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Chapter 4.5. Division of Workers' Compensation
Subchapter 2. Workers' Compensation Appeals Board--Rules and Practice Procedure
Article 5. Pleadings
§10404. Labor Code Section 4906(g) Statement.
The employee, insurer, employer and the attorneys for each party shall comply
with Labor Code Section 4906(g) by filing a statement under penalty of perjury
wherein it is declared that the party on whose behalf the declaration is made
has not violated Labor Code Section 139.3, has not offered, delivered, received,
or accepted any unlawful 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 by a physician.
Except as otherwise provided herein, failure to comply with this rule shall result
in refusal to file or process that party's application for adjudication or answer.
If any of the above parties are not available, cannot be located or are unwilling
to sign a declaration under penalty of perjury setting forth in specific detail
the reasons that the party is not available, cannot be located or is unwilling
to sign as well as good faith efforts to locate the party may be filed with the
application or answer. If the presiding workers' compensation judge or designee
determines from the facts set forth in the declaration that good cause has been
established, he or she may accept the application or answer for filing. For the
purpose of this rule, a compromise and release agreement or stipulations with
request for award shall not be treated as an application for adjudication.
Authority cited: Sections 133 and 5307, Labor Code. Reference: Sections 4906(g),
1. New section filed 12-23-93; operative 1-1-94. Submitted to OAL for printing
only pursuant to Government Code section 11351 (Register 93, No. 52). For prior
history, see Register 91, No. 7.
2. Amendment filed 12-19-2002; operative 1-1-2003. Submitted to OAL for printing
only pursuant to Government Code section 11351 (Register 2002, No. 51).
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