(a) If as the result of an audit, the Administrative Director determines that compensation is due and unpaid to an employee, (s)he shall serve on the audit subject, personally or by first class mail, a Notice of Intention to Issue a Notice of Compensation Due specifying the amount, reason and period for which compensation is due. If liability for compensation is clear but the amount cannot be determined from information in the claim file, the Administrative Director may direct the claims administrator to gather the necessary additional information.
(b) The audit subject may file an Objection to the Notice of Intention within 14 days of receipt. The Objection shall state in detail the reasons the compensation found due is disputed and may include supporting documentation and legal argument.
(c) The Administrative Director will review any Objection, and may set the matter for an administrative meeting, which may be included as part of a post audit conference. The administrative meeting or the post audit conference may be set on the Administrative Director's own initiative or at the request of the audit subject. After review, the Administrative Director shall either dismiss the Notice of Intention to Issue a Notice of Compensation Due or issue a Notice of Compensation Due.
(d) If no timely Objection is submitted, the Administration Director may issue a Notice of Compensation Due. A Notice of Compensation Due which was issued without a timely Objection shall be final without right of further review unless the Workers' Compensation Appeals Board agrees to hear an appeal after a late Objection.
(e) A Notice of Compensation Due shall specify the amount, reason and period for which compensation is due and shall order payment of the compensation to the employee or dependent. The Notice of Compensation Due shall be served on the insurer, self-insured employer or third-party administrator personally or by certified or registered mail, and a copy shall be sent by first class mail to the affected employee or dependent. The compensation due must be paid within 15 days of receipt of the Notice of Compensation Due unless appealed to the Workers Compensation Appeals Board in accordance with Section 10115 of these Rules and the applicable rules of the Workers' Compensation Appeals Board.
NOTE: Authority cited: Sections 59, 129.5, 133, 4603.5, 5307.3, Labor Code. Reference: Sections 129, 139.5, 3207, 4453, 4550, 4600, 4621, 4636 through 4638, 4639, 4653, 4658, 4659, 4660, 4661.5, 4701-4703.5, 4900 and 4902, Labor Code; and Section 10952, Title 8, California Code of Regulations.
1. New article 4 heading, renumbering of former section 10110 to section 10114 and new section filed 1-28-94; operative 1-28-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 94, No. 4).