UPDATED: Watch out for SB 335—shorter time-frames to deny a case will impact investigations, especially for public agencies.
- April 18th, 2021
- Lauren Zalona
- No comments
UPDATE:SB 335 was approved on 04/26/2021 and passed to Committee on Appropriations. On May 10, 2021 the Bill was passed and continues to move through the Senate. Thus far, it appears the Bill will pass the Senate but then proceed to the House, followed by the Governor, if passed under the House. We will continue to track this Bill.
California Senate Bill 335, if passed, would amend the timelines for investigating and denying a claim under Labor Code section 5402. The existing law allows for 90 days to accept or deny a claim, at which time, if no action was taken to deny a claim, it is presumed compensable. SB 335 would cut that timeline down to 45 days.
In addition, SB 335 would decrease the time-frame for COVID claims under Labor Code section 3212.88 from 45 days to 30 days and other safety officer presumption claims under Labor Code sections 3212 and 3212.2, from the existing 90 days to 30 days.
If the 45 day (or 30 days for claims under sections 3212 et. seq.) period lapses without a denial or acceptance, the claim would be presumed to be accepted and benefits due.
SB 335 also proposes to increase the $10,000 treatment cap for claims under investigation, to up to $17,000.
Finally, SB 335 also adds a provision for a 10% increase in benefits for unreasonable delay in under Labor Code section 3212 to 3213.2 (safety officer presumptions).
Changes to the accept or deny timeline
Under existing law, except for specified injuries, if a denial is not issued within 90 days after the date the claim form is filed with the employer, the injury is presumed compensable and the presumption is rebuttable only by evidence discovered subsequent to the 90-day period.
SB 335 would reduce those 90-day time periods to 45 days and, for certain injuries or illnesses, including hernia, heart trouble, pneumonia, or tuberculosis, among others, sustained in the course of employment of a specified member of law enforcement or a specified first responder, would reduce those time periods to 30 days.
Initial Claim treatment cap
Existing law requires an employer, one working day after an employee files a claim form, to authorize the provision of all treatment, as specified, for the alleged injury and to continue to provide the treatment until the date that liability for the claim is accepted or rejected. Existing law limits liability for medical treatment to $10,000 until the date the claim is accepted or rejected.
This bill would increase that amount from $10,000 to $17,000.
This bill would require, if payment of compensation has been unreasonably delayed or refused, either prior to or subsequent to the issuance of an award, for specified claims of injury or illness, including hernia, heart trouble, pneumonia, or tuberculosis, among others, sustained in the course of employment of a specified member of law enforcement or a specified first responder, the full amount of the order, decision, or award to be increased by 10%.
Effects of SB 335: Increased Burden on Employers
Shortening the investigative window provides for an increased investigative burden on employers, but these shorter time-frames also allow for greater employer liability for treatment, in that shorter amount of time. In other words, current law limits an employers liability to provide a worker treatment for an alleged industrial injury within that 90-day time-frame for up to $10,000. This bill would decrease that window t to either 45 or 30 days depending on the nature of the claim and applicable law, while nearly doubling the liability for medical treatment during that 45 or 30 day window.
If SB 335 passes, it will be even more crucial to investigate claims in a timely manner and to refer cases to a workers’ compensation defense attorney to perform strategic discovery, like setting the worker’s deposition and subpoenaing and reviewing medical records within that 45/30 day timeline.
This bill is set for hearing in the Senate on April 26, 2021. RTGR will be following this bill to assure our clients are fully up-to-date on changes to these very important timelines. If you have questions, please reach out to your local RTGR office.