A requirement that the California Division of Workers’ Compensation revise its existing data collection processes to capture the date an injured worker is notified if 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 appropriations language to SB1127, which would require employers to accept or deny liability within 75 days for certain injuries deemed compensable.
Employers currently have 90 days to make a liability determination for most claims. For example, claims for covid-19 are presumed compensable for first responders if they are not denied within 30 days, while claims for other workers are presumed compensable if they are not denied within 45 days.
SB 1
127 would also create a new penalty for unreasonably denied claims 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 Appeals Board to assess the reasonableness of a denial of a claim in accordance with the circumstances 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.
Atkins said the bill creates an opportunity to make fair and positive changes to the workers’ compensation system where injured workers continue to experience delays and denials that prevent their claims and access to medical care from moving forward in a timely manner.
California Professional Firefighters, which is sponsoring the bill, said the measure strikes a balance between providing a remedy for injured workers who face unreasonable denials and employers who face additional costs to fill positions for injured firefighters.
The California Workers’ Compensation Institute released an analysis in July that indicated 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.
SB 1127 is up for a third and final vote in the Assembly. If approved, the measure will go back to the Senate for concurrence on the latest changes.
WorkCompCentral is a sister magazine to Business Insurance. More stories here.
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