Limits on Workers Comp Proceedings

Labor Code Division 4, Part 4, Chapter 2 deals with limitations on workers’ compensation proceedings in California.

Section 5400 provides that no claim to recover compensation under this division is to be maintained unless within thirty days after the occurrence of the injury which is claimed to have caused the disability or death, there is served upon the employer notice in writing, signed by the person injured or someone in his behalf, or in case of the death of the person injured, by a dependent or someone in the dependent’s behalf.

Section 5401 provides that, within one working day of receiving notice or knowledge of injury, which injury results in lost time beyond the employee’s work shift at the time of injury or which results in medical treatment beyond first aid, the employer is required to provide a claim form and a notice of potential eligibility for benefits under this division to the injured employee, or in the case of death, to his or her dependents. The term “first aid” is defined.

The notice of potential eligibility for benefits required by this section and the claim form must be a single document and instruct the injured employee to fully read the notice of potential eligibility. The form and content of the notice and claim form is prescribed by the administrative director after consultation with the Commission on Health and Safety and Workers’ Compensation. The notice must be easily understandable and available in both English and Spanish. The content must include at least the nine specified items.

Section 5401.7 requires the claim to contain, prominently stated, the specified statement.

Section 5402 explains that knowledge of an injury, obtained from any source, on the part of an employer, the employer’s managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400.

If liability is not rejected within 90 days after the date the claim form is filed, the injury is presumed compensable under this division. The presumption of this subdivision is rebuttable only by evidence discovered subsequent to the 90-day period. For specified injuries or illnesses, if the liability is not rejected within 75 days after the date the claim form is filed, the injury is presumed compensable under this division. The presumption of this subdivision is rebuttable only by evidence discovered subsequent to the 75-day period.

Within one working day after an employee files a claim form, the employer authorizes the provision of all treatment for the alleged injury and continues to provide the treatment until the date that liability for the claim is accepted or rejected. Until the date the claim is accepted or rejected, liability for medical treatment is limited to $10,000. Treatment provided does not give rise to a presumption of liability on the part of the employer.

Section 5403 provides that the failure to give notice or any defect or inaccuracy in a notice is not a bar to recovery under this division if it is found as a fact in the proceedings for the collection of the claim that the employer was not in fact misled or prejudiced by such failure.

Section 5404 explains that, unless compensation is paid within the time limited in this chapter for the institution of proceedings for its collection, the right to institute these proceedings is barred.

Section 5405 states that the period within which proceedings may be commenced for the collection of the benefits provided is one year from any of the three specified dates.

Section 5406 says that the period within which may be commenced proceedings for the collection of the benefits provided is one year from either of threeexplai specified dates. Proceedings cannot be commenced more than one year after the date of death, nor more than 240 weeks from the date of injury.

Section 5406.5 states that, in the case of the death of an asbestos worker or firefighter from asbestosis, the period within which proceedings may be commenced for the collection of the benefits provided is one year from the date of death.

Section 5406.6 states that, in the case of the death of a health care worker, a worker with an HIV-related disease, the period within which proceedings may be commenced for the collection of benefits is one year from the date of death, providing that one or more of the three specified events has occurred. The term “health care worker” is defined. 

Section 5406.7 specifies that, in addition to the timelines established, proceedings for the collection of the benefits may be commenced after 240 weeks from the date of injury and no later than 420 weeks from the date of injury, but in no event more than one year after the date of death, if all of the specified criteria are met.

No dependency death benefit is payable pursuant to proceedings commenced more than 240 weeks from the date of injury unless either no proceedings were commenced within 240 weeks from the date of injury, or, if proceedings were commenced within that period, it has been finally determined that no person is entitled to dependency death benefits pursuant to the proceedings that were commenced within that period.

Section 5407 explains that the period within which may be commenced proceedings for the collection of compensation on the ground of serious and willful misconduct of the employer is as specified.

Section 5407.5 states that the period within which may be commenced proceedings for the reduction of compensation on the ground of serious and willful misconduct of the employee is as specified.

Section 5408 provides that, if an injured employee or, in the case of the employee’s death, any of the employee’s dependents, is under 18 years of age or incompetent at any time when any right or privilege accrues to such employee or dependent under this division, a guardian or conservator of the estate appointed by the court, or a guardian ad litem or trustee appointed by the appeals board, may, on behalf of the employee or dependent, claim and exercise any right or privilege with the same force and effect as if no disability existed.

Section 5409 states that the running of the period of limitations prescribed by this chapter is an affirmative defense and operates to bar the remedy and not to extinguish the right of the employee. The defense may be waived.

Section 5410 explains that nothing in this chapter bars the right of any injured worker to institute proceedings for the collection of compensation within five years after the date of the injury upon the ground that the original injury has caused new and further disability.

Section 5410.2 provides that, where any party to a proceeding institute proceedings to reduce the amount of permanent disability awarded to an applicant by the appeals board and be unsuccessful in the proceeding, the board may make a finding as to the amount of a reasonable attorney’s fee incurred by the applicant in resisting the proceeding to reduce permanent disability benefits previously awarded.

Section 5411 provides that the date of injury, except in cases of occupational disease or cumulative injury, is that date during the employment on which occurred the alleged incident or exposure, for the consequences of which compensation is claimed.

Section 5412 states that the date of injury in cases of occupational diseases or cumulative injuries is that date upon which the employee first suffered disability therefrom and either knew, or in the exercise of reasonable diligence should have known, that the disability was caused by his present or prior employment.

Section 5413 provides that a determination of facts by the appeals board under this chapter has no collateral estoppel effect on a subsequent criminal prosecution and does not preclude litigation of those same facts in the criminal proceeding.