Insurance Rights and Privileges

Division 4, Part 1, Chapter 4, Article 3 deals with the insurance rights and privileges regarding workers’ compensation insurance and security in California. Section 3750 provides that nothing in this division affects five specified items.

Section 3751 provides that no employer is permitted to exact or receive from any employee any contribution, or make or take any deduction from the earnings of any employee, either directly or indirectly, to cover the whole or any part of the cost of compensation under this division. Violation of this subdivision is a misdemeanor.

If an employee has filed a claim form, a provider of medical services is prohibited from collecting money with actual knowledge that a claim is pending, directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed. This limitation does not apply, unless the medical provider has received written notice that liability for the injury has been rejected by the employer and the medical provider has provided a copy of this notice to the employee. Any medical provider who violates this subdivision is liable for three times the amount unlawfully collected, plus reasonable attorney’s fees and costs.

Section 3752 precludes liability for compensation from being reduced or affected by any insurance, contribution or other benefit whatsoever due to or received by the person entitled to compensation, except as otherwise provided by this division.

Section 3753 specifies that the person entitled to compensation may, irrespective of any insurance or other contract, recover compensation directly from the employer. In addition, he may enforce in his own name, in the manner provided by this division the liability of any insurer either by making the insurer a party to the original application or by filing a separate application for any portion of such compensation.

Section 3754 provides that payment, in whole or in part, of compensation by either the employer or the insurer are a bar to recovery against each of them of the amount paid.

Section 3755 states that, if the employer is insured against liability for compensation, and if after the suffering of any injury the insurer causes to be served upon any compensation claimant a notice that it has assumed and agreed to pay any compensation to the claimant for which the employer is liable, the employer is relieved from liability for compensation to the claimant upon the filing of a copy of notice with the appeals board. The proceedings do not abate on account of substitution but are continued against the insurer.

Section 3756 states that, if at the time of the suffering of a compensable injury, the employer is insured against liability for the full amount of compensation payable, he may cause to be served upon the compensation claimant and upon the insurer a notice that the insurer has agreed to pay any compensation for which the employer is liable. The employer may also file a copy of such notice with the appeals board.

Section 3757 provides that, if it thereafter appears to the satisfaction of the appeals board that the insurer has assumed the liability for compensation, the employer is relieved from liability for compensation to the claimant. The insurer must be substituted in place of the employer in any proceeding instituted by the claimant to recover compensation, and the employer is dismissed.

Section 3758 states that a proceeding to obtain compensation does not abate on account of substitution of the insurer in place of the employer and on account of the dismissal of the employer, but must be continued against the insurer.

Section 3759 authorizes the appeals board to enter its order relieving the employer from liability where it appears from the pleadings, stipulations, or proof that an insurer joined as party to the proceeding is liable for the full compensation for which the employer in such proceeding is liable.

Section 3760 explains that every employer who is insured against any liability imposed by this division is required to file with the insurer a complete report of every injury to each employee as specified in law.

Section 3761 provides an insurer securing an employer’s liability under this division must notify the employer, within 15 days, of each claim for indemnity filed against the employer directly with the insurer if the employer has not timely provided to the insurer a report of occupational injury or occupational illness. The insurer is required to furnish an employer who has not filed this report with an opportunity to provide to the insurer, prior to the expiration of the applicable time period specified for rejecting a claim, all relevant information available to the employer concerning the claim.

An employer is required to promptly notify its insurer in writing at any time during the pendency of a claim if the employer has actual knowledge of any facts that would tend to disprove any aspect of the employee’s claim. If an employer notifies its insurer in writing that, in the employer’s opinion, no compensation is payable to an employee, at the employer’s written request, to the appeals board, the appeals board may approve a compromise and release agreement, or stipulation, that provides compensation to the employee only if there is proof of service upon the employer by the insurer, to the employer’s last known address,. The insurer must file proof of this service with the appeals board.

Section 3762 requires the insurer to discuss all elements of the claim file that affect the employer’s premium with the employer, and supply copies of the documents that affect the premium at the employer’s expense during reasonable business hours.