California Regulations 10404

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§ 10404 Labor Code Section 4906(g) Statement


The employee, insurer, employer and the attorneys for each party shall comply with Labor Code Section 4906(g) by filing a statement under penalty of perjury wherein it is declared that the party on whose behalf the declaration is made has not violated Labor Code Section 139.3, has not offered, delivered, received, or accepted any unlawful rebate, refund, commission, preference, patronage dividend, discount or other consideration, whether in the form of money or otherwise, as compensation or inducement for any referred examination or evaluation by a physician. Except as otherwise provided herein, failure to comply with this rule shall result in refusal to file or process that party's application for adjudication or answer. If any of the above parties are not available, cannot be located or are unwilling to sign, a declaration under penalty of perjury setting forth in specific detail the reasons that such the party is not available, cannot be located or is unwilling to sign as well as good faith efforts to locate the party may be filed with the application or answer. If the presiding workers' compensation judge or designee determines from the facts set forth in the declaration that good cause has been established, he or she may accept the application or answer for filing. For the purpose of this rule, a compromise and release agreement or stipulations with request for award shall not be treated as an application for adjudication.

Note: Authority cited: Sections 133 and 5307, Labor Code. Reference: Section 4906(g), Labor Code.