SB1127: Shortens Time Limits on Presumptive Claims Investigations By: Tom Richard, RTGR Law, Oakland, CA

SB1127 has been signed into law by California’s Governor.  The law raises the TD cap for certain cancer injuries and shortens claims investigation time limits.

SB1127 changes the 4850/TD benefits cap for police and firefighter cancer injuries under Labor Code section 3212.1, starting 01/01/2023. Those are extended from 104 weeks (2 years) to 240 weeks (over 4 years).

4850 pay would still be capped at 52 weeks, so the additional weeks payable under this law are all TD benefits. This means that each safety officer cancer claim that falls under Labor Code section 3212.1 is entitled to up to 52 weeks of 4850 pay followed by up to 188 weeks of TD (rather than only 52 weeks of TD as usually allowed).

SB1127 does not shorten the deadline to deny or accept ANY Workers’ Comp claim from 90 days to 60 days, as originally proposed. Instead, the claim denial investigation period for most claims remains unchanged at 90 days. However, for safety officers’ presumptive injury claims, the time limit is reduced from 90 to 75 days.

Covered presumptive injuries subject to the new 75-day investigation limit include hernia, heart trouble, pneumonia, cancer, PTSD, tuberculosis, MRSA, meningitis, and low back injuries for some police officers. COVID-19 presumptive claims, however, are excluded. Those are covered by separate time limits.

The penalty cap for “unreasonable” denial of any of these presumptive injury claims is increased to fifty thousand dollars ($50,000.00), down from the original $100,000 penalty proposed in the bill.

The 75-day time limit may be unworkable under the current Workers’ Compensation scheme, especially for those claims that need medical-legal input as part of any sound investigation.  For example, Rule 31.3e, effective 02/02/2023 extends the initial QME exam-setting time limit from 30 to 90 days. That means that a claim subject to the 75-day investigation window may not even get a QME appointment within those 75 days. Even if the exam takes place quickly, it can easily take over 75 days to receive the QME report determining whether a claimed injury or illness is work-related. 

Under this bill, provisional denials of claims despite due diligence, for lack of a QME exam or other investigatory reasons, may increase.

You can read the text of SB1127 here.