.
S.B. 1127 is up for a third and final vote in the Assembly. If passed, the measure will go back to the Senate for concurrence in the recent amendments.
WorkCompCentral is a sister publication of Business Insurance. More stories here.