California Labor Codes 5402

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§§ 5402 Knowledge of injury; Limitation on medical liability

History: Knowledge of injury; Limitation on medical liability (a) Knowledge of an injury, obtained from any source, on the part of an employer, his or her managing agent, superintendent, foreman, or other person in authority, or knowledge of the assertion of a claim of injury sufficient to afford opportunity to the employer to make an investigation into the facts, is equivalent to service under Section 5400. (b) If liability is not rejected within 90 days after the date the claim form is filed under Section 5401, the injury shall be presumed compensable under this division. The presumption of this subdivision is rebuttable only by evidence discovered subsequent to the 90-day period. (c) Within one working day after an employee files a claim form under Section 5401, the employer shall authorize the provision of all treatment, consistent with Section 5307.27 or the American College of Occupational and Environmental Medicine's Occupational Medicine Practice Guidelines, for the alleged injury and shall continue to provide the treatment until the date that liability for the claim is accepted or rejected. Until the date the claim is accepted or rejected, liability for medical treatment shall be limited to ten thousand dollars ($10,000). (d) Treatment provided under subdivision (c) shall not give rise to a presumption of liability on the part of the employer.

FURTHER RESOURCES Maranian v. WCAB Note: 90-day limitation runs from date of receipt of Claim Form; Order on Recon final re appellate review. SCIF v. WCAB (Welcher) Note: Failure to reject claim within 90 days created presumption of compensability; Testimony inadmissible b/c not identified as witness at MSC. Honeywell vs. WCAB (Wagner) Note: Employer must have actual notice of knowledge of an injury before duty to provide claim form arises. Wagner vs. Allied Signal Note: Duty to provide claim form when reasonable certainty of claim of industrial injury. Kaiser Foundation Hospitals v. WCAB (Daly City) Note: Breach of employer's duty to notify employee of rights to benefits tolls limitations period; duty arises if employer has constructive knowledge of injury. Leegin Creative Leather Products, Inc. v. Diaz Note: Employer cannot bring civil suit for fraud against claimant. Honeywell vs. WCAB (Wagner) (Cal Sup Crt) Note: Injured worker must actually deliver the Claim Form to the employer before the 90 day limitation on investigations in LC 5402 starts to run. Muna v. WCAB Note: [Unpublished] Employer met its burden of proof in rebutting the presumption of compensability. Fleetwood Enterprises, Inc. v. WCAB (Moody) Note: Injury sustained while on pleasure trip is not compensable under the going and coming rule. Williams vs. WCAB Note: Presumption of compensability applies even if claim is accepted then denied after 90 days. Leinon vs Fishermen's Grotto (#2) Note: When indemnity becomes due under 4650 does not depend on whether denial was 'wrong' under 5402.