Beginning January 1, 2023, peace officers, fire fighters, and other qualified public servants in the State of California (and the attorneys who represent them) will have new tools to ensure that workers’ compensation claims administrators fairly and timely handle claims involving legal presumptions for these employees.
A “presumption” effects the burden of proof. Typically, an employee has the burden of proving an injury is work-related. In a case qualifying for a presumption, the injury is presumed industrial unless the defendant can prove otherwise.
Presently, Labor Code sections 3212 and 3213.2 make it a legal presumption that certain injuries, including hernias, heart trouble, pneumonia, tuberculosis, cancer, low back injuries (for those wearing duty belts), etc. are compensable industrial injuries. However, Senate Bill No. 1127 makes some significant changes to the California Labor Code. The goal is to expedite these claims, provide additional benefits, and increase potential penalties for unreasonable delay in providing benefits for certain workplace injuries affecting peace officers, fire fighters, and other qualified State employees.
In the typical worker’s compensation case, the claims administrator has up to 90 days to review a claimed work injury. However, for the above employees and claims, Senate Bill No. 1127 would reduce the review period to a maximum of 75 days.
Additionally, except for certain types of injuries like hepatitis, amputations, severe burns, etc. current law caps wage loss payments for a single injury at 104 weeks within a period of 5 years from the date of injury. Senate Bill No. 1127 extends the wage loss payments for illnesses or injuries related to cancer for the above employees to 240 weeks without limitation as to time from the date of injury.
Finally, existing law currently caps penalties on unreasonably delayed or refused benefits to a maximum of 25% or up to $10,000, whichever is less. The amendments to the Labor Code arising out of Senate Bill No. 1127 will allow specified members of the law enforcement or first responders to seek penalties in the amount of five (5) times the amount unreasonably delayed (capped at $50,000) where claims of injury or illness, including hernia, heart trouble, pneumonia, or tuberculosis, among others, have been unreasonably delayed or denied.
If you are a peace officer, fight fighter, and other qualified public servant, and believe that your claims administrator is not fairly reviewing your claim or providing benefits, give the attorneys at Wiesner, English, P.C. a call for a free consultation.
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