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Chapter 4.5. Division of Workers' Compensation
Subchapter 1. Administrative Director--Administrative Rules
Article 8. Benefit Notices; Claims Administrator’s Duties and Responsibilities; Claim Form and Notice of Potential Eligibility for Benefits; Regulatory Authority of the Administrative Director.
(a) “Claims Administrator” means a self-administered insurer providing security for the payment of compensation required by Divisions 4 and 4.5 of the Labor Code, a self-administered self-insured employer, a self-administered joint powers authority, a self-administered legally uninsured employer, a third-party claims administrator for a self-insured employer, insurer, legally uninsured employer, or joint powers authority, or an administrator for an alternative dispute resolution (ADR) program established under Labor Code section 3201.5 or 3201.7.
(b) “Date of knowledge of injury” means the date the employer had knowledge of a worker's injury or claim of injury.
(c) “Date of knowledge of injury and disability” means the date the employer had knowledge of (1) a worker's injury or claim of injury, and (2) the worker's inability or claimed inability to work because of the injury.
(d) “Dependent” means any person who may be or is claimed to be entitled to workers' compensation benefits as a result of an employee's death (including compensation which was accrued and unpaid to an injured employee before his or her death), and includes the parent or legal guardian of a minor dependent child.
(e) “Duration” means any known period of time for which benefits are to be paid, or, where benefits will continue for an unknown period of time the event that will occur which will determine when benefits will terminate.
(f) “Employee” includes dependent(s) in the event of any injury which results in death.
(g) “Employee's (or claimant's) remedies” means the statement of the employee's rights, as set forth in subdivision (e) of section 9810, of which an employee or claimant shall be informed in benefit notices when specified in these regulations.
(h) “Employer” means any person or entity defined as an employer by Labor Code section 3300.
(i) “Injury” means any injury as defined in Labor Code section 3208 which results in medical treatment beyond first aid, lost time beyond the date of injury, or death.
(j) “Medical issue” means a dispute or question that is subject to Labor Code section 4060, 4061, or 4062, and does not include a medical treatment issue that is subject to Labor Code section 4610, 4610.5, and 4610.6.
(k) “Permanent and stationary status” means the point when the employee has reached maximal medical improvement his or her condition is well stabilized and unlikely to change substantially in the next year with or without medical treatment.
(l) “Salary continuation” means payments made to an employee pursuant to a plan that meets the criteria specified in Labor Code section 4650(g).
(m) “Temporary disability payment” includes salary continuation as defined in subdivision (l) of this section.
Note: Authority cited: Sections 59, 133, 138.3, 138.4 and 5307.3, Labor Code. Reference: Sections 138.4, 3201.5, 3201.7, 3208, 3300, 3351, 3351.5, 3700, 3753, 4060, 4061, 4062, 4062.2, 4610, 4610.5, 4610.6, 4650(a)-(d), 4653, 4654, 4700, 4701 and 4850, Labor Code; Sections 11651 and 11652, Insurance Code; Section 19871, Government Code; Section 89529.03, Education Code; and Sections 2330 and 2332, Civil Code.
1. Amendment of section and Note filed 1-7-94; operative 1-7-94. Submitted to OAL for printing only pursuant to Government Code section 11351 (Register 94, No. 1).
2. Amendment of section and Note filed 12-11-2007; operative 4-9-2008 (Register 2007, No. 50).
3. Amendment of section and Note filed 8-24-2015; operative 1-1-2016 (Register 2015, No. 35).