Section 138.4 Of Chapter 5. Division Of Workers’ Compensation From California Labor Code >> Division 1. >> Chapter 5.
138.4
. (a) For the purpose of this section, "claims administrator"
means a self-administered workers' compensation insurer; or a
self-administered self-insured employer; or a self-administered
legally uninsured employer; or a self-administered joint powers
authority; or a third-party claims administrator for an insurer, a
self-insured employer, a legally uninsured employer, or a joint
powers authority.
(b) With respect to injuries resulting in lost time beyond the
employee's work shift at the time of injury or medical treatment
beyond first aid:
(1) If the claims administrator obtains knowledge that the
employer has not provided a claim form or a notice of potential
eligibility for benefits to the employee, it shall provide the form
and notice to the employee within three working days of its knowledge
that the form or notice was not provided.
(2) If the claims administrator cannot determine if the employer
has provided a claim form and notice of potential eligibility for
benefits to the employee, the claims administrator shall provide the
form and notice to the employee within 30 days of the administrator's
date of knowledge of the claim.
(c) The administrative director, in consultation with the
Commission on Health and Safety and Workers' Compensation, shall
prescribe reasonable rules and regulations, including notice of the
right to consult with an attorney, where appropriate, for serving on
the employee (or employee's dependents, in the case of death), the
following:
(1) Notices dealing with the payment, nonpayment, or delay in
payment of temporary disability, permanent disability, supplemental
job displacement, and death benefits.
(2) Notices of any change in the amount or type of benefits being
provided, the termination of benefits, the rejection of any liability
for compensation, and an accounting of benefits paid.
(3) Notices of rights to select the primary treating physician,
written continuity of care policies, requests for a comprehensive
medical evaluation, and offers of regular, modified, or alternative
work.
(d) The administrative director, in consultation with the
Commission on Health and Safety and Workers' Compensation, shall
develop, make fully accessible on the department's Internet Web site,
and make available at district offices informational material
written in plain language that describes the overall workers'
compensation claims process, including the rights and obligations of
employees and employers at every stage of a claim when a notice is
required.
(e) Each notice prescribed by the administrative director shall be
written in plain language, shall reference the informational
material described in subdivision (d) to enable employees to
understand the context of the notices, and shall clearly state the
Internet Web site address and contact information that an employee
may use to access the informational material.