Chapter 1. Payment And Assignment of California Labor Code >> Division 4. >> Part 3. >> Chapter 1.
No claim for compensation, except as provided in Section 96,
is assignable before payment, but this provision does not affect the
survival thereof.
No claim for compensation nor compensation awarded, adjudged,
or paid, is subject to be taken for the debts of the party entitled
to such compensation except as hereinafter provided.
No compensation, whether awarded or voluntarily paid, shall
be paid to any attorney at law or in fact or other agent, but shall
be paid directly to the claimant entitled thereto unless otherwise
ordered by the appeals board. No payment made to an attorney at law
or in fact or other agent in violation of this section shall be
credited to the employer.
The appeals board may determine, and allow as liens against
any sum to be paid as compensation, any amount determined as
hereinafter set forth in subdivisions (a) through (i). If more than
one lien is allowed, the appeals board may determine the priorities,
if any, between the liens allowed. The liens that may be allowed
hereunder are as follows:
(a) A reasonable attorney's fee for legal services pertaining to
any claim for compensation either before the appeals board or before
any of the appellate courts, and the reasonable disbursements in
connection therewith. No fee for legal services shall be awarded to
any representative who is not an attorney, except with respect to
those claims for compensation for which an application, pursuant to
Section 5501, has been filed with the appeals board on or before
December 31, 1991, or for which a disclosure form, pursuant to
Section 4906, has been sent to the employer, or insurer or
third-party administrator, if either is known, on or before December
31, 1991.
(b) The reasonable expense incurred by or on behalf of the injured
employee, as provided by Article 2 (commencing with Section 4600),
and to the extent the employee is entitled to reimbursement under
Section 4621, medical-legal expenses as provided by Article 2.5
(commencing with Section 4620) of Chapter 2 of Part 2, except those
disputes subject to independent medical review or independent bill
review.
(c) The reasonable value of the living expenses of an injured
employee or of his or her dependents, subsequent to the injury.
(d) The reasonable burial expenses of the deceased employee, not
to exceed the amount provided for by Section 4701.
(e) The reasonable living expenses of the spouse or minor children
of the injured employee, or both, subsequent to the date of the
injury, where the employee has deserted or is neglecting his or her
family. These expenses shall be allowed in the proportion that the
appeals board deems proper, under application of the spouse, guardian
of the minor children, or the assignee, pursuant to subdivision (a)
of Section 11477 of the Welfare and Institutions Code, of the spouse,
a former spouse, or minor children. A collection received as a
result of a lien against a workers' compensation award imposed
pursuant to this subdivision for payment of child support ordered by
a court shall be credited as provided in Section 695.221 of the Code
of Civil Procedure.
(f) The amount of unemployment compensation disability benefits
that have been paid under or pursuant to the Unemployment Insurance
Code in those cases where, pending a determination under this
division there was uncertainty whether the benefits were payable
under the Unemployment Insurance Code or payable hereunder; provided,
however, that any lien under this subdivision shall be allowed and
paid as provided in Section 4904.
(g) The amount of unemployment compensation benefits and extended
duration benefits paid to the injured employee for the same day or
days for which he or she receives, or is entitled to receive,
temporary total disability indemnity payments under this division;
provided, however, that any lien under this subdivision shall be
allowed and paid as provided in Section 4904.
(h) The amount of family temporary disability insurance benefits
that have been paid to the injured employee pursuant to the
Unemployment Insurance Code for the same day or days for which that
employee receives, or is entitled to receive, temporary total
disability indemnity payments under this division, provided, however,
that any lien under this subdivision shall be allowed and paid as
provided in Section 4904.
(i) The amount of indemnification granted by the California
Victims of Crime Program pursuant to Article 1 (commencing with
Section 13959) of Chapter 5 of Part 4 of Division 3 of Title 2 of the
Government Code.
(a) Every lien claimant shall file its lien with the
appeals board in writing upon a form approved by the appeals board.
The lien shall be accompanied by a full statement or itemized voucher
supporting the lien and justifying the right to reimbursement and
proof of service upon the injured worker or, if deceased, upon the
worker's dependents, the employer, the insurer, and the respective
attorneys or other agents of record. Medical records shall be filed
only if they are relevant to the issues being raised by the lien.
(b) Any lien claim for expenses under subdivision (b) of Section
4903 or for claims of costs shall be filed with the appeals board
electronically using the form approved by the appeals board. The lien
shall be accompanied by a proof of service and any other documents
that may be required by the appeals board. The service requirements
for Section 4603.2 are not modified by this section.
(c) All liens filed on or after January 1, 2013, for expenses
under subdivision (b) of Section 4903 or for claims of costs shall be
subject to a filing fee as provided by this subdivision.
(1) The lien claimant shall pay a filing fee of one hundred fifty
dollars ($150) to the Division of Workers' Compensation prior to
filing a lien and shall include proof that the filing fee has been
paid. The fee shall be collected through an electronic payment system
that accepts major credit cards and any additional forms of
electronic payment selected by the administrative director. If the
administrative director contracts with a service provider for the
processing of electronic payments, any processing fee shall be
absorbed by the division and not added to the fee charged to the lien
filer.
(2) On or after January 1, 2013, a lien submitted for filing that
does not comply with paragraph (1) shall be invalid, even if lodged
with the appeals board, and shall not operate to preserve or extend
any time limit for filing of the lien.
(3) The claims of two or more providers of goods or services shall
not be merged into a single lien.
(4) The filing fee shall be collected by the administrative
director. All fees shall be deposited in the Workers' Compensation
Administration Revolving Fund and applied for the purposes of that
fund.
(5) The administrative director shall adopt reasonable rules and
regulations governing the procedure for the collection of the filing
fee, including emergency regulations as necessary to implement this
section.
(6) Any lien filed for goods or services that are not the proper
subject of a lien may be dismissed upon request of a party by
verified petition or on the appeals board's own motion. If the lien
is dismissed, the lien claimant will not be entitled to reimbursement
of the filing fee.
(7) No filing fee shall be required for a lien filed by a health
care service plan licensed pursuant to Section 1349 of the Health and
Safety Code, a group disability insurer under a policy issued in
this state pursuant to the provisions of Section 10270.5 of the
Insurance Code, a self-insured employee welfare benefit plan, as
defined in Section 10121 of the Insurance Code, that is issued in
this state, a Taft-Hartley health and welfare fund, or a publicly
funded program providing medical benefits on a nonindustrial basis.
(a) Any lien filed pursuant to subdivision (b) of Section
4903 prior to January 1, 2013, and any cost that was filed as a lien
prior to January 1, 2013, shall be subject to a lien activation fee
unless the lien claimant provides proof of having paid a filing fee
as previously required by former Section 4903.05 as added by Chapter
639 of the Statutes of 2003.
(1) The lien claimant shall pay a lien activation fee of one
hundred dollars ($100) to the Division of Workers' Compensation on or
before January 1, 2014. The fee shall be collected through an
electronic payment system that accepts major credit cards and any
additional forms of electronic payment selected by the administrative
director. If the administrative director contracts with a service
provider for the processing of electronic payments, any processing
fee shall be absorbed by the division and not added to the fee
charged to the lien filer.
(2) The lien claimant shall include proof of payment of the filing
fee or lien activation fee with the declaration of readiness to
proceed.
(3) The lien activation fee shall be collected by the
administrative director. All fees shall be deposited in the Workers'
Compensation Administration Revolving Fund and applied for the
purposes of that fund. The administrative director shall adopt
reasonable rules and regulations governing the procedure for the
collection of the lien activation fee and to implement this section,
including emergency regulations, as necessary.
(4) All lien claimants that did not file the declaration of
readiness to proceed and that remain a lien claimant of record at the
time of a lien conference shall submit proof of payment of the
activation fee at the lien conference. If the fee has not been paid
or no proof of payment is available, the lien shall be dismissed with
prejudice.
(5) Any lien filed pursuant to subdivision (b) of Section 4903
prior to January 1, 2013, and any cost that was filed as a lien prior
to January 1, 2013, for which the filing fee or lien activation fee
has not been paid by January 1, 2014, is dismissed by operation of
law.
(b) This section shall not apply to any lien filed by a health
care service plan licensed pursuant to Section 1349 of the Health and
Safety Code, a group disability insurer under a policy issued in
this state pursuant to the provisions of Section 10270.5 of the
Insurance Code, a self-insured employee welfare benefit plan, as
defined in Section 10121 of the Insurance Code, that is issued in
this state, a Taft-Hartley health and welfare fund, or a publicly
funded program providing medical benefits on a nonindustrial basis.
(a) A lien claimant shall be entitled to an order or award
for reimbursement from the employer of a lien filing fee or lien
activation fee, together with interest at the rate allowed on civil
judgments, only if all of the following conditions are satisfied:
(1) Not less than 30 days before filing the lien for which the
filing fee was paid or filing the declaration of readiness for which
the lien activation fee was paid, the lien claimant has made written
demand for settlement of the lien claim for a clearly stated sum
which shall be inclusive of all claims of debt, interest, penalty, or
other claims potentially recoverable on the lien.
(2) The defendant fails to accept the settlement demand in writing
within 20 days of receipt of the demand for settlement, or within
any additional time as may be provide by the written demand.
(3) After submission of the lien dispute to the appeals board or
an arbitrator, a final award is made in favor of the lien claimant of
a specified sum that is equal to or greater than the amount of the
settlement demand. The amount of the interest and filing fee or lien
activation fee shall not be considered in determining whether the
award is equal to or greater than the demand.
(b) This section shall not preclude an order or award of
reimbursement of the filing fee or activation fee pursuant to the
express terms of an agreed disposition of a lien dispute.
(a) The appeals board or arbitrator, before issuing an
award or approval of any compromise of claim, shall determine, on the
basis of liens filed with it pursuant to Section 4903.05, whether
any benefits have been paid or services provided by a health care
provider, a health care service plan, a group disability policy,
including a loss-of-income policy or a self-insured employee welfare
benefit plan, and its award or approval shall provide for
reimbursement for benefits paid or services provided under these
plans as follows:
(1) If the appeals board issues an award finding that an injury or
illness arises out of and in the course of employment, but denies
the applicant reimbursement for self-procured medical costs solely
because of lack of notice to the applicant's employer of his or her
need for hospital, surgical, or medical care, the appeals board shall
nevertheless award a lien against the employee's recovery, to the
extent of benefits paid or services provided, for the effects of the
industrial injury or illness, by a health care provider, a health
care service plan, a group disability policy or a self-insured
employee welfare benefit plan, subject to the provisions described in
subdivision (b).
(2) If the appeals board issues an award finding that an injury or
illness arises out of and in the course of employment, and makes an
award for reimbursement for self-procured medical costs, the appeals
board shall allow a lien, to the extent of benefits paid or services
provided, for the effects of the industrial injury or illness, by a
health care provider, a health care service plan, a group disability
policy or a self-insured employee welfare benefit plan, subject to
the provisions of subdivision (b). For purposes of this paragraph,
benefits paid or services provided by a self-insured employee welfare
benefit plan shall be determined notwithstanding the official
medical fee schedule adopted pursuant to Section 5307.1.
(3) (A) If the appeals board issues an award finding that an
injury or illness arises out of and in the course of employment and
makes an award for temporary disability indemnity, the appeals board
shall allow a lien as living expense under Section 4903, for benefits
paid by a group disability policy providing loss-of-time benefits
and for loss-of-time benefits paid by a self-insured employee welfare
benefit plan. The lien shall be allowed to the extent that benefits
have been paid for the same day or days for which temporary
disability indemnity is awarded and shall not exceed the award for
temporary disability indemnity. A lien shall not be allowed hereunder
unless the group disability policy or self-insured employee welfare
benefit plan provides for reduction, exclusion, or coordination of
loss-of-time benefits on account of workers' compensation benefits.
(B) For purposes of this paragraph, "self-insured employee welfare
benefit plan" means any plan, fund, or program that is established
or maintained by an employer or by an employee organization, or by
both, to the extent that the plan, fund, or program was established
or is maintained for the purpose of providing for its participants or
their beneficiaries, other than through the purchase of insurance,
either of the following:
(i) Medical, surgical, or hospital care or benefits.
(ii) Monetary or other benefits in the event of sickness,
accident, disability, death, or unemployment.
(4) If the parties propose that the case be disposed of by way of
a compromise and release agreement, in the event the lien claimant,
other than a health care provider, does not agree to the amount
allocated to it, then the appeals board shall determine the potential
recovery and reduce the amount of the lien in the ratio of the
applicant's recovery to the potential recovery in full satisfaction
of its lien claim.
(b) Notwithstanding subdivision (a), payment or reimbursement
shall not be allowed, whether payable by the employer or payable as a
lien against the employee's recovery, for any expense incurred as
provided by Article 2 (commencing with Section 4600) of Chapter 2 of
Part 2, nor shall the employee have any liability for the expense, if
at the time the expense was incurred the provider either knew or in
the exercise of reasonable diligence should have known that the
condition being treated was caused by the employee's present or prior
employment, unless at the time the expense was incurred at least one
of the following conditions was met:
(1) The expense was incurred for services authorized by the
employer.
(2) The expense was incurred for services furnished while the
employer failed or refused to furnish treatment as required by
subdivision (c) of Section 5402.
(3) The expense was necessarily incurred for an emergency medical
condition, as defined by subdivision (b) of Section 1317.1 of the
Health and Safety Code.
(c) The changes made to this section by Senate Bill 457 of the
2011-12 Regular Session do not modify in any way the rights or
obligations of the following:
(1) Any health care provider to file and prosecute a lien pursuant
to subdivision (b) of Section 4903.
(2) A payer to conduct utilization review pursuant to Section
4610.
(3) Any party in complying with the requirements under Section
4903.
Where a lien claimant is reimbursed pursuant to subdivision
(f) or (g) of Section 4903 or Section 4903.1, for benefits paid or
services provided, the appeals board may award an attorney's fee to
the applicant's attorney out of the lien claimant's recovery if the
appeals board determines that all of the following occurred:
(a) The lien claimant received notice of all hearings following
the filing of the lien and received notice of intent to award the
applicant's attorney a fee.
(b) An attorney or other representative of the lien claimant did
not participate in the proceedings before the appeals board with
respect to the lien claim.
(c) There were bona fide issues respecting compensability, or
respecting allowability of the lien, such that the services of an
attorney were reasonably required to effectuate recovery on the claim
of lien and were instrumental in effecting the recovery.
(d) The case was not disposed of by compromise and release.
The amount of the attorney's fee out of the lien claimant's
recovery shall be based on the extent of applicant's attorney's
efforts on behalf of the lien claimant. The ratio of the amount of
the attorney's fee awarded against the lien claimant's recovery to
that recovery shall not exceed the ratio of the amount of the
attorney's fee awarded against the applicant's award to that award.
The director, as administrator of the Uninsured Employers
Fund, may, in his discretion, provide compensation, including medical
treatment, from the Uninsured Employers Fund in cases to which the
director is a party before the issuance of any award, if such
compensation is not being provided to the applicant.
The appeals board shall determine and allow as a first lien
against any sum to be paid as compensation the amount of
compensation, including the cost of medical treatment, provided by
the director pursuant to this section.
(a) If a dispute arises concerning a lien for expenses
incurred by or on behalf of the injured employee as provided by
Article 2 (commencing with Section 4600) of Chapter 2 of Part 2, the
appeals board may resolve the dispute in a separate proceeding, which
may include binding arbitration upon agreement of the employer, lien
claimant, and the employee, if the employee remains a party to the
dispute, according to the rules of practice and procedure.
(b) If the dispute is heard at a separate proceeding it shall be
calendared for hearing or hearings as determined by the appeals board
based upon the resources available to the appeals board and other
considerations as the appeals board deems appropriate and shall not
be subject to Section 5501.5.
(a) A lien claim for expenses as provided in subdivision
(b) of Section 4903 shall not be filed after three years from the
date the services were provided, nor more than 18 months after the
date the services were provided, if the services were provided on or
after July 1, 2013.
(b) Notwithstanding subdivision (a), any health care service plan
licensed pursuant to Section 1349 of the Health and Safety Code,
group disability insurer under a policy issued in this state pursuant
to the provisions of Section 10270.5 of the Insurance Code,
self-insured employee welfare benefit plan issued in this state as
defined in Section 10121 of the Insurance Code, Taft-Hartley health
and welfare fund, or publicly funded program providing medical
benefits on a nonindustrial basis, may file a lien claim for expenses
as provided in subdivision (b) of Section 4903 within 12 months
after the entity first knew or in the exercise of reasonable
diligence should have known that an industrial injury is being
claimed, but in no event later than five years from the date the
services were provided to the employee.
(c) The injured worker shall not be liable for any underlying
obligation if a lien claim has not been filed and served within the
allowable period. Except when the lien claimant is the applicant as
provided in Section 5501 or as otherwise permitted by rules of
practice and procedure adopted by the appeals board, a lien claimant
shall not file a declaration of readiness to proceed in any case
until the case-in-chief has been resolved.
(d) This section shall not apply to civil actions brought under
the Cartwright Act (Chapter 2 (commencing with Section 16700) of Part
2 of Division 7 of the Business and Professions Code), the Unfair
Practices Act (Chapter 4 (commencing with Section 17000) of Part 2 of
Division 7 of the Business and Professions Code), or the federal
Racketeer Influenced and Corrupt Organization Act (Chapter 96
(commencing with Section 1961) of Title 18 of the United States Code)
based on concerted action with other insurers that are not parties
to the case in which the lien or claim is filed.
(a) Except as necessary to meet the requirements of Section
4903.5, a lien claim or application for adjudication shall not be
filed or served under subdivision (b) of Section 4903 until both of
the following have occurred:
(1) Sixty days have elapsed after the date of acceptance or
rejection of liability for the claim, or expiration of the time
provided for investigation of liability pursuant to subdivision (b)
of Section 5402, whichever date is earlier.
(2) Either of the following:
(A) The time provided for payment of medical treatment bills
pursuant to Section 4603.2 has expired and, if the employer objected
to the amount of the bill, the reasonable fee has been determined
pursuant to Section 4603.6, and, if authorization for the medical
treatment has been disputed pursuant to Section 4610, the medical
necessity of the medical treatment has been determined pursuant to
Sections 4610.5 and 4610.6.
(B) The time provided for payment of medical-legal expenses
pursuant to Section 4622 has expired and, if the employer objected to
the amount of the bill, the reasonable fee has been determined
pursuant to Section 4603.6.
(b) All lien claimants under Section 4903 shall notify the
employer and the employer's representative, if any, and the employee
and his or her representative, if any, and the appeals board within
five working days of obtaining, changing, or discharging
representation by an attorney or nonattorney representative. The
notice shall set forth the legal name, address, and telephone number
of the attorney or nonattorney representative.
(c) A declaration of readiness to proceed shall not be filed for a
lien under subdivision (b) of Section 4903 until the underlying case
has been resolved or where the applicant chooses not to proceed with
his or her case.
(d) With the exception of a lien for services provided by a
physician as defined in Section 3209.3, a lien claimant shall not be
entitled to any medical information, as defined in subdivision (g) of
Section 56.05 of the Civil Code, about an injured worker without
prior written approval of the appeals board. Any order authorizing
disclosure of medical information to a lien claimant other than a
physician shall specify the information to be provided to the lien
claimant and include a finding that the information is relevant to
the proof of the matter for which the information is sought. The
appeals board shall adopt reasonable regulations to ensure compliance
with this section, and shall take any further steps as may be
necessary to enforce the regulations, including, but not limited to,
impositions of sanctions pursuant to Section 5813.
(e) The prohibitions of this section shall not apply to lien
claims, applications for adjudication, or declarations of readiness
to proceed filed by or on behalf of the employee, or to the filings
by or on behalf of the employer.
(a) (1) Any order or award for payment of a lien filed
pursuant to subdivision (b) of Section 4903 shall be made for payment
only to the person who was entitled to payment for the expenses as
provided in subdivision (b) of Section 4903 at the time the expenses
were incurred, and not to an assignee unless the person has ceased
doing business in the capacity held at the time the expenses were
incurred and has assigned all right, title, and interest in the
remaining accounts receivable to the assignee.
(2) Paragraph (1) does not apply to an assignment that was
completed prior to January 1, 2013, or that was required by a
contract that became enforceable and irrevocable prior to January 1,
2013. This paragraph is declarative of existing law.
(b) If there has been an assignment of a lien, either as an
assignment of all right, title, and interest in the accounts
receivable or as an assignment for collection, a true and correct
copy of the assignment shall be filed and served.
(1) If the lien is filed on or after January 1, 2013, and the
assignment occurs before the filing of the lien, the copy of the
assignment shall be served at the time the lien is filed.
(2) If the lien is filed on or after January 1, 2013, and the
assignment occurs after the filing of the lien, the copy of the
assignment shall be served within 20 days of the date of the
assignment.
(3) If the lien is filed before January 1, 2013, the copy of the
assignment shall be served by January 1, 2014, or with the filing of
a declaration of readiness or at the time of a lien hearing,
whichever is earliest.
(c) If there has been more than one assignment of the same
receivable or bill, the appeals board may set the matter for hearing
on whether the multiple assignments constitute bad-faith actions or
tactics that are frivolous, harassing, or intended to cause
unnecessary delay or expense. If so found by the appeals board,
appropriate sanctions, including costs and attorney's fees, may be
awarded against the assignor, assignee, and their respective
attorneys.
(d) At the time of filing of a lien on or after January 1, 2013,
or in the case of a lien filed before January 1, 2013, at the
earliest of the filing of a declaration of readiness, a lien hearing,
or January 1, 2014, supporting documentation shall be filed
including one or more declarations under penalty of perjury by a
natural person or persons competent to testify to the facts stated,
declaring both of the following:
(1) The services or products described in the bill for services or
products were actually provided to the injured employee.
(2) The billing statement attached to the lien truly and
accurately describes the services or products that were provided to
the injured employee.
(e) A lien submitted for filing on or after January 1, 2013, for
expenses provided in subdivision (b) of Section 4903, that does not
comply with the requirements of this section shall be deemed to be
invalid, whether or not accepted for filing by the appeals board, and
shall not operate to preserve or extend any time limit for filing of
the lien.
(f) This section shall take effect without regulatory action. The
appeals board and the administrative director may promulgate
regulations and forms for the implementation of this section.
(a) If notice is given in writing to the insurer, or to the
employer if uninsured, setting forth the nature and extent of any
claim that is allowable as a lien in favor of the Employment
Development Department, the claim is a lien against any amount
thereafter payable as temporary or permanent disability compensation,
subject to the determination of the amount and approval of the lien
by the appeals board. When the Employment Development Department has
served an insurer or employer with a lien claim, the insurer or
employer shall notify the Employment Development Department, in
writing, as soon as possible, but in no event later than 15 working
days after commencing disability indemnity payments. When a lien has
been served on an insurer or an employer by the Employment
Development Department, the insurer or employer shall notify the
Employment Development Department, in writing, within 10 working days
of filing an application for adjudication, a stipulated award, or a
compromise and release with the appeals board.
(b) (1) In determining the amount of lien to be allowed for
unemployment compensation disability benefits under subdivision (f)
of Section 4903, the appeals board shall allow the lien in the amount
of benefits which it finds were paid for the same day or days of
disability for which an award of compensation for any permanent
disability indemnity resulting solely from the same injury or illness
or temporary disability indemnity, or both, is made and for which
the employer has not reimbursed the Employment Development Department
pursuant to Section 2629.1 of the Unemployment Insurance Code.
(2) In determining the amount of lien to be allowed for
unemployment compensation benefits and extended duration benefits
under subdivision (g) of Section 4903, the appeals board shall allow
the lien in the amount of benefits which it finds were paid for the
same day or days for which an award of compensation for temporary
total disability is made.
(3) In determining the amount of lien to be allowed for family
temporary disability insurance benefits under subdivision (h) of
Section 4903, the appeals board shall allow the lien in the amount of
benefits that it finds were paid for the same day or days for which
an award of compensation for temporary total disability is made and
for which the employer has not reimbursed the Employment Development
Department pursuant to Section 2629.1 of the Unemployment Insurance
Code.
(c) In the case of agreements for the compromise and release of a
disputed claim for compensation, the applicant and defendant may
propose to the appeals board, as part of the compromise and release
agreement, an amount out of the settlement to be paid to any lien
claimant claiming under subdivision (f), (g), or (h) of Section 4903.
If the lien claimant objects to the amount proposed for payment of
its lien under a compromise and release settlement or stipulation,
the appeals board shall determine the extent of the lien claimant's
entitlement to reimbursement on its lien and make and file findings
on all facts involved in the controversy over this issue in
accordance with Section 5313. The appeals board may approve a
compromise and release agreement or stipulation which proposes the
disallowance of a lien, in whole or in part, only where there is
proof of service upon the lien claimant by the defendant, not less
than 15 days prior to the appeals board action, of all medical and
rehabilitation documents and a copy of the proposed compromise and
release agreement or stipulation. The determination of the appeals
board, subject to petition for reconsideration and to the right of
judicial review, as to the amount of lien allowed under subdivision
(f), (g), or (h) of Section 4903, whether in connection with an award
of compensation or the approval of a compromise and release
agreement, shall be binding on the lien claimant, the applicant, and
the defendant, insofar as the right to benefits paid under the
Unemployment Insurance Code for which the lien was claimed. The
appeals board may order the amount of any lien claim, as determined
and allowed by it, to be paid directly to the person entitled, either
in a lump sum or in installments.
(d) Where unemployment compensation disability benefits, including
family temporary disability insurance benefits, have been paid
pursuant to the Unemployment Insurance Code while reconsideration of
an order, decision, or award is pending, or has been granted, the
appeals board shall determine and allow a final amount on the lien as
of the date the board is ready to issue its decision denying a
petition for reconsideration or affirming, rescinding, altering or
amending the original findings, order, decision, or award.
(e) The appeals board shall not be prohibited from approving a
compromise and release agreement on all other issues and deferring to
subsequent proceedings the determination of a lien claimant's
entitlement to reimbursement if the defendant in any of these
proceedings agrees to pay the amount subsequently determined to be
due under the lien claim.
(f) The amendments made to this section by the act adding this
subdivision are declaratory of existing law, and shall not constitute
good cause to reopen, rescind, or amend any final order, decision,
or award of the appeals board.
The payment of liens as provided in Section 4904, shall in
no way affect the commencement of immediate payments on any balance
of the award to the injured claimant where an installment payment for
his disability has been determined.
Except with regard to liens as permitted by subdivision (b)
of Section 4903, if it appears in any proceeding pending before the
appeals board that a lien should be allowed if it had been duly
requested by the party entitled thereto, the appeals board may,
without any request for such lien having been made, order the payment
of the claim to be made directly to the person entitled, in the same
manner and with the same effect as though the lien had been
regularly requested, and the award to such person shall constitute a
lien against unpaid compensation due at the time of service of the
award.
(a) No charge, claim, or agreement for the legal services or
disbursements mentioned in subdivision (a) of Section 4903, or for
the expense mentioned in subdivision (b) of Section 4903, is
enforceable, valid, or binding in excess of a reasonable amount. The
appeals board may determine what constitutes a reasonable amount.
(b) No attorney or agent shall demand or accept any fee from an
employee or dependent of an employee for the purpose of representing
the employee or dependent of an employee in any proceeding of the
division, appeals board, or any appellate procedure related thereto
until the amount of the fee has been approved or set by the appeals
board.
(c) Any fee agreement shall be submitted to the appeals board for
approval within 10 days after the agreement is made.
(d) In establishing a reasonable attorney's fee, consideration
shall be given to the responsibility assumed by the attorney, the
care exercised in representing the applicant, the time involved, and
the results obtained.
(e) At the initial consultation, an attorney shall furnish the
employee a written disclosure form promulgated by the administrative
director which shall clearly and prominently describe the procedures
available to the injured employee or his or her dependents. The
disclosure form shall describe this section, the range of attorney's
fees customarily approved by the appeals board, and the attorney's
fees provisions of Section 4064 and the extent to which an employee
may receive compensation without incurring attorney's fees. The
disclosure form shall include the telephone number of the
administrative director together with the statement that the employee
may receive answers at that number to questions concerning
entitlement to compensation or the procedures to follow to receive
compensation. A copy of the disclosure form shall be signed by the
employee and the attorney and sent to the employer, or insurer or
third-party administrator, if either is known, by the attorney within
15 days of the employee's and attorney's execution thereof.
(f) The disclosure form set forth in subdivision (e) shall
contain, prominently stated, the following statement:
"Any person who makes or causes to be made any knowingly false or
fraudulent material statement or representation for the purpose of
obtaining or denying worker's compensation benefits or payments is
guilty of a felony."
(g) The employee, the insurer, the employer, and the attorneys for
each party shall sign and file with the board a statement, with the
application or answer, under penalty of perjury that they have not
violated Section 139.3 and that they have not offered, delivered,
received, or accepted any rebate, refund, commission, preference,
patronage dividend, discount, or other consideration, whether in the
form of money or otherwise, as compensation or inducement for any
referred examination or evaluation.
(a) The privilege of any person, except attorneys admitted to
practice in the Supreme Court of the state, to appear in any
proceeding as a representative of any party before the appeals board,
or any of its workers' compensation administrative law judges, may,
after a hearing, be removed, denied, or suspended by the appeals
board for either of the following:
(1) For a violation of this chapter, the Rules of the Workers'
Compensation Appeals Board, or the Rules of the Administrative
Director.
(2) For other good cause, including, but not limited to, failure
to pay final order of sanctions, attorney's fees, or costs issued
under Section 5813.
(b) For purposes of this section, nonattorney representatives
shall be held to the same professional standards of conduct as
attorneys.
A claim for compensation for the injury or death of any
employee, or any award or judgment entered thereon, has the same
preference over the other debts of the employer, or his estate and of
the insurer which is given by the law to claims for wages. Such
preference is for the entire amount of the compensation to be paid.
This section shall not impair the lien of any previous award.
Any payment, allowance, or benefit received by the injured
employee during the period of his incapacity, or by his dependents in
the event of his death, which by the terms of this division was not
then due and payable or when there is any dispute or question
concerning the right to compensation, shall not, in the absence of
any agreement, be an admission of liability for compensation on the
part of the employer, but any such payment, allowance, or benefit may
be taken into account by the appeals board in fixing the amount of
the compensation to be paid. The acceptance of any such payment,
allowance, or benefit shall not operate as a waiver of any right or
claim which the employee or his dependents has against the employer.
Authorized representatives of the Department of
Corrections, and the Department of the Youth Authority may request
the State Compensation Insurance Fund to provide any payment,
allowance, or benefit as described in Section 4909. When requested by
an authorized representative, the State Compensation Insurance Fund
shall administer the benefits in a timely fashion.