Hi WCC Forum Members:

Attached is a sample petition for an unrepresented IW to seek LC 5814 penalties for the unreasonable denial or delay of benefits. The most common denials and delays, addressed in this petition, are as follows:

1. Unreasonable delay or denial of medical treatment pursuant to LC 5402(c);
2. Unreasonable delay of initial TTD payment;
3. Unreasonable denial of TTD payment per LC 4650(a);
4. Unreasonable denial of TTD payment with penalty required by LC 4650(d) and interest per LC 5800;
5. Unreasonable denial or delay of permanent disability advances (PDAs) after P&S;
6. Unreasonable denial or delay of proper TTD payment at correct rate per LC 4661.5;
7. Unreasonable denial or delay of authorization and/or provision of medical treatment;
8. Unreasonable continued failure to self-assess 10% payment on late TTD payment;
9. Unreasonable failure to pay unpaid disability indemnity within 25 days after F&A; and,
10. Unreasonable failure to pay self-imposed LC 4650(d) penalty on PD.

This listing is far from all inclusive, but should cover the majority of day-to-day issues commonly encountered. The user should fill in the areas in brackets where specific information is necessary; delete those allegations that do not apply; renumber the allegations to conform to the modifications; attach all necessary supporting documentation; attach a proof of service delineating service to the appropriate parties; then serve and file it. This is written in MS Word.

If an IW succeeds in being awarded a LC 5814 penalty, or multiple LC 5814 penalties, be sure to mail copies to the DWC Audit Unit, the DWC Medical Unit (medical treatment only), and of course our AD.

Please keep in mind that this is a generic LC 5814 petition, and that I am not an attorney.

York McGavin
ymcgavin@socal.rr.com

LC-5814_PETITION_IN_PRO_PER.doc  (56 KB)