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Chapter 4.5. Division of Workers' Compensation
Subchapter 2. Workers' Compensation Appeals Board--Rules and Practice Procedure
Article 13. Liens

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§10770.6. Verification to Filing of Declaration of Readiness By or on Behalf of Lien Claimant.

No Declaration of Readiness to Proceed shall be filed for a section 4903(b) lien, or for a lien claim for medical-legal costs, without an attached verification executed under penalty of perjury:

(a) stating either that:

(1) the declaration of readiness is not being filed because of a dispute solely subject to the independent medical review and/or independent bill review process; or

(2) a timely petition appealing the Administrative Director's determination regarding independent medical review and/or independent bill review has been filed; and

(b) stating either that:

(1) the underlying case has been resolved; or

(2) at least six months have elapsed from the date of injury and the injured worker has chosen not to proceed with his or her case.

The declarant shall make a diligent search to determine that the injured worker has chosen not to proceed with his or her case and the verification shall specify the efforts made in conducting the diligent search. A diligent search shall include contacting the injured worker, contacting the employer or carrier, or inquiring at the district office with appropriate venue pursuant to Labor Code section 5501.5(a)(1) or Labor Code section 5501.5(a)(2).

The verification shall be in the following form:

I declare under penalty of perjury under the laws of the State of California that:

[ ] the declaration of readiness is not being filed because of a dispute subject to the independent medical review and/or independent bill review process; or [ ] a timely petition appealing the Administrative Director's determination regarding independent medical review and/or independent bill review has been filed (Check one box); and

[ ] the underlying case has been resolved; or [ ] at least six months have elapsed from the date of injury and the injured worker has chosen not to proceed with his or her case (Check one box). In determining that the injured worker has chosen not to proceed with his or her case, I have made a diligent search consisting of the following efforts (specify):

________________________________________________________________

________________________________________________________________

________________________________________________________________

________________________________________________________________

s/s ____________________________on _____________________________

Failure to attach the verification or an incorrect verification may be a basis for sanctions.

Note: Authority cited: Sections 133, 5307, 5309 and 5708, Labor Code. Reference: Sections 4903 and 4903.6, Labor Code.

HISTORY

1. New section filed 11-17-2008; operative 11-17-2008. Submitted to OAL for printing only (Register 2008, No. 47).

2. Amendment filed 9-23-2013; operative 10-23-2013. Submitted as a file and print by the Workers' Compensation Appeals Board pursuant to Government Code section 11351 (Register 2013, No. 39).


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