Managing Employee Injuries and Disability and Occupational Safety

a. Reopening A case may be reopened if any factor or circumstance unknown at the time of the original award or order renders the previous findings inequitable.

Possible grounds include:

 The disability has recurred, increased, diminished or terminated.

 Mistake or fraud was present in the initial determination.



New evidence is discovered.

 The claim was not properly investigated.

b. Termination When the board makes a continuing award of temporary disability, it is anticipated that eventually the worker’s entitlement will terminate when the injury becomes permanent and stationary or the employee improves sufficiently to return to work. The employer may file a petition to terminate. The employee then has an opportunity to object.

Under various circumstances, an employer may be held liable for penalties.

P ENALTIES

Section 6

A. U NREASONABLE D ELAY IN F URNISHING B ENEFITS (10%)

1. U NTIL 6-1-04

If the WCAB determines that furnishing of workers’ compensation benefits has been unreasonably delayed or refused, a penalty of ten percent (10%) of the full amount of the delayed benefit will be assessed. Labor Code Sections 5814, 4650(d). Penalties may be imposed when the employer, although not under compulsion of an award, unreasonably fails to voluntarily provide benefits. The determination of reasonableness is made by the Board. The employer must have a genuine doubt as to liability arising from a medical or legal standpoint to excuse a delay in payments. The penalty is assessed against all benefits of the class which were delayed, and are payable to the employee. Effective with respect to injuries occurring on or after January 1, 1990, an additional ten percent (10%) penalty may be imposed automatically (i.e., without regard to unreasonableness) if the employer makes a late payment of disability indemnity, unless the employer cannot determine if anything is due and informs the employee within the time for the first payment of benefits. If the employer has not informed the employee of its determination as to benefits, any delayed

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