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Article 3. Insurance Rights And Privileges of California Labor Code >> Division 4. >> Part 1. >> Chapter 4. >> Article 3.
Nothing in this division shall affect:
(a) The organization of any mutual or other insurer.
(b) Any existing contract for insurance.
(c) The right of the employer to insure in mutual or other insurers, in whole or in part, against liability for the compensation provided by this division.
(d) The right to provide by mutual or other insurance, or by arrangement with his employees, or otherwise, for the payment to such employees, their families, dependents or representatives, of sick, accident, or death benefits, in addition to the compensation provided for by this division.
(e) The right of the employer to waive the waiting period provided for herein by insurance coverage.
(a) The organization of any mutual or other insurer.
(b) Any existing contract for insurance.
(c) The right of the employer to insure in mutual or other insurers, in whole or in part, against liability for the compensation provided by this division.
(d) The right to provide by mutual or other insurance, or by arrangement with his employees, or otherwise, for the payment to such employees, their families, dependents or representatives, of sick, accident, or death benefits, in addition to the compensation provided for by this division.
(e) The right of the employer to waive the waiting period provided for herein by insurance coverage.
(a) No employer shall 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.
(b) If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, 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 shall be liable for three times the amount unlawfully collected, plus reasonable attorney's fees and costs.
(b) If an employee has filed a claim form pursuant to Section 5401, a provider of medical services shall not, with actual knowledge that a claim is pending, collect money directly from the employee for services to cure or relieve the effects of the injury for which the claim form was filed, 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 shall be liable for three times the amount unlawfully collected, plus reasonable attorney's fees and costs.
Liability for compensation shall not be reduced or affected
by any insurance, contribution or other benefit whatsoever due to or
received by the person entitled to such compensation, except as
otherwise provided by this division.
The person entitled to compensation may, irrespective of any
insurance or other contract, except as otherwise provided in this
division, recover such compensation directly from the employer. In
addition thereto, 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.
Except as provided in paragraph (12) of subdivision (f) of
Section 1202.4 of the Penal Code, payment, in whole or in part, of
compensation by either the employer or the insurer shall, to the
extent thereof, be a bar to recovery against each of them of the
amount so paid.
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, such employer shall be relieved from
liability for compensation to such claimant upon the filing of a copy
of such notice with the appeals board. The insurer shall, without
further notice, be substituted in place of the employer in any
proceeding theretofore or thereafter instituted by such claimant to
recover such compensation, and the employer shall be dismissed
therefrom.
Such proceedings shall not abate on account of such substitution
but shall be continued against such insurer.
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.
If it thereafter appears to the satisfaction of the appeals
board that the insurer has assumed the liability for compensation,
the employer shall thereupon be relieved from liability for
compensation to the claimant. The insurer shall, after notice, be
substituted in place of the employer in any proceeding instituted by
the claimant to recover compensation, and the employer shall be
dismissed therefrom.
A proceeding to obtain compensation shall not abate on
account of substitution of the insurer in place of the employer and
on account of the dismissal of the employer, but shall be continued
against such insurer.
The appeals board may 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.
Every employer who is insured against any liability imposed
by this division shall file with the insurer a complete report of
every injury to each employee as specified in Section 6409.1. If not
so filed, the insurer may petition the appeals board for an order, or
the appeals board may of its own motion issue an order, directing
the employer to submit a report of the injury within five days after
service of the order. Failure of the employer to comply with the
appeals board's order may be punished by the appeals board as a
contempt.
(a) An insurer securing an employer's liability under this
division shall 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 pursuant to Section
6409.1. The insurer shall furnish an employer who has not filed this
report with an opportunity to provide to the insurer, prior to the
expiration of the 90-day period specified in Section 5402, all
relevant information available to the employer concerning the claim.
(b) An employer shall promptly notify its insurer in writing at any time during the pendency of a claim when the employer has actual knowledge of any facts which would tend to disprove any aspect of the employee's claim. When 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 where there is proof of service upon the employer by the insurer, to the employer's last known address, not less than 15 days prior to the appeals board action, of notice of the time and place of the hearing at which the compromise and release agreement or stipulation is to be approved. The insurer shall file proof of this service with the appeals board. Failure by the insurer to provide the required notice shall not prohibit the board from approving a compromise and release agreement, or stipulation; however, the board shall order the insurer to pay reasonable expenses as provided in Section 5813.
(c) In establishing a reserve pursuant to a claim that affects premiums against an employer, an insurer shall provide the employer, upon request, a written report of the reserve amount established. The written report shall include, at a minimum, the following:
(1) Estimated medical-legal costs.
(2) Estimated vocational rehabilitation costs, if any.
(3) Itemization of all other estimated expenses to be paid from the reserve.
(d) When an employer properly provides notification to its insurer pursuant to subdivision (b), and the appeals board thereafter determines that no compensation is payable under this division, the insurer shall reimburse the employer for any premium paid solely due to the inclusion of the successfully challenged payments in the calculation of the employer's experience modification. The employee shall not be required to refund the challenged payment.
(b) An employer shall promptly notify its insurer in writing at any time during the pendency of a claim when the employer has actual knowledge of any facts which would tend to disprove any aspect of the employee's claim. When 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 where there is proof of service upon the employer by the insurer, to the employer's last known address, not less than 15 days prior to the appeals board action, of notice of the time and place of the hearing at which the compromise and release agreement or stipulation is to be approved. The insurer shall file proof of this service with the appeals board. Failure by the insurer to provide the required notice shall not prohibit the board from approving a compromise and release agreement, or stipulation; however, the board shall order the insurer to pay reasonable expenses as provided in Section 5813.
(c) In establishing a reserve pursuant to a claim that affects premiums against an employer, an insurer shall provide the employer, upon request, a written report of the reserve amount established. The written report shall include, at a minimum, the following:
(1) Estimated medical-legal costs.
(2) Estimated vocational rehabilitation costs, if any.
(3) Itemization of all other estimated expenses to be paid from the reserve.
(d) When an employer properly provides notification to its insurer pursuant to subdivision (b), and the appeals board thereafter determines that no compensation is payable under this division, the insurer shall reimburse the employer for any premium paid solely due to the inclusion of the successfully challenged payments in the calculation of the employer's experience modification. The employee shall not be required to refund the challenged payment.
(a) Except as provided in subdivisions (b) and (c), the
insurer shall discuss all elements of the claim file that affect the
employer's premium with the employer, and shall supply copies of the
documents that affect the premium at the employer's expense during
reasonable business hours.
(b) The right provided by this section shall not extend to any document that the insurer is prohibited from disclosing to the employer under the attorney-client privilege, any other applicable privilege, or statutory prohibition upon disclosure, or under Section 1877.4 of the Insurance Code.
(c) An insurer, third-party administrator retained by a self-insured employer pursuant to Section 3702.1 to administer the employer's workers' compensation claims, and those employees and agents specified by a self-insured employer to administer the employer's workers' compensation claims, are prohibited from disclosing or causing to be disclosed to an employer, any medical information, as defined in Section 56.05 of the Civil Code, about an employee who has filed a workers' compensation claim, except as follows:
(1) Medical information limited to the diagnosis of the mental or physical condition for which workers' compensation is claimed and the treatment provided for this condition.
(2) Medical information regarding the injury for which workers' compensation is claimed that is necessary for the employer to have in order for the employer to modify the employee's work duties.
(b) The right provided by this section shall not extend to any document that the insurer is prohibited from disclosing to the employer under the attorney-client privilege, any other applicable privilege, or statutory prohibition upon disclosure, or under Section 1877.4 of the Insurance Code.
(c) An insurer, third-party administrator retained by a self-insured employer pursuant to Section 3702.1 to administer the employer's workers' compensation claims, and those employees and agents specified by a self-insured employer to administer the employer's workers' compensation claims, are prohibited from disclosing or causing to be disclosed to an employer, any medical information, as defined in Section 56.05 of the Civil Code, about an employee who has filed a workers' compensation claim, except as follows:
(1) Medical information limited to the diagnosis of the mental or physical condition for which workers' compensation is claimed and the treatment provided for this condition.
(2) Medical information regarding the injury for which workers' compensation is claimed that is necessary for the employer to have in order for the employer to modify the employee's work duties.
