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California shortens window for claim decisions, extends COVID presumption

California employers will have less time to accept liability on certain presumptive injury claims and face penalties of up to $50,000 for unreasonably denying them, under a bill signed by Gov. Gavin Newsom on Thursday.

The governor also extended the presumption that COVID-19 is compensable through 2024 and signed a bill giving the insurance commissioner more authority to meet with county prosecutors, insurers and self-insured employers to discuss potential fraud.

S.B. 1127 cuts the window for employers to determine liability on claims for injuries that are presumed compensable when suffered by first responders, to 75 days from 90. The shorter time frame applies to presumptions in Labor Code Sections 3212 through 3212.85, and 3212.9 through 3213.2.

The bill allows firefighters and peace officers to receive up to 240 weeks of temporary disability benefits for presumptive cancer claims rather than the 104 weeks of TD available to other injured workers.

And it creates a penalty equal to five times the amount of delayed benefits, capped at $50,000, for unreasonably denying any presumptive injury claim identified in Labor Code Sections 3212 through 3213.2.

A.B. 1751 keeps the COVID-19 presumption in place for only one more year — until Jan. 1, 2024.

The governor vetoed two comp measures: A.B. 334, which would have given peace officers for the Departments of Fish and Game and Parks and Recreation a presumption that skin cancer is compensable, and S.B. 284, which would have included additional firefighters, peace officers and safety dispatchers in a PTSD presumption that took effect in 2020.

This article was first published in Business Insurance.

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